EMDR: A Power Tool in the Treatment of Attachment Disorders
The Attachment Disorder Center of Minnesota, a division of The Family Attachment and Counseling Center of Minnesota, Inc., (the Family Attachment Center) was established in January, 1995. From the first, we incorporated EMDR in all phases of treatment. Our methodology includes nurturing holding by parents, narrative therapy, cognitive restructuring, play therapy, and sensory integration.
EMDR (eye movement desensitization and reprocessing) was "discovered" by Dr. Francine Shapiro in 1987. The initial focus was the treatment of post traumatic stress disorders (PTSD). Adults who had suffered for years seemed to be able to move beyond the traumatic past in one or two EMDR sessions.
Dr. Shapiro hypothesized that the experience of trauma results in an over-excitation of a cortical locus with resulting pathological changes in the brain chemistry. These changes cause information processing to stop. Consequently, the conclusions formed during a traumatic event are "frozen." Dr. Shapiro posited that EMDR had the capacity to trigger a physiological mechanism resulting in the activation of the information processing system.
Information processing and the formation of conclusions is a part of every day living. As we experience life, we form conclusions about ourselves, about others, and about our experiences. We use our senses to group experiences together. The way something or someone looks or sounds or smells may remind us of another time or place. We are also reminded of the way we felt and the way we thought in that other situation. In fact, it may be "as if" we are experiencing the original encounter. We are forever applying past conclusions to present situations. When the past was traumatic, the application of the previous conclusion may be faulty. For instance, the conclusion of a seven year old molestation victim may be "I'm helpless, others have control over my body." The conclusion may be accurate for the child but does not necessarily apply to the adult. EMDR affects the cognition that accompanies the memory of a traumatic event. Instead of being forever locked in the cognition that accompanied the original trauma, a new more adaptive conclusion is spontaneously achieved.
The theoretical conceptualization of Attachment Disorder as a type of PTSD and the application of EMDR as a curative mechanism was an addition to the existing theories of attachment and loss and came after many years of working with Attachment Disordered children in foster care, residential treatment, and out patient facilities. My initial theorizing went something like this. "Could it be that the "frozen" developmental and cognitive features seen in Attachment Disordered children are similar to the "frozen conclusion" commonly seen in adult PTSD clients? If it is a similar phenomenon, would the application of EMDR shift the dysfunctional conclusions shared by many Attachment Disordered children?" This would include the conclusion that parents and other caring adults cannot be trusted.
My early theorizing led me to the work of Bessel van der Kolk and Bruce Perry. Dr. van der Kolk was a key note speaker at the ATTACh conference in October. It is my understanding that his recent brain scan research indicates that the application of EMDR results in a dramatic increase in the activity in the anterior cyngulate which filters impulses from the amygdala as they rise toward the cortex. This increased activation results in the brain's ability to screen out inappropriate levels of activation. Basically, it sounds as if the application of EMDR, allows the brain to conclude that the past is different from the present and that the old "frozen conclusion" is no longer valid.
After two and one-half years of using EMDR with Attachment Disordered children, it is possible to conclude that EMDR consistently provides a mechanism for shifting frozen conclusions. Typical dysfunctional conclusions are: 1. The abuse I endured must mean I am bad or evil. 2. It is not safe to trust adoptive parents. 3. The only way I can survive is to be in control. 4. I am bad or evil and my behavior is who I am. 5. There is nothing I can do that is right. 6. I deserve to be hated. 7. Others deserve my hate.
A common concern is that EMDR will "re-traumatize" the children. This has not been our experience. Attachment Disordered children have often experienced trauma in the first two years of life. The young child that is unable to use a fight or flight response will often "freeze" or disassociate. When parent cannot be relied on to provide protection and comfort, the adaptive survival response is vigilance. In order to remain vigilant, affect is disassociated (secondary or peritraumatic dissociation). This may account for the diminished affect (other than anger/rage) so often observed in Attachment Disordered children.
When we use EMDR to revisit the original trauma, the child often gives a non-emotional, detailed observer account of past trauma and then spontaneously arrives at the conclusion that the abuse was not their fault and that the parent was not being responsible. At times, the child will naturally move into a gestalt, empty chair conversation with the biological parent. Frequently, the child concludes that the parent should have come to therapy to learn to be "responsible and respectful." This cognitive shift is usually achieved without input from the therapist. Later, when attachment is accomplished, we see a full range of affect. For instance, the child may exhibit fear of losing this "new" relationship with the adoptive parent(s).
The Family Attachment Center is a training institute providing internships for master and doctoral interns. In our capacity as a teaching institution, we have a research focus. The first quantitative outcome study on our work with Attachment Disordered children has been completed. The results show significant improvement in behavior in all of the diagnostic categories measured (oppositional defiant, conduct disorder, ADHD, and RAD). This study did not attempt to separate the various treatment components, however. Future research will include a study, with the proper controls, to determine the most robust treatment variables. At this point, our clinical judgement is that EMDR significantly adds to our ability to effectively treat the attachment disorderd children we serve.
Joanne May, Ph.D., L.P., L.M.F.T.
The Family Attachment and Counseling Center of Minnesota, Inc.
18322-C Minnetonka Blvd.
Deephaven, Minnesota 55391
(952) 475-3356 fax