Disclaimer: This blog entry is neither intended to provide a step-by-step guide to using the Feeling-State Addiction Protocol (FSAP) nor is it in any way meant to stand as a scientifically supported statement of effectiveness. The results described herein are merely illustrative of the anecdotal experience of its author when employing the protocol. The FSAP—or any other EMDR treatment protocol—should not be employed by anyone not specifically trained in EMDR and stabilization techniques. The following is meant to represent this writer’s impressions of the protocol and is not meant to supplant writings and research conducted by FSAP developer Robert Miller, PhD. This writer has taken utmost care to ensure that clients participating in this treatment have been fully supportive and desiring of the hoped for results.
It has been such a busy couple of weeks, and I’ve been remiss in posting. It’s nice to be back at the keyboard doing something fun.
I’ve continued to work with clients employing the EMDR Feeling-State Addiction Protocol, and I wanted to offer up a bit more detail of my (and my clients’) experience of it. The client about whom you will read has granted me permission to share this information for training/learning purposes. Please note that names and some details have been changed to protect the confidentiality of the client.
I began working with ‘Tommy’ some months ago, at which point he sought to remain abstinent from methamphetamine use. This was a great struggle for Tommy, owing to the powerful feelings he gained from using, combined with the sex he had enjoyed while high. He acknowledged, though, that he no longer got the same ‘high’ that he experienced very early on in his use, and that, in fact, he rarely if ever had sex anymore when using. The drug had gotten in the way of his enjoyment of the thing he started using for in the first place. Nevertheless, Tommy remained ambivalent about not using. He was in meth’s grip.
After a brief participation in, then an extended hiatus from, therapy, and finding that his life was falling apart around him, Tommy made the decision to go into a rehab program and get ‘clean’. Tommy did just that for a number of weeks, then transitioned into an intensive outpatient program (IOP) and living in a recovery home. It was during this period that Tommy reconnected with me.
The quality and degree of engagement in this second period of work has been very different, and this is when I began to discuss with Tommy the possibility of employing EMDR to address long-standing, unhealed traumatic experience (physical, emotional, and sexual) that appeared to have informed his later use of substances. I already knew that I’d be attending Robert Miller’s Feeling-State Addiction Protocol training in March 2013, and Itold Tommy so. He seemed enthusiastic about possibly being one of the first clients with whom I would try to use it once I returned.
Oh, and before we begin, a ‘key’ for the uninitiated:
BLS = bi-lateral stimulation
EM = eye movements
SUDs = subjective units of disturbance
VOC = validity of (positive) cognition
FS = feeling-state (emotion+sensation+cognition+addictive/compulsive behavior)
PFS = positive feeling-state (the FSAP version of the SUDs)
PC = positive cognition
NC = negative cognition
FSAP processing commenced on April 12, 2013, in a 60 minute session, which progressed as follows:
EMDR FSAP Processing – FSAP Phase III
FS Processing – Session 1
Target Behavior: Methamphetamine Use
Most Intense Part(s): Preparing syringe for injection
Feeling State #1: Euphoria+preparing syringe
Starting PFS: 6
Location in Body: chest
Notes: EM used to facilitate BLS in this session. PFS for FS#1 dropped to 0 after 1 set of BLS. Tommy could identify no other positive feelings connected to preparing to use.
—————————-
Deficit Processing
Wanted Feeling #1: Euphoria
SUDs: 9
Location in Body: upper chest
Notes: Intensity of WF#1 dropped from 9 to 0 after 2 sets of BLS.
—————————-
Future Template
Tommy wanted to be motivated in his life, and feel that he ‘belongs’ there, working, attending school, etc. Tommy reported somatic blocks in his chest and stomach, as well as feelings of sadness, in successive sets of BLS, and reported that the initial ‘scene’ felt clear of disturbance after 3 sets of BLS and that it felt totally try that he was motivated and belonged in his life. Tommy was able to proceed through his imaginal ‘film’ of living his life and dealing with potential barriers feeling motivation and a believing that he belongs to life, and responded well to reinforcement of this situation with BLS.
****************************
May 19, 2013 (45 min session)
FS/Behavior Evaluation Since Last Session: Tommy reported that he was unable to ‘conjure up’ any experience of euphoric recall related to preparing to use methamphetamine (the identified initial target) since last session. Tommy reported ‘feeling different’, as well, although he could not necessarily quantify this. Tommy reported two additional triggers: a) Drawing back the syringe after shooting up; b) Imagining someone else using, seeing someone have that ‘first rush’. The second target was addressed first in today’s session. Session progressed exactly as documented below, without any breaks in the 45 minute session.
EMDR FSAP Processing – FSAP Phase III
FS Processing – Session 2
Target Behavior A: Methamphetamine use
Most Intense Part(s): Seeing someone else injecting meth and witnessing their ‘first rush’
Feeling State #1: Feeling free+witnessing another person’s rush
Starting PFS: 5 – 6
Location in Body: Behind eyes; chest
Feeling State #2: Relief+watching
Starting PFS: 4 – 5
Location in Body: Behind eyes; chest
Notes: EM used to facilitate BLS in this session. PFS for FS#1 dropped from 5 – 6 to 0 after 2 sets of BLS. PFS for FS#2 dropped from 4 – 5 to 0 after 1 set of BLS
Although, most of the time, relief is not the core feeling, thus not part of a feeling-state, in this case Tommy appeared very much to be seeking a sense of relief from emotional pain, etc.
—————————-
Deficit Processing
Wanted Feeling #1: Feeling free [from mother]
SUDs: 9
Location in Body: Back of head
Notes: SUDs dropped from 9 to 0 after 3 sets of BLS.
—————————-
EMDR FSAP Processing – FSAP Phase IV
NC Underlying Feeling: I’ll never amount to anything
Float Back Target: Mother saying this to him when he was younger
EMDR Reprocessing – Target #1
Target: Feeling that he won’t amount to anything
Most Disturbing Part: Mother saying this to him as a child and later in life
NC: I’ll never amount to anything
PC: I can achieve what I put my mind to
VOC: 3
Emotions: sadness; disappointment
SUDs: 9
Location in Body: chest/heart
Processing Notes: Tommy reported SUDs of 0 after 6 sets of EM; adaptive processing began almost immediately. After initial reprocessing, VOS increased from 3 to 5. After 1 additional set of EM, VOC increased to 7. In body scan, Tommy reported no disturbance at all, with no EM necessary. Positive feelings reinforced with BLS. At this point, moved on to addressing Target Behavior B.
================
Target Behavior B: Methamphetamine use
Most Intense Part(s): Seeing someone else injecting meth and witnessing the ‘first rush’
Feeling State #1: Excitement+witnessing another person’s rush
Starting PFS: 2
Location in Body: Behind eyes; chest
Notes: When initially asssessed at beginning of session, PFS=4. After processing Target Behavior A, PFS dropped to 2, which was reprocessed at this pointin session. PFS for FS#1 dropped from 2 to 0 after 1 set of BLS.
—————————-
Deficit Processing
Wanted Feeling #1: Excitement
SUDs: 0 with no BLS
Notes: Nothing remarkable observed. Identification and processing of NC not undertaken for this cluster, as the session concluded.
****************************
April 26, 2013 (60 min session)
FS/Behavior Evaluation Since Last Session: Tommy reported having a meth using dream where nothing would give him his desired high–at least, not anywhere near to the degree he was used to experiencing it. Tommy reported experiencing a ‘mild rush of heat’ in his body, but he recalled getting angry in the dream because he wasn’t getting his high.
Tommy also reported that a friend who recently relapsed (on meth) offered client a graphic retelling of his relapse experience, and Tommy experienced no triggering at all.
EMDR FSAP Processing – Phase III
FS Processing – Session 3
Target Behavior: Using methamphetamine
Most Intense Part(s): Could not identify
Notes: Client experienced no triggering, but expressed a strong desire for a feeling of relief. No processing on FS, as no positive feelings could be identified.
—————————-
Deficit Processing
Wanted Feeling #1: Relief
SUDs: 6
Location: heart/chest
Notes: EM used to facilitate BLS in this session. Desire for relief dropped from 6 to 0 after 1 set of BLS. Processing moved on to FSAP Phase IV from here.
—————————-
EMDR FSAP Processing – FSAP Phase IV
NC Underlying Feeling: If I put my guard down, I’ll get hurt
Float Back Target: Volatility at home growing up
EMDR Reprocessing – Target #2
Target: Volatility at home growing up
Most Disturbing Part: same as above
NC: If I put my guard down, I’ll get hurt
PC: Putting my guard down opens me up for love
VOC: 3
Emotions: sadness
SUDs: 6
Location in Body: chest
Processing Notes: Processing on this target was rather brief, due to time constraint. However, after 6 sets of BLS, Tommy reported feeling much more accepting of the general situation at home growing up, yet realizing how much pain and suffering was there for him and his siblings. Tommy experienced a revelation in processing: ‘It was so much to process [back then]. When I found drugs and alcohol, I didn’t have to process anything’.
****************************
May 3, 2013 (45 minute session)
In this session, Tommy asked to ‘take a break’ from EMDR/FSAP processing to reflect on the work done in the past three sessions. When I asked Tommy about his desire/urge to use methamphetamine, this was his response:
“It would be like if someone said [to me], ‘Let’s go for a swim in the sewer’…it’s like, ‘No thanks. Not today’.”
Tommy reported no evidence at all of cravings or urges to use methamphetamine and no using dreams. Tommy also reported no experiences of feeling triggered to use, explaining by way of the quote noted above. Tommy explored what it has been like for him not to experience cravings.
Summary
At this point, Tommy continues to experience no cravings or urges to use methamphetamine, and we are delving more into the underlying trauma that created the needs that made the development of the feeling-state(s) possible. The final phase of treatment will include reprocessing the negative beliefs Tommy developed as a result of his meth use (the final phase in FSAP processing) remain.