8.10.1 Preparation
The best way to deal with countertransference is to become aware of it before it interferes with the work. Clinicians’ being fully prepared for seeing the client, experiencing his or her personality, and hearing his or her issues goes a long way toward preventing our own old, unfinished memories from getting triggered. As I get ready for a client session, I begin by taking out the client’s chart and reviewing my notes. I take the time to scan my body, notic- ing my feelings and beliefs in the moment about my client and about myself. I remember how our past sessions have flowed, and I think about what opportunities and problems may arise. I also picture my client and notice my feeling state and any negative self-referencing beliefs that may come up.
I am acutely aware of my inner reactions to my various clients. These range from feeling like I am welcoming an old friend for tea to experiencing anticipatory empathy or a sense of purpose. (EMDR strikes a rich chord in me because Shapiro’s mission is to end the cycle of violence. Practicing EMDR is my way of joining with like-minded colleagues to help heal our traumatized planet.) There are darker moments I may face as I prepare to see a client. Sometimes I experience myself as “not getting it,” meaning that I feel I have lost my sense of collaborative communication with the client. When I notice this, I ask myself: What I am missing? Am I triggered by something that happened in the last session or in recent sessions? Is there something about my client that I do not like? If so, where is that coming from?
When I picture my client and use elements of the procedural steps out- line, I am often surprised to feel a surge of anxiety in my chest and abdo- men. I take this as evidence of my own negative self-referencing beliefs. My usual ones are the garden-variety negative beliefs many of us hold. For instance, the negative cognitions I most commonly discern are I am
inadequate, I am a faker, and I am incompetent. When this occurs, I usually
headphones and do some audio processing. Often this will quickly clear the issue for me, and I can decide whether this work was sufficient to put me back on track with my client or whether I need to seek consultation from a trusted colleague. (Clinicians — of whatever school — who have not done at least five years of their own growth work would be well advised not even to try to do any work like this on themselves, by them- selves. I have been doing my own growth work for some 35 years.)
One of two major events usually occurs when I do this. I may discover something in the way I am experiencing my client that was triggered by previous patterns of dysfunctional interactions I have had. This discovery may lead me to realize that I am not “getting it.” Suppose I am working with a hypoaroused client who does not seem to get triggered into any kind of state-dependent memory and just shuts down. In this case, I may discover that I have been feeling frustrated but am unable to recognize my part in this process.
One option I have is to educate myself. I may consult some of my text- books or call a colleague for a consultation. For me, new learning is always welcome, especially when it sheds light on something I must be missing. At other times, I may find that there is an underlying theme in the “flow of states” between myself and my client. This information may be helpful in my understanding the deeper issues embedded in the client’s verbal and nonverbal messages. The questions for me are then twofold: Why was I missing this message? And what old issues have come up for me that my body knows, but my consciousness does not? When an old issue has come up, I mentally review a piece of the client’s previous processing session and determine what may be activating me. Sometimes the client has inadvert- ently stimulated some of my “old stuff.”
Other times I discover my client has been reacting transferentially, implicitly trying to get my attention, but I was not cognitively aware of it. My body usually gives me clues. When I think about a client’s problems and the way I am dealing with them, I may find myself having similar problems. Again, I view these occurrences as opportunities for me to grow rather than as evidence of any psychopathology.
Here is an example of how I helped a consultee work with his process. He had been working with Walter, and Walter had been displeased that my consultee would not immediately begin trauma processing. He had let Walter have his way, and the result was that Walter went to the hospital with chest pains. My consultee’s first memory had the following components:
Picture: Walter looking unhappy when I initially said that I would not start active trauma processing
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Emotion: shame Body: abdomen
Having triggered him, I have him erase Walter’s image and just medi- tate on “I’m defective” and the feeling of shame, with auditory processing. He told me a story: “I relate back to when a popular kid wanted me to push some gum he had put on top of a kid’s hair in the movies. The kid was in front of me. I couldn’t do it, and ‘earned’ the scorn of the popular kid.” My consultee learned a valuable lesson that day (and survived being traumatized by causing Walter to go to the hospital with chest pains).
I want to reiterate that I do not recommend clinicians attempt the self-stimulation that I do unless they have already done years of their own work. Younger clinicians or those going through a rough time in their lives would do better to work with consultation groups of other EMDR clini- cians who have proven their worth as friends and colleagues.
8.10.2 Compartmentalization
When I find myself triggered by anything during a session in a way that interferes with the flow of states of mind between my client and me, I fol- low a series of internal steps in the moment to return to a state of cen- teredness. (This countertransference often takes place during the Phase 4 work of desensitization.) I offer these steps as a guide rather than a hard and fast set of rules. I call the technique compartmentalization.
For an example, suppose my client is angry with me for not showing enough concern for him. I listen as nonjudgmentally as possible. I make an intervention, but the client refuses my interventions and stays in a hyperaroused state. This triggers my defectiveness schemas.
I notice a discomforting sense of arousal in my body, and I experience an internal interruption in the flow of collaborative communication. I am acutely aware that I need to determine whether my being triggered appears to have interrupted the client’s work. If so, the following strategy is not appropriate; instead, a relational interweave is called for (see Chapter 9).
First, I take a cleansing breath and bring to mind of one of my safe places or consult my inner coaches and guides, asking them for advice. I feel the comfort of my safe place or listen to what my coaches and guides have to say.
Next, I press my left big toe into the floor, then my right big toe, simul- taneously keeping in mind the words of my guides or my feeling of com- fort. The toe pressing simulates tapping. I have found that using bilateral stimulation at this point centers me and returns me fully to the present.
I take note of what triggered me, and I work on it after the session is over, using techniques similar to those I use in preparing for a session.
Then I record what happened in my psychotherapy notes, and I review the client’s chart, problems, flow of progress, and fixation points.
Here is an actual example of a session where I used the compartmental- ization process. Dick is a 56-year-old divorced man who works as an accountant. He came to me for EMDR treatment on his old issues of having been verbally abused. His current-day referent was the legal separa- tion procured by his wife, Lynn, which left no room for negotiation. After 20 years of marriage, she had had enough of his verbal abuse of her and their 18-year-old daughter.
Dick’s approach to treatment was similar to his approach to most issues in his life. He was impatient, wanting me to “move my fingers” and make the pain go away. He started off rather intensely and expressed feelings of disappointment and anger when I informed him of the multiphasic nature of EMDR work. Although he seemed to tolerate the boundary for the first two sessions (while I gathered history, developed a case conceptualization, and prepared him for processing), he remained fixated on the belief that once again he was going to “get screwed.” (I did not do a good enough job in developing the collaborative alliance; he gave it lip service, but that was all.) Up to this point, I had experienced myself as feeling challenged but not triggered. Dick got through the Safe Place exercise, though with some difficulty. His DES score was low (an 8). I finished prepping him, and we started Phase 3 work in the next session.
Dick had trouble with the idea of the two nows. His verbiage and left-brain thinking interfered with his entry into state-dependent memory. He was the youngest of five children and had always perceived himself as “getting the short end of the stick.” Now, as we were about to start active trauma work, he flinched and started accusing me of making this process too confusing for him. He said, “You therapists just want to make the pro- cess longer so you can get more money out of us.” At this point I felt a tightening in my gut, and I noticed that my patience was wearing thin. I had the impulse to strike out verbally at him.
I consulted my inner coaches Don and Elizabeth, who told me to calm down and just notice what old memories might be getting triggered in me. I could not come up with anything in the moment, so Elizabeth sug- gested that I imagine myself at Kripalu, a place that Elizabeth, Don, and I visit frequently and where I experience a sense of spirituality and peace. I have learned to use EMDR Safe Place and RDI strategies on myself, and I apply them even when I am in session. My self-cuing word is “mountains.”
Once I activated my resources, I found myself calming down and was able to bring my sense of calm spirituality back with me into the consulting
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room, and to separate the past from the present. This is the compartmen- talization part.
Finding myself back in a state of attunement, I then asked Dick to notice if he had any old memories connected to getting “screwed” (his word). Up came a memory of when he was 7 and he was denied the chance to do something with his siblings at a resort because he was too young and frail to take part. With this awareness, he was able to return to a co-regu- lated relationship with me where collaborative communication resumed. He productively processed this memory. With this first protocol under our belts, our relationship strengthened, and Dick was able to continue doing his work.
After the session, I went back to the tightening in my gut. As I let my awareness wash over me, I noticed that the words He’s being unfair to me came up. I asked myself, “Mark, when you hear the words He’s being unfair
to me, what negative self-referencing beliefs do you hold about yourself?”
The words I am a failure came up. I then linked those words with the pic- ture of Dick and with the tightened sensation in my gut. I realized that I had dissociated shame attached to this episode. Using floatback, I came upon a state-dependent memory of an old trauma with my father, who at times was quite demanding. In this case, I was able to do my own work and become re-centered.
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