As I wrote last week I am in St John of God Hospital receiving treatment for my Complex PTSD and DID following an overdose and repeated self-harm. As well as Group Therapy focusing on Anxiety Management I am attending individual one-on-one therapy sessions.
I normally have EMDR with a psychotherapist twice a week which works very well. The psychologist who is treating me in the hospital is using a therapy which is an adjunct to EMDR and makes it more productive to work with dissociative patients.
It is well documented the EMDR model is highly effective for clients who are troubled by disturbing memories. However, clients who are dissociative often have great difficulty in maintaining present orientation and the “dual attention” that is a necessary condition for processing. Dissociative clients are highly vulnerable, during the EMDR Preparation, Assessment and Dissociation Phases, to becoming disoriented and overwhelmed by the surprising intrusion of dissociated parts that bring intensely disturbing images and other information. Since, with these clients, there is a greater risk of non-therapeutic dissociative abreaction, it is very important to counter this risk with an increased emphasis on safety and containment of effect. The treatment is CIPOS (Constant Installation of Positive Orientation and Safety) procedure, which is a method of slowing down processing, and carefully containing and controlling the emergence of potentially overwhelming post-traumatic material.
With CIPOS, the client is first helped to experience a full orientation to the present safety of the therapist’s office (as assessed and verified through the Back of the Head Scale (BHS) procedure. and then is assisted very briefly to access the disturbing material in a highly controlled and predictable way. Through alternating between safety and carefully titrated exposure to trauma, back and forth, the client can learn, often very quickly, the valuable skill of emerging from a traumatised ego state back to a safe orientation to the present. Bilateral stimulation (BLS) is used to constantly strengthen to constantly install in the client’s awareness a clear subjective sense of being present in the immediate real-life situation (ie the therapy office). This method is described to clients during the Preparation Phase, prior the Desensitisation work and then may be used during the actual Desensitisation of a particular highly disturbing traumatic memory. By constantly strengthening the person’s present orientation the BLS, and carefully controlling the amount of exposure to the trauma memory, the individual is more easily able to maintain dual attention. Through the use of the CIPOS procedure, processing of the memory can proceed more safely, that is, with much less danger of unproductive, dissociated reliving of the traumatic event.
With the CIPOS procedure, BLS is paired initially only with images and statements that express present orientation and safety Ath the start of the procedure, when the client is most vulnerable to being overwhelmed by disturbance, BLS is not paired with information directly related to the traumatic disturbance. After the procedure continues successfully, used within a single session, the client will be increasingly able to simultaneously be aware of both present safety and trauma and at that point, the usual pair of BLS with trauma-related information can be safely initiated.
The therapist used grounding techniques, marbles in the hand, a stress thrown back and forth, observation of the room, sight, sound and smell observation techniques as forms of Installation material. I was asked to go “into” my trauma initially for two seconds and then using my hand indicate where in my head the trauma was (Back of the head). He then got me to roll the marbles in my hand, stomp my feet on the ground, observe the room, verbalising the objects in the room. Then I had to again indicate where in my head with my hand and arm my trauma was. My hand at this stage was now about six centimeters from my head. (BHS). We repeated this technique until my arm was fully extended ad I was fully “out of my truama. We practiced this technique two days in a row several ties using the same trauma until I was able to “pull” myself out of the trauma just using the marbles by myself.
The idea is to obviously extend the length of tie you go into the trauma and with the assistance of the therapist learn to come into the present and therefore be able to process the trauma using EMDR and not be dissociated. It allows you to be in a dual state.
I was very impressed with CIPOS and am very hopeful that it will allow me to work more productively with EMDR and not allow the alters to constantly interrupt sessions as they are doing now.