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.
Kelly O'Horo:
Close your eyes and just tune in, what's there now?
Jaime Castillo:
There's still a sensation there, it's like tingling.
Kelly O'Horo:
Just notice that sensation. See what comes up. I'm curious what it might be, still hold.
Kelly O'Horo:
Go ahead and name things in the ocean.
Jaime Castillo:
Fish.
Jaime Castillo:
Dolphins
Jaime Castillo:
Blue whales.
Jaime Castillo:
Sharks.
Jaime Castillo:
Seals.
Jaime Castillo:
Seaweed.
Kelly O'Horo:
What do you get now?
Jaime Castillo:
It was harder to connect...the experience. My body feels pretty hot.
Kelly O'Horo:
There's some energy there. I'm going to have you close your eyes and tune into the heat. Go ahead back to whatever's left of that image. I'm curious what point in the image a memory or anything else that's coming up that seems to be connected to that heat.
Jaime Castillo:
I think of this picture I have of my husband holding the baby. It says Matthew. Just wanting him to be a dad.
Kelly O'Horo:
It hurts. I know. It's okay to cry. It's okay.
Kelly O'Horo:
Say "hip hop. Zig zag. Tick tock."
Jaime Castillo:
Hip hop. Zig zag. Tick tock.
Kelly O'Horo:
Keep saying it.
Jaime Castillo:
Hip hop. Zig zag. Tick tock.
Jaime Castillo:
Hip hop. Zig zag. Tick tock.
Jaime Castillo:
Hip hop Zig zag. Tick tock.
Jaime Castillo:
Hip hop. Zig zag. Tick tock.
Kelly O'Horo:
Open your eyes.
Jaime Castillo:
Just still sad.
Kelly O'Horo:
It's okay to let yourself be sad. It's okay. I'm so sorry sweetie.
Kelly O'Horo:
Let it go. Let it out.
Kelly O'Horo:
Foods we eat at the holidays. Christmas.
Jaime Castillo:
Ham.
Jaime Castillo:
Mashed potatoes.
Jaime Castillo:
Cranberries
Jaime Castillo:
Green beans.
Jaime Castillo:
Gravy.
Kelly O'Horo:
Tissues over there.
Jaime Castillo:
I thought of this happy memory. My husband and I were hospitalized recently, and I came to visit him obviously. I showed up and the first thing he said was, "Am I in heaven because you look like an angel." And he was just being his goofy self, but I just thought of how much he loves me.
Kelly O'Horo:
How valuable you are to him. You're his angel.
Kelly O'Horo:
Snap twice on the left and once on the right.
Kelly O'Horo:
What'd you notice?
Jaime Castillo:
I just feel a lot of love for him. And I do know that we'll be parents soon, that he's going to be a great dad.
Kelly O'Horo:
You're going to be a great mom.
Jaime Castillo:
Thank you.
Kelly O'Horo:
Why don't we go back to the memory that we started with and just check in and see where we're at? What it looks like now?
Jaime Castillo:
It feels like I'm seeing the future image now.
Kelly O'Horo:
What do you see?
Jaime Castillo:
I see him holding a baby and it feels reachable or possible because...
Kelly O'Horo:
And the memory we started with? Is there any disturbance left?
Jaime Castillo:
It's not. It feels exciting. It feels like it's going to happen for us.
Kelly O'Horo:
On a scale of 0 to 10, were 0 is no disturbance now and 10 is the greatest you can imagine, what would you say this memory we're working on is at right now?
Jaime Castillo:
It's a 0. It feels positive.
Kelly O'Horo:
Okay. And the goal that you said you wanted about yourself was "I'm valuable." Is that still a belief you want?
Jaime Castillo:
I think so.
Kelly O'Horo:
May I offer a potential up the ante?
Jaime Castillo:
Yeah.
Kelly O'Horo:
I'm valuable and I can be hopeful. Or, I'm valuable and I don't need to be afraid. What do you think?
Jaime Castillo:
I like that. I feel like stuff happens when you say that.
Kelly O'Horo:
So, we got a little more work to do, but we want that, right? Because what you said you wanted is to not have to be afraid.
Jaime Castillo:
Yeah.
Kelly O'Horo:
So we need to remove any part of you that is still holding on to that fear of the future because you have this beautiful future image. We don't want to be like this still, right?
Jaime Castillo:
Yeah.
Kelly O'Horo:
Does that feel okay to you to change that because it's your decision?
Jaime Castillo:
It does.
Kelly O'Horo:
I'm valuable and I don't have to be afraid.
Jaime Castillo:
I like, "I can be hopeful."
Kelly O'Horo:
I'm valuable and I can be hopeful. Hope is the absence of fear, anyway.
Kelly O'Horo:
So when you think of the picture now, and the words, "I'm valuable," and "I can be hopeful," how true is that where 1 is not true and 7 is completely true?
Jaime Castillo:
It's 6.
Kelly O'Horo:
Go ahead and parrot those words. You had a little sematic tell, so we got a little more work to do. So, parrot those words, "I'm valuable," and "I can be hopeful." Whatever that image holds now...
Kelly O'Horo:
Desert critters.
Jaime Castillo:
Birds.
Jaime Castillo:
Rattlesnakes.
Jaime Castillo:
Coyotes.
Kelly O'Horo:
You can take your eye away.
Jaime Castillo:
It feels true. It feels like the only way to be.
Kelly O'Horo:
Nice. Right on. So, 1 to 7, I'm valuable and I can be hopeful?
Jaime Castillo:
Seven.
Kelly O'Horo:
And we'll go ahead and do a body scan, so I'm going to have you pair up whatever's left of that memory now, whatever it looks like now, and I know that it's changed quite a bit, and those words "I'm valuable" and "I can be hopeful." I'm going to have you scan from the top of your head to the bottom of your feet, noticing any tightness, tingling, or tension. Information for us to make sure we're thorough.
Jaime Castillo:
I feel good. I just feel open.
Kelly O'Horo:
Nice. So it's a complete target.
Jaime Castillo:
Thank you.
Kelly O'Horo:
We've got a chance, we've got 10 minutes to make sure you can get out of here on time. Would you like to do a quick future template?
Jaime Castillo:
Sure.
Kelly O'Horo:
Okay. So I want you to imagine a video or an image or...I want you to play a video of something in the future that might create some anxiety around this topic. Think about what that might be. You'd be imagining getting pregnant, being pregnant again. We can do some desensitization on this future template. When you have a video or a future memory that could happen and you can see it from start to finish, I want you to play that video while I do BLS and we're just going to make sure we get anything that might be in the future template and anxiety before it happens. Let's just see.
Kelly O'Horo:
Do you have one?
Jaime Castillo:
Yeah.
Kelly O'Horo:
Okay. You ready?
Jaime Castillo:
Mm-hmm (affirmative).
Kelly O'Horo:
And you tell me when you're through with it.
Jaime Castillo:
Okay.
Kelly O'Horo:
If there are any tough spots, we can stop and check.
Kelly O'Horo:
So how'd it go?
Jaime Castillo:
Good. I imagined getting a call that I am pregnant after IVF and jumping into my husband's arms and getting excited. Then I thought of what would normally be a scary few weeks after that, but just prioritizing ourselves. Going on a van trip. My husband's building a camper van, so just doing things and connecting, not being scared.
Kelly O'Horo:
And taking care of yourself.
Jaime Castillo:
Yeah.
Kelly O'Horo:
Was there any anxiety or anything that came up that we need to just hit again?
Jaime Castillo:
Not really. It just felt exciting.
Kelly O'Horo:
So I want to play it again and if you need to modify anything, you can. I want to make sure we… and I like to usually run a future template at least two to three times just to be sure because sometimes stuff comes up that you didn't know.
Kelly O'Horo:
So play the movie again.
Jaime Castillo:
I just feel so much love for him. Like that's going to be such a... I don't know, a time to turn toward each other and get to experience something exciting that's about the two of us.
Kelly O'Horo:
So special.
Jaime Castillo:
Yeah.
Kelly O'Horo:
Wonderful. How do you feel?
Jaime Castillo:
I feel good. I feel a lot more open.
Kelly O'Horo:
And what's the takeaway for you today after this piece of work we did?
Jaime Castillo:
I think just that my value was separate from that. Even if it never happened, I'm still valuable and my husband and I would still figure something out, but that it's also possible that it doesn't feel so far out of reach.
Kelly O'Horo:
Well, thank you so much for being brave and doing this with me and it's been an honor, truly. Thank you for that.
Jaime Castillo:
Thank you so much. I can't thank you enough.
Kelly O'Horo:
You're welcome.
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