Maybe we need to deal with one type of emotion first, then another emotion later, and we get into the deeper layers of the onion, and eventually we get to that core, that delicious core of the onion. And then we season that, we fry that one up too, and then after it becomes this delicious experience of compassion.
My name is David Archer, I’m an EMDR therapy trainer, approved consultant, and an anti-racist psychotherapist from Montreal, Canada, and this is your weekly consult. Let’s go.
Hey everyone, glad to see you here. I think that today is a good day to speak a bit about a clinical issue that affects a lot of people.
I also want to say that I’m losing my voice a little bit today because both of my kids are in daycare. There’s a synergistic effect in their daycares where these previously unreleased exclusive viruses are affecting people. It just so happens I’m the only person in the house who has lost their voice. This is just what it is with kids, being a therapist, and all this stuff. Anyways, excuse me. Sorry, let me edit out those coughs.
Understanding EMDR and Depression
Here’s the basic idea: we need to find some ways of helping people who are impacted by depression. We’re going to see that, unfortunately, the stresses in our world—whether it’s war, poverty, neoliberal policies, things that are making it so that we put profits before people, police violence in Montreal, these kinds of things—we are going to see some people who will be expressing some helplessness based on these conditions.
So it’s a good idea in today’s weekly consult to focus on a case that relates to a person who is experiencing depression as their presenting issue. Let’s get into this, all right?
Case Study: A Young Adult Navigating EMDR and Depression
Who is our client? Let’s say that Jake is a guy in his 20s and he’s going through a bit of a rough patch. He contacts me because he says that he’s just not as happy as he used to be. Things are a little challenging for him.
He might have had some thoughts relating to suicide, and so it becomes a little challenging. Even though he doesn’t feel that good about himself, a part of him was courageous enough to make that phone call and to speak to me. It takes a lot of courage to be able to ask for help when you get thoughts like that. And so we got to work doing the approach.
Phase One: History Taking and Treatment Planning
When we’re talking about using EMDR therapy, there are eight phases. We know there’s history taking and treatment planning, preparation, assessment, desensitization, installation, body scan, closure, and re-evaluation. This is just what it would typically look like working with Jake suffering from depression.
I’m going to administer some assessments in phase one just to check and see, okay, he’s saying he’s depressed. I get that. Let me give some assessments for other things. Turns out he might have some depressive symptoms. There might be some anxious symptoms that are there as well. There could have been things that have happened to him on the PTSD side of things as well. And there’s a chance that if he’s saying there’s suicidality, there might be some dissociative symptoms that we got to consider.
That’s all part of my assessment. That’s all part of me trying to get to know in phase one what exactly it is that’s going on. The next step in my initial meeting with him is going to be just trying to understand how he makes sense of the world, how he makes sense of these difficulties that have been impacting him.
I will also, as best as possible, make it so that I get an understanding of what it means that he’s meeting with me. In my intake, it’s not only that he has this depression, it’s also that he has maybe a racial element that’s there too. We talk about the fact that in recent years, there has been a lot of online trolls, there’s a lot of digital blackface, a lot of challenges. Then I realized, wait a second, there is this depression. He might not know where it came from, but there seems to be an accumulation of stresses that he’s been going through as well. Now I’m starting to consider the importance of his racial identity.
Phase Two: Preparation and The RAP Technique
In my phase two preparation, I’m now going to teach him some resources. I might teach him the RAP technique. I might teach him the calm scene. I might teach him a container light stream. But I would also teach him resource integration.
Resource integration is a derivative of resource development installation. It gives me the opportunity to teach him some skills that are consistent with his strengths. Sure, he does come in with his depression. Sure, he does come in with some aspects of racial injury, racial trauma. But turns out he’s a fan of video games. Great. We could bring the video games in as a resource. Turns out he’s a fan of MotoGT, of racing and all that. I don’t know nothing about none of that stuff. But this is really important for him. We bring that in.
When he’s thinking about the motorcycles, when he’s thinking about fast cars and all this, it gives him a positive feeling. Guess what? We’re going to need that as a desensitization. We’re going to need that as a disconfirmation of the narrative. Now that I found something that is actually of interest to him, we’re going to challenge the idea that life is not interesting.
Because there were the suicidal thoughts, we also want to have a resource that can challenge the bad feeling that relates to the suicide ideation. When he thinks about the suicidal thoughts, he might get a bad feeling that comes up first. Guess what? There’s a resource for that. That bad feeling can then be challenged by something that relates to his identity of being able to love the blackness of himself.
It turns out that when he is able to visualize himself being a black obsidian mineral—an energy crystal, I guess that’s what black obsidian is—when he imagines himself protected by this, this actually strengthens his identity and his reason for being here and keeps him solid and grounded. Which is again, an antidote or disconfirmation to what happens when you’re out of your body, when you’re thinking of suicide and these kinds of things. Now we have our resources.
Phase Three: Assessment
Phase three, most likely we would have also done the racial trauma target history. I got a list of everything that has bothered him from age zero to his present age in his twenties. Because there’s that racial trauma element, I might also ask, is there anything that happened before you were alive that still to this day impacts you based on racial trauma, cultural identity, any of these social identities?
There’s a hypothetical thing. He might bring up slavery; even though this happened centuries ago, it still is in his mind something that has bothered him. He might also bring up the suicidal ideations, the times that he attempted, the times he came close to being stressed out. We may have also been able to identify multiple reasons for why the depression started. We’re focused on etiology and there’s a bunch of other targets as well that are not so focused on the presenting issue, which we would then be able to deal with when the time is right.
With assessment, we’re going to find out: what are the images he associates with the bad feeling? What is the negative belief? What is the positive belief? How close is he to believing this positive belief? What are the body sensations, the feelings that are associated with the specific target? And then after we get this plane for takeoff, while we’re flying this plane, we move to phase four desensitization.
Phases Four and Five: Desensitization and Installation
There may be targets that are going to go a little smoother and some can have a little bit more challenges. Luckily, we have our resources that are there when he feels as if he’s unable to deal with these stresses. There’s a time when processing is going to be slow, meaning that we’re using the bilateral stimulation and eventually we get there. Eventually the target is cleared, but sometimes those barriers can come up.
There might be a part of himself that might be fearful of processing this trauma. What if he gets rid of the suicidal ideation? How is he going to feel that he has an escape now? What if he gets rid of this idea of racial trauma? Is that betraying his own culture? That could be something that’s a limiting belief that needs to be dealt with.
Luckily, if we’re not using the cognitive interweaves, there’s a way of using the cognitive interweaves that relates to the resources. It’s a prime opportunity to install the resource integration and help to overcome that stuck feeling. Maybe at that point, that’s when we use the resource and we bring in his video games. It’s a strange thing, that blocked feeling that’s going to come up during desensitization could be really inconvenient to actually have it. Maybe he needs to have the convenience of a video game he can play on his cell phone anytime. That’s a disconfirmation that comes up and makes him feel differently about the stresses, maybe even gaining some insights from the video games as we complete targets of just knowing that this is just another level that needs to be overcome.
Over time, as we get into phase five of the installation of the positive beliefs, we start to get some positive beliefs that he can then bring into reality. Loving himself, being able to say, “I accept myself,” being able to say, “I can heal. I have a purpose.” Even if he doesn’t know what the purpose is, being able to say that I can learn my purpose when sometimes installation gets a little stuck. Being able to add these operative words in can help a person to overcome that hump and just lend credence to the possibility that in the future, even if you don’t know it now, you can learn to trust people in the future.
If you don’t know it now, you can feel better about yourself in the future. These types of positive beliefs—instead of focusing on the binaries of what depression is, of things are absolutely bad, instead of trying to say things need to be absolutely good—being able to say, “I can potentially heal.” These are additional disconfirmations that take place.
Phases Six, Seven, and Eight: Body Scan, Closure, and Re-evaluation
After we install the belief, then there’s going to be the body scan. We just want to check to see when we think about the positive belief and we think about the specific event, is there any remaining doubt, any remaining discomfort about believing this? Just doing a quick body scan. If everything’s all good, then we are going to wrap it up. We have then been able to close up the session.
For the closure, we have a closure script that we’re going to use. That’s just going to take into account all the good work that he’s been able to do. Take into account the fact that even if there’s any remaining stresses, we can deal with it another time. I tell my clients, “Look, your job is to practice feeling awesome. And also to leave all of your trauma history with me on the cloud, in the internet, in our virtual sessions.”
Their job is not to ruminate on these things, but to find ways of being able to contain it. Even if bad things do come up, you got your resources for your black obsidian, your blackness. You got some resources for your video games of feeling good about yourself. You got the resource that is you.
In the next session, which is going to be re-evaluation, what’s going to happen? We’re going to check in with the target and check to see, was the thing actually cleared? If it was cleared, fantastic. We’re moving on to the next one. If there’s still some work to be done, that’s even better. It means that we might’ve got the layer of sadness, but maybe we need to get this next layer of anger.
Sometimes there are layers to trauma processes where maybe we need to deal with one type of emotion first, then another emotion later. We get into the deeper layers of the onion. Eventually we get to that core, that delicious core of the onion. Then we season that, we fry that one up too. After, it becomes this delicious experience of compassion.
Eventually, even the person who’s been through so much hatred of themselves, who’s been at conflict with these different parts of themselves, resenting what happened to them, resenting what others have done to them… Eventually they get to that point of compassion where they can understand, okay, this is what took place. By adding that positive belief, they add meaning to their suffering. As we continue to add meaning to our past, we then are able to add meaning to our future.
Whole Person Care and EMDR and Depression
There are times that we might use the future template, making it so that the next time the suicidal thoughts come up, these are things that you can do. You can think about things differently. You can use these resources differently. The next time that you feel discouraged, just imagining that this is how you can move through the world, making sure that your resources, these concepts, these characteristics, your ancestors are always walking with you.
This is how we would end up using EMDR therapy in this type of way. People are not going to always come in saying it’s about racism or racial trauma or gender depression, homophobia, et cetera. They might come in with a specific reason, but we are looking for whole person care. That’s why we’re going to be asking questions about identity as well, not from a pathological perspective or identifying it in terms of something that’s a deficiency, but making it so they can cultivate that strength that is deep within every single one of us.
This is how we would use EMDR therapy when we’re helping someone who experiences depression. If you have any questions, put your comments in the chat. If you have any other suggestions of what you’d like to hear me address, it’d be my honor. This is a weekly consult with David Archer. If you like this material, like, share, subscribe, do all of that stuff, and let everyone in the world know that you’re beautiful as you are. Let everyone in the world know that we all deserve to heal.
That’s what’s up. So I’m going to go and get some chicken noodle soup. I think my throat needs it. Many blessings. Take care. Peace.
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