BST: Introduction The BST protocol has been used safely and effectively in various countries. It can be used to treat oneself or others. While case studies suggest there may be emotional, psychological, and medical-physical benefits from its use, only recently have scientific studies of its efficacy been initiated. Persons who use the protocol for self-use or for treating others accept full responsibility for any effects. The protocol should not be used as a substitute for any psychotherapeutic, medical, or pharmaceutical treatment that has been recommended by professionals. The protocol utilizes eye movements and other bilateral stimulation as well as methods from energy medicine and energy psychology. The bilateral stimulation techniques, in particular eye movements, have been used for hundreds of years as part of South American Toltec shamanic traditions and other Andean energy practices. They have also been described by Donna Eden and Albert Villoldo in their books on energy medicine Readers may find similarities with the early eye movement strategies that John Grinder incorporated into Neurolinguistic Programming (NLP); the Eye Movement Integration Therapy (EMI) approach developed by Danie Beaulieu within the same NLP model; Eye Movement Desensitization and Reprocessing (EMDR) as developed by Francine Shapiro; David Grand’s Brainspotting; and other similar practices.

Several assumptions are made. � To ensure that any emotional experiences during BST use are managed well, persons who practice or teach BST already know and are able to correct energy reversals, teach Heartmath coherence breathing, use Tapas Acupressure Techniques (TAT), and practice and are able to teach at least one example of a meridian-based treatment. A course in BST begins with training in these and other interventions, using as a supplemental training manual the book Innovative practices from the East and West for bodymind health (Hartung, 2012, Singapore: Bodymind Integration Insrtitute). � If BST is used to treat others, the practitioner is trained in and follows relevant ethical and practice codes of the mental health professions.

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� The presenting problem is not purely a reflection of lack of skill or ongoing environmental danger but has roots in the past. BST has been used in various ways:

With persons of all ages To supplement other psychotherapies, including couples and family As direct treatment or as adjunct for medical problems, including allergies In classrooms (applied and educational kinesiology) During emergencies and crises, where follow-up is not feasible To treat family and friends (versus traditional therapy rules) For self-use between or in place of professional treatments In groups To train paraprofessionals as trainers To reduce or eliminate obstacles to performance As a daily psychological and positive energy routine For prevention of problems and to improve physical health, immune

functioning, mental, and intuition In life and leadership coaching Where religious, political, social, and cultural paradigms may render

other psychological treatments or trainings unacceptable As scientifically testable, falsifiable, hypotheses

BST can be explained within varying contexts: philosophical, spiritual, esoteric, scientific, business, medical, psychological, and educational. The format of the BST protocol This protocol is composed of six steps. Scripts that the practitioner can follow are [“bracketed, in quotes, and underlined.”] With time you will paraphrase according to your client’s language and education. The steps, to be detailed next, have to do with (1) preparing for trauma work, (2) demonstrating the BLS, (3) identifying the target, (4) setting up the P.A.S.T., (5) processing the trauma, (6) and closing the session.

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Step ONE. Preparation for the processing of traumatic

memories: account for 8 issues

Note that these 8 issues do not need to be done in any particular sequence; follow the client’s lead

1. Make sure you have a therapy relationship. BST may require additional trust because of the memories and emotions involved. Make sure your client trusts you. Talk about this. It is also recommended that the practitioner be familiar with attachment theory (e.g., the polyvagal model of Porges) and the relevance of attachment for therapy.

2. Give new information so the client can make an informed decision whether to use BST or not. The client needs to know that this therapy is about exploring and resolving the past, not just talking about the present and future. This also might be a time to discuss why bilateral alternating stimulation (BAS) might produce benefit: � Ask yourself: What did you decide to tell your client about BST? Have you ensured that the client knows and uses the alternative strategies of breathing, TAT, Emotional Freedom Technique (EFT), and Heartmath, for example? Have these not been sufficiently helpful and is this why you are introducing BST? � Explain that eye movement techniques have been used by the shamanic and other energy practitioners for hundreds of years (cf Energy Medicine by Donna Eden, and the works of Alberto Villoldo. � Draw a picture of the brain mapping (cf. Luria and others) to show where brain functions are located, and how BST likely involves different locations to connect or integrate memory networks.

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� Mention research that suggests certain eye movements help to retrieve memories, and then to reduce negative feelings we have about those memories (perhaps by producing healing delta brain waves). � Mention the possibility of an “abreaction” during treatment, that is, that the client could feel more intense emotion than usually happens with breathing, TAT, EFT, and coherence; say that you will work slowly and carefully, and that the client will always control the speed and direction of the memory processing; explain this possibility within the context of memory networks, memory retrieval through eye movements, and emotional reduction as a consequence. � Mention that other unusual changes could occur. The image or picture about a past event might become more or less vivid, or even disappear. This is significant if the person for some reason does not want to lose a picture of a memory, such as someone planning to testify in a court of law as an “eye witness.” � For some time the person could have unusual – perhaps disturbing – dreams, as memories are uncovered. Some clients report unusual body feelings with BST.

3. Ask the client to state an initial treatment goal. [Note that all of the tasks in step one can be covered out of sequence, always depending on the client’s readiness and need. Hence, some clients will state their goal immediately, even before you begin discussing BST.] Generally clients are most concerned about a present or very recent past incident. Listen, then invite them to speak of the history of the problem. This prepares the client for later exploration and processing of past memories with BST. Ask the client to measure the goal in some way. If it is a negatively-stated goal (e.g., “I want to feel less anxiety when I …”), ask how much anxiety the person feels now. Most practitioners now use the subjective units of discomfort (SUD) scale from zero to 10, where zero would mean “no anxiety” in this case, and 10 would mean “the most anxiety I could imagine feeling.” If the goal is positively stated, such as “I want to get serious about changing my diet”, ask how much confidence the client feels that s/he will change the diet. Measure it with a positive 0-10 or in percentages from zero to 100 or something similar. (Notice that this goal is not stated behaviorally; we accept it as the first draft. Throughout treatment we will be inviting the client to restate the goal so the client eventually will know if s/he is reaching or has reached the goal.)

4. Take a history.

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The extent and depth of history-taking depends on the client and the presenting issue. In the very least, ask why now? That is, what happened recently that motivated the client to seek help now, and now before or later? Also ask about allergies (as these can worsen during treatment), medical conditions, and other evidence of inadequate positive internal resources or risk factors. Also ask about possible secondary gain factors as these may not be clear until after treatment has begun and the client’s internal and external systems have a chance to comment on the consequences of healing. Different practitioners use different guidelines for gathering and organizing information. The BASIC I.D. acronym from the multimodal approach of Arnold Lazarus is one option:

� behavior (B); at work & play, virtually anything that others can see or hear; during history taking, observe your client’s posture, movement � affect (A); meaning the client’s dominant feelings in daily life � sensations(S); include all the senses and how the client utilizes them � specific images (I), how the client tends to visualize and imagine � cognitions or self-talk I; how the client tends to think about the world � interpersonal issues (I); at work, play, w/ family, friends, colleagues � diet, drugs (D), health, all aspects of biology, chemical use (both legal and not); include fitness, exercise; illnesses

Cover the past, present and future during history taking. Ask what the client has done to try to meet the goal. What did/did not worked? Ask about successes in general as well as failures, the positive and the negative. Ask about present-day skills, plans, and resources – both internal and external. Also ask about ongoing negative triggers caused by unprocessed memories. Whenever possible and necessary, invite the client to revisit the original goal as it will often change throughout treatment.

5. Check for additional risk factors. Certain conditions require caution in the use of BST. Give special attention to: � Some clients are not prepared to handle strong feelings and will need training in affect management or regulation prior to initiating work in the past. Instead of beginning BST bilateral stimulation at first, you and your client might spend time practicing one of the energy therapies such as TAT or a meridian-based approach. Heartmath coherence breathing is also recommended.

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� Check the history for these signs of risk:

� self harm or self mutilation � suicidal or homicidal ideas or plans � threats or risk to others � secondary gain � problems in the person’s environment (e.g. some people will find

themselves in physical danger if they get better and become more assertive) � Check for the possibility of dissociation. If you do not have experience in working with dissociative persons, you should not try to learn while treating someone with BST. In general, it is not proper to learn how to treat dissociation while conducting BST or while using any past-focused treatment. Instead, use the following list to identify persons with dissociation tendencies so that you do not treat them with BST (of course, simply knowing this list does not prepare you to treat dissociative persons):

Does the client have years of psychotherapy with little progress? Multiple diagnoses? Many hospitalizations? Is there depersonalization and/or derealization? Feels bigger or smaller?

Reports surroundings do not look the same? Experiences “floating” alongside or above the body? Daily environment seems dream-like, or as if s/he is walking in a fog.

Memory lapses? Does not recall how s/he got to the mall? Finds unfamiliar objects at home? Cannot offer a coherent history?

Flashbacks and intrusive thoughts? Hearing audible voices from within? Experiences “made” feelings, that is, feelings that come “out of the blue”.

(Look for something similar in thoughts and behaviors) Chronic headaches that do not respond to over-the-counter analgesics? Sleep disturbance such as frequent nightmares, sleepwalking (note that

sleepwalking in childhood may be normal) Depression, affective disorder, suicide ideation, suicide attempts, all may

characterize a dissociative disorder

6. Inventory the client’s stabilization skills. At a minimum, ask the client to demonstrate: � Corrections for energy reversals: the sore spot (NLR), Cook’s hook-up � Heartmath coherence breathing � TAT

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� At least one example of a meridian-based treatment, such as EFT or TFT � Ensure that the client has and uses containment skills as necessary If the client cannot do so, take time to teach and demonstrate. Do not continue until the client can also demonstrate without help from the therapist.

7. Inventory and strengthen positive resources Resources are distinct from stabilization skills. These are positive traits, qualities, or virtues that enable the client to be naturally hopeful and resilient. When the client begins to face traumatic memories in step 8, these qualities will help him or her to manage negative emotions and to take a break from processing as needed.

� Maintain an especially positive focus, with examples of success.

� Option: use a large sheet of paper and draw the positive events on a life line. On the life line below, positive memories are placed above the line. You can also invite the client to draw and list the events. Begin with direct questions: �+ �+ �+ 8 12 29

(Notice: no negative memories are placed on the time line yet.) � To find more positives, use the trackback from Transactional Analysis, or the affect bridge from the work of the Watkins in psychoanalysis, with a positive focus, asking the client’s body to find memories from his or her history.

� The client might be able to increase the positive experiences (+) by searching for imagined or wished-for positives. It’s OK to distort the past in this case: “What might you have said then that you wished you had said?” Ensure that the invention or distortion produces only a positive emotional experience.

� Add in positives from today:

�+ �+ �+ �+ �+ �+ �+ �+ 2 5 8 10 12 21 29 today

(Notice: no negative memories are placed on the time line yet.)

� Use other strategies to identify positive memories and ask about the client’s positive sensory experience. You might lend the client a list of positive qualities to prompt additional ideas. Invite the client to choose one or more from the list

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that are personally relevant. The virtues list below, from Seligman, which has been endorsed around the world, is one option among many. WISDOM AND KNOWLEDGE: creativity, curiosity, open-mindedness, love of learning, perspective. COURAGE: authenticity, bravery, persistence, zest. HUMANITY: kindness, love, social intelligence. JUSTICE: fairness, leadership, teamwork. TEMPERANCE: forgiveness, modesty, prudence, self-regulation. TRANSCENDENCE: gratitude, hope, humor; seek purpose and meaning in life. The reader may notice parallels with Heartmath emotions, with Ho’Oponopono, and other traditions. Consider contexts where the virtues might not be appropriate: for example, victims of domestic violence may actually put themselves in greater danger if they forgive a perpetrator who does not intend to behave better; and optimistic gamblers increase their bets even when they are losing. Here is an example for doing this exercise: The person identifies a virtue, thinks back to a moment when s/he put it into practice, and/or looks forward to an opportunity for putting it into practice. While visualizing a past or future scene, the client then feels the virtue bodily, places a hand over the positive feeling/sensation, enhances the feeling with posture or movement or further visualization until the experience is 100% positive (or close), then strengthens with the butterfly hug (BH): The BH involves cross the hands over the chest and tapping, with fingers of each hand, the K-27 point under the collar bones. Ensure with ongoing inquiry that the client remains positive.

------------------------------------------------------------------------ Go no further until the client has resources (from 6 & 7) that will be necessary for trauma processing

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------------------------------------------------------------------------

8. Make a treatment plan � If the client has demonstrated steps 6 & 7, you can proceed and ask about treatment targets. You may use the same time line, placing the negative memories below the line, as depicted next. Begin with direct questions: �+ �+ �+ �+ �+ �+ �+ �+ 2 5 8 10 12 21 29 today �- �- �- 4 19 37 � To search more deeply into the past, you can use an “emotion bridge” or “sensation bridge”. These involve the client talking about some present-day issue or problem or trigger, then searching for a memory that seems to be maintaining or “feeding” the present problem. This allows the client to begin by talking about what is most important to him/her (the present-day issue), and then drifting back in time to a moment where s/he felt or experienced something similar to what s/he is experiencing today. Two examples follow. Say: [“You tell me that you have a feeling of tension in your stomach when you think about that how the face of your friend triggers you today. With your hand on that tension, I would invite you to drift back in time, very slowly, and notice how many times you can notice where you had this tension, or something like it, before. Take your time.”] This is useful when a client reports a sensation for which there is no known medical, organic, or other present-day explanation. Ask for an age of each memory. Consider doing this for chronic stomach pain, muscle aches, headaches (again, for no known medical reason), tensions, and muscle weakness. As another example, say: [“You say that you tell yourself frequently that ‘I’m stupid.’ I would like you to say those words now, notice where you feel them in your body, and then drift back to times where you heard people telling you that, or where you felt something like the feeling you have now. Take your time.”] Sometimes a positive word will also provoke a negative reaction, perhaps because the person has self-doubts or superstitions about being allowed to feel good, to be successful, to forgive and be forgiven, or even to live and breathe. Ask the person simply to repeat the word that triggers the negative reaction, and use the above procedures.

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The same can be done when a person is upset by a photo or image that cannot be explained away. Looking at the picture, the client notices a feeling and drifts back to a time when the feeling began. The person can also draw a picture and track it back. For some people colors, textures, or shapes will serve as triggers. In the above discussions we have examples of triggers. A trigger is any stimulus in the present that causes a reaction in us that does not make sense today, which means that the stimulus is partially in the past. Final example: if a person is touched by a good and non-dangerous person, for example, on the wrist or shoulder, the natural reaction is simply to feel the touch. However, if the safe touch causes anxiety, it probably has reminded the person of an unresolved memory. The touch is another trigger. You can see that a trigger can be explained only by reference to the past and to unresolved memories. When using these trackback or affect bridge techniques, the time line is likely to become further expanded, as depicted below: �+ �+ �+ �+ �+ �+ �+ �+ 2 5 8 10 12 21 29 today �- �- �- �- �- �- 4 7 19 22 27 37 � The resulting visual panorama allows the client to see that the negatives fit within a broader context: there are positives as well. A general rule of thumb is to see if the client can maintain a 3:1 formula, with 3 positives for every negative. Use the graph to explain why the client feels less than optimal today: the past feeds unpleasant emotions, thoughts, and images in the present. Begin to explain that when processing begins, the client will be asked to identify which of the negative memories will become the first treatment target. � Frequently a client will report feeling overwhelmed in this task; simply remembering what s/he has been avoiding through life can bring up powerful negative emotions. If this happens, consider stopping the history taking and ask the client to return to a stable state using an energy intervention. Once the client can show that s/he can manage emotions, stabilize, and recover from recalling the past, you can resume history taking. � To repeat from above, invite the client to inventory the positive resources, habits, relationships, goals, wishes, etc., of today.

� Ask about positive triggers. A photo of one’s grandchild that produces a smile on the client’s face would be an example.

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� Invite the client to identify future goals, indicated below on the right side. Follow the same inquiry as above: use direct questions, and consider the floatback to elicit more information. When the client reports a positive emotion in the present, ask, “As you float back into your early life, see how many times you can find when you felt this positive feeling, or something close to it.”

�+ �+ �+ �+ �+ �+ �+ �+ �+�+ 2 5 8 10 12 21 29 today future … �- �- �- �- �- �- 4 7 19 22 27 37 � CAREFUL! Some persons overly preoccupied with the past will not be able to do this. The clinician does not insist, or accepts very modest goals. Consider returning to tasks #6 or #7 above. Also consider switching to performance enhancement if this activity causes difficulty. � Adding this to the time line can help the client to visualize this baseline, and then to appreciate changes in the time line as s/he updates it following memory processing. In BST we specifically ask the client to identify a memory that continues to bother the client, and that interferes in some way with the client’s efforts to move along in his or her life. We consider that the presenting problem the person wishes to resolve is somehow being maintained by an early memory that has never been fully processed by the person’s natural healing. BST will help them to re-start this natural healing process.

Step TWO. Demonstrate BAS

Tell the client that you will be teaching him/her the mechanics of BAS. Say: [“We begin by practicing some bilateral movements that we will use during the treatment. For example, I will invite you to move your eyes from side to side as

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you follow my fingers. Besides eye movements (EMs), at times I might offer to snap sounds from side to side, or offer to tap the backs of your hands, first one, then the other. We will do all of this carefully. Sometimes this bilateral alternating stimulation helps you heal the past, and sometimes it brings up more memories that need healing. So I will consult with you fairly frequently so make sure that I know if you are feeling better and want to continue, or if you want to continue but at a slower pace, or if you want to stop and take a break.”] Ask if the client has questions and answer them. Then say: [“Do you have any eye problems that suggest we should not use EMs?”] Use EMs if possible, but not if the client reports eye pain or other problems. Say: [“We are not starting the processing yet, but just trying out the movements. Now I want to be sure that you are in a 100% positive place before we begin this practice. So, how close to 100% positive do you feel right now?”] It is extremely important that you not begin the BAS practice until the client is very close to, if not at, 100% positive, as the simple practice of BAS can open up the disturbing memories and produce quite a shock for both client and practitioner. Ask the client to use any energy intervention, visualization, or other resource to enter into the 100% positive before proceeding. Then say: [“OK, good. Now let’s do just one movement for you to try. Would it be OK, first of all, for me to sit next to you, fairly close up and off to the side? This can be touchy. Make sure the client feels OK with you sitting nearby; say: [“Thank you. Let me know if for any reason you change your mind and do not want me to sit so close. Now, would it be OK if I moved my hand in front of you from side to side, slowly, while you follow with your eyes?”] If and when the client gives permission, place your hand about 2 feet in front of the person, then move slowly toward his or her face while saying: [“If it’s OK with you, I’d like to see how close I can move my hand before you feel uncomfortable.”] When you have permission, slowly move your hand closer until the client tells you that it’s close enough. Then say: [“Thanks. Now, if you are OK with this, I will move my hand from side to side, once, while you follow with your eyes. I will first move to your right (left), then your left (right). OK? Then, how does this next direction seem to you?”]

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With permission, move your hand one time, beginning in and ending in the middle of the client’s visual field. Then continue with diagonals, a circle, and the infinity or lazy 8 movement. Do the same with touch or tapping, always ensuring that the client is comfortable with your touching him or her. Touch the backs of hands, not the palms; consider placing a pillow under client’s hands; tap knees or shoulders for children, and so forth. Also test out SOUNDS, such as snapping your fingers on each side of the client’s head. NOTE � Obviously all of these instructions are to be ignored if for any reason the client exhibits discomfort that could interfere with therapeutic relationship building, and/or treatment. In some cultures, and with certain persons, sitting close to the client could constitute intrusive and even unethical behavior. In other cases it may appear to be rude and provocative to look someone directly in the eyes. The clinician will exercise good judgment in deciding whether the prescribed physical position and bilateral testing are appropriate or not. NOTE: The therapist would not sit so close to clients with childhood experiences of abuse, attachment difficulties, dissociative tendencies, or signs that there are difficulties with self-regulation. Even if the therapist has asked for and received permission, the client who has difficulty setting boundaries may not really be able to consent to have the therapist be too physically close.

Whenever it is inappropriate for the therapist to sit close to, or touch the client, say: [“Fortunately, there are devices that allow for the bilateral stimulation while I sit further away from you. Also, for now, you can tap yourself instead of having me to the bilateral movements. If you wish, you can also use the butterfly hug which we did before.”] This will protect the client’s space. You then again demonstrate by tapping under your collar bone on kidney-27, with the fingers of the two hands about 2” apart. Remind the client to tap first with one hand, then the other.

Step THREE. Identify the target The protocol was originally designed to treat specific bothersome memories. It has since been adapted to treat present-day triggers or future worries as well as difficult and unresolved memories from the past. The past, present, and future options are now described.

How to target memories from the perspective of the past

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This is the most common perspective. You have already prepared the client with the time line. Simply show the time line now and ask the client which memory s/he would like to target first. If there is any doubt, explain by saying: [“We will be working on memories you have that are still bothersome to you. What we find is that bothersome memories are largely the reason why we have difficulties in the present. These memories also have a way of keeping us from imagining and planning for the future. You will decide which memories to work on first, and together you and I will use the BST method to help to resolve those memories, which means that I will be asking you to talk about the memories, and then to do some simple eye movements or something similar, so that the emotional part tied to the memory begins to fade. Hopefully, all of the upsetting emotions you feel now will go away, leaving only the memory itself. So, how does this sound to you so far? Do you have any questions?”] Answer questions, and give more information as needed or requested. Note that if the client chooses the earliest memory on the time line, you can proceed below with step four. If the client chooses a more recent memory to begin with, perhaps because of fear of remembering earlier ones, tell the client s/he might tap into the earliest memory without meaning to, something that occurs as processing continues. Offer to help the client stay on the chosen memory if this becomes necessary. This strategy, “staying on target”, will be explained below.

How to target memories from the perspective of the present For various reasons a client may not be able to identify a specific old memory. In other cases the client may choose not to start with an old memory, fearing that simply remembering what happened may be overwhelming. And in other cases the therapist might be legitimately concerned: perhaps the client is a recovering addict, it which case opening up the past too soon could cause a relapse: many clients ignore the past out of fear of feeling the urges all over again. In all of these cases, the target can be a present-day trigger instead of a specific memory. To review: In the above discussions, a trigger was defined as any stimulus in the present that causes a reaction in us that does not make sense today, which meant that the stimulus is simultaneously in the present (such as a picture, a face, a smell) and in the past. Even a well-intentioned hug or touch can be a trigger. If a person is touched on the shoulder, for example, by a good and non-dangerous person, the natural reaction is simply to feel the touch. However, if the safe touch causes anxiety, it probably has reminded the person of an unresolved memory. The touch is another trigger. You can see that a trigger can be explained only by reference to the past and to memories that are not yet finished.

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In this case, you do not trackback into the past but use the trigger alone as the treatment target.

How to target memories from the perspective of the future Sometimes you will work with persons who are working on goals they have not yet met, or on a performance issue, or on a future plan. The person might have in mind a realistic and practical picture of how the person would like things to be, or a thought that the person would like to come to believe. An example might be, “I deserve to succeed.” Another example: “I am intelligent and prepared and am at peace.” While rehearsing a thought or a future scene, the person may feel anxious, ambivalent, or in some other way doubts that s/he can succeed with the plan. In this case, you have 2 options: (1) You can do as was suggested above with the “affect bridge” or “trackback” and have the person pay attention to the negative feeling or sensation that the future thought generates, and again float back in time to find various events where the person felt something similar. Identify that memory (with an age, etc.), and follow the procedural steps below. (2) The second option is simply to ask the person to focus on the future event or challenge, which of course means that the target is a future trigger.

Step FOUR. Develop the P.A.S.T. Once the treatment target has been identified as an old memory, a present-day trigger, or a future trigger, you will ask about more P.A.S.T. details and keep the information in your notes, referring to memory or trigger as appropriate. Note that all of the PAST information is negative and will be bothersome to the client. Say: [“Well, we are ready to begin. I will be asking you for a little more information about the memory/trigger we have agreed on.”]

P Begin with the P or “picture”, by saying:

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[“I would like to get some information about what you will be working on. This information will help you to have a deeper healing experience. You will either use memory or trigger to refer to what you say next, depending on whether the target is a specific memory, a present trigger, a future trigger, or a past trigger. [“Let’s begin with a picture of your target. Imagine taking a photo of the worst part of the memory/trigger. What is in your picture?”] Write the client’s response in your notes. If the target is a memory, ask, [“How old are you in the memory?”] You might also ask about where the event took place and a time and date. Do not spend too much time here, as it is not important to get all of the details, but rather to focus on the emotion and sensation that come next. If the target is a past, present or future trigger, ask: [“What else do you notice about it?”]

A Then continue with the A for “affect” (or emotion or feeling).

[“What do you feel when you think of the memory/trigger?”] Some common feelings reported are fear (anxiety, panic); anger (irritability, rage); sadness (depression, loss, hopelessness); disappointment; frustration; regret; guilt or shame; or worthlessness. If the person says, “I don’t know”, ask: [“When you think about the memory/trigger, is what you feel right now more like sadness, or is it more like anger, or is it more like fear, or would you say it is more like frustration, or disgust…?”] until the person can choose an emotion that seems to express what s/he is feeling.

S Then ask about the “S or sensation”: [“Where do you feel that feeling?”]

If the person has trouble understanding this, you can ask that s/he concentrate on the site of the feeling by placing a hand on it or by noticing other features of the sensation: [“You might be able to concentrate better on the sensation if you place a hand over the place where you feel it. Where do you feel it in your body? Could you place your hand over it? By the way, what is the shape? Size? And if it had a color or weight, what would that be?”]

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Remind the person that sometimes a sensation will move around during BST. If it happens during BST, talk to your client in ways that show that you know that this is normal and natural and a positive thing: [“That is perfectly normal. You are experiencing a body memory. It is like remembering through your body. You are doing good work. You are remembering. Just notice it.”] To accentuate the sensation you can ask the client to make a certain pose or posture, and to move his or her hands or feet or other body parts to show the feeling in active physical form. Encourage the client to think of the sensation and memories as fluid, as changeable. You might say: [“Once processing begins, you may notice this posture changes. In a similar way, you might notice that the sensation moves around in your body, something that is perfectly normal and a sign that you are remembering through your body, through the processing of body memories. Is this OK with you if it happens?”]

T For the T or the “thought”, ask:

[“As you think of that memory/trigger, as you look at that picture, what do you think about yourself right now that is negative or unfriendly about you?”] The T is often the most difficult task for the person, so feel free to turn the page to help the person come up with a negative thought or belief (the column to the right). Notice that the thought should meet these criteria if at all possible: � It is related to the person (begins with “I …”). � “It feels right”, and is related to the event that is to be treated. � It is said in the present tense (”Now”). � It’s false (it may seem or sound illogical, absurd, or irrational but will feel true

when the person thinks about the memory). If anyone has trouble with this, say: [“This is usually the hardest part. What we are looking for is a thought that you learned about yourself that probably sounds false and even absurd, but something you feel to be true when you think about what happened to you. Look at this page and see which though from the second column fits you best.”] Then show them the right-hand column on next page: NOTE: Taking information about the entire P.A.S.T. is the standard way for the client to get access to the problem. There are many exceptions to this, however. Here is a

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brief list of exceptions to remind the clinician that BST is client-centered: the client’s preferences are always superior to what is written in this manual. � Some clients will find that information about their entire P.A.S.T. will generate too much negative emotion. In these cases we might skip one or more of the elements. � Some clients will not have an image, in which case we might ask them to “Think about what happened.” � Some clients may be unable to identify an event, in which case we might just ask them to concentrate on where they feel “it” in their body. � Some might find it sufficient to start with a trigger, realizing that if they are triggered, they are already somewhere in their past. � And some clients may need even more than information from the P.A.S.T., in which case we might also ask them to assume a posture, demonstrate a behavior, or role play what the feeling might look like.

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Examples of core beliefs

Positive equivalent Negative equivalent I am achieving. I am not achieving. [I am a failure.] I am appealing. I am unappealing. [A disgusting person.] I am attractive. I am unattractive. [I am an ugly person.] I am capable. I am incapable. I am cherished. I am/will be abandoned. I am competent. I am incompetent. I am creative. I am not creative. [I am boring.] I am deserving. I am undeserving. [I am worthless.] I am fortunate. I am unfortunate. I can get what I want. I cannot get what I want. I am good. I am bad, evil. I am healthy. I am unhealthy, sick, ill. I am honorable. I am shameful. I am innocent. I am guilty. [I learn from my mistakes.] I am intelligent. I am unintelligent, stupid. I am interesting. I am uninteresting, dull [boring]. I am likeable. I am unlikable. [I am repulsive.] I am loveable. I am unlovable. I am loving. I am unloving [I hate, I am hateful.] I am mentally healthy. I am mentally ill, crazy. I am motivated. I am unmotivated. [I am lazy.] I am not inferior. I am an equal. I am inferior. I am powerful. I am powerless. [I am weak.] I am productive. I am unproductive. I am respectable. I am not respectable. [I am despicable.] I am safe. I am unsafe. [I am in danger.] I am secure. I am insecure. [I doubt myself.] I am smart. I am stupid. I am strong. I am weak. I am successful. I am unsuccessful. [I am a failure.] I can trust. I cannot trust. I am understanding. I am not understanding. [a confused person.] I am understood. I am misunderstood. I am valuable. I am valueless, worthless. I am warm. I am cold. I am worthy. I am unworthy, inadequate. I am worthwhile. I am not worthwhile.

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Step FIVE. Processing This step consists of 15 procedures. They are designed to guide the client through processing safely and effectively. Please follow them all, and in order.

1. Give information about the process. Repeat information already given if necessary. Say: [“Well, we are ready to begin the processing. If at any point you want to stop and take a break, and we are using eye movements, just close your eyes and the processing will stop. If we are using some other movements, let me know you want to stop. You are in control of this process. OK?”

2. The client develops a window of tolerance [“I would like to invite you now to construct a window that shows the limits of emotion that you wish to experience today, from the minimum to the maximum. On the scale from zero to 10, where zero represents no upset whatsoever, and 10 the most upset you could imagine feeling, you can now construct your window. What would be a low number to begin with, that is, enough emotion so you can start processing your memory, but no more than necessary?”] You can use a whiteboard to sketch this, or, better, invite the client to sketch out his or her parameters. Refer to this during processing. See the example: The window of emotional 10 tolerance of a 9 hypothetical client: 8

7 ……….…………………………………….. . 6 . . 5 maximum 6, . . 4 minimum 3 . . 3 . ………..…………………………………….

2 1 0

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In the example above, the client said, “I don’t want to experience more than a SUD of 6 today.” Honor the window throughout EMDR today. In subsequent sessions, invite the client to change the window parameters. [“Fine. Now, during our work today I will ask you from time to time where you are with regards to that window. If you feel you have left that window, let me know, and we will use one of the energy techniques so you can get back within those limits. If you feel too high, we will do something so your level of emotion goes lower. If you are too low, we will do something so that it rises. Questions?”] OPTION: If the client cannot do this, you might arbitrarily suggest that you will stop if the client reports any emotion higher than a 6 on this scale.

3. Summarize the P.A.S.T. [“Now I’d like you to return to the PAST, that is, the picture, emotion, the sensation, and the negative thought about yourself that you told me about, where you said ‘I ( ….). Here you repeat the negative self-statement exactly as the client said it. Then say: [“Remember what you said?”] Wait for the client to recall, and help if necessary. Repeat information already given if necessary. Ask the client to update the P.A.S.T. in any way if s/he wishes.

4. Measure with the SUD scale. [“Now I would like you to notice the picture, with the negative thought] … repeat information already given if necessary. Say: [“On the zero to 10 scale, how upset do you feel now?”]

5. Consider the options you have. � If the client reports a zero or being lower than his or her minimum, apparently the client does not have access to the memory in an emotional way, so gather more information until the client feels some emotion. You may need to educate, or use advanced strategies to help the client to feel. � If the person reports being higher than his or her maximum, do an energy correction, then breathing, TAT, EFT, or Heartmath until the SUD number reported is again within the window of tolerance. The reason is that once you begin the bilateral alternating stimulation, it is very possible that the number will climb higher. This can happen because the bilateral alternating stimulation can

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connect the person to other memories that can produce even more intense emotions. It is recommended that the person first lower the intensity of feeling before the bilateral alternating stimulation is begun. This is a rule of thumb that should be followed throughout this treatment: whenever the number gets too high, switch from this BST exercise to one of the earlier 4 until the feeling is reported to be within the window of emotional tolerance.

� If and when the person reports being within the window of tolerance, you can continue to procedure 6.

6. Only if and when the client is within the window of tolerance, say: [“Now I’d like you to bring up the picture, the negative thoughts (the practitioner reads the clients negative thought here, in the client’s words beginning with ‘I’ if appropriate) …… and notice where you feel this in your body, and put your hand over that feeling.”]

7. Do one bilateral movement and stop. Say: [“OK, let’s begin. I will now do only one bilateral movement. Just notice what happens.”] This can be one pass with your hand, one pair of taps, one pair of sounds, or a brief butterfly hug by the client on the R-27 (collar bone) points.

8. After one movement, stop. Say: [“OK, take a breath, and notice your exhale. Now I would like you to return to the memory/trigger you are working on and tell me how much it bothers you on a 0 to 10 scale, where 0 means it doesn’t bother you at all, and 10 is the most you could feel bothered.” � Write in your notes the number that the person gives to you.

-10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0

9. Continue repeating procedures 6, 7, and 8.

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The practitioner watches the client closely, asks questions as to the client’s experience, and modifies the bilateral movements when the client gives permission or asks for changes. Here are several examples of how to modify: If the client appears to be doing well: [“I have been doing only one pair of movements. Would you like more? If so, how many?”] Do as many as the client asks for, reminding the client to let the therapist know if the BAS is too much or too little. If the client appears to be doing very well, is stable, or says s/he is ready for more processing: [“I have been asking you to return to the original target after each set of bilateral movements. If you would like, I will not instruct you to do that but instead will invite you to associate freely to whatever comes up for you, that is, whatever you might remember, see, hear, or feel, whether it is related to the target or not. How does that sounds to you?”] If the client consents, then you will skip the part about “I would like you to return to the memory/trigger you are working on” and after you have stopped the BAS movements, say only: [“OK, take a breath, and notice your exhale. What comes up for you?”] You can also say, “What do you notice?“ Or “What do you get?” Do not ask more specific questions such as “What do you feel/think/see?” From time to time, or when it doubt, ask: [“Now I would like you to return to the memory/trigger you are working on and tell me how much it bothers you on a zero to 10 scale, where 0 means it doesn’t bother you at all, and 10 is the most you could feel bothered.” If the client seems to be having trouble following or reporting, say: [“Do you want me to continue or not?”]

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10. After the client seems to have worked through some difficult material, check on the power of the target to produce upset. Say: [“OK, now I would like you to bring up the target again, and now the thought about yourself,” (repeat the client’s exact words at this point) “and now notice where you feel that. How much are you bothered now, zero to ten?”]

Consider the options you have. REFER TO PROCEDURE 5 for options. If the client is still above a zero, ask: [“What would it take to be a zero?”]. Continue processing.

11. After the client reaches a zero (or any other SUD number that seems appropriate), focus on the positive. Take a new set of P.A.S.T. information, now with a positive focus. Say: [“OK, now I’d like to give you the opportunity to think about that memory in a new and positive way. Let’s start with the picture. What is the picture you have of the memory now?”] Write this down in your notes, along with the information that follows. [“Now, what feeling does it bring up for you?”] A positive emotion should be reported. If not, explain, or ask if some part of the memory needs to be worked on further. One way to say this: [“What we find is that as you clear out the negative there is room for the positive. So, if you cannot imagine or think of the positive yet, maybe there is still something negative blocking you. If so, what do you think it might be?”] As the client is able to talk about a positive picture, move into the next questions. [“Where do you feel that feeling?”] Note that the place of the new feeling may be the same as or different from where the original negative feeling was felt.

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[“And how would you rather think about yourself as you recall that memory?”] Recall that identifying a belief is often the most difficult task, and if your client has difficulty with this last task, consider using the list of positive and negative pairs on page 18 to help the client to consider options. For example, if the original thought was “I am guilty”, the present thought might be “I have learned”, or “I forgive myself”, or “I am learning to be free.” Note that the positive does not need to match the negative one. As always, the client chooses.

OPTION: Some people will not get as low as a zero in procedure 10. In this case, look for anything positive that the person might be able to strengthen. It might be as simple as one of these: “I am on the way.” “Things don’t look quite so bad now.” “I seem to be getting somewhere.” While not optimal, these are half-steps towards healing.

12. Measure the believability of the positive. Say to the client, [“OK, take a breath. Now I’d like to give you another scale. Imagine that the original zero to ten scale continues on into a positive range.”] You can draw this out on paper to show to the client:

-10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 +1 +2 +3 +4 +5 6 +7 +8 +9 +10 [“Now, as you look at the positive side of the scale, let us use the zero as ‘not at all’ and the +10 as ‘the most I could believe something’. Now, when you think of the memory, and the new words (and here you repeat the positive belief from procedure 16 above, using the client’s exact words) how much do you believe that as you think about the memory?”] If the person has difficulty, say something like, “How believable does it feel in your body when you think of the memory now and say, ‘I … (read the new positive belief again).”

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Different clients will have different ways of responding. The main thing here is to let the client decide how to rate the strength of this new thought. Here are some other ways that clients may report their experience: �by moving their hands close together or far apart �by rating their experience on a scale of their choosing, such as 1-100 �by using symbols or colors from weak to strong �or simply by showing through a smile that they are feeling stronger Children may choose animals to represent strong versus weak.

13. Strengthen the positive. Once the client has chosen a new phrase, ask the client to attend to all of the positive while recalling the original memory, and do one bilateral movement. [“OK, now I would ask you to put yourself into as much of a positive place as possible, beginning with the positive words you just told me [the therapist repeats the client’s positive statement exactly as the client just said it, beginning with “I”]. And now I invite you to add any positive emotion you experience along with those positive words, and any positive sensation you feel.” ] [“Now as you experience these positive words and feelings, I would ask you to return to that memory that we just worked on and hold that memory together with this positive experience. Now just follow my fingers as I make one movement”.] You could also do one pair of taps or one pair of sounds. Alternately, the person could focus on a positive feeling by placing a hand over a positive sensation, or assume a positive pose (for example, standing assertively or courageously or kindly), and while they do that you can then do one bilateral movement. The client could also do the Butterfly Hug instead for self treatment.

14. Take another measure of the believability or strength of the positive; repeat procedures 12 and 13 as necessary. Say to the client, [“Take a breath. Now I’d like to ask you to measure again how much that positive thought feels true to you. Your words were: [repeat the positive statement the client just gave you]. Using that 1 to 7 scale, how believable do those words feel now as you think back to that difficult memory?”]

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Keep updating the number as it changes.

-10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 +1 +2 +3 +4 +5 6 +7 +8 +9 +10 Continue until your client is ready to stop, or there is no more time. Some clients will get to a “+10”but then report that the 10 keeps getting stronger as you continue the bilateral movements. So, if a client reaches a +10, continue to offer more bilateral movements to see if the positive can deeper further.

15. Ask the client to do a scan of the body. Following the principle of “the body does not lie,” ask the person: “Let’s see how you are doing. I’d like you now to return to the memory that you just worked on and tell me where you feel something. You can scan your body from head to toe, very slowly, first the top of your head, … then your face, down to your jaw [continue guiding the client down to the soles of the feet and the toes] and let me know whatever you feel.” When clients report a negative feeling, ask what they can do in this session to reduce the negativity. If they say they do not know, ask if they remember the other exercises (breathing, TAT, EFT, HeartMath) and then ask them to show you how they would treat themselves at home in between sessions. When clients report a positive feeling, ask them what they would do at home to strengthen that feeling further and hope (!) they also report planning to use breathing, TAT, EFT, or HeartMath with a positive focus.

Step SIX.

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Closing the session & homework � Take a moment to reflect on the work today. If the client had any trouble, especially with feeling too upset during the processing or not feeling enough emotion today, then say that at the next session you will teach the client some additional strategies so that he or she can feel less or more emotion, depending on the client’s need. � Take the final minutes of a session to debrief, which means asking the client to reflect on the improvements/gains/benefits/learning s/he recalls. � Check that the client remembers how to self-treat between sessions. For BST, you can teach the client to cross hands over the chest and to tap beneath the collarbone, first one side and then the other, to reduce stress. Also review breathing, TAT, and EFT. � Write out a personal action plan in collaboration with the client. You can introduce this as follows: [“I wonder if you would tell me what your plan will be until I see you again. For example, what will you be doing to treat yourself on a daily basis?”] Also ask about the client’s plans to improve physical exercise, diet, nutrition, and other habits. Then xerox a copy of the plan for the client and ask that it be returned in the next session. Ask the client to use the list to keep a log of experiences between sessions. � Predict possible experiences that the client could have by saying: [“You have done a very good job. You are getting your memory back and are finding that you can change how you feel about what you remember. You will not lose your memory for what happened, but you will feel different about what you remember. You are also making a journey into memories that were stored away because you did not know that you could handle them, and now you are learning that you can handle them. This means that you may remember more and more of them. As you get more and more of your memories back, you may find that the way you remember is different from the way you usually thought we remember. For example, you might remember through your dreams, and in that sense you might have unusual dreams even tonight. You also might remember through feelings or sensations. You might begin to recall certain conversations, or see certain sights, or hear other sounds from the past.

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You might find that you act differently, or that certain people who used to trigger things in you now seem to cause you to feel something new, as if you are less bothered by them. This is all normal. Not just normal, but a sign that you are remembering better and better, and changing in the direction you want. Whatever you remember or notice, you might just write down your experience so we can work on it in the next session.”] Basically, treat changes as good news, and normalize the possibility that other problems will appear. This is all part of the healing process: as one problem resolves, another may show up that was hidden from view before. � Have a plan for how the client can contact you in an emergency. For example, they should have a phone number where they can contact you, or contact someone who works with you. This does not happen very often because BST teaches people to take care of themselves, but when it does happen that a client calls you between sessions, these responses are recommended:

Do not teach anything new unless absolutely necessary. Remember that your client already knows how to handle strong emotion so just ask the person (over the phone, if possible) what s/he can think of doing right now to feel better. Wait for a response. If necessary, remind the client of TAT, etc. But be careful not to take over and not to do what the client can do for himself or herself.

Do not spend more time on the phone than is necessary. We do not want to “disable the able”, as one of my clients once said.

Ask the client what s/he has been doing that is working or going well. Take a solution focus, and concentrate on the positive.

You must intervene if the client is in danger to self or others. Remember, though, that this is rare in BST so do not overreact.

� A note for the therapist: Consider treating yourself between seeing clients, using energy corrections and treatment strategies.

THIS ENDS THE SESSION

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Review so far & other strategies for persons who

have trouble

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during treatment

Let’s summarize. You have been following these principles: �Always follow the client’s instructions. Stop if the client wants to stop. Slow down if the client asks for that. Speed up if that is what the client requests. We do not insist that the client talk if s/he does not want to. �Begin treatment slowly, and then slowly add stimulation (faster speed, more movements in a sequence) as the client can tolerate more and/or asks for more. The rule is not to “go slow”. The rule, instead, is to “start slow, then speed up” – which is quite a different matter. Processing is better if the client can process faster. But too fast can be worse than anything. � It is worth repeating: whenever the client asks for less, then provide less. When the client asks to stop, always stop. No arguing on this, please. The goal is to help the client to begin working on the memory slowly, cautiously, carefully, with timing and pacing, with safety, hence with an experience of growing success in being able to feel, remember, and resolve the memory. Paradoxically, slower is faster. Faster, on the other hand, can be too fast, which can cause the client to feel too much, and to be frightened away from the memory. This kind of avoidance of the memory is what the client probably has been doing in previous years, and we do not want to repeat this experience. �Sometimes you can continue the movement and help the client through a tough memory by reminding that client that “It’s in the past”, or “It’s over.” Depending on the number reported on the -10 to 0 scale, you will continue with BST or refer back to an earlier exercise. On the following page you will find a formula that helps to guide decisions at this point: if zero, gather if -1, -2, -3, -4, or -5, if -6, -7, -8, -9, or -10, more information for it is OK to proceed as use breathing, TAT, EFT, greater emotional access is adequate heartmath, etc. as access is access; and low risk too intense and high risk;

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this client can be � this client can be said said to be too distant Only under this condition to be too close to from the problem do you begin or continue the problem

processing with the bilateral movements;

this client can be said to have appropriate access to the problem � After each single movement, stop, and ask “What do you notice” or “What do you get” or “What happened?” Avoid asking, “What do you feel”, “What do you see”, and “What do you think,” as these words may not fit the client’s experience. � As you continue in this way, you can discuss with your client about his or her experience and ask if s/he would like you to change the movements. Always follow the client’s instructions. There are always four choices:

1. Continue what you have been doing (because what you are doing seems to be working for the person, and it is neither too risky nor too slow) 2. Do less, i.e., do an even briefer stimulation, such as ½ a movement, or a slower movement, or a softer and slower tap (because the movements or stimulation is producing too much emotion too quickly, and you need to slow down) 3.Stop and use one of the other 4 exercises (because the person is getting too distressed and it is time for a break from the bilateral stimulation) 4. Do more, i.e., increase the stimulation, either in number, speed, or other modality, so that the client feels greater emotion, processes better, and gets through this difficult work faster; notice that “more” can mean much faster, or more stimulations in a row, even repeating 100 or more taps or sounds in some cases; notice also that in this case of continuing stimulation that you should not use too many eye movements (EMs), and always check to ensure that the EMs are not hurting your client.

� Remember that you can help the client to get through some tough parts by saying things that help the client to stay in the present while working on the past. These are some things you can say while continuing with the bilateral stimulation: “You’re still here in my office as you work on that memory,” “You can keep one foot in the past and one in the present,” or “You got through it before, you know.” � Maintain attention on PAST, PRESENT, and FUTURE

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The Past BST works especially well to help clients access and then resolve bothersome memories. The EYE movements seem to facilitate memory processing best.

The Present When we follow-up with clients, we ask about triggers in the present (that is, stimuli today – such as a sound, a face, a word, a sight – that are more bothersome than they “should” be). We then target these triggers, often using an affect bridge to identify the memory that is maintaining the trigger today – and we than work on that memory as we would with any other memory. In other words, anything in the present that is more bothersome than it “should” be owes its power to the past, not the present. Of course if a present-day stimulus makes sense (for example, feeling fear when looking over a high and unguarded railing, running away in panic to escape a thug), we want to keep that reaction and we explain this concept of “appropriate responses” to our clients.

The Future The comments about the present are also relevant when we work with a client on a future goal or wish. When a client talks about wanting to accomplish/feel/do/think something in the future, and feels more bothered than seems to make sense, it is probably because the future thought reminds the client of some related but unresolved memory. We then target the thought/plan/wish that triggers the inappropriate reaction, often using an affect bridge to identify the memory that is maintaining the unrealistic and unnecessary fear of the future. In other words, anything in the present that is more bothersome than it “should” be owes its power to the past, not the present. If all you do is follow the BST protocol as it has been described up to this point, you will probably find that it is sufficient to help your clients more than half the time. They will be able to keep the process moving and to begin to heal their memories. However, in some cases a person will get stuck, that is, will seem to be working on the same issue over and over without feeling any differently. Still have questions? Go to the next page for more ideas.

Now let’s look at some trouble-shooting ideas that you can use when the client gets stuck

� Change the bilateral simulation in some way.

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If the person seems to get stuck on some part of the processing, first ask if you might be going to slow or too fast, and adjust the stimulation as needed. Also, consider using a different mode. That is, if you are doing horizontal eye movements and the person still seems stuck in the same emotion or sensation, stop and tell the client you will try a different direction such as the diagonal or the figure 8. Often this will be sufficient. You can also consider tapping or sounds if the eye movements do not seem to be producing change. � Correct a psychological reversal If the person is stuck because some emotion or sensation does not seem to change, use the correction for psychological reversal. Have the person rub the sore spot while saying, “I accept myself deeply and completely even though I seem to be stuck” or “… even though I still have some of this problem left.” � Use the feeling bridge. If the person remains stuck, try the feeling or affect bridge to search for another memory, and do bilateral alternating stimulation when the person recalls another memory. � Use the thought bridge. Sometimes the person will get stuck because of some thought (such as “I really shouldn’t get over this”, or “I really don’t deserve to feel better”. A war veteran may think, “If I get over this I will be abandoning the persons who died,” or “Real men don’t cry”). Have the person repeat that thought, and do bilateral movement. Or use a thought (or cognitive) bridge to track down an earlier memory, and work on that earlier memory. �Use the hierarchy. Consider using a hierarchy for persons who want to continue but cannot deal with the memory all at once. (Is this explained more somewhere in terms of how to use a hierarchy?) � Look for other entry points in the P.A.S.T. acronym. Sometimes it helps a person who is stuck if you can help them link among different aspects of the P.A.S.T. For example: If a person is stuck on a sensation, go to the T and ask them, “If the sensation had a voice, what would it say right now?” After the person responds, do a bilateral movement. Or if the person is stuck on a thought or picture, ask the person, “Where is that thought (or picture) in your body?” Then ask them to hold their hand over the place and do a bilateral movement. � When a person comes upon a dilemma, try this procedure:

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Ask the person to place one side of the dilemma in one hand, the other side in the other hand (the person chooses), close the hands, then have the person notice differences. If they have trouble, ask: “Which is heavier … lighter … colder … warmer … bigger … stronger … more relaxed …” and so forth. While they focus on their hands, do bilateral movements. Stop, and ask them to notice changes. Continue until the dilemma resolves. If new memories come up during the dilemma work, either continue working on them or use one of the other exercises to try to heal them more quickly. Tell your client that this is perfectly normal, and say anything else to normalize the experience. You can also tell the client that this is “Good work. You are regaining your memory.” Also show empathy because the client is probably experiencing the reasons why s/he has been avoiding this work for so long, that is, because of the fear or panic involved in remembering. Continue in this way until the person seems to be feeling better or wants to stop. Then ask the person to return to the original incident and ask how the person feels about it now, and how strong the emotion is on the 0 to 10 scale. Do not ask for a picture as the picture will often have changed. Instead, ask the person to “Think now about what happened.” If the number reported is greater than zero, ask, “Where is that number in your body?” or “What part of the event or memory continues to trouble you?” and continue working with bilateral stimulation. � You may find it helpful with a person who is stuck to use the “9 X 9” technique. Sketch a drawing below to represent the visual field of your client, which is the basis for this strategy:

• • •

• • •

• • •

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According to NLP findings, a person will access different memories depending on where s/he looks on the visual field. In general, looking up accesses visual memories, to the side is for auditory memories, and downward is for kinesthetic or body memories. Whether this is predictable with all person or not, the important things is that if the person looks at different sites on the visual field, it is likely s/he will report a different level of upset from one to the other (while thinking of the stuck point or a specific memory). Use the infinity eye movement, stopping at each of the nine visual areas to ask: [“What number do you get now, where zero is no upset and -10 is the worst you can imagine?”] You can then switch to diagonals, or simply ask the person to notice while you do one slow infinity movement. Often this will bring new access or insight and allow processing to continue again. �Some people will get “stuck” because they think that if they process a memory they will lose it entirely. In this case you will need to remind them that there are many ways to remember – for example – a loved one who has died. You might tell them that they can “keep the person in your heart” while giving up the intense grieving. Or, that they can decide how much pain to release, and remain with some of it. Or that they can change their feeling so they can continue to live. Sometimes when a person revisits the initial memory, they will notice that the image, feeling and thought may have changed. Tell your client that this is all normal. Remind the client also that even though aspects of the memory have changed, the client has not “forgotten” the memory.

Subsequent sessions � Check to see if your client has completed the agreed-upon homework. Refer to the action plan as a reality check: Does your client make realistic plans? Does your client follow through and persevere? Use this information for follow-up treatment, and as a possible introduction to performance enhancement. � Inquire about the apex phenomenon, that is, does the client trouble “believing” that s/he made the gains that have been documented? � Inquire about the possibility of secondary gain; healing has consequences.

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� Treat resistance as if it were a psychological reversal. � Make sure you have informed consent before trying out a new technique. � Check to see if therapeutic gains in the previous sessions were maintained, or if

the old problems returned; measure the original problems with the SUDs scale; check triggers to see if they are as they were originally.

How to adapt the BST model

for subsequent sessions You will find that in subsequent sessions your client will frequently report changes that will require you to consider the first six steps of treatment in a new light. Step 1, rapport, may need to be revisited if the client has not had the kind of experience that was expected. Sometimes a client will not experience change, or will change but trivialize the change (apex phenomenon), and may lose confidence in the therapist. Check your own energy and possible reversals, as well as your heart coherence. Review the information on heart-based intuition. Usually the best way to promote rapport is for the client to experience positive change and hence to trust that the therapist is both competent and on the client’s side. Step 2, informed consent, implies that you will continue to see if your client has any new questions. Even if you provided information earlier, often clients forget what was said, were too anxious to pay attention, or are now more curious as a result of their previous session. What can feel like a review to you may seem to be fresh data to your client. Step 3, history, is often a surprise in subsequent sessions, as the client’s perspective and feelings about the past may change. What was initially a troubling event may now seem to be “in the past” and no longer significant. What was unacknowledged or unknown may now become salient. Recall the metaphor you used to talk about “aspects,” and mention it again. (Perhaps more information would be helpful here to remind the reader what the “aspects” metaphor is?) For certain, explain to the client that what is coming up has been

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there all along, and that it is “good news” because the client is “getting your memory back.” It may also be useful to review the client’s major negative and positive memories. The negative one’s will point to new targets; the positive ones will help the client to feel more optimistic and to look more to the future possibilities. Step 4, preparing the energy system, often becomes more important as time goes on. Many therapists will skip this step at first, and refer to it if treatment stops or plateaus. You can use follow-up sessions to check for energy reversals, and then teach the client how to correct them. Often treatment will begin well even if you skip this step, but may need to be helped back on track by introducing the concepts and techniques in this step. This is also helpful with a client whose treatment has not gone well, as it shows another way to explain why the treatment might have gotten blocked. That it, it is a way to take the burden off the client by saying, “You are working hard and with good intention, so I don’t think you are necessarily responsible that your treatment has become blocked. Let us look to see if your energy system has stopped cooperating, and if we might try some new strategies to get treatment moving again. An attitude we both might have is that there is a good reason for why your treatment has stopped working.” When you review step 5, treatment, first check to see if your client has been doing the homework you discussed last time. Homework – A number of issues can be pursued: � Does the client remember if there was any homework planned!? Did the client change the homework plan, for better or for worse? � Did the client keep track of progress and problems? Did the client do self-treatment? If so, how was it tracked? If not, what happened? Use these questions to check on client motivation, on the need for more information, and on whether the client learned how to do self-treatment last time. Check to see if the self-treatment produced expected results. � Ask the client to show you how he or she did or tried to do self-treatment, and then re-teach as necessary. � There are consequences to healing. Ask your clients to tell you whether their changes have produced other changes, and whether these other changes have

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been positive or not. Some clients will find that other people do not like how they have changed, which could raise secondary gain issues. On the other hand, many clients like their changes, find that others like them, and find that their changes generalize to other behaviors and parts of their lives. Could these experiences explain why the client has/has not been doing homework?

� Modify the homework – if necessary – at the end of this session. Next, identify the target again. There are three broad possibilities. (What are the three broad possibilities?) What is the original target like today? Ask the client to give a 0-10 number that describes how much it troubles the client this week. Begin by asking the client if he or she remembers what you both worked on. This empowers the client to work with you, and helps to check on whether that target still is upsetting to the client. If the client says it is a “1” or more on the 0-10 scale, consider working on it further. If the client says it feels worse than when the last session ended, check to see if it is rated worse than when you started the previous session. Often the 0-10 will start high and end low in one session, then be reported as medium at the beginning of the next. This can mean new aspects came up during the week, and that the client is remembering more. Again, this is good news. Also check the other issues that came up during the last session: Ask for a 0-10 on each. Check your written notes from last week. See how the client has been since the last session: Ask about any new experiences the client has had. This, of course, should cover both successes and failures (“I did/did not give that speech without feeling to anxious”), as well as new experiences and awareness (“I found out what makes me nervous in that setting/I found a new setting where I get nervous/I did something I usually avoid and it felt good.”) Some clients find it helpful to organize keeping track of their between-session experiences by using the BASIC I. D. (Did you already explain what BASIC ID stands for earlier?) Some keep a general log. Most might not write down anything at all. Finally, ask the client what treatment to use this week: Review the options from step 5. Consider additional resources.

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Notes regarding beliefs: The list of beliefs is from Fred P. Gallo, (2000). Energy diagnostic and treatment methods. New York: Norton. (Reproduced with permission) � It seems that the strongest positive beliefs use the word “I”, are stated in the present tense, are very general rather than specific, and are realistic. For example, “I deserve to be successful”, “I am forgivable”, and “I am lovable” are all realistic. “My family loved me,” might not have been true, and might never be true, so will not change during treatment. � It seems that the strongest negative beliefs are also stated with an “I”, in the present (or the future), and are essentially false. It may have been true that “My family never loved me”, but to conclude therefore that “I am unlovable” is false. Therefore, the first statement would not be accepted as a negative belief, while the last one would. � Sometimes it is preferable to ask the client to come up with his or her own beliefs, ones that resonate with the event remembered, or that resonate with the emotion felt. For example, some persons may find that their present-day guilt is due to a belief that they must continue to feel guilty, rather than to forgive themselves and to move on. Here we see how a belief (or thought about oneself) uses the same word that describes the emotion. � Some people find it useful to categorize beliefs according to their reference to the past, present, or future. Examples: Past reference: “I did the best I could” or “I have learned from my mistakes” versus “It was my fault” or “I must continue to feel guilty”. Present reference: “I am in danger” (where there is no real present-day danger) versus “I am safe” or “I am learning to care for myself. Future reference: “I am confident” or I will succeed” versus “I cannot be a success” or “I am a failure.” This practice is especially powerful if the therapist has a white board or, better, a large sheet of newsprint. The client is then invited to use a marker to draw his or her own time line. As usual, ask the client first to sketch in events on the top (positive) of the line. The therapist can ask questions, for example: who in your life was a pillar for you? That is, who said kind things, encouraged you, smiled, in a way that left you feeling good and confident about yourself? If the client has difficulty, say: These can include strangers, people you did not know well, relatives that you did not see often. With time the person will be able

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to fill in with positive memories. Encourage the client to put words and positive faces above the line. The client is then encourage to connect events with lines that suggest a particular thought or feeling that characterizes different events (“cognitive schemas” or “cognitions”, or common emotions and sensations). With time, the person can also be encouraged to fill in the bottom with troublesome memories in the same way, also looking for common thoughts or feelings that connect different events. Teenagers might be especially fascinated by this exercise. � Consider half-steps when the person is unable to accept a positive belief. For example, if a person cannot even contemplate the possibility that “I forgive myself”, you might offer an alternative such as “I am learning to forgive myself” or “I want to forgive myself” or even “I would like to believe that I am forgivable.” As treatment proceeds, consider enhancing the original half-step so they slowly become stronger and richer. (Have you considered possibly moving the notes about beliefs to the section earlier in the manual where you give the examples of core beliefs? Just a thought)

To terminate therapy (suggestions for the client)

resources, books, continuous education

daily self-care plan

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a long-term plan to include visualizing the future while using EP techniques; ever greater attention away from the past and toward the future

consider therapy as intermittent, and call your therapist for another session if you need

you might look for ways to teach and treat others; both the giver and the receiver benefit