Clinical Notes

Some thoughts about improvising EMDR in difficult situations. This is what I do when a client is blocked or overwhelmed and has given up hope: I start from the feeling, even when the feeling is nothing.

You can't script an improvisation. What follows, however, are the building blocks, like the keys and chords musicians learn so that they can improvise together. EMDR is like that: you are doing something with a person and, unless you've gone completely rogue, within the community of EMDR practitioners who believe there's something to be said for following protocol. Like Nina Simone might have played a standard and done something wild with it (her 'Wild is the Wind' rather than the original by Johnny Mathis), this intervention is based on the Standard Protocol. All of my work is. Everything you need is within it. All you need to do is learn it inside out, and then, when you are doing EMDR, go with what's in front of you so the standard still, somehow, holds together. If you do that, the person you are working with should hold together, too.

This one is for when you're working with someone who is blocked or regularly overwhelmed, maybe held in the grip of a terrible anxiety 24/7, who has given up hope and possibly hates life. Fun stuff.

Before you start

Because these are clients who may have given up hope and may hate life, do your risk assessment first. Make sure the preparation phase is done: the client has resources, and you both know how to get them back to their window of tolerance. Don't begin this with someone at risk until you have assessed that risk and made a plan for it.

Finding the target

Look for the dominant feeling, even if that is numbness. Approach that feeling as you would any target using the Standard Protocol, but create the target image using the questions from the Light Stream technique, or something similar. If you know Light Stream as a calming resource, I use only the first part of it, the questions that give the feeling a form. There is no healing light, just processing.

The idea is that you will create something that symbolises your client's dominant feeling in that moment: anxiety, for instance, or depression. You will objectify it. The client stays in touch with the feeling, and at the same time can 'see' it as they might see a moment of an event from a memory.

The questions

I usually ask what shape the feeling has, what colour it is, what it weighs, what it sounds like, how big it is, and where it is. This last one is important. I've had many different responses, usually after the client has asked me to clarify what I mean. I mean inside them, outside, all over, everywhere apart from under their feet, or moving around to block them, as one person once said.

Ask these questions of numbness as well. Affect is never unconscious: whatever someone is doing, they will be feeling something, even if it feels like 'nothing'. Always do the Light Stream questions with nothing.

Assessment

Once you have the image, obtain a negative cognition, a positive cognition and the VOC. Check for emotions like you'd check for a pulse. SUDS can be your pulse reading.

Go

Before you begin BLS, activate the client by going through the material again. Memorise the acronym TICES, it helps: the Target, its Image, the Cognitions, the Emotions, the Sensations. Maybe something has already changed. Then go back to the target image and ask the Light Stream questions again, so that the feeling is as present as it was when you made the image. You may be making a new image as you bring back the one you had.

Begin BLS immediately after you have got a strong sense of the feeling, whatever it is.

Going to the past

When the feeling has begun to shift and the client is staying with it, ask the client where they go if they think about the past. Leave the question open. It may bring a memory, a time in their life, a place, or a state of mind. Process whatever comes, as you would in any set.

If it is too much

Get the client back to their window of tolerance by focusing on sounds. Ask them to notice the furthest away sound, then others, cycling around. Instruct the client not to get into the story of the sound, just its feeling: this is all about affect. Once the client is regulated, go back to your target feeling.

Affect and repression

People get in touch with repressed material, and I am talking about repression as Freud wrote about it. Repression removes or alters representations: scenes, images, words, sounds and fantasies that would connect a person to a particular affective conflict. The affect does not simply disappear. It may persist as anxiety, dread, bodily pressure, agitation or deadness, without a representation the person can recognise or narrate. The representations that are repressed would bring the person into contact with that affect and the affect might lead them to imagine themselves, to put it crudely, as contrary to their ego ideal. Freud writes about repression and representation in The Unconscious (1915), and about the ego ideal as a condition of repression in On Narcissism (1914). The affect itself was never unconscious. That is why you can start from the feeling.

I also use this method with addiction work.

At the end

The final image you get may well now be a resource, a positively infused version of the original frightful thing.

I recently had a proposal for a talk turned down. I had not expected it to be accepted: it ran against the grain of what the conference seemed to want, and its argument may initially have seemed obscure.

Still, if anything holds together what I write and what I do, maybe it is whatever whoever’s on bass does in a certain kind of group. What follows—in the manner of Paul Chambers, if only—is that.

If anybody wants a talk?

“All the Things You Could Be by Now, If Sigmund Freud’s Wife Was Your Mother”: Psychoanalysis and Creativity  

How can we say ‘we need others to find ourselves’ without recognising that the refusal of personhood, for instance under racialized slavery or because someone is a woman, continues to shape the conception of individual subjectivity?

My title partly repeats Hortense Spillers, writing on Psychoanalysis and Race, quoting Charles Mingus, who introduces a recording of All the Things You Could Be by Now If Sigmund Freud’s Wife Was Your Mother by saying ‘It means nothing’, then playing a fabulous improvisation of All the Things You Are. For Spillers psychoanalysis means nothing for anyone whose personhood has been refused. But she does not leave it there. Psychoanalysis might mean something if we flipped it, like Mingus does, out of its standard form.

Despite Freud’s emphasis on plurality, fluidity and deferral, psychoanalysis keeps returning to a self that is only itself, the subject of a corpus juris; and this body of laws is topographic, creating thresholds, an inside and an outside. What is more disturbing than treating somebody as an outsider, a nobody, as nothing?

I’d point to the epigraph at the head of Freud’s On the History of the Psychoanalytic Movement (1914), the paper this conference’s organisers quoted in their address to us:

 Fluctuat nec mergitur (On the coat of arms of the city of Paris).

The coat of arms of Paris shows a ship: tossed by the waves, but still afloat. Freud describes repression (Verdrängung) as the ‘cornerstone’ of psychoanalysis. In German, Verdrängung is also a nautical term: the displacement of water which keeps a ship afloat. Creating the space to keep afloat involves displacement. Psychoanalysis is ‘my creation’ – meine Schöpfung. Schöpfen is to draw, to scoop water from a well. The well becomes erschöpft, exhausted, once it is drawn dry. Creation is also a taking; a depletion. Disturbance is unavoidable. Freud knows this, shouldn’t we? In Repression (1915), he compares this disturbance to ‘ordering an undesirable guest out of my drawing room and my refusing, after recognising him, to let him cross my threshold at all’. A footnote: ‘I must set a permanent guard over the door which I have forbidden this guest to enter, since he would otherwise burst it open.’ That undesirable becomes unrepresentable.

This is the refusal Spillers describes; one psychoanalysis recreates unthinkingly.

The others we need and the selves we must find are ana-psychoanalytic. The ana-lysis of psychoanalysis takes us to a loosening of the psyche (Greek ana-, a going back, and lysis, a loosening); like the ana- of Nicolas Abraham’s anasemia (sēma, a mark or sign), which takes us to a reading of repression that lets us understand what was refused in translating Freud’s Verdrängung from German to English. Ana-psychoanalysis could take us, like Mingus does, towards psychoanalysis as a social psychotherapy: a practice no longer imagining the disturbance it treats as only interior, but turns, like Walter Benjamin’s angel of history, to face the social wreckage of the past – now.

I wonder: could there be a relationship between humanities courses being cut, on the grounds that they offer no proper access to employment, and the possibility that those same courses—and the work that might come out of them—are among the things least replaceable by AI?

Believing, as I do, in something that amounts to the unconscious; in tech barons, mostly men, having far too much power; and in capitalism, overrun by men, being something really sick, I imagine there is.

Such a shame, then, that the humanities have also long been a refuge for insecure men wanting to prove a point and get laid. That is sick too—and I mean sick in the old sense of the word, which means I am old enough to be really sick of it and to know what I’m talking about. Guys: what did we expect? Men built a machine that proves points and never has to get laid.

I began with this thought while thinking about anxiety:

An experience of Freud’s Repression: the presence of affect in the absence of a representation that might lead to the expression of a drive.

Put more simply: Freud’s theory of repression concerns the relation between affect and representation. Repression bars the mental representative of a drive from consciousness, but the affect attached to it does not disappear. It persists—displaced, transformed, or experienced as anxiety, bodily disturbance, or symptom.

Perhaps EMDR helps because it allows affect that has survived without an accessible representation to become linked: in memory, in language, to an image, and towards an object. What had been felt but could not be thought, located, or spoken can begin to acquire form.

Anger is often present in anxiety - unsurprisingly, if a person has lost the ability to protest. What persists may be what we call resentment: anger with nowhere to go; a feeling that returns because the injury, need, or situation behind it has not found a way to be acknowledged, understood, or changed.

Resentment often persists in rumination. Rumination keeps a person caught in the disturbance generated by repression. It also provides a painful kind of continuity: a way of holding on to an experience when there has been no safe person, place, or relationship in which it might be shared.

The effects of distress take us towards its causes.

EMDR is not simply about changing a memory inside an individual mind. As part of a social psychotherapy, it may help create enough safety and room for a person to connect what they feel with what happened, what they need, whom they can turn to, and what might make life more bearable now.

If you kick the can down the road, as they say, make sure you take a good look at it when you find it again. It won't be the same. I'd encourage everyone to kick cans down the road. My Aunt Maria used to do it when she came to London on holiday from Germany: football with the boys I was scared of down the middle of the road, with a can. She was a good thing, Maria.