EMDR and the Art of Psychotherapy With Children Robbie Adler-Tapia, PhD, is a licensed psychologist who has worked with traumatized children and their families for more than 25 years. Dr. Adler- Tapia is EMDRIA certifi ed in EMDR, an EMDRIA approved consultant, an EMDR Institute Facilitator, and an EMDR HAP trainer-in-training and has volunteered for EMDR HAP in New Orleans. Dr. Adler-Tapia has extensive training in developmental psychology and working with children 0–3 years of age. Dr. Adler-Tapia has served as clinical direc- tor for several nonprofi t agencies and is currently in private practice in Tempe, Arizona, and has taught graduate-level classes on counseling and consultation. Dr. Adler-Tapia provides counseling, consultation, and psy- chological services for children and families referred by Arizona Child Protective Services and works with local police departments providing counseling and CISD services at her private offi ce in Tempe. Dr. Adler- Tapia has provided training internationally on psychotherapy with trau- matized children, including specialized trauma treatment with EMDR at several EMDRIA conferences, and she is conducting research on EMDR with young children. With her colleague Carolyn Settle, MSW, LCSW, Dr. Adler-Tapia is coauthor of E MDR Treatment Manual: Children ’ s Protocol and has coauthored several studies on EMDR with children. Carolyn Settle, MSW, LCSW, is EMDRIA certifi ed in EMDR, is an EMDRIA approved consultant, an EMDR Institute Facilitator, and an EMDR HAP trainer-in-training. Carolyn has been an EMDR facilitator for 11 years and has facilitated in Japan, as part of the HAP team in New Orleans, and for the psychiatric residents at the University of Pittsburgh. Carolyn also provides specialty training on EMDR for children and has presented at several EMDRIA conferences and on using EMDR with chil- dren at EMDR Europe. Carolyn is a clinical social worker with 30 years of experience working with children. Carolyn specializes in posttraumatic stress disorder, depression, anxiety, phobias, attention-defi cit/hyperactiv- ity disorder, and gifted counseling for children, adolescents, and adults in her private practice in Scottsdale, Arizona. Along with her colleague Dr. Adler-Tapia, Ms. Settle has conducted a fi delity study on using EMDR with children under 10 years of age. EMDR and the Art of Psychotherapy With Children Robbie Adler-Tapia, PhD and Carolyn Se(cid:308) le, MSW, LCSW New York Copyright © 2008 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Sheri W. Sussman Production Editor: Julia Rosen Cover design: Joanne E. Honigman Composition: Apex CoVantage 08 09 10 11 12/ 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Adler-Tapia, Robbie. EMDR and the art of psychotherapy with children / Robbie Adler-Tapia and Carolyn Settle. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8261-1117-3 (alk. paper) 1. Eye movement desensitization and reprocessing for children. I. Settle, Carolyn. II. Title. [DNLM: 1. Desensitization, Psychologic—methods. 2. Psychotherapy— methods. 3. Child. 4. Eye Movements. 5. Professional-Patient Relations. 6. Psychotherapeutic Processes. WS 350.6 A237e 2008] RJ505.E9A35 2008 618.92'8914—dc22 2007052665 Printed in the United States of America by Bang Printing. This book is dedicated to our husbands— Hugo Tapia and Ron Smith, and our children— Michael, Max, and Maura Tapia and Alex and Sara Smith —our greatest joys, blessings, and accomplishments! This page intentionally left blank Contents Foreword xv by Robbie Dunton Preface xix Acknowledgments xxv 1. THEORETICAL UNDERPINNINGS AND RESEARCH ON EMDR WITH CHILDREN 1 Basic Training in EMDR 1 Adaptive Information Processing and EMDR in Child Psychotherapy 2 Assessing the Literature on EMDR With Children 5 Research on EMDR 5 Research on EMDR in Psychotherapy With Children 6 EMDR Individual Studies With Children 6 EMDR Group Studies With Children 12 Our First Research Study 13 Summary 17 2. GETTING STARTED WITH EMDR 19 Getting Started With EMDR 20 Books on EMDR 20 Research on EMDR 21 The Eight Phases of EMDR 22 Client History and Treatment Planning Phase 22 Preparation Phase 25 Assessment Phase 27 Desensitization Phase 30 Installation Phase 32 Body Scan Phase 33 Closure Phase 33 Reevaluation Phase 36 First Client Considerations 37 vii viii CONTENTS The Therapist’s Role in EMDR 38 Setting Up the Offi ce for EMDR, and Especially for Working With Children 38 Integrating Play Therapy Into the EMDR Protocol 39 EMDR Progress Notes 39 Cognitive Interweaves 40 Additional Tools for Getting Started With EMDR 40 Study Groups 40 Listservs 41 Summary 41 3. EMDR PHASE 1: CLIENT HISTORY AND TREATMENT PLANNING 43 Client History 44 Interviewing Parents and Children 49 Procedural Considerations 50 Listening for Targets 52 Presenting Problem 52 Psychosocial History 52 Parent–Child Attachment/Attunement 53 Educational History 53 Religious Affi liations/Cultural Dynamics 54 Developmental History 54 Medical History 54 Assessment of Current Stability 55 Affect Tolerance 55 Trauma History 56 Current Resources, Innerpersonal, and Interpersonal Skills 56 Potential Targets 56 Listening for Negative Cognitions 57 Treatment Planning 58 Therapist Script for Client History and Treatment Planning 59 Informed Consent 60 Establishing the Therapeutic Relationship and Engaging the Client in Therapy 60 Assessment Tools for Evaluating Children 61 Ethical and Legal Issues 61 Cognitive/Intellectual Assessment 62 Academic/Achievement Assessment 62 Developmental Assessment 62 Behavioral Assessment 63 Contents ix Emotional Assessment 63 Assessing Children’s Readiness for Therapy/Selection Criteria 64 Monitoring Child Symptoms 65 Providing Psychoeducational Information 65 Summary 66 Initial EMDR Session Protocol 66 4. EMDR PHASE 2: PREPARATION PHASE 69 Explaining EMDR and Informed Consent for Treatment 69 Explaining EMDR to Parents 69 Explaining EMDR to Children 70 Assessing the Child’s Resources 71 Assessing the Child’s Internal Resources and Skills 71 Assessing the Child’s External Resources 74 Teaching the Mechanics of EMDR 77 Bilateral Stimulation (BLS) 77 Clinical Decision Making With BLS 79 Differences Between Adults and Children Regarding BLS 80 Speed and Number of Saccades 81 Demonstrating BLS to Clients 81 Safe/Calm Place 82 Safe/Calm Place Protocol for Children 85 Stop Signal 87 Metaphor for EMDR 88 Procedural Considerations 89 Techniques for Distancing and Titrating Intense Affect 92 Containers and Types of Containers 92 Organizing the Offi ce for Treating Children With EMDR 96 Resourcing and Mastery Skills 96 Skills for Dealing With Between Sessions and Incomplete Sessions 96 Summary 97 Preparation Phase Session Protocol 97 5. EMDR PHASE 3: ASSESSMENT PHASE 99 Procedural Steps of the Assessment Phase of EMDR 100 Target Identifi cation 101 Clinical Implications 102