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reply to at leastonecounseling therapy.
In your reply post, state whether you agree with your peers. Read and respond in a
scholarly fashion, commenting on how they incorporated theory with evidence-based
practice. At a minimum, your response should be three to four paragraphs of three to
four sentences each.
Please make certain that all counseling therapies have a peer response.
Eye Movement Desensitization and Reprocessing Therapy
Eye Movement Desensitization and Reprocessing Therapy (EMDR), is a fairly new
treatment option, initiating in 1989, that was specifically meant to help individuals with traumatic
memories (Lilienfeld, 2019). In the last twenty years the use of EMDR has increased drastically
and is currently “recognized by the World Health Organization as a first-choice treatment for
Posttraumatic Stress Disorder (PTSD)” (Castelnuovo, Fernandez, & Amann, 2019, p. 2185).
Although, the initial use of it was only for PTSD, the therapy has been extended to be used in
various other conditions “including phobias, obsessive compulsive disorder, clinical depression,
eating disorders, schizophrenia, sexual dysfunction, discomfort concerning sexual orientation,
and psychological distress resulting from cancer” (Lilienfeld, 2019, p. 182).
Lewey, Smith, Burcham, Saunders and Elfallall (2018) state that EMDR “protocol contains
both exposure and cognitive components; for example, clients are guided through a relaxation
exercise to assist them in visualizing a ‘safe place’ and asked to visualize aspects of the trauma
and replace negative thoughts with positive ones” (p. 462). This is done with the use of eye
movement to help the patient focus on the present while remembering their past. The Adaptive
Information Processing (AIP) model is used in EMDR treatment “which posits that much of
psychopathology is due to the maladaptive encoding of and/or incomplete processing of
traumatic or disturbing adverse life experiences” (Castelnuovo, Fernandez, & Amann, 2019, p.
2185). By reconstructing the memories and replacing negative thoughts with positive thoughts
patients are able to better handle their past traumas.
Children and Adolescents
Currently, EMDR therapy and trauma focused cognitive behavioral therapy “are the only
well-supported, evidence based treatments for children with traumatic stress identified by the
World Health Organization” (Wesselmann, Armstrong, Schweitzer, Davidson, & Potter, 2018).
EMDR has been proven effective with single-event trauma, cumulative trauma, in different
cultures and in both genders with children and adolescents (Barron, Bourgaize, Lempertz,
Swinden, & Darker-Smith, 2019). In children and adolescents, the relationship greatly defines
how they approach therapy and how much they are willing to work. It is important to determine if
the therapist is an appropriate fit for the patient, especially in EMDR, due to the vulnerability
seen with traumatic memories.
The use of EMDR in adolescence is fairly similar to treating an adult, the patient is able to
recall their trauma and determine the negative that they experienced. Although, it can be difficult
to treat adolescence with any type of therapy, depending on their will to work through their
trauma. It is important to build therapeutic relationships with adolescents and create a trusting
environment in which they feel heard. Although the relationship is key for treating adolescents, it
is important to make sure that they understand that certain issues that affect their safety may
need to be discussed with the parents or with the authorities if warranted. Family therapy may
also be incorporated to let the adolescent discuss certain situations clearly with the parents.
EMDR in children has shown that it can significantly lessen trauma symptoms, helps them
return to their overall function, and can improve future psychopathology (Lichtenstein, & Brager,
2017). There are many “creative modifications of procedures throughout the eight phases that
can assist EMDR clinicians with achieving cooperation, regulation, safety, and trust with
complex, high dysregulated children” (Wesselmann, Armstrong, Schweitzer, Davidson, & Potter,
2018, p. 197). For children, it is important to incorporate another form of therapy such as “play,
art, sensorimotor support, story-telling, metaphors, family therapy, and parent support”
(Wesselmann, Armstrong, Schweitzer, Davidson, & Potter, 2018, p. 198). Although, it may be
difficult to build a therapeutic relationship with a child, depending on the trauma that they have
experienced as well as their ability to separate from their parental support. There are many
children that refuse to have one on one sessions with the therapist, parents should always be
included when necessary, but children are more likely to become distracted and not take part in
the therapeutic process when parents are always present.
Adult and Older adult
As many would agree, post-traumatic stress disorder is the emblematic mental illness that
become popular recently. Trauma and their psychological problem become a serious talk in
many event because it effects not just the veteran but also many others individual who suffer
from traumatic event in their life. Since that time, the range of traumas has expanded to include
hearing hate speech, abuse, learning of a relative’s death, accident, or watching a catastrophe
unfold on television. Virtually, almost every individual may experiences such “traumas” during
their lifetimes. The different is the level of severity that individual suffer. The trauma according to
Horwitz (2018) will “sufferers dissociate or repress their traumatic memories into a hidden part
of the mind or brain, where they are still present yet are inaccessible to conscious recall” (p. 5).
Interestingly, Ophir and Jacoby (2020) described those symptoms are
The first includes invasiveness and re-experiencing the trauma in the form of sudden
flashbacks, dreams, thoughts, and emotional distress when exposed to stimuli that evoke the
traumatic experience. The second is characterized by an avoidance of proximity to people,
places, activities, and thoughts which may evoke the initial traumatic experience and also
includes substance abuse. The third category, hyper-arousal, is expressed in tension, sleep
disorders, difficulty in concentrating, and sudden uncontrollable outbursts of anger. (p. 2)
Both the existing literature and clinical practice provide the evidence of the effectiveness
of Eye Movement Desensitization and Reprocessing (EMDR) therapy in treating symptoms are
promisingly well. Furthermore, Smajić-Hodžić, and Hasanović (2018) found “positive effect of
EMDR therapy on cognitive, psychological, and behavioral symptoms caused by complex
trauma was confirmed” (p. S305). Basically, there are eight phases of treatment and in the rapid
eye movement phase, the individual focuses on a disruptive memory and identifies the belief
they hold about themselves.Overall, this EMDR is a bottom-up approaches similar to neuro-
feedback and brain-spotting, which allow emotions to be processed at an unconscious level.
Phillips (2019) claimed it work better to treat survivor guilt and other trauma related symptoms
than does a top-down approach such as CBT, which assumes that changing thoughts will
change behavior and feelings. EMDR allows the individual to explore further what they
traumatized or even what they afraid off. Therefore, the use of this therapy become more
diversify in treating other mental disorder such as depression and anxiety. By identifying the
negative self-belief and reprocessing and desensitizing what happened, clients can come to
terms with what occurred in a more rational way and are more in control of their emotions when
they are triggered. It works the same way for all age client including adult and older adult.
Conclusion
Eye Movement Desensitization and Reprocessing Therapy (EMDR) is effective to treat
PTSD in all ages. However, there are may be some difficulty to perform it with children because
there are many factors play a role in this intervention such as therapeutic relationship, child’s
interaction level, the severity, etc. The use of this type of therapy has been diversify into many
different disorder treatment such as anxiety disorder, stress, panic disorder, etc. The approach
can be concluded using bottom up approach so the client will have to explore or go back to the
trauma event in the safe clinical setting to change their perspective of that event. The use of eye
movement tool is to help the clients focus on the present while they are exploring and replacing
their past. There are eight phases in this therapy approach. It is depending on how the client
progress but those phases are divided into a few therapy sessions ranging from 6 to 12
sessions. The effectiveness of this therapy is well study.
References
Barron, I. G., Bourgaize, C., Lempertz, D., Swinden, C., & Darker-Smith, S. (2019). Eye
movement desensitization reprocessing for children and adolescents with posttraumatic stress
disorder: A systematic narrative review.Journal of EMDR Practice and Research,13(4), 270-
283.
Castelnuovo, G., Fernandez, I., & Amann, B. L. (2019). Present and Future of EMDR in clinical
psychology and psychotherapy.Frontiers in Psychology,10,
2185.https://doi.org/10.3389/fpsyg.2019.02185
Horwitz, A. V. (2018).PTSD: A Short History. Massachusetts, MA: Johns Hopkins University
Press.
Lewey, J. H., Smith, C. L., Burcham, B., Saunders, N. L., Elfallal, D., & O, T. S. K. (2018).
Comparing the effectiveness of EMDR and TF-CBT for children and adolescents: A meta-
analysis.Journal of Child & Adolescent Trauma,11(4), 457–
472.https://doi.org/10.1007/s40653-018-0212-1
Lichtenstein, A., & Brager, S. (2017). BUP trauma unit, child psychiatry Stockholm County
Council, Stockholm, Sweden.Journal of EMDR Practice and Research,11(2), 75.
Lilienfeld, S. (2019). Eye movement desensitization and reprocessing (EMDR).Salem Press
Encyclopedia of Health.
Ophir, I., & Jacoby, R. (2020). “Sparks that became a little light over time”:A qualitative
investigation of musicking as a means of coping in adults with PTSD.PLoS ONE,15(1), 1–
23.https://doi.org/10.1371/journal.pone.0228050
Phillips, L. (2019). Relieving the heavy burden of survivor guilt.Counseling Today,62(1), 28–35.
Smajić-Hodžić, L., & Hasanović, M. (2018). The efficiency of EMDR therapy in treating early
multiple traumas - a case report.Psychiatria Danubina,30(Suppl 5), 302–306.
Wesselmann, D., Armstrong, S., Schweitzer, C., Davidson, M., & Potter, A. (2018). An
integrative EMDR and family therapy model for treating attachment trauma in children: A case
series.Journal of EMDR Practice and Research,12(4), 196-207.
Eye Movement Desensitization and Reprocessing Therapy
Peer Response
Eye Movement Desensitization and Reprocessing Therapy (EMDR), as stated in the post,
primarily aims to help individuals with traumatic memories. I fully agree with the argument that
building therapeutic relationships helps to improve the use of EMDR in adolescents, children,
and adults. According to Good Therapy, "the purpose of a therapeutic relationship is to assist the
individual in therapy to change his or her life for the better." These relationships are essential, as
it is oftentimes the first setting in which the patient being treated shares his or her intimate
thoughts, feelings, beliefs, and emotions regarding the issues in question.
Moreover, the post states that EMDR therapy is effective in the treatment of symptoms of post-
traumatic stress disorder in adults and older adults. While I also agree with this particular
statement, it is well-founded and supported by scientific evidence. According to WebMD (2019),
EMDR employs an individual's own rapid, rhythmic eye movements. In so doing, the eye
movements tend to reduce the power of psychologically and emotionally charged memories of
past traumatic events. This makes EMDR an important intervention in the treatment of post-
traumatic stress disorder.
Additionally, the post states that there is adequate scientific evidence to show that EMDR is
effective in the treatment of symptoms. In the words of American psychological association
(2019), "during EMDR therapy, clinical observations suggest that an accelerated learning
process is stimulated by EMDR's standardized procedures, which incorporate the use of eye
movements and other forms of rhythmic left-right (bilateral) stimulation." For this reason, the
author of the post is justified to use EMDR as the treatment approach in this particular case. In a
nutshell, EMDR is effective in the treatment of PTSD for patients across all ages.
References
Good Therapy, (2019). Therapeutic Relationship. Retrieved from
https://www.goodtherapy.org/blog/psychpedia/definition-of-therapeutic-relationship
American Psychological Association (2019). Eye Movement Desensitization and Reprocessing
(EMDR) Therapy. Retrieved from https://www.apa.org/ptsd-guideline/treatments/eye-
movement-reprocessing
WebMD (2019). EMDR: Eye Movement Desensitization and Reprocessing. Retrieved from
https://www.webmd.com/mental-health/emdr-what-is-it#1
Journal
Optionone
Write about situation that you felt you handled well. What did you do? Provide justification and
reasoning for your actions. This commentary should include reference to relevant course content or
research.
GENERALIZED ANXIETY DISORDER
Journal
Over the week, I encountered a 21-year-old woman complains of muscle tension, especially in
her shoulders and neck, contributing to tension headaches. The patient also complained about
decreased sleep, chronic fatigue, and constant restlessness, poor concentration at work as well as
repeated run-ins with her coworkers. She also reveals that she has been a worrier throughout her
childhood, and the problem tends to worsen when under stress. Currently, the patient is having a
hard time controlling her worries, which extends to many topics. Physical exam reveals a
healthy, tense woman with normal vital signs and generalized muscular tension. She does not
abuse substances, and medical history is unremarkable. The patient was diagnosed with a
generalized anxiety disorder.
One of the important things I feel I handled well in this particular case was the diagnosis. I
began with a physical exam to look for signs and symptoms, then ordered both blood and urine
tests. In addition, I took the patient through a detailed question and answered the session in order
to gain deeper insights into her symptoms and medical history. From her medical history, I
established that the patient and two of her siblings suffer from the same problem. According to
the Mayo Clinic, genetics is one of the critical risk factors of generalized anxiety disorder.
Also, I asked the patient to fill a psychological question in order to determine the most
appropriate diagnosis. I employed the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5). The DSM-5 is currently the widely used the authoritative guide to the diagnosis of
mental disorders not only in the U.S but also around the world. According to the American
Psychiatric Association (2019) "determining an accurate diagnosis is the first step toward being
able to treat any medical condition appropriately, and mental disorders are no exception."
GENERALIZED ANXIETY DISORDER
The other important step that I took to help improve the patient's condition is a combination of
medications and psychotherapy. Antidepressants such as selective serotonin reuptake inhibitors
(SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) have been identified as
useful first-line medications for the treatment of generalized anxiety disorder. For this reason, I
prescribed citalopram (Celexa) for this particular patient. According to WebMD (2019) works by
works by restoring the balance of a certain natural substance (serotonin) in the brain.
On the other hand, I chose Cognitive behavioral therapy as the most effective psychotherapy to
help improve the patient's mental disorder. Essentially, the CBT sessions will involve teaching
the patent specific skills to help redirect and overcome her worries. In turn, this will help the
patient return to her normal activities.
In the words of Cuijpers et al. (2018), a combined treatment (medications and psychotherapy) is
more superior for the treatment of major depression, obsessive-compulsive disorder, among
other mental deriders. Therefore a combined treatment remains a very effective strategy for the
treatment of mental disorders such as in this particular case. Moreover, my treatment approach
was enhanced by close consultation with some of the experienced colleagues at the facility. In a
nutshell, despite the few challenges, I believe I performed well in this case.
GENERALIZED ANXIETY DISORDER
References
American Psychiatric Association (2019). DSM–5. Retrieved from
https://www.psychiatry.org/psychiatrists/practice/dsm/feedback-and-
questions/frequently-asked-questions
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds III, C. F.
(2014). Adding psychotherapy to antidepressant medication in depression and anxiety
disorders: a meta-analysis. Focus, 12(3), 347-358.
Mayo Clinic (2019). Generalized anxiety disorder. Retrieved from
https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-
causes/syc-20360803
WebMD. (2019). Celexa. Retrieved from https://www.webmd.com/drugs/2/drug-8603/celexa-
oral/details
Generalized anxiety disorder
21-year-old woman complains of muscle tension, especially in her shoulders and neck,
contributing to tension headaches. She describes decreased sleep, chronic fatigue and constant
restlessness in addition to poor concentration at work, with repeated run-ins with her coworkers.
She has been a worrier since childhood, with worsening bouts when under stress; currently she
reports having a hard time controlling her worry, which extends into several topics. Physical
exam reveals a healthy, tense woman with normal vital signs and generalized muscular tension.
She does not abuse substances, and medical history is unremarkable.
