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SUSAN C. GOODELL, M.A., M.S., M.F.T.
Offices in Del Mar and San Diego, CA
Mailing: P.O. Box 2328, Del Mar, CA 92014-1628
Phone:(619)997-5333, CA Lic. #MFC20533
http://www.sandiegotherapists.com/goodell.html
http://www.emdrtherapistnetwork.com/susan.goodell
Mark Grant: “EMDR Treatment of Pain” summary notes
Visit www.overcomingpain.com to download all of his forms and handouts
Pain is a problem which manifests both physically and emotionally. Important to make connection
between physical pain and other events. Most people disconnect the physical from their emotional
lives. Those with adverse childhoods are more at risk for chronic pain and accidents in part due to
having had insufficient safety and support and therefore more prone to unhealthy behaviors. Pain
cannot be explained in terms of physical injury and is regularly co-morbid with other problems.
Dissociation and pain: the dissociative barrier can break down and the pain leaks through. “Endpoint
of chronically experiencing catastrophic states of relational trauma in early life: progressive
impairment of ability to adjust, take defensive action, or act on one’s own behalf, and a blocking of the
capacity to register affect and pain, all critical to survival.” Shore, 1993
AIP Model: “ Pathology results when unprocessed experiences are…unable to link up with anything
adaptive, the stored memories contain within them the emotional and physical sensations of the
frightening events, the disturbance also serves to block access to other positive events, and present
situations are viewed as triggers for past, unprocessed events.” (Shapiro 2007)
AIP model of pain: Chronic Pain often follows trauma, including: abuse, neglect and/or accident or
injury, unpleasant sensations and feelings which persist long after the precipitating event is ended, an
inability to connect with positive emotions such as pleasure or joy, and may be exacerbated or
maintained by present situation and stressors. All of the areas in the brain that are involved in trauma
are the same as those involved in chronic pain. . Treating the chronic pain changes the emotional
response.
Melzack, 1999: “Stressors have destructive effects on muscle, skeletal and hippocampal neural tissue,
which may become the immediate basis of pain, or provide a basis for the devastating effects of later
minor injuries in which the severity of pain is disproportionately far greater than would be expected
from the injury”.
PREAMBLE: “We can’t predict how your nervous system will respond to the EMDR stimulation, so
try and adopt an open mind and just notice the sensations of your pain and let whatever happens
happen. Very rarely the pain can increase. In the unlikely event that this happens, you can keep going
or just raise your hand like this (show stop signal) and I will stop. Remember your nervous system
knows what to do, so there’s no need to try and make anything happen. Just notice and just let
whatever happens happen.”
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Trauma: use eye movements. Pain, use auditory bls. With pain, more success with auditory and
kinesthetic due to greater impact on nervous system. Grant uses auditory bls for 30 seconds (40 max)
so that something can begin to happen while avoiding dissociation. bls ( has 3 CD’s, including a new
one on pain included with the book: Change Your Brain, Change Your Pain)
Skills and elements of somatic resource installation:
sensory focus (after bls “What do you notice now? What’s it like? What does that feeling remind you
of?
labeling feelings: cool, warm, dull, draining, soft, loose, light, ebbing, flowing, tingling, shrinking,
easing. If one can’t identify or express their feelings or sensations they can’t regulate them.
affect-bridge: finding earlier experience of resource: “What’s it like?”, “What does it remind you
of?” PC “Think of a phrase that goes with that”
strengthening the resource: antidote resources for ongoing pain by building a resource out of
somatic changes , “What’s that feeling like?”, “What does that feeling remind you of?”
installing the resource: once stable image is attained, create cognitive label, link and
install/reinforce: “What word or phrase goes with that image and feelings?”, Pair image, feeling and
word with bls and install “Think of that image, and the feelings that go with it, and that word, and just
notice”, instruct client to practice thinking of antidote imagery with bls.
Narrative techniques: close questioning “Tell me more about…”, Externalizing the problem “Are you
ever able to escape the problem?” Unique outcomes, exceptions, contradictions “Wait a minute, did
you just say…”, Excavating “Was there ever a time when things were different?” This allows therapist
to be curious observer, not taking at face value the client’s view.
Problem: What is client’s definition of presenting problem?
Client: what does way client describes problem indicate about coping style/capacity?
Goals/expectations: What do they really want/need?
Resources: What resources are discernible?
Entry point: Where might you begin?
Preparation: What inputs might be necessary prior to desensitization?
Doorway: pain is dominant in presentation, so begin there, and doorway to healing other aspects
opens. (you can begin with the pain, stress injury trauma or neglect/abandonment/deprivation)
Case Conceptualization:Pain is not an isolated issue. Its Pain plus: injury/medical condition, or stress
(anxiety, depression), or PTSD (abuse, accident, assault, etc.), or Neglect (emotional deprivation), or
DESNOS, or substance abuse, or marital problems
Initial Goal: decrease pain and then get into the other work. Fractionate the targets to help avoid
triggering other things. Target pain and keep it is the present time, with smaller, shorter sets.
Adjunctive treatment elements: support, psycho-education, sleep management, emotional skills
training, cognitive therapy, life skills training (diet, exercise), goal setting; rewarding activities,
building resilience.
Treatment Rationale Explanation to client: explain this while showing the brain diagrams:
AIP model: “Your nervous system is designed to process experience, including physical and emotional
pain, so that once the injury that caused the pain is healed, everything returns to normal. You have
probably already experienced this many times in your life. But if your nervous system has suffered too
much stress, it gets damaged and cannot re-set itself again in the normal way.”
Brain structure and functioning: “To the extent that pain is in your brain, the best way to reduce pain is
to stimulate your brain in a way that decreases the brain activity that maintains pain. Because of how
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your brain is organized, the best way to do this is by creating an experience which directly stimulates
the sensory-emotional areas of your brain where pain is mainly stored. Non-verbal strategies such as
focused attention and bilateral stimulation, which are part of EMDR, seem to be an effective way to do
this.”
Processing: look for ability to concentrate and suspend thinking self, to be in the present (vs.
intellectualizing, dissociating), to observe, discriminate and label bodily changes non-judgmentally,
adverse responses. Continue with processing until complete resolution or stable acceptable state. If
pain increases, provide reassurance, continue, or revert to other modalities.
Questions: Where was the pain while you were listening to the tones?, What do you notice about the
pain now?, What do you notice about how the rest of your body feels?, How does your head feel?
Multiple sites of pain: prioritize, follow the pain.
Looping: change modality, ask “What’s stopping the pain from changing?”, “Think of something that
could take the pain away or make it better” Ask client to hold question in mind and notice the bls.( to
bypass left brain).
Blockages:”If there were an emotional contributor to the pain, what would it be?, If this pain really is
just physical, what could you give your body that might take the pain away or make it better?”
PC’s: possibly “I can cope”, “I can control my pain”, “I’m alright”