EMDR- rapid healing of “small t” and “big T” trauma

4 12 2013

The beginning of the end…

I recently received a new, unexpected diagnosis when I went to a skilled EMDR  therapist for help with chronic pain: Post-traumatic Stress Disorder (PTSD- DSM-IV definition and PTSD DSM-5 definition). Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for trauma developed by Francine Shapiro, PhD.  I have a less severe form of PTSD than many others who have been through horrific experiences. I have what Shapiro calls “small t” trauma. LOTS OF IT! “Big T” trauma is comprised of the things people typically think about as major causes of PTSD (see the chart below).

For me, one more thing happened this year and my resilience and coping efforts were just worn out. My already daily pain escalated. Many of us have “small t” trauma and our own unique levels of resiliency.  I grew up as a Campbell’s Condensed Soup kid (tomato was my favorite). Going into treatment I felt like a can of “Trauma Soup”- lots of trauma ingredients packed tightly into the can of mind/body/spirit!  Yet I never really considered these “small t’s” as causing my pain and other struggles. I felt as if I had these evil gremlins clinging to my mind and body, persistently resisting cognitive-behavioral efforts to make them let go of me.

It bothers me greatly that people often focus on the “big T” trauma and overlook the damaging power of “small t” trauma. Many of our clients have both types, and tragically for some, years of horrific “big T” trauma. “Small t” traumas  can also derail  quality of life and functioning. Universal trauma screening could identify many trauma survivors, change treatment plans,  and CHANGE THEIR LIVES!  Psychological trauma is a hidden epidemic. 90% of clients in public behavioral health settings have experienced trauma. – SAMHSA-HRSA Center for Integrated Health Solutions.

Below is a great chart from the TraumaAndDissociation Facebook page via www.dissociative-identity-disorder.net/wiki/Trauma  that shows some differences between “small t” and “big T” trauma. “Small t” trauma is sometimes called complex trauma and those with multiple incidents of “big T” trauma can also have complex trauma. (Link to the graphic image of this chart.) 

“Big T” Trauma

  • Major events normally seen as traumatic
  • Emotions, beliefs  & physical sensations occur in both the mind & body

Examples

-Serious accidents

-Natural disasters

-Robbery, rape and urban violence

-Major surgeries, life threatening illness

-Chronic or repetitive experiences, e.g., child abuse & neglect

-War, combat, concentration camps

*May cause PTSD in some people but not all

“Small t” Trauma

  • Overwhelming but not often seen as traumatic
  • Emotions, beliefs  & physical sensations occur in both the mind & body
  • Unprocessed traumas have a long-lasting, negative effect
  • Can cause concentration, self-esteem & emotional regulation difficulties
  • Stunts and colors later perceptions
  • Often no intrusive imagery
  • Most common in neglected/abused children
  • Become part of a negative spiral when a “Big T” trauma occurs
  • Sometimes referred to as “complex trauma”

 

What does EMDR treatment feel like?

  • I have been told that it is not possible to accurately describe what EMDR feels like to someone who has not experienced it. I agree that this is probably true- even when I give a trusted person very detailed descriptions of a session. But I wanted to try in the hope that more clinicians will consider becoming EMDR trained and  more people will seek out treatment.
  • Memory reprocessing is unique to each person. No judgments are to be made. There is structured EMDR protocol as well as strong clinical skill used. (Here are some EMDR Frequently Asked Questions.)
  • Every EMDR treatment session feels like a miracle to me. It rapidly reprocesses the gremlins of traumatic memories in my brain so that they no longer control me. And after resolving memories in an EMDR session, it is fascinating how much easier cognitive-behavioral methods now work!
  • After the basic intake information, I was asked to go back to my earliest memories and quickly give a short statement to create a log the therapist wrote of bullet points for  all of my memories. No judgments were made about what felt traumatic to me. Traumatic is a person’s perception of the experience. This list created the working plan for how we would proceed from beginning to end. Some memories are treated as individual memories, and some that have a similar theme are addressed through a cluster that enables the first, worst,  and most recent to be reprocessed and then the larger cluster is pulled together for reprocessing.
  • Before starting EMDR, I was taught to make a mental container so that I could place disruptive or unfinished memory reprocessing into the container. Using the EMDR technique, the container was “installed” so that it would stick (my word) in my brain and be there to use when needed. I practiced in session and then practiced using my container in various ways during the week so that I had mastery before I needed to use it for powerful feelings and memories.
  • To the best of my recollection, working on a single memory feels like this: I am asked to briefly describe it, notice and rate the distress level as well as the place in my body where I feel the trauma. I hold that focus and then starting using the eye moment as directed by my therapist. I can feel the memory changing in many ways during EMDR. After a brief period of doing the eye moment, we stop and I take a relaxing breath.  I share how the memory and feelings changed. No matter how crazy I feel about the way the memory is reprocessing (sometimes like watching a movie that I am writing as I sit there), there is no judgment- just attentive, compassionate focus from my therapist. We keep repeating the process- focusing on changing feelings, reassessing my distress level as we work to let my distress drop down to zero, and installing positive feelings/affirmations. Yes, there are tears but it still feels so effortless for me, so fast. I feel very relaxed and free the entire time, even when a tough memory makes me weary or takes 1 ½ sessions to complete the reprocessing. Sometimes we can do two memories in a one hour session.
  • When I arrive for the next session, my therapist always checks in to ensure that the memory work done in the last session has remained at zero distress. In one instance, more feelings bubbled up over the week and we had to work a while longer to finish resolving the memory. That is normal.
  • I am committed that I am not going to stop treatment until I get through every bit of trauma. As they say, “the way out is the way through”. I attend weekly sessions. Some people have a need or an option to go through an EMDR intensive that is usually done in a couple of days and includes multiple sessions during that time. Here are some examples of how people healed in a recent blog written by Ricky Greenwald, PsyD about the intensive EMDR treatment model.

View a client video about EMDR including the effect of PTSD on the brain (this video shows the use of EMDR equipment instead of therapist fingers for the eye movement).

Summary

Trauma is NOT about what is wrong with someone, it is about what HAPPENED to them. Needing treatment to heal and asking for it is about COURAGE, not about society’s perception that it is a weakness.

We need to remember that there two faces of trauma, “Big T” and “small t”- both deserve equal respect and a nonjudgmental approach. Evidence-based practices and a good therapeutic relationship can take you behind the human curtain and help a person heal. When trauma is not treated, people do not heal and sometimes they die. EMDR is evidence-based, fast, and life changing. We need more skilled EMDR therapists across our country, throughout the world.

I know there are people who think I should not talk about this in the way that I am in this blog…I do so because I am a social worker…I am an advocate…I am one of the many faces of PTSD…one of the many trauma warriors battling to become stronger, wiser, healthier, and happier than we ever thought possible.

Author: Lesa Fichte, LMSW, Director of Continuing Education

Photo credit: free photos at www.morguefile.com and drkathleenyoung.wordpress.com through Creative Commons Attribution

Additional Resources

EMDR & EMDR Training

EMDR International Association www.emdria.org

Trauma Institute & Child Trauma Institute (Ricky Greenwald) http://www.childtrauma.com/

EMDR Institute, Inc. (Francine Shapiro) http://www.emdr.com/francine-shapiro-phd.html

Western New York EMDR Training http://www.socialwork.buffalo.edu/conted/emdr.asp

 Trauma-Informed Care

 National Center on Trauma-Informed Care http://www.samhsa.gov/nctic/

National Child Traumatic Stress Network http://nctsnet.org/

International Society for Traumatic Stress Studies http://www.istss.org//AM/Template.cfm?Section=Home

Online Trauma-Informed Clinical Foundation Certificate Program, University at Buffalo School of Social Work Office of Continuing Education http://www.socialwork.buffalo.edu/conted/trauma-ticfc.asp

University at Buffalo School of Social Work Institute on Trauma and Trauma-Informed Care http://www.socialwork.buffalo.edu/research/ittic/

The Anna Institute www.theannainstitute.org


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14 responses

5 12 2013
didisreal http://traumaanddissociation.wordpress.com

this is really interesting, thanks for blogging and thanks for linking back to our wiki
If you want to include the poster or others you can link direct to them from here http://www.facebook.com/TraumaAndDissociation/photos_stream or http://www.facebook.com/TraumaAndDissociation/photos_albums

5 12 2013
UB Social Work Continuing Education

Thanks, didisreal! Most appreciated!

5 12 2013
1000 posts on tumblr – what were the most popular posts? | Trauma and Dissociation

[…] EMDR- rapid healing of “small t” and “big T” trauma (behindthehumancurtain.com) […]

6 12 2013
Rg

Yeah, I started logging memories and such, but, in all honesty, the only thing that’ll make me feel better is to tell the bastards that did shit to me to fuk off, hurt them in some way, and then receive some of their money.
I’m serious, and I don’t care what u think, whether you’re judging me or not.
I’m sick of all of the bullsht that I’ve taken for 59 yrs, and who knows how many more that’ll suck just as bad if not worse, prob worse.
So forget your edmr or whatever u call it, it’s not strong enough for what happened to me so find a new therapy or job or both.
Good luck.

6 12 2013
UB Social Work Continuing Education

Dear Rg, I am so sorry for all that you have been through. Those who have hurt you were wrong to do so. Holding you in healing thoughts. Lesa

6 12 2013
What is Complex PTSD? | Trauma and Dissociation

[…] EMDR- rapid healing of “small t” and “big T” trauma (behindthehumancurtain.com) […]

7 12 2013
dorleem

I take my hat off to you, Lesa
It takes much courage to go through EMDR and face the issues that caused the pain/traumas. It also takes immense bravery on your part to share part of your journey with us.
Wishing you much strength and as smooth healing as possible,
Dorlee

8 12 2013
UB Social Work Continuing Education

Thank you, Dorlee. 🙂

8 12 2013
Living the life we really want to live | Trauma and Dissociation

[…] EMDR- rapid healing of “small t” and “big T” trauma (behindthehumancurtain.com) […]

24 02 2014
31 01 2016
3 05 2017
eugene

What if you have no specific memory or memories don’t bring much SUDS. In small t, memories are multiple or before age 5, in subconscious. Today’s experience is PTSD-type but no memory. It is my case. Did you work on those with EMDR?

3 05 2017
UB Social Work Continuing Education

Hi Eugene, I am not an EMDR clinician but added some info that might be of interest. A skilled therapist is key and EMDR is not the only way to resolve trauma. There is an EMDR technique that addresses conception to preverbal related to memories held in the body that are not conscious. Some clinicians are trained in this. I did not care for this approach to EMDR but some reportedly find it helpful. info at http://www.bainbridgepsychology.com/our-services/et-clearing/
Bessel van der Kolk, MD, has also been doing research and training has been created on Trauma-Sensitive Yoga to use body work to resolve trauma. We are blessed to have one of his trained practitioners here in Buffalo. Details at http://www.traumacenter.org/clients/yoga_svcs.php
Best,
Lesa

4 05 2017
eugene

Hi Lesa, thank you.

I will check references. I see L Parnell does Attachment based EMDR, trains in it as well. In one of the chapters she talks about using body memory where visual memory is not available (at least at beginning)

My therapist is not trained in this way of doing EMDR. She relies on visual memory.

There are some that use EMDR with children where obtaining visual memory may be hard. They apply same protocol but use different expressions (drawings for example).

Cheers

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