Part Three: EMDR & Listening to Women

This article originally appeared in Science and Sensibility.

In this series about EMDR (Eye Movement Desensitization and Reprocessing), Part One looked at qualitative research evaluating EMDR as treatment for post-traumatic stress disorder (childbirth onset). In Part Two, EMDR clinicians weighed in on their feelings about the safety of EMDR during pregnancy.

Mend a broken heart When those EMDR posts were published, I received a lot of behind the scenes feedback from women who either loved or hated their experiences with EMDR; there didn’t seem to be a middle ground!

I felt these women’s voices need to be heard (many thanks to Sharon, S&S editor, for her gracious agreement!). The results are here: four interviews conducted with four real women who suffered from trauma in the perinatal period and tried EMDR.

 

It ‘s unfortunate these lovely women suffered extreme emotional turmoil at such an important time of life; when they were working and hoping to build their emergent family and when they were primarily responsible for the safety and care of their infants.

 

Through sharing their stories, all women indicated to me that they hope that their voices will contribute to the collective movement to incorporate mental health care into the overall care of women and their families in the childbearing year.

 

 

Characteristics of Their Trauma

 

All  of the women interviewed experienced trauma in the early postpartum period. Three suffered specifically from birth trauma; all experienced a severe perinatal mood disorder. Three of the women additionally were coping with complex, long-term, multi-layered emotional trauma, stemming back to abuse in childhood.

 

All of the women interviewed were seeing licensed therapists who incorporated  EMDR into their overall treatment plan for trauma.  Some asked to have their identities masked, so identifying details and names are obscured, but the overall personal  statements and feelings are preserved.

 

They are empowering to all of us in that ALL of them valued their mental health and were brave enough to seek professional  help!

 

 

Personal Healing Processes

 

The women interviewed are all emotionally mature adults. They’re aware of their life situations and the impact of trauma on their well-being.  They’ve worked hard to explore and develop life-long skills and methods of managing their emotions.

Thus, these are all women who are proactive, sophisticated and intelligent about their emotional healing processes. Before they used EMDR, all of the women had already incorporated many forms of healing into their personal self-care plans.

Their self-care plans included: long-term psychotherapy,  journaling, expressive therapies such as art, music and movement,  yoga, exercising, gardening, CBT, goal setting and medication. One woman indicated she was in so much pain from long-term, severe, past abuse she had seriously discussed ECT with her psychiatrist. So, when their trusted therapists suggested trying EMDR, specifically designed to treat trauma, all the women agreed.

 

Personal Perinatal Traumatic Events:

 

In their own words, the women share their individualized, personal perinatal trauma experiences below.

 

Birth Trauma:

Kim (not her real name) shares her traumatic birth story:

My son was born after an easy pregnancy but a complicated birth. I’d very nearly had a vaginal birth; the nurses could see the top of his head, but it was turning to the side each time I pushed. After nearly 2 hours of this, I underwent a c-section because I had spiked a fever and things were not progressing. During my c-section, I was overcome by anxiety and completely paralyzed by fear.

I literally thought I was dying as my son was being born, yet due to the panic, I was unable to verbalize this fear to anyone.

I spent that time shaking and having what I thought were my last panicked thoughts and breaths. It was the the most afraid I’ve ever been in my entire life, and also the most alone I’d felt, despite being surrounded by others.

After the surgery, I wasn’t able to hold my son for 3 hours. I spent the time in recovery, scared that something were wrong and nobody was telling me. I am still not sure of the reason for the delay.

My maternity leave felt long, due to postpartum anxiety and depression and a baby who barely slept and I cried nonstop some days. I felt like a terrible mother who was unable to console her child or enjoy him. I felt tremendous guilt. In addition to the emotional aspects, my c-section scar was not healing properly, so I felt as if I were constantly making a 30-mile trek (newborn in tow) to my ob-gyn’s office for checkups. “

 

Birth Trauma Layered on Childhood Trauma:

Karen (not her real name) said:

“My very traumatic birth triggered already active memories of severe childhood abuse, parental suicidal attempts in front of me, active alcoholism & substance abuse in the family and severe childhood neglect.”

 

Helen (not her real name) said:

 

“I was working on birth trauma at the start of the EMDR, but later on, abuse, illnesses, and martial distress. I was mainly focused on the birth trauma I had experienced when I used EMDR.”

 

 

Postpartum Traumatic Event Layered on Childhood Trauma:

Jessica Banas explained her perinatal trauma as such:

 

“I was traumatized by my childhood with my father. He was very emotionally abusive.  Seeing him overdose (on a drug called GHB) the first night my parents were to supposed to have been watching my infant son for me, so I could rest, felt like the ultimate betrayal.  Once again, not only were they NOT there for ME, but I had to SAVE them (again) instead!!!”

 

Women’s Experiences Show Us:

Moms with PTSD Suffer Co-morbid Perinatal Depression & Anxiety 

 

It is fascinating and sad that all three women with pre-existing trauma stated their prior trauma was re-triggered by a perinatal traumatic event (traumatic birth or other traumatic event postpartum).  And all four suffered from a severe postpartum depression and anxiety after their traumatic perinatal event. A woman’s mental health is an important aspect of the childbearing year.

 

As discussed in a previous blog post, one in four women suffers depression at some point in her life, and women are more likely to suffer depression during and shortly after pregnancy than at any other time (Nonacs, 2006).  Ruta Nonacs, MD (2011), editor-in-chief of Massachusetts General Hospital’s Center of Women’s Mental Health’s website estimates annually in the US, there are about 4 million births, and about 950,000 to 1,000,000 mothers suffer from depression either during or after childbirth every year.

 

Having a personal history of a mental illness in her lifetime, such as depression, anxiety, PTS/PTSD, OCD or bipolar disorder (remember, this is whether it was diagnosed & treated or undiagnosed & untreated) increases a woman’s risk of postpartum depression.  A previous history of previous postpartum depression increases a woman’s risk of a recurrence to 50 – 80 % risk of recurrent PPD, as compared to a 10- 20% risk factor without having had a prior episode.

 

It’s important to note that the women’s constellation of PTSD symptoms intensified and  they developed severe postpartum depression and anxiety.

 

Jessica eloquently states how important women’s mental health is to the postpartum period:

 

” One important symptom of my PTSD that complicated and worsened my PPD was when my infant son would cry and interrupt my ruminations of my father Od-ing. I’d get angry….that would trigger thoughts of wanting to harm my son and cause me great anxiety and incredible guilt…..there were many times I was too afraid if I went to tend to him, I’d treat him harshly, or hurt him This created such a sense of worthlessness and shame, I thought of suicide one night. Instead I told my husband and we reached out and got help.

 

It is a very important aspect of PTSD in that I am personally aware how detrimental it is on PPD. My  PPD rapidly escalated after getting PTSD.  And  one seemed to feed on the other. Getting treated for BOTH issues was very important.”

 

 

Women’s Experiences Show Us:

EMDR Outcomes 

 

Two very positive experiences

Kim’s Experience with Traumatic Birth & Postpartum Anxiety & EMDR

Kim, who suffered from birth trauma and postpartum anxiety, had a positive experience with EMDR. Here is her story of healing.

Kim said that her therapist incorporated EMDR into her current psychotherapy sessions. She said she hadn’t realized that she’d been suffering with PTSD until almost a year after the incident.  She says she discovered her anxiety was stemming from a traumatic birth experience at a therapy session:

Kim says:

“…of course I’d had PTSD from thinking I was dying while my son was being born! My anxiety, which had a lot to do with waiting for something terrible to happen to me or my son, started to make sense in light of this new revelation.”

Kim experienced the EMDR itself as calming. She held tappers in her hands while her therapist lead her through visualizations. Her therapist warned her that EMDR could be emotionally triggering and if she needed to call her, she was welcome to do so.  And it was triggering for Kim. After her first session, she suffered from an anxiety attack and had to call her therapist, and received the help she needed.

Ultimately, Kim’s overall experience with EMDR was  emotionally freeing and healing.

She goes on to say:

“Up until the EMDR, I was unable to speak about my c-section at all. I couldn’t see anything related to the birth experience (with or without c-sections involved) on television, either. If I caught a glimpse of a birth on TV, I cried. I had a lot of anxiety on the few occasions I tried to watch A Baby Story on TLC, as a test to see how I felt watching another woman’s experience.

After EMDR a few times, I became more comfortable thinking about and processing my experience, and even eventually talking about it with others. I no longer viewed my scar as something horrible and ugly. Having EMDR gave me back my confidence because it helped me stop seeing myself as a failure (because I needed a c-section instead of birthing vaginally). “

 

Kim would recommend EMDR to another person trying to recover from trauma, but with some warnings about the emotional response.

 

Jessica’s Experience of Postpartum Traumatic Event, PPD, Suicidal Ideation & EMDR

Jessica, who experienced the trauma of her father’s overdose while her parents were supposed to be watching her baby, had a positive experience with EMDR. Here is her story of healing:

Jessica said that her therapist incorporated EMDR into her current psychotherapy sessions. Her therapist suggested she try something “new” that would remove the sting of the trauma from my mind. Jessica was skeptical but thought she’d give it a try.

 

Jessica says: 

“The EMDR was pretty much wrapped around by talk therapy in that we’d start out by talking and end up by talking… EMDR  took the emotional ties from the traumatic memories away.  I no longer find myself reliving any of those memories that were treated with EMDR.  I no longer feel any emotional pain from the OD event.  I have no loss of sleep, anger, depression, or any anxiety over that event.”

Jessica says she did not find the EMDR emotionally triggering at all, but many childhood memories came flooding back. .

“Not at all…frankly, I thought it was lame at first (wiggling a finger in my face?  REALLY?) and had no hope it would have ANY effect at all. Once we (quickly) healed the OD trauma, memories from my childhood did come flooding back!  I found that to be very interesting!  Fortunately, my childhood was not as terrible as many, so I could handle this phenomenon.”

 

Jessica recommends EMDR:

“…as long as the person is seeing a well trained, compassionate therapist! EMDR  helped me and I have gone on to suggest it to other people who were in pain as I was….those people have been healed by EMDR as well….I find it a useful treatment and extremely non-invasive compared to other treatments!!”

 

Two very negative experiences

 

Karen’s Experience with Birth Trauma, Past Trauma, PPD, PPA  & EMDR 

 

“My experience was physical and emotional and in both cases negative. I felt physically ill, vertigo, nausea. Disorientation, short-term memory loss, headache. Emotionally, it was detrimental as it brought up my most difficult trauma and I felt completely triggered. I tried to hang in there with the process, but only did a few sessions.  The EMDR sessions were not processed with in-between traditional talk therapy sessions.. The EMDR made my symptoms worse, my anxiety worse, and the neurological side-effects were horrible.. While my therapist did a wonderful job at regrouping. After we decided to stop doing it, I actually went up on my medications and saw her 2x a week for a while. It was just too much. What I think had happened to me was more resurfacing old memories that I had compartmentalized in years of talk therapy and medication. I actually think I needed a medication adjustment when I was so desperate for relief. “

 

Karen would not personally recommend EMDR to another.

 

Helen’s Experience with Birth Trauma, Past Trauma, Postpartum Mental Health Complications & EMDR 

 

“My therapist suggested the EMDR may be helpful for both traumas (birth and childhood). I had 6 sessions that where each an hour long. Some of this process was also traditional talk therapy in between the EMDR. I found EMDR not helpful in treating my traumas.”

 

“It was extremely triggering and the therapist pushed me into a lot of it. She would try to help me regroup by taking deep breaths and little breaks in between. But I always felt drained after each session and even more triggered with PTSD.”

 

Helen would not recommend EMDR for another person:

 

“I do not think I would personally recommend EMDR to another person for a trauma. I believe the therapist shoved me into it too soon and left me for days swirling in the emotions of that. I have heard it can be wonderful for others healing. For me it triggered too much to soon and my experienced left me more traumatized. I can’t think of those (EMDR) coping skills and techniques without feeling overwhelmed with memories.”

 

 

Conclusions

 

As we can see from real women’s experiences, EMDR was extremely triggering to two of the women, but resolved emotional distress well for the two other women. Again we are reminded that one size does not fit all when it comes to treating mental health.

 

The women’s experiences indicated that when working with EMDR for trauma, even experienced and trusted therapists encountered strong triggering responses in their clients. In these instances, these therapists needed to know how to appropriately re-group and therapeutically support their clients either in the session and/or be appropriately available outside of scheduled sessions.

 

It was not appropriate for a therapist to urge a client to try or keep using EMDR if the client did not really want to, or if the client was having an overall non-therapeutic effect.

 

As we can see from these real women’s experiences, the treatment of post-traumatic stress has the potential to be devastating to the client as far as awakening or re-triggering compartmentalized past emotional distress.

 

In this small article and small example, it is interesting to me that the four women who volunteered to share their stories in this small had extreme reactions to EMDR, none neutral.   These results reinforce my usual conservative approach to managing emotional distress, that is, if one is suffering from debilitating mental and emotional distress, it is best to consult with a licensed professional.

 

What I find empowering about these interviews is that ALL of these women VALUED their mental health and were brave enough to seek help. Fight the stigma!  Don’t be afraid to get help!

 

 

 

 

Author’s Note: NONE of these women were or are my clients. I neither refer to nor interview my clients online. Never.

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