Question 1

Can you share a bit about your background and how you came to EMDR therapy?

Carolyn Settle · Accepted Answer

Before being trained in EMDR therapy, I worked as a clinical social worker for 20 years in various mental health settings, such as community mental health, psychiatric hospitals and private practice. This included work with children, adolescents and adults and training in multiple treatment modalities. After completing EMDR basic training, I was skeptical because it did not fit with my experience of therapy in general, my education, and my previous training. I thought a therapy that has clients moving their eyes back and not talking while the therapist follows a script seemed strange at best. However, since the research supported EMDR therapy for use with trauma, I was determined to move forward with clients I knew well and who had agreed to try it. What I did not anticipate was that many of my clients got better quickly and I saw that their changes lasted over time.  I discovered, despite my doubts, that my clients were experiencing considerable benefits both in their lives and in their relationships. Once I became more confident, I began to integrate EMDR with other treatment modalities, along with children and teens. Over twenty years later, I have never looked back. EMDR therapy has not only transformed many of my client's lives; it has been burnout prevention for me!

Question 2

Are there specific types of trauma and mental health issues for which EMDR is particularly effective in children and adolescents?

Carolyn Settle · Accepted Answer

Research shows that EMDR therapy is very effective in treating children and adolescents diagnosed with PTSD. This includes traumas resulting from abuse, neglect, natural disasters, accidents and medical trauma. What's more, evidence supports the use of EMDR with children and teens struggling with attachment issues, anxieties, phobias, grief, and a multitude of other youth-oriented issues, disorders, circumstances and challenges. It is important to note that child and adolescent-specific EMDR training is needed for therapists to successfully adapt EMDR therapy with their young clients. More information is available at the following link: https://www.emdria.org

Question 3

How do you tailor EMDR for children and teens? How does your approach change across developmental stages?

Carolyn Settle · Accepted Answer

Initially, EMDR therapy began as a treatment for adults. With creativity and flexibility, EMDR can be easily adjusted to be used with children and adolescents. Bridging the protocol into ‘kid-friendly’ language based on the client’s age and developmental level is the first step in translating EMDR with children and teenagers. Younger children require communication through simple, concrete language or with expressive activities like play, art, or sand tray therapy. Older children and teenagers don’t usually need many adjustments in communicating the protocols but they may still benefit from uncomplicated language and utilizing the expressive arts. Attunement to the child/teen’s developmental needs, interests and daily life activities assists in the pacing and timing of each element of EMDR therapy.  Shorter reprocessing sessions are normally needed for babies, toddlers and young children due to their short attention spans. Typically, older children and teens do fine with the standard adult length of reprocessing sessions. Bilateral stimulation (BLS) modalities may also need to be modified based on the child’s age to keep the client engaged and maintain emotional regulation. Types of BLS used in EMDR therapy include eye movement and tactile and auditory BLS. The clinician can exercise a variety of creative BLS with any of these modalities. Examples include: Finger puppets or wands for eye movements Tapping, clapping, drumming and stomping for tactile BLS Music or electronic sound devices for auditory BLS

Question 4

Do young people reprocess traumatic memories in the same way as adults?

Carolyn Settle · Accepted Answer

The difference between adult and child/adolescent reprocessing is that children and adolescents often process quickly. We hypothesize that fast reprocessing is because children haven’t had as many experiences in life as adults resulting in fewer memories to process. The younger the child, the less time is needed for reprocessing. Infants, toddlers and early elementary-age children may only take 15 to 20 minutes of reprocessing time with only one to three sessions needed. Young children may not show emotions during reprocessing, which can make the therapist unsure whether any actual processing has occurred. Evaluating the client’s original symptoms and behaviors in the follow-up session is how the therapist ascertains a client’s progress. It’s important to know that once in a while, a child will become very active during reprocessing which may necessitate adjustment in the length, direction, or type of BLS. At times, teenagers can become overwhelmed during reprocessing which requires a shift to resourcing and containment exercises to assist in emotional management.

Question 5

How does EMDR conceptualize trauma in children and adolescents?

Carolyn Settle · Accepted Answer

EMDR therapy conceptualizes child and adolescent trauma from the Adaptive Information Processing (AIP) perspective, which is the hallmark of EMDR. The AIP model postulates that any client’s current symptoms and behaviors result from maladaptively stored memories. When conceptualizing EMDR therapy, the therapist uses the “Three-Pronged Approach”; Reprocess the past trauma(s) Present triggers Develop a future template The distinction in working with children and teens is that they may not have many memories to process. Subsequently, children and teens may be more likely to identify recent memories, current triggers, or anticipatory anxieties to work on instead of earlier foundational memories like adults. Additionally, younger children often store trauma as body sensations or as emotions and may express trauma in imaginative and seemingly irrelevant ways. This compels the clinician to understand the unique way each child has stored their trauma. As an example, younger clients may report their issue as an apparently unrelated fear, such as a nightmare, shot phobia, or social anxiety. From an AIP lens, this necessitates the therapist being open to their client’s identification of the issue to be reprocessed over the adult’s identified target, even if it doesn’t appear to be related to the trauma.

Question 6

Do children need to be able to verbalize their trauma for this treatment?

Carolyn Settle · Accepted Answer

One of the truly remarkable aspects of EMDR therapy is that the client does not have to talk to identify their presenting issue or reprocess the distressing incident. This can be conveyed through drawings, role-play, clay and sand tray activities. Moreover, the baseline scales representing the Subjective Units of Disturbance (SUD) and the Validity of Cognition (VOC) can be demonstrated with hand movements showing how disturbing or true the cognition feels. The client simply holds their hands apart or moves them together to share the level of their experience. Most significantly, the client does not have to verbalize during reprocessing. The client is not talking when the bilateral stimulation (BLS; eye movement, tactile, or sound) is being applied. When the BLS stops, the client can express themselves through drawings, role-play, clay and sand tray activities. EMDR therapy is uniquely positioned to work with clients of many ages and cultures since communication can be done in expressive, non-verbal ways.

Question 7

What are some of the most important points to keep in mind when working with children and adolescents who have experienced trauma?

Carolyn Settle · Accepted Answer

Create a safe therapeutic environment through listening, attunement, trust and rapport. Foster empowerment by being flexible, collaborative and patient. Use developmentally appropriate language and encourage communication through art, play and sand tray activities with young children. With teens, be mindful of their need for autonomy and show respect for their interests and viewpoints. Make sure the client has resources, both internally and externally, and address any deficits they may have through skill building and the Safe Place and Resource Development Installation (RDI) exercises. For professional growth, it is vital for a therapist to stay informed on emerging EMDR trauma therapies, get consultation, and develop a practice of continuing education regarding cultural and social equality and inclusion.

Question 8

Can EMDR help children with addiction to gaming and screens?

Carolyn Settle · Accepted Answer

Absolutely! There are several EMDR protocols designed to address addictions and compulsions that can be applied to gaming and screen addictions. The DeTUR (Desensitization of Triggers and Urges) model is one of the most helpful models to tackle game and screen addictions. The book EMDR and the Art of Psychotherapy: Guidebook and Treatment Manual (3rd Edition) by Springer Publishing has a chapter on ‘Treating Pediatric Substance Use, Misuse, Abuse, and Addictions with EMDR Therapy’. Also, there are resources and training on addictions on the EMDRIA website. More information is available at the following links: https://psycnet.apa.org/record/2005-07450-007 https://www.amazon.com/Emdr-Art-Psychotherapy-Children-Guidebook/dp/0826169953 https://www.emdria.org/

Question 9

Can EMDR be helpful for challenges at school, such as learning difficulties and bullying?

Carolyn Settle · Accepted Answer

EMDR therapists successfully treat children and teens who have been bullied or are fearful of attending school for many reasons. Bullying, which can cause low self-esteem and suicidal thoughts and behaviors can be effectively addressed with EMDR. Integrating assertiveness training, a social skills group and/or family therapy can provide the comprehensive treatment needed for a client who has been or is currently being bullied. EMDR therapy can also help with the trauma and stress of dealing with learning difficulties. While EMDR therapy cannot fix learning challenges, it can heal the suffering caused by academic failures and relationship struggles. Reprocessing through the pain of a child or teen’s learning issues can restore a client’s sense of self resulting in resiliency. EMDR therapy blends well with adjunct resources such as tutoring and family therapy, which can be incorporated into the treatment plan.

Question 10

How do you involve family members in EMDR for children and adolescents?

Carolyn Settle · Accepted Answer

Parents and caregivers are an integral part of the EMDR therapy process. It is important to get the parent/caregiver’s perspective regarding the child or teen’s presenting issue(s). However, depending on the child’s age, it may not be necessary to have the parent/caregiver in the reprocessing portion of the session. With older children and teens, the parent/caregiver may only be needed at the beginning and end of the session to transfer information. Nevertheless, with a younger child or a session focused on attachment issues, the therapist may need to have the parent/caregiver in the full session. The clinical reasons for not having a parent/caregiver in a reprocessing session are: A child or teen may filter their responses to protect the parent/caregiver The parent/caregiver may influence what the client identifies as a target The parent/caregiver may experience vicarious trauma hearing the child/teen’s narration of the trauma In the follow-up session, it is crucial to receive information from both the parent/caregiver and the child/teen for reevaluation. The only way to fully assess a child/teen’s progress is to get information about the client’s symptoms and behaviors after the session from both the parent/caregiver and the child/teen. Additionally, it may be necessary to involve the parent/caregiver in family therapy, parent education classes, conflict management skills training, or attachment therapy to complete treatment.

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