EMDR

Counselor's Clinical Note Date: 1 November 2024 Presenting Issue or Memory Ms. Johnson presented with feelings of anxiety and sadness related to a past traumatic event. She reported difficulty sleeping, intrusive thoughts, and avoidance behaviours. She expressed feelings of self-blame and worthlessness, particularly in relation to the traumatic incident. She also described feeling overwhelmed by her emotions and struggling to cope with daily stressors. She has been experiencing flashbacks and nightmares related to the event, which have significantly impacted her daily functioning. She also reported feeling isolated and withdrawn from social activities. Image Ms. Johnson described a positive image of herself as a child, playing in a park with her family. She recalled the sensory details of the warm sun, the smell of freshly cut grass, and the sound of laughter. The positive cognition associated with this image was a sense of safety, love, and belonging. Negative Cognition Ms. Johnson identified several negative cognitions, including "I am not safe," "I am worthless," and "It's all my fault." She expressed a strong belief in these statements, particularly in moments of distress. She also stated, "I can't trust anyone," and "I'm going to be alone forever." Positive Cognition During the session, positive cognitions were introduced, such as "I am safe now," "I am worthy of love," and "I am resilient." Ms. Johnson initially struggled to accept these cognitions but gradually began to acknowledge their validity. She responded positively to the idea of self-compassion and the possibility of healing. Validity of Cognition Ms. Johnson rated the validity of her negative cognitions as high initially, but as the session progressed, she began to question their accuracy. She rated the validity of the positive cognitions as moderate, acknowledging their potential but still struggling to fully embrace them. She rated the negative cognition "I am not safe" as a 9/10 at the start of the session, and a 5/10 at the end. She rated the positive cognition "I am safe now" as a 3/10 at the start of the session, and a 7/10 at the end. Emotions Ms. Johnson reported experiencing intense feelings of fear, sadness, and anger. She also described feeling shame and guilt related to the traumatic event. Therapeutic techniques such as grounding exercises and deep breathing were used to help her manage these emotions. She reported feeling a sense of calm after practicing these techniques. SUDs Before the session, Ms. Johnson's Subjective Units of Distress (SUD) level was 8/10. During the session, she visualized the traumatic event, which initially increased her distress to 9/10. After processing the memory and introducing positive cognitions, her SUD level decreased to 4/10. Location of Body Sensation Ms. Johnson reported feeling a tightness in her chest and a knot in her stomach when recalling the traumatic event. She also experienced a racing heart and shallow breathing. These physical sensations were most intense during the visualization of the traumatic memory. Desensitization The desensitization process involved repeatedly visualizing the traumatic event while focusing on the positive cognitions. The therapist used bilateral stimulation (eye movements) to facilitate processing. Ms. Johnson's responses included initial distress, followed by a gradual decrease in anxiety and physical sensations. Her SUD level decreased from 9/10 to 4/10 during the desensitization phase. She reported feeling a sense of relief and empowerment at the end of the session.