Multimemory Associative Processing
As most EMDR therapists who work with clients with layered and complex traumas know, additional steps and considerations are necessary for successful processing. As a specialist in this area, I am intentional in being well-informed when making treatment decisions with my clients, after all, people’s wellbeing depend on this!
The following points come from Francine Shapiro’s EMDR Therapy 3rd edition book and my clinical experience.
First is first, when working with a client with multiple trauma memories, the therapist should cluster the traumatic incidents into groups of similar events & select a target that represents an incident from each group.
How to do this? well, therapists, we can do this by asking a client to identify their 10 most disturbing (if possible) childhood memories or earliest memories. Then, ask the client to rank the level of disturbance 0-10 (SUD scale) of each of the 10.
The next clinical question for the therapist would be, which one would be an appropriate target memory to begin with? Time for considerations, based on phase 1 & 2 assessment, is the client well resourced? Do they they have the distress tolerance capacity? Are the able to orient to the present, regulate? Can they add more activation into their present lives and still have stability? okay, you get the drift…
Well, while starting with a target that has lower SUDs can be the most appropriate selection for your client, Francine Shapiro makes a valuable case for starting with the memory that has the highest SUDs. According to Francine, preparing a client for the worst content and highest disturbance means there will not be any surprises in the future. Meaning, starting with a low SUDS target does not guarantee low activation during reprocessing, in fact, SUDS usually rise during reprocessing and a client might not be prepared for that increase in activation, abreactions may occur (no bueno if client and therapists are not prepared). Additionally, they may feel a great sense of accomplishment and the following targets will most likely be easier for them. What are you thinking? Re-read this paragraph because it is quite a valuable insight. Of course, some clients may simply not want to start with the worst or too much indeed can be too much for some.
Okay, still with me? The next is the last point but essential for treatment planning. Francine, recommends the targeting of ALL 4 ElEMENTs, 1. the target memory you decided to start with 2. any flashbacks since they might differ from the memory material 3. any nightmares, specifically recurrent nightmares 4. any triggers.So how would we do this? I have some options from a trauma-informed lens.
option A: with a client with limited capacity and/or time-limitations, you might want to consider targeting the most intrusive memory/material like the nightmares first using restricted processing.
option B: with a client with an open-time frame, stability and capacity to tolerate all the work, cluster the memory material and nightmare material together and start with the memory or material with the highest SUDs, make that the target memory and process all associated memories.
Flashbacks are conceptualized as being part of the present prong and are addressed with triggers using the future template after all past prong material is processed.
Okay, that is a lot to consider, take your time and consult as needed, hope this was useful.
