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Section 18
Using Arts and Dreams in EDMR

Question 18 | Test | Table of Contents

In the last section, we discussed how your client with multiple traumas can develop targets.

In this section, we will discuss using art or dreams as targets for the EMDR process.

Using Art as a Target:

I have found that art can be a useful tool for aiding clients in their development of EMDR targets. Often clients can use the art to draw what they are feeling or draw the issue they are currently in. This can work as an expression of the client’s inner experience. Art can create distance between your client and the overwhelming feelings he or she is going through and can help them with clarification.

From one image that a client creates, you and your client can gather a wealth of information about your client’s internal experience. Verbal processing works in a linear manner while drawing provides a spatial matrix. I have art supplies in my office and provide client with at least 15 minutes to draw for client’s that I feel will benefit from artistically expressing his or her processing.

I have found that using art to from targets for clients is helpful when…

1. The client has strong emotions and does not know why
One young client, Erica, age 21, did not know why she was having such strong feelings. I had her draw what she felt and she scribbled forcefully with red, black, purple, and orange markers. She was then able to express that she was very upset and feeling a kind of inner chaos. She was able to identify that the red swirls she drew in a tight ball were anger and fear. I then asked her to elaborate.
Clinician: What do you feel in your body?
Erica: a swirling energy in the front of my body
Clinician: What do you believe about yourself?
Erica: I’m out of control.

2. The client is having difficulty coming up with a target memory
Another client Linda, age 40, remembered being beaten up by her father but was having difficulty targeting a specific scene. I then asked if she wanted to draw an image and she drew a picture of her father very large and dark hitting a small child with his belt. She also had an image of her mother in the corner very small. I then began asking Linda about details of the drawing to begin her memory network. From there I could continue the process of asking about the feelings, negative cognition, body sensations, and images regarding memories Linda had of her father beating her.

Encourage your client to modify or create a new drawing after the EMDR session. It can be helpful for your client and you to observe the progress made in the session. I have found that it gives the client something tangible and undeniable to take from the session.

Diegelmann’s CIPBS…
The following is a summary of the process called CIPBS (conflict imagination, painting, and bilateral stimulation) developed by Christa Diegelmann as an effective way to incorporate art into EMDR treatment.

1. Have your client divide a large paper into four quadrants. They can begin drawing going from the upper left, upper right, lower left, and finally lower right. I had Linda use this process when she first came in to see me.

2. Have your client draw a safe place on a separate piece of paper and reinforce it with bilateral stimulation. Linda drew an image of her childhood friend’s home. Linda would often spend time there and felt that her friend’s parents were her parents in a way too.

3. Have your client draw his or her conflict or problem. As mentioned earlier, Linda drew an image of her father, herself much smaller, and her mother as a small image in the corner.

4. Ask your client for the SUDs. However, if your client is too distressed you can omit the SUDs process. The NC, PC, emotions, and body sensations are omitted.

5. Clients can then begin BLS by either tapping their knees or cross their arms in front of their chest and tap their shoulders in a "butterfly hug". Have your client tap until a new image appears for him or her. I explained to Linda, "Continue the BLS until a new idea, emotion, color, or whatever appears." I then had Linda draw the change.

6. I had Linda repeat this process two more times until she filled in all four quadrants with drawings.

7. You and your client can then go over the progress of the images he or she created. For Linda, the experience of making four smaller pictures served as a distancing technique and gave her a sense of hope and new perspectives.

Using Dreams as a Target:

Dreams also make good targets because they are a way into the unconscious mind of your client. I will give two processes that you can use to incorporate a dream as a target.

Dreams Protocol…
1. Have your client tell you their dream. Ask your client to scan his or her dream and identify the most disturbing parts of the dream. I ask clients, "What image represents the most upsetting part of the dream?"
2. Ask your client to identify the negative cognition (NC) by asking, "When thinking of this image, what do you believe about yourself?" You can skip this step if the client cannot come up with something.
3. Have your client identify the emotions and body sensations that go with the image.
4. While bringing up the image, NC, emotions, and body sensations begin BLS and continue until the dream is no longer charged (a 0 or 1 on the SUDs scale).
5. Ask your client what he or she believes about himself or herself when the dream images are brought up and use this to install the PC.

Beginning of the Dream Protocol…
1. Begin by having your client identify the first image of the dream and get as many of the target components (NC, emotions, body sensations) as possible associated with that image. The dream may unfold and remain in a symbolic form, it may link to a memory right away, or it may go back and forth between symbolic and memories.
2. From time to time, check the beginning of the dream to see if it is still charged for your client.
3. Once the beginning of the dream no longer holds a charge, have your client return to the rest of the dream for charge. Begin to process any other charged parts of the dream.
4. Continue this process until your client can scan the dream from beginning to end without any charge.
5. Once your client rates his or her dream as a 0 or 1 on the SUDs, help your client identify and install a PC to go with the dream.

In this section we discussed using art or dreams as targets for the EMDR process. The two types of clients that are most helped by using art to develop targets are a client that has strong emotions and does not know why or a client that is having difficulty coming up with a target memory.

In the art process we discussed the seven steps of Diegelmann’s CIPBS process for using art to develop targets for EMDR: have your client divide a large paper into four quadrants; have your client draw a safe place on a separate piece of paper and reinforce it with bilateral stimulation; have your client draw his or her conflict or problem in the first quadrant; ask your client for the SUDs; clients can then begin BLS until a new image appears for him or her; repeat this process two more times; and you and your client can then go over the progress of the images he or she created.

We also discussed two different protocols that can be used to incorporate dreams into developing targets for EMDR.

Parnell 184-189
Reviewed 2023

Update
Quantitative changes in mental health measures with 3MDR treatment for Canadian military members and veterans

Jones, C., Smith-MacDonald, L., Brown, M. R. G., Pike, A., Vermetten, E., & Brémault-Phillips, S. (2022). Quantitative changes in mental health measures with 3MDR treatment for Canadian military members and veterans. Brain and behavior, 12(8), e2694. https://doi.org/10.1002/brb3.2694


Peer-Reviewed Journal Article References:
Baker, F. A., Metcalf, O., Varker, T., & O'Donnell, M. (2018). A systematic review of the efficacy of creative arts therapies in the treatment of adults with PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 10(6), 643–651.

Balbo, M., Cavallo, F., & Fernandez, I. (2019). Integrating EMDR in psychotherapy. Journal of Psychotherapy Integration, 29(1), 23–31. 

Houben, S. T. L., Otgaar, H., Roelofs, J., Wessel, I., Patihis, L., & Merckelbach, H. (2021). Eye movement desensitization and reprocessing (EMDR) practitioners’ beliefs about memory. Psychology of Consciousness: Theory, Research, and Practice, 8(3), 258–273.

Kuiken, D., Chudleigh, M., & Racher, D. (2010). Bilateral Eye Movements, Attentional Flexibility and Metaphor Comprehension: The Substrate of REM Dreaming? Dreaming, 20(4), 227–247.

Shapiro, R., & Brown, L. S. (2019). Eye movement desensitization and reprocessing therapy and related treatments for trauma: An innovative, integrative trauma treatment. Practice Innovations, 4(3), 139–155. 

QUESTION 18
What are the seven steps of Diegelmann’s CIPBS process for using art to develop targets for EMDR? To select and enter your answer go to Test.


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