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Based on feedback from clients, it seems like a lot of therapists don’t tell you how they structure therapy. They don’t tell you what type of therapeutic techniques they’re using, why they are using them, or how the process should look. That’s not my style though–I want you to know it all because when you have the information then you feel empowered. And when you’re empowered, that’s when real change happens.
So let’s talk about it…
Step 1: Goal setting
I approach counseling as a collaborative, non-shaming process. I may have training in specific therapeutic techniques, but you are the expert of your own life. This means we work together to form the goals you want to achieve.
Whether you come in knowing that you want to reprocess a specific situation/belief or with a vague idea of “I’m unhappy and I don’t want to be anymore”–we’ll work together to figure it out. We form goals Day 1 of therapy and continue to review them throughout our work together to guide the direction of your sessions. These are moving targets so if something isn’t working or we need to switch things up, we can.
step 2: a foundation of safety
We have to feel safe and secure to be vulnerable. It’s a necessity. Not only do you need to build trust in our therapeutic relationship, but also in yourself to do the work. One of the biggest fears my clients often have is that if they open up, they will emotionally flood and will no longer be able to control their feelings. It’s a paralyzing fear that leads us to pushing down our emotions until we simply can’t anymore. I work with you, at your own pace, to develop skills to deal with distress so that you can feel confident exploring emotionally charged topics–knowing that you can successfully bring yourself back to an emotionally neutral place. This is an ongoing process that we revisit throughout the therapeutic process, but an essential component that we start discussing in the very first session.
step 3: history taking & target selection
In order to know how we got here and what is causing the distress, we have to look in the past. Through an attachment and family systems lens we look at your history to start to conceptualize what your negative beliefs are and how they formed. This is an involved process that moves at your own pace and can include homework to help you get a deeper understanding of themes, patterns, behaviors, and meaning taken from certain situations you have experienced. This process helps clients gain the insight and understanding they need to feel confident in reprocessing. During this stage we also get a really good idea at what situations and beliefs you want to target with EMDR. With specific targets in hand we’re ready for the next step.
Step 4: EMDR Reprocessing
For most clients, EMDR reprocessing is the goal that we’re working towards. We’ve identified the distressing situations and beliefs that are holding them back, have coping skills and resources in place to handle emotions that come up, and we’re ready to start the process.
Our first target is always a minimally distressing target so that we can get our feet wet and you can see just how the process works without too much on the line. After a successful session (typically 45-50 minutes) with a minimal target we will move on to our main goal targets.
I like to use the phrase that we can either “pull leaves or cut branches” when it comes to reprocessing our big targets in EMDR. In this analogy we think of our brain as a tree with the the trunk being our sense of “self” and the branches coming off of it being various negative beliefs. Where the branch meets the trunk is our “touchstone event” or the first memory we have of a particular belief. It is the strongest connector of that belief to our self, which means two things: 1) It is a powerful and sometimes difficult event to reprocess 2) We will typically get the most relief from reprocessing it. These events are often rather young in our development and as we get older we have more and more events that occur that reinforce that original beliefs (these are the “leaves” growing on the branches). These reinforcing events are often a little easier to reprocess and definitely provide some relief, but they don’t get rid of the whole branch as easily as reprocessing the touchstone does. This means that we will still get to reprocessing the whole belief, it will just take a little bit more time and that’s okay. The important part is that you feel comfortable and confident with the work.
step 5: maintenance
Hooray! You made it to the maintenance stage! This means that you’ve done the hard work to reprocess the distressing beliefs and experiences that have been holding you back. You’re probably noticing some significant changes in your life and may be feeling pretty good right about now. This is awesome and I’m super proud of you. So where do we go from here? Well, that’s up to you. Throughout this process you’ve gained all sorts of skills to help you tackle life’s challenges as they come at you. That means that you will most likely be able to handle the day to day type stuff that comes up. Most clients at this stage go to once a month sessions. These are more check-in style sessions where we make sure things are running smoothly and therapeutically address anything that you may need a little help with.
After a while of once a month maintenance sessions, with no significant issues coming up, it may be time to “terminate” aka end therapy sessions. This is a really beautiful moment in the therapeutic process because it is a culmination of all the work we’ve done together. Don’t worry, if something does come up in the future and you need help you can always reach out. But for now, go enjoy your life 🙂
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Jessica L. Kraemer, MA, PLPC is under the supervision of Dr. Brittany N. Murphy, PhD, LPC, BC-TMH MO License 2013022876
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