Video 056 Reverse Protocol

Use this solution

With clients unable to reprocess trauma events from the past or manage the things that trigger them in the present, and have no hope of change in the future and very limited resources for dealing with the present. Useful in situations  such as:

·       Limited time for treatment, e.g. impending medical intervention or  court appearance

·       Military clients facing deployment or return to active service

·       Children who may struggle to see the point of talking or thinking about the past; talking about the future can be much more appealing

Video production

Matthew Davies Media Ltd, Llanidloes, Powys. www.matthewmedia.com

Take-Away Section

What this covers

The case is about a man in his forties who has lost his family and career. He experiences extreme dysregulation, suicidality and an inability to make sustained relationships due to poor attachment and complex PTSD. He has a childhood of extreme neglect and abuse. The defining condition is a lack of any hope of change or relief in the future.

 This video demonstrates the use of the Reverse protocol in which the standard protocol with the three –pronged approach is reversed.  Instead of past-present-future this protocol reprocesses targets starting with the future and working to the present and then the past.  Once the client can imagine a future there is greater hope and they are more willing and better able to tolerate reprocessing the past.

 When we conceptualize a case using this protocol, we are focusing on a more positive future outcome and reprocessing this  before thinking about the present and past.  This is not a future template, nor the ‘Flash forward protocol’ that addresses present acute/overwhelming anxiety about the future.  The Reverse Protocol uses all 8 phases of the standard protocol while focusing on a potential solution rather than the present problem. In this regard it’s akin to Brief Solution Focused therapy (SFBT). Indeed, SFBT can be extremely helpful in identifying ‘hopeful futures’ for use in the first phase of this EMDR protocol (see Wrap up below)

How long

16.15 minutes

Go to ‘Take-away’?

Wrap up: Finding hope when nothing seems possible using SFBT

Aide mémoire: Step by step guide how to use the protocol - available to copy and paste.

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+ Wrap up

Below are some exercises taken from Solution Focussed Brief Therapy (SFBT). If the client is bereft of hope for the future, and is unable to come-up with any ideas in conversation with you as therapist, try some of these exercises below and then adapt the information to use with the Reverse Protocol focus on the future.

As therapist you can work with the client in your office or online or ask them to do the exercise at home on their own. My own (Richard W-D’s) preference is to work with the client so that a discussion can be held as the client goes through the exercise. You may use one of these exercises to uncover some hope and you do not necessarily need to work through all of them –after all you are only seeking enough information to use the standard EMDR protocol on a hopeful future scenario. If as a therapist I am only using SFBT without any knowledge of EMDR, then I would probably be working through all of these exercises.

MIRACLE QUESTION EXERCISE Suppose tonight, while you are asleep, a miracle happens. The problems you are having in your life are solved. However, because were asleep when the miracle happened, you didn't know it had occurred. When you waken in the morning how will you be able to tell that the miracle has happened? As an exercise, sit or lie down somewhere quiet where you won't be disturbed, and carry out the miracle exercise. Allow your breathing to slow, settle comfortably and let your mind wander where it will. Ask yourself 'After the miracle, What will I see that is different?', 'What will I hear that is different?', 'What will I be that is different?', 'What will I feel inside that is different from the way I feel now?' Think about those questions for a while, and then ask yourself this question: 'What would the other people in my life see, hear, notice, that was different?' Think about each of the people in your life and see yourself after the miracle from their point of view, imagining what is going into their eyes and ears, what is going through their mind as they deal with the new you. Think about what they would think about your behavior, attitude, values in your new life. Think about how you would behave, knowing what they think and see, and what you would have to do to make them see you behaving that way. Spend about ten minutes or so doing the exercise. Then resume your normal tasks, go through the rest of your day, and in every situation, as you get into that situation, imagine how you would behave if the miracle had happened, and then do as much of that behaviour as you can. The following day, think about how you acted when you assumed that miracle had happened, and how many things you actually did that were part of the miracle, and then imagine your life after the miracle in even more detail. Repeat the Miracle question exercise every day until the miracle has happened. You will then be living the miracle.

THE AS-IF EXERCISE THERAPY How to use the miracle question in solution focused therapy. Tomorrow morning, as soon as you get up, as soon as you are reminded of your problem in some way, repeat the miracle question, ask yourself "What would I be like if the miracle has happened, if I was magically rid of my problem? What would it be like if my problem had just vanished? What would I be doing? What could I do that I don't do now?" Then let something come to mind. Probably several things will come to mind.
Choose the smallest, least significant thing that you would be doing if your problem had gone, that you don't already do. Choose something definite, some act or behaviour, something that could be measured or noticed, not just an attitude. Then during the day, act 'as-if' your problem was gone. Put the 'as-if' change into practice, actually do it, that small insignificant thing. And all day keep doing it, and the next day choose something else, some other small insignificant thing, to do as well. And keep doing those things 'as-if' you did not have the problem. Add a new behaviour each day. And a miracle will happen: you actually will not have the problem. Acting 'as-if' frees you to not have the problem anymore.

THE DARE QUESTION EXERCISE How to use the Dare Question in solution focused therapy. So how do you work out what you really want? The Dare Question may have an answer for you. Suppose somebody said you could have anything you wanted in the world, anything at all, how would you know what to choose?
One way is to ask yourself the Dare question: "What would you do if you knew you could not fail?"
Most people in fact have never really thought about what they want, what they might be capable of, because they are so focused on the daily routine or on the past and its failures that they just don't take the time to think about their own future. And not knowing what you want is the route to a wasted life. So, ask yourself the Dare question, and note what your answer is.
Think about what would happen if you actually succeeded at what your answer was. Most people doing this exercise find that they start off with some conventional answer almost automatically, but when they have had some time to actually absorb the idea of being unable to fail, come up with an entirely different, and sometimes surprising, answer. Your answer will tell you what you really want to achieve.

The SHOULD QUESTION EXERCISE How to use the Should Question in solution focused therapy. Get a bit of paper and divide it into three columns. At the top the first column write the words 'I should....'. Then in that column write down all the things that you feel you should be doing. The list can be as long or as short as you like. Look at your list and rearrange them into the most important. Then, beside each 'I should...' statements, ask yourself 'Why?' and write down the answer in the second column. Then for each Should statement ask yourself 'Says Who?' and write the answer in the third column. Doing this exercise will let you find the basic beliefs you have about yourself. The 'Says Who?' column will challenge your assumptions and will show how you have been programmed to believe certain things that are causing problems for you. Now go through the list again, but this time rewrite all statements in the form 'I COULD....'. These will turn into your affirmations. These affirmations will targeted exactly at the things in your life that you need to focus on.

+ Aide Mémoire

  1. Take a history and work with your client to make a clinical choice between the standard protocol and the reverse protocol based on the level of distress, time constraints, developmental stage and attachment history.
  2. Explain EMDR and agree on the method of bi-lateral stimulation (BLS)
  3. If the reverse protocol is chosen, install resources such as a calm / happy place; grounding techniques; a container or time capsule to hold material that emerges during the reprocessing that isn’t helpful at this point in the therapy. Installation of resources is a good way of introducing the BLS so that the client is comfortable when it comes to desensitization
  4. Identify the future positive target image – the hoped for future. If this proves difficult to identify use one or more of the Solution Focused Brief Therapy techniques in the Wrap up section.
  5. Identify the negative cognition that stops the client from believing they can have the hoped-for, positive future
  6. What would they rather believe about themselves? Identify the positive cognition and the VoC
  7. Hold the negative cognition together with the target future image, what feelings does it engender?
  8. How disturbing are the feeling? This elicits the SUDs rating
  9. Where are the feelings held in the body?
  10. Hold the target image, the NC, the emotions and the body sensations together and start reprocessing
  11. If the client makes links to past trauma or current triggers, use a cognitive interweave to decide on whether or not to go with these links (EMDR) or to restrict the reprocessing to the current future target (EMD)
  12. Once the SUDs are reduced, go to the installation phase
  13. If the VoC is acceptably high (not necessarily 7 at this stage), then move on to other fears that relate to the future target
  14. If the VoC becomes stuck, there may be a blocking belief that needs to be processed
  15. Once all the fears are reprocessed, it is likely that the VoC will reach 7
  16. At this point, do a body scan.
  17. Check with the client - are they ready to adress present and past issues now they have hope for the future. Follow the client's inclinations.
Complex PTSDRichard Worthing-DaviesComment