Episode 34: Strategies for History Taking Preparation in EMDR Therapy with Brittany Meredith

Welcome back to Your Clinical Supervisor’s Couch podcast, and I’m your host, Kayla Das

In today’s episode, Brittany Meredith, Registered Psychologist and EMDR consultant will discuss strategies for history taking preparation in EMDR therapy.

Hi, Brittany, welcome to the show. I’m so glad to have you here today.

Hi, Kayla. Thank you. Happy to be here.

Brittany, before we dive into today’s episode, please introduce yourself. Tell us a little bit about your practice, where you’re from, and definitely about your EMDR consulting journey.

Like you said, Kayla, my name is Brittany Meredith and I’m Registered Psychologist in Alberta. And an EMDR consultant and training coach. I started my EMDR journey in 2016 when I first got trained, and then I pretty quickly became a consultant in training and then a consultant in 2018 and started doing coaching in training settings from there forward.

That’s so great. When it comes to being an EMDR consultant, I’m curious on how that differs, say than, traditional clinical supervision. As therapists that we might need for our clinical hours and so forth.

Yeah. So consultation is more specific to EMDR, to the process, the protocols, integrating it with specific clients where supervision would be potentially more far ranging than that. But the consultation piece is quite focused on integrating EMDR into your practice specifically.

So why is history taking so critical in EMDR and where do clinicians most commonly get stuck when they’re doing this process?

History taking can be really important in terms of knowing where we’re going with EMDR, especially when we’re getting started with EMDR. We wanna know the roadmap. Oftentimes before we get into it.

And so I provide training and consultation through Roy Kiessling’s EMDR consulting group, and we take a belief focused approach, so it helps to lay out specific networks based on cognitive beliefs, which we can work through one at a time.

There are a lot of choice points in EMDR regarding whether to start in the past, present, or future, and the belief focused approach makes EMDR easier to navigate. Sometimes with traditional approaches, we could start say with one experience and one belief, and then we might move to another experience and belief.

So we’d have multiple belief networks open at one time. So working through one network at a time I think can be really helpful and making it easier for clinicians and for clients to go through the process of EMDR.

History taking also allows clients to r ecognize where those beliefs originated, which helps us move through them more easily.

That’s helpful. What information specifically is essential to gathering during EMDR history taking that maybe even clinicians sometimes overlook when they’re doing the history taking process?

Yeah, I think it is important to narrow down the beliefs specifically. Sometimes we don’t get the belief accurate enough, which ends up in clinicians backtracking at times or not doing the processing as effectively as we want to or could be. Because EMDR integrates negative and positive belief networks. It zips them together where clients have this existing Positive Belief network and have this existing negative belief network and we are tying them together so that the Positive Belief Network becomes the preferred kind of go-to for our brains.

It can be important to ensure that client has a positive belief network. And which experiences are related to their positive preferred belief. And sometimes identifying the positive belief network is the most impactful thing that we can do. And it’s important in order to be able to do the processing that we actually have a positive belief network developed.

Or we don’t really have anything to integrate or go to or help our brain get to. So sometimes that takes a bit more work in the forefront of identifying positive beliefs or experiences that are associated with positive beliefs. And then for some clients it’s easier

to do. so, as I’m hearing you speak, I’m in my mind kind of balancing, how does this differ between say, a bio-psychosocial assessment, or a traditional like history taking in traditional therapy. How does it differ in EMDR history taking, or does it

You can certainly use those approaches. I often tell clinicians you don’t have to abandon the things that you’re already doing. ’cause there are so many ways to get that history taking. There are some ways that are specific to EMDR. Like we often talk about the float back, which actually comes out of hypnosis. But the float back is starting with the belief that we have, the emotions that go with it and the body sensations that go with it. And floating back to an earlier time in our lives that we’ve had that belief with that body sensation, with that emotion to help identify, kind of somatically what comes up there.

Or sometimes doing a biopsychosocial or kind of traditional intake doesn’t always get to the same things that the float back does this accessing or subconscious more to what else might be connected there? We can do a traditional or just kind of question asking or talking about what’s related to the particular beliefs.

Sometimes when we integrate that more somatic or subconscious approach, then we get things that we don’t necessarily remember or connected to it. Of course, some part of us knows that’s there, but it’s not always obvious to us consciously where these things come from.

I love that. How can clinicians assess readiness for reprocessing during the preparation phase of EMDR?

So it’s really important to ensure that clients can return to their resources and be able to integrate them into their lives. So even say when they’re in the middle of processing or they’re in between sessions, it’s really important that they’re able to access and utilize those resources. They come into a place of like optimal arousal as we like to call it.

So we do some practicing of coming back to resources. Roy Kiessling talks about rehearsing and rescripting which involves going back to a previous event in our minds, and imagining using that resource in a rescripting way or imagining a time in the future and rehearsing what might be helpful with that particular resource in the future.

So going to something that we know might happen soon and just doing a little imagining or video or thinking of what and how that resource might be helpful. Some clients need more resourcing or extended resourcing, and of course there’s some clinical judgment involved in assessing when they’re ready to get into processing.

What are some signs that more preparation is needed before moving into processing?

So when a client is having difficulty implementing those resources whether it’s in session or between session, so they become flooded and it’s difficult to come out of that, or they’re experiencing dissociation and again, it’s difficult to get them back in the room, so to speak, then we might need to spend more time in that preparation phase.

I also wanna note that many of us prefer to do preparation first. So technically history taking is phase one in EMDR, but sometimes we do phase two first. To make the history taking easier. When you have those resources online, it’s easier to go through all the experiences that you’ve had without getting flooded or overwhelmed or dissociating.

So we like to give the clients more resources to get through the history taking phase, because of course that can be emotional at times.

Thinking of how someone might incorporate, phase two before phase one. When it comes to EMDR, are clinicians required to go through each step chronologically or are there certain steps that can go back and forth if needed?

Yeah, that’s a good question. The chronological nature of it, so to speak, becomes more important later on, but there’s always room for like backtracking or moving things around in a way that works best for your clients. So exactly like we’re doing with moving preparation first, I think it leads to more client attunement and makes it easier for both the clinician and the client to work through the next phases. So there is some flexibility in that.

So how do you adapt, say the history taking and preparation for clients with complex or developmental trauma compared to maybe, less complex trauma?

Yeah, so we have what we call extended resourcing. We have our go-to resourcing things. Like for my clients generally in their first session, I like to do some kind of resourcing.

I use a lot of what’s called the four elements, which is from Elon Shapiro where he developed this technique that involves four different resourcing strategies and we can use them all together or we can use them one at a time. So it’s the four elements because it’s earth, air, water, and fire.

And so earth is like grounding, using your senses.. Air is the next one is some kind of breathing exercise, there’s lots of options for that, right? But I like four count or square breathing. Water is producing saliva to help our nervous system feel more regulated. Because when we get into fight or flight mode, our digestive system turns off because it’s not the best use of resources at that time.

So if we can produce saliva in our mouths, then we can get our nervous system back into relaxation parasympathetic a rousal or lack thereof. and then the last one is fire. Sometimes we adapt it to light to go to a container, which is a really important piece in EMDR. Create a container that you can store things in or go to our safe, secure, calm, peaceful place, whatever clients refer to call it.

So the four elements tends to be my go-to, that I give to all of my clients. I try to do that in the first session and then I have a little set of beads that goes with them. I actually have a key chain that has my dog on it. I have a service dog that I work with, so they get a set of beads and I think that helps ’em to feel more confident in being able to use it in between sessions and also encourages them to come back. ’cause everybody likes to have a gift, right? Or something that enhances that therapeutic relationship.

Some clients need more than that. So we get into what we call extended resourcing. This might involve parts work or integrating other strategies that lots of different clinicians EMDR clinicians talk about. So one of those is what Laurel Pernell identified as bringing in like a team of helpers.

Laura Parnell talks about protective, nurturing and wise figures that we can help the client to recognize and integrate into their daily lives of bringing these up as a team that helps to support them, whether it’s in between sessions or during processing. Sometimes it takes a bit of time to identify those things especially where clients haven’t had a lot of protective or nurturing or wise figures in their life.

So we can allow that to also, to be characters and movies or imagine things or animals even are sometimes a really good resource for people. I can spend More time in preparation and history taking. And sometimes taking it quite slowly, like it can take a long time for really complex clients to do enough history taking in preparation.

Some clients do it quite easily but with really complex clients. Tends to need more time, need more sessions. I’ve had complex clients that we’re in the preparation phase for a year right before we can get into processing. Sometimes that involves lots of parts work stuff or ego state therapy too. That can be really helpful in integrating with EMDR.

Amazing. So how does effective preparation influence, say pacing safety and overall treatment outcomes in EMDR?

So I do think that preparation is the most important phase, and if we don’t spend enough time there, clients can certainly have a difficult time getting through the history taking and processing. We might move too quickly or too slowly. If we don’t have a good idea. You have the client’s capacity for processing. Also clients don’t have resources that they feel confident in using in and out of EMDR sessions or between sessions, they may be less likely to get through processing and all the things that we have laid out in target sequence planning. So it’s important to have an accurate assessment of the client in order to determine the appropriate pacing.

So I know you mentioned that you have a therapy dog. Can you tell us a little bit about your therapy dog? ’cause I’m sure that many listeners like myself are dog lovers and I would just love to know more about your therapy dog.

So his name is Indi and he is Alliance foundation of Canada facility Support dog. So he actually supports our whole practice at Power psychology. He’ll be with me sometimes or he’ll be with other clinicians sometimes. But he is very calm and well-mannered and mostly cuddles with clients on the couch while they’re working through stuff, which can really help to stabilize them.

They often say like his breathing is very regular. Sometimes he’s snoring or brings in some room for laughter in the things that he does. So he’s a really good resource and just the presence in the room, like it’s a non-judgmental, attuned presence. And so that can be really helpful for clients.

Oh, so amazing. So Brittany, I know you offer EMDR consulting. Can you share with listeners how they can work with you and who might be a best fit?

So you can access me through more Power Psychology website or through emdrconsulting.com. When participants do the EMDR training, you get access to their full list of consultants. And so you can access anybody that you want to work with through there.

I mostly work with complex trauma, body focused, repetitive behaviors, anxiety and pain. So if you’re really interested in any of those things in particular I can help with that. But also just integrating EMDR into your practice generally, I think I can help with that as well.

So to access EMDR consulting with Brittany, head to emdrpower.com, or you can simply scroll down through the show notes and click on the link.

Brittany, thank you so much for joining us on the podcast today to discuss strategies for history taking preparation in EMDR therapy.

My pleasure. Thank you.

Thank you everyone for tuning into today’s episode, and I hope you join me again soon on your Clinical Supervisor’s Couch podcast.

Until next time, bye for now.