EMDR in Child & Adolescent Psychotherapy
Ricky Greenwald, 1999
The definitive book on using EMDR with kids...
This book is written for anyone interested in child/adolescent therapy, and features:
- an introduction to EMDR in child/adolescent therapy, with many case examples for different ages and types of problems
- presentation of a trauma-based comprehensive therapy approach including systemic and behavioral components, and integrating EMDR
- emphasis on disruptive behavior disorders
For those child/adolescent therapists already trained in EMDR, this book also offers a technical guide to age-appropriate methods and variations.
Preface [Literature Review] (p. ix)
Acknowledgments (p. xix)
Introduction (p. xxi)
PART I: EMDR IN CHILD AND ADOLESCENT THERAPY
1. Child and Adolescent Trauma(p. 3)
Case Vignettes (p. 6)
2. Latency-Aged Boys with Disruptive Behavior Disorders(p. 23)
The Treatment Approach (p. 26)
Assessment (p. 28)
Treatment (p. 37)
3. Adolescents with Conduct Disorder(p. 75)
Motivation (p. 78)
Skill Building (p. 93)
Trauma Work (p. 108)
PART II: THE TECHNICAL REPERTOIRE
4. EMDR: A Review of the Standard Protocol(p, 117)
Accelerated Information Processing Theory (p. 119)
Basic Components of EMDR (p. 121)
The EMDR Protocol: The Eight Phases of Treatment (p. 126)
Advanced Applications (p. 130)
5. Overview: Using EMDR with Children(p. 135)
Safety First (p. 140)
6. Basic Components of EMDR for Children and Adolescents(p. 153)
Imagery (p. 155)
Negative Cognition (p. 156)
Positive Cognition (p. 157)
Validition of Cognition (VoC) Scale (p. 157)
Emotion (p. 158)
Subjective Units of Disturbance Scale (SUDS) (p. 158)
Physical Sensation (p. 160)
Eye Movements (p. 160)
7. The Eight Phases of Treatment for Children and Adolescents(p. 167)
Phase 1: Client History and Treatment Planning (p. 170)
Phase 2: Preparation (p. 171)
Phase 3: Assessment (p. 183)
Phase 4: Desensitization (p. 187)
Phase 5: Installation (p. 192)
Phase 6: Body Scan (p. 200)
Phase 7: Closure (p. 201)
Phase 8: Reevaluation (p. 202)
PART III: SPECIAL APPLICATIONS
8. Infants and Toddlers(p. 207)
Parents' Reactions (p. 210)
Parent Education (p. 212)
Parent Involvement in Treatment (p. 213)
Slightly Older Children (p. 215)
9. Young Children(p. 217)
Assessment (p. 219)
Discussing the Problem (p. 220)
Magical Thinking (p. 221)
Parent Training (p. 222)
Introducing and Doing EMDR (p. 227)
10. Families(p. 233)
Parents and EMDR (p. 236)
Other Family Interventions (p. 238)
11. Bed-Wetting(p. 245)
Assessment (p. 248)
Trauma (p. 248)
Positive Parenting (p. 249)
Sleep Hygiene (p. 249)
Positive Developmental Approach (p. 250)
Muscle Development (p. 251)
Externalized the Problem (p. 251)
Incentive Program (p. 252)
12. Special Treatment Settings and Populations(p. 253)
Settings (p. 255)
Problems and Populations (p. 262)
Appendix A: EMDR and Child Trauma Resources (p. 273)
Appendix B: The Trauma Orientation and Child Therapy(p. 275)
Definition of Trauma (p. 275)
Vulnerability to Trauma (p. 277)
Prevalence of Trauma (p. 279)
Effects of Trauma (p. 280)
Assessment of Trauma (p. 284)
Recovery from Trauma (p. 290)
References (p. 293)
Index (p. 305)
Robbie Dunton, M.S.
Executive Director, EMDR Institute
"This exceptional book is imperative reading for professionals who provide services for children and for parents seeking help for their child. We have much to learn from Dr. Greenwald. In addition to guiding readers through the EMDR protocol as it applies to children, he models the essential elements of skillful communication and demonstrates through engaging case examples and creative metaphors the art of working with adolescent and young clients. This book, which offers specific tools for integrating EMDR into an overall treatment plan for disruptive behaviors and conduct disorders, gives us hope for working successfully with this very challenging population."
Francine Shapiro, Ph.D.
Originator of EMDR
Author of EMDR: Basic Principles, Protocols, and Procedures (1995 Guilford)
Senior Research Fellow, Mental Research Institute, Palo Alto
"A very welcome addition to the EMDR literature. Dr. Greenwald places EMDR within a systemic framework with explanations of how to lead parents into a supportive therapeutic role. He carefully weaves together treatment suggestions from a wide range of sources to guide the clinician through practical and innovative variations that are suited for children and adolescents. In this excellent volume for the practicing EMDR clinician, special attention is given to the treatment of disruptive and conduct-disordered children."
Charles R. Figley, Ph.D.
Professor, Florida State University; Founder/Director, FSU's Traumatology Institute
Author of 14 books, including Helping Traumatized Families (1989) and Trauma and Its Wake (1985)
Founding Editor, Journal of Traumatic Stress and Traumatology on-line journal
Founding President, International Society of Traumatic Stress Studies
"I am convinced that EMDR is an effective treatment approach for those who seek relief from life-disrupting trauma symptoms. Greenwald has done a fine job of producing a useful guide for practitioners trained in EMDR to work effectively with hcildren and adolescents. It represents the new traumatology paradigm that assumes that desensitization is probable, not just possible, especially with children. Long live the new paradigm!"
Philip Dutton, B.Sc., Dip. Clin. Psychol., C. Psychol., A.F.F.Ps.S.
Consultant Clinical Psychologist, Scotland
From a Book Review published in the EMDR International Association Newsletter, Volume 4, Issue 4, 1999, pp. 15-19.
Eye Movement Desensitization and Reprocessing (EMDR) in Child and Adolescent Psychotherapy
by Ricky Greenwald, Psy.D.
Publisher: Jason Aronson, 1999
The first chapters establish the author's interests and describe the basic EMDR protocols for work with children. EMDR is seen to be effective for a range of conditions, viewing trauma in its wider perspective as a common development from early upsetting experiences. An accelerated information-processing model is used to illustrate the possible mechanisms of EMDR. Disruptive behaviour is viewed with an impulse control model and its links with ADHD are examined. Essential skills to engage non-communicative children are uniquely illustrated with examples of necessary preliminary work prior to using EMDR.
This text demystifies therapy and makes explicit the introduction of treatment to families. The importance of consistent child-management is explained to parents, keeping the fine balance of illustrating inconsistencies while encouraging their strengths. Rules and limits for therapy, managing parental disagreements and engagement of families are presented. Concepts including "reinforcement" are explained without jargon to clients. Greenwald shows clear skills in communicating essential principles to families with illustrative and inventive metaphors in highly successful formulae. Indeed, this book does not simply present EMDR; it examines the absolute basics of interviewing children and adolescents.
Inventive techniques of engagement are used to entice the patient into eye movements. Gaining street credibility by mastery of small but important elements such as installation of "safety devices" (an advancement on "safe place" for children) are among the well-practised techniques demonstrated. Protocols are obtained conversationally and installations occur almost casually. Positive outcome is methodically assured at the outset. Obtaining negative and positive cognitions by extracting them as elements of a movie make this a jargon-free interaction for the child.
Immediately explicit examples such as "wearing a sign" use a "curiosity killed the cat" principle to entice the reader to follow Greenwald's line of argument. One can imagine an adolescent who, faced with an interesting proposition without quite being able to figure the therapist's angle, has no choice but to become involved. The "early-warning system" begins with "You know how in the movies an attacker can sneak right up to the house, and maybe even inside before anyone ever knows he is there" and illustrates a route into the young psyche. Attention is captivated, eye movements are added, and the first stages of therapy are completed before they notice! Skillful integration of conversation with cognitive-behavioural sequences of treatment and EMDR are neatly combined. Other easy-to-remember illustrations include "tease-proofing" (a form of resource installation?) and the "Who's in charge of you?" dialogue to demonstrate the inadvertent reactivity of us all.
In Part Two, "Technical Repertoire," the standard protocol as applied to children is reviewed in detail. I do not always agree with the terminology, but the message is always clear. Discussions include dilemmas about when to start therapy, how to prevent blocking and use of "safety devices." The collective inventiveness of several clinicians is shared (and always credited) showing ways to encourage eye movements. Protocol components are discussed and expanded. Topics include modalities of bilateral stimulation, the complexity of litigation and potential interaction of EMDR and memory. More metaphors are illustrated including "The Dislocated Finger" and "The Chest of Drawers." I enjoyed the "Stuffed Animal Mode," a projective method of engaging in therapy without overt reference to the identified targets or original trauma. A variation of the safety device uses "Let's make believe it was a dream, what could help?" to overcome impasse due to concrete thinking. Examples then move to the wonderfully surreal "sibing rivalry with an animal" allowing it to interact with a manipulative child.
Part Three, "Special Applications," looks at infants and toddlers. In the "Young Children" section, I found an excellent explanation of the development of magical thinking and the "terrible two's" (coincidentally on page 222 of my copy). Chapter 11 uses bed-wetting as one example in which work with the whole family is necessary to good effect (but I do not agree there should be even minor consequences for bed-wetting, such as washing sheets). The problem of how to explain basic concepts to parents without making them appear inadequate is solved by a demonstration to the child with the parent present. It would be interesting to be a fly on this consulting room wall to observe an interactive demonstration.
Strengths: Excellent ways of engaging non-communicative children and adolescents are illustrated. This book contains essential basics of interview and assessment techniques for any child worker and shows how to progress smoothly into EMDR, introducing clever modifications to the protocol.
Primary Audience: The text is almost equally suitable for EMDR and non-EMDR child-workers due to its excellent ways of engaging difficult or non-communicative families. I highly recommend this book for all practitioners of child disciplines honing their craft and those wishing to gain insight into rapport-building and engagement. Mandatory for my trainees, I also recommend it to seasoned therapists.
Opinion: The text is engaging to read, maintaining your curiosity about what is coming next. It has a direct and open style and is a wonderful amalgam of ideas and techniques. The book is easily forgiven its occasional repetition, as this helps the reader find what he or she needs. This is the book I wish had been written when I was training. It might have prevented some of the grunts and blank stares we occasionally had to observe during interviews. The captivating dialogue baits, leads, baits again, and hooks you inexorably, just as the child would be in therapy. It de-jargonises and demystifies therapy but also shows new angles. EMDR child-protocols are examined in detail with many case examples. This text is especially suitable as a primer for new therapists of any "child" discipline. Detailed interactive, engagement skills and communication basics, are made explicit. Empirically-based techniques of self-control training, rapport, and relationship-building are illustrated using structured choice methods. Dr. Greenwald's experience and enthusiasm for working with a young population shine through.
All therapists learn to manipulate and child therapists might become arch-manipulators, but this text inspires me to quote a Scottish poem my daughter recently recited, "A Dug A Dug" by Bill Keys. "Ah don't think thur's ever been embdy like you. Ye could wheedle the twist oot a flamin coarkscrew."
Mental health professionals can earn 7 CEUs and 7 EMDRIA CEs with TI/CTI's Home Study Program, which includes the book.
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