Working with EMDR

Monday, May 01, 2023 6:14 PM | Anonymous
Interview with Jim Arjani, LMFT by Liliana Ramos, LMFT, Director-at-Large

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Liliana: Hi!  Thank you for doing this interview.  Can you please tell us a little about yourself and your private practice.

Jim: I am an LMFT. I have a group practice, Mountain View Therapy, where I employ a few other LMFTs. We do a lot of trauma work and that’s partly because of my background. I used to work with veterans and the 129th Rescue Wing, which is part of the California Air National Guard. There’s a training at the VA—PTSD Clinical Training—that enhanced my knowledge and interest in the area of trauma. Before licensure, as a trainee and intern, I used to work at a therapeutic preschool, Building Blocks, which was part of Seneca Center. Many of these children had backgrounds marked by emotional, physical, and sexual trauma. So, when it came to my private practice, I had experience and interest in working with people who have experienced trauma.

Liliana: How many in your group practice?

Jim: I’m thinking of adding to my group practice. Right now, I have two other licensed therapists in my practice, and am planning to add associates; I have  started supervision training.

Liliana: Where did you go to school and how long have you been an LMFT?

Jim: I went to JFK University and graduated in 1997 when they had a campus in Orinda. Some of the internship sites were elementary schools. It was a nice small university. I was in the school of holistic studies, the transpersonal psychology program. That appealed to me: It was interesting to learn about the similarities between spirituality and psychotherapy.

Liliana: Do you still use it or have you headed a different direction?

Jim: I still use it. The program required us to have a spiritual practice. I was already interested in spirituality before graduate school. It reinforced this idea of taking care of yourself, working on yourself, and the value of some of practices like yoga and meditation.

Liliana: Certifications or specialties? You talked about the VA.

Jim: I have some training in hypnosis but I’m not certified in it. There is an interdisciplinary association called ASCH, American Society of Clinical Hypnosis, the gold standard for hypnosis training. Dentists, doctors, therapists, social workers, and nurses all learn hypnosis together. They also have a certification program.

Liliana: You are certified in EMDR also?

Jim: I’m trained in EMDR. Certification is a more advanced level of training through EMDRIA. Once you have completed the basic training, you need additional hours of working with patients using EMDR and supervision. I plan to do it: One more item on my list.

Liliana: You said you used to work with veterans. Who do you work with now?

Jim: It tends to be tech workers because of the area. Regardless, they have had difficult events happen whether it’s recent or in the past. I consider using EMDR with them if it’s appropriate, especially if I think some of these past situations are impactful, and they’re ready for it.

Liliana: So if I heard you right, you don’t use EMDR with everyone.  

Jim:  Yes, that’s correct. Some clients are not interested in doing EMDR therapy. Other clients may be interested but current stressors may prevent them from addressing the past trauma.

Liliana: What should the patient be ready for?

Jim: When we do the EMDR, we are often bringing up some intense thoughts, feelings, sensations, and memories. This has to be the right time for them to do that work. Maybe we go back to their childhood trauma or some significant event in their life. We want to do that, but we don’t want to overwhelm them if they don’t have the resources to address these issues. So we resource them as preparation. We do interventions such as a safe place and container exercises. Sometimes, we’ll just do the resourcing for people. I find it to be very effective. EMDR uses different modalities combined in one.

Liliana: Can you explain that more.

Jim:  In EMDR, we have someone bring up an image. Now bringing up an image is something we can do in hypnosis or imagery work. Then we help them look at the negative cognition, which is similar to CBT. What is that negative belief you have about yourself or the world? We also try to find out what would they like to believe instead of the negative, which is similar to solution focused therapy. What would be a more rational way to say things to ourselves. So, we get the image, the negative cognition, and the positive cognition.

We also ask them emotions that they are feeling now and where they feel them in their body.  We get a Subjective Units of Distress (SUDS) level—how disturbing does the memory feel for you now. We also measure how truly they feel about their positive cognition. If their positive cognition is “I am a good enough", we ask them whether bringing up this image of being good enough is truly how they feel on a scale of 1-7 (where 1 is completely false and 7 is completely true). We do these measurements as part of the assessment for each target.

We do this bilateral stimulation of the brain. The client brings up the negative thoughts and sensations in their body which is similar to somatic therapy and mindfulness.  We follow with the bilateral stimulation: it’s a very organic process. We ask “what is coming up for you now?”  The client comes up with their own memory, feeling, or thought. The therapist relies on the client for thoughts and emotions to come up. It’s really powerful as they create the insights, images, emotions, and sensations.

I think it can help people with anxiety, depression, and trauma. People think of it as trauma because it came out of that work, but it can be helpful for other disorders too.

Liliana: How have you seen it work with people who have anxiety, depression, or anger?

Jim: Sometimes the anxiety and depression are related to an event or emotion that happened.  I don’t feel good enough about myself so I’m depressed. There might be some events that they have experienced where they learned to feel not good enough. We have a process in EMDR to help them figure out what those experiences could be. What am I (the client) feeling now and link it back to what they’re feeling and where it originated from. It might not be Big T trauma but the event affected them. For example, it might be something that a teacher might have said to you. People don’t realize how these traumatic events have impacted them. In EMDR, we can often help them figure it out. While using the analytical part of their brain during EMDR, they have a chance to look at this more objectively. So they, in turn, may realize why they think, act, or feel a certain way.

Liliana: Let me just go back to the bilateral stimulation. Can you explain that a little bit more for our readers?

Jim: I’ll give you the more technical way of explaining it for therapists. These traumatic memories are locked in a dysfunctional storage state in your mind. Through EMDR, we move the memories out of this dysfunctional state into a more functional storage state. Then you can use your adult resources and experiences to process them and release them from the state they were prior to EMDR therapy.  

But for clients, I explain this as self-healing. We are going to let whatever comes up happen without judgment. You can’t do this wrong. We’re trying to integrate the adult part of you with the child part of you or the thinking part of you and the emotional part of you.  

Liliana: Thank you for that. So the bilateral connects the two?

Jim:  With bilateral stimulation, we are stimulating both sides of the brain. We can do that in a number of ways: Through eye movements (although some people find it distracting), or the client can do butterfly tapping on their shoulders, or tap the just above their knees. There is a variety of ways to do the bilateral stimulation.  

Liliana: Why do you think EMDR is important?

Jim: I think that talk therapy has a lot of value. EMDR therapy can give clients an experience of reprocessing something painful without having to talk about every detail of it. In hypnosis we use different parts of the brain. Similarly, In EMDR, we also use different parts of the brain because we are working with thoughts, emotions, body sensations, and images. It’s a different experience from traditional talk therapy. Here we are setting up the conditions so that something can get reprocessed.  

Liliana: When you talked about having worked with the techies and the veterans, is there a difference in treating these two populations?

Jim: There is clearly a difference. With veterans, because of their training, it can be difficult for them to show weakness and vulnerability. They expect so much from themselves. They’re often very resilient so it has to get really bad before they come into therapy. They may use substances, or their marriage is on the brink, or something else, before they seek support. I’m overgeneralizing of course: Many veterans don’t believe in therapy or see it as a threat to their career.  

Liliana: Are people in the tech world more ready to talk about their emotions?

Jim: The issues are different. Some of these veterans, who were in Afghanistan and Iraq had life threatening situations. They experienced explosions, had to rescue people, events that are often life threatening.

Liliana: In the tech world, are many of them immigrants and might have had trauma?

Jim: Yes, definitely. Some of them are still dealing with those immigration issues. Will I lose my job? Will I lose my visa? Will I have to leave this country? Will I lose my friends and everything I have built for myself here?

Liliana: Is there an issue that is prevalent with trauma?

Jim: In EMDR therapy we say the earlier the better when identifying trauma targets. Trauma tends to be linked in our brain. If we can identify that original situation, that can make a big difference in the healing process. We help clients process present triggers. There is also a  future template to prepare people: We have them play in their mind a situation that could potentially be triggering for them in the future to try and help them deal with issues.

Liliana: Building them up so they have the confidence to know what to do when they encounter the situation again. Where did you get your training?

Jim: I got my training at the EMDR Institute. That was started by Francine Shapiro, the founder of EMDR. They have good training that counts for certification.

Liliana: I have a question that our readers might also have. The PESI EMDR courses are more for knowledge than certification?  

Jim: I think so. However, it’s still good knowledge.  

Liliana: If there was one takeaway for readers, what would that be?

Jim: EMDR is a way for clients to make connections and integrate some memories that they may have some difficulty integrating in other therapy modalities. With EMDR, clients can connect past situations and trauma with the present day struggles they experience. The trauma is in their thoughts, images, body, and feelings. It can be eye-opening to them as to how much something still bothers them: the small T traumas that EMDR can help them understand and resolve.

Liliana: Is there something else that you would like to tell us about EMDR?

Jim: I didn’t go through the nine phases of EMDR because I think it is too much detail. One other thing: In one of the phases of EMDR called installation, people bring up the negative experience with the positive cognition. We have them do the bilateral stimulation to strengthen that, which is similar to Rick Hanson’s neuroscience research: Something else I found interesting.

Liliana:  Thank you so much for doing this interview.  The information that you shared about EMDR will be informative and helpful for our readers.  


References

EMDR Institute, Inc., Eye Movement Desensitization and Reprocessing (2020). https://www.emdr.com/

EMDRIA, EMDR International Association (1995-2023). Creating global healing, health & hope. https://www.emdria.org/

Shapiro, F. (2018). Eye movement desensitization and reprocessing therapy (EMDR): Basic principles, protocols, and procedures. (3rd ed.). New York, NY: Guilford Press.

Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR. New York, NY: Rodale. 

Jim Arjani, LMFT, is the owner of Mountain View Therapy, a group private practice that works with teens, adults, couples and families. He graduated from JFK University in 1997 and has been a licensed therapist for the past 21 years. After starting a private practice in 2002, he joined SCV-CAMFT and really values how much he has received from the chapter. Since 2018, he has been the facilitator for the SCV-CAMFT Pre-Licensed Support Group.  

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