Trauma-Informed EMDR Therapy and CPTSD: When reprocessing is not the best practice
I am a Trauma-Informed Latina Therapist primarily and an EMDR Therapy Therapist and Consultant. I have been practicing for over a decade and have specialized in trauma related mental health conditions which includes years of training, 5 years of working with both adolescents and adults with high-risk behaviors and layers of traumas. The remainder of my career years, I have focused on working with adults with CPTSD (Complex Post Traumatic Stress Disorder) and Interpersonal Attachment Traumas. When I consider what best practice is for people with a current diagnosis of CPTSD, I always prioritize do no harm. While this is always a priority for all clients, do no additional harm is the priority given the layers of sensitivity to present triggers.
As a consultant, my most common consultee question without a doubt revolves around EMDR reprocessing for CPTSD. I often refer to the work of Dolores Mosquera and Sandra Paulsen as framework understandings of layered trauma impact on the person’s psychological state and attachment wounding. In my role, I try to facilitate an introduction or for those with more experience, a clearer picture on how layered attachment and abuse trauma interact. Additionally, I caution on the urge both from the client and therapist to start “doing deep work” without first having a clear mapping of the present triggers and risks.
Mapping present triggers simply means, talking with you client about what occurs when they get triggered and evaluate the risks of those triggered reactions. For organizational purposes, it is helpful to write this information in your treatment plan document, using SUDs to measure the risk can be useful as well. The importance of this has to do with the fact that during your therapy work starting with phase 1, rapport relational building, the triggers will begin appearing. In CPTSD, nothing huge needs to be excavated, a benign first session interaction can feel internally overwhelming or threatening to the preservation of survival. Dissociative conditions can also be co-occurring at higher levels.
Returning to the question, what is best practice for CPTSD? While Dolores Mosquera’s Progressive Approach can be used as a guide for EMDR providers to approach reprocessing, it is important to be clear if EMDR Therapy reprocessing is the best practice for addressing trauma memories in a CPTSD expression. There is no debate that phase 1 and 2 are appropriate and that it is indeed EMDR Therapy. However, what we know from the diagnosis and through clinical experience is that CPTSD is both a relational and internal self-disorganization condition with trauma memory reactivity (symptoms). There is an apparent need for an interpersonal therapy integration as the foundation for CPTSD Treatment Planning. Additionally, context, the C in CPTSD indicates layers that interact, these layers far more often than not, are generational. Legacy burdens, burdens passed down by family systems and collective systems also require social cultural framework integration in therapy.
My recommendation is, be patient and be thoughtful. Doing deep work is only appropriate if it’s going to be helpful which means at minimal risk of further self-disorganization and higher gain of internal and interpersonal integration.
EMDR Therapy continues to expand its own capacity and CPTSD is a condition that will continue to challenge EMDR Therapy to grow.
References
Book: What My Bones Know, A memoir of healing from complex trauma by Stephanie Foo
Book: The Pain We Carry, Healing from Complex PTSD for people of color by Natalie Y. Gutierez, LMFT
Book: We’re Listening Body by Sandra L. Paulsen, PhD
EMDRIA Magazine Article: Challenges in the Use of EMDR Therapy with Dissociative Disorders By Dolores Mosquera
