In response to the posts concerning the
“childhood
roots of victimization” (the consequences faced by adults who
grow up with parents who fail to respect the characteristics and
needs of children), I've received several emails asking for advice
about how to find a good counselor.
Given the very promising research and
my own positive experience, and though I'm a big fan of Cognitive
Behavioral Therapy, I really believe that when dealing with
trauma and depression, I believe that Eye
Movement Desensitization and Reprocessing offers the best
alternative.
So what weird language am I speaking?
Types of Therapy
CBT
Cognitive Behavioral Therapy (CBT) is
generally accepted as the best, standard therapy, and most people
consider general talk therapy to be synonymous with CBT (though I no
longer necessarily do). Cognitive means “thinking,” and CBT
looks at how thought affects behavior (and emotion).
It assumes that if your thoughts are healthy and realistic, your
thoughts will guide your emotions, and your emotional state will
become more positive. Essentially, this is the principle behind
spiritual warfare. If you thoughts remain governed by a proper
understanding of Scripture, good behavior and emotions will flow from
those thoughts. I think that right thinking is essential. In the
previous related post concerning resources for healing, I mentioned
The
Lies We Believe and the great companion
workbook by Chris Thurman and a similar book by David Stoop
called You
Are What You Think. These Christian books can get you well
on your way to doing much of your own CBT work yourself.
Another nice thing about these books?
They can help give you structure for keeping a personal journal which
for some marvelous reason helps to speed and aid emotional healing.
I have an associate who once saw data from a study quoted by Marcia
Means which showed that writing with pen and paper actually helped
enhance healing of the mind and emotions. However, I have also heard
people claim that the bilateral use of hands to type on a keyboard
creates the same effect that EMDR achieves which helps reintegrate
the brain. Either way, keeping a journal daily and expressing your
feelings in some kind of written form does accelerate healing.
EMDR
But on to the mysterious EMDR – Eye
Movement Desensitization and Reprocessing. EMDR encompasses the same
principles of CBT and adds to them the additional (very
goal-oriented) focus on the body's felt sense to the healing process
in a way that dramatically speeds therapy. (The most promising
therapies for PTSD and depression, according to the newest research
have been somatic therapies or those therapies which focus on body
sensation, body movement, and felt sense. Some call this
“mindfulness.”) A good place to start to learn more would be
the EMDR website's general
information and their FAQs
page. (The drop down tabs at the top of the
webpage will also provide you with lots of info.) This website also offers a description of the process.
In depression and in trauma in
particular, it is as if the different parts of the brain loose their
ability to work smoothly together. The right cerebral hemisphere
focuses on feeling, and the left focuses on analytical thought and
reason, and based on personality preference, the overwhelmed person
will try to “live” in only one side. They will try to avoid
feelings, or they will be incapacitated because they find that they
are unable to avoid them. At the same time, other areas of the brain
become overactive (such as those structures involved in survival),
and some become underactive, producing a less than healthy state and
practical level of function. Signs of this that we see translate as
depression, an inability to concentrate, or unpleasant memories that
become triggered and invade our focus, etc..
By stimulating the mind and the body to
think about how the body feels while simultaneously stimulating
several very different parts of the brain to work together at the
same time through feeling and movement, basically, the technique of
EMDR helps the brain realign itself and reintegrate so that it can
smoothly work together again. While the separate areas of the brain
come back into balance, the technique also realigns the person's
thought and ability to feel physical sensation that the body
experiences, so it teaches a new level of self awareness which
ultimately improves a person's ability to respond to new difficult
experiences in the future. In that sense, part of the healing
involves a level of physical self-awareness which also helps align
these areas of the brain.
In depression and non-complex PTSD,
EMDR produces
complete relief of symptoms without medication or other
intervention in 75% of adults without a history of childhood
PTSD/dysfunction during a limited 12 week comparison study with
continued improvement upon six month follow up. Adults who
experienced some type of depression or trauma as children experienced
complete symptom relief at a rate of 33% in only 12 weeks. ([We]
just need to work at it a little longer to develop the skill and
coping ability that [we] failed to develop in
childhood.) Explore additional
research HERE.
At the level of neuroanatomy and
physiology, as I understand the process and for those with interest
in the technical aspect, the focus on the the way the body feels as
it moves stimulates an area in the pre-frontal cortex (PFC, a part of
that thinking area in the brain's higher cerebral cortex) which seems
to have a natural and reflexive calming action on the survival system
areas in the brain (the basal ganglia) which becomes very overactive
in trauma and in depression. This is why mindful walking, yoga, tai
chi, meditation, hypnosis, massage, acupuncture and any repetitive
movement which requires the body to both move and focus on the
sensations of the body helps in trauma – because they cause that
medial PFC to become active, the area that appears to be our only
“switch” which allows us to modulate and calm those structures of
the brain that regulate the survival response. (In trauma or
clinical depression, the idea of distraction or “Don't think
about the negative” message that one tends to hear in nouthetic
or typical types of “Biblical” counseling actually works against
healing. Pastoral counseling can certainly be an adjunct to healing if it enhances the healing of the underlying physiology of trauma.) If you're struggling with overwhelming (irrational)
emotion, EMDR presents a very targeted way of contending with those
emotions and helps reunite thought and emotion.
A session of EMDR involves the
identification of an underlying negative thought and establishes the
desired healthy thought objectively and as a measure of intensity of
discomfort of the idea which gauges progress. Then, while the
therapist guides the client to focus intently on how they feel in
body and mind in response to the underlying negative thought that
fuels the experience of depression or trauma, the therapist uses
rapid bilateral stimulation of the body of some type (eye movement
back and forth via tracking an object or light, alternately “tapping”
the right and left sides of the body, or through sound alternating
from right to left through a device) as the client focuses on their
overwhelming and painful emotion. The therapist watches the client
for cues and varies the speed of the stimulation to achieve either
liberation of the negative emotion (from the vantage of safety) so
that the person can “think through it” and make sense of it, or
they can use the speed and pattern of the movement or stimulation to
reinforce pleasant emotion (accompanied by the client's spontaneous
ideas or epiphanies that they experience once they've pushed through
the negative emotion).
The aptly named process thus guides
the client into a desensitization to their experience of painful
memory (so that it no longer feels overwhelming, ongoing, or part of
that relived type of re-experienced memory that is typical of
trauma). The memories of events remain, but the desensitized client
can access the memory without that deep and threatening sense of
overwhelming and invading emotion that tend to trigger the perception
of threat. It becomes like any other memory instead. The
reprocessing aspect concerns the CBT element of drawing on rational
thought which allows the client to put the experience into
perspective.
Shadowspring, a blogger who discusses
her recovery after spiritual abuse speaks highly of her experience
using EMDR as a powerful help in her journey to find healing and
wholeness. HERE
is the link to many posts on her blog discussing her experience
with the therapy. I have also been a very pleased recipient of the
benefits of EMDR myself, after years of CBT alone which did nothing
to alleviate the PTSD component of my symptoms. Particularly when
dealing with issues of childhood trauma, I believe that EMDR presents
the current ideal type of therapy. It will certainly save you time,
money, and perhaps the necessity of medication (which I believe can
be helpful in the early stages of treatment, especially when
accompanied by physical pain and illness).
Develop a Working
List of Affordable Practitioners
So stated reasons, I
would recommend finding an EMDR therapist first, then I would
narrow down possibilities by asking certain questions related to your
particular therapy need. And word of mouth and the recommendation of friends is also a most valuable resource, too. The next consideration for most people
likely concerns finding a provider that participates with their
insurance plan if they have one. Visit the referral engine at
www.emdr.com on their
site HERE (and take note of their “Hints” on how to
best use the search engine which is quite important).
Narrow Down Your
Working List
The National
Association for Christian Recovery site features a nice and
general list of questions to ask a potential therapist as well as a
list of Christian counseling organizations. It offers good advice
and is well worth reading through.
For stated reasons, I'm less inclined
to start my search with the list of organizations they offer, as
Nouthetic counselors can be members of some of the groups listed (my
general, negative thoughts concerning nouthetic counseling can be
found
HERE). You may choose to try to cross-reference referrals from
the EMDR site and from these Christian organizations, or you may
choose to navigate directly from one of these groups:
Here is my own tailored list of
suggestions that one might ask a therapist, once you've created a
working list of possible providers:
- Qualifications and Credentials. Once you've narrowed down some possible candidates in your local area that ideally work with your insurance provider, ask questions about credentials. I highly recommend finding a therapist with a more clinically oriented background and would avoid some of the study from home counseling programs that do not include instruction in real mental health disorders. You can also check with your state to see who they consider to be legitimate licensed or certified practitioners. In my own state, a practitioner with under a full year of full time experience in counseling can work independently, and their credentials can give you some indication of their level of experience.
- Focused Care for Dealing with Problems Arising from Dysfunctional Families. If you've responded to the material in this series of blog posts, before deciding to schedule a session with a therapist, find out whether your therapist appreciates the addictions and recovery approach or a Twelve Steps approach to therapy (I've used a codependency and recovery model to address child development in these posts, so if you responded to them, it would likely be wise to find a practitioner who also approaches matters from the same perspective.) Some counselors do not take this approach or specialize in different types of therapy.
- Ask about their favorite authors, books and researchers. I also prefer the brain based approach to therapy because of the objective nature of the new findings concerning mental health. Ask the therapist if they are familiar with “three camera SPECT” studies or the writings of Daniel Amen who specializes in these types of brain imaging. Ask who their favorite researchers are concerning trauma, and if Bessel Van der Kolk, Peter Levine, or anyone associated with The Meadows facility in Wickensburg, AZ or The Trauma Center in Boston, MA, you've very likely found a fairly good practitioner who takes an approach to these topics that is similar to my own (if the material on this blog speaks to you.)
- What does the therapist require of the client? Ask whether the therapist assigns homework or requires clients to do certain reading related to the therapy. Do they also encourage or require you to journal? What does the therapist expect of a client?
- How do they evaluate progress? I tend to prefer to seek care from a practitioner who writes a plan of care and evaluates that plan on a regular basis. Ideally, the client (you) should initially work with the therapist to establish very clear and easily evaluated goals for your work together. (A good therapist will show skill at setting goals and working with you to establish measurable and meaningful goals to guide your work with them.)
… And these ideas should give you
a place to start!
