Page 114 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Chapter 5
The start of EMDR therapy for participant two was difficult. He missed three
therapy sessions during the first three days of treatment. He remained in
bed despite his caregivers encouraging him to attend the therapy. When
he attended therapy, he exhibited dissociative behaviour; he sat silently in
his chair and stopped responding to the therapist, which meant that he
was unable to follow the therapy properly. The therapists decided to let
him walk around during the sessions so that the movement would prevent
him from lying down quietly and shutting himself off the therapy process.
His tension increased, and he ended the therapy session with a Subjective
Units of Disturbance (SUD) score of 10 (0 = no distress to 10 = extreme
distress). After this session, his professional caregiver decided to drive with
him to a sheepfold so that she could talk to him calmly. During the drive,
he began to talk spontaneously about his intrusive distressing memories.
This moment showed how emotional safety created outside the therapy
room, with a trusted caregiver, enabled him to open up, underlining the
importance of relational security in supporting affect regulation. On the
same day, therapists discussed that the traumatic memory they had been
treating up to that point might have been triggered by other traumatic
memories. They decided to treat these other traumatic memories first
using EMDR therapy. When the participant returned to therapy the next day,
the therapy progressed step-by-step. Ultimately, the original memory, which
had previously ended at a SUD of 10, was successfully treated to reach a
SUD of 0, meaning that the patient no longer experienced distress when
thinking of the traumatic memory.
Participant two (after therapy): “When they ask questions, I think
back and then you think back. And they [EMDR therapists] say;
then you think about it and there are all kinds of thoughts that
come to mind... And then you get distracted and they say; yes,
that image, yes no, that image is no longer there.”
Participant two (after therapy): “Then [in the second week] you
already know what to do because you know what’s going to
happen.”
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