Institute Inbrief - 16/12/2016
Welcome to Edition 260 of Institute Inbrief! If you were to have a traumatised client, which type of therapy would you choose to treat them? In a previous article, we explored the use of CBT and CBT-related therapies to treat trauma. In this edition’s featured article we’ll focus on eye movement desensitisation and reprocessing, or EMDR.
Also in this edition:
- Bachelor and Master of Counselling: 2017 Intake Now Open
- ACA Launches Australian Counselling Research Journal
- A Case of Domestic Violence
- Treatment Options for the Depressed Elderly
- Making Your Goals Powerful
- Social Media Updates & Much More!
Enjoy your reading!
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Bachelor and Master of Counselling
Semester 1, 2017 intake – now open
Have you started thinking about study in 2017?
Our Semester 1, 2017 intake is now open for the Bachelor of Counselling and Master of Counselling. Places are strictly limited, so please express your interest early.
The programs are all government Fee-Help approved, so you can Learn Now and Pay Later.
Some unique features of the programs include:
- [Master] Receive up to 6-months credit for prior Counselling studies
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Diploma of Counselling
It’s time to start loving what you do!
We’ve been training qualified Counsellors for over 25 years. Overwhelmingly, the number one reason people cite as why they became a Counsellor – to start loving what they do. They were stuck in a rut doing something they had no passion for, and it was dragging them down.
If you want a deeper understanding of yourself, and to use that knowledge to assist others overcome their challenges and start enjoying life again – then counselling is likely for you.
Too often we get drawn into a career that offers little personal satisfaction. Counsellors are passionate about the important work they do. They’re often someone that friends and family naturally come to for assistance. And they get immense personal reward helping others.
If that sounds like you, then it’s time to start pursuing your passion:
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ACA Launches Australian Counselling Research Journal
The Australian Counselling Association (ACA) has just released the first edition of their new, revamped research journal: Australian Counselling Research Journal (previously CPH). The latest edition of ACRJ – along with all past issues (2005-2016) – can be downloaded FREE of cost via the ACRJ website. The Journal also offers opportunities for authors wishing to submit original articles, reflection papers or case studies for peer-review and publication.
Eye Movement Desensitisation and Reprocessing for Trauma
If you were to have a traumatised client, which type of therapy would you choose to treat them? In a previous article, we explored the use of CBT and CBT-related therapies to treat trauma. In this article we’ll focus on eye movement desensitisation and reprocessing, or EMDR.
Background
EMDR is a trauma-focussed psychological intervention created from an accelerated information-processing model. Because it also incorporates dissociation and nonverbal representation of traumas (such as visual memories), EMDR is sometimes classified as a cognitive therapy. It is based on the assumption that, during a traumatic event, overwhelming emotions or dissociative processes may interfere with information processing. This leads to the experience being stored in an ‘unprocessed’ way, disconnected from existing memory networks. In an EMDR session, the client is asked to focus on trauma-related imagery, negative thoughts, emotions, and body sensations while their eyes simultaneously follow the movement of the therapist’s fingers across their field of vision for 20-30 seconds or more; the process may be repeated many times. EMDR’s proponents argue that this dual attention facilitates the processing of the traumatic memory into existing knowledge networks.
Francine Shapiro developed EMDR in 1987 as a treatment for traumatic memories (Shapiro, 1995), The client’s eye movements are part of the structured, multistage treatment, which involves a combination of exposure therapy elements and eye movements, hand taps, or sounds to distract clients’ attention. After each sequence, clients indicate their Subjective Units of Distress (measurements used to describe an individual's level of suffering or grief associated with painful memories). If the Subjective Units of Distress rating is high, the client practices relaxation techniques. When the client is ready, EMDR resumes. Shapiro (1995) claims that EMDR, with its brief exposures to trauma material, an external/internal focus, and structured therapeutic protocol, represents a different new paradigm in therapy (Dass-Brailsford, 2007).
Controversy and Applications
However, EMDR is not without its attendant controversies. One point of contention is that EMDR lacks a theoretical foundation, empirical data, and sound methodology (Resick, 2004). Secondly, claims that EMDR is a rapid and effective treatment have been subjected to much scientific scrutiny and not always supported. A study of Vietnam veterans (Devilly, Spence, and Rapee, 1998) compared EMDR to control conditions using two different forms of EMDR and psychotherapy. While the EMDR groups showed improvement, those gains were not maintained at the six-month follow-up. In a separate study, Devilly and Spence (1999) compared EMDR with a combination of exposure, SIT, and cognitive therapy techniques in a mixed sample of traumatised clients with PTSD. EMDR was found to be effective, but inferior to cognitive therapy, the treatment gains from which were maintained at the three-month follow-up.
Over time, EMDR has increasingly included treatment components that are comparable with CBT-based interventions such as exposure therapy/prolonged exposure, systematic de-sensitisation, cognitive processing therapy, cognitive therapy, narrative exposure therapy (NET) and stress inoculation therapy (SIT). These include “cognitive interweaving”, which is analogous to cognitive therapy, imaginal templating (rehearsal of coping responses to anticipated stressors), and standard in vivo exposure. We can note that, in combination with the imaginal focus on traumatic images which was originally part of EMDR, the therapy now includes all of the core elements of standard trauma-focussed CBT. Moreover, the original protocol of a single session is now expanded to eight phases of treatment with the above elements included, which makes it a similar length to standard trauma-focussed CBT. The unique feature of EMDR is the use of eye movements as a core and fundamental component throughout treatment (Australian Centre for Posttraumatic Mental Health, 2013a).
But the question arises as to whether those same core eye movements are actually necessary. There are differing opinions about how EMDR works and what the underlying mechanisms are. Some researchers have claimed that EMDR might be understood as an exposure or imaginal flooding technique (Seidler & Wagner, 2006). Others (Lee, Taylor, & Drummond, 2006) have suggested that EMDR and exposure are different processes, and that EMDR processes trauma in a more disidentified way. A study by Davidson and Parker (2001) concluded that eye movements might even be unnecessary for a positive outcome. It may be that EMDR’s efficacy derives from a client engaging with and processing the traumatic memory, rather than from eye movements. EMDR may thus be more effective if extensive behavioural and imaginal exposure is included (Dass-Brailsford, 2007).
EMDR’s creator, Shapiro, claims that even a single session of EMDR produces positive results (1989). The research continues to illuminate aspects of this therapy, but there is some evidence meanwhile that attentional alternation, which is unique to EMDR, may facilitate the accessing and processing of traumatic material in adults (Chemtob, Tolin, van der Kolk, & Pitman, 2000, in Dass-Brailsford, 2007).
Ultimately, sampling and methodological flaws and lack of control groups in some of the studies already produced limit the generalisability of findings that are already out; we can only hope that replication studies will be undertaken in order to confirm their reliability (Dass-Brailsford, 2007).
References:
Australian Centre for Posttraumatic Mental Health. (2013a). Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. ACPMH, Melbourne, Victoria.
Dass-Brailsford. (20007). Models of trauma treatment. Retrieved on 4 August, 2015, from: hyperlink.
Devilly, G.J., & Spence, S.H. (1999). The relative efficacy and treatment distress of EMDR and cognitive behavioral trauma treatment protocol in the amelioration of post-traumatic stress disorder. Journal of Anxiety Disorders, Vol 13, No 1-2, 131-157.
Devilly, G.J., Spence, S.H., & Rapee, R.M. (1998). Statistical and reliable change with eye movement desensitization and reprocessing: Treating trauma with a veteran population. Behavior Therapy, Vol 29, 435-455.
Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, Vol 13, 97-107.
Resick, P.A. (2004). Stress and trauma. Philadelphia: Taylor Francis.
Seidler, G.H., & Wagner, F.E. (2006). Counselling for post-traumatic stress disorder (3rd Ed.). London: Sage.
Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York: Guilford Press.
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A Case of Domestic Violence
The client, Gary, called to make his first appointment and said he was persuaded by “a mate” to attend counselling to control his anger. In short Gary was a perpetrator of physical abuse against his intimate female partner, Julie, who is 22 years of age. The couple have no children but his partner has recently expressed a desire to have a child with him. The client is 28 years old and a labourer by occupation. He has only had casual/ contractual employment and has been subject to periods of unemployment, the longest being three months. At the time of beginning counselling Gary was unemployed and renting with his partner in a shared house with another couple.
Treatment Options for the Depressed Elderly
Because depression in older adults is so widely unrecognised, it can be difficult to comprehend just how forcefully conditions such as deteriorating health, a sense of isolation and hopelessness, and the challenge of adjusting to new life circumstances can create a “perfect storm” pushing an already-depressed person over the edge to suicide.
Mental Health Academy – First to Knowledge in Mental Health
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Mental Health Academy is Australia’s leading provider of professional development for mental health practitioners. MHA’s all-inclusive memberships give you instant access to over 300 hours of learning – including videos presented by internationally-renowned experts in counselling, psychology and mental health.
Topics explored include: Evidence-based therapies, mindfulness, CBT, focused psychological strategies, children & adolescents, relationship counselling, motivational interviewing, depression & anxiety, addictions, trauma, e-therapy, supervision, ethics, plus much more.
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Have you visited Counselling Connection yet? There are hundreds of interesting posts including case studies, profiles, success stories, videos and much more. Make sure you too get connected (and thank you for those who have already submitted comments and suggestions).
Making Your Goals Powerful
Do you write down your goals? You probably have ideas rolling around in your mind about what you want to accomplish now, soon, next year, and over your lifetime, but have you actually written them down? World-renowned speaker and best-selling author Brian Tracy notes that only 3 percent of adults have written goals and plans, but “this 3 percent earn more than all of the other 97 percent put together” (Tracy, 2010, p 65, emphasis his).
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"Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle. As with all matters of the heart, you'll know when you find it."
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Many students of the Diploma of Counselling attend seminars to complete the practical requirements of their course. Seminars provide an ideal opportunity to network with other students and liaise with qualified counselling professionals in conjunction with completing compulsory coursework.
Seminar topics include:
- The Counselling Process
- Communication Skills I
- Communication Skills II
- Counselling Therapies I
- Counselling Therapies II
- Legal & Ethical Framework
- Family Therapy
- Case Management
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