Interviews

Recently I was interviewed by a local magazine writer who was writing about getting children to do chores. As always, I suggest that parents/caregivers use positive reinforcement and logical consequences to guide children into making good choices and growing up to be kind and loving human beings. I believe that theory supports that children are born with a temperament and develop personalities based on interactions with caregivers and the environment. If you are cared for with love and given healthy guidance to make good decisions, children gave confidence and empathy. I encourage parents to teach children to make good choices and exhibit healthy behaviors by "catch them being good." Most parents will intervene when children are misbehaving; however, I suggest that you try to ignore poor choices (unless there is a safety issue) and instead to focus on when children are behaving and making good choices. For example, how about rewarding random acts of kindness? When have you ever rewarded your child for being nice to a sibling or another child? Making a big deal about what behaviors and words you want repeated will decrease the need for discipline and consequences, but that takes work on the part of parents. So back to the interview with the magazine writer. As I was trying to explain this concept, I typically use the example of slot machines. The way that casino owners get a high rate of responding to slot machines is by making it random when a person will hit a winning spin on the slot machine. That's called a variable rate of reinforcement. The person playing the slot machine never knows when they are going to hit a pay off AND watching all the people around them randomly hit payoffs also encourages them to keep putting money in the slot machine. How does this apply to rewarding children? Well, if you randomly reward your child for behaviors you want repeated then children are more likely to repeat those positive behaviors. If I congratulate and hug you and sometimes even give you a special reward for being nice to your sister, you might want to be nice to your sister more often. That's a variable, unpredictable reinforcement for doing something healthy. This works great for kids and is easy as a parent. Remember to hug and congratulate and cheer for your child when they do something that is healthy and appropriate and your child will be more likely to repeat that behavior in the future. So, the magazine writer missed a great deal of the explanation and basically wrote that I said that "children are like slot machines. The more you put in the more you get out." Well at least the last sentence is true. The more we invest in our children, the more our children will grow up to be healthy, wonderful people.

A Friend

A friend is one who knows you as you are,

understands where you have been,

accepts what you have become,

and still allows you to grow.

-William Shakespeare

Workshops by Dr. Robbie

This post is to give the reader some information on the workshops I present. Since I am trained in child development and attachment, I especially love this first presentation. I hope to have chapters on this topic in a new book. I have presented workshops in attachment, infant-toddler mental health, EMDR in psychotherapy with children, and our research on EMDR with children that resulted in the reduction in depressive symptoms in traumatized children. For a list of workshops I have presented, please check out my curriculum vitae (CV).

WORKSHOPS:

Treatment of Attachment Trauma and the Dissociative Sequelae

in Clients of All Ages:
EMDR and Case Conceptualization

Presented by
Robbie Adler-Tapia, Ph.D.

When earliest relationships are traumatic, attachment injuries can significantly change the trajectory of one’s life. Bonding and attachment are neurobiologically driven survival mechanisms; but when irreconcilable conflict exists within these innate mechanisms, individuals can experience extreme distress leading to mental health disorders and physical disease. Although these conditions may begin in infancy, if untreated the aftereffects can endure for a lifetime. It is essential that attachment disruptions be addressed in both children and adults experiencing complex trauma reactions, including Axis II conditions and dissociation. EMDR provides a comprehensive, integrative, and effective approach to the treatment of attachment and dissociation.

EMDR HAP and the HAPKIDS Project

EMDR HAP or the EMDR Humanitarian Assistance Program is "an international non-profit EMDR-Humanitarian Assistance Programs (HAP), a 501(c)(3) nonprofit organization is the mental health equivalent of Doctors Without Borders: a global network of clinicians who travel anywhere there is a need to stop suffering and prevent the after-effects of trauma and violence." Volunteers for EMDR HAP travel the world providing training, treatment and consultation for communities who have experienced trauma and violence. After responding to the earthquakes in San Francisco and the terrorist bombing in Oklahoma City, EMDR HAP has responded to international disasters including, Hurricane Katrina in the Gulf Coast Region of the United States, the Tsunami in South Asia; the terrorist attacks that occurred on 9/11 in the United States; the killing of students in a high school in Columbine, Colorado; the floods in Central and South America; a school of students who witnessed a plane crash into the building next to their school in Milan Italy; and, to regions of the world with on-going trauma including Palestne and Israel. These are but a few of the events to which EMDR HAP volunteers have responded. To learn more about EMDR HAP and EMDR HAPKIDS please explore the EMDR HAP website at http://www.emdrhap.org/.

What is EMDR HAPKIDS? EMDR HAPKIDS is a fledgling part of EMDR HAP that focuses on bringing together professionals who focus on working with children. In addition to the EMDR HAP trainings, HAPKIDS' goal is to focus on offering training, treatment, consultation and services to communities where the most vulnerable children need support and mental health professionals need specialized training in working with children. Many amazing child specialists have traveled the world volunteering for EMDR HAP and many more amazing individuals are working in the trenches to help children. As I have volunteered for EMDR HAP, I have had the honor of meeting these individuals who are helping children.

Dr. Bob Tinker and Dr. Sandra Wilson have worked in a refugee camp near Hemar, Germany with ethnic Albanians from Kosovo providing training and mental health services.

Reyhana Seedat from South Africa has provided many services for EMDR HAP including a recent trip to providing EMDR training and treatment in Gaza.

Mona Zaghrout-Hodali and Ferdoos Alissa are providing services at the East Jerusalem YMCA in Beit Sahour, Palestine where they offer training, supervision, and treatment to children.

In 1999, after 2 earthquakes killed some 25,000 people and displaced 750,000 Dr. Jim Knipe, EMDR HAP Project Coordinator for Turkey, lead a team of volunteers to Turkey in collaboration with the Turkish Psychological Association to provide mental health services to victims.

Janet Wright, Peggy Moore, Jim Knipe and many others have traveled repeatedly to the Middle East to provide specialty child EMDR services and training in collaboration with local mental health professionals.

Dr. Nacho Jarero, Dr. Lucinda Artigas along with a group of EMDR professionals have responded for over 10 years to the disaster needs of communities in Central & South America. During this time they created an "EMDR Butterfly Hug or Group Protocol" to work with groups of victims and especially with children.

Dr. Isabel Fernandez and her team responded to the needs of a school of children in Milan, Italy after a plane crashed into the building next to the school.

These dedicated professional volunteers are representative of the international community of individuals working to stop pain and suffering especially with children.

For more information:

http://www.emdrhap.org/ The EMDR HAP website

http://www.emdria.com/ The EMDR International Association website with links to other international EMDR organizations

http://www.emdr.com/ The EMDR Institute website

http://www.emdr-europe.org/ The EMDR Europe website

The Social and Emotional Needs of Gifted Individuals

Thanks to a series of workshops by Dr. James Webb, I have been reading more about the social and emotional needs of gifted individuals. Dr. Webb is the President of a publishing company that publishes books on many different topics related to understanding and working with gifted individuals. For more information on Dr. Webb's company, please check http://www.giftedbooks.com/. I have also included a few links below.

In working with all age clients, I have noticed that individuals who are highly intelligent present with mental health challenges especially with self-soothing, relationships, and at times, sensory integration issues. Because I focus on a client's strengths, I explore possible logical explanations for the client's symptoms. Young children who are highly intelligent often present in the therapist's office with parents reporting that the child's symptoms include high activity, temper tantrums, difficulty in school, impulsivity such as blurting out questions and being disrespectful to teachers, and difficulty self-soothing. What is especially noticeable with children is the discrepancy between what the child can cognitively think about, but cannot emotionally handle. This discrepancy often is evidenced in emotional dysregulation and difficulty self-soothing and/or calming. Preverbal toddles often struggle until language develops that is commensurate with intellectual level and speed.

Many children who are gifted may have also experienced a range of traumas because they can't relate to other children and struggle socially, adults may have difficulty with these precocious children who asks many questions, and gifted youngsters may be mislabeled with mental health disorders. Gifted individuals may experience existential depression, anxiety, obsessions and compulsions, and varying degrees of trauma. This is where using EMDR with gifted individuals can be very successful. Targeting the clients symptoms through the additional lenses of giftedness and trauma can be very helpful.

Therapists need to assess all clients for level of intellectual functioning and possible giftedness. It isn't always necessary to conduct intellectual assessments, but therapists can ask the older client about what classes the client was placed in school. There are many indications of a client's giftedness that are evident without formal psychological testing.

http://www.psychotherapyservicesforthegifted.com/Gifted/UserFiles/File/GROBMAN_Underachievement_in_Gifted.pdf
http://www.sengifted.org/

http://www.sengifted.org/articles_counseling/Amend_MisdiagnosisOfAspergersDisorder.shtml
http://www.sengifted.org/articles_counseling/Webb_dabrowski_s_theory.shtml

http://www.hoagiesgifted.org/social_emotional.htm


My goal with this post is to get all therapists providing psychotherapy to consider the role that giftedness may play with each client. I hope this begins your exploration of giftedness in mental health.

EMDR With Children Living in Residential Treatment Centers

When children are living in a residential treatment center (RTC), the therapist may be working to stabilize the child and the episode of care may be short. The therapist may not be able to move to the trauma processing phases of EMDR, yet EMDR is still important to use with children in RTCs. After completing the Client History and Treatment Planning Phase and establishing clinical rapport, I would spend time in the Preparation Phase with positive affect tolerance and RDI focused on installing mastery experiences. For children in RTCs, trauma processing of the EMDR Phases 3 + may be too much and the therapist may need to focus on the Preparation Phase for a period of time. What is the goal of this episode of care for the child? Many children are in RTCs because they struggle with affect regulation and need to learn affect regulation and emotional literacy. Psychoeducational training while installing successes with RDI and mastery can be extremely beneficial, but it may take some successes in therapy before the kids are ready to proceed with trauma processing. When I have children who balk at desensitization, I know that I need to provide more resources to continue. I need to help the child be ready for trauma processing. Children in RTCs are often in high stress situations and may need to focus on coping with issues in RTC. So, in case conceptualization, I might ask the child about something that's happening at the RTC that's bothering them and then do a future template focused on the child handling the situation in a different way. I need to determine if there is anticipatory anxiety and/or missing skills and information as I continue by installing the future template of the child's definition of being successful at the RTC.

Living in an RTC is an ideal opportunity to move through the phases of EMDR with children. If I have taught the child 2 portable self-soothing techniques that the child is reportedly using (and I check with staff about the child's success on the unit) then I most likely will move forward to reprocess any minor traumas while teaching the child to contain the more severe traumas from the past. Before targeting any significant past traumas, I explain to the residential staff what they might expect from the child and how to provide additional support for the child during this difficult process.

This brief overview is intended to encourage therapists to consider how to conceptualize the use of various phases of the EMDR protocol when the child is living in a residential treatment center.

EMDR and Case Conceptualization With Children With Symptoms of Reactive Attachment Disorders

How do I conceptualize the use of EMDR with children with symptoms of reactive attachment disorder? This is a question that I struggled with when first learning EMDR and process with many EMDR therapists. This blog is just an overview, but I wanted to document a few strategies for case conceptualization.

1. The psychosocial intake is very important in order to add the appropriate valence to targets. I would suggest that interviewing the parent and the child both together and separately are important. Why is the child in your office? What do the parents want to accomplish and what does the child want to accomplish? Many children are very present oriented and in order to feel successful in therapy and in turn engage in the process of EMDR, I focus on selecting targets initially that the child wants to address. "I don't want to get in trouble so much." Set up the treatment plan focused on this goal of treatment from the child's perspective and explain to parents why this is important in treatment. It is important to remember that in the new training, we discuss that if the client is too overwhelmed by the process of defining the targeting sequence plan, the therapist may need to move to Preparation Phase and IMHO this more circular process of EMDR in psychotherapy makes great sense clinically. Moving to Preparation to teach self-soothing and calming and emotional regulation skills and RDI may be necessary before being able to identify a targeting sequence with many children because of the severity of trauma, less than secure attachment, as well as, the developmental overlay of the child's age and funcitoning.

2. When the child chooses targets as we do during the "Mapping" process, the child is much more likely to be engaged in the process of psychotherapy. Many therapists encounter what is labeled "resistance." I am uncomfortable with the word "resistance" and instead believe that is my job as the therapist to get the child to engage in the therapeutic process. If the child chooses the target and experiences the therapist as the child's ally in the treatment process, the child is much more likely to actively participate.

3. With children the presenting problems (symptoms) identified by the child may result in targeting sequences focused on a presenting problem defined by something other than a dominant core negative cognition (NC). Since children may be more focused on emotions and body sensations, a negative cognition or "what bad thought do you have about you" may be too confusing. In case conceptualization with children, this makes sense for children and parents to start with the symptom and focus on a presenting problem while a targeting sequence plan is developed. Children with symptoms of RAD, especially those adopted internationally may have no cognitive or verbal history, at least in English. Many of the children I work with were adopted from non-English speaking countries so even if they do remember, they remember in another language that they may have forgotten which makes it even more confusing! Again, this is part of learning about the unique issues of this population. At some point in treatment, it is helpful to have the child create a narrative of their own history and even make a Life Book can be helpful to resolve the past history that is often unknown. Using Joan Lovett's narrative is helpful to teach kids. I have kids write a Life Book with a story that tells what we know about their parents, their former home (s), their childhood before adoption and then what we know about the adoption process and what has happened since adoption. Adoptive parents can help with some of the information, but then this becomes the parents' story, not the child's. It surprises me what many children will report if I ask them to write their own story. Once the story is written, we can identify targets from the book that the child might think would have been uncomfortable for a child. This is very simplistic overview of the process, but I wanted to give the reader some thoughts about using EMDR with children.

4. Often when children are in unstable home and community environments such as foster care, residential treatment and/or groups homes, parallel interventions may be necessary - developing and enhancing resources, teaching replacement behaviors, and/or new skills, etc. in addition to, and concurrent with, reprocessing of appropriate targets. This process of establishing a base from which to process the trauma is important because many children with symptoms of attachment trauma and/or RAD do not have the emotional scaffolding with which to tolerate additional distress that may arise from trauma processing. Parallel interventions are often necessary with children with attachment trauma and the therapist may need to spend a great deal of time in Preparation Phase with children AND parents because parents often have their own unresolved attachment traumas, sometimes fertility trauma, and often trauma from trying to love and parent a child with attachment trauma.


5. Targeting chronologically may not be an appropriate course of treatment because the child/adolescent is not prepared to reprocess any past traumas. This is often true with children with trauma and especially with children with symptoms of RAD. So, I'm suggesting that establishing a targeting sequence may not be the first choice for children with RAD or for any client with a chronic trauma history if the client does not remember or is too overwhelmed by the target selection process. I actually am more likely to install mastery experiences and a positive future template with any child. Installing mastery is asking the child, "Tell me about something you are really good at or something you've done that's made you really proud." Installing this mastery experience with short, slow sets of bilateral stimulation helps to build scaffolding for self-esteem, positive feelings about self, and establishes a positive association with the therapy process. In addition, installing a positive future template often helps the child have hope and believe that he or she has something to work towards in the future. Remember, with trauma and depression, a foreshortened sense of future and a negative lens of life may prevent the child from engaging in treatment. If by installing a positive future template, the client has hope for the future, the child may be more likely to engage in treatment. Installing mastery and a positive future template can also help when the therapist has a limited episode of care with the child such as occurs in residential treatment, group homes, shelters, schools, and other programs where the therapist may not have a great deal of time to treat the child. If the episode of care engages the child and creates a positive association with psychotherapy, the therapists has provided the foundation for the next therapist who works with the child.



These are some simple ideas for using EMDR in case conceptualization with children with EMDR EMDRIA has a Children's SIG, there are advanced trainings on using EMDR with children listed in the EMDRIA website, there are at least 5 books on using EMDR with children, and we are in the process of starting a new EMDR HAPKIDS website to share experiences in using EMDR with children.

"EMDR and the Art of Psychotherapy With Children"

EMDR and the Art of Psychotherapy With Children (Adler-Tapia & Settle, 2008). If you are interested in reading about EMDR with children of all ages, Carolyn Settle and I have written a book that provides detailed steps of how therapists can use EMDR with children. Published by Springer Publishing in New York, this book explains the subtleties of using EMDR with children including play therapy, sand tray, and art therapy techniques. The book also includes several original techniques that we have created to assist therapists with eliciting the procedural steps of EMDR with clients including "Mapping" and "Graphing." Along with the book, we wrote a manual that includes the protocols and forms that therapists need for using the EMDR 8 phase protocol created by Dr. Francine Shapiro. This manual can be copied and used by therapists during the psychotherapy process. We wrote the book to encourage therapists to use EMDR with clients and the book includes practical applications, protocols, research, specific diagnoses of children including attachment and dissociation, and recommendations for future research on EMDR with children. We hope you enjoy the book!

Eye Movement Desensitization and Reprocessing (EMDR)

What is EMDR? EMDR is a integrative psychotherapy created by Dr. Francine Shapiro. After more than 20 years of practicing psychotherapy, I began training in EMDR and found that with EMDR I had a comprehensive psychotherapy approach with which to assist clients in dealing with the stress and traumas with which clients presented in my office. Since learning EMDR and using the 8-phase protocol, I find that I am more effective at assisting clients in dealing with the symptoms that initially brought clients to my office. You can learn more about EMDR at the EMDR Institute website at http://www.emdr.com/ or the the EMDR International Association website at http://www.emdria.org/ or at the EMDR Humanitarian Assistance Program (HAP) at http://www.emdrhap.org/.

Along with my colleague, Carolyn Settle, I have also written a book EMDR and the Art of Psychotherapy With Children (Springer Publishing, 2008). Carolyn and I have provided presentations on using EMDR with children and have two chapters that are included in several other soon to be published books. Our work has been focused on advancing the use of EMDR with children in order to gain support for EMDR with children as evidence based practice. We have undertaken this work so that EMDR will some day be available to the poorest and most vulnerable children around the world. In this quest, I have collaborated with EMDR HAP to begin the development of an EMDR HAP project entitled HAPKIDS. This project is being developed by EMDR HAP in order to promote training, research, and treatment of EMDR for children on an international basis.



If you have interest in learning more about EMDR, seeking EMDR treatment, and/or getting training or volunteering to help with any EMDR HAP Projects, I would be happy to assist you with additional information.



I intend to include many future posts on EMDR so feel free to ask questions that I will attempt to answer or at least assist you in finding links to others who might have the answers.

Namaste'

So why do I use the word Namaste' in my blog?
Well for me this word is one of love and respect for all others.



The translation I like the most follows:



I honour that place in you

where love and truth dwell and

when you are in that place in you and

I am in that place in me, we are one.



I think that what is important is that we are all connected and impact each other.
For me it is very simple - we all need to take care of and respect each other!

Welcome

Welcome to my new blog! I hope this is the beginning of a great learning process for all of us as we maneuver the adventure of life. I have chosen to start a blog to share information about my work and the amazing individuals with whom I have the opportunity to meet. The longer I practice as a psychologist the more I realize how much I have to learn. And, I typically learn the most from my clients with whom I have the honor to work - especially children. I also enjoy the company of many brilliant and compassionate professionals both within the mental health community and other professions. Even though I will never share any confidential information, posts will include descriptions of what I have learned from the experience of being a psychologist, woman, wife, mother, daughter, sister, and friend. The posts that review clinical practice and literature are designed to provide information that may benefit you in your life. The blogs may challenge you to learn, or question your life, or experience many different emotions. Ultimately, the goal is to share what I've learned to help you in fulfilling your life goals and finding peace and happiness. Namaste!