An EMDR case study
Session 1 (Continued)
I felt she was now ready to do some of the processing of the 9/11 incident. Note that I wouldn't do this as quickly with most traumatized clients. Many, because of multiple past traumatic events and a lack of resiliency, might need more self-strengthening and contact with me to develop more trust in our relationship and my ability to support them through the trauma processing. I also determined that, if she became overwhelmed with affect, I would stop the processing, take her back to her Safe Place, and teach her other grounding and calming methods.
She said she was ready, so I gave her the choice of processing the worst part of the experience or the most recent. She chose the worst. She was at ground zero, hearing people screaming, seeing people jump, and seeing body parts. She was struck that they didn't have clothing attached to them. She was also hearing the plane crashing into the building.
I asked how upsetting this was, on a scale of 0-10, with 0 being not at all upsetting, 10 the absolute worst she could imagine. This is the Subjective Units of Disturbance Scale or SUDs, almost always used by EMDR therapists. She said it was a 9.
I then asked her what this incident said about her, made her believe about herself (the Negative Cognition or NC in EMDR). She said, "I'm guilty [for watching], I'm helpless, I can't do anything to help those people." I then asked if there were something she would prefer to believe about herself instead of "I'm Guilty," (the Positive Cognition or PC), but she couldn't think of anything, so I said we would return to that later.
The numbers in the following account refer to each set of bi-lateral stimulation and the number of times I moved the pointer back and forth.
- #1 (70 movements, during which I saw many emotions flitting across her face): I very quickly decided to let her tell me when to stop the eye movements instead of my making the decision, which is what I usually do. When she told me to stop moving the pointer, she said, "The people are not screaming as loud, they're just talking. They have their arms around each other. Well, kind of on each other."
- #2 (63 ) "I hear people talking, the building seems farther away now. Before it was so close, one football field away, now it's five football fields away. She sounds surprised and looks calmer.
- #3 (24) She shakes head, at one point, looks very upset. She then says, "I think of a nightmare I keep having. Two people are jumping out of the building, but they're holding hands, they're waving at me!" I ask her if she actually saw that, and she says, "No, I saw two people jumping together but they didn't wave."
- # 4 (35) "I started with seeing something, then there was nothing. Then I saw the girl who walked away. The girl who left, who said she couldn't watch and just walked away. I, like a dummy, had to stay there and watch." I said that she seemed upset about that, and she replied, "Yeah, I have a morbid fascination. I've always been interested in death and destruction. I don't know why." It was clear to me that she was critical of herself for that trait.
- #5 (65) "I'm thinking of a woman I saw when I was walking away who was all bandaged up. An ambulance came and news people asked her if she would be interviewed. People were still jumping out of the buildings and it seemed like she liked the attention. She was full of herself. They asked me if I would be interviewed, but I said no." I said that she seems proud of herself, and she admitted that was the case.
- #6 (65) "I didn't see much that time. Then I began to think of a movie I saw the other night about a woman, a singer, who killed herself. She was a drunk, a loser who wasted her life." She is obviously critical of herself for thinking of this, believing that she isn't sticking to the task, that she's being scattered. I reassure her that anything she comes up with is appropriate, is the right thing.
At this point I decide to assess her degree of disturbance (SUDs level) and again ask her how upsetting the images are on the 0-10 scale. She picks the number 7, but says that she's already feeling much better. She certainly looks better.
Although many EMDR therapists would not make any interpretations at all, I, being an integrative therapist, decide to make one that I feel is appropriate and will further the process. I suggest that the movie may have been about Dorothy Dandridge, a black woman, and that the woman with the "ticker," who died, was black and did a "stupid" thing by running away instead of doing what she did. She admits she's angry with that woman for running and getting killed, but then says she feels guilty for feeling that way.
She tells me that she got the idea to dive for the "crevice" from a disaster movie in which the wife and son of Will Smith dive for a tiny place during a huge attack by aliens, and are saved. I commend her for her presence of mind. She again expresses guilt that she got through the bombing relatively intact while so many others died, and I explain to her about survivor guilt, which she seems to understand. She also tells me that Dorothy Dandridge had a baby who was retarded and her husband wanted them to move to France and leave the baby here. I wonder to myself if this connects to the abortion she had as a teenager, but decide to continue with the bi-lateral stimulation.
- #7 (37) "I now think of the Eiffel Tower. I wonder what would have happened if it had been hit and wonder if France is behind us. I doubt it." I am feeling very moved and admiring of her for her courage and tell her that she is a hero, that she saved some people and herself. She gets a big smile on her face, says she is no hero, but says that the woman she pulled in and told not to breathe thanked her, says she saved her life.
It's now near the end of our session, so I take her back to her Safe Place, which is now at 3:00 PM and she is putting on suntan lotion. But her friend doesn't do this, because she never does. She seems quite calm and I ask her if she feels as if this is a good stopping place, and she says it is. I tell her to call me if she needs to and ask if she's taken one of my business cards from the waiting room. She indicates very forcefully she has two of them, one for home and one for her office. She shakes my hand, and says she's very happy to have met me.
Continue to Ellie's Second Session