Most of us are reluctant to revisit our unhappy past. Our instinct is to push these memories down and bury them deep.
But where such past cuts us deep, it will find ways to pop back into our life to torment us. We could be triggered by anything happening in our environment that echoes the past. Then in a flash, in the most unconscious and uncontrollable manner, we re-experience and relive the shudder and pain as though we are back there, back then. That in turn instantly affects our mood and behaviour.
Such flash back or reliving of the past could happen at a very inconvenient time, in the middle of a dinner party or a board meeting.
Repeated recurrence of such instances drives people to seek professional help for relief.
Clients in a bind
Most trauma-focused therapies require clients to verbalise details of the traumatic events as part of the activation of memories to facilitate processing or treating the traumatic experience.
However, when it comes to the specifics of a traumatic event, there are times clients just find it too hard to verbalise and retell. The incidents may be so clear in clients’ heads: the sight, the sound, the smell, the taste, the sensations in their bodies.
But to translate these into words and allow the narrative of the episodes to cross their lips could be so horrific, so demeaning, filling them with shame, disgust and guilt all over again.
Or they may be embarrassed by the contents, or fearful they may be judged for what happened.
All these places the clients in a bind, they desperately want relief, want to heal from the trauma, but petrified about talking through the details of the experience. The thought of having to retell may even drive some to opt out of therapy.
Clinicians: Do not harm
Clinicians, on the other hand, are obliged to observe the principle to do no harm, especially when working with psychological trauma. We seek ways to deliver therapy without retraumatizing our clients. We want the healing journey for our clients to be as comfortable as possible.
A variation of the EMDR Standard Protocol
A variation of the EMDR standard protocol to allow non-verbalising of the trauma target was first alluded to by Bessel van der Kolk in early 1990s and then Francine Shapiro around 2001. For various reasons these early ideas became obscure, until around 2018, when clinicians revived and experimented with this technique.
Its efficacy was studied and reported in a paper published in 2020.
The paper reports on a project where the participants were Yezidi survivors of gross human rights violation at the hands of ISIL [the Islamic State of Iraq & the Levant]. Amongst other abuses, they were captured and sold as sex slaves. These episodes were but the most recent of generations of persecution and trauma suffered by the Yezidi over the centuries because of their religion.
The study was a humanitarian project of several NGOs to build trauma capacity in Northern Iraq. At that time, ISIL was still active in Northern Iraq and the environment was considered a “theatre of conflicts”.
The context gives us a clue why the victims had great difficulty disclosing details of the abuse for reasons including shame, and fear of reprisal and retribution.
The group of survivors-participants was briefed on the resolution of their traumatic experience with EMDR therapy. It was repeatedly emphasized that they were under no obligation to divulge details. In brief, they were to just think of the episode and inform the therapists of the level of distress.
The study found that EMDR remains effective, safe and efficient in reducing the level of distress in these victims, notwithstanding that the details of the target episodes remained “blind” to the clinicians. This technique is also known as “Blind to Therapist”, or B2T.
B2T: there is no need to verbalise and retell details of trauma
Difficulty of verbalising details of a traumatic event is experienced by survivors of trauma, in civilian as well as war settings. B2T is therefore a useful tool in the EMDR tool box.
For that reason, B2T has gained adoption by EMDR clinicians. We now have a sensitive and compassionate way to help clients overcome the fear and pain of processing trauma.
Clinician only needs to know the general subject matter to guide client in the therapy. The client does not have to disclose the specifics of the incidents. EMDR will still work effectively without clients verbalising the details.
One explanation is this: when a client silently recalls the trauma incident and notes the related emotions and body sensations, the essential details of the memory are activated in his/her brain, ready for processing, without having to verbalise and retell the episode.
Oftentimes clients are visibly relieved when they are told they do not have to tell me the full details of the event we are working on. When they are ready, or when they are drawn to it, they may disclose it. Clients feel empowered with this approach.
Trauma-focused therapy works best when it is respectful and meets the needs of patients.
