Eye Movement Desensitization and Preprocessing (E.M.D.R.)
Ego State Therapy in the Treatment of Sexual Addiction
"Leggo My Ego" by Jennifer Barbieri, LCSW
With snot dripping from the end of his nose and a body physically drained from crying and shaking, he takes a deep breath and asks when he can get more. No, it isn't a drug scene; it's the end of an E.M.D.R. session.
Eye Movement Desensitization and Preprocessing (E.M.D.R.) is a trauma processing method developed by Francine Shapiro in 1989, after she discovered that painful traumatic memories can be reduced by using bilateral stimulation while a patient recalls the trauma.
Although it is not yet understood exactly why or how E.M.D.R works, its effectiveness emerges consistently from controlled studies. Brain scan research suggests the amygdala and hippocampus are stimulated by the E.M.D.R. process. These areas of the brain are instrumental in resolving traumatic memory.
Wearing a set of headphones and holding a small vibrator in each hand, a patient describes a disturbing event or emotion. As bilateral stimulation occurs (beep, beep, buzz, buzz, left right, left right), the patient moves through the scene. Disturbances are lowered and cognitive distortions created in the patient's mind under stress are reprocessed into reality based, present day interpretations.
At the Gratitude sexual addiction program, patients eagerly await their E.M.D.R.sessions. Describing vivid imagery, intense emotional release and a calming effect, they consistently pronounce E.M.D.R. as essential to their treatment process. Not every session is intense. Clients may also experience thoughtful, quiet sessions.
Soon after its initial development, E.M.D.R. quickly proved a logical application for war veterans and other patients with post traumatic stress symptoms. Although many patients entering the Gratitude program present with post traumatic symptoms, not all patients identify trauma history.
Bilateral stimulation (DeTur method) is used to help patients overcome urges and triggers. Also valuable for building ego strength, pain management, goal setting, and breaking through denial, E.M.D.R. is a multi task therapy technique. Whether used in conjunction with clinical hypnosis, ego state work and color therapy, separately or in combinations, this therapeutic method provides a well-rounded menu to address trauma and addiction.
After being clinically approved, patients prepare for E.M.D.R. with a foundation of relaxation to establish a “safe place” scene. The safe place scene serves as a base for further trauma work. The patient invites his or her spiritual presence into the safe place scene. The spiritual presence may appear as a figure (God, Jesus, angels, etc.) or a concept, “I feel a sense of peace.” Regardless of the manifestation, patients consistently report seeing light when describing their spiritual presence. A spiritual presence may also not manifest at all. The pain of unprocessed trauma fuels addictions. Emotionally arrested at younger ages by trauma, inadequate parenting, abuse or life circumstances, humans develop shame cores, then build layers of protection in the form of maladaptive coping skills to mask or medicate the shame core.
Life stressors including physical, emotional and sexual abuse create internal pain reservoirs. Attempts to escape new or reserved pain may include the addictive behaviors of self medication. Sexual behaviors including masturbation, pornography, anonymous sex,affairs and fantasy are some common maladaptive coping skills to medicate pain. Other maladaptive behaviors include the use of drugs, alcohol, work, spending or avoidance. Alone or in combinations, these behaviors only add more pain to the reservoir and increase shame The result of this process; trauma, shame core, and maladaptive coping skills is an internal division of self. From this division springs the ego state family.
Ego state theory, developed in 1932 by Paul Ferdan and expanded by Eric Berne, John and Helen Watkins, and Richard Schwartz presents that an internal family exists within us. Patients are introduced to ego state work and examine their own internal ego family in their first E.M.D.R. session. This family of arrested ego states interacts in mini vignettes weekly as patients address their internal struggles with addiction. Recurring among Gratitude patients are 0-5 year old ego states, 8-12 year olds, teenagers and addicts. By examining initial ego state scenes and position of characters and tracking change, the treatment process can be monitored.
Patients frequently describe their addict ego states as dark, evil, unkempt or dangerous. The addict ego state is often perceived by the patient as angry, rebellious and powerful with a strong intent to stay in addiction. Some addicts are depicted as objects or animals, ranging from monuments to fireballs to bears. Some describe them as attractive and seductive. An ego state battle emerges as the functional adult attempts to learn new coping skills and release pain (from the reservoir which fuels addiction). The addict relies on this pain to remain strong. Child ego states consistently carry pain from unresolved trauma. As the functional adult ego state attempts to heal from the pain, the addict ego state needs it to survive. The functional adult attempts to soothe the pain of traumatized children ego states while the addict consistently re-traumatizes the children through trauma reenactment, trauma bonds and acting out behaviors.
A typical ego state scenario may involve a functional adult rescuing a five year old from an abuse scene and placing the child in the pre arranged safe place. In successive struggle between the adult and addict ego states sometimes becomes very clear. In one scene, a patient rescued a traumatized child from a household of dysfunctional, abusive parents. The addict commented to the adult as he comforted the child in the safe place, “He'll have to go back there, you know.
Although the goal in ego state work is for the functional adult to embrace all parts of self, it is common for the functional adult to reject the addict at first. There is usually a struggle for the addict to remain in control and the introduction of the spiritual presence to the addict ego state. Patients consistently report great distance, fear or shame when attempting to consider their addict ego state and spirituality together. Dark and light are unable to exist in the same space. This sense of opposing forces, dark and light or good and evil, depicts the internal struggle addicts live with daily. As treatment progresses, the addict, typically comes “out of the shadows.
An ego state tracking system for each patient facilitates crosswork. As patients move from processing groups to trauma groups, psychoeducational groups and expressive therapy groups, clinical team members interactively support trauma and ego state work. For example, when asked about his nine year old ego state following an E.M.D.R. session, a client remarked he'd left him in trauma group the previous day.
Addicts often fear and even hate themselves for having an addiction. They wrestle with the truth that their addictive behaviors have impacted not only their lives, but the lives of spouses, children, co workers, friends and strangers. They are internally conflicted. As E.M.D.R. and ego state work continue, the ego state family, led by the functional adult often learn to live in peace with the spiritual presence as master of the house. In best case scenarios, the functional adult and addict ego states link arms and join in recovery together. E.M.D.R. is a powerful part of the Gratitude program. Patients consistently report insight, progress and strength from E.M.D.R. sessions. The results are observable by clinicians. Gentle Path patients are learning to love and accept themselves and face their addiction with their heads up and their hearts strong. They are examining their shame and being accountable for their behaviors with a greater peace and authentic grief. They are accepting earned consequences with grace and humility. They are setting boundaries and self limiting, practicing self care and assertiveness. In essence, they are maturing.
As they begin to know, accept, trust and even love themselves and others, Gratitude patients are finding there are many shades of grey between darkness and light. Patientsexiting the Gratitude program are continuing their journey into wellness. Withongoing support and a dedicated commitment to, and investment in, sexual healing, some patients may find not only a light at the end of the tunnel, but a rainbow.
Who will win the ego state battle? Will every addict obey the command of the functional adult when he cries, “Leggo my ego?” The answer is beyond us all. It may be best to reflect upon the basic twelve-step tradition and Leggo and let God (as you know Him).