emdr pain protocol mark grant. ma, maps. goals of treatment resolve or reduce pain develop pain...
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EMDR pain protocol
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Goals of treatment
• Resolve or reduce pain
• Develop pain control skills
• Resolve trauma
• Reduce associated emotional distress
• Address identity issues
• Alleviate health fears
• Stimulate improved adjustment and functioning
Goals of treatment
“ EMDR treatment of chronic pain includes the processing and desensitization of both; •the automatic emotional response to the pain sensation and, •the automatic components of the stored memories related to the etiology of pain.”
- Mazzola et al, 2009
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Elements of treatment
1 HistoryMedical diagnosis
2. PreparationSafety, Medical issuesAIP model for pain
3 AssessmentTarget: Traumatic memory, present pain, effects of pain
4. DesensitizationContinuous auditory Bls“Incomplete processing”Self-use of DAS/BlsDealing with blockages
‘
Mark Grant. MA, MAPs
Elements of treatment
5. Installation+’ve cognition and/or antidote imagery
6. Body Scanaddressing persistent pain
7. ClosureEducating client about how to notice and integrate
changesResources for living with pain
8. Re-evaluationPhysical vs mental changes
Mark Grant. MA, MAPs
Stage 1. History
1 History2. Preparation3 Assessment4. Desensitization5 Installation6. Body Scan7. Closure8. Re-evaluation
Mark Grant. MA, MAPs
History
• Medical diagnosis
• Trauma?
• Family background
• Cormobid problems
• Narrative (how, when, where, what)
• Medications?
• Suitability for EMDR
• Target sequencing
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Medical diagnosis
• What is the client’s medical diagnosis?• Implications of medical diagnosis• To what degree does client
accept/understand it?• What treatments? Outcomes?• How long in pain?• Prognosis?
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Trauma History
• Sexual abuse• Accident (auto, work, other)• Injury• Diagnosis of life-threatening illness• Surgery• Combat trauma• Complicated bereavement• Abortion• Assault• Torture• Rape
Developmental trauma
“unless there is solid evidence to the contrary, clinicians would be wise to assume that virtually all clients carry with them some degree of developmental fixation or stuckness.”
- Kitchur, 2005
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Developmental trauma.
• Abuse, neglect, instability
• Early childhood illness
• Family breakup
• Family dynamics
• Intergeneration physical and mental health problems
Mark Grant. MA, MAPs
Effects of developmental trauma.
• Co-morbid cluster C symptoms
• Avoidant, Dependant, Borderline
• Emotional regulation problems
• More likely to dissociate
• Relationship problems
• Identity issues (defective schema)
Mark Grant. MA, MAPs
Co-morbid problems.
• Depression• Anxiety• Personality disorder• Insomnia• Substance abuse• Other health/medical problems• Life circumstances • Adjustment problems
Mark Grant. MA, MAPs
Narrative (client’s story).
• Problem: What is client’s definition of presenting problem? How well does it fit the facts?
• Client: What does way client talks about problem indicate about their coping style/capacity?
• Goals/expectations: What do they really want? Or need
• Resources: What resources are discernible?• Entry point: Where might you begin?• Preparation: What inputs might be necessary
prior to desensitization?
EMDR ‘targets’
Mark Grant MA
Event NC
PAST TRAUMA:
Car accident I can’t cope
Having to live with abusive ex-wife while recovering from injuriesNeeding breathing apparatusFailed marriage
I’m trapped
I’m helplessI’m a failure
PRESENT STRESS:
Freeway phobia I’m out of control
Mark Grant. MA, MAPs
Narrative (client’s story).
• Problem: What is client’s definition of presenting problem? How well does it fit the facts?
• Client: What does way client talks about problem indicate about their coping style/capacity?
• Goals/expectations: What do they really want? Need
• Resources: What resources are discernible?• Entry point: Where might you begin?• Preparation: What inputs might be necessary
prior to desensitization?
Psychology of Workers Insurance.
Loss of;• control•Privacy•Freedom/choices (feels trapped needs the benefits and treatment but) •Health/physical integrity•Future•Safety
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
How much history?
“ask for only the most basic facts, the bare minimum that will allow us to proceed with the case formulation.”
- Greenwald, 2007
History-taking.
• A process of both gathering and uncovering information about the client
• Includes verbal and non-verbal information• A function of the therapeutic relationship (eg; safety)• Also part of therapy (eg; developing a narrative)• Not necessary to complete prior to reprocessing• May continue well into therapy• Pacing is important• Goal-oriented
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Case conceptualization.
Physical pain
+ – injury/illness– Trauma– Family problems, Neglect– Comorbid problems (anxiety, depression)– Current stressors– Personality factors– Resources
Mark Grant. MA, MAPs
The Pain Pyramid.
Assessing personality
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Ego strength
• Ability to; engage in satisfying relationships, • experience a relatively full range of age-expected
feelings and thoughts, • function relatively flexibly when stressed by external
forces or internal conflict, • have a clear sense of personal identity, • are well adapted to their life circumstances, • neither experience significant distress nor impose it on
others.- Psychodynamic Diagnostic Manual
Mark Grant. MA, MAPs
Defence mechanisms.
• Denial ‘Primitive’• Dissociation• Projection• Somatization• Masochism• Repression• Sublimation (Hyperactivity - manic defence)• Intellectualization• Humour ‘Sophisticated’
Mark Grant. MA, MAPs
Personality disorders and pain.
Avoidant Control issues *Trust and safety issues *Hypervigilance *
Borderline Affect regulation problems *Propensity to dissociate *Fear of abandonmentLack of support *Identity issues *
Histrionic High emotionality *Attention-seeking behavior
Dependant Submissive *Needing to cared for by othersFear of separation
Trauma related symptoms
• PTSD symptoms (increased physiological arousal etc)• Dissociative symptoms• Affect regulation problems• Somatization• Depression• Relationship problems• Identity issues
- van der Kolk (1996)
Mark Grant. MA, MAPs
Brain Hemispheric Differences
LH RH“what?” “How?”Inflexible FlexibleNarrow focus attention open, sustained attentionPrefers known Likes novelty - Never fully knownEmotionally - Anger Emotionally - DepressionSelf= act of will Self in relation to othersDenotative language metaphors, symbolsCompetitive , exploitative EmpathicSequential processing Parallel processingDecontextualized world “Lived world”
Acknowledgement: Ian McGilchrist (2009)
Mark Grant
Mark Grant. MA, MAPs
Problem of pain
Pain:
•A stressful, often traumatic event
•Exacerbates pre-existing trauma
•Overwhelms coping mechanisms
(medical model):
“not my problem – the doctor should fix me”
The medical model:
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Traumatic pain vs medical pain
• Traumatic pain:
A memory (‘past’)
“Stored memories related to etiology of pain”
Emotional distress with or without injury
Pain = maintained by memory • Medical pain:
An event (‘present’)
“Automatic emotional response to pain”
Pain = maintained by physical injury
Goals of treatment
“ EMDR treatment of chronic pain includes the processing and desensitization of both; •the automatic emotional response to the pain sensation and, •the automatic components of the stored memories related to the etiology of pain.”
- Mazzola et al, 2009
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Pain + trauma
Mutually exacerbating problems, comprising physical and emotional factors, past and present experiences, which involve;
- Intrusive thoughts and feelings, avoidance, numbing
- Autonomic dysregulation, (sleeping problems, fatigue)
- Emotional dysregulation, (depression, hyper-sensitivity, mood swings)
Mark Grant. MA, MAPs
Pain + injury
Pain +
Effects of pain:on physical functioning
(‘work, love and play’)sleepmoodrelationshipscopingidentity
Mark Grant. MA, MAPs
My 5 “secret” assessment criteria
1. What is client’s affect range/capacity2. What is client’s medical diagnosis? (if
applicable)3. How much is person able to distance
themselves consciously from their problem?4. Personality (strong, stable?)5. Life circumstances (stable?)
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Pain Tests.
• Impact of Event Scale (Horowitz, et al, 1979)• Pain Disability Index (Chibnall & Tait, 1994)• Beck Depression Inventory• Beck Anxiety Inventory• Pain Catastrophizing Scale (Sullivan et al,
1995)• SFMPQ, VAS• Pain Self-Efficacy Questionnaire (Nicholas,
1989)
PPI vs affect in SFMPQ
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Stage 2. Preparation
1 History2. Preparation3 Assessment4. Desensitization5 Installation6. Body Scan7. Closure8. Re-evlaluation
Mark Grant. MA, MAPs
Preparation
• Therapeutic relationship
Transference & counter transference
• Safety and containment issues
Pain control
Safe place (if necessary)
• Medical issues
• Explanation of EMDR
Mark Grant. MA, MAPs
Transference
" A person seeking help for chronic pain could be said to be inactive with secondary physical deconditioning, to hold unhelpful beliefs, to be overly passive or reliant on others for resolution of his/her problems.."
-Nicholas, (1996).
Mark Grant. MA, MAPs
Transference and countertransference
Therapists are always influenced by their patients:
“We hope for the best; we are saddened by their [patients] failures, gladdened by their accomplishments; and we suffer real losses when they complete therapy”
- Beitman (1983)
Mark Grant. MA, MAPs
How to recognize your transference
1. Emotional reactions:Frustration, Anger, Guilt, Shock, Pity, Sadness.
2. Ego states:‘Helpless child’, ‘Incompetent Failure’, ‘Rescuer’, ‘Omnipotent fixer’, ‘Critic’
Mark Grant. MA, MAPs
Uses of Transference
•Assessment tool•Facilitates therapeutic relationship•Facilitates clients exploration of feelings•Client safety•Therapy more likely to be aligned with clients capabilities•Professional development•Self-protection (avoiding burn-out)
Uses of Transference
T: I’d like you to think about some place that feels calm or safe.C: I’m on the beach. It’s a sunny day. The sand is warm and the ocean is calm.T: Bring up the image of that calm place, concentrate on the pleasant sensations in your body and follow my fingers… How do you feel now?C: I am not a good swimmer, I feel anxiousT: Feeling compassionate and hoping something else will work. Think of another place. (Client can’t find anything) T: Do you ever feel safe anywhere?C: Not really, no.
Mark Grant. MA, MAPs
Uses of Transference
T: I just noticed that I went numb all over my body. I’m wondering if you are feeling something similar.C: Yes as a matter of fact I am. Finding a safe place is such a simple thing, Why can’t I do it?T: It seems like the memory feels safe at first, but then an unpleasant memory intrudes and destroys the safety.C: I am beginning to realize that I don’t know what safety feels like. I don’t think I have every felt safe anywhere, with anybody.Does this mean I can never feel safe.. can’t do EMDR?T: We are doing EMDR right now…for people who don’t have a safe place we can work to develop that.
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Therapeutic relationship.
“The heart of the preparation stage is the feeling of trust that comes from knowing we’re engaged in the same task...”
- Mark Dworkin, 2008
Mark Grant. MA, MAPs
Safety.
• Adequate control over pain/affect
• Freedom from threat
• Secure living conditions
• Psychological safety (safe place)
• Access to support
Mark Grant. MA, MAPs
Explanation of EMDR
AIP model and pain
“Pain can occur for many reasons. We generally understand pain as a signal that something is wrong physically. However, sometimes pain can continue longer than expected, despite medical treatment. Pain can persist because of fatigue, stress, and biochemical changes. As a result of these changes, the pain becomes “locked” in the nervous system…
Mark Grant. MA, MAPs
Explanation of EMDR
AIP model and pain
You are not meant to suffer from pain indefinitely. Your nervous system is actually designed to process experience, including physical and emotional pain, so that once the injury that caused the pain is healed, everything returns to normal. EMDR is a way of stimulating the nervous system to facilitate healing. Even though we might not be able to completely eliminate your pain, EMDR often stimulates feelings of relaxation, which will help.”
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Stage 3. Assessment.
1 History2. Preparation3 Assessment4. Desensitization5 Installation6. Body Scan7. Closu8. Re-evaluation
Mark Grant. MA
Creating a ‘pain target’
1 What targets appear to have set groundwork for clients presenting issue?
2. What negative reactions does the client possess in the present that can be traced to experiences in the past?
3 Which of these targets appear to have potential to fill in deficits in the clients life and optimize a healthier level of functioning?
4. Is the client able to access these identified experiences and process them to successful resolution?
- Hensley, (2009)
5. What present physical discomfort is the client seeking relief from?
- Grant, (1998)
Mark Grant. MA, MAPs
Creating a pain ‘target’
Key question:
Where to begin..past, present or future?
(Based on client’s needs and readiness)
Either:
– Traumatic pain; targeting past memory
Or:
– Medical pain; targeting present pain
Mark Grant. MA, MAPs
Creating a pain target
1. Traumatic Pain:
- Image + pain
2. Medical pain
- Pain + image
3. Symptom-related memory
- pain-related traumatic experiences
(de-Roos & Veenstra)
Plus; NC, PC, SUD’s etc
Creating a pain target
Trauma or; Pain
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Trauma target (picture)
Memory:
“What incident or event comes to mind when you feel pain?”
Sensory:
“What does the pain feel like - how would you describe it?”
Mark Grant. MA, MAPs
Medical pain target (picture)
Sensory:
If the pain had a size, shape colour… how would you describe it?
Imaginal:
What does the pain feel like, what does it remind you of?
Can you draw a picture?
Trauma ‘Target’
Mark Grant
Pain ‘Target’
Mark Grant
Mark Grant. MA, MAPs
Negative cognitions (trauma and pain).
Lack of safety/vulnerability:– I’m helpless– I’m going to die
Lack of control/power*:– I‘m trapped – I’m helpless’ – ‘I can’t control it (the pain)’
Responsibility/being defective*:– ‘I’m weak’ – ‘‘There’s something wrong with me’
Mark Grant. MA, MAPs
Negative cognitions (effects of pain).
• ‘I’m worthless/useless’
• ‘I’m unloveable
• ‘I deserve to suffer’
• ‘I’m a burden’
• I’m a failure
Mark Grant. MA, MAPs
Positive cognition.
Trauma and pain (lack of safety/vulnerability) ;•‘Its over, I’m okay’•“I’m alright”•‘I survived’
Managing on-going pain (lack of control/power) ;•“I can cope”•“I can control my pain”•‘I will survive’
Effects of pain (responsibility/being defective) ;•I’m okay/I’m alright•I can still be useful
Mark Grant. MA, MAPs
Partial positive cognitions
• “Based on what happened today, what is the most positive statement that you can make about yourself?”
- Lazarov, 1996
• “What is the most positive thing you have learned about yourself today regarding your ability to control the pain?”
- de Roos, 2009
MVA victim (traumatic pain)
Mark Grant
Injured worker (present pain)
Mark Grant
Mark Grant. MA, MAPs
Stage 4. Desensitization
1 History2. Preparation3 Assessment4. Desensitization5 Installation6. Body Scan7. Closure8. Re-evaluation
Mark Grant. MA, MAPs
Desensitization checklist
1. Is the client mindfully present?2. Is the client experiencing affect?3. Is the client able to adopt detached observer
stance (distance)4. Informed consent (AIP rationale, ensuring client
understands what is happening)
Mark Grant. MA, MAPs
Set-up
“Okay, so now we are ready to see if we can help you to have less pain. So I’m going to ask you to listen to these tones whilst simultaneously focusing on your pain.
We can’t predict how your nervous system will respond to the EMDR stimulation, so try and adopt an open mind and just notice the sensations of your pain and let whatever happens happen.
Most people find it harder to concentrate on their pain, and start to feel more relaxed, but there is no right or wrong, just let whatever happens happen. Very rarely the pain can increase. In the unlikely event that this happens, just raise your hand like this (show stop signal) and I will stop.”
Mark Grant. MA, MAPs
Focusing/Dual Attention
“So just focus on the pain [or image] now, how you see it and where you feel it in your bodyAnd the negative thoughtAnd just notice..Just let whatever happens happen..”
Commence DAS/Bls
Mark Grant. MA, MAPs
Desensitization
1. Bls/DAS;auditory bilateral tones (recommended), (with eyes closed or open & fixated)eye-movements tapping.
2. Pause (optional) cease bls; “take a breathe”
3. Refocus attention;“what do you notice now?”“what seemed to happen then?”“What do you get now?”
Mark Grant. MA, MAPs
Types of responses to DAS/Bls
• sensory changes (reduced intensity)• perceptual changes (distancing effect)
“The pain seems smaller, further away”• cognitive changes (decreased worry, conc’n)
“it just doesn’t seem so important..”
Don’t just rely on client self-report; also look for;physiological changes▼ pain & tension (postural changes), changes in breathing rate / facial expression
•
Grounding questions
• As you’re telling me that what do you notice is happening in your body?
• Where do you notice the sensations in your body?
• How would you describe those sensations? (tight, hard, stiff, heavy etc)
• What feelings go with those sensations?
Mark Grant MA
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Target within target
Mark Grant. MA, MAPs
Blockages.
• “Nothing” or “no change” responses• Intellectualization• Increased pain• Unconscious fears• Medication• Dissociation• Other psychopathology• Strong Left Hemisphere
Dominance
Mark Grant. MA, MAPs
“Nothing” or “No change”
• “What do you mean by nothing?”
• “what were you feeling in your body whilst you were listening to the tones?”
• “Where was the pain while you were listening to the tones?”
• “What do you notice about how the rest of your body feels?
• “Some people notice feelings of distance, relaxation lightness, do you notice anything like that?”
• How does the pain feel now compared with how it felt before (present vs past dichotomy)
Mark Grant. MA, MAPs
Pain increases
If pain increases;
1.stop2.check with client, review diagnosis3.continue or - 4.Change treatment modality
Mark Grant. MA, MAPs
Unconscious fears
• “Is there any part of you that might need this pain?”
• “is there anything that might be stopping the pain from getting better?”
• "If there was an emotional contributor to this pain, what might it be?"
• “Is there something else your body needs in order to feel better?”
Mark Grant. MA, MAPs
Dissociation.
I. Use grounding techniques to bring client back into present.
II. Teach client how to self-soothe instead of self-injure/not feel
III. Teach client how to attend to their pain by showing appropriate care and concern
IV. Challenge feelings of unworthinessV. Develop self-soothing strategies
Mark Grant. MA, MAPs
Other psychopathology
• Dissociative Identity Disorder
• Bipolar Disorder
• Schizophrenia
• Autism
Strong Left hemisphere dominance
Mark Grant. MA, MAPs
Hemispheric Dominance Inventory
Study skills page,Middle Tennessee State University
http://frank.mtsu.edu/~studskl/hd/hemispheric_dominance.html
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Stage 5. Installation
1 History2. Preparation3 Assessment4. Desensitization5 Installation6. Body Scan7. Closure8. Re-evaluation
Mark Grant. MA, MAPs
Positive cognition.
Trauma and pain (lack of safety/vulnerability) ;•‘Its over, I’m okay’•“I’m alright”•‘I survived’
Managing on-going pain(lack of control/power) ;•“I can cope”•“I can control my pain”•‘I will survive’
Effects of pain (responsibility/being defective) ;•I’m okay/I’m alright•I can still be useful
Mark Grant. MA, MAPs
Partial positive cognitions
• “Based on what happened today, what is the most positive statement that you can make about yourself?”
- Lazarov, 1996
• “What is the most positive thing you have learned about yourself today regarding your ability to control the pain?”
- de Roos, 2009
Mark Grant. MA, MAPs
Resource installation
1. Focus on the image of the resource and the positive emotions and sensations that accompany that image (top-down)
2. Focus on strengthening the positive sensations that clients have when thinking about a friendship, safe place, etc. (Shapiro, 1995, Leeds, Kiessling 2005)
3. Focus on an image based on positive sensations client noticed following DAS/Bls. (Grant, 1998, 2009)
Mark Grant. MA, MAPs
Resource imagery/strategies
• Healing light/light-stream• Anesthetic mist• Breathing techniques
Strengthening pre-existing resources:• Skills• Friendships• Experiences• Linking pre-injury values with present functioning
Mark Grant. MA, MAPs
Stage 6. Body Scan
1 History2. Preparation3 Assessment4. Desensitization5 Installation6. Body Scan7. Closure
8. Reassessment
Body Scan.
•Look for changes in affective states associated with trauma but not directly targeted•Accept there may be residual pain when treating medical pain•Accept pain may return following successful ‘reprocessing’ of medical pain
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Body scan.
• If I ask you to mentally scan your body for pain or discomfort, what do you notice now?
• How do you feel in your body now?
• Whats there now where the pain was before?
• Review SUD’s – emotional distress
- physical pain
Mark Grant. MA, MAPs
Stage 7. Closure
1 History2. Preparation3 Assessment4. Desensitization5 Installation6. Body Scan7. Closure8. Re-evaluation
Mark Grant. MA, MAPs
Closure.
• Stabilizing client
• Expectations
• Homework
• Reinforcing possibility of change
Stabilizing client.
Completed session:•You’ve done well, see, you can learn how to feel different, you have learned something very important about yourself
Incomplete session:•You’ve made a good start, obviously it takes time to learn to feel different, but judging by the way you have responded today, I am sure you will continue to make progress•If you have any problems with your pain or trauma, you can always use your calm place, or the self-help CD.
Mark Grant. MA, MAPs
Expectations.
Traumatic pain;•Because your pain is associated with a trauma, processing the trauma often leads to a reduction if not a complete resolution of the pain. •We have no way of knowing. The important for you is to just have an open mind and let whatever happens happen.
Medical pain;•The work we have done today should have a permanent effect on your pain memories. In other words even though the pain might return, it will probably return in a less severe way so keep an open mind for changes in how you experience your pain.
Mark Grant. MA, MAPs
Reinforcing possibility of change.
• You might find that hard to believe, but you probably didn’t come here expecting anything much right?
• So its important to just have an open mind and try and observe your pain each time as if for the first time, and try and be aware of any subtle changes.
• When you’ve been in pain for a long time it seems like it can never change, but pain can change … it just has … so have an open mind let whatever happens happen.
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Re-evaluation
1 History2. Preparation3 Assessment4. Desensitization5 Installation6. Body Scan7. Closure8. Re-evaluation
Mark Grant. MA, MAPs
Re-evaluation.
• Reviewing changes since last session;
Have you noticed anything different about your pain and how you experience it?
Have you noticed any other differences in how you live your everyday life?
• Reviewing previous work;
How do you feel now when you think of what we worked on last time?
• Resuming reprocessing;
Mark Grant. MA, MAPs
Target within target
Mark Grant. MA, MAPs
Cognitive Interweaves for pain.
• New Information:
Do notice a feeling of distance.. or lightness..• Whose responsibility is it?;
Did you ask to be in pain?
Do you like feeling like a burden?• “I’m confused”;
If you’re really so worthless how come….• Stories of survival;
We all have the ability to overcome bad things• Socratic method;
Resource installation
1. Image (of a resource) + positive emotions and sensations that accompany that image (‘top-down’)
2. Strengthening positive sensations that clients have when thinking about a friendship, safe place, etc.
3. Pleasant bodily sensations (“some part of your body that feels okay, calm, comfortable”) + image
(Shapiro, 1995, Leeds, Kiessling 2005)4. Developing imagery based on positive sensations
client noticed following DAS/Bls (‘bottom-up’)(Grant, 1998, 2009)
Mark Grant MA MAPS
Somatic resource installation
‘The more capable the body is of being affected in many ways.. the more capable of thinking is the mind.’
Spinoza, 1650
Mark Grant MA MAPS
Key assumptions
• Usual AIP precepts• DAS/Bls is de-arousing for most people• You should expect clients to feel more relaxed,
decreased pain, more distance from pain following DAS/Bls
• If client fails to report positive changes, it indicates;1. Not set up right (problem with ‘target’)2. Problem with clients ability to process sensory
input3. You are dealing with pure pain (nociception)
Mark Grant MA MAPS
Somatic Resourcing Steps
1.Help clients identify and label positive changes in sensation following DAS/Bls
2.Utilize affective changes following DAS/Bls to create resource/antidote imagery for coping with future pain
3.Install and reinforce clients ability to utilize resources/antidote imagery
Mark Grant MA MAPS
Accessing questions (resources)
Mark Grant MA
Comfort words
Cool (vs Hot)Dull (vs Sharp)Soft (vs hard)Loose (vs tight)Light (vs heavy)Ebbing (vs pulsing)Flowing (vs stuck)Tingling (vs stinging)Easing (vs worsening)
Mark Grant MA MAPS
Accessing words
• “Safe”• “Comfort”• “Relief”• “Healing”
Mark Grant MA MAPS
Hypnotic installation
“you will notice that your head has gone quiet, that the usual thoughts and preoccupations are absent for the moment… just notice that … and how different it feels .. because things are usually so busy up there... just sitting in the chair, with nothing particular to think about. And physically you’ll notice a feeling of calmness.. or emptiness.. maybe a feeling of lightness.. and that your breathing has slowed down.. just notice that.
Mark Grant MA MAPS
Hypnotic installation
You probably haven’t felt this way for a long time because of everything you’ve had to deal with… but that’s normal. You’re not actually supposed to feel anxious and tense all the time. You are supposed to feel relaxed and carefree sometimes…. Imagine what life would be like if you felt like this all the time?”
Mark Grant MA MAPS
Self-use of DAS/Bls
Affect management tool rather than relaxation Not reprocessing – so no need for PC, NC etc Effective for stress, pain, insomnia, Training effect from in-session work Can also be used without audio equipment Usual precautions apply
Mark Grant MA
Self-use of DAS/Bls
• Pain control• Alleviating anxiety • Reducing worry• Alleviating insomnia• Stress management
Mark Grant MA MAPS
Accessing questions (for resources)
• What’s there now where the pain was before?• Can you describe that feeling in terms of a size,
shape etc?• What does that feeling remind you of?
(Suggest some possibilities if client is having trouble finding words to describe)
• What image would go with that memory/description?
• What word best summarizes that feeling/image
Mark Grant MA MAPS
Stories of hope
Mark Grant. MA, MAPs
Mark Grant. MA, MAPs
Summary of pain protocol differences
• History - Preparation:
- attention to medical history/diagnosis
- safety as freedom from pain/physical disability
- modified version of AIP• Assessment (Targeting):
- traumatic memory or present pain
- NC/PC; 3 x possibilities - trauma, pain and coping• Desensitization:
- reliance on auditory DAS/Bls
- partial positive cognitions, incomplete processing• Installation:
- addition of antidote imagery
- self-use of DAS/Bls
Pain managementResources based on EMDR
Mark Grant. MA, MAPs