Healing Trauma: EMDR & Parts Work

Inner Solutions' Clinical Director Jessica Heil and DBT Clinician Cheska Vanderburg discuss the process of healing Trauma through EMDR and Parts Work.

Transcript

SPEAKER_00 0:04

Welcome to the Inner Solutions Podcast. I'm your host, Jessica Heil. I own and operate Inner Solutions, a private practice clinic located in Calgary, Canada. Inner Solutions seeks to understand and help our clients by providing empirically supported treatments and evidence-based practices with compassion and expertise. This podcast will provide you with information regarding complex psychological conditions as well as treatments that are available. Thanks. I'm glad to be here. Awesome. Today we're going to be talking about trauma work. Jessica is one of our trauma specialists at Inner Solutions. She does a beautiful job of being able to see people when they have been experiencing different symptoms that are related to past adverse experiences that they've gone through. Sometimes those can range from being what we would consider like objective traumas to things that are more kind of a subjective experience for people where they have just changed because of the things that have happened to them in the past, but it hasn't necessarily been like a full objective trauma as we would normally think of it. So objective traumas I think about as being like assaults, car accidents, war. Those things certainly can be traumatic. But what we know is that trauma and adverse experience can be so much more than that, that it involves things like bullying and feeling like things just didn't go the way that we had anticipated in life, feeling like we've been left out, having a sense of abandonment when we're kids. Like any of those types of things can really create these symptoms of trauma as we see them today. Where I want to start is Jessica, I'm wondering if you can just briefly define for us what is EMDR, because that is one of the treatments that you specialize in. And we did talk about EMDR in a previous episode. So audience listeners can go back and listen to that episode if they want to do a deep dive. But just for today's purposes, do you think you can just give us a brief explanation of how you would define EMDR?

SPEAKER_01 2:15

Yeah, so EMDR, eye movement, desensitization and reprocessing is an evidence-based therapeutic modality that uses bilateral stimulation, which is just a fancy word of saying helping our left and right sides of our brains communicate with each other. It replicates and enhances our brain's natural ability to process information, digest it down, make sense of the information and experiences that we've gone throughout the day or past experiences throughout our lives as well.

SPEAKER_00 2:45

Perfect. And and what would you say that EMDR is usually used to treat?

SPEAKER_01 2:48

Oh, EMDR treats a whole lot of different things, um, such as trauma, anxiety, OCD, phobia, suppression, the list really goes on.

SPEAKER_00 2:57

Yeah. So it's it's not necessarily just trauma per se. You can actually use it for a wide range of things. Kind of cool because I I don't think a lot of people know that.

SPEAKER_01 3:05

Yeah. EMDR is uh more a therapeutic modality that was originally for trauma, but as people have been practicing and and treating um individuals, it it was more so knowing that, hey, I we can desensitize the distress that the person is experiencing.

SPEAKER_00 3:23

And I I love that it it really is about desensitizing to distress, that we when we experience distress, it's usually because something has happened at some point and it has created this response in the brain where the brain feels quite overwhelmed whenever it's in the face of whatever these cues might be. So let's let's bring it back to trauma for today, because that's that's what we're gonna speak about today. But yeah, I think really important uh mentioned that it EMDR can be used for a lot of other things. When it comes to trauma, uh, maybe just really briefly, can you walk us through what, like really, how would I put this? Very standardized EMDR. Like, what would you expect to see in a client kind of from start to finish in terms of how long EMDR should take? And like if it's really smooth ceiling, what would that look like?

SPEAKER_01 4:11

So EMDR as a protocol as prescribed goes through eight stages where we pick a target, an event, a memory that has happened, and we use the bilateral simulation to process things and can go as quickly as a couple sessions to maybe five, 10 sessions, depending on how big the event is for that individual.

SPEAKER_00 4:33

Yeah, and I would say that's probably true about like usually it's gonna be fairly quick per target.

SPEAKER_01 4:39

Yeah. And up depending as well if it's like all one specific event that happens, such as like one accident that happened, the the more and more events that kind of coincide and fall under kind of one umbrella, then that could take a little bit longer.

SPEAKER_00 4:56

Yeah, that makes sense. And then yeah, we're gonna be adding on sessions depending on kind of the complexity of it. And that's an interesting. So that's where I I want to talk about what happens when EMDR doesn't go as planned. Because I think in a perfect world, we we know what our target is, we know what we're treating, we do EMDR. It's like, yeah, like five, 10 sessions, and like wham-bam, we're done. People are feeling better, distress has come down. But you and I both know oftentimes it doesn't go that way.

SPEAKER_01 5:22

Yeah.

unknown 5:23

Right.

SPEAKER_01 5:23

Some of the things that we start probably observing would be the client starts to dissociate a little bit more, they're starting to avoid, they're missing their sessions, increase in their problem behavior. So when maybe it's been stable or non-existent for a while, pretending everything is better and say I don't need therapy anymore, an increase in emotional dysregulation, denial that these things have happened in their life, also like an increase of self-harm so that ideation can occur.

SPEAKER_00 5:53

Yeah. So any of those things, if if we're seeing those obstacles come up, right? If if EMDR st starts to go awry, then that might be an indicator that using just kind of like a regular protocol of EMDR may not be enough.

SPEAKER_01 6:09

Totally. Yeah. So that's when I kind of take a pause and consider, okay, what else can be happening for this person? Checking in with their vulnerabilities, what else might be happening in their lives that can be maybe contributing to this to the stress that their mind is shifting to. And also I might consider that this person um might have parts of themselves coming into play and maybe blocking or not agreeing with the processing of these traumatic memory.

SPEAKER_00 6:37

Yeah, and I would agree with that. Usually when I'm seeing any of those kind of like behaviors coming up, avoidance, uh, things that are just getting in in the way of EMDR, usually I'm gonna ask myself the question of are these parts that are interfering? So, how would we define parts?

SPEAKER_01 6:54

Parts are, I would say, our inner experiences or sensations, moods, patterns that really have developed within ourselves throughout the years based on what we needed to survive or function in the world. Sometimes when I mention parts, people start getting worried or scared because they automatically think of um different personalities of themselves. So that dissociative identity disorder, which is not necessarily what I mean.

SPEAKER_00 7:22

Yeah, so DID or dissociative identity disorder is on the total extreme side of the spectrum of parts. DID used to be known as multiple personality disorder. We don't call it that anymore. We call it dissociative identity disorder, and that's very, very extreme and usually only forms when somebody has been through very, very, very severe forms of developmental trauma from childhood. When we talk about parts, usually what we mean is that there is this piece of us that's just a little bit different because of the past experiences that we've had, where, like you said, Jessica, we have different thought patterns, different emotions, different urges that show up because of something that happened to us in the past. It can be quite a range of things. Like sometimes it would be something traumatic that can create those parts, and other times it would be something that's maybe not traumatic per se, but just like an aversive experience that starts to get us to think about the world and ourselves and others a little bit different. So definitely parts, I would say we're we're not talking in this episode anyway about dissociative identity disorder. We're really talking about these parts of us that form just simply because we've gone through something that has been quite difficult.

SPEAKER_01 8:34

And another way to think about it could be like these pieces of ourselves are our strengths. It's something that we're using more often than others in various different situations as needed.

SPEAKER_00 8:46

I actually I love that because yeah, parts form as a coping mechanism. It's something that happens because we in a moment of distress needed to figure out how to be able to cope with the situation that was happening in a way that was going to get us through whatever that adverse event was. Do you think you can share a bit about why parts form when someone has undergone these adverse events? And I would say generally parts, so you can tell me whether you would agree with this or not. I would say parts generally form because of adverse childhood events. Would you say that that would be true? Totally.

SPEAKER_01 9:21

Yeah, it usually starts off as we're younger, because as we're developing and growing up, we typically look at our environment to help us figure out how to act, how to respond in various different situations. We're not just born with the ability to know how to deal with everyday things. So we learn through what's modeled in our environment, which may not always be the most effective way to cope with things. And there are also situations where those models aren't there, such as a neglect. And when someone goes through an adverse event that happens, either single event, like you were talking about, like a natural disaster, for example, or something more chronic such as bullying, as ourselves, as individuals, or even the environment might not necessarily know or be prepared for like what's what's to come. How do we handle this situation? So our brain and body tries to tries its best to cope with the situation with the tools that we already have. How do we understand, make sense of the things that are here? And it might be so confusing of like, why did this happen? And so our survival mechanism just automatically kicks in to protect ourselves in a way, in one way or another. If the vi individual didn't have an opportunity to talk to and connect with people in their environment, or they were invalidated for something that had happened, or they just had a thought, this person in my life is already struggling in some way. I don't want to add more to their plate, so I'm just gonna keep it all to myself. These patterns start to emerge as we keep interacting with our environment and they become ways of coping, ways of living, ways of surviving.

SPEAKER_00 11:04

Absolutely. That makes a lot of sense. It's like we, if we keep on doing or thinking about something in the same way, especially when there's these like chronic pervasive type of experiences, then it's like we just are creating a thicker schema, if you will, of thinking about things through that lens. And eventually that's going to create a part, um, is essentially what ends up happening. Could you give examples of what are some common parts that people may experience when you think about your own clients that you've seen before? Like what are some of the typical parts that start to emerge?

SPEAKER_01 11:38

So, some of the parts that I typically see would be protector parts, somebody who manages the day-to-day things, for example. Their goal is to just protect the individual, their body, their mind from being in that painful situation again. Sometimes it shows up as people pleasing or a negative critical self-talk that happens within themselves. Perhaps it is just nurturing themselves, but they didn't get what they needed as a young kid. Like they didn't get the nurturing or the support that was helpful for them in that moment in time. That could be a part that shows in for themselves. Another part could be called a firefighter, which is a part that just wants to be impulsive. I I want to feel something different. I need this problem situation to go away. So I'm gonna do whatever I can to do that. So that can include substance use, that might be self-harm, society. It could be so many different things. And it's very different for each individual person because what they are needing is totally different. We also have something called exiles, or sometimes we call them like younger versions of ourselves, right? That that little kid version of me who feels like they didn't get what they needed. They didn't feel heard, they felt isolated and alone or abandoned, who maybe carries the shame, the anger, the loneliness. These are some of the parts that can show up.

SPEAKER_00 13:18

I and those are absolutely, I would say that uh those are are quite common, those three themes of parts. And coming back to EMDR, this is where it gets interesting. So people will come in, they'll say that they want to do trauma work. Uh, sometimes they choose, they say that they want to do EMDR, or the clinician will make that choice just based on the type of trauma that the person has uh endured. We just know that EMDR would be a good fit. We start to do EMDR and then something shows up during the EMDR work. When I'm doing EMDR with somebody, I sometimes will notice that they might start to criticize themselves, that they're like, I'm not doing this right. Uh, I can't, I don't know how to do this. I'm I'm too whatever it might be, right? I'm I'm too non-insightful to do this, I don't have capacity for this. When I start hearing things like that, then my mind will immediately start to think, hmm, I wonder if that's a critical part, which would be a form of protector, which sounds so funny, right? Because protectors, you would think that they would actually like protect us, right? And you think, how can critical parts be protective? But it's because if we are the first ones to judge ourselves, then other people can't judge us, right? Like we've already said those like awful things to ourselves. And so there's nothing left for somebody to hurt us with if we've already said the worst things to ourselves. Do you see things like that with your clients?

SPEAKER_01 14:38

Yeah, I often see critical judgmental parts show up for clients. They want to build these walls. I need to be my worst enemy so that nobody else can inflict back pain on me anymore. I need to protect myself and hide my vulnerabilities from other people and pretend everything is actually okay when inside I'm in turmoil. So that that can happen. That can show up quite often.

unknown 15:05

Yeah.

SPEAKER_00 15:06

And I think dissociative parts is another one that I see a lot of. So we'll be doing EMDR, and all of a sudden somebody just feels like they're really, like they're quite numb, they're not really present anymore. And we we would say that in in EMDR and with parts, that would be uh it's another protector. A dissociative part. Dissociation means that you uh lose capacity to feel emotions in the way that we typically would. And sometimes we can lose track of time or feel like we're like not really part of our body anymore. When that happens, the theory behind parts, we would say that the dissociative part is coming to protect us from feeling those really intense emotions. That if we dissociate, then we don't have to experience and suffer with those emotions anymore. So it's it's protecting us from those emotions in the short term. But of course, in the long term, we know that we need to feel those emotions in order for trauma work to be effective. So I think that may be a good place for me to ask you, how do we work with a part? Like, let's say we have a dissociative part like that that shows up in EMDR. What would you do?

SPEAKER_01 16:06

First thing that I would jump into is to like bring curiosity for myself of like, okay, like what is happening? Was there something that was triggering this person, for example? It might not be necessarily as we're doing the trauma processing, but like maybe we're about to go in it and they start to dissociate or they're starting to distract in some way. So my goal is to help ground with EMDR how we process the memories, the thoughts and body sensations is that we want one foot in the past and one foot in the present moment. So we're always having that access to the here and now so that the person understands that this event, this horrible, painful event is not happening again right now at this moment. That we're processing from a distance. So really grounding them to the here and now. And that could be something as quick as using some DBT skills to help get them grounded and such as mindfulness, using cutting the temperature, popping in a quick uh sour candy in their mouth to get them to the here and now so that they're not dissociating completely, and then keeping them grounded in the moment. And then exploring with the parts of bringing curiosity of okay, what just happened? With parts work, trust is such a big thing between the client and the therapist. If the client or the parts of the client feel like they don't feel safe in any way, they're not gonna allow processing to happen.

SPEAKER_00 17:41

They'll block essentially. They're gonna get in the way of being able to do the EMDR. And that's, I think that part is so important to understand that the the person who is doing the EMDR, like the client, may really want to do the work and their parts may not trust it yet. So parts can come in and interfere with the actual processing because they just don't feel like they have trust either about the like towards the therapist or sometimes even towards the client. Uh, that sometimes parts may, when you think about like why they form in childhood, it's because there was something that the person was going through that they needed to cope with. And the theory behind parts is that when a part forms like that, it's because the the self, the um like DBT would call it the wise mind. Um, there's different words for it, though, like that self-energy um core person wasn't able to cope in that moment. They were overwhelmed by what was happening. So a part formed to be able to protect their core self from whatever was going on. And when that happens, sometimes that means that the part loses faith, loses trust in the core self to be able to handle things. So it feels like it needs to show up whenever the core person is going through a lot of distress because they feel like that person can't really handle it. So part of it too is around trying to rebuild trust between self and these parts so that the parts start to trust that the person truly can handle whatever they're going to be given.

SPEAKER_01 19:12

Totally. And that's where emotional phobia kind of comes in as well, that the these parts think that it's too much. This individual is not going to be able to handle how much pain is gonna arise. So I'm just going to take it away from them instead of allowing them to feel in the moment.

SPEAKER_00 19:30

What would you say then is the end goal when working with parts?

SPEAKER_01 19:34

The goal is really to figure out and map out, okay, what are these parts of myself? Who is trying to protect me in certain areas? What's really their function and what do they want to say? All these parts of ourselves are doing a role to help us get to the next day, to help us survive the state-to-day things. And it and they have a voice. Part of it is they they come in and they take over, not because they actually want to, but because they're not getting their needs met in certain ways. So as a therapist, working with the client, creating that safety, bringing curiosity to see what the function is, where in time do the parts start to form, and what do what are they needing so that they're not necessarily taking over for the core self anymore moving forward? If the goal is to create that harmony, communication between these parts of yourself so that they're not the ones functioning for you anymore.

SPEAKER_00 20:35

Yeah, that your core self is back in the driver's seat rather than having the parts be in the driver's seat. Let's tie this all back to EMDR. So once you've worked with these parts and you've established that harmony amongst them and the self, then what happens in EMDR therapy? What do you notice?

SPEAKER_01 20:52

EMDR processing becomes so much smoother once we have permission from the parts to process that have been protecting, we are able to hit the targets, process, desensitize these memories, not necessarily erase them, which some clients may bring up as a worry that, oh, like I'm gonna forget this memory ever happened. That's not the point of this. It's the point is to just say, like, okay, this is this thing, this event happened in my life. It's part of my story, and it doesn't have to hinder me from moving forward anymore. Sometimes parts come in and we want to negotiate and they might think like, okay, this target is actually more important and it's more distressing, and it has to be the one that's processed first rather than what the client thinks is the actually the actual trigger. So it's kind of like peeling the layers of an onion to to get to where to to the core to where it's all started.

SPEAKER_00 21:53

Yeah. And so if we work with those parts and listen to them rather than fight them, then usually they're going to Help lead us to what are those core memories that need to be treated so that we can get the person back up and on their feet and having it be that these are maybe memories that have happened in the past, that yes, the trauma happened, but it doesn't have to define who they are going forward.

SPEAKER_01 22:14

And a part of the beauty of EMDR as well is like once we've desensitized all these things and strengthened it, a part that can be helpful would be how do we strengthen future events, like a belief that, hey, I I can get through this. There can be painful emotions that are going to be thrown at me and I can get through them because I've gone through them already before. And these parts of myself don't have to be the ones to take over. I, the person of the here and now today, am capable and can feel and tolerate this painful event that could happen.

unknown 22:50

Yeah.

SPEAKER_00 22:50

And that's so powerful when you see somebody being able to know that about themselves and have the confidence that they're able to handle future situations because of all the processing that they've done.

SPEAKER_01 23:00

Yeah, I was gonna say something that um clients feel after EMBR and the parts work is that they just are able to trust themselves a little easier. Uh, they're calm, they're curious, they have clarity and maybe have a better sense of like, okay, this is me.

SPEAKER_00 23:18

Yeah, more of a sense of that identity and then certainly that confidence and that that calmness for sure. It's just such a beautiful thing to be able to see kind of that uh that completion right after doing the trauma treatment. They generally are are going to just feel so much better, much more regulated and ready to take on whatever's next in in their lives. Jessica, thank you so much for coming on the podcast. This was a lot of information. I hope that people learned a lot today, and we really appreciate your time. Thank you for having me. Thanks so much for listening. If you found today's episode helpful, please go ahead and leave us a review. And you can also follow the show so that you don't miss out on any future episodes. For more information about us, you can check out our website, www.inersolutions.ca