EMDR as a Special Form of Ego State Psychotherapy
Expanding EMDR by Using the Ego State Therapy Model
In addition to informing the therapeutic process in general, the ego state therapy model offers several specific ways to enhance the EMDR process. In treating trauma patients, the following variations of the standard EMDR protocol might be considered:
- If a patient is having difficulty identifying a relevant cognition, other more salient ego state components can be used to identify and amplify the target ego state prior to initiating EMDR.
- If the clinician is concerned about the possibility of a surprise catharsis during the EMDR processing, a preview of the potential EMDR process can be had by doing an ego state bridge without EMDR.
- If the patient is not staying adequately focused during the EMDR process, inviting the patient to attend to various ego state components, such as image, somatic sensations, can help amplify the relevant problematic ego state.
- When the SUDS stays high, and when the therapist suspects that other channels need exploring, they can be accessed quickly and directly through the use of an ego state bridge, which takes the process to the earliest manifestations of the ego state (neuro network).
- The cognitive interweave may not provide the most relevant resolution for a therapeutic impasse. For example, the traumatized ego state may not need an adult cognitive perspective, but rather the affective experience of nurturing, comforting, or safety.
- The identification of the most appropriate and powerful therapeutic intervention can be accomplished best by asking the patient, “What needs to happen to give you relief?” when the patient is imaging the traumatized ego state in its original context. Formulaic protocols can work, but less precisely.
- When a therapeutic impasse occurs because of a blocking belief or a protector ego state with a contrary agenda, the “resistant” ego state can be accessed and explored directly through various ego state techniques. Such direct exploration will facilitate identification of what needs to happen to shift the system, rather than requiring the therapist to guess as to what cognition might help the system. Again, a cognitive intervention may be less relevant than an affective one.
In treating non-PTSD patients, including character disordered patients, the ego state model in conjunction with EMDR can be especially useful, because such patients may not present with readily identifiable targets. The therapist can use the ego state model to formulate the ego state conflicts underlying the presenting symptoms or issues. In articulating the ego state system, the therapist can note in particular where there are dissociative breaches within the system. These associative failures can then become the target of the EMDR work, which will facilitate the development of a cooperative, integrated ego state system.