EMDR PSYCHOTHERAPY �FOR FEAR OF DEATH OR TRAUMATIC DEATH MOMENTS

By Linda Hochstetler, MSW RSW

Annual Conference�April 24-26, 2022

Presenter Name: Linda Hochstetler

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Relationships with financial sponsors:

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“NOT APPLICABLE”

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Faculty/Presenter Disclosure

Annual Conference�April 24-26, 2022

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None

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Disclosure of Financial Support

Annual Conference�April 24-26, 2022

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None

Mitigating Potential Bias

Story: Dead Fish

• 38 year old woman with a “lifelong” fear of death
• Specific fear of others dying
• Age 3 - story of taking a pet fish out of the water so it wouldn’t drown
• Age 8 – beloved grandmother died, and after last visit, was told she was “sleeping”
• Negative Cognition: I cannot trust others to stay alive
• Developed a complex bedtime routine to keep self and everyone else alive
• 4 target sessions and SUD went from 9-0
• Bedtime routines vanished!

What is EMDR?

• Eye Movement Desensitization & Reprocessing
• 1987 Francis Shapiro
• Started with eyes and moved to include other senses (touch and hearing)
• Somatic psychotherapy
• Dual attention stimulus - right brain & left brain
• Present & past orientation
• Now called EMDR Psychotherapy
• 2^nd most evidence-based research studies proving efficacy
• Treatment causes neurobiological changes in the brain

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EMDR and Dying/Death

• EMDR welcomes conversations about dying and death into therapy even earlier than actual deaths
• Watching other deaths triggers memories of death
• Death is already all around us and in our minds, no matter whether we’re talking about it or not
• Hospice palliative care invites us to talk about earlier experiences of dying and death
• Bereavement – Anticipatory Grief - EMDR

Story: Aunt died in Childbirth

• 28 year old woman grieving for 4 years after her aunt died in childbirth
• Aunt’s 4 year old daughter never heard mention of her mother by anyone and just lived with her dad
• Extended family refused to talk about the death, but the children were asking questions
• Extreme anxiety and inability to work
• Negative Cognition: I cannot control death
• 2 target sessions and SUD went from 8 – 1
• Client recognized own needs for grieving through talking were overshadowed in the family’s silent way of grief

All Senses

• EMDR began with eye movements – visual
• Early protocols focused on hand movements and light meters
• Currently most commonly use Tac/Audio Scans – touch and auditory
• Closing eyes encourages inner journey
• Sit side by side, not looking at each other
• More easily accessible to clients with shame-based traumas

Story: Witnessed Gasping for Breath

• 26 year old man attended the final moments of his mother’s death as she gasped for air and died
• His father “couldn’t visit” at the end and refused to acknowledge she was dying
• All ACP wishes and funeral plans were shared with young man, and not his father
• Negative Cognition: I am responsible for my mother’s death
• 2 target sessions and SUD went from 7 – 0
• Client confronted his father and they agreed to distribute ashes together as per her wishes

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Negative Cognitions

Positive Cognitions

Based on �Polyvagal Theory

• 3 brains (amphibian, mammalian, neo cortex) working together
• Polyvagal nerve connects brain, lungs, and stomach
• Trauma interrupts Polyvagal nerve and changes connectivity with self and others
• Trauma-informed therapies must allow body and nervous system to release trauma

Principles of EMDR

• We are animal organisms with advanced brains
• We are born as blank slates
• Beliefs about ourselves are added as the result of specific experiences
• Beliefs can be changed at any time
• Factual memories and emotional memories are stored in different brain parts
• Humans hang on to emotional memories that support negative cognitions
• Traumatic memories can be reprocessed and released

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Story: Fear of Others Dying

• 31 year old woman who came to therapy to discuss her relationship breakup
• Can’t remember not being petrified of death and what happens afterwards
• Client had a child’s voice and tears when discussing loss
• Remembered anxiety of parents’ divorce at age 6 and spending extended periods of time away from both parents and being with her grandmother
• At age 12, she was the only child to be with her grandmother in the room as she died
• Negative Cognition: I cannot trust others to care for me
• 4 target sessions and SUD went from 9 – 2
• Decided to stay single and be alone for a while

8 Phases

Listening for Death Issues

• Clients may lead with connection to fear of death or simply mention it in passing
• Near death experiences may be as experienced as real
• Medical experiences produce many death issues
• The therapist’s capacity to hold the conversation on death will determine the client’s willingness to share

Story: Medical Manipulation

• 52 year old man came to therapy wondering why he couldn’t grow up
• Told the story told to him of being born with some form of scoliosis and both parents had to hold him down to straighten his spine for an hour a day between ages 1-2
• His body remembered what he didn’t
• Negative Cognition: I cannot trust others
• 2 target sessions and SUD went from 8 – 0
• Changed his wardrobe, bought a house in a community in Costa Rica, and started a new relationship

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Resolution Phrases

• I’m bored with my memory
• It feels like it happened to someone else
• I see how different the memory looks to my adult self
• I’m ready to move on
• I can barely remember the original memory now
• My dysfunctional patterns have just fallen away, without any effort

Story: Killing Puppies

• 48 year old male police officer on sick leave because he has panic attacks in situations with the possibility of needing to shoot his gun
• Daily memory of a traumatic memory from age 3 witnessing his father killing a litter of puppies, and being asked to participate
• Negative Cognition: I cannot trust myself around death
• 2 target sessions and SUD went from 10 – 0
• Other target sessions on other traumas lessoned their impact on his life

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EMDR Psychotherapy

• Integrate loosening of fears
• Believing Positive Cognition opens up possibilities
• Return to present functioning issues
• Speak as the client’s parent (or significant other) when validating client
• Some clients need longer Positive Cognition stage than others
• Addressing death issues outside of hospice palliative care helps clients be ready to deal with present death

Thank You!

lindafhochstetler@gmail.com

www.lindahochstetler.com

Link to Presentation on Psychotherapy tab

Book - 21 Days to Die:

The Canadian Guide to End-of-Life

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