CBT | Attachment focused EMDR
Attachment focused EMDR (AF-EMDR) is a variant of Eye Movement Desensitisation and Reprocessing (EMDR) which adapts the standard EMDR model to help with current psychological problems which may have their origins in traumatic events experienced in early childhood. These problems include CPTSD, PTSD, Low self Esteem, Anxiety Disorders and Depression.
Attachment focused EMDR was developed by Laurel Parnell and, while using the main mechanisms of EMDR such as bilateral stimulation, dual attention and adaptive information processing, it also incorporates a great deal of resource development which helps people with traumatic childhoods feel safe in working with distressing memories.
Not everyone who has had a traumatic childhood feels safe in entering therapy. This article will show you just what to expect from Attachment-Focused EMDR Therapy so that, when you feel ready to enter therapy, you know what to expect.
We offer Attachment-Focused EMDR from our clinic in Liverpool and online.
How is Attachment-Focused EMDR different to standard EMDR?
EMDR is a type of psychotherapy that uses the brain’s natural healing processes to alleviate the symptoms of Post-traumatic stress disorder (PTSD) and other trauma-related problems. A key feature of EMDR is bilateral stimulation. This is the process in which eye movements, hand taps or sounds are used to stimulate the left and right sides of the brain while the traumatic events are active in the client’s mind. EMDR uses this process to make the trauma memories less distressing and enable the brain to think about them in different, less threatening ways.
When the distress associated with painful memories has been successfully reduced, current and potential future problems influenced by the memories are then resolved using further processing and resource building. In a nutshell, EMDR seeks to remove the barriers to normal current functioning by alleviating the pain from the past. It’s excellent at doing this.
Attachment-Focused EMDR works in a very similar way. Just like standard EMDR, Attachment-Focused EMDR works on difficult, distressing memories using bilateral stimulation. In AF-EMDR, however, the focus can be more on memories that occurred much earlier in life and which serve as feeder memories to later PTSD, CPTSD and other problems later in life.
Attachment-Focused EMDR is informed by Attachment theory. Attachment theory was initially proposed by John Bowlby and later developed further by his colleague Mary Ainsworth, and looks at how early relationships with our closest caregivers contribute to our experience of the world, our emotional development and our interactions with others.
A secure relationship with a caregiver can lead to the child developing an internal model about themselves and the world which contributes to a greater ability to feel safe – “My mother is there when I need her, I’m ok.” When the relationship is less secure, then the child may struggle to feel safe and, as a result, exhibit anxious, avoidant or other behaviours.
Take a look at this video which shows how Mary Ainsworth studied early attachment through the famous Strange Situation Experiment.
Attachment theory suggests that a child develops within a stable relationship with its primary caregiver – typically the mother. If attachment is interrupted in some way, then the child will develop various strategies as a way of coping.
Now let’s say that the mother has a problem which leads to her own emotional distress – e.g., mental health problems, addiction, relationship problems. The child still needs the mother.
In fact, on an evolutionary basis, the child has hardwired systems, including internalising their own role in the mothers welfare (“I’m responsible.”) which requires them themselves to be available to and protect the mother. Because of this, they may manage their own distress by dissociating it in some way from themselves – their distress is actually partitioned into another part of their “psyche.”
The barrier between the child’s “normal” part and their now dissociated partition takes the form of the behaviour or strategy that people may sometimes view as unhelpful.
So unhelpful behaviours we take into adulthood – emotional distance, aggression, avoidance, substance use, eating too much – may have served a purpose for us in childhood in stopping our emotional part becoming too problematic for our caregiver, which would have led to further problems for us.
This diagram shows how behaviours (defences) serve to keep the emotional part separate from the “apparently normal part” that the child needs to show to get by in childhood. This is called “primary dissociation.”
How does Attachment Focused EMDR work?
If we work from the premise above – traumatic events experienced early in childhood dissociate from the “normal self” and are shielded by behavioural strategies – Then we can hypothesise that a therapy that allows us to “speak to” and heal the dissociated parts would lead to a reduction in distress and unhelpful current behaviours. This is exactly what attachment focused EMDR sets out to do.
One of the strengths of EMDR as a trauma focused treatment is, through it’s “assessment phase”, it’s ability to “light up” and activate a vivid, meaningful and emotional memory to work on. AF-EMDR is no different, however, because of the nature of the memories that we will be working on – i.e., events that happened in childhood – particular attention needs to be paid to the level of resource building required to take place before any processing of the trauma memory begins.
Significantly, because the memory is based in earlier experiences, it has often not yet been given the opportunity to be contextualised by later developed verbal and narrative parts of the adult brain. This means that in essence, despite working with adults, we are actually communicating with child parts of the brain.
Let’s look at the ways in which resource building, or more commonly called “Tapping in”, takes place in AF-EMDR
“Tapping in” resources
Preparation is an essential part of the standard EMDR process, and is an integral part of other trauma focused treatments too. Typically, the EMDR preparation process is about developing resources for use in the desensitisation phase of treatment and can take the form of internal, imaginal strategies such as the safe place, container exercise or lightstream technique or they can be external such as utilising behavioural activation or problem solving strategies. The key idea is that we are developing the internal and external resources so that the client feels prepared and ready to tackle what ever memory targets are needed.
AF-EMDR is no different. The slightly less clinical term, “Tapping in” refers the preparatory phase of AF-EMDR and a key approach is identifying and tapping in people or resources into our minds which can be available when we need them. We identify one or more Compassionate or caring resources, another set of resources which are Strong and Protective and a third which we view as being wise and knowledgeable. These resources can be real things or people such as using the Dalai Lama as a Wise resource or a Lion as being strong or protective.
What we’re doing when we tap in resources is creating a set of readily available “interweaves” – sets of images and associations which activate emotional and physiological states which enable us to get through the processing of distressing memories without feeling the need to stop. If we reach a particularly distressing point in a memory which causes a high level of emotion, or if we just reach a point where the processing seems to drop off, we can quickly say, “what would your protective team member say right now?” or “your wise figure steps forward – what would they want you to know that would help you right now?”
This is in many ways similar to current Cognitive Behavioural therapy trends which use things like Imagery rescripting and compassion focused imagery to update and ease distressing memories. These work because memory is reconstructive rather than reproductive which means that, rather than having a single snapshot or video stored away in our minds that always gets activated when we remember an event, we get a reproductive representation. This means that we get a new, reconstructed version if the event, which combines elements of old content with new, contextual information. By using Imagery rescripting in CBT or Cognitive Interweaves in EMDR, we are adding helpful context and content to the reconstruction of the memory meaning that when we remember it again it is less distressing and causes us fewer problems.
Bridging to the trauma memory
Once we have tapped in our resources, we need to decide what memory that we want to target. EMDR takes a three-pronged approach to helping with problems – Past, Present and future. We aim to resolve current problems, and reduce sensitivity to future ones by processing blocked and unprocessed memories from the past.
To identify the early memory we need to focus upon we initially need to do a “bridge.” This has different names in other strands of EMDR – it can sometimes be called a “floatback” or an “affect bridge.” The Bridge is a technique in which we invite our minds to literally bridge to an earlier time in our lives when we experienced an emotion similar to the one that is causing us our problem now.
So for instance, lets say that I have a problem in which I experience intense anxiety whenever I have to attend meetings at work. In AF-EMDR we would activate a recent memory of this problem. We would bring up an image of the event, the emotion that we felt and the negative thought or belief that I have about myself when the memory is there. We then say…
“I’d like you to allow your mind to float back to an earlier time when you felt this way. Allow your mind to go as far as it can go, without censoring it…Notice what comes up.”
The bridge usually results in us coming across an earlier memory of an event in which we experienced the same emotion. Sometimes, the result might be something quite unexpected like an event that seemed insignificant or was forgotten about. Whatever comes up however, this is typically the memory we will focus on.
Processing the trauma memory
Once we have identified our trauma memory, Attachment focused EMDR then uses the staple of EMDR processing – Bilateral Stimulation – to activate the brain’s natural healing capacity and alleviate the distress.
While doing this process, just like in normal EMDR, new thoughts, memories and sensations arise, some seemingly related, some less so. We don’t seek to interpret these experiences as right or wrong, good or bad in EMDR. We just let them happen. This is all part of the healing.
Here you your brain is making new connections, dissolving the blocked traumatic memory and integrating it with more up-to-date knowledge that you have about yourself, the world and your experiences. We repeat this process, returning to the target memory when appropriate, until your distress has reduced to a minimal level.
If appropriate at this time, we then return to the current problem and assess how much distress you now experience in relation to it and whether you are able to fully believe a positive, balanced cognition in relation to it.
The process gets repeated until your distress is reduced and your treatment goals have been achieved.
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