Eye Movement Integration Therapy E-Book

Danie Beaulieu

• Herausgeber: Crown House Publishing
• Kategorie: Fachliteratur
• Sprache: Englisch
• Veröffentlichungsjahr: 2003

Seitenzahl: 672

Beschreibung

Eye Movement Integration Therapy is the first book on the subject, introducing one of the most innovative and effective new treatments available to psychotherapists today. "a splendid, coherent analysis" Marlene E. Hunter MD FCFP(C)

Leseprobe

Contents

Title Page

Acknowledgments

Preface

Chapter One The Origin of EMI

Introduction

I The originators of EMI

II Roots of EMI: Neuro-Linguistic Programming

Representational systems

Accessing: eye movements as cues to information retrieval

Altering processing with accessing cues

Eye Movement Integration

III Refinement of EMI: the author’s contributions

Experience and exploration: modification of EMI

Eye Movement Desensitization and Reprocessing: influence on EMI

Impact Therapy: adjunct to EMI

The state of the art: EMI in practice

Chapter Two The Application of EMI: Treatment of Traumatic Memories and their Consequences

Introduction

I The causes of psychological trauma

Defining trauma and traumatic stress

Research on the causes of psychological trauma

Biology of traumatic experience

II The consequences of traumatic memories

Extent of the problem

Psychological and emotional consequences

Intellectual costs

Physiological and health costs

Social and relationship costs

Financial and societal costs

III The treatment of distressing memories with EMI

The treatment dilemma

EMI treatment effects

Realistic expectations

Conclusions

Chapter Three Eye Movements and the Mind

Introduction

I Clinical observations and preliminary research

Clinical observations

Preliminary research findings

II Eye movements and vision during wakefulness

Visual fixation

Smooth pursuit eye movements

Saccadic eye movements

III Eye movements and thought processes

Thought content and direction of gaze

Neuro-Linguistic Programming

Lateralization and integration

Visual–linguistic integration

IV Eye movements and psychological disorders

Schizophrenia

Other psychotic disorders

Physical disruption of the brain

V Eye movements in sleep

Sleep stages and eye movements

Sleep and mentation

Possible implications for EMI

VI Eye movements and therapeutic effects

EMDR

Two minds

VII Summary and implications for EMI

Conclusions

Chapter Four Evaluation of the Client and His Social System

Introduction

I Evaluation of the client

Physical conditions

Psychological conditions

II Coping strategies of the client: past, present, and future

Past: established coping skills

Present: common defense mechanisms during therapy

Future: anticipating the client’s reactions to EMI

III Evaluation of the family and social systems: obstacles and resources

Evolution of family and support networks

Influence of family and support networks on therapy

Post-treatment modification of family and support networks

IV Planning the treatment

Time requirements

Frequency of treatments

Defining limits for a single session

Other concurrent problems

Presence of others at therapy

Additional therapy and counseling

Chapter Five Setting up the Therapy Session

I Preparation of the therapist

Position, attire, and voice

Focal point

Mental preparation

II Preparation of the client

Explaining the technique

Useful analogies

Creating and using a secure anchorage

Determining the visual range

A model of instructions to clients

Chapter Six Discovering the Memory Network

Introduction

I Selecting the starting memory

Intensity matters

Obscure memories

Unknown origins

Absent emotions

Mistaken beginnings

Dream memories

False memories

Phobias, mourning, obsessions, panic disorders, and other complaints

II Exploring traumatic-memory networks

Longitudinal networks

Distributed networks

Central dominant networks

Multiple networks

Including and excluding new circuits

III Describing the inner representation of memory

The factual content of the memory

Modalities and submodalities

Emotions and cognitions

Localization in space

Chapter Seven Eye Movement Integration

Introduction

I Using the eye-movement patterns

The basic patterns

The sequence of segments

Beginning the eye movements

Number, rhythm, and duration of movements

Technical details of the hand movements

Wandering eyes or fixed gaze

Uneven tracking

Enlarging a small frame

II During the movements

Verbal cues

Nonverbal cues—staging

III Between the movements

Gathering information

Exploring modalities

Working with “nothing”

Following the client’s preferred modality

Keeping it brief

Dealing with emotional or physical distress

IV Adjusting to client needs

When the process is not advancing

When the process goes “too fast”

Client questions

Using the individual map of accessing cues

Changing the target

Chapter Eight Completing the Treatment

Introduction

I Concluding EMI

Applying pattern F for complete integration

Using patterns G and H

Customized eye movements

Ending early—or not

II Anchoring

Last check and future projection

Eye-movement anchoring to consolidate the positive state

Alternative anchoring techniques

III Closing the session

Unanswered questions and comments

What to expect after EMI

Between multiple sessions

Staying in touch

Getting home after the session

IV Closing an incomplete integration

Plan enough closing time

Ensure the stability of the client

Present the results positively

Use the resourceful anchorage

Questions, comments, and explanations

Schedule another EMI session early

Phone contact

V Follow-up sessions

Assess the changes

Reassess the previous problem

Explore and treat new images, additional targets

Chapter Nine Meeting Challenges

Introduction

I When the process stalls

Staging

Shifting the frame

Reconsidering the chosen knot

Overcoming resistance

II When the integration is overwhelming

Facing strong reactions

Managing strong reactions

III Adding material

Choosing the right moment

Selecting the right material

Integrating the added material

IV Seeding new competencies

Sowing new experiences in real life

Drawing on Gestalt for resolution of unfinished business

Teaching new competencies with coaching

V Psychiatric populations

Considerations before therapy

Considerations during therapy

Special considerations in psychopathy and schizophrenia

VI Preventing traumatizing imprints

Averting encoding of experience as trauma

Protecting the therapist

Conclusion

Appendices

Appendix A Research Article

Appendix B Client Assessment Questionnaire

Appendix C Eye Movement Guide Sheet

Bibliography

Copyright

Acknowledgments

This book could never have been completed without the assistance, cooperation and support of many people. First and foremost, I am grateful to Connirae and Steve Andreas, not only for their generosity toward the psychotherapy community in developing and disseminating effective techniques like Eye Movement Integration, but also for their kind permission to write the first book about EMI, as well as all of their support and advice during the preparation of the manuscript.

Several other internationally recognized speakers, authors and trainers in the field of psychotherapy have also given me their wonderful friendship, encouragement, confidence, and the benefit of the worlds of knowledge they possess. My humblest appreciation goes to Jeff Zeig, Bernhard Trenkle, Ed Jacobs and Camillo Loriedo.

Writing a book in a language not my own was a daunting undertaking, one which was made possible by the patient collaboration of Heidi Hoff-Fortier, whose knowledge, professionalism, creativity, perseverance and autonomy made it a pleasure to work with her.

The vast clinical experience that informs this book is not mine alone, but also represents that of the many participants in my workshops. Their openness to new methods and willingness to break new ground has furthered the development and refinement of EMI as a comprehensive therapy. I thank them all for their ceaseless collaboration, endless questioning and for thousands of hours of illuminating conversation.

No therapist can master a new method without the active participation of her clients. My clients, and those of my trainees, have contributed largely to the advancement of EMI with courage and enthusiasm, and I am deeply grateful to all of them.

My wonderful editor at Crown House, Helen Kinsey, and her extremely capable team, including Caroline Lenton, Rosalie Williams, Tom Fitton and Clare Jenkins, have made the process of transforming a manuscript into a book seemlessly efficient. I am indebted to all of them for their meticulous work and unfailing professionalism.

For their unwavering patience during the preparation of this book, and for their support for all my projects and my whirlwind life, my sincerest love goes to my son Jordane and spouse Kevin.

With the book now in your - the readers' - hands, I look forward with high hopes to productive conversations with many of you, filled with feedback, suggestions and criticisms, that will assure the future improvement of this method.

Preface

It is an immense privilege to be a practicing psychologist in our era. Never before have we had such a range of effective treatments available to us, backed by an ever-deepening understanding of the nature of the mind and its disturbances. In the last twenty years, we have seen incredible changes in the way psychologists, physicians, and scientists approach the question of emotional and physical wellbeing, resulting in impressive progress in our ability to help our clients. The development of Eye Movement Integration therapy (EMI) is, I believe, among the most important contributions psychology has made to human society in modern times. It is a new technique of psychotherapy, merging insights and knowledge from formerly disparate fields into a coherent, flexible approach. Most significantly, EMI is rooted firmly in the belief that the human mind is endowed with powerful means of healing itself, if only we can trust them and find ways to facilitate them.

I feel fortunate to have learned this astonishing method during my search for greater efficacy in assisting my clients, and in my personal quest for a deeper understanding of the human mind. For so long, all of our good will, caring, and therapeutic skills were too often insufficient to alleviate the distress of people living with unresolved memories of traumatic events. Whether labeled shell shock, hysteria, depression or PTSD, the daily struggle of these individuals defied resolution in too many cases. But now, with EMI, there is reason for optimism.

EMI is the most effective method I have used for accessing and integrating traumatic memories. It has the power to unlock recesses of the multisensory mind that would remain forever closed to talk therapy. Many people have difficulty talking about their traumatic experiences, arriving in the therapist’s office saying, “I can’t understand. This is stupid, I know [the trauma] won’t happen again, but … I can’t help feeling the way I do.” The more they try to express themselves, the more they feel inadequate, stupid, foolish—or crazy. After years of therapy, some clients feel hopeless and exhausted by both their problems and the efforts to overcome them. Talk hasn’t helped these clients, but EMI’s unique methods and characteristics can result in remarkable—and remarkably fast—healing of previously refractory traumas.

In light of the fact that I am not the originator of the method, I am humbled and honored by the opportunity to share this exceptional technique with my colleagues and students. Several years ago, when Steve Andreas (who developed the method with his wife Connirae) first proposed the idea of writing a book about EMI to me, he told me that he was unfortunately too occupied with other projects to find the time required for such an undertaking. Given that I felt this therapy to be every bit as important as the advent of penicillin, I could not conceive of its not being made widely available. With Steve’s encouragement—and his confidence that my background, experience, and enthusiasm would see me through—I embarked on the adventure of writing what we both agreed was a much-needed book. I felt that I simply could not let this important work be further delayed because of side issues, knowing as I do that many therapists are searching, as I was, for effective solutions to persistent problems. The healing power of EMI is just too astounding to let it remain a well-kept secret. It is worth remembering that, when penicillin was put into common use, its mechanism of action was not understood. But it was understood that it saved lives. The reader will therefore find many questions and hypotheses in this book, and may discover even more when he begins using EMI in practice. But it is my hope that the magic of the results and the process will outweigh any doubts, as it has for me, for the professionals I have trained and for our clients whose lives have been transformed.

This volume is designed to be both introductory text and clinician’s guide to EMI therapy. It is not intended to replace training with an experienced EMI therapist or supervised practice within a training program. Likewise, because the material recorded in a person’s memories can have complex psychological effects, only trained psychotherapists, with a full range of other methods available to them and an excellent understanding of the complexities of trauma, should undertake EMI therapy.

I have arranged this book to serve its dual purposes by providing information on the development and underlying concepts of EMI therapy in the first chapter. Chapter Two presents a brief review of our current understanding of the nature of traumatic memories, their impacts on wellbeing, and the utility of the EMI approach for their resolution. The interrelationship between eye movements and thoughts is explored in Chapter Three, including a discussion of the various psychotherapeutic approaches that have made use of this fascinating interrelationship. Chapters Four, Five, and Six guide the reader through the groundwork that precedes an EMI treatment session. These three chapters present, respectively, the pretreatment assessment process, the preparation of both client and therapist for EMI, and the selection of the initial targeted memory. The heart of the method is covered in the next two chapters: Chapter Seven describes in detail how to conduct an EMI session, while Chapter Eight presents extensive information on closing a session, completing treatment, and providing follow-up. Advanced techniques and advice for working with challenging situations or clientele are offered in the final chapter.

As the first book written about EMI, this volume cannot be considered the “final version” of the treatment, nor can it provide all the answers to the numerous questions that EMI raises. My goal in writing it has been to make EMI available to more therapists, so that they can add this incredible tool to their clinical repertoire. It is my fond hope that some readers will be inspired to add their expertise to the further development of EMI, and to explore the full range of its applicability. I would also be delighted if this book provided food for thought to academicians hungry to learn more about the mechanisms of memory and the interlocking lattice of the multisensory experience.

Chapter One

The Origin of EMI

Introduction

Marc was referred to me about five years after prison inmates took one guard and three other prisoners hostage at the maximum-security penitentiary where Marc was a guard on the crisis-management team. The hostages had been tortured savagely during the long negotiations before the gymnasium, in which the hostage takers had barricaded themselves with their victims, was finally forced open. Marc was the first guard on the scene, and the first to confront the horrifying vision of the mutilated corpses of the three hostage prisoners and the appalling wounds of the guard, Jean. Marc’s friend and co-worker lay with burns covering every exposed inch of skin, the result of torture with cigarettes and lighters. Later, Marc was to recall most distinctly the intense concentration of energy that was required to deal with the psychopathic inmates, the long minutes as he carried Jean in his arms to the infirmary, and the clean-up of the pieces of brain tissue and smears of blood from the walls and floor of the gymnasium.

When I met him, Marc had not been able to work for the past three years, disabled by a tremor in his right arm that had developed progressively as he attempted to maintain his self-appointed role of protector of his fellow guards—helping them recover from the trauma of the hostage incident and continuing to be the first to take action whenever there was trouble. He had been examined by a neurologist and told that the tremor was a permanent condition for which no treatment was offered. The tremor worsened whenever a conversation with old colleagues or the sight of passing prison trucks reminded him of the hostage crisis.

Even without the shaking in his arm, it is doubtful that Marc could have held a job at that point: he was suffering severe symptoms of posttraumatic stress that several attempts at psychotherapy had been unable to improve. He was plagued by frequent nightmares, paralyzing flashbacks, outbursts of rage, and fits of depression. He had become sexually impotent, violent toward his wife, completely impatient with the slightest provocation. Marc reacted most strongly to the sight of men with tattoos or men who, according to his view, “looked like criminals”. As his symptoms worsened, he had self-medicated his pain with alcohol and drugs, and eventually spent many weeks in a psychiatric ward for treatment of his suicidal tendencies. By the time I saw him, it was clear that he held out no great hope that yet another psychologist with yet another new form of therapy would be able to help him.

In our first session, we discussed Marc’s background, the nature of his current difficulties, the effects of his problems on his family and social life. I explained to him how Eye Movement Integration works, and the type of reactions he might experience, and he agreed to return the following week for the first treatment. During that second session we began EMI with Marc focusing on his most intense memory—the first impression he had when he broke through the gymnasium door and saw the devastation. For ten seconds or so, Marc’s eyes tracked the movement of my hand, leading him in a series of horizontal, vertical, and diagonal patterns, while he concentrated on his memory. After each segment of eye movements, we paused briefly, and Marc told me what was in his mind.

During sequential eye movements, Marc revived many associated impressions of terrifying and appalling situations at the prison, and the fury he felt toward the inmates who were capable of such brutality. However, as he continued to track my hand movements with his eyes while thinking about Jean, for the first time his thoughts contained elements of emotional satisfaction. Letting go of his entrenched belief that it was all his fault, that he should have taken action earlier, he was able to realize that it was the psychopathic prisoners who were the source of the horror, that he had done everything he could, and that Jean had been placed in good hands. Although it was emotionally wrenching at times, by the end of an hour and a half of integration, Marc felt real relief. Immediately after the integration, as we were reviewing the results together, he looked down at his hands—which were not trembling now—and exclaimed, “Hey! I won the lottery!”

In the weeks following the first treatment, Marc’s sexual potency returned, and he began to feel more in command of his reactions. Although the trembling in his right hand occasionally returned, it was no longer uncontrollable. He began to perceive the tremor as a signal that he should switch his attention away from his experiences at the prison. Not surprisingly, though, certain aspects of the experience still caused him pain, and when he returned for the third session we chose to work on the most pressing remaining problem.

One of the triggers of his outbursts of fury seemed to be the particular yellow-green color of his little girl’s plastic scissors. At the mere sight of them, Marc would fly into a wild, inarticulate rage. After such outbursts he was devastated and exhausted, barely able to stand, and would spend most of the remainder of the day lying down on the couch. Beginning with that situation in mind and following a few eye movements, Marc suddenly recalled that the color of Jean’s burned skin was the same vivid yellow-green as the scissors. Although some progress had been made in the previous session, a strong visual association persisted. Subsequently, when I asked him to picture a good memory of the yellow-green color, he mentioned that, when he was young, his mother had hung some cheerful yellow-green floral curtains in the kitchen. When asked to hold both images in his mind—the original scene where he found his friend covered with yellowed burns and the picture of the kitchen curtains—Marc was astonished at the image that suddenly sprang to mind: he saw his friend Jean, lying comfortably in a garden of yellow flowers, with a wide smile on his face. In the next segment of eye movements, Jean was waving goodbye as he drove off, still smiling. Marc felt an unburdened lightness at the conclusion of that day’s work, and had no further problems with his daughter’s plastic scissors.

A total of six treatments were needed to overcome the entirety of Marc’s original trauma. At one defining point toward the end of the integration, he saw himself walking out of the prison, waving goodbye, as if it was all over. Previously potent triggering stimuli had lost the power to provoke flashbacks or anger, and Marc was able to perceive “criminal” types more objectively and calmly. The trembling in his hand had become almost nonexistent as fewer and fewer situations triggered distress. Today, Marc is employed in the information-technology industry, no longer uses any drugs or alcohol, and enjoys a renewed happiness and vigor in his relationship with his wife.

* * *

One of the objectives we share as psychotherapists is to help our clients as quickly and efficiently as possible. Numerous therapeutic approaches are used to help suffering clients surmount and resolve a myriad emotional and mental difficulties, with various degrees of success. However, some of the presenting complaints that we encounter are more difficult to face and more difficult to heal: the victims of violence and abuse who are trapped in an endless cycle of flashbacks and nightmares; the young college student who has been rejected by her boyfriend, and is despondent to the point of suicidal thoughts; the retired engineer whose wife has died of cancer, and who remains fixated on the injustice and prematurity of her death; the businessman whose life is “absolutely great”, except for the persistent pain in his back and the unremitting headaches for which doctors can find neither cause nor solution; and people like Marc, who have seen true evil, up close and personal.

The distress of these clients elicits our deepest sympathy and desire to help, and yet we are often frustrated in our attempts to do so. Traditional forms of counseling and psychotherapy—which generally entail talking with the client about his problems at length—assume that the cognitive processes will eventually permit the client to arrive at a healthier understanding of his situation, and to develop appropriate behaviors. Even when cognitive therapy helps, it often takes too long for those who endure intense anguish and who await alleviation of their symptoms. Statistics on usage of mental-health care indicate that clients remain in therapy for an average of only five appointments (Weiner-Davis, 1993). If no concrete progress is evident in that period, we are simply offering too little, too late. And some clients, like those described above, have problems that are almost inaccessible by cognitive means and therefore experience limited improvement with purely cognitive interventions, no matter how many hours they are seen. What can we offer those whose reactions are at the level of reflex, not involving thought at all? Marc’s enraged response to his daughter’s yellow-green scissors was so rapid and intense that it seemed to preclude thought entirely. And what can we do for a client who assures us that his life is “absolutely great”, but whose body is screaming a contradictory message?

What is called for, in these and many other situations, is a therapy that does not require the client and therapist to reveal, analyze, and comprehend every aspect of the various causes and effects of the distress. Clinging to the expectation that the rational mind is capable of resolving all problems dooms therapists to frustration—and too many of our clients to a lifetime of supportive therapy and medication that control, but do not relieve, the pain. But the human mind is capable of much more than purely conscious, cognitive processes. All the specialized sensory organs feed endless information into the brain, via the thalamus, and thence to the central integrator of the hippocampus, to the emotional hub of the amygdala and the infinite complexity of the cortices. The recordings of all the events—major and minor—of our lives are retained in distributed, multisensory form somewhere in our brains. Our conscious cognitive processes can lead us to only the smallest fraction of this information. The remainder—the vast majority of the information recorded and stored in multisensory and emotional form—continues to have profound and subtle influences on all of our behavior.

How can we tap into this rich mine of experience and memory, and recruit it to the benefit of our clients’ mental health? Is there some system by which we can activate these resources, which naturally and constantly help us to adjust to the stresses of life? This is the hope that EMI offers. By facilitating access to the individual’s associated memory networks, and unleashing the power of internal multisensory experience, EMI promotes a process of self-healing that is “made to measure” for each person and for their specific difficulty. It relies, implicitly, on an internal, homeostatic regulator to help find and retrieve the information that will help the client adjust to whatever bad experience or situation brings them into the therapist’s office. It is not a miracle, not a trick, not a gadget or a gimmick, but rather an amazing technique that has been in use for over thirteen years, and has been continually refined during all that time. It wasn’t invented in the blink of an eye, or inspired by a dream, but was carefully created by two highly skilled developers of Neuro-Linguistic Programming (NLP). This chapter will present the roots of EMI, from the fundamentals of NLP and the devoted work of Connirae and Steve Andreas in developing the technique, through the modifications I have made, including the influences of other therapies.

I. The originators of EMI

Effective new therapeutic methods arise from experience and ingenuity, two characteristics that Connirae and Steve Andreas possess in abundance. When they developed EMI in 1989, it was the latest of an extensive list of innovative therapeutic techniques that they had developed. Motivated by the desire to assist people in the process of personal change, Connirae and Steve have consistently sought the most effective and practical solutions to address issues as diverse as accepting criticism constructively; patterns for forgiveness, guilt and grief; evolving family relations; improving job performance; and establishing or pursuing life goals. Their educational backgrounds—Connirae Andreas holds a PhD in psychology and Steve Andreas an MA (studying under the tutelage of Carl Rodgers)—provided the starting place, but it is their pursuit of clinical effectiveness that guides their work.

Steve’s curriculum vitae reads like a road map to unexplored territory. From his early days as a polymer chemist (already making linkages between discrete entities!), to his first teaching experiences in psychology, he followed a path of his own making. As a rising star in the world of Gestalt therapy, under his previous name, John O. Stevens, he worked with both Fritz Perls and Virginia Satir. Later in his studies with Richard Bandler and John Grinder, the founders of NLP, he ventured further into the frontier regions of psychology. Always breaking new ground, he established his own publishing company in 1967, Real People Press, with the specific objective of putting into print works in new areas of psychology and personal change. When NLP began to take form as a discipline, Steve edited and published Bandler and Grinder’s fundamental book, Frogs Into Princes: Neuro-Linguistic Programming (Bandler and Grinder, 1979). In the same year, Steve and his wife, Connirae, started their own institute, NLP Comprehensive, for training and certification of NLP practitioners, and to offer the power of NLP to any who were interested. Since then, Steve has become an internationally known speaker and NLP trainer, in addition to his work as an editor and author. As Steve has been known to say, “I’m a searcher, not a researcher,” and his life quest has been to find ways to help people blaze their own trails. Steve’s journey has included numerous books, the latest of which is Transforming Your Self: Becoming Who You Want To Be, an amazing guide to self-discovery and change (Andreas, 2002).

Connirae has followed a more direct path, with a clear vision of her role as a therapist, a researcher, and a trainer, and it is she who took the lead in developing EMI. The warmth, skill, and insight she brings to bear in every sphere of activity have made her a much-sought-after and respected educator. Connirae’s research and development efforts have made contributions to many aspects of NLP. She has left her mark in numerous articles and books. Among others, Connirae has co-authored the groundbreaking book Core Transformations with her sister Tamara (Andreas and Andreas, 1994). With Steve, she co-wrote Change your Mind and Heart of the Mind, in which they explain numerous NLP techniques that they had either created or modified (Andreas and Andreas, 1987, 1989).

EMI developed as a part of their never-ending search for what works. As we will see in the next section, their thorough knowledge of NLP, combined with Steve’s willingness to go into unknown territory and Connirae’s more analytical approach, permitted them to recognize and harness the power of eye movements to facilitate change.

II. Roots of EMI: Neuro-Linguistic Programming

When John Grinder and Richard Bandler began the collaboration that gave rise to the field of Neuro-Linguistic Programming (NLP), they constituted a formidable team of a linguist with an interest in behavior and a mathematician with training in Gestalt therapy. This rare combination of interests, training, and skills drove the research that built the foundations of NLP. In 1974, they set out to construct a model of language patterns and behaviors that made some therapists remarkably effective. Two essential elements of their approach to the study of effective behaviors were the observation of behavior with astonishing attention to detail, nuance, and patterns; and the codification of those observations into reproducible, teachable methods. Their early books, The Structure of Magic, The Structure of Magic, Volume II, and Patterns of the Hypnotic Techniques of Milton H. Erickson, M.D., they analyzed the behavioral strategies of three legendary psychotherapists: Milton Erickson, Fritz Perls, and Virginia Satir (Bandler and Grinder, 1975a, 1975b; Grinder and Bandler, 1976). The groundwork of NLP is largely derived from observation of the effective communication methods that these therapists used to lead people to make changes in their lives.

Widely acknowledged as one of the most important figures in the field of hypnotherapy, Milton Erickson was also responsible for developing an entire style of therapeutic intervention that integrates nonverbal communication, pacing, and leading—three mainstays of NLP. Fritz Perls was the originator of Gestalt therapy, in which the sensory aspects of experience are regarded as of equal importance with the cognitive, and the separation between body and mind is regarded as artificial. Gestalt techniques are designed to be experiential rather than intellectual exercises, and the goal of therapy is to reach full awareness of the “here and now”, without avoidance or undue influence from the past. NLP derives its emphasis on nonverbal cues and sensory experience in part from a close analysis of Gestalt methods. Satir’s specialization in family therapy and interpersonal dynamics likewise influenced the development and early applications of NLP. Bandler and Grinder demonstrated that part of the secret of the “magic” that Perls and Satir created with their clients depended on their innate abilities to observe, pace, mirror, and modify the behavior that the clients displayed during therapy sessions. While Perls’s and Satir’s effective behaviors were mostly unconscious, Bandler and Grinder found that if other therapists adopted the same behaviors they could achieve similar results with their clients. These original investigations concentrated on modeling the behavior of highly competent individuals and creating a useful analysis of those behaviors that correlated with their effectiveness. Eventually, that work led them to study general patterns of subtle behaviors; in particular, it led them to an awareness of the representational systems and accessing cues.

Representational systems

As the term Neuro-Linguistic Programming implies, this branch of psychology focuses on the relationship between the linguistic representation of our world and the neurologic representation, and the “programs” by which these two representational systems interact to produce behaviors. Essentially, it is a field of behavior modeling devoted to the study of the structure of subjective experience. NLP recognizes that all human mental processes are neurologically based, and that experience is essentially the synthesis of all the information that is received and processed through the nervous system. Language—the means by which we communicate our experience to other people—is an imperfect translation of that internal, neurologic representation. Words serve as triggers that permit access to internal meanings, which are represented in sensory, emotional, and cognitive terms; however, the specific information accessed in response to a given word is unique to each person.

One of the principles underlying NLP is borrowed from the father of general semantics, Alford Korzybski, who stated, “A map is not the territory it represents, but if correct, it has a similar structure to the territory, which accounts for its usefulness.” In NLP shorthand, we say simply, “The map is not the territory.” Korzybski recognized that we do not experience objective reality, but rather our perception of that reality—our “map” (Korzybski, 1995). Our perception of reality is the aggregate of the information collected by our senses and processed by our internal representational systems. The sensory systems of the body act as both conduit and filter of information. The information collected is also stored in the five anatomically distributed sensory modes: visual, auditory, gustatory, olfactory, and kinesthetic, with associated emotional and cognitive connections.

The nature of our maps of reality—our internal representational systems—is consequently multisensory and multifaceted. All mental functions, as described in NLP theory, involve sequences and networks of sensory information. Memory, learning, decision making, motivation, creativity—even dreams—are all dependent on a structured, ordered pattern of sensorial information processing, which forms the program for each mental activity.

Accessing: eye movements as cues to information retrieval

The mental process of seeking and associating information in disparate sensory modes and in different neuroanatomical sites is referred to as an accessing strategy. An individual’s accessing strategy, in any given cognitive task, is reflected by and affected by subtle behavioral and physiological changes, which NLP refers to as accessing cues. These include such observable behaviors as gestures, facial expressions, breathing patterns, voice tones, flushing, head movements, posture adjustments and eye movements; as well as physiological changes that are difficult or impossible to observe casually, such as altered heart rate, respiration, perspiration, and muscular tension. Among these accessing cues, eye movements are most easily observed and most consistent among different populations and cultures.

Robert Dilts, one of the early students of Bandler and Grinder, focused on eye movements as a behavior to be observed and modeled, and devoted substantial effort to decoding the meaning of eye movements as accessing cues. Beginning with what had already been learned about the lateralized organization of the brain, and the tendency of eye movements to reflect the type of information accessed, Dilts conducted experiments to further refine the mapping of eye movements on the informational landscape of the mind. Dilts recognized that the mind might differentiate between not only the sensory/cognitive mode in which information is available, but also whether that information is part of memory (recorded) or imagination (constructed). While tracking both eye movements and electroencephalogram with electrodes, Dilts asked each subject a set of questions designed to elicit visual, auditory, kinesthetic, or visual information, from either a memory or a mental construction. From his recordings and subsequent observations, Dilts was able to recognize a prevalent pattern of eye movements as associated with different types of processing (Bandler and Grinder, 1979; Dilts, Grinder, Bandler, and DeLozier, 1980) (see Figure 1.1).

While making no claim that the described pattern is universal, Dilts, Bandler, and Grinder determined that careful observation of any individual will reveal a more or less consistent pattern of eye movements that that person unconsciously makes when activating different sensory modalities in their thoughts. In fact, the pattern described above is sometimes reversed in left-handed people, and may be organized quite differently in ambidextrous individuals. No matter what pattern of eye movement accessing cues a person follows, however, they will systematically use the same movement when accessing the same sensory mode.

Figure 1.1: Eye accessing cues

Up and left: Nondominant hemisphere visualization; i.e. remembered imagery (Vr). Seeing images of things seen before, in the way they were seen before. Sample questions that usually elicit this kind of processing include, “What color are your mother’s eyes?”, “What does your coat look like?”

Up and right: Dominant hemisphere visualization, i.e. constructed imagery and visual fantasy (Vc). Seeing images of things never seen before or seeing things differently than they were seen before. Questions that usually elicit this kind of processing include, “What would an orange hippopotamus with purple spots look like?”, “What would you look like from the other side of the room?”

Lateral left: Nondominant hemisphere auditory processing; i.e. remembered sounds and words, and tonal discrimination (Ar). Remembering sounds heard before. Questions that usually elicit this kind of processing include, “What’s the last thing I said?”, “What does your alarm clock sound like?”

Lateral right: Dominant hemisphere auditory processing; i.e. constructed sounds and nonsense words (Ac). Hearing sounds not heard before. Questions that tend to elicit this kind of processing include, “What would the sound of clapping turning into the sound of birds singing sound like?”, “What would your name sound like backwards?”

Down and left: Internal auditory dialogue, or inner self-talk (Ad). Talking to oneself. Instructions that tend to elicit this kind of processing include, “Say something to yourself that you often say to yourself.”, “Recite the Pledge of Allegiance silently to yourself.”

Down and right:Kinesthetic feelings, both tactile and visceral (K). Feeling emotions, tactile sensations (sense of touch), or proprioceptive feelings (feelings of muscle movement). Questions to elicit this kind of processing include, “What does it feel like to be happy?”, “What is the feeling of touching a pine cone?”, “What does it feel like to run?”

Straight ahead, but defocused or dilated: Quick access to almost any sensory information, but usually visual.

(Adapted with permission from Trance-formations Grinder and Bandler, 1985)

Altering processing with accessing cues

Further experience with eye movement accessing cues revealed a reciprocal relationship between accessing cues and processing modes: eye movements indicate which sensory mode is dominant during a thought process, but also processing modes can be changed by changing eye movements. If a person’s gaze is guided in the direction of a different accessing cue from that which they would unconsciously use, the sensory mode in which they think about a given cognitive task may be altered. Connirae and Steve Andreas described these methods in detail in their book Heart of the Mind (Andreas and Andreas, 1989).

One line of evidence for the behavioral effects of changing sensory modes comes from work done by NLP practitioners with bad spellers. Having observed that many people with spelling difficulties gaze up and to the right when thinking about how to spell a word, practitioners realized that these people were probably accessing constructed visual imagery—in essence, trying out various possible spellings that could be used for a given word. Good spellers, however, will look up and to the left, accessing remembered visual imagery—looking for the remembered shape of the written word as they have seen it before. By guiding poor spellers to gaze up and to the left, copying the behavior of good spellers, it was found that their spelling performance improved (Andreas and Andreas, 1989).

Rarely does a situation evoke thought that is purely in one sensory mode. For instance, when listening to symphonic music, a listener might be constructing visual images of mountains and forests inspired by the auditory experience, then remembering a similar scene that she saw when hiking in the mountains, and finally feeling the kinesthetic sensations that she felt when she was there. In response to a trigger—a spoken word, or a passage in the music in our example—the sensory system first used to seek information is called the lead system, which characteristically will be accompanied by a brief corresponding eye movement. The representational system is that which is present in consciousness—the content that we would use to answer the question, “What are you thinking about?” Finally, many thought processes use a reference system to verify whether a given piece of information is valid or not. As a person’s thoughts progress from lead, to representational, to reference systems, their eye accessing cues will track the pattern of informational access. In our example, the lead system would have been auditory, as she listened to the tones of the music, while the representational system would be first constructed visual imagery, swiftly followed by representation in remembered visual imagery. Finally, the kinesthetic sensations induced by being in the mountains are an evaluation of the experience of being in the mountains.

The precise sequences of multisensory processing that people use when dealing with any situation may vary enormously. When choosing from a menu in a restaurant one person may read the words, visualize the food, have an internal dialogue with themselves about the characteristics of the food, and finally imagine tasting it and imagine the feeling of pleasure that the food might bring to them. Someone else, however, might proceed through a completely different sequence in making his or her choice, starting with taste perhaps, while yet another might first have an internal dialogue. Each person’s strategy is unique, and each strategy will influence the decision they finally make.

While in theory any individual can follow any sequence of thought, in practice each person tends to develop habitual sequences. Irrespective of context, they tend to consistently use one mode as their lead system, another as their representational system, and another for their reference system. While this is expeditious, it is not necessarily the best sequence for all contexts. A person who uses many different accessing strategies has greater flexibility in their approach to the varied experiences of life. By using different sequences of access to diverse types of information and processing, a distinct perspective can be gained.

Eye Movement Integration

Working from the premises given above, Connirae and Steve Andreas began to use guided eye movements to assist clients who were facing persistent problems that they couldn’t seem to resolve. The principle involved is that many limitations in a person’s life are internally generated, and are related to habitual modes of thought, i.e. to habitual accessing sequences. Changing the accessing sequence facilitates access to all the mental resources a client has at their disposal, including those habitually neglected. Altering the ordered sequence of thought disrupts the client’s limiting habits, permitting a fresh perspective on the problem to be reached. Notably, these modifications are not restricted to a verbal cognitive mode, as might be the case in therapy based on talking and listening alone. In talk therapy, the words exchanged do act as triggers for access to information, but the sequence of access will follow the habitual, ingrained pattern; that ingrained pattern has thus far not helped to resolve the problem the client is facing. With guided eye movements, the multisensory representations are accessed nonverbally, resulting in modifications of linkages that are derived from the full repertoire of sensory modes (as well as emotional and cognitive associations) of the internal representation. Because the therapist interjects no new information during the process, the changed linkages are also completely ecologic, having been generated on the basis of the person’s own mental resources.

The Andreases’ experience with this method led them to develop a distinct therapy, Eye Movement Integration, which they began teaching in 1989. The basic process of the treatment requires that the client hold in their mind a representation of the problem they wish to address and simultaneously follow a moving target with their eyes. As the therapist guides the client’s eyes into different regions of the visual field, access to different mental resources is facilitated, allowing the formation of linkages between formerly separated modes of information processing. The processing characteristics of the client’s habitual modes of thought are modified, permitting adjustment of their perception of the problem and its solutions. Again, the therapist’s role is limited to facilitation and monitoring of this internal process; he does not analyze, counsel, or in other ways attempt to control or influence the associations and connections that the client forms between the problem itself and ameliorating information.

Further experience with EMI led to the recognition that the clinical results they achieved were dependably positive for clients whose problems were related to unpleasant or traumatic memories, or to uncertainty or anxiety about the future. In both these cases, the thought process is heavily sensory in nature, and lack of integration of the sensory information could lead to distress. The methodological details of EMI therapy will be described in Chapters Four through Seven, including the components of the technique that I have added to create a comprehensive treatment. The underlying principles and the essential approach, however, remain as the Andreases developed them in the late 1980s. As described below, the revisions in the method derive from my own experience with several other psychotherapeutic approaches, striving always to achieve better efficacy and greater acceptability by the client.

III. Refinement of EMI: the author’s contributions

Experience and exploration: modification of EMI

I was first introduced to EMI in 1993, when Steve Andreas was an invited speaker at the Erickson Conference in Orlando and presented his technique. Curious to hear about this new eye movement treatment, I sat in on his workshop. The whole presentation lasted about an hour and a half at most. Steve briefly explained EMI to the audience and then did a live demonstration of his technique with a Vietnam veteran who had been suffering from painful flashbacks about five nights a week for over twenty years. I was definitely impressed by Steve’s skills as a therapist, and the apparent simplicity of his technique. I was also amazed by the results he had been able to get after only fifty minutes or so of treatment. Clearly, Steve could make EMI work, but it wasn’t clear to me how I could make it work for my clients. When I walked out afterwards, I must admit that my first impression was, What is this? It seemed just too strange, and I thought that it could not be possible to help anybody just by waving your hand in front of his or her eyes. To be completely honest, I was a little angry, thinking that I had wasted my time. I was also frustrated because the technique had not been extensively explained and described. (From my training, I was used to absorbing a good five hundred hours of theoretical information before putting it into practice!)

Over the next few days, I tried to analyze what I had seen in Steve’s demonstration. I could understand that, by being immersed in his memories, the client would recall different scenes and noises, or he would re-experience the emotions that were associated with the memory. But the surprising thing for me—and the most incomprehensible at the time—was the rapidity of the emergence of the information and its effects: the shift in the type of material recalled during each eye movement segment; the physical, emotional, and cognitive reactions; and, most of all, the strong manifestations of autonomic nervous system responses, which are not under the conscious control of the client, such as hot flashes, shaking and flushing. This was unlike anything I had seen before, so by the time I was back in my office, I had decided, “There must be something to this. Let’s give it a try!”

In spite of Steve’s inspiring example, my initial attempts to use EMI were not breathtaking successes. I started using the technique with an extensive range of problematic complaints, even though I had so little information to start with. However, as Vernon Law, ex-pitcher for the Pittsburgh Pirates, said years ago, “Experience is a hard teacher because she gives the test first, the lesson afterward.” I was often taken by surprise in these early experiences. It was—and still is—fascinating to see how quickly this technique can put the client right back into his memory of the trauma—mentally, physically, and emotionally—sometimes after only one single segment of eye movements. When these memories are associated with panic, dissociation, or nearly fainting, the “test” becomes quite astounding, and sometimes scary, for the client and for the therapist. Also, sometimes the information that was spontaneously emerging did not appear relevant to the disturbing memory, or at least I could not see the link, so I was not sure what to do with it. Should I keep going or return to the strongest memory? At other times, the initial memory targeted did not seem strong enough, or charged with enough emotion, to generate the new material I thought would be necessary to integrate or to wake up helpful synaptic associations. On yet other occasions, I simply didn’t know where to start.

Without answers to these questions, the results I obtained with the first clients I treated with EMI were variable. At best I was able to achieve amazing efficacy, but I was mostly in the dark as to why I was effective. At the other extreme I was landing on rocky ground, to the extent that two or three clients refused to continue the treatment, because it was just too painful to remain in full contact with their disturbing experiences. (I realized afterwards that these clients had one thing in common: the treatment was being given too soon after the trauma.) Whereas my “successful” clients felt some degree of relief on one or even many of the eye movement segments that I was asking them to follow, my “unsuccessful” clients experienced a lot of distress and turbulence, no matter in which direction the patterns led their eyes. Fortunately, I was trained in hypnosis, knew several relaxation techniques, and had a solid background in Impact Therapy (I’ll tell you more about this therapy technique in the following section), and was classically trained in cognitive-behavioral psychotherapy, so I was able to end these high-speed learning sessions without any harm to the clients or to the therapeutic relationship. Simultaneously encouraged and frustrated, I was certain of one thing at this point: that EMI had the potential to be one of the most effective procedures I had ever used.

I realized that there was more to this amazing technique than initially meets the eye. Somehow, Steve was using his training as a psychologist, a Gestalt therapist, and a master of NLP—and probably a lot of his own considerable natural intuition and charisma—to get results that I could achieve only occasionally for my clients. So I pursued the training that would help me develop more reliable protocols for working with a diverse clientele. I had no doubt that this was a fabulous approach to therapy for deep-seated problems, but I needed to know more about why and how the method worked, and exactly how to make it work every time. Shortly after my first experiences with EMI, I began attending workshops and reading a lot about NLP. Although my knowledge of the field is still not complete, I did find some very interesting tools and information to help me understand a little better what I was doing and why, and this naturally improved my ability to cope with some of the different situations I was encountering with my clients.

Based on this new information, along with my own observations and background, I started adding new components to the original method as I had learned it. My concern was always for the protection and benefit of my clients, because I recognized the power of EMI and knew that, if I could learn to use it well, I could help people in a way that no other therapeutic technique had allowed me to do. I began using a more thorough assessment of the problem, as well as of the client’s emotional resources and social environment, to help avoid some of the surprises that had come up during treatment. I also found it necessary to prepare the client for this new “neurotherapy” technique, by explaining how it worked and what he could expect. Indeed, for the client, the experience is totally different from what he might normally undergo during a more traditional psychotherapy, because it is really a means of activating unconscious neural networks to heal themselves. Rather than talk about his problems for week after week, he will briefly re-experience the initial trauma, with all of the associated multisensory memories. To reflect this difference, I call EMI a “neurotherapy” rather than a “psychotherapy”. These added precautionary measures of improved assessment and preparation helped the client to feel more secure, more engaged, and more in control in the process, all of which allowed me more flexibility to serve better the needs of each client.

I quickly discovered that I had to anticipate longer treatment sessions with EMI, compared with standard “talk” therapy, but, until my schedule was adjusted for it, I developed different ways to help the clients avoid the negative experiences that can accompany interrupted sessions. In addition, I used some of my NLP and Impact Therapy training to “anchor” the client’s final positive state, so that the treatment effects would endure. Adding all of these components to the established EMI protocol improved my clinical efficacy substantially and I felt more comfortable using it even with my most difficult cases. In retrospect, about half of the changes I made in the protocol were a codification and standardization of what Steve does by intuition and experience. The other half of the modifications are derived from my own experience and background. The combination provides readers with a powerful, flexible, dynamic therapy that can be safely offered to a wide variety of clients, even those with profound, complex and unresolved traumatic experiences.

Eye Movement Desensitization and Reprocessing: influence onEMI

Some time later, after I had been using—and modifying—EMI for a few years, I heard about Eye Movement Desensitization and Reprocessing (EMDR). Another technique for therapy using eye movements! What was this? By then it was 1996, seven years after the original publications by Francine Shapiro on her innovative approach (Shapiro, 1989a, 1989b; Shapiro, 1995). However, EMDR was still not very well known in Quebec, where I practice, since this province is mostly French-speaking and at that time workshops and training had not been offered here. Instead, I went to Toronto to attend the first-level EMDR training in October of that year and completed the second level in June 1997. It was fascinating to see the differences and the similarities between the two eye movement (EM) techniques.

Among the distinctions, EMI uses many EM patterns, in different directions, while EMDR usually maintains the same pattern (or segment) until no more change is observed in the client’s responses; only then does the therapist use a segment in another direction. In EMI, the movements follow the speed that the client chooses, while in EMDR they are done as fast as possible within the range of comfort of the client. There are also some differences in the protocol during and between the segments, such as the emphasis on conscious cognitive restructuring in EMDR, while EMI relies on facilitated multisensory integration to achieve a similar effect. Those readers who are familiar with EMDR will be able to see many of these differences as they read those sections of this book, and I will point out some as we go along. Being comfortable with both techniques now, and having experienced both on personal and professional levels, I suspect that they may share certain underlying mechanisms. Research on these mechanisms—their commonalties and differences—would be extremely interesting for what it might reveal about the healing processes of the mind and the intricacies of the structure of memory.

With regard to the similarities between the two methods, I must say that it felt good to find a method that shared my perspective about the importance of making a sound assessment of the client and the trauma before beginning the treatment. The trainers at the EMDR workshop also presented some warnings about use of the technique without supervision, with which I agreed wholeheartedly in light of my own early experiences with EMI. As is demonstrated in our preliminary clinical studies, included in Appendix A, clinicians who have attended the second level of EMI training tend to get much better results than those who have received the first level only. Now that I have been teaching EMI to therapists in my own workshops for several years, I can report that all of the attendees, once they have seen a demonstration of the technique, recognize the crucial aspect of supervision before trying it on their own with a client. In addition, most of them believe that both workshops, Level 1 and Level 2—which represent 32 hours of training—are essential for working with difficult populations and psychopathologies.

One more important similarity between the two approaches is their capacity to retrieve fully, in all dimensions, the intensity of the memory. The therapist is often as surprised as the client by the physical manifestations of the multisensory disturbances related to a traumatizing memory. Perhaps this will eventually become a significant contribution to the understanding of the human organism: to recognize that—behind a thin veneer of rational cognitive thought—the pain and the fear have been hiding, still trapped in the mind, the muscles, the nerves, and the body. When compared with most psychotherapeutic approaches, EM techniques do not give as much weight to the cognitive aspects of trauma, which are often responsible for restraining the otherwise overwhelming reactions (although, as I mentioned above, EMDR does have an explicit element of conscious cognitive restructuring). This self-protective rational aspect, however, may also be responsible for slowing down the process of integration of the memory of a trauma, or for the persistent manifestations that can remain locked away in the body.

I devote part of this book, as I do a part of my workshops, to offering strategies to the clinicians for dealing with these strong and sudden reactions that are part of some client’s reawakened experience. Some therapists—like Steve—are experienced enough to have the knowledge, the skills, and the charisma to face almost anything that comes up during EMI treatment. However, from having taught EMI to hundreds of trained therapists, I can affirm that most of them appreciate having some powerful and effective tools available that they can use when the client relives a difficult passage of their trauma, especially when there are strong physical expressions of the experience. This technique doesn’t generate these signs of distress, but it seems to liberate the physical manifestations of the traumatic memory and to let the body “speak”. Most psychotherapists aren’t used to witnessing their clients’ suffering bodily discomfort, but it is crucial that the therapist learn to handle it. Without knowing a few strategies for dealing with physical responses, the therapist risks slowing the process or even interrupting it, and—at worst—they risk letting the experience retraumatize the client.

Some observers of EMDR have argued that warning the client that he might suffer intense physical signs related to reliving his trauma—also called abreactions—actually gives rise to those very signs, simply by the power of suggestion. I disagree strongly with that perspective. Having worked with both techniques, I recognize that both have the same power to release a very vivid re-experience of the trauma, along with all the emotional and physical reactions associated with it. For instance, a woman who was bitten by a dog when she was six years old, and who was immobilized, dissociated, and close to fainting with fear when the dog jumped on her, cannot help but relive the panic and intense fear related to this experience during the treatment. Even though we help the client to separate past and present, the intensity is there, and, if we intend to modify the associations established with the memory, we must address that memory directly. EMI, like EMDR, works at the level of the neuronal traces containing the pathogenic material. Being prepared to face all that this implies does not create abreactions, but it does permit us to make the experience as helpful and smooth as possible.

Impact Therapy: adjunct to EMI