EMDR nowThe newsletter of the EMDR Association of the United Kingdom & IrelandJan 2015 Vol.7 No.1

Regional News • News • Book Reviews • Research • Letters • In Practice

Imagining the EMDR Asso-ciation for a moment as adebating society, I’d like topropose a motion: “ThisHouse believes that theEMDR Standard Protocol,and especially its third As-sessment Phase, hasserved its purpose in itspresent form, and that it isnow time to redefineEMDR with focus on itscore elements of AIP, safe-ty, trauma-focused target-ing and bilateralstimulation.” Revolutionary stuff -apostasy even. I’ve usedEMDR for more than 10years now, and it’s at theheart of the psychotherapyI offer. As trainee, thenPractitioner, then Consul-tant, I have faithfully re-cited and adhered to theStandard Protocol, com-plete with its eight phasesand order of questions andphrases, NCs, PCs, VoCs,SUDs and the rest. But EMDR is not a reli-gion. And dogma in psy-chotherapy doesn’t justlimit growth and develop-ment. It’s dangerous. I’m not wishing to chal-lenge Francine Shapiro’sbrilliant AIP-based insightinto how emotional heal-ing takes place, or theoverarching progress ofEMDR from preparationand history-taking through

target selection and focus,BLS, installation of PCs andclosure/re-evaluation. But 25 years on, I believethat Shapiro and her disci-ples are wrong to insist onthe primacy of the Stan-dard Protocol and of eyemovements, and to con-demn other approaches tocore EMDR as model drift. If you’re really honest andput fear of supervisor-cen-

sure to one side, how oftenhave you struggled and,what’s worse, found yourclient struggling with theblocking of affect and flowthat so often comes withstrict adherence to thephraseology and sequenceof the Standard ProtocolAssessment Phase, and es-pecially the heavy, earlyfocus on cognitions andscoring.

How often have you foundyourself guiltily going “off-piste”, and missing out orre-ordering bits of theStandard Protocol, dancingwith your client in themagic of the moment, find-ing it works brilliantly andquietly resolving never,ever to admit this either toan EMDR colleague or, es-pecially, to your supervisor.That is, if you have

The Standard Protocol: Time to Move On?

Join the Humanitarian Assistance Programme

‘Give a man a fish, and youfeed him for a day; showhim how to catch fish andyou feed him for life’. Thisis the guiding principle ofthe Humanitarian Assis-tance Programmes (HAP),providing training in trau-matology and EMDR to lo-cal mental health pro-fessionals working withpeople in traumatisedcommunities worldwide.

In the UK and Ireland, HAPhas been an independentregistered charity since2011; most of its 300 mem-bers have a particular in-terest in EMDR. Many of you will knowabout the project in Bosniawhich began in 2009. WithHAP support - and the vol-untary help of Trainers andConsultants from the UK -more than 75 Bosnian clini-

cians have been fullytrained in EMDR. Three areaccredited and are nowConsultants in training. UKand Ireland Consultantsoffer supervision to Bos-nian clinicians working to-wards accreditation bySkype. Last year the EMDRAssociation of Bosnia-Her-zegovina was founded andits first annual event washeld in April 2014. Contd. p2

Participants and trainers from the HAP Istanbul Training, 2014

Contd. p2

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a supervisor? If as thera-pists we feel we have tohide our best work fromour accrediting supervisorsor the Association, are wereally furthering EMDR? And, this is critical: thinkhow many trainees andclients have been discour-aged from continuing withEMDR, or even getting go-ing at all, because of anoverly rigid emphasis onthe Standard Protocol.In my practice, and (everless) discreetly in my su-pervision work, I have be-come a fan of LaurelParnell’s no-nonsense, di-rect, client-focused ap-proach to EMDR (see ATherapist’s Guide to EMDR(2007) and Attachment-Focused EMDR (2013)). For Parnell, EMDR com-prises only four essentialphases – Safety, Firing upthe Networks, BLS andending with Safety. I’msure this will resonate withthose who’ve found attimes that just adding BLSto whatever is going on inthe moment can shift thedeepest of blocks.That’s what we do withchildren and, if you thinkabout it, in most of theEMDR therapy we do withadults, aren’t we workingwith child ego states? Parnell’s core sequence,or Modified Protocol, cuts

out the left-brain complica-tions, progressing fromPreparation to an Assess-ment Phase which identi-fies Target Image,Emotions, Body Sensationsand Self-Belief (no need toadd the descriptor nega-tive) in that order, withscales only if they’re help-ful, followed by a rapidtransition to BLS. The Mod-ified Protocol continues onthrough the usual phasesof Installation (with an ap-propriate PC which usuallyemerges spontaneously),Body Scan, Closure and Re-evaluation. I also applaud Parnell’semphasis on resourcingwell beyond the Safe/ Spe-cial Place, to include rou-tine installation ofNurturing, Protector andWisdom Figures and herencouragement of simplebridging back from presentdistress with the phrase:Trace that back in time. Asfar as you can. Withoutcensoring: What do youget? and then targetingwhat comes up with kneetaps or buzzers / head-phones rather than EMs. Of course, we all knowthat the Standard Protocolcan work very well, espe-cially with single-incidentPTSD (which, let’s not for-get, is all it’s officially vali-dated for internationally by

bodies such as NICE or theWHO), and with clients atrisk of getting lost in right-brain affect. And it has hadits important, indeed evensurvival-critical, place inthe 25 years that EMDR hasneeded to establish itself,in the face of often un-pleasant political hostility. But in the rich and com-plex psychotherapy whichmany of us practise, I arguethat an inflexible emphasison a manualised StandardProtocol, in training and in

supervision, has becomecounter-productive. Forthe sake of our clients, it’snow time to move on. Yes,the Standard Protocol isEMDR. But EMDR is notthe Standard Protocol.

Reading: Van der Kolk, B.,2014. The Body Keeps theScore.Marich, J., 2011. EMDR MadeSimple: Four Approaches to Us-ing EMDR with Every Client.

Client E is a 65-year-old female presenting with classicPTSD (IES-R at 75/84), following three experiences over30 years of finding male intruders in her home, the mostrecent of which was two years ago. Intelligent and other-wise high-functioning, she cannot sleep alone, and stillexhibits a profound startle response. In the course ofeight sessions, we first work through the three signatureevents one by one, starting with the most recent (andstill most alarming), using Parnell’s Modified Protocolwith knee taps. With fourth-phase processing, all inci-dents resolve rapidly, the SUDs coming down to zero andpositives emerging spontaneously – it’s over, I’m safenow, I can look after myself – ready for installation andbody scan in the normal manner. However, there is re-sidual distress whose cause she can’t identify. We do asimple bridge from that emotion and its somatic sensa-tion (Trace that back in time, as far as you can, withoutcensorship), and we go straight back to the death of herlittle sister when she was three, and the family’s inabilityever to have discussed that. The emotions of her childego state are suddenly running high, so we again use the– picture, emotion, body, self-belief –and with much af-fect and a cascade of insights and memories, a 62-year-old trauma is safely laid to rest.

Plans for 2015 in Bosniainclude a Level-1 ChildTraining by Joanne Morris-Smith and training of clini-cians working with Bosnianwar victims of rape. This year 30 participantsfrom six countries in theMiddle East completedEMDR training provided inArabic by Mona Zagrout (aPalestinian EMDR Accred-ited Trainer) and her team.This took place in Istanbul

and was organised by DrWalid Abdulhamid, an Iraqipsychiatrist and EMDR Ac-credited Practitioner basedin UK. Participants getSkype supervision by ateam of volunteer EMDRConsultants in English andin Arabic by volunteer Con-sultants in training. There is a huge demandfor further training but aplanned training in 2015will require almost £18,000

in funding - money that wehave yet to find! Please help HAP by be-coming a member for aminimum of £15 per year,or making a one-off dona-tion. You can also supportHAP by buying EMDR-re-lated products we haveproduced on stalls at EMDRconferences or workshopsor by post via our website. All of you will know thetremendous potential of

EMDR and we are surethat you will wish to en-able others in parts of theworld with fewer re-sources to benefit fromthis remarkable therapy. For further details aboutHAP and to become amember, visit:www. hapuk.org

Robin Logie and SianMorgan

What Might a Modified Protocol look like?

Mark Brayne is an EMDR EuropeAccredited Consultant and BoardMember of EMDR UK & Ireland

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A Place of Greater Safety: The Rewind Technique and EMDR

I was interested to learnmore about the rewindtechnique as I felt that itmight be beneficial for cli-ents who, for whateverreason, might not be ableto engage with EMDR, orwhere the number of ses-sions is too limited for theuse of EMDR. Muss is very particularabout the use of the Re-wind Technique. He says itis only to be used for trau-matised clients. He usesthe shorter version of theImpact of Events Scale toassess its appropriateness;if the client is suited, theywill experience the ap-proach in that session. After our introduction topost traumatic stress andpost-traumatic stress dis-order, Muss spoke a littleabout his rationale for de-veloping the model, whichincluded his personal expe-rience of trauma as well asthe experience of a familymember. Then, after a var-ied career as a medicaldoctor and training in hyp-notherapy and Neuro-lin-guistic Programming, hebegan to formulate an ap-proach that helps the cli-ent to reconstruct theirperception of the trau-matic event so that its im-pact was no longer aninterference with their cur-rent functioning. Mussthen demonstrated themodel before we brokeinto our groups of four topractise the technique. The Rewind Technique en-tails asking the client toprepare themselves for theexperience of two 'films' oftheir trauma. The only rule

is that they are detachedfrom the event. In order todo so the client imaginessitting in their own comfycinema seat and watchesthe first film start from agood place before the trau-matic event, which is thenfast-forwarded to a placeof safety after the event.This process should onlytake a couple of minutesWhen the client reachesthe end of the 'film' theythen step into the eventand allow themselves to bepulled backwards, as thefilm is rewound quicklyback to the good startingpoint. This part of the pro-cess should only take 5 to10 seconds. It is a simpletechnique, but takes prac-tise! When done correctly,the results can be power-ful. I was intrigued andthought of how the RewindTechnique compares withEMDR, as there are impor-tant differences. Rewinddoes not use bilateral stim-ulation, but is a processthat takes place within theclient's mind once they un-derstand the technique'sprocedures. The rule of de-tachment is embedded inthe process of watchingthe events as if on the cin-ema screen and is similarto one of the metaphorsused in EMDR. Rewind does not addressthe Negative Cognitions orPositive Cognitions, but itdoes address what the cli-ent thinks could have hap-pened. The time spent onthe Rewind Technique it-self is about two to threeminutes and is not applied

for more than two ses-sions; however, as withEMDR if other issues arise,then the technique can beused again. Like EMDR, the therapyshould not be tried athome for the experiencecan be very cathartic andlike EMDR, detachment isessential to the process sothat the client does not re-experience the trauma in away that exacerbates im-pairment to psychologicalfunctioning. Finally, because the clientdoes not have to talk aboutwhat they are doing, nordoes the therapist have tobe physically engaged withthe process through theuse of bilateral stimulation,the model can be used

with groups and not justindividuals. Muss has usedthe technique effectivelywith participant groups inRwanda after the geno-cides, as well as with mili-tary personnel andcivilians. He has publishedresearch papers and aimsto help organisations, par-ticularly military charities,to take the work further. I found the training dayvery interesting and seethat there is scope for us-ing it with some of my cli-ents. I am also readingDavid Muss' book (now outof print) entitled TheTrauma Trap (1991, Dou-bleday).

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Jen Popkin is an EMDR AccreditedPracttioner and BACP Senior Ac-credited Counsellor based inHastings.

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Asperger’s Syndrome usedto be known as a pervasivedevelopmental disorderand was identified as suchin the DSM IV. It has sincebeen excluded from DSMV and replaced with socialcommunication disorder (acontroversial topic of dis-cussion for another time).Asperger’s Syndrome is anAutistic Spectrum Disorder(ASD). As suggested, thereis a continuum or spec-trum upon which peoplewith the condition may beseen to present a range ofsymptoms. Many areprobably undiagnosed anda significant number arediagnosed in adulthood.Absence of diagnosis orlate diagnosis can influ-

ence the understanding ofa person’s experiences inchildhood as well as theirpresentation today. It isnot uncommon that peoplewith Asperger’s Syndromehave been victims of bully-ing, found it hard to fit intofamilies and social groupsor understand their identi-ty. Rigid (black and white)thinking is the most promi-nent commonality amongstthis client group. Theyshow a varying level of dif-ficulty with social commu-nication, although theymay not recognise thisthemselves. Due to theuniqueness of the individu-al, there is much diversityamong those diagnosedwith Asperger’s Syndrome

or who have Asperger’straits, making it unrealisticto have a scripted protocolfor ASD. I have used EMDR success-fully with this client groupover the years. There are,however, implications foradaptive practice whenworking with this clientgroup. For your interestand reflection I have high-lighted these below. During history-taking, ASDclients will often requiredirect questioning in orderto elicit the informationnecessary for a formula-tion. Some offer more de-tail than is requiredregarding single events,and remain focused onthose. They may need sup-port for establishing abroader timeline. Open-ended ‘tell me about yourchildhood’ questions areoften not specific enough.Asking for a thorough his-tory is important as it is un-likely that people with ASDwill assume the connec-tions between past eventsand current experiences. In the preparation phasesome clients with ASD findit very difficult to establisha safe place. The conceptof an imaginary place mayseem unrealistic and there-fore purposeless and un-available. In such cases,practical grounding strate-gies/ breathing techniqueshave proved to be moreeffective for affect regula-tion. I have not experi-enced success with thespiral technique or lightstream. This may be due tothe abstract nature of giv-ing an emotion a colour

and imagining a shape. Some clients have narrowfields of interests or hob-bies. These have some-times proved useful forengaging in mindfulness-based practices. Duringthis stage of therapy it isoften useful to explore theindividual’s understandingand description of emo-tions. It is not uncommonfor clients to be confusedby emotions and so unableto express or label them.Additional resourcing maybe required to help clientsestablish an understandingregarding emotions andways to express them. In the Assessment Phase,establishing the positivecognition can prove diffi-cult. Clients see this as anabstract concept that isunavailable independentlyand often dismiss it as pur-poseless. The validity ofthe PC may also be dis-missed: ‘If I could think ofsomething like that Iwould not have a prob-lem’. Processing can occur rela-tively quickly. Generalisa-tion to other areas of lifecan be absent, the focustends to be solely uponthe incident targeted.Feelings may disperse nat-urally, clients have re-ported blanking out thethoughts or blacking outthe memory. Commentssuch as ‘I’m not botherednow’, ‘it’s done’ and ‘Ican’t see it now’ havebeen reported. Followingthis, the installation of theprompted positive cogni-tion has been difficult be-cause the clients havereported that they can nolonger hold the target inmind. Returning to the tar-get to evaluate any ongo-ing distress or body scan

EMDR North West RegionSpring Conference

Brush up your skills!A workshop for all levels

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Saturday 25th April 2015 09:30-4:30pmVenue: Museum of Science and Industry

ManchesterEarly Bird rate (until 1 Feb 2015) - £55.

Then £60.Six CPD points applied for

Details and application forms fromNick Adams: nickadams@psychtherapy.co.uk

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EMDR in the context of Autistic Spectrum Disorder

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After a few sessions of disastrous CBT sessions, mytherapist suggested EMDR. It took me a little time toget my head around how and why it worked but theconcept of not having processed certain distressingoccurrences, and therefore being able to ‘file’ themaway, made sense. For example, I had been workingfor an incredibly nasty boss, who was manipulativeand devious and certainly didn't want me in her seniormanagement team. Her behaviour resulted in me los-ing my job and my house. I couldn't think of her with-out having panic attacks, or being sick, shaking orbecoming so frustrated with the injustice that Iwouldn't sleep or settle to anything. Even after justthe first session I could picture her smirk and just thinkthat she was a nasty person. Gone were the distress-ing reactions and constant anger. Eureka! Why had noone suggested this before?! We did quite a few ses-sions for different things - it was like a wonder drug!Having Asperger’s, this type of therapy certainly suitedme: there was no right or wrong and no feelings offailure because I could not accept the CBT response. Iam not saying that it was easy...there were very diffi-cult times that were worse before they got better buthaving experienced how EMDR worked successfully, Iknew that it worked but might take a few more ses-sions. My therapist and EMDR literally saved my life.

The experience of EMDR from the perspec-tive of a client with Asperger’s Syndrome

once ‘it’s done’ has beenreported to be ‘irritating’. When processing seems tobe blocked, clients may beunable to explore cognitiveinterweaves that are openor Socratic. Asking a clientwhat they needed hasproved unhelpful, elicitingresponses such as ‘I don’tknow’ or ‘it doesn’t matterbecause I didn’t have it’.Clients may need the ther-apist to identify that al-though an alternativeexperience may not haveactually happened, if wethought about it we couldrecognise that it wouldhave felt different. With-out this clients may deemsuch things ‘pointless, asthey are not fact’. I have used EMDR to helpclients with anger, anxiety,trauma responses, bully-ing, bereavement and sex-

ual abuse. As with anyclient, the therapeutic alli-ance has been critical inensuring sufficient trustand understanding to ar-rive at a good formulation.A strong alliance facilitatesexploration of the client’sability to use the standardprotocols and to identifywhere they might requireadaptation. The key toworking with clients withASD appears to me to beone of getting to know theindividual first. Under-standing ASD and some ofthe common presentationshas certainly helped me tounderstand the client’sperspectives and avoidmisinterpretations due tocommunication style.

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Caroline Fuidge is an EMDR Con-sultant and CBT Therapist work-ing with the South Staffordshireand Shropshire Healthcare NHSFoundation Trust

The latest Journal of EMDR Practice and Research (Vol.8, No.4, 2014) commemorates 25 years of EMDR by highlighting itscontribution to relieving suffering worldwide through its Hu-manitarian Assistance Programmes. In an introductory article,Francine Shapiro summarises the individual and societal costsof unprocessed trauma. She reminds us of the birth of the USEMDR HAP and its subsequent spawning of HAP worldwide.Shapiro concludes with a call to “expand outreach to the mil-lions more in needless suffering worldwide”. Rolf Carriere, retired UNICEF Country Director in Asia, talks ofthe four violences: Direct, Natural, Structural and Cultural andthe need to scale up trauma treatment. It is a cogent argu-ment: more than 200 wars have claimed the lives of 41 millionpeople since the end of WWII to 2000; natural disasters affect268 million people annually; last year, extreme poverty ex-erted its traumatising effects on the 2.4 billion people world-wide who live on less than $2 per day and, to top it all, culturalviolence feeds direct and structural violence. Without scalingup our response , we have no chance of reducing the preva-lence of trauma and PTSD. But, Carriere reminds us, EMDR isperfectly positioned for the scaling up that is required. Robert Gelbach traces the formation and development ofHAP and the remaining eight papers outline the impressivework of HAP chapters in the US, Europe and Germany and thetraining of clinicians in Pakistan, Africa, the Middle East, Asia,Latin America and the Caribbean. Read more here:http://www.ingentaconnect.com/content/springer/emdr

EMDR’s gift to humanity

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EMDR an effective and less stigmatising treatment for Olfactory Reverence Syndrome

This case study outlines the success-ful use of EMDR in the treatment ofOlfactory Reference Syndrome.Mary, a 33 year old single woman,was referred to me by her GP forhelp with her belief that she smelled.She was tearful as she recountedvarious aspects of her ‘smell’. I coulddetect no obvious odour emanatingfrom her. Mary informed me that it had all be-gun on the bus home from second-ary school when someone passed aremark behind her and she quicklyfound that nobody wanted to sit be-side or behind her on the bus. Shewas in fourth year and she remem-bered the details of where she wassitting, what she was wearing, theweather and so on, all of which hadthe hallmarks of a ‘TouchstoneMemory’ which could be targetedfor treatment. Mary had already reached menar-che and was menstruating at thetime the remark was made. Ataround the same time, a teacherplayed a prank on her. My workinghypothesis was that the combinationof both negative experiences at avulnerable stage in her developmentrepresented a trauma that played akey role in the development of herbelief that she smelled. She reported biological features ofdepression but did not fulfil criteriafor Major Depressive Disorder (ICD-10) and I could elicit no previous psy-chiatric history. She reported somesocial anxiety and in one job hadtaken redundancy after five years inorder to avoid her colleagues. Maryhad consulted dermatologists andother specialists over the years withlittle improvement and had hadthree sessions of cognitive behaviourtherapy (CBT) with no change. The rest of her history was unevent-ful, although she had continued tobelieve that people avoided her be-cause of her odour and consequentlytended to avoid social situations. Sheindicated ideas of reference such asinterpreting people rubbing theirnoses or sniffing as evidence of her

body odour. She also believed thatshe had bad breath. She washed sev-eral times a day, changed her clothesfrequently during the day and show-ered several times daily. Important-ly, she lived with her boyfriend oftwo years who did not detect anybody odour from her. At the end of Session 1, I offeredher the formulation that this was atype of ‘olfactory after- image’ re-sulting from the traumatic event ofthe negative remark made about heron the school bus. I outlined theEMDR approach in general and ex-plained the stages of treatment,which she was motivated to try. Amore detailed explanation of theEMDR protocol was undertaken inPhase 2 and I taught Mary variouscoping strategies including the SafePlace (SP), Deep Breathing (DB),Grounding (G) and Present Focus(PF) – a type of ‘Mindfulness Lite’which she was to practise beforeSession 3. At the beginning of Session 3 Maryreported success using DB and PF toregulate her feelings, especiallythose associated with the olfactoryimage of odour. The third phase ofEMDR (Assessment) was then begun.The Target Memory identified waswhen she was on the school bus,aged 14. The Negative Cognition(NC) was ‘I’m powerless’. The Posi-tive Cognition (PC) was ‘I’m fine as Iam’ which had a Validity of Cognition(VoC) of 2. The emotions associatedwith the TM and NC were: Anxiety,Loneliness, Rejection, Hopelessness,Sadness, Anger, Shame, Humiliation,Depression, Disappointment, Dejec-tion, Vulnerability, Powerlessnessand Hurt. The SUDs were 6 and theLocation of Body Sensation was inher stomach. Desensitization, Phase 4 of the Pro-tocol, was then completed success-

fully in 30 min. when the SUDsdropped to 1 In Phase 5, VoC in-creased to 7 after 10 min. She re-ported a strong association betweenanxiety and the olfactory sensationof body odour at this point in thesession. Coping techniques of PF andSP were used to help her regulatebefore the session ended. Phase 6Body Scan revealed a deep sense ofrelaxation in her stomach. Phase 7,grounding and closure were com-pleted to prepare her for any post-EMDR reactions. Mary reported no adverse reactionsin her next session. SUDs had in-creased to 3 for the TM and process-ing was resumed until they reducedback down to 1 and Body Scan re-vealed a sense of relaxation in herchest and stomach with a corre-sponding feeling of a weight havingbeen lifted from her shoulders. VoCremained at 7 for the PC. Closureand grounding were completed forSession 4. In Session 5, about a fortnight later,Mary reported continued progress.SUDs were still low (SUDs=1) and shewas no longer vigilant around peopleabout non-verbal signals indicatingodours or smells in her vicinity. Shewas able to re-assure herself thather clothes were clean and did notsmell and that she herself was clean.Her boyfriend was a good positiveresource for her, able to confirmthat she was no longer seeking reas-surance from him nearly as often.She reported some minor sensitivityabout body odour which she couldsuccessfully challenge with cognitiveinterweave and reality testing, forexample: What evidence is there thatI smell? At this point it was agreed toend therapy as she felt that she hadachieved her objectives and hadovercome a major obstacle to herown happiness. At a three month follow up she wasstill free of the belief that shesmelled.

DiscussionOlfactory Reference Syndrome is

Case studyBy Dr Timothy Dunne

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oks books books books boIf you have attended Jim Knipe’s ex-cellent two day ‘EMDR Toolbox’workshop you will know what thisbook is all about. If you haven’t at-tended the workshop, it is all here -Jim’s lucid explanation of his under-standing of complex trauma and dis-sociation and the powerful ‘toolbox’of techniques that follow from thistheoretical foundation. Having at-tended the workshop myself Ithought there would be nothing newfor me to find in this book. Howwrong I was, perhaps because I don’trecall that part of the workshop orbecause it wasn’t included. Or Iwasn’t concentrating?! Whatever;reading this book has given me awhole host of new ideas about work-ing with complex and dissociativeclients. Jim appears to see the world interm of overlapping (and sometimesnot overlapping) ovals. Occasionallysquares but usually ovals. Dissocia-tion is explained (with ovals) in the

context of the AIP model and attach-ment theory in a way which even Ican understand. And I never fully un-derstood the thing about ‘good par-ents vs bad parents’ (as I call it) untilI read the following: “Within the logic of a child, it is bet-ter to be a bad kid with good parentsthan a good kid with bad parents.For a child who is being abused orneglected by a caretaker, it is com-pelling to try to think, ‘I am - I mustbe – a bad child, and my parentsmust be good parents…I will try very,very hard to be perfect, perhapsthen they will love me…” It may befar too frightening for the child to befully aware of the reality of the situa-tion – that is, “I am a good, innocentchild with abusive, neglectful, disen-gaged, or disinterested parents”. That realisation would lead to asense of helplessness or hopeless-ness. It is a rare child who is able toaccurately perceive the reality of hisor her own innocence during abuse

A clear and engaging ac-count of complex trauma

EMDR Toolbox: Theory andTreatment of Complex PTSDand DissociationJim KnipeSpringer New York, 2014Paperback £49.95 (Amazon)Reviewed by Robin Logie

considered to be related to Obses-sive-Compulsive Disorder (OCD) oreven a specific sub-type of OCD be-cause of the strength of the delu-sional belief which the person hasthat they smell, despite no evidencethat they do. Begum and McKenna (2011) in a re-view of the world literature found 84case reports (52 male and 32 fe-male). Age of onset of ORS was be-fore the age of 20 years and “smellprecipitating events” (Trauma?)were reported in 42 percent of cas-es. In just under half the reportedcases, the authors expressed reser-vations about the delusional natureof the belief. Begum and McKennareported that over 66 percent im-proved or recovered with the help ofanti-depressant medication or psy-chotherapy (not specified). Whetherboth were used is not reported. Bothmedication and psychotherapyproved superior to neuroleptics inthe treatment of ORS according toBegum and McKenna. Fiore (2010),

in a paper presented to the AmericanPsychiatric Association, reported asmall sample study of 20 patientswith similar findings. McGoldrick, Be-gum and Brown (2008) reported onfour cases of ORS which were treatedsuccessfully using EMDR. Mary’s rapid response to EMDRtreatment adds weight to the ideathat trauma should be considered inthe first instance in cases of ORSrather than more stigmatising labelssuch as OCD or Delusional beliefs. Italso suggests that the Adaptive Infor-mation Processing (AIP) model ofShapiro (1995) can be an explanatorymodel for successful treatment ofORS. McGoldrick et al. also suggestthat, although the traumatic eventwhich gives rise to ORS may notreach clinical criteria sufficient for adiagnosis of PTSD, nonetheless therecan still be trauma involved which

was “humiliating with a strongshame element” ( p.66, McGoldricket al., 2008). This was most certainlythe case with Mary’s ORS. This caseprovides further clinical evidence forthe effectiveness of EMDR in thetreatment of ORS and suggests thatEMDR may be considered a front-line treatment approach, perhapsmore so than anti-depressant medi-cation, for sufferers of ORS.

Tim Dunne is an Accredited EMDR Prac-titioner and Consultant Clinical Psychol-ogist who works in a GP Practice basedin Co. Carlow, in rural Ireland.

ReferencesBegum, M, and McKenna, P.J. (2011). OlfactoryReference Syndrome: A systematic review of theworld literature. Psychological Medicine, Vol. 41,Issue 3, March, 453-461.Fiore, K. (2010). “Clinical Features of OlfactoryReference Syndrome”. APA, Abstract NR4-87.http://psychcentral.com/blog/archives/2010/05/07accessed on 11-08-2014McGoldrick, T., Begum, M., & Brown, K.W. (2008).EMDR and Olfactory Reference Syndrome. Jour-nal of EMDR Practice and Research, 2, 63-68.Shapiro, F. (1995). Eye Movement Desensitizationand Reprocessing: Basic principles, protocols andprocedures (1st Ed). New York: Guildford Press

Case study

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or neglect. A child in this situationrealistically has no options. He can’tjust move down the street into an-other family. However, if the child inthis situation becomes intenselyself-critical, searching his own be-haviour to find fault, that child willprobably be able to find somethingnegative, which will then result in anillusion of control: “‘If I caused it, I’mnot powerless!’… The child is likelyto take on beliefs – a self-definition– of badness and shame” (pp 17-18). Jim goes on to explain the tech-niques based upon his theoreticalframework, including methods fortargeting avoidance (including achapter on addictions), ‘the lan-guage of ovals’, using drawings, the‘conference room’ method, ‘LovingEyes’, the ‘back of the head scale’and ‘CIPOS’. Intrigued? There is noway in which I can summarise all ofthis here, so perhaps you just needto buy the book! Well, that’s a bit ofa cop out for a book reviewer so Iwill just focus on one of these tech-niques: “The Loving Eyes procedure, simplyput, is asking an oriented part – typi-

cally the Apparently Normal Part(ANP) – to form a visual image of anEmotional Part (EP) – a younger partthat is experientially reliving a trau-matic event” (p. 173). In the earlierpart of the book, Jim explains thatthe ANP is oriented in the present,focussed on appearing ‘normal’ toothers and maintaining the tasks ofdaily living. EPs are states of mindthat re-experience the traumaticevent, with a sense of timelessness. Often the ANP is fearful of the EP.The client is asked from their presentoriented, adult rational self, to imag-ine their child self at the time of thetrauma and “sitting in this chair, theadult you are today, can you just lookat that child?” Using BLS the client isasked to “just see this child. Whenyou see this child, just see whateveryou see”. Sometimes the adult clientinitially is unaccepting of their childpart and the therapist will need tosay “what’s good about knowing thatyou today are not that child? What’sgood about knowing that you are notstupid (or weak, powerless, naïve,etc.)?” and then process the re-sponse. The next step is to ask “when

you look at that child, can you seethe child’s feelings?” and the adultself may then begin to share thetraumatized child’s feelings (tissuesat the ready!) This may then bestrengthened with a question suchas “is there anything that you know,as an adult, that would be helpful tothat child? Something that childdoesn’t know?” Clear and engaging, peppered withrelevant case histories, this bookwould make an important additionto anyone’s EMDR related book col-lection.

EMDRNow is published four times a year and is always on the lookoutfor good material to publish. I hope that you will enjoy this issue -thanks to all those who contributed articles - and consider sendingyour case studies, regional news, questions about EMDR, views aboutthe Association and so on. Tell us about the books you’d recommend(or avoid!), workshops you’ve attended, research you’ve done or arethinking of doing. Write to the Editor at o.sattaur@gmail.com. I’d bedelighted to hear from you. Copy deadlines are: Winter: 1 October;Spring: 1 March; Summer: 1 June and Autumn: 1 September.

Make EMDR Now truly your own newsletter!

Robin Logie is an EMDR Consultant andPast President of the EMDR Association

EMDR Now has a circulation of 1,700 and is the most effectiveway of advertising events. We aim to publish four quarterlyissues per year and consider advertisements relating to: booksales; EMDR equipment for BLS; courses and workshops relat-ing to EMDR and conferences on mental health. Adverts forevents organised by the EMDR Association (including RegionalGroups, Sections or Special Interest Group Events) and HAP UK& Ireland are free of charge. All other adverts are charged atthe following rates (subject to increase): one-quarter page at£100 and one-eighth page at £50. Deadlines for adverts are:Winter: 1 November; Spring: 15 February; Summer: 15 May;Autumn: 15 August. Write to o.sattaur@gmail.com

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http://www.emdr-europe.org/Dafna Kalkstein, the EMDR Europe As-sociation administrator:dafna@emdr-europe.orgKeith Piper, EMDR Europe Association'sSecretary, kpaap@kpaap.demon.co.uk

The views expressed in this publicationare entirely those of the authors anddo not necessarily represent the viewsof the EMDR Association UK & Ireland