Monday, November 3, 2014

Alternative Resourcing: Thinking Outside the EMDR Protocol Box

For years I have used Eye Movement Desensitizationand Reprocessing (EMDR) as a major weapon in my battle against complex trauma. My therapist, a well-rounded social worker who understands the importance of a client-centered approach, was trained in EMDR nearly six years ago and I was fortunate enough to be offered this treatment right after her training. In the years to come we have both learned a lot from the processing I have done.

Before I get into the meat of it, let me take a minute to define some basic EMDR terms. Bilateral stimulation: outside stimulation that causes both sides of the brain to engage, which may include: following a finger or light source back and forth with your eyes, hearing binaural tones through headphones, plastic eggs that are held in the hands and alternate pulsations, and alternating left and right tapping on the upper arms, hands, or knees. Processing: use of bilateral stimulation with the goal of changing a target (image/memory) from a negative experience with a negative belief (i.e.- memory of abuse with the belief "I am a horrible person") to a neutral/less horrible experience with a neutral or positive belief (i.e.- memory of abuse now with the belief "It wasn't my fault"). Resourcing: use of shorter sets of bilateral stimulation with the goal of installing positive attributes via memory or image, positive emotions, and positive belief (i.e. the memory of being held as a child, feeling calm/safe, and the belief "I am safe and cared for"). Tapping in: tapping oneself on the arms, legs, knees, alternating left and right. Normally only a short series (3-6 sets) of taps to reinforce a resource. Keeping it short is key so that you don't end up processing. Personally, I recommend practicing tapping in to yourself with your clinician so that you get the feel for how short the taps should be and you learn your body's response to this technique.

One of the things my therapist and I found out right away is that I am very sensitive to processing and need some resourcing after processing in order to ensure that I am back to a better mindset after processing. Even when I felt good after processing, I found that without resourcing I would go home and experience dreams and flashbacks days after the session. Another thing I found is that sometimes just resourcing was enough to get me through the trauma responses I was having. A lot of my needs surrounded feeling uncertain, vulnerable, and unsafe; something most trauma survivors can relate to. With resourcing I was able to reinforce the confidence and competence I had already in me. At any given time I was able to think of the images I resourced and feel better, often tapping in the feeling to deepen the connection.

Lately I have started in on a trauma that has literally haunted me for years. Nightmares, flashbacks, and panic attacks plagued me on and off along with feelings of shame, guilt, embarrassment, and hopelessness.  My recent increase in these trauma symptoms has not surprised me as I know some of the deep emotional and spiritual work I have been doing in and out of therapy the last year has lead me to a place where I am ready to begin to work through this trauma. When I began the prep work with my therapist we both knew that this was not going to be like any other trauma I have processed. This trauma in itself was complex, held many core issues for me, and was going to take time to work through. As we talked about what I needed and what ground work needed to be done, it became obvious that I was going to need some new resources.

Ever the diligent client, I went and reached out to others who have experienced similar issues. Most reported that they needed a lot of varied resources in order to feel confident enough to start their processing, but I knew just adding traditional resources was not going to be enough. I went back and reread Dr. Jamie Marich's book EMDR Made Simple, after having a long discussion with Jamie about my situation. In addition to helping me map out a plan for processing secondary gains prior to trauma processing (which I will share in another post), Jamie also lead me to the idea of what I like to call alternative resourcing.

I use the term "alternative" not because I think of this as a new-agey, out-there type of resourcing, but because it provides a viable alternative to what many EMDR practitioners consider the holy grail of resources: the Safe Space. Not to say that the safe space isn't a valid option, it just is not the only option. Having a place, either real or imagined, that you can bring up in your mind that feels safe is GREAT. However, what if safety isn't what you really need? What if you need confidence, a feeling of happiness, joy, or competence? There are more traditional resourcing strategies for these emotions; you can use imagery or memories that create these feelings and resource those. Alternative resourcing goes a little further- it uses more than just images to access the emotional state you want to build a stronger connection to.

The basic idea behind alternative resourcing is to use other senses to either enhance a resourced image or in place of an image. Before I delve too far in, let me first explain that the approach my therapist and I use for resourcing is slightly different than "traditional" methods. Instead of setting up the image, where I feel it in my body, the emotions behind it and then attempting to hold it all together, my therapist just lets me talk. I describe the image, often closing my eyes, talking about how it made me feel and my therapist alternately taps on my left and right knees at intervals she sees as pertinent based on my affect. She may ask questions to clarify or encourage me to go deeper, but overall I lead the resourcing, which seems to add a lot of meaning and makes it easier for me to connect my memories/images with my emotions.  This confirms a feeling I have had for a long time- the protocols set forth by Dr. Shapiro and EMDRIA are wonderful, but a good therapist who knows her client will be able to tweak EMDR in order to meet the client where they are at and to obtain the maximum benefit.

The first thing my therapist and I attempted to alternatively resource was a lotion that I use to help me sleep and that carries happy memories. I alternated between taking deep breaths and describing the feelings that came with the scent. Before the bilateral stimulation I was already feeling deeply calm and relaxed. Adding the tapping lead me to a much deeper place where suddenly I was able to leave the nagging fears and thoughts behind and just enjoy the scent and my experience. After several series of taps, I was able to smell the lotion and bring up the feeling without trying. I could already feel the power behind this alternative resource. Since the first time resourcing this, I have started every resource session re-tapping in the lotion scent and the calm it brings. It helps me relax and fully engage with any other resourcing I may be doing.

The second thing I resourced was a small, furry kitty-shaped tape measure. It's an orange tabby, resembling my cat, Bodhi, who has been with me for the past 7 years. As I closed my eyes and focused on rubbing/petting the mini-Bodhi I felt compelled to talk about getting my cat and the joy he brings me. I talked about how he always seems to know when I'm upset and how petting him brings me a feeling of peace, calm, and safety. As I talked, I petted the kitty tape measure, and my therapist did the alternate knee tapping. Again, I found myself transported into a deep sense of security and calm, much stronger than any image I had resourced previously.

With both the lotion and mini-Bodhi, I found that I was combining sensation, emotion, memory/image, and body reactions without having to be prompted. They were natural combinations and I think that is what made the resourcing so successful. In the days to come I found that I was able to transfer the calm/serene/safe feelings from the targets (lotion/mini-Bodhi) to a broader range of items. I get an immediate sense of deep calm when smelling anything similar to the lotion I initially used (though the closer to the scent, the deeper the connection it seems). Also, when I pet the real Bodhi, I find myself right back to the happy and calm place I was in on my therapist's couch. I continue to tap in every time I activate these alternative resources and the results have been amazing.

The after-effects of nightmares no longer plague me as I am now able to use resources that not only comfort but help me to stay grounded and in the moment. Panic attacks and emotional flashbacks are easier to navigate and the daily living issues I have had are dulled now that I have these defenses in place. 

I still use other images I have resourced in addition to the lotion and mini-Bodhi, sometimes I combine them in order to relax even further. This has been a major blessing, as current events in my life have prevented me from being able to process trauma, but the resourcing I'm doing is helping me to maintain and live without letting PTSD symptoms control my life.  It is amazing to me what happens when clinicians are willing to allow their clients to mold therapeutic modalities to fit what they need.

Friday, June 20, 2014

From Divine Being to Dear Friend

The Merriam-Webster dictionary defines a crush as " a strong feeling of romantic love for someone that is usually not expressed and does not last a long time." In my life I have had many text-book crushes, but as I get older I realize the word tends to encompass a feeling not always romantic in nature. For me, a "celebrity crush" is something that happens when the want to become emotionally closer to someone you view as a mentor is so great it begins to exhibit the same symptoms as a romantic crush. The person may be someone you actually know (teacher, therapist, etc) or someone you don't know personally but look up to (religious leader, public speaker, author, etc). While I don't yearn for romantic relationships outside of my marriage, the presence of crushes in my life is still abundant.

 The first non-romantic crush I had was on a high school teacher. After graduating she became both my mentor and friend and I was obsessed with her. I wanted to help her, take care of her, and be the main part of her life. There were no sexual feelings attached, I simply wanted to be a part of her world. Unfortunately this relationship ended abruptly and harshly after I attempted to find autonomy from our enmeshed lives. Looking back, it is no shock to me that my obsession with her began around the same time I began to take my mother off of the childhood pedestal I had kept her own for so many years.

 At the time, I was slowly piecing together that my mother was a human who was not perfect and had let me down. It was a process so upsetting that I even forcefully argued with my therapist over the impact my mother had had in my life. I insisted she hadn't let me down, upset me, or treated me unkindly, ever. As I began to realize that my childhood hadn't been perfect (whose has?!) I looked to find someone to replace my mother on the pedestal that I felt I needed in order to have someone to look up to. Like many before me, I was banking on the idea that whomever I looked up to had to be some sort of fairy-tale goddess, there to save me from myself.

As I watched yet another woman fall off of my pedestal, I struggled to be without a goddess to model myself after. Since then I have had a steady stream of pedestal goddesses and they have never actually saved me from myself. They have helped me to realize who I am and to strive to grow to my full potential, but none of them have been perfect or able to erase all my problems. I like to think I've matured in my taste for the women whom I develop celebrity crushes on, picking individuals who refuse to play into the role of divine being and insist on challenging my perspective on what a mentor is.

I, like many, went through the rite of therapeutic passage that is having a crush on your therapist. Like the obsession with my high school teacher, it was never sexual in nature, but purely a "please adopt me" situation. To clarify, this developed around the time I had ended my friendship with my former teacher and returned to my home state after living cross-country for a year. I was ripe for a new goddess to place on my pedestal and my therapist was the only source of encouragement I had at the time.

I was working on going back to college and my therapist was there, encouraging my change of degree (from English to Psychology) and my decision to pursue my dream of becoming a social worker. She was practically asking to be deified! I became obsessed, talking about my therapist all the time to friends and living therapy session to therapy session. I craved the attention, support, and commitment she gave me. Eventually I realized it for what it was: a deep desire to be included in her life because I didn't believe I could ever live my life in that manner. She was exactly what I wanted to be: a self-assured, independent, forward thinking, social worker living her life and teaching others to do the same. Eventually I was able to take a step back and appreciate the aspects of my therapist that I wanted to emulate. I still look up to her and strive to be able to live my life in such a fulfilling manner, but I've finally begun to see her as a human instead of some goddess whose word is law.

 My most recent crush was taken off of the pedestal when I realized I couldn't befriend her and idolize her at the same time. It started off a social media mutual stalking situation (I'm told the more publically accepted term is "networking") that gave way to me utilizing her services as a retreat leader. This then morphed into a very special friendship that simply had no room for pedestals. In being able to analyze my motives for seeking her out (her opinions on the mental health system, recovery, and life in general both complimented and challenged my own beliefs) I was able to realize I wasn't looking for a goddess anymore. I was looking for a friendship. A deep-seated relationship based on mutual admiration for each other's views and beliefs. And that is exactly what we have.

Do I still find myself emotionally drawn to her, and others, from time to time? Certainly. I think it's perfectly natural to yearn for growth and betterment. But am I still obsessed and crazed like I was with my high school teacher? Certainly not. Reality has kicked in and I know now that I cannot fill the hole that was created when my mother came off of her (imagined) pedestal. Disappointment, fear, and need naturally come out of the realization that our parents are not the perfect beings we once imagined. The pedestal also served a sadder purpose: to keep me believing that I would never be good enough to be accepted. By having someone who was "ideal" on a pedestal, I always had someone to compare myself to in order to see just how "bad" or far from ideal I was. This perpetuation of the core belief that I can never be enough has helped to keep me in a comfortable position: depression and despair. I know that this may not seem comfortable to most, but when you have lived a large percentage of your life in crisis and depression, it becomes the norm. The norm is horribly comfortable.

 Thankfully, I have finally started to overcome these beliefs and grow up emotionally. Growing up means realizing that this need for a goddess on a pedestal is not really a need, per se, it's really a want. I wanted someone to save me, to keep me safe, and to make my life easier. I wanted the safety and security of childhood. All of these wants are okay (and perfectly normal during the stages of emerging adulthood), but in order to continue moving forward with life it was necessary to accept that I cannot have everything I want. This is exactly why the dictionary states that crushes are often undisclosed and pass rather quickly; humans are resilient and able to overcome desire in order to focus on necessity.

 Crushes, no matter the form, teach us something deep about ourselves. They allow us to see what we want in our lives, what we desire from others, and what life can be if we follow our dreams. Acknowledging these "celebrity crushes" and using the information to move forward towards our potential is something that can help make our feelings seem a little less overwhelming. By being able to say "I love that person for who they are, I admire their attributes, and I want to bring those same attributes into my life" I have been able to overcome my need to deify those who I look up to. Instead of beating myself up for such "childish" behaviors, I try to commend myself for being able to recognize my obsession for what it truly is: just a crush.

Wednesday, June 18, 2014

Boundaries: Stop Guessing!

I care for my therapist. That's a hard sentence to type. I grew up with the belief in firm boundaries with providers. Therapists and doctors are meant to help with specific problems. As I grew up, I fell very hard into black and white thinking. Either you are in control or you are not. Either you are living or existing. Either you are professional or you are ineffective. School reinforced this- don't care for your teachers. Don't make friends with them. I tested this out and was able to find comfort in my "inappropriate" relationships with teachers, but there was always a time limit. Eventually, you move on, graduate, and make "real" friends.

The problem with my therapist is I'm not moving on anytime soon. I enjoy self exploration and don't foresee that stopping anytime soon. I'm embarrassed to admit this comforts me. I enjoy my relationship with my therapist and I feel that this is bad. I still can't quite figure out why, but every fiber in my being seizes up and wants to retract when I begin talking about my therapeutic relationship. The discrepancy between the "rules" and practical application of a therapeutic relationship has created a confusion that is very frustrating. It's even more vexing because I have been lead to believe that mentioning these boundaries is a taboo subject.

I started off with very simple boundaries for therapy: go, talk, leave it at the door. However, life's problems are not so accommodating. They refuse to just be left at a therapist's office. Everywhere I went, there they were! The first few therapists I had never made an attempt to extend their services beyond the therapy room. In fact, when I went inpatient they wouldn't attempt to allow for contact until whatever follow-up program I was sent to was completed. The lack of consistency lead to frustration when each therapy team member had different goals for my progress. Around my fifth hospitalization someone finally realized the inconsistency and insisted on me starting with a therapist willing to work with the team the college I was attending had set in place for me. I would have no clue what kind of life-altering event this was until years later.

This therapist, who is my current therapist, started changing my views on boundaries nearly immediately. The first text I ever received was sent to me at the beginning of 2004. It was one simple line, "we're meeting at 5 on Tuesday, right?" and it blew my mind. I replied, sending my very first text, with a simple answer of "yes." Suddenly I didn't know what to think. My therapist was using an alternative means of communication. This lead me to a very scary realization: my therapist is human!

She challenged me a few months later when I had had a late-night crisis. She asked why I didn't call and I couldn't form the words to say, "because I'm not supposed to." She recognized my discomfort with the subject, but continued to encourage me to attempt to call her when I needed to. Eventually, I called. I'm still not 100% comfortable calling her, but now it's a viable option. Calling gave way to emailing her when I moved cross-country. Not only did she reply, but she continued to counsel me while attempting to find a therapist, and then again when my therapist broke up with me while I was inpatient. She emailed/phone coached me until I was settled. When I returned to my home state, she was still there, willing to take me back on. Email became an option for non-emergent crisis and telling parts of my story I was too embarrassed to bring up during therapy. The lines kept blurring for me, as I felt these were positive interaction, but I was being taught by my degree program that these out of the office interactions lead to dreaded "dual relationships" with clients. I kept my mouth shut, silently trying to rectify this discourse within myself.

Eventually my social media found her social media, as I began to find my voice in the social media world as a psychology student and advocate. This lead to a quick discussion on the fact that it was "ok" for me to friend her professional twitter account. Even though my twitter account is also professional, I still haven't followed her for fear of crossing a line that, I'm pretty sure, is just in my head. I've pressed my own limits a few times: she and I exchanged gifts when I left for OR and she has given me CDs and books to help feed my ever-growing appetite for self help sundries. I've given her a book or two along the way as well. All of this has muddled the gray area for me and left me uneasy as to where the line is.

Last year I breached what I felt was a very firm barrier only to find my therapist sticking to her firm stance of non-judgment and unconditional care . I expected to be let go because of my actions, which included sending a very upsetting suicide note to her email, but instead I was given the opportunity to speaking freely about how I felt. I sincerely did not want to, afraid admitting to what I wrote would end up being held against me. Ironically, it wasn't the things I wrote about death, dying, and self hatred I was terrified to admit, but the tender sentiments I wrote to my therapist about her place in my life. Why can I say "I care for you" when I'm nearly dead, but can't admit to saying that when I'm in my right mind?

Recently this came up again and my therapist wasn't having the attempt to gloss it over. She confronted it head on, wanting to understand my embarrassment and other emotions that speaking about our relationship brought up. She actually said the words "I care for you" and I thought I was going to pass out. Not in a good, excited way, but more in a fully mortified and I-want-this-couch-to-eat-me-now sort of way. She's not supposed to say stuff like that! I'm not supposed to be cared for like that by her!

Up until now I've gone with the idea that I could be anyone and my therapist would do the same. In my head, I'm not special, she's just a special and caring person. But perhaps I am special. Maybe my care is very person-centered and the extra time in sessions when I needed it, and the out of office support, isn't just a generic service, but based on what my therapist can give and what I need. What then? Well then I have to admit that we do have a relationship, she does genuinely care for me, and I am worth spending time on. She believes in me. She's advocated, pushed for me, pushed me, and pushed herself (I'm guessing here, but it's pretty obvious that I have brought about some unique and trying circumstances) in order to not just meet my basic needs, but to help me on a much more complex, and humanistic, level.

That someone would think of me first and be so selfless baffles me. And yet, I do the same. I can't claim I have the same relationship with all of my residents or that I care for them each in the same way. I don't attempt to. Some residents I am close with, while some I will never develop a strong relationship with, but still care for them, just on a different level. And yet other residents I have developed a strong bond with and do some things, when appropriate, above and beyond, when I can, to help them. Some have even touched my heart in such a way that I am forever changed by our time spent together. It's just hard to translate the bond I have with a kid who needs my help to the bond my therapist has with me. This means I'm the person who needs, and deserves, help and support.

After ten years of avoiding boundary talks, I have learned something very important: Not only is it NOT a taboo subject, it's what you SHOULD be discussing with your therapist. This doesn't make it any easier for me to broach the subject, but this knowledge does give me the push I need to not run out of the room screaming. I'm still attempting to define where the line is. Maybe there never was a line. Perhaps boundaries are just about expressing what you need and want out of a relationship instead of making assumptions out of sweeping generalizations. Maybe it isn't about boundaries at all, but about human connections and relationships.

Regardless of my inability to accept caring graciously, I have learned that it's okay to discuss whatever I'm feeling with my therapist- that's what she's there for! Too many times have I gone without the care I need because I was too upset/embarrassed/afraid to approach a subject. I'm learning that it's okay to ask and it's okay if the other person, be it therapist, friend, or coworker, is taken aback by it. Part of learning to have meaningful interactions is learning that the reactions of others are not for us to determine or worry about. When the focus is communicating, instead of making everyone comfortable, better understanding can be reached for everyone involved.