EMDR Mysteries: A Case Of The Stuck SUD

You’re in session with an EMDR therapy client and you’ve diligently walked through the first 3 Phases of treatment. Now you are doing set after set of bilateral stimulation and the subjective units of distress (SUD) is just not coming down. You do more sets, check the SUD… still no movement… 

Has this ever happened to you? It’s happened to me. And it can feel frustrating, confusing and leave you scrambling for just the right cognitive interweave and over involving yourself in the process. Or perhaps you begin walking down that long, dark road of “Maybe I’m just not that good at EMDR….” Wait. 

Before you take one more step, breathe. Did you know there are other ways to experience movement and healing besides the SUDs? Yes – the SUD rating is important. But it’s not the only sign that your client is progressing. Worse, by overlooking these signs you risk changing gears when in actuality you were on the right path. 

So what should you do when a SUD is stuck? First, explore other areas of processing. Here are 3 other ways you can track and experience your client’s progress: 

  • The client observes the target memory differently. When you reassess the client’s experience of the target memory be mindful of any and all changes. Does the image of the target memory feel farther away? Is it cloudy or harder to see? Has there been a change in perspective (i.e. looking at it versus being in it)? Does it feel less important? Are they able to get closer to it without fear or numbing? Trust the client’s experience in and of the target memory and remain curious. 
  • The client reports a difference in the worst part. My preferred method of reassessing the target memory is to ask them not only to recall the target in general but to identify the worst part of the target now. For example, the target memory might be “Being abused by my first grade teacher.” At the start of the session the worst part might be, “The teacher calling me into his classroom.” Later, the worst part might shift to, “Leaving the classroom and feeling confused.” The client is talking about where they feel the emotional charge within that target memory. Allow them to continue to move and connect to the experience in all the necessary ways. This is good! 
  • Increased access to emotion. Many of us have had clients who are numb to their trauma. They may have difficulty expressing emotion or experiencing it in their body. Watch for their personal growth as they are able to move from numbness and avoidance to sad, angry, fearful, etc. You might also witness ‘positive’ emotions such as increased ability to experience acceptance, empathy, compassion, etc. For clients who tend to be hyper-aroused, you might witness them better managing intense feelings, breathing through emotions, maintaining eye contact with you and needing less containment. In

other words, they are better able to remain in the window of tolerance even though the work still feels disturbing. This emotional flexibility is a win! 

Finally, you may need to return to your client’s education about what “SUD” is: what it means to be a 10, what it means to be a 0, etc. Often it can be helpful to share an appropriate story of an event from your own life that was once a “6” and is now a “0” and how you can feel the difference. For example, I often share my personal story about my dog Lucky who I had to have euthanized. I explain that while it’s still sad and always will be sad I don’t cry now and can feel the sadness in my body without difficulty. I feel “a zero”. 

Similarly, I once had a client tell me, “I know I’m a zero because I’m still anxious but I don’t have to do anything about it. I don’t’ have to actively manage it.” I have used this explanation with other clients and it has clicked for them. Explore a variety of ways to help your clients understand SUD in a way that makes sense for them. Begin to collect your client’s perspective on what “SUD” means to them. My most analytical clients often tell me “It can’t be a zero – nothing is a zero.” So I know for them, when they are a SUD: 2…. That’s their zero. If the PC installs and their body scan clears I know our work is complete. 

The art of EMDR therapy is different from standard protocol. We have to remember that the goal is not necessarily a SUD of 0… or a VOC of 7… or a totally completed series of past, present and future troubles. Every client is different, has different goals and each of them will have a unique journey. If you find yourself struggling or filled with doubt as you explore the art of this therapy do not hesitate to reach out for consultation. When clinicians seek me out for consultation I love being able to provide the education they desire and help them connect with their own gut as they weave these life changing 8 phases together for their clients. As an EMDRIA Consultant it’s an absolute joy to be on this journey with you as your skills grow. Know you are never alone. 

 

If you are already EMDRIA certified, don’t neglect your need for continued consultation. It will transform your client’s progress and deepen your toolbox in ways you couldn’timagine on your own. And if you aren’t certified, check out my blog, “​10 Reasons to get your EMDR Certification.” to see if consultation is right for you.

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