Transcript Generic cognitive interweaves

EMDR with Difficult Clients:
Dyadic Resourcing
Philip Manfield, Ph.D.
(www.philipmanfield.com)
June 13, 2010 Hamburg, Germany
A fresh approach to preparing difficult
clients for processing of early trauma.
Early Trauma
Think of an infant in a crib hearing her
parents fighting in the next room
Clients with very early trauma are the
ones who need resourcing the most
because they flood, dissociate or
defend when they recall early trauma.
Range of Difficult Clients
Generally, the earlier the onset of PTSD,
the deeper the distortions
Already have ready access to adaptive
adult perspective, but not with respect to a
particular traumatic event. (C.I. work well)
 Distorted view of self is general, not N.C.
 Adult perspectives adaptive for other
children, but not self.
 Adult perspectives are distorted
 Distorted view of adults is "rational."

Early Trauma
They are also the ones most
difficult to resource because:
They
have poor access to memories of positive
experiences
Their trauma usually took place over time, so
they associate all early memories eventually with
trauma.
 they keep returning to negative attitudes
towards themselves, even during resourcing.
They view their internal child as bad or defective
They lack an internal caring adult.
When is Elaborate Resourcing
Necessary?
only necessary when C.I. don’t work, which
is usually when the client is unable to view
the child as lovable, no adaptive adult
perspective is readily accessible.
Assess:
 “How do you feel towards that child? Do
you like the child? How would you feel
holding that child?”
 "Can you picture yourself at that age?"
Initial Assumptions for
Clients with Early Trauma

Children need a loving adult before then can
feel lovable
 Clients with attachment deficits need an
internal relationship resource dyad (lovable child
& loving adult)
 Feeling lovable and feeling loving towards
one’s self are both important.
 For successful resourcing, these clients must
avoid accessing their damaged internal child
selves
Dyadic Resourcing
 A resourcing
process that establishes
an internal healthy child and a caring
adult.
Clear boundaries prevent clients from
tainting or contaminating the resource
with negative projections.

Dyadic Resourcing
Overview (Easier Clients)
Identify a loving adult (resource) from the
client’s life experience
 Intensify the Resource; Make it Real
 Focus on that adult loving the client as a
child (dyad)
 Intensify this Resource Dyad
 Create identification with the loving adult

Dyadic Resourcing
Overview (Difficult Clients)

1. Identify a loving adult (resource) real or
fictional.
 2. Intensify the Resource; Make it Real
 3. Focus on a dyad, that adult loving a child
(NOT the client)
 4. Intensify this Resource Dyad
 5. Foster identification with the loved child
 6. Foster identification with the loving adult
1. Identify a Loving Adult
Resource, Real or Fictional
Identify a loving adult (resource)
 Identify positive qualities of that adult.
 Build a positive affective connection
between the client and that adult
 Help the client to connect to her present
experience, which should be pleasurable.

Avoid complex relationships
for initial dyadic resources
Parents
 Spouses
 Siblings
 Offspring
 Jesus or God,
 “Good. Now think of another person who
has had your best interest at heart.”
 short sets

Fictional Resources Are Preferable
for Clients with Early Trauma
The client has normally not been
harmed in any way by them.
 It is easier to avoid merging with them
 They are uncomplicated
 They bypass client’s need for perfection
in a resource
 They are easier for the client to perceive
as internal

Finding Fictional Resources
What's your favorite media, TV movies or
books?
 What's your favorite all time book
(/movie/TV show)?
 What is a character you admire?
 What are that character’s positive traits?
 What is it like for you to picture/think of
him?

2. Make the Resource Real
(Eidetic Psychotherapy)

When the client thinks of the resource
person, we want her to experience a
present “glow.”

“I’m not asking you to remember. I simply
want you to look, and tell me what you
are seeing, even if it’s not consistent with
the facts as you know them.”
3. Focus on a dyad
(Adult loving a child)
Identify or create a child for that
adult to nurture (NOT the client)
 Adjust the child’s age as needed.
 Create a “tableau” of this adult
nurturing this child (involving physical
contact)

The Child Need Not be Real
Does this person have children? What
kind of a mom do you think she is?
 Have you ever seen this person relating to
children?
 Do you imagine he would be a good dad if
he had kids?
 Can you imagine what she might have
been like when her children were
younger?

4. Intensify the Resource
Dyad
Identify positive details involving all senses
 Highlight positive affect whenever it occurs.
 Build a positive affective connection
between the client and the tableau.
 Use visual observation to help maintain
adult observer perspective.

Video (1) Captain Picard
Intensifying a Resource Dyad
Feed the Flame (Tending the fire)
 Add new fuel
 “What’s coming up for you now?” “Focus
on that” BLS As long as the client
continues to report positive experiences or
associations

Feed the Flame
If “Nothing new,” or “Pretty much the same
things,” or a reduction in glow:





All the senses
Adjust the age
Reduce distance
Physical Contact
Locate body
Sensations




Eye contact
(Gratuitous caring)
(Is it difficult?)
Anchor
5.Create identification with
the loved child (“Morphing”)
“Morphing” is a process of helping the client to
assume the identity of the child and the adult in
the resource dyad, while maintaining present
perspective.
 Begin the morphing process only after the
nurturing relationship is firmly established.
This shift is accomplished through small
incremental steps.
If steps are skipped the client often responds,
“How would I know what that feels like? I’ve
never had it.”

Steps in Morphing the Dyad
(child)
1. “What do you think it is like for the child
2. “Imagine what it is like for the child?”
3. "What do you think the child feels in her
body?"
4. “Imagine what she feels in her body.”
5. “How do you think it would be to be this child?”
6. “Imagine being that child?”
“Do you think it’s hard for the adult to love this
child?
“What do you think that child did to deserve all
this love?
Video (2) Morphing (Child)
Dyadic Resourcing
Steps –Transitional Questions
Do
you think it’s difficult for this adult to
love you?
What did you do to deserve all that love?
begin 2nd set of Morphing
questions.
Then
6. Steps in Morphing the
Dyad (adult)
1. “What do you think it is like for the adult
2. “Imagine what it is like for the adult?”
3. "What do you think the adult feels in her
body?"
4. “Imagine what she feels in her body.”
5. “How do you think it would be to be this
adult?”
6. “Imagine being that adult?”
“Now let your attention alternate back and forth
at your own pace between the experience of the
child and the experience of the adult”
Video (3) Morphing (Adult)
Maintaining Present-time Awareness
is a Key to Preventing Contamination
of the Internal Lovable Child
Use a fixed tableau of a caring adultchild interaction to anchor clients in
present time.
 Maintain an adult perspective by
requiring clients to observe visually and
report
 “What is it like for you to see that?”
 Use physical sensation to anchor clients
in present time.

Dyadic Resourcing
Pitfalls
Initially,
prevent the client from becoming
either the adult or the child in the tableau.
Keep the client from associating to
personal history (positive or negative)
 Prevent the client from accessing
disturbing material. (no trauma processing!)
Video (4) Difficult Client
This Client Repeatedly Brings Up
Negative Associations
Fixed tableau of a caring adult-child interaction
has been firmly established.
 Once morphing begins we can no longer rely
on the adult observer role. Always refer to the
child in third person until question #5. “As you
think of the grandfather with the child, …”
 “What is it like for you to think of that?”
 Use physical sensation to anchor client in
present time. (built into Questions 3 and 4)

Video (5) Morphing (Child)
Helping the client identify with the
caring adult deepens the resource
even further
Feeling loveable is very important, and feeling
compassionate and loving towards the internal
child is also extremely important.
 This adult process moves more quickly than
the child process.
 The glow must always be present.
 Often the internal adult and child are
eventually become one.

Video (6) Morphing (Adult)
Dyadic Resourcing
Final Step in Morphing
Final step is to ask the client to alternate
between being the lovable child and the
loving adult.

This question seems to cement the
notion that the client has both of these
pieces of the resource inside him, and
often during this phase the client reports
that the two parts of the dyad become one.

Favorite Utilizations
Besides Standard Cognitive
Interweaves
Imagine
adult spirit in the room, over the
client´s shoulder
Imagine
telling the resource adult about
the trauma
Chapters Available to
Download Free
Chapters 4, 5 and 6 of EMDR Clinical
Skills: Case Conceptualization and Dyadic
Resourcing are available to download free
from:
www.philipmanfield.com

Click
on “Books by Dr. M.” and then click
on the download link.