Mila Molero-Zafra
University of Valencia
The impact of traumatic experiences is particularly important for young children as their sense of safety depends on the perceived safety of their attachment figures.
To address the processing of traumatic or high-stress experiences in children, trauma-focused therapeutic perspectives are an excellent choice. In our work, we use the EMDR psychotherapeutic approach, which is a transdiagnostic model of addressing clinical conditions that have as their etiological or sustaining basis traumatic or high-stress experiences that have not been processed in a functional way (Shapiro, 1992, 2001, 2017). This working model proposes an structure of 8 phases that combine access and exposure to memories with bilateral stimulation (BLS) of attention through eye movements or tapping, which generates an associative process in the memory network that stimulates the processing of the disturbance by integrating the blocked memory into the adaptive network. These phases are: 1) evaluation and collection of the history that will help us to conceptualize the case and the work map; 2) preparation of the patient, offering psychoeducation and regulation strategies necessary to approach traumatic experiences, 3) evaluation of the event, decomposing it into the elements that help activate access to memory in the network (Image, Negative Belief, Positive Belief, VOC, Emotion, SUD, and Sensation; 4) processing using BLS; 5) Installation of an adaptive positive belief; 6) Body check-up; 7) closure and 8) re-evaluation.
This EMDR standard protocol has been adapted to address trauma in children, making the appropriate modifications for children and adolescents (Morris and Silvestre, 2014). Authors included attachment issues, family dynamics, developmental psychology, neurobiology and psycho-traumatology providing a complete way to work with each stage of evolutionary development.
One of the challenges to work with trauma in children is helping them tolerate the discomfort that this work entails when exposed to memories. The tendency to avoid disturbance feelings can be a difficulty in the process and lead to dissociation as an emotional regulation strategy. Children with a history of poor attachment usually have a narrower window of tolerance and may require aditional work to achieve an appropriate level of resilience in order to be able to use EMDR for trauma processing. Many children will show resistance to coming into contact with disturbing material being reluctant to process the memories, especially if their caregivers have difficulty sustaining this discomfort and have poor regulatory skills. In these cases, it is more difficult to process stressful events as children become overwhelmed or disconnected. And this can be a risk factor for them to later develop dissociative symptoms to protect themselves from this disturbance in their day-to-day lives.
That is why an adequate preparation of parents to improve their competencies in the emotional regulation of children and in stabilization through bonding, will provide a security context that facilitates this work in children. In addition, to prepare children to cope with the processing of disturbing memories, strategies are required to help children sustain discomfort from the safety of the present.
In this sense, within the framework of EMDR, safety orientation strategies have been developed that will help children during the preparation phase to reduce the intensity of disturbing memories and help overcome fears of traumatic memories. There are used prior to commencing the standard EMDR protocol to process the targets selected after the conceptualization work. Some researchers and clinicians has developed useful tools to increase tolerance to negative feelings as Jim Knipe book (2018) that provides a toolbox with many resources for phase 2 of patient preparation, some of which can be adapted for use in children.
One of these tools is the Constant Installation of Present Orientation and safety (CIPOS) which has been adapted for use in children (Eckers, D. 2010). It is used to install a strong basic feeling of security that helps the child focuses on the traumatic memory for a defined and controlled period of time, before to apply the phases 3-7 from EMDR protocol.
Other strategies that are useful for this purpose is The Four-Field-Technique (hat it can be use with individuals and in a group format, and it is and adaptation from IGTP EMDR protocol by Jarero, Artigas, Hartungt, (2006). to work with EMDR in groups. This technique is useful with children who might not have the verbal and self-awareness skills required to work with the standard protocol or who would be unable to tolerate the standard EMDR procedure; also if, for example, several members of a fame.
