EMDR – blockages, blockages, and more blockages

In my last post I already mentioned the first attempt of an EMDR session in my last therapy session. Was it a failure? I don't know, it depends a bit on what failure means. It's true that we didn't manage to work with EMDR, and that I was again terrible, with many difficult emotions, with frustration, fear, anger at myself, shame, as I already wrote on Wednesday. But at the same time I started to realise many blockages that prevented me from working with EMDR this day, and this is a positive thing (and seeing it this way has helped me to feel less frustration - everything is a process, and who said it was going to be an easy process?)

Wikipedia Spanish says about EMDR: "Eye movement desensitization and reprocessing (EMDR) is a psychological therapeutic technique used to attenuate the negative effects of traumatic events". According to the Spanish EMDR Association, "EMDR therapy is endorsed by the World Health Organisation and the International Clinical Guidelines for the treatment of trauma. It is based on understanding the effect of adverse and traumatic life experiences on pathology and on processing these experiences through structured procedures that include eye movements or other forms of bilateral stimulation. Its application has been extended to a wide range of clinical problems."

Trauma expert Bessel van der Kolk says in his book The Body Keeps the Score about his research into the efficacy of EMDR:

We obtained funding (...) to compare the effects of EMDR with standard doses of Prozac or placebo. Of our 88 subjects, 30 received EMDR, 28 received Prozac and the rest received placebo. As is often the case, the people given placebo did well. At the end of 8 weeks, their 42% improvement was greater than that of many other treatments touted as "evidence-based". The Prozac group did slightly better than the placebo group, but just barely. This is typical of most PTSD drug studies: simply participating brings 30-42% improvement; when the drugs work, they bring an additional 5-15%. However, patients who did EMDR had substantially better results than those on Prozac or placebo. After eight sessions of EMDR, one in four were completely cured (their PTSD scores had dropped to negligible levels), compared to one in ten in the Prozac group. But the real difference came over time: when we interviewed our subjects after eight months, 60% of those who received EMDR had scores that indicated they were completely cured. As the great psychiatrist Milton Erickson said, once you kick the log, the river will start to flow. When people begin to integrate their traumatic memories, they continue to improve spontaneously. In contrast, everyone who had taken Prozac relapsed as soon as they stopped taking the drug.

But, unfortunately, it gets complicated when it comes to complex trauma (as always):

Another key finding from our study: adults with childhood trauma histories responded very differently to EMDR than those who had been traumatised as adults. After eight weeks, almost half of the adult-onset group who had received EMDR had a score of completely healed, while only 9% of the childhood trauma group showed such a pronounced improvement. After eight months, the cure rate was 73% in the adult-onset group, compared to 25% in the group with childhood abuse histories. This childhood abuse group had small but consistently positive responses to Prozac. These results reinforce the findings I described in [another] chapter (...): chronic childhood abuse causes very different mental and biological adaptations than discontinued traumatic events in adulthood. EMDR is a powerful treatment for stuck traumatic memories, but it does not necessarily resolve the effects of betrayal and neglect that accompany childhood physical or sexual abuse. Eight weeks of treatment of any kind is rarely enough to resolve the legacy of long-term trauma." (retranslated from pages 311/312 of the Spanish edition)

Notwithstanding this warning of the challenge with complex trauma, I want to try EMDR, as I feel that just by talking I can't get any further. And even though the first EMDR session didn't "work", I'm already getting to places I've never been to before in five years of therapy. Admittedly, it's probably not just the EMDR - I'm also at another point in my work with my trauma - but I find it interesting.

So what are some of the blockages?

The first blockage is the issue of trust. I have every confidence in my therapist in the sense that I feel able to share everything that's going through my head with her. But, in EMDR, to what extent do I have to give up control to my therapist? I understand that I don't really, but I still lack confidence and/or more knowledge about EMDR to "just let go" in terms of what might happen (new images, memories, emotions, ...). I think I simply need more information to manage my fear and feel able to "give up control" to my therapist.

Another blockage, and much more significant, is the language, i.e. the blockage of my mother tongue, German. There is a part of me that resists working with EMDR, the same part that in my permanent internal dialogue resists coming to terms with sexual abuse. This part - which we can call my inner child or a protective part - is very afraid, and wants in a way to protect me by sabotaging the EMDR. In the last session we agreed that I write to this part to reassure them and explain that I am now an adult, that I have the tools to protect them and face my past, that I already have five years of therapy, etc. - in German. We came to the conclusion that this part - this inner child - speaks neither English nor Spanish. But, when I only think of writing to them in German, I get blocked. I don't feel able to write to myself, to talk to myself, in German.

I always knew that I would not have been able to do therapy in German. Spanish gives me a safe distance and signals to me that I am now somewhere else and that I am someone else - it gives me security. But I was not aware of this total blockage of talking to myself in German. It is true that I always write in my diary in Spanish, and when I lived in England in English. I have never done it in German for more than 20 years now. Never.

This morning I thought about this, and I thought that I can easily write to my friends in Germany in German, or talk to them in German. And I thought - in German - that I am not able to converse with myself in German, and I directly felt my stomach contracting and I started to cry. I had to speak to myself in Spanish to calm down - trying to do it in German just made everything worse, and made me cry more.

In an article about bilingual people originally published (in English) in 2012, I found the following:

Why would the brain block access to the native language at an unconscious level?

Professor Guillaume Thierry explains: "We think this is a protective mechanism. We know that in trauma for example, people behave very differently. Surface conscious processes are modulated by a deeper emotional system in the brain. Perhaps this brain mechanism spontaneously minimises negative impact of disturbing emotional content on our thinking, to prevent causing anxiety or mental discomfort.

in another article I found this:

Sometimes, bilingual patients of a psychotherapist who is fluent in both their respective languages use their mother tongue if they want to know in detail the consequences of an issue, but choose their second language if they prefer to establish some emotional distance.

As far as I know, my therapist does not speak German, but what interests me is the emotional distance that Spanish allows me - a distance that I seem to need. I don't feel able to get close enough to my inner child to speak to it in German, and without doing so this inner child keeps resisting and/or hiding. It seems that in order to access the most damaged part of me I need to unlock German.

I will not go back to EMDR before resolving these blockages - I think it makes little sense. The first one seems simpler to me, as what I need is simply more information, more knowledge. The second is more complex, and I don't know how much time I need to be able to have a conversation with myself - with my inner child - in German.