Healing the Heart of Trauma and Dissociation with EMDR and Ego State Therapy

384 Pages·2007·2.28 MB·English

by  Carol Forgash

Healing the Heart of
Trauma and Dissociation
Carol Forgash, LCSW, BCD, is a psychotherapist in private practice in
Smithtown, New York, specializing in EMDR and ego state therapy. She
is an EMDR Institute facilitator and an EMDRIA Approved Consul-
tant. She presents at psychotherapy conferences and at workshops in the
United States and internationally on the integration of EMDR with ego
state therapy and psychodynamic treatment, the treatment of complex
posttraumatic stress and dissociative disorders, and the treatment of the
complex health issues of sexual abuse survivors. She is the board presi-
dent of EMDR Humanitarian Assistance Programs.
Margaret Copeley, MEd, is a freelance editor specializing in the mental
health fi elds.
Healing the Heart of
Trauma and Dissociation
With EMDR and Ego State Therapy
Carol Forgash, LCSW, BCD
and
Margaret Copeley, MEd
Editors
New York
Copyright © 2008 Springer Publishing Company, LLC
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, without the prior permission of Springer Publishing
Company, LLC.
Springer Publishing Company, LLC
11 West 42nd Street
New York, NY 10036
www.springerpub.com
Acquisitions Editor: Sheri W. Sussman
Project Manager: Julia Rosen
Cover design: Margaret Copeley
Composition: Apex Publishing, LLC
07 08 09 10/ 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Healing the heart of trauma and dissociation: With EMDR and ego state therapy /
edited by Carol Forgash, Margaret Copeley.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8261-4696-0 (alk. paper)
ISBN-10: 0-8261-4696-1 (alk. paper)
1. Psychic trauma—Treatment. 2. Dissociative disorders—Treatment.
3. Eye movement desensitization and reprocessing 4. Hypnotism—
Therapeutic use. 5. Dissociation (Psychology) 6. Ego (Psychology)
I. Forgash, Carol. II. Copeley, Margaret.
[DNLM: 1. Stress Disorders, Post-Traumatic—therapy—Case Reports.
2. Dissociative Disorders—therapy—Case Reports. 3. Ego—Case Reports.
4. Eye Movements—Case Reports. 5. Hypnosis—Case Reports.
6. Psychotherapy—methods—Case Reports. WM 170 H4333 2008]
RC552.T7H43 2008
616.85'2106—dc22 2007035619
Printed in the United States of America by Maple-Vail Book Manufacturing Group.
With gratitude to my husband, Hank Glaser, for his
enduring love and support.
—Carol Forgash
For Marco Boscolo, who taught me about the life journey
and accompanied me across the threshold.
And for Kevin, who showed me where to fi nd the Best Self.
—Margaret Copeley
This page intentionally left blank
Contents
Contributors xi
Foreword xiii
John G. Watkins
Preface xvii
Carol Forgash and Margaret Copeley
Acknowledgments xxi
1. Integrating EMDR and Ego State
Treatment for Clients with Trauma Disorders 1
Carol Forgash and Jim Knipe
Introduction: New Help for Clients
with Trauma Disorders 1
A Preliminary Note to Therapists 3
The Nature and Sequelae of Trauma 4
Attachment Disorders and Their Relation
to Affect Regulation and Dissociation 6
Dissociation 8
Treatment Goals for Trauma-Disordered Clients 13
Ego State Theory and Therapy 14
Introduction to EMDR 17
The Eight Treatment Phases of EMDR 18
Potential Problems with Using EMDR
with Dissociative Clients 21
Unique Challenges of Working with Clients
with Complex Trauma 22
Phased Treatment with Combined
EMDR and Ego State Therapy 35
Phase 1: Stabilization and Symptom Reduction 36
vii
viii CONTENTS
Phase 2: Trauma Work 48
Phase 3: Resolution 51
The Person of the Therapist Working
with Challenging Clients 53
Conclusion 55
2. She’s Come Undone: A Neurobiological
Exploration of Dissociative Disorders 61
Uri Bergmann
The Relationship between Trauma
and Dissociation 62
The Evolution of Biological Action Systems 63
Types of Dissociation 65
The Neurobiology of Primary Dissociation 66
The Neurobiology of Secondary Dissociation 75
The Neurobiology of Tertiary Dissociation 82
Dissociation and Medical Illnesses
of Unknown Origin 84
Conclusion 84
3. Combining Hypnosis with EMDR and
Ego State Therapy for Ego Strengthening 91
Maggie Phillips
Joyce: Resolving Anxiety through
Hypnosis and ECEM 94
Benefi ts of Adding Hypnosis to EMDR
and Ego State Therapy 96
The Importance of Ego Strengthening 98
Introducing Hypnosis to EMDR Clients 101
Sequential Uses of Hypnosis in the Standard
EMDR Protocol: An Extended Case Study 102
Conclusion 116
4. Changing Cognitive Schemas through
EMDR and Ego State Therapy 121
Michael C. Paterson
Maintenance of Irrational Beliefs and Behaviors 124
Terrorism and Trauma in Northern Ireland:
Police as Victims 126
Margaret: A Case Study of Trauma
in Northern Ireland 127
Conclusion 138
5. Treating Dissociative Identity Disorder with EMDR,
Ego State Therapy, and Adjunct Approaches 141
Sandra Paulsen
CONTENTS ix
Talking to Parts 141
The Crux of the Problem and New
Treatment Approaches 142
Working with the Dynamics of Dissociative
Identity Disorder 144
Technical Challenges of the Treatment 148
ARCHITECTS: A Process for Abreactions 166
Case Studies 169
Conclusion 176
6. Loving Eyes: Procedures to Therapeutically
Reverse Dissociative Processes While
Preserving Emotional Safety 181
Jim Knipe
One Foot in the Present, One Foot in the Past 181
EMDR and Dissociation 183
Loving Eyes: Seeing the Traumatized Child 184
Mehmet: Dissociated Affect Due to
Childhood Deprivation 188
Veronica: Targeting an Avoidance Defense 193
Enhancing Present Orientation 199
Chris: Dissociative Identity Disorder
Resulting from Childhood Sexual Abuse 203
Conclusion 221
7. Hidden Selves: Treating Dissociation in
the Spectrum of Personality Disorders 227
Uri Bergmann
Historical and Contemporary
Conceptualizations of Ego States 229
The Defi nition and Spectrum
of Personality Disorders 235
The Treatment of Personality Disorders
with EMDR 236
Dissociation: A Developmental Line
of Personality 237
Treatment Goals 239
Integrating Ego State Treatment into
the Eight-Phase Protocol 240
Case Presentations 247
Conclusion 259
8. EMDR in Couples Therapy:
An Ego State Approach 267
Barry K. Litt