Tag: FSAP | D. Michael Coy MA LICSW

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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’.

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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.

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.

After addressing such a challenging topic in last week’s blog post, I decided to take up a lighter subject in my second blog entry: Addictions and compulsions.

My observations have suggested to me that, for some therapists, regardless of their particular bent, addictions are often something that ‘other therapists deal with’. Addictions can feel overwhelming and scary, not only for the person experiencing them first hand, but for the therapist in the room with them. So often in treatment, it seems, there are far more questions than answers in addressing addictions. One of the most prominent questions, in my experience of conducting both group and individual therapy, is, ‘Why does knowing something not translate into feeling/believing it and result in changed behavior?’

As a social worker who employs EMDR rather frequently, I have become very comfortable with addressing the varied reasons why, by helping people move through the emotional barriers that prevent the ‘knowing’ from agreeing with the ‘feeling’—at least when it comes to negative irrational beliefs. (For an explanation of EMDR treatment, please click here.)

Although there are also ways of targeting irrational positive affect via EMDR (Knipe, 2005), until more recently, there seems not to have been an explanation of why someone might keep going back to the same behavior, over and over, even when the person knows that it is hurting them or others in their life. In March 2013, I attended a two-day, intensive workshop training that introduced the Feeling-State Addiction Protocol (FSAP). The FSAP is undergirded by the Feeling-State Theory of Addiction and Compulsion. Both the theory and the treatment protocol were developed by Robert Miller, PhD, based on the EMDR standard protocol developed by Francine Shapiro, PhD. According to Dr. Miller,

The feeling-state theory (FST) of [impulse control disorders (ICDs)] was developed by this author. The theory postulates that ICDs are created when positive feelings, linked with specific objects or behavior, form a state-dependent memory. This state-dependent memory, composed of feelings and the event, form a unit called a “feeling-state” (FS). The FS is hypothesized to be the cause of ICDs (Miller, 2010).

A ‘feeling’ is not the same as an ’emotion’ in this way of looking at things. Here, a feeling is the combination of an emotion, the physical experience of that emotion, and a positive cognition that accompanies them. For example, someone could experience happiness, feel it in their chest, head, and arms, and experience a thought such as, ‘Wow, I really belong with these people’. The three combine into, ‘I feel like I belong’.

The implications of this theory are pretty heady. Just as negative feelings that ‘won’t go away’ can be the result of a state-dependent memory (i.e., the state a person was in when the experience got emotionally ‘stuck’), so can positive feelings. This isn’t just any positive experience we’re talking about, though. This has to have been an overwhelmingly positive feeling for the person, rooted in a strong, unmet (and perhaps hidden) emotional need to feel whatever that feeling is (feeling powerful, feeling like a winner, feeling in control, etc.). The ‘feeling-state’ is a combination of the powerful, positive feeling(s) essentially fused with the behavior that gave the person that feeling. It appears that addictions and many compulsions are not done for the sake of the behavior, according to this theory, but as a deeply felt, emotionally driven desire to experience the overwhelming positive feeling(s) again. For more detailed information, please refer to Dr. Miller’s website.

So, always up for something that might help my clients move through their difficulties more swiftly (if possible), I’ve begun employing this protocol with clients. It’s not easy. (Well, sometimes it is, actually.) However, the key is to accurately identify with the client the feeling states they are experiencing connected to the specific behavior (or part(s) of the behavior) that yield the strongest positive feeling. Without having correctly identified those feeling-states, the protocol doesn’t work. The initial processing phase of the protocol is where the separation of the target behavior and the feeling-state(s) occurs.

I’ve not gotten all the way through the full protocol with any client yet. I’ve only begun employing the thing in the past three weeks, and I’m still getting a ‘feel’ for it (pitfalls, dead-ends, and all) but my clients and I have already seen some really impressive results. Examples include:

Client with a history of polysubstance dependence, focusing on past intravenous cocaine use. After one session, client reported no longer being able to trigger the craving to use cocaine.

Client with history of cutting behaviors. After two sessions (one focusing on the cutting itself, another focusing on the feeling of relief after cutting), client no longer finds cutting—or even other, harm reduction inspired alternatives—desirable or appealing.

Client with history of binge eating of both savory and sugary foods. After one session, client reported that she was able to choose to eat only two small pieces of chocolate rather than eating the whole chocolate bar—and still felt satisfied. Client reported that she had no additional urge to eat more than she wanted.

A single behavior can have multiple feelings attached, so the real trick for me has been to identify all those feeling-states. Also, different aspects of the behavior can been attached to different positive feelings for the client. The key is to weed all of them out at the root. The person does not even need to remember the original, powerful experience. However, it does require that the person be willing to engage in what is known as ‘euphoric recall’ in order to elicit those feelings. Also, if the targeted behavior has become one of a person’s primary coping strategies, then the therapist is potentially pulling the rug out from under their client if they blow through this treatment without a good amount of prep work and resource development, as should be standard with any employment of EMDR as a treatment.

According to Dr. Miller in the training, he has also seen success in taking what I would consider a harm reduction approach to addressing behaviors: Not entirely eliminating the feeling state, but reducing it slightly, so that the client feels a bit more in control and maybe feels that there is a bit more room in their life for other things. Some people may also be happy with reduced rather than entirely eliminated use or behavior.

The examples described above are but a few. However, it appears that this protocol can be used on most any behavior with an emotional compulsion component, including ‘process’ addictions, including relationship co-dependence, and substance abuse/dependence issues. Evidence offered by Dr. Miller in training suggested that this protocol is not effective with features that are specifically linked to Obsessive-Compulsive Disorder, owing to confounding factors.

For more information about the FSAP and Dr. Miller’s work and research, as well as training opportunities for EMDR clinicians, please direct your browser here.

References
Knipe, J. (2005). Targeting positive affect to clear the pain of unrequited love, codependence, avoidance, and procrastination. In R. Shapiro (Ed.). EMDR solutions: Pathways to healing (pp. 189-212). New York: W W Norton & Co.

Miller, R. (2010). The Feeling-State Theory of Impulse-Control Disorders and the Impulse-Control Disorder Protocol, 16(3), 2-10.

FSAP

Treating Methamphetamine Addiction Using the EMDR Feeling-State Addiction Protocol

Tackling the EMDR Feeling-State Addiction Protocol