Blind to therapist (B2T)
EMDR Protocol
Blore & Holmshaw 2009a; b
1
Some uses for the B2T
•
Clients wishing to maintain or reassert control (e.g. Thompson 1981 Blore 1997,
2005; Blore & Holmshaw 2009b)
•
Clients experiencing acute embarrassment or shame (Blore & Holmshaw 2009b)
•
Where there is a risk of vicarious traumatisation of the therapist
•
In translator-situations where the client is reluctant to divulge material
because of fear of real or imagined retaliation ‘back home’
•
MoD clients wishing to preserve ‘confidentiality’ and thus not
compromise adherence to the Official Secrets Act
•
Clients with serious speech impediments that may result in stalling the
flow of processing
2
Underpinning of B2T
•
B2T provides a client-centred solution to problems largely of
behavioural avoidance
•
B2T facilitates compliance by ‘meeting the client half way’
•
B2T facilitates therapist’s adherence to client-centred work
3
B2T
•
Phase 1
– Identify non-disclosure as an issue during suitability assessment/
history-taking
– Explanation that treatment will not suffer if material cannot be
disclosed
•
Phase 2
– Coach client to recognise change, using simple descriptions
– Simple descriptions may need further explanation:
• ‘leading’ the client or setting expectations?
– Subtlety of change metaphor
4
B2T
•
Phase 3
– Negotiate a cue word to refer to target image
– Check that image is static
– If not static then ‘freeze frame’ at most distressing point
– Make no attempt to obtain NC, PC or take VoC
•
Phase 4
– Commence first set:
• Notice (cue word)
• Notice emotion
• Notice where the emotion is located
– Process as normal but feedback only ‘change’ or ‘no change’
5
B2T
•
Phase 4 (cont)
– If no change, distinguish between end of channel of association
and blocking/looping:
• Ask “is (cue word) distressing neutral or positive” (as an
experience)
• If distressing then assume blocked/ looping
• If neutral/positive then two consecutive instances assume end
of channel of association > return to (cue word)
• If assumed blocked/ looping then:
– Use basic strategies (change speed direction modality of
BLS). If these don’t work then go to visual interweaves:
– ‘morphing’/ stretching image, or two image strategy
– Keep repeating until ‘change’ indicated
6
B2T
•
Phase 4 (cont)
– Disclosure may never occur. Disclosure not needed for resolution
– If disclosure occurs continue with the standard protocol
– PCs tend to emerge spontaneously – don’t ‘make’ PCs happen!
– Never attempt to identify a NC retrospectively particularly if obvious
from an emerging PC
– Phase 4 complete when SUDs = 0
• Phase 5
– Install PCs that have emerged
– If still no PC go to body scan (phase 6)
• Phase 6
– If no phase 5 then be prepared for further dysfunction material to
arise and then return to phase 4 (B2T version)
7
B2T
•
Phase 7
– Be aware that the incomplete protocol for the B2T protocol may
differ considerably from normal
• If SUDS not 0 treat as a normal incomplete session and allow extra
time for phase 7
• If no PC emerges and/or body scan can’t be completed then treat this
as an incomplete session to
– Two ‘yeses rule’:
• Yes client safe to leave clinic
• Yes, client has required resources AND will use them between now and
next session
• Phase 8
– Reassess as usual, don’t forget cue words if disclosure hasn’t
occurred
8