A Proposal for an EMDR Reverse Protocol

Introduction

As a psychologist for the child welfare system working with severely and
chronically traumatized children and families, and as a psychologist for law
enforcement, I returned to my office following my EMDR Basic Training I
struggled to implement the protocol with my clients. In my 25 year career, I
cannot recall ever encountering one client with a single incident trauma. So
how then could I use EMDR? Because literature has discussed that EMDR
trauma reprocessing (Phases 3-7) must be delayed due to the clients need
for extended resource development and skills to manage intense affect, I
initially abandoned case conceptualization with EMDR because time and
external resources did not afford my clients the opportunity to complete the
entire targeting sequence plan. My clients were consistently presenting with
intense and complex trauma histories.

I continued to provide psychotherapy as I had practiced all along, while I

also explored opportunities with clients to develop resources to prepare for
trauma reprocessing with EMDR. Yet I noticed that many clients still
struggled because they had no hope for the future. Many clients had been in
therapy and believed that therapy was to help them learn to cope with
symptoms. EMDR offered the opportunity for the client to reprocess
symptoms so those symptoms no longer would be present in the future;
however, most clients could not imagine a future at all, let alone a future
with no mental health symptoms.

The children referred from the child welfare system adamantly avoided the
past because they were young and their pasts were horrendous. In addition,
the future was not something these children could imagine nor was the
present a pleasant existence for many of them either. Many clients
struggled to exist in the moment and to cope with each day. I struggled to
integrate EMDR into my practice even though I was working with severely
and chronically traumatized clients who needed EMDR.

So how could I think conceptually through Shapiros Adaptive Information

Processing (AIP) theory in my treatment approach and yet not focus on
reprocessing past events first? Could I help clients with those horrendous
past events that were maladaptively stored in the clients memory thereby
preventing the client from seeing any kind of future at all? It was evident to
me that many of my clients came to psychotherapy for symptom relief
without the expectation of a healthier, happier future. Was it possible for me

to assist my clients to reprocess the clients foreshortened sense of future

that was driven by the past events they had experienced?

What is the EMDR Reverse Protocol?

The Reverse Protocol is the EMDR 3-Pronged Approach targeting in reverse

order - Future-Present-Past. This protocol uses all 8 phases of the standard
protocol. It is not beginning therapy with a future template or resource
development (Korn & Leeds, 2002; Leeds, 2001). Some who are familiar with
Solution Focused Brief Therapy (SFBT) (de Shazer, Berg, Lipchik, Nunnally,
Molnar, Gingerich, & Weiner-Davis, 1982) will recognize a flavor of focusing
on the solution rather than the problem in that this EMDR reverse protocol
focuses on addressing the clients negative beliefs about the future before
reprocessing past traumas. This reverse protocol reprocesses the anxiety
and negative cognitions about the future before reprocessing present
triggers followed by reprocessing past events. Many clients with trauma,
dissociation and depression exist in survival mode and cannot participate in
past trauma reprocessing because they experience life through the lens of
trauma with a foreshortened sense of future. These clients need extended
psychotherapy focused on skill building, affect regulation, and developing
emotional intelligence in which the client can identify and tolerate intense
emotions. Past trauma cannot be reprocessed without significant time in the
Preparation Phase of EMDR. Another potential for case conceptualization is
to reverse the temporal order of the targeting sequence plan. This idea still
considered that maladaptively stored information from the clients history
were driving current symptoms; however, the client was not
developmentally capable of focusing on trauma reprocessing about the past
until the client could imagine a future.

This is the essential proposal for a Reverse EMDR Protocol

1. The Reverse Protocol is about a beginning therapy by reprocessing future

targets before present triggers and past events. Treatment begins with
identifying a positive future and the negative cognitions about why the
client cannot consider the future and/or does not entertain a future free of
symptoms. Future reprocessing is also a resource focused on the client
anticipating using replacement behaviors integrated with plans for what to
do in the future when you have these symptoms. The therapist might ask
the client, How do you see the future without these symptoms that brought
you into treatment? What prevents you from accomplishing this future goal
(NC)?.

2. Present symptoms: While reprocessing the future targets, therapy

simultaneously monitors triggers, stressors and the use of self-soothing/selfcalming skill. After the client has reprocessed negative cognitions, emotions,
and body sensations about the future, then present triggers are
reprocessed.

3. Past events: Past events/targets are reprocessed using the standard

protocol. This still includes reprocessing the past target, present triggers
and completing the target by installing a positive future template consistent
with the standard EMDR protocol. Essentially the temporal order of therapy
is future-present-past (reverse protocol) and then past-present-future
(standard protocol.) Why use the reverse protocol and the standard
protocol? The therapist may consider the Reverse Protocol because the
client cannot initially manage the standard protocol.

If you are interested in learning more about the Reverse Protocol, please
listen to one of my trainings, attend a new one, or look for this complete
article to be published.