Therapy with Tough Clients by Gafner George;

Author:Gafner, George; [George Gafner]
Language: eng
Format: epub
ISBN: 1531439
Publisher: Crown House Publishing
Published: 2013-08-15T00:00:00+00:00

EMDR and cognitive-behavioral therapy (CBT)

In a randomized, controlled trial involving civilian trauma survivors in the Netherlands, Nijdam, et al. (2012) compared eye movement desensitization and reprocessing (EMDR) to brief eclectic therapy, which consisted of imaginal exposure, cognitive restructuring and other components. The researchers found both treatments effective but EMDR resulted in a faster recovery compared with gradual improvement with brief eclectic therapy. Now, these results mirror the current state of research on therapy and PTSD where both EMDR and any number of versions of CBT totally dominate the literature as effective treatments. As such, these evidence-based, manualized approaches predominate inside and outside the V.A., but this was not always so.

During the Vietnam War a new school of therapy, behavior therapy, burst on to the scene. Among techniques such as reinforcement, extinction, and desensitization, was flooding, which meant that in a highly structured, 20-minute-or-more session, the client was inundated repeatedly with a negative stimulus (the stressor), thus activating the fear response over and over again so the client becomes habituated to it. Nowadays in many circles, flooding, which was renamed prolonged exposure, or PE, may be less intense, consisting of talking about, say, the killing of people in a village in Vietnam, over and over again in individual or group therapy. One technique commonly used is having the client make an audio recording of the stressor and having them listen to their own voice describe the stressor over and over again. I use that technique with Maggie in this book. Thanks to Albert Ellis and others, starting in the 1970s a cognitive component was added to the behavioral in what we now call CBT. What in the nomenclature was flooding became PE, which is now encompassed by the term trauma-focused therapy.

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