A Comprehensive EMDR Therapy Session

Kelly O’Horo, EMDR Therapy Facilitator as therapist, and Jaime Castillo, Consultant in Training as the client, demonstrate a comprehensive EMDR Therapy session. All 8 phases of EMDR Therapy, with the exception of reevaluation, are demonstrated. An abbreviated history regarding the subject targeted specifically is modeled. The Standard Protocol is utilized with EMDR 2.0 strategies, which are a modification to standard bilateral stimulation (BLS).


Kelly O'Horo:


All right.


Kelly O'Horo:


How's everything? On par?


Jaime Castillo:


We're good.


Kelly O'Horo:


So, miss Jaime, thank you so much for being brave to do this piece of work with me so that we can share with other EMDR therapists the appropriate protocols and how to set something up from - presenting information and taking that presenting information and putting it into the standard protocol and doing a target in a session. That's what we're trying to show we can do today. With an explicit memory that was rooted more in fear and less in shame, we're not working on attachment stuff.


Kelly O'Horo:


We're going to model some 2.0 strategies as well. So, deviating a little bit from standard ELS, which is what we all learn in basic training and we're going to do some ways to modify that a little bit to decrease distress in processing, and hopefully accelerate processing a bit. So, thank you for doing this with us.


Jaime Castillo:


Yeah, I'm excited.


Kelly O'Horo:


And I think that we can share this with people and hopefully they learn a lot from it, or at least have a sample that we can see. Also, for our clients who are nervous about what is EMDR going to be like, and what can we expect when we choose to do EMDR, to be able to have a little bit of a snapshot about what it might look like if we are clients. So, hopefully this will serve a few purposes.


Jaime Castillo:


Yes.


Kelly O'Horo:


I'm excited to have you here and hopefully we find it a beneficial experience for us.


Kelly O'Horo:


So, tell me a little bit about what you'd like to work on today.


Jaime Castillo:


Yes. So, I experienced a couple months ago a chemical pregnancy. My husband and I have been trying to conceive for several years and started the IVF process about a year ago. We had our first IVF transfer and it resulted in a positive pregnancy test, but my levels were so low that the pregnancy didn't stick. That brought up a lot of sadness and grief.


Kelly O'Horo:


Right.


Jaime Castillo:


And some kinds of feelings of being broken or defective in some way.


Kelly O'Horo:


Yeah. And is this your first pregnancy? Have you had other children? Have you ever been pregnant before? Can you tell me a little bit about your history on this topic?


Jaime Castillo:


Yeah, so I have been pregnant once before this. That was a result of an IUI procedure that we did. I miscarried that pregnancy at about seven or eight weeks.


Kelly O'Horo:


Okay.


Jaime Castillo:


Before that, I had never experienced a pregnancy.


Kelly O'Horo:


Okay.


Jaime Castillo:


And that was about a year and a couple of months ago.


Kelly O'Horo:


And have you done any EMDR processing on that other miscarriage?


Jaime Castillo:


I did.


Kelly O'Horo:


Okay.


Jaime Castillo:


Yeah, I did.


Kelly O'Horo:


Okay. When you had the recent chemical pregnancy, did you notice any feeling, flashbacks at all from the previous miscarriage? Can you recall that?


Jaime Castillo:


Yeah. I wouldn't call them flashbacks. I did have a sense of this general sort of it's taken this long. This combined with that must mean there's something wrong with my body, really. So it does feel kind of meshed together.


Kelly O'Horo:


You spoke to me before about this being longer than three months ago, this chemical pregnancy, which indicates we would want to use a standard protocol. If it's sooner or more recent than three months, we would want to use a more recent incident protocol, like R-TEP or something like that. Since this event was more than three months ago, we'll use the standard protocol for this.


Kelly O'Horo:


I wanted to just make sure you feel okay doing this with me. It's sensitive material and I know that it can... you have choices and don't have to do this and I have no expectations about any of that. I just really want to make sure that you're checking in with yourself in this moment and that it feels all right to do a little bit of work with me on this.


Jaime Castillo:


It does. It feels good.


Kelly O'Horo:


Okay. So I'm going to go ahead and I know you have good resources, I know you have strong supports, I know you have a consistent therapist, so I feel comfortable just inviting you to do this piece of work with me and not doing a really elaborate history taking. I think that's unnecessary for today.


Kelly O'Horo:


A little bit of history around the getting pregnant, I think, is probably important, just in case something comes up that I can use as an interweave that might help.


Jaime Castillo:


Okay. Great.


Kelly O'Horo:


So, I'm wondering regarding the history of trying to get pregnant. Do you mind sharing a little bit with me about what that's been like and what you've learned along the way? You don't have to go into great detail, but just a little bit to help me understand what brought you to medical interventions and things like that.


Jaime Castillo:


Sure. My husband and I... well, actually, I went off birth control in 2018. I started tracking my cycles. We were doing timed intercourse and it didn't happen and it just kept not happening. It was interesting, my mind flashed back to when I was a teenager. My friends and I would always talk about what if one day I can't get pregnant? And that was like the big fear, or one of my big fears was this idea that you'd get married and go off and want to have a baby and feel stuck or not be able to. I think that pre-dates going back to being a little kid and having babies and carrying around babies in strollers as a two year old. It feels so ingrained for me.


Jaime Castillo:


So it didn't happen and I knew that that was a possibility, but after about two years, I started to get worried and that's when we pursued a fertility clinic. That experience was good. They said, "You look great. Your anatomy is fine, so we'll start pursuing some interventions, some medical support with it."


Jaime Castillo:


It felt a little bit like my biggest fear happened, but there's still a part of me that's hopeful.


Kelly O'Horo:


Good. You're kind of early in this part of the journey and I think hope is a really powerful emotion that can change a lot in a body to produce a different outcome in the future at some point.


Kelly O'Horo:


By doing this today, what is your hope? When we think about present triggers, what comes up for you around current present triggers and makes you decide I think we should do this piece of work today? What would you say are some current present triggers?


Jaime Castillo:


Just fear. Fear about trying again. Feeling fearful instead of joyful if I do get pregnant again. There's a lot of responsibility, so I think one of the biggest things is this idea that because I'm guarded, that will somehow impact my ability to get pregnant or to carry a healthy pregnancy because I'm so scared of it. I want to be open.


Kelly O'Horo:


Right. So, you ultimately want to be able to remove this fear and the feelings associated with these two failed attempts at getting pregnant with some medical intervention so that you can get your body into a place where it can more openly receive the potential and the opportunity to become pregnant and carry that pregnancy to term.


Kelly O'Horo:


So, I'm wondering - is it that you don't want your fear about what's happened to sabotage the possibility of it not continuing to happen?


Jaime Castillo:


Exactly.


Kelly O'Horo:


Awesome. That's great insight and I think that it's all we can do. Also, it's really scary because although the guard isn't going to protect you if it happens again, it also isn't going to contribute to it not happening again, right?


Jaime Castillo:


I know that it's best to not be guarded and the pain of feeling excited and then having that taken away is so great that it feels almost impossible to not be guarded. I want that experience to be a joyful, exciting time.


Kelly O'Horo:


Well, let's see what we can do to kind of bring down that guard, that part of you that's resistant to being open and hopeful all the way because you've been through a couple of things that kind of have dampened that possibility of hope because when it's happened to somebody, what if it happens again is what our bodies do. What if it happens again and how do I tolerate that?


Kelly O'Horo:


I think it makes a lot of sense. It's brave to want to get the guard down because it will probably feel more vulnerable if it does happen again, but at the same time, the odds of it happening again are much greater if we don't have all that energy in our system that's full of fear. Let's go for it.


Jaime Castillo:


Okay.


Kelly O'Horo:


When you said present triggers, you're feeling fearful and then being afraid that you won't experience joy when you do finally get pregnant because the fear will override it. So, it's like a thought that happens, it's not necessarily something that's happening around you, but it's a thought that's triggering. If I imagine myself pregnant again, will I be able to feel joy? You talk a lot about responsibility and feeling defective or broken, so maybe that, but I'm also hearing a lot of powerlessness, like, I can't control...


Jaime Castillo:


Yeah.


Kelly O'Horo:


And I see your eyes change a little bit when I say the powerless piece, so we'll have to check in and make sure we get the right side because a lot of times we do this work and we think we've cleared something, but we've maybe only cleared one of the negative cognitions around the topic. It often times gets interweaved with more than one domain.


Kelly O'Horo:


As I noticed your eyes change, I think you probably did do the work to whatever was available around the last miscarriage, but the powerlessness about what could happen in the future may or may not have been addressed, I don't know. We'll have to just check in and see what happens, okay?


Jaime Castillo:


Okay. Sounds good.


Kelly O'Horo:


When you think about this recent chemical pregnancy, if you close your eyes and you tune in to that, can you get a snapshot of a moment? Does an image that represents the worst part for you?


Jaime Castillo:


Yeah. We knew that it was a boy embryo that we transferred. That's the most painful part. I picture just a little boy with my husband.


Kelly O'Horo:


So, it's the picture of what could have been and already feeling such exquisite loss because of what our mind will do for us to create hope. So we already have an image and a picture of what it would be. So it's the picture is having seen it already and then losing it.


Kelly O'Horo:


And when you think of that picture what's the negative belief you have about yourself?


Jaime Castillo:


I'm defective.


Kelly O'Horo:


And can you get in touch with the emotions that you're experiencing as you think about that?


Jaime Castillo:


I think the most overwhelming one is grief.


Kelly O'Horo:


Can you feel it in your body?


Jaime Castillo:


Yeah. It's right here in my chest.


Kelly O'Horo:


So just to make sure that we're checking our work, let's go ahead and do a float back. I want you to really tune into that space in your stomach and that deep grief that's coming up for you, and those words, "I'm defective." As you hold those things together, I'm just going to have you float back to other times in your life where this feels familiar. Just tell me briefly age and event if anything's coming up as you float back.


Jaime Castillo:


I can't seem to find an earlier experience that lead to this type of feeling.


Kelly O'Horo:


But did you come up with anything that felt familiar even if it's not a similar event, if that makes sense. Sometimes our emotions or that space in your stomach are the only sensory input that will tie it together. I just want to be certain there's not something before that made you feel... somehow you fell short, and that created this grief or loss and that pit in your stomach.


Jaime Castillo:


My mind, or maybe my body, goes to when I was really young, I think about five. Some stuff around my parents' divorce. Maybe internalizing...


Kelly O'Horo:


A lot of kids give me, "Maybe if I had just done better, they wouldn't be doing this." It's pretty common, and you were so little. No frame of reference but self at that point. Can you feel that?


Jaime Castillo:


Yeah.


Kelly O'Horo:


We need to make a decision. We can work on that and set up a target on that and it will maybe, likely generalize into this current defectiveness grief stuff and we can check our work to make sure it does, or we can keep on that present memory and the miscarriages specifically. It's up to you. Check with your body to see what feels best for you to do.


Jaime Castillo:


The recent experience definitely feels stronger, but I'm open..


Kelly O'Horo:


We can check our work because it might reverse generalize, too, if you want to stick with the sharper, more recent feelings. Maybe just talking about that will help it go there anyway if it needs to, but if not, I recommend we look back at doing that piece or that you take that to your therapist just to make sure. We know there was information stored there, or you wouldn't have gone there, so it's not fully resolved either way. So we should make sure we're thorough and check our work.


Jaime Castillo:


Sounds good.


Kelly O'Horo:


When you think about the recent chemical pregnancy, does that memory feel stronger or more sharp, or the miscarriage that happened before, as you put them both in your...


Jaime Castillo:


I think definitely the chemical pregnancy feels...


Kelly O'Horo:


So when you think of that chemical pregnancy, you had said that the negative belief was "I'm defective." What would you rather go with instead about yourself when you think of that picture of it was a boy, and that boy with my husband, and it didn't happen in the grief. What you rather think about yourself?


Jaime Castillo:


I'm valuable.


Kelly O'Horo:


And when you think of that picture and the words, "I'm valuable," and that picture of the boy that could have been and your husband, how true does that feel, where one is not true and seven is all the way true and valuable?


Jaime Castillo:


A four.


Kelly O'Horo:


Okay. Any emotions coming up now as you think about it?


Jaime Castillo:


Grief. Just sadness.


Kelly O'Horo:


You don't have any guilt around it? Ask your body, not your head. I know your head knows the truth, but because we're going on a five year old memory, just want to make sure there's not something in your body that says maybe there was.


Jaime Castillo:


Yeah, there's some guilt.


Kelly O'Horo:


Where in your body do you feel it is right now? I'm sorry, how disturbing are the emotions on a scale of 0 to 10, where 0 is not at all and 10 is the worst you can imagine when you think about this image. In other words, I'm defective, and the grief, and the sadness, and the guilt.


Jaime Castillo:


I'd say it's a 6.


Kelly O'Horo:


And you'd said you'd felt it in your stomach. Is there anywhere else that you feel it as well?


Jaime Castillo:


It's right here, like the pit of my stomach.


Kelly O'Horo:


I'm going to start with more of a standard BLS, but I'm going to modify it if I notice we're having more trouble getting in there because you were really transparent about that guard. I want to make sure we identify it if it's helping you out a little too much.


Jaime Castillo:


Okay. Sounds good.


Kelly O'Horo:


I want you to just notice that image that we just talked about, the little boy and your husband, and those words, "I'm defective," and the grief, and the guilt, and the sadness, and that deep pit in your stomach and how that's affecting you.


Kelly O'Horo:


Tap twice on your left knee and three times on your right and keep that up.


Kelly O'Horo:


Take a deep breath. What did you get?


Jaime Castillo:


Sensations moving around in my body and I was able to picture that image, but it felt a little less… and more sharp.<