Agate Institute: 4th Summit of EMDR, Complex Trauma & Dissociation
Module 1: Working with Chronic Shame in Complex Trauma – January 31, 9 am to 11 am AZ time
Chronic shame often underlies stuck places and lack of progress in therapy, and is an enduring problem in clients who have experienced complex trauma. By its very nature, shame is hidden from others, including the therapist, and is difficult to acknowledge. Shame is re-experienced in similar ways as traumatic memories, with symptoms of intrusion, avoidance and arousal, and thus must be approached carefully within a window of tolerance of the client. Therapists often feel they do not have sufficient skills to address shame effectively, as it is so powerful, embedded, alienating and disconnecting. Talking about shame is often an ineffective strategy by itself. We will explore several functions of shame, distinctions between shame and guilt, and how chronic shame may perpetuate other symptoms or problems. We will discuss ways shame interferes with therapy. A practical integration of cognitive, emotional, relational and somatic interventions to resolve chronic shame will be discussed. We will also explore specific “antidotes” to shame, as well as ways to help clients (and therapists) develop resilience to shame reactions. Most importantly, we will examine how to be with shame – our own and our clients – with curiosity and compassion, finding ways to create a safe relational space in which to deeply attune with and repair our client’s chronic shame.
- Recognize the several functions of shame, and the difference between healthy and chronic shame.
- Distinguish at least three cognitive, three emotional, and three somatic interventions to diminish chronic shame.
- Distinguish t at least three ways to support the development of shame resilience in ourselves and our clients.
Kathy Steele, MN, CS has been in private practice in Atlanta, Georgia for over three decades, specializing in the treatment of complex trauma, dissociation, attachment difficulties, and the challenges of complicated therapies. She is an adjunct faculty at Emory University, and a Fellow and past President of the International Society for the Study of Trauma and Dissociation. Kathy teaches and consults internationally and has received a number of awards for her clinical and published works, including the Lifetime Achievement Award from ISSTD. She has published thee books. The most recent in 2016 is Treating Trauma-related Dissociation: A Practical, Integrative Approach.
Module 2: “There Is Something Wrong with Me:” Working with the Effects of Emotional Abuse, Severe Neglect and Invisibility in Complex Trauma – January 31, 12 pm to 2 pm AZ time
The effects of emotional abuse, feeling like a burden for others or unwanted have a profound effect on the child and future adult. In early childhood, caregivers’ affective signals and lack of contingent availability present a more common perceived threat to the child’s development of a secure sense of self than the actual level of physical danger or risk for the child’s survival. These “hidden traumas” of neglect, related to the caretakers’ inability to modulate affective dysregulation, result in deactivating responses to attachment cues. Children who learn to deactivate automatic responses never develop basic abilities such as co-regulation, emotional regulation, and self-care. In addition, in some households, having needs or expressing them may be dangerous and children are neither given the chance to trust others nor themselves. Experiencing other types of additional traumatic events will complicate the picture even more.
Since children must adapt to survive, victims of severe emotional abuse and neglect must develop strategies to deal with their experiences. These survival strategies become automatic and may be difficult to identify in adults. Clients often learn to ignore their emotions and their most basic needs, which makes them feel invisible, unseen, defective and ashamed. As adults they keep seeing themselves through the eyes of the people who have hurt them and tend to treat themselves in the same way they were treated as children.
In this workshop, participants will learn practical EMDR tools to work with the effects of early attachment disruptions, shame and neglect, including feeling invisible, avoidance, distrust, and lack of self-acceptance. As therapists, modeling a new way for clients to learn look at themselves through empathy and compassion becomes crucial.
- Identify and identify internalized toxic messages and how the show up in therapy
- Recognize diverse difficulties with positive affect, including dysfunctional positive affect and how to work with it
- Distinguish at least 4 complicated issues around severe neglect and invisibility
Presenter Bio :
Dolores Mosquera, is a psychologist and psychotherapist specializing in severe and complex trauma, personality disorders, and dissociation. She is an accredited EMDR Europe Trainer and supervisor. Dolores is the director of the Institute for the Study of Trauma and Personality Disorders (INTRA-TP) in A Coruña, Spain—a 3-clinic private institution initially founded in 2000. She collaborates with two different gender violence programs, one focused on gender violence victims and the other on males with violent behavior towards their partners. She belongs to the Spanish National Network for the Assistance of Victims of Terrorism, and also collaborates with an organization aiding victims of emergencies, accidents, violent attacks, kidnapping and other traumatic incidents. She is a member of the editorial board of the European Journal of Trauma and Dissociation, a member of the Journal of EMDR Practice and Research, and the co-editor of the European Society for the Study of Trauma and Dissociation´s Newsletter.
Dolores has extensive teaching experience leading seminars, workshops, and lectures internationally. She has participated as a guest speaker in numerous conferences and workshops throughout Europe, Asia, Australia, and North, Central, and South America. She has published 16 books and numerous articles on personality disorders, complex trauma, and dissociation, and is a recognized expert in this field. She also teaches in several universities, and collaborates supervising clinical psychologists in postgraduate training programs in Spain. She received the David Servan-Schreiber award for outstanding contributions to the EMDR (Eye Movement Desensitization and Processing) field in 2017, and was made Fellow of the International Society for the Study of Trauma and Dissociation in 2018, for her important contributions to the trauma and dissociation field.
Module 3: Dealing with Attachment Issues and Advanced Strategies to Work with EMDR on Anorexia and Eating Disorders. – February 1 , 2019 from 9 am to 11 am
The comprehension of the attachment’s dynamics, from the adaptive information processing perspective, it is a necessary starting point to shed light on the complexity of the patient and the mechanisms resulting in the ego-states defense formation. This workshop will focus on treatment strategies for complex clinical population and in particularly on eating disorders. Eating disorders pathology is a greater challenge at all stages of the therapeutic process, in which a very focused conceptualization on the attachment history and the ego-states work play a crucial role especially for getting the most effective results with EMDR therapy.
Through videos of clinical cases, participants will learn strategies to recognize and understand attachment issues in the patient’s life and consequently develop a more effective case conceptualization and a more complete treatment plan with EMDR. Participants will also comprehend how to identify, validate and work with ego-states, focusing on the fundamental role that such ego-states defenses play in the stuck points during the therapeutic process. Clinical case videos will illustrate interventions and modalities to successfully manage some of these defenses strategies (like avoidance, blame, shame, mistrust, phobia).
- Identify how to deal with complex cases (e.g. eating disorders) in the light of attachment issues and parts work.
- Distinguish how to identify, comprehend and work with the different patient’s parts.
- Identify new strategies to overcome blocks during the reprocessing of traumatic memories
Maria Zaccagnino, PhD is a psychologist and psychotherapist, and EMDR Europe Consultant and Facilitator. She is the director of Center of EMDR Therapy for Eating Disorders in Milan with Isabel Fernandez. She has done Post-Doctoral program in Clinical Psychology at the University of Turin, where she is Honorary Fellowship in Clinical Psychology, and is Senior Researcher at Italian Swiss University of Lugano, her research topics mainly concern the study of the dynamics of family relationships and, in particular, mother-child interactions in the light of Attachment Theory. Her main publications are in the area of developmental psychology. She has collaborated also with the University College of London (prof. M. Target), the University of Manchester (prof. J. Green) and the University of Austin, Texas (prof. D. Jacobvitz). She has extensive teaching experience, leading seminars, workshops and lectures throughout Italy and Europe conferences. She has published 3 books and many articles on attachment, parenting, eating disorders, complex cases and dissociation.
Module 4: EMDR Therapy for Complex PTSD: An Integrative Approach to Treating Clients with Chronic, Repeated, and/or Developmental Trauma – February 1, 12 pm to 2 pm
Many mental health practitioners are trained in the treatment of single traumatic events. However, clients with complex PTSD (C-PTSD) come to therapy with an extensive history of trauma that often begins in childhood and continues into adulthood with layers of personal, relational, societal, or cultural, losses.
The most common question asked by EMDR Therapy clinicians treating C-PTSD is, “where do I start?” In this training, you will develop confidence in your ability to successfully organize and prioritize your client’s treatment goals. Successful treatment requires a compassionate therapeutic relationship and effective, research-based interventions. You will learn how to effectively work with clients who have experienced multiple traumatic events and prolonged trauma exposure. You will learn valuable leading-edge strategies that will allow you to successfully address dysregulated affect and arousal. You will come away with resourcing techniques drawn from relational psychotherapy, DBT, EMDR Therapy, Parts Work Therapy, Somatic Psychology, and mind-body therapies. We will discuss modified protocols from EMDR Therapy for desensitization and reprocessing.
- Identify contributing factors to the development of Complex PTSD and explore how Complex PTSD impacts the cognitive, emotional, and physical health of the client.
- Recognize differential diagnosis of Complex PTSD as related other diagnoses such as personality disorders, mood disorders, anxiety disorders, and dissociative disorders and describe the tri-phasic model of complex trauma treatment as related to EMDR Therapy
- Differentiate and identify two modified protocol options for clients with dissociative symptoms of C-PTSD
Arielle Schwartz, PhD is a licensed clinical psychologist, EMDR Therapy consultant, and certified yoga instructor with a private practice in Boulder, Colorado. She earned her Doctorate in Clinical Psychology at Fielding Graduate University and holds a Master’s degree in Somatic Psychology through Naropa University. She is the author of two books The Complex PTSD Workbook: A Mind-Body Approach to Emotional Control and Becoming Whole (Althea Press, 2016), EMDR Therapy and Somatic Psychology: Interventions to Enhance Embodiment in Trauma Treatment (W. W. Norton, 2018), and The Post Traumatic Growth Guidebook (Pesi Publishing, in press). She offers Trainings and Workshops on topics of EMDR Therapy, Somatic Psychology, C-PTSD, and Chronic Pain. She is dedicated to offering informational mental health and wellness updates through her writing, public speaking, social media presence, and blog.
Module 5: Yoga, Mindfulness, and the Expressive Arts in Phase 2 Preparation: Imperatives for Working with Complex Trauma and Dissociation – February 7, 9 am to 11 am AZ time
When treating complex trauma and dissociation with EMDR therapy, one “Calm Safe Place” exercise is insufficient in Phase 2 preparation. In this presentation, EMDR therapy trainer, expressive arts therapist, and yoga/mindfulness teacher Dr. Jamie Marich makes a case for how strategies from yoga, mindfulness, and expressive arts therapy can enhance Phase 2 preparation. Marich explains how Phase 2 must not only work with containment and retreat. Teaching clients how to tolerate distress, practice awareness, and get used to questions like what are you noticing now is imperative in Phase 2 for working in the phases to come; especially in addressing complex trauma and dissociation. Participants will obtain at least five skills that they can immediately use in EMDR Phase 2 preparation, which can automatically link to Phase 7 closure and in-between session care. Participants will also gain awareness on how they can expand their skill set and training in these areas to enhance their effectiveness as EMDR therapists.
- Explain why one “Calm Safe Place” exercise is insufficient in working with complex trauma and dissociation in EMDR therapy and discuss how skills from yoga, mindfulness, and the expressive arts can assist EMDR therapists in providing more comprehensive preparation in Phase 2
- Apply at least five skills from yoga, mindfulness, and expressive arts therapy into EMDR therapy preparation (Phase 2) and EMDR therapy closure (Phase 7)
- Distinguish how skills from yoga, mindfulness, and the expressive arts can assist clients in more effectively handling the reprocessing phases of EMDR therapy
Presenter Bio: Jamie Marich, Ph.D., LPCC-S, LICDC-CS, REAT, RYT-200
Dr. Jamie Marich describes herself as a facilitator of transformative experiences. A clinical trauma specialist, expressive artist, writer, yogini, performer, short filmmaker, Reiki master, and recovery advocate, she unites all of these elements in her mission to inspire healing in others. She began her career as a humanitarian aid worker in Bosnia-Hercegovina from 2000-2003, primarily teaching English and music while freelancing with other projects. Jamie travels internationally teaching on topics related to trauma, EMDR therapy, expressive arts, mindfulness, and yoga, while maintaining a private practice in her home base of Warren, OH. Marich is the founder of the Institute for Creative Mindfulness and the developer of the Dancing Mindfulness practice to expressive arts therapy. She is also the co-creator of the Yoga Unchained approach to trauma-informed yoga. Marich is the author of EMDR Made Simple: 4 Approaches for Using EMDR with Every Client (2011), Trauma and the Twelve Steps: A Complete Guide for Recovery Enhancement (2012), Creative Mindfulness (2013), Trauma Made Simple: Competencies in Assessment, Treatment, and Working with Survivors, and Dancing Mindfulness: A Creative Path to Healing and Transformation (2015). Marich co-authored EMDR Therapy & Mindfulness for Trauma-Focused Care along with colleague Dr. Stephen Dansiger, which was released with Springer Publishing in 2017. Her newest title, Process Not Perfection: Expressive Arts Solutions for Trauma Recovery, released in April 2019. North Atlantic Books is publishing a second and expanded edition of Trauma and the 12 Steps, due for release in the Summer of 2020. Marich’s writing and work on Dancing Mindfulness was featured in the New York Times in 2017. In 2015, she had the privilege of delivering a TEDx talk on trauma. NALGAP: The Association of Gay, Lesbian, Bisexual, Transgender Addiction Professionals and Their Allies awarded Jamie with their esteemed President’s Award in 2015 for her work as an LGBT advocate. The EMDR International Association (EMDRIA) granted Jamie the 2019 Advocacy in EMDR Award for her using her public platform in media and in the addiction field to advance awareness about EMDR therapy and to reduce stigma around mental health.
Module 6: The Utilization of EMDR with Complex Trauma and Dissociative Symptoms – February 7, 12 pm to 2 pm
It is essential that therapists are informed about dissociation including therapists working with EMDR. The theory of structural dissociation of the personality (TDSP) postulates that chronic trauma (e.g. abuse or neglect), can result in a division of the personality into parts. One type involves parts of the personality (ANP), primarily mediated by daily life action or motivational systems. The other type involves emotional parts (EP), primarily mediated by the defensive action or attachment cry system, that contain the individual’s traumatic memories. The more complex and chronic the traumatization, the more complex also the structural dissociation, manifesting in the development of more EPs and ANPs respectively.
The workshop will describe the nature of structural dissociation and discuss a practical and theoretically sound phase-oriented approach to treating the “whole” client while dealing effectively with dissociative parts. How to integrate EMDR therapy will be introduced, including approaches for stabilization and modifications of the standard EMDR protocol for effective memory processing and safe processing.
- Explain the Theory of Structural Dissociation of the Personality
- Apply stabilization methods that can help stabilize parts of the personality.
- Explain how to modify the standard EMDR protocol when there are significant dissociative symptoms.
Dr. Roger Solomon is a psychologist specializing in the areas of trauma and grief. He has been on the Senior Faculty with the EMDR Institute since 1993 and teaches EMDR internationally. He is a consultant with the US Senate, and has provided services to numerous government agencies, including the FBI, Secret Service, and Polizia di Stato in Italy, and many law enforcement agencies. He has been collaborating with Onno Van der Hart for over 15 years, and is part of a team that has published 3 articles on complex trauma and EMDR therapy. Dr. Solomon also teaches “The Art of EMDR therapy” which focuses on the relational aspects of EMDR therapy (the dance of attunement between client and therapist as expressed thorough bilateral stimulation) and working with complex trauma.
Module 7: The Cultural Component in Complex Trauma: Spotting and Treating Internalized Oppression – February 8th, 9 am to 11 am AZ time
Although there is far greater evidence that cultural marginalization and discrimination can lead to a similar if not worse fate than high scores on the ACE scale, many trauma-informed therapists feel ill equipped to address social identity and cultural considerations. The scope of complex trauma needs to include awareness of the often “unspoken” client histories of cultural adversity across a range of severity including social exclusion and stigmatization, discrimination and oppression (the many “isms”), refugee and acculturation challenges, and ongoing micro-aggressions. The internalized impact of these experiences can be embedded in struggles with self-worth, safety, power, and a sense of belonging and will persist and impede healing if they remain invisible and ignored. This presentation seeks to bring understanding and practical suggestions for assisting clients in self-discovery and healing from cultural wounds. Implications for therapist-client working alliances, assessment and case formulation, resourcing, treatment priorities and target selection will be discussed with multiple clinical examples. EMDR therapy can provide a uniquely empowering and transformative experiences for clients in this area, if we give it a chance.
- Summarize clinical examples of the internalized impact of discrimination/stigmatization/oppression
- Explain how to Integrate cultural considerations into assessment and case formulation
- Recognize how to Select appropriate targets and protocols for treating the internalized impact of discrimination/stigmatization/oppression
Module 8: The Introject Decathexis (ID) Protocol: An Integrative EMDR Therapy Approach to ‘De-fanging’ Perpetrator-Imitating Self-States – February 8th, 12 pm to 2 pm AZ time
The EMDR therapy and complex trauma-dissociative disorders literatures have established that ego state interventions can be both helpful and frequently necessary to achieve stabilization/containment, trauma resolution, and integration of treatment gains.
With limited exceptions, established interventions focus on perpetrator-imitating parts to 1) orient them to present realities; 2) persuade them to ‘stand down’ or reconsider how they protect; 3) and, help other parts feel less afraid of them. The exceptions involve either hypnotically induced abreactions; reducing the charge of negative beliefs; or, limiting partially-dissociated intrusions into conscious awareness. Most, if not all, of these interventions present conceptual and/or practical issues, however, making it difficult to achieve or maintain treatment gains with some clients.
In this presentation, we will look at the development of perpetrator-imitating parts and the functions they can serve within, and the impact they can have upon, the self-system, as well as discuss the existing approaches to working with them.
We will then examine a novel, yet highly effective and safe, integrative approach developed by the presenter to permanently ‘de-fang’ perpetrator-identifying parts. The protocol itself will be described through case examples, which will provide the context for discussing the treatment frame and necessary preparatory tasks and precautions for its safe use.
- Identify the phenomenon of introjective identification and name three existing approaches to working with perpetrator-imitating self-states
- Identify two reasons for mapping a client’s self-system early in treatment and identify at least two precautions for employing the Introject Decathexis protocol.
- Recognize the specific components of the Introject Decathexis protocol.
D. Michael Coy, MA, LICSW, is a Seattle-based therapist whose focus in the integrative treatment of persons who have struggled with the effects of pre-verbal and attachment trauma, addictions/compulsions, and complex trauma and dissociative disorders. Michael is an EMDRIA Approved Consultant, has intermediate training in clinical hypnosis through ASCH, and is Level I trained in Sensorimotor Psychotherapy. He served on the Standards & Training committee of the EMDR International Association from 2014 to 2017. Michael began collaborating with co-presenter Jennifer Madere and Multidimensional Inventory of Dissociation developer Paul F. Dell, PhD, in 2016 to overhaul the MID Analysis and MID Manual. Since 2017, he has presented on the MID extensively, both on his own and in collaboration with Ms. Madere, within and outside the US. Michael offers individual and group consultation both on the MID and more generally on working with clients with complex trauma histories and dissociative features. He is currently working with Ms. Madere to complete MID Analysis v5.0 and a third edition of the MID Interpretive Manual.
Michael currently serves as Treasurer, and in 2019 was named a Fellow, of the International Society for the Study of Trauma and Dissociation (ISSTD). Since 2017, he has co-chaired a task group developing ISSTD’s own, home-grown EMDR ‘basic’ training. Michael is slated to present an expanded version of his presentation on working with introjects at ISSTD’s 2020 Annual Conference in San Francisco, California.
Module 9: EMDR and emotional processing: Working with severely dysregulated patients – February 9th, 9 am to 11 am AZ time
EMDR is being used in a wide range of psychopathological conditions beyond simple PTSD. Complex traumatization and the presence of dissociative symptoms have been related with difficulties applying standard protocol, and with the need of modifications in therapeutic procedures. This workshop will be oriented to understand the role of other two factors: (1) The influence of severe emotion dysregulation in EMDR treatment, and (2) The specific aspects to have in mind when we are working with EMDR in severe mental disorders, where biological factors are relevant to understand patients’ problems.
Emotion dysregulation is a frequent feature in trauma-related disorders. Different kinds of regulation problems seem to be linked to particular psychiatric conditions, and there is growing evidence of the association between neurobiological correlates and those dysregulation patterns. Nevertheless, many of the recent findings from the field of the neurobiology have not been translated into clinical practice and are insufficiently contemplated in trauma-oriented therapies. The aim of this presentation is to review recent developments in the field of emotion regulation, connecting these issues with the practical implementation of psychotherapeutic procedures in complex cases. The evaluation of emotion dysregulation patterns can guide decision making during the therapy independently to the approach, but there are some findings that can be especially useful for some concrete modalities of therapy. In this presentation I will focus on how emotion dysregulation may influence eye movement desensitization and reprocessing (EMDR) treatment in trauma-related disorders. Different patterns of emotion dysregulation may influence EMDR treatment and procedures, and the application of EMDR beyond non-dissociative PTSD should take into account the predominant emotion-regulation strategies in each patient.
Different clinical cases will be presented to illustrate the theoretical concepts and to describe a decision-making having into account the specific emotion regulation problems that each patient presents.
- Recognize a comprehensive perspective on emotion dysregulation in trauma-related disorders
- Identify how factors related to emotion regulation may disrupt EMDR reprocessing
- Apply specific tools to EMDR procedures in severely dysregulated patients
Anabel Gonzalez, MD. PhD. is psychiatrist and psychotherapist, trained in various orientations as Group Therapy, Cognitive Analytic Therapy, Systemic Therapy and trauma-oriented therapies. PhD in Medicine and specialist in Criminology. She belongs to the Board of the European Society for Trauma and Dissociation (ESTD) and is Vice President in the EMDR Spanish Association. He works at the University Hospital of A Coruña (CHUAC), coordinating the Trauma and Dissociation Program, oriented to patients with severe traumatization. Is an active docent, giving training on dissociative disorders, trauma, attachment and emotional regulation. She is accredited consultant and trainer of EMDR therapy. Is teaching collaborator in her hospital, where she coordinates the training in psychotherapy of the residents in psychiatry. She participates as a guest lecturer in the Master of EMDR Therapy in the Universidad Nacional de Educación a Distancia (UNED). At the level of research, she directs several projects in the field of trauma and dissociation and the treatment with EMDR for various disorders. He has published numerous articles on dissociation, trauma and EMDR, and is author/co-author of the books: Dissociative Disorders, Dissociative Identity Disorder, EMDR and Dissociation, the Progressive Approach, and EMDR and BPD. Her last books are I am not myself: Understanding Complex Trauma, Attachment and Dissociation. A Guide for Patients and Therapists and EMDR and Emotional Processing.
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