I haven't talked to S14's therapist about it yet -- I plan to. S14 uses humor as an effective distancing defense with his T, something the T told me during a parent session. The T felt that S14 seemed to "tolerate" him, and also said that this type of thing is typical and even appropriate given that they are establishing an intimate relationship. S14 is also very somatic, and will talk about physical complaints a lot when he's in therapy, instead of his feelings. I am interpreting all of this as S14 doing his best, while also not being sure what else he can do in therapy. It feels like things have hit a plateau. EMDR seems like a treatment for sneaking in a different door to the heart while the mind keeps guard. That's my scientific take on it.
Meanwhile, my T said there is new research about EMDR and OCD, too, so I thought that makes two reasons to look into it.
I have been digging into the research, and it sounds like many of the studies on EMDR and teens focuses on Type I Trauma (things like car accidents, earthquakes, one-time traumatic events). Only one study focused on Type 2 Trauma (like repeated child sexual abuse or what they call interpersonal stressors, such as divorce).
Treatment of Type II Traumas. Although the treatment of Type II traumas, particularly interpersonal violence, has been heavily researched in studies investigating CBT therapy (Sánchez-Meca et al., 2011), there has been only one EMDR controlled study that has focused on this trauma type with children (Jaberghaderi et al., 2004). This lack of EMDR research is surprising given that Type II traumas are related to an increased risk for PTSD as well as many other lifelong consequences (Wenar & Kerig, 2006). This lack of child research appears to parallel a lack of EMDR research investigating treatment of adults with complex PTSD from childhood interpersonal traumas (Korn, 2009).I imagine Type II Traumas can include having a BPD parent or living in a high-conflict home.
This is something that stood out for me:
Attachment disorders and severe personality changes can follow Type II traumas (Terr, 1991), thus impacting on the required treatment. In such cases, family therapy can be of great benefit and has been shown to be particularly advantageous in cases of domestic violence and abuse (Amaya-Jackson, 1995). The integration of EMDR with family therapy can address the complex sequelae that follow sexual abuse (Maxfield, 2007), and other interpersonal stressors such as divorce (Klaff, 2007). De Roos et al. (2011) offered parental counselling to the parents of all the children involved in their study. This enabled the parents to resolve their own anxieties and cognitive distortions regarding their child's traumatic exposure and provided them with psychoeducation and parental skills training that would help them support their child and correct maladaptive coping behaviors. Further research is needed to investigate the effects of an integrative approach such as this.So many of the improvements with S14 follow my own
from working with a T. I do wonder what things would be like if S14 and I did family therapy together after the divorce. Live and learn I guess
I also found it interesting that different studies focus on different PTSD symptoms. S14, for example, has very strong avoidant behaviors. That's really what made me want to know more about EMDR. He is responding to the therapy he's doing with his T, and he's also still very avoidant. How do you get through that wall?
Avoidance Symptoms. Tufnell and De Jong (2008) advised that EMDR is particularly effective with avoidant children as it relies less on verbal proficiency and a willingness to communicate orally with the clinician than CBT. One may therefore expect to see large improvements in avoidance symptoms, but this is contradicted by Oras et al. (2004), who found that, although significant, it was these symptoms that improved least following treatment. They note, however, that once the living situation of the refugees they investigated had stabilized, these symptoms improved, thus supporting Adler-Tapia and Settle's (2009) idea that the child's environment influences the resolution of PTSD symptoms.The article talked about other PTSD symptoms like hyperarousal, maladaptive cognitions, and re-experiencing symptoms. Maladaptive cognitions include things like a child believing his father has a mental illness because of the child, or that the child caused the divorce.
I also read that EMDR can involve a computer, and that might appeal to S14. He's into anything that has a screen
