Eye Movement Desensitisation and Reprocessing (EMDR) is a procedure that uses different phases to treat post traumatic stress disorder. The approach is underpinned by the idea that traumatic memories may become stuck and need help to be processed and stored in a way that is not detrimental to the person’s functioning. By activating the memory and bilateral stimulation the client is assisted to create new, more adaptive neural pathways.
Jane Steeples, Psychotherapeutic Counsellor in the NHS shares information on her own practice in this area with parent carers:
“I have found the use of EMDR with parent carers to be very effective. Interestingly very few parents I have assessed for PTSD and C-PTSD meet the diagnostic criteria, most often due to an absence of the “re-experiencing” criteria such as flashbacks and nightmares. Occasionally there is PTSD due to specific birth trauma or infantile seizures, especially if the parent feared that they, their partner or their baby would die. This is often compounded by the way in which medical professionals responded at the time. One parent’s “worst part” of her baby’s complex birth was the Consultant’s words, indicating that their lives would never be the same again. The ”second worst” was being stopped in a corridor on their way home and asked to sign a Do Not Resuscitate form. Another parent experienced PTSD when their teenage son with Downs Syndrome struggled with being at home during lockdown and suddenly became very aggressive towards her, leaving her fearing for her life.
More often however there is a gradual accumulation of “small t” traumas with little time to recover and recharge before the next blow occurs, whether that is another period of sleep deprivation or a beloved PA leaving. It seems that the lack of recovery time is key here. Without time to process and make sense of the bad thing that just happened, the memory is stored in its raw form. The more pressing issue of getting on with another day in which your child is unwell or dysregulated or sent home from school takes precedence. Hypervigilance and “never switching off” are common and bear similarity with PTSD features. Many parents talk about fighting hard to get support then not being able to enjoy it once it arrives. There is simply not enough time to physiologically relax from a chronic heightened state of alert before then having to get back into gear. After a few years, this state of prolonged duress often manifests as exhaustion, both physically and existentially, akin to Prolonged Duress Stress Disorder (PDSD) proposed by Hans Selye.
“My depression was predominantly caused by the combination of 18 years of exhausting 1.1 hyper vigilant parenting coupled with the magnitude of issues faced in obtaining the right provision for my son across education, social care and health therapies; everything has felt like a battle to advocate for my son since he was age 4, and as a parent carer I feel I have been pushed to keep going yet another extra mile or six to ensure the right provision/support is in place for his good outcomes, ultimately the experience has felt like an endurance test of epic proportions that consumes all sense of time and ability to enjoy the aspects of parenting and self that should be enjoyable.
Couple the battle, with isolation from your friends and family, as services are not readily available, followed by the further arduous task of the transition to adulthood- all in all a perfect storm for burnout and despair that became an inevitable outcome for me. My counsellor was excellent at supporting me through my exhaustion and despair at this later stage of parent caring. I also had a very specific and distressing issue that I asked for support with, the counsellor suggested EMDR. The EMDR was transformational for me, but I feel it is important to say that as a traumatised parent carer at the time it was essential that I undertook the talking part of counselling ahead of embarking on EMDR, I definitely needed to do the talking and processing first.” – Post therapy parent carer feedback
For some parents with a childhood trauma history and more classically defined Complex Trauma, EMDR has helped to lighten the load of their past trauma and freed up emotional energy for present day challenges of parent caring. For example, I have worked with parents who experienced childhood bullying, memories of which were being triggered by their child’s aggressive behaviour. EMDR helped to disentangle the then from the now, helping to improve their connection with their child as their own childhood fear reduced and parental authority and empathy for their child increased. Similarly for parents whose own parents struggled to adequately care for or protect them from abuse, EMDR has helped shift their unhelpful core beliefs such as “I am unloveable/weak/to blame for everything” into a more balanced self-appraisal. I have noticed how much more focused and confident parents then feel when dealing with professionals and perceived authority figures around advocating for their child.
“EMDR has transformed the trauma the sessions were particularly focussed on in a dramatic way. I have tried other forms of therapy that have helped me understand why I feel and behave the way I do and the changes I need to make, and then it has required a lot of work and practise to make even small changes. With the EMDR I found that the changes are deeper and immediate – I feel them in my body rather than having to practise towards the change I want. It’s like the sessions have rewired my neural pathways as I do them. I have found them to be massively beneficial and I am very grateful to have had access to this resource.” – Post therapy parent carer feedback
As a relational therapy, EMDR is also attentive to attachment relationships and this can help parents who want to strengthen their understanding and bond with their child. Some parents have experienced struggles to bond with their premature or poorly baby, others have contemplated suicide and infanticide. EMDR has helped parents to explore their parental ambivalence, internalised biases about “disability” and guilt for having experienced “taboo” thoughts and feelings about their child.
Whether trauma is from the past, more recent or an interplay between the two, EMDR is a strengths based approach. The first phase focuses on developing resources and coping skills before directly addressing trauma. Many parents benefit from reconnecting to long forgotten skills or positive parenting experiences. It is also an approach that takes into account the wider societal and political context of people’s experiences, helping to move away from pathologising individual parents by recognising the discriminations and microaggressions routinely experienced by disabled people and their families as well as the cruelties and failures of some aspects of the benefits, health and social care systems they come to rely upon. For this reason, it helps if EMDR therapists have an understanding of the social model of disability and some awareness of the complex systems parents need to negotiate.
Sometimes the parent is themselves neurodivergent and experiencing sensory processing difficulties. They might have experienced being misdiagnosed with Bipolar or Personality Disorder and their child’s diagnosis has brought about a new perspective on their own historical struggles with socialising or executive functioning. EMDR has helped neurodivergent parents to reframe their sense of self, gain self-compassion and a better understanding of their child. Neuro-typical therapists need to understand how to adapt their practice in order to successfully engage and assist neurodivergent parents. Simple things such as asking the parent whether the lighting or sound of a ticking clock in the room is problematic, offering additional appointment reminders, using more concrete language or explaining rather than assuming a mutual understanding of concepts such as metaphor might be required.
Without regular childcare support however, no parent can benefit from interventions such as EMDR when they are too exhausted or have no space to attend. EMDR can work relatively quickly but parent carers sometimes need longer than the recommended 8-12 sessions (I offer 4-6 months) in order to circumvent the regular disruptions in attendance, caused by lack of childcare, school refusals, multiple appointments and regular “crises”. Therapists need to be flexible and willing to roll with these disruptions whilst working collaboratively with parents to ascertain whether or not “now” is the right time for EMDR.
It would of course be helpful if the systems that purport to support parent carers and their children were more trauma-informed and did not add to any underlying trauma or indeed cause trauma through anxiety provoking processes, insensitive comments or dismissing a mother’s instinctive pre-diagnosis concerns about her child. One parent described trying to access mainstream IAPT services and being told she had “the wrong type of anxiety”. Her son was autistic and born not long after her previous baby had died. She had experienced birth trauma and Post-Natal Depression and believed she had “caused” her son’s autism. EMDR helped her to process her grief, honour her baby who died and free herself from the erroneous belief that she had caused her son’s autism and was “beyond help”, as inferred by the IAPT practitioner.
It is worth noting that now, more than ever, post pandemic health and social care practitioners are themselves experiencing unprecedented levels of trauma. I offer Reflective Practice to practitioners across the public sector and many are overworked, exhausted and thwarted in their attempts to be helpful due to a chronic lack of resources. People who bear witness to others’ distress can mitigate the impact of Vicarious Trauma if they feel they are making a positive difference to those they support and they have enough space to process disturbing experiences witnessed in their work. How can a traumatised A&E doctor be expected to offer trauma informed care? Traumatised practitioners are at high risk of burnout or the type of defensive practice which can lead to insensitive and unempathic treatment. Being truly trauma informed means applying those principles to all, practitioners and people who access support services alike.”