Following on from Part 1 of this blog

EMDR in the addiction continuing care process

…”Post-EMDR Assessment Toward the end of her EMDR experience, Nancy was able to leave a job where she felt devalued, and she sought more meaningful employment. She attributed this exit to believing that she no longer had to tolerate being put down by others. Nancy was able to do the AA “inventory” steps (4 and 5) and “amends” steps (8 and 9) for the fi rst time in 12 years of recovery attempts. Nancy recognized that the shame blocks had kept her from doing these steps during past attempts at recovery. When treatment terminated in February 2008, Nancy had been free of alcohol and drug use for more than a year, she no longer met criteria for PTSD, and she had also refrained from sexually acting out since the beginning of her treatment. At the time of termination, she reported that she finally felt “worthy of a healthy relationship in which a man respects my total self as God does.”

Follow-Up Interview Analysis

Nancy was interviewed 6 months after EMDR closure. As verifi ed by her AA sponsor, Nancy was still clean, sober, and free of sexually acting out behaviors. Nancy continued to maintain employment at the job she acquired while in treatment, and she had made signifi cant strides in repairing her relationships with all three of her children. During the hour-and-a-half interview, Nancy freely addressed the questions that were asked of her about her active addiction, treatment, and recovery experiences. In the analysis of the interview text using the descriptive phenomenological psychological method (Giorgi, 1997; Giorgi & Giorgi, 2003), the following major themes were identifi ed: escape, transformation, addiction recovery as a life-or-death matter, EMDR an important part of addressing past issues, a combination of factors necessary for successful treatment, and restoration.

Escape

Nancy initially began to use alcohol, drugs, and sex to escape feelings of pain that she experienced, primarily as a result of her various, sexually traumatic experiences. Nancy could not talk to her parents about her pain, and it was not within her understanding as a youth to seek help from a counselor. In the conceptualization of Shapiro’s (2001) adaptive informationprocessing model, Nancy was not able to process her traumatic experiences, and they became “stuck,” thus causing her to seek out maladaptive ways to address the unprocessed pain.

For Nancy, these maladaptive ways were alcohol and other drugs and seeking validation in an unhealthy relationship with another alcoholic/addict: I felt so insecure and then so overwhelmed with feelings of shame and of pain, like I didn’t understand why things had happened to me and I couldn’t talk about them to anyone and I didn’t know how. I didn’t know how it processed in my mind. From having experience with drugs and alcohol, I knew that when I did that, those feelings left me. And so, that was—that is how I think I started to relate with the way to escape.

Transformation

When Nancy’s using to escape became an addictive process that progressively worsened, she was transformed from “the person that God made her to be” into a broken individual whom she described as insane, crazy, selfish, unloving, hateful, and uncaring: Very hateful, very mean, very negative attitude, I hated life, I hated myself—I just hated myself, I couldn’t—I hated what I had become during my addiction and the only way I could describe it is I just didn’t want to live with myself anymore and I felt like the biggest failure. I had tried so many times to get out of it, to get sober and I never could and I just felt hopeless. I felt totally hopeless, devastated like the only way that it was ever going to end was death.

Addiction Recovery as a Life-or-Death Matter

Nancy’s initial transformation in addiction progressed to the point where she saw death as her only way out, her ultimate escape. In contrast, Nancy also recognized that a major roadblock to her previous attempts at recovery was that she did not view her addiction as a life-or-death matter: I just hoped everyday that death would come. That totally devastated my life and that’s how it made me feel. I really never thought in a million years that I would ever be able to get sober and stay sober.

EMDR an Important Part of Addressing Past Issues

Nancy described EMDR sessions as “taking the garbage out”; she left sessions feeling emotionally and mentally drained, yet with each session, it was like experiencing more of a load lifting each time. This initial drain resulted in a feeling of freedom at the end of the process. In the interview, Nancy was very enthusiastic as she refl ected on her total EMDR experience. Nancy believed that self-examination was impossible before this treatment episode because she had such a distorted view of herself. She believed that EMDR freed her from the victim role and made it easier for her to self-examine in a more rational way: [EMDR] dug deep into my soul or into my mind. And along with the trash came the pain, the shame, the guilt, the remorse, whatever went along with the situation. When I faced it, and I dealt with it, and I talked about it, and I analyzed it, and then I was able to release it and forgive myself and others for what had been done to me and what I had done to other people. And then I felt a great sense, I felt freer. Nancy expressed her belief that the trust she established with her EMDR therapist, a recovering female, was also critical to the success of the therapy. Being able to “relate to” her therapist was important to Nancy.

Combination of Factors Necessary for Successful Treatment

Nancy noted that EMDR helped her to better work the 12 steps of AA. Nancy attributed the combination of EMDR, 12-step work, opening up to a sponsor, seeing addiction as a life-or-death matter, her willingness to change, and deepening her spirituality as factors that worked together to get her sober and well. Nancy was also able to recognize the synergistic effect of the different factors working together. For instance, she knows that her trauma history made it diffi cult for her to get through the 12 steps of AA before: You can’t put anything in the proper perspective. And you can’t really get a heads up on what really happened because you were so traumatized and you had such bad experiences and like in my case, I had the trauma then I had the—I call it the aftereffect of my ex-husband—pounding over and over and over and over it for like 14 years after that. I took so much responsibility for it. It was almost like I victimized myself all over again in my mind.

Restoration

Nancy viewed her recovery as a restoration to the person whom God intended her to be. She noted several concrete examples of change (e.g., holding down a good job, being there for her children and her elderly mother) in addition to an overall change in attitude and personal development. Nancy described EMDR as helping her put the sum total of her life, including her “demons and secrets,” into proper perspective so that she could fi nally face the past and move on: The obsession and all the bad memories and the pain were replaced with hope and faith, and a sense of: I’m not crazy, I’m not insane. I’m okay, I’m getting well, I’m getting back to sanity.

Discussion

The beauty of any case study is that it can allow us to explore a person’s treatment in greater depth. For clinicians who routinely work with addictions, Nancy’s case illuminates the possibilities of using EMDR to treat a female in addiction recovery, and it offers them suggestions for how and when to best implement EMDR in working with a case like Nancy. Nancy’s EMDR treatment commenced when she was sober for 3 months, and the preparation stage of her EMDR treatment was relatively short (one session). Although some clinicians may be hesitant to begin EMDR so soon into sobriety, Nancy was ready for the treatment because enough foundational elements were in place, specifi cally, access to sober supports via her AA groups and an AA sponsor. Moreover, Nancy presented for treatment with a high degree of awareness about what barriers existed in previous attempts at recovery and an equally high degree of willingness to address these myriad barriers, especially as they related to past trauma

References

1. Marich, J. (2009). EMDR in the Addiction Continuing Care Process Case Study of a Cross-Addicted Female’s Treatment and Recovery.Journal of EMDR Practice and Research, 3(2), 98-106.