Online Psychotherapy with STEPHAN TOBIN Ph D

CLINICAL
PSYCHOLOGIST

Dr. Stephan Tobin Clinical Psychologist

For confidentiality, I will call this client Ellie...

This is an account of a brief therapy conducted with a survivor of the World Trade Center bombing in 9/11/2001. It is an example of the power of EMDR to help some trauma survivors work through their post traumatic disorders very quickly. Ellie has given me permission to cite her case as an example of the help that is available to survivors of abuse, violence and other kinds of traumatic events with EMDR.

Her therapist, an intern at a clinic where I supervised therapists-in-training, referred Ellie to me to work through her PTSD. I was pleased to be able to be of service to someone who had survived that horrific event.

Session No. 1

Ellie had been staying in a hotel across the street from the World Trade Center during that weekend. She lived in California but had to go to New York City periodically as part of her work as a graphic artist. All I knew about her from her therapist was that she was feeling chronically anxious, was having great difficulty sleeping through the night, having nightmares, and continually fighting with her boyfriend. I told her that we would only meet for a limited period of time, but she said she was very grateful to get any help for her PTSD and we set up a time to meet.

She is an attractive, tall young woman who seemed intelligent and conveyed the impression that she was very determined to come to grips with her experience. She repeated what the couples' therapist had said about her symptoms and added that relatives, friends, and people at work were quite unsupportive and not understanding of why she was still upset.

I learned that there had been some earlier incompletely resolved abuse, including a horrendous teenage rape that had resulted in pregnancy and a few years later a very serious illness linked to the rape. Because she was no longer on her parents' medical insurance, she had accrued almost $90,000 in medical bills, which she was slowly paying off.

Images and feelings associated with this earlier trauma had resurfaced. I explained that we would be doing EMDR and told her a bit about the theory of how it worked and about the procedure. I asked her if she wanted to work on that earlier incident first, thinking it would be less emotionally charged, but she insisted she wanted to deal with the bombing.

I asked her then to tell me what had happened.

She had decided to sleep in that morning, but had awakened in the hotel when she heard the horrendous crash of the first plane hitting the tower. She turned on the TV, called her boyfriend back in Los Angeles and then saw the second plane hitting the other tower. An announcement came through the hotel intercom system from the police saying that everyone must evacuate the hotel. She hurriedly threw on her clothes and ran down to the lobby. It was pandemonium there, she said, with people almost climbing over each other to get out.

When she got outside, she was faced with horrible sights and sounds: screaming, great clouds of smoke, body parts on the ground, seeing people jump from the towers. She said she got mesmerized looking up at the smoke and seeing the people jumping. A woman next to her said that she couldn't look anymore and started walking quickly away, but Ellie couldn't tear her eyes away. Then the building began to come down. Another woman with whom she was walking and looking at a ticker on her cell phone began to run, but Ellie dove for a "crevice," which turned out later to have been a freight elevator in an apartment building. She pulled another woman in with her. She was unable to breathe because of all the smoke and debris falling down around her and heard the woman next to her hyperventilating. She whispered to her to hold her breath, as she herself was doing. Just when she felt she couldn't hold her breath any longer and thought she would die, the building manager of the apartment building opened up the back of the elevator and she and the other people inside were able to go into the apartment and then out the back door.

She next started going toward the Brooklyn Bridge and saw the woman with the "ticker" who had started running lying dead on the ground.

She seemed understandably upset when telling me about the event but not overwhelmingly so. She seemed intelligent, determined to work it through and relatively open to emotion. She had an excellent work history and a responsible, well-paying job. She also seemed to have a good attachment history, having felt loved by her parents, even though there was a history of some substance abuse in the family. Her account was lucid and linear, and I decided that she could probably handle the intense emotion that would be triggered by re-visiting the traumatic scenes.

As the first step, I explained the EMDR procedure and told her that I wanted to help her create a Safe Place to which she could imaginatively go if she got very upset, either in my office or after our session. This also enabled me to decide what type of bi-lateral stimulation would be best for her. I asked her if there were some place that she could imagine being that would feel safe, comforting and enjoyable. She immediately chose a beach in Italy where she had been with a girlfriend. The visual bilateral stimulation seemed fine with her; I use a telescoping pointer, which I move back and forth while the client follows with his or her eyes, keeping the head still.

She imagined herself at the beach with her good friend Louise, to whom she always goes for comfort. They're lying on the sand, hearing the waves and children playing. There are lots of people around, barbecuing. She was able to go to this place easily and immediately looked calmer. I did a few short sets of bi-lateral stimulation with her, after each set asking her what she was experiencing. She became calmer and calmer after each set and elaborated on the beach scene, filling in more and more of the details: the time of day, the smell of the ocean and the cooking food, the laughter and shouts of the children, the feeling of the sun on her body.

I asked her then to imagine a mildly upsetting event to test the strength of the Safe Place installation. She remembered a recent argument with her boyfriend, and said she was moderately upset thinking about it. I then asked her to go back to the beach, which she was able to do, with immediate calming.

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