Addressing Client Ambivalence and Avoidance in EMDR Therapy
Understanding Client Ambivalence and Avoidance
A common difficulty prompting EMDR therapists to seek consultation is when a client initially expresses a wish to address past trauma, but as therapy advances, they exhibit indications of ambivalence or avoidance. This can present in a range of ways, including the client arriving late for sessions, being tangential, reporting numbness, emotional detachment, having difficulty activating targets, and defences such as minimising, denial, and intellectualising.
When this occurs, it’s likely that one or more ‘parts’ in the client’s internal system may be unsettled by the trauma work. In these cases, internal fears, phobia, or conflict may need to be addressed in Phase 2 before attempting trauma reprocessing in EMDR Therapy. Otherwise, these will likely prevent the natural flow of EMDR Therapy. Awareness, empathy, compassion, and cooperation need to exist between parts for internal phobia to be overcome, and for trauma processing to proceed safely and effectively without getting blocked.
The Role of ‘Parts Work’
‘Parts work’ (sometimes referred to as ‘ego state work’) often harmonises beautifully with EMDR Therapy. Whether you're trained in schema modes, internal family systems, structural dissociation, ego state therapy, or another approach, the key idea remains the same. When working with a client, we're not just engaging with the person in front of us; we're interacting with all aspects of them. These parts may hold varying feelings, thoughts, and perspectives on trauma processing.
While one or more parts might be motivated and determined, others could be fearful and resistant. Approaching trauma processing without acknowledging and understanding these parts can lead to complications - defences arise, emotions become inaccessible, or clients may exhibit signs of ambivalence or avoidance.
Recognising and Engaging with Parts
Integrating parts work techniques into your EMDR practice - such as dialoguing with different parts, using imagery to visualise and communicate with parts, or incorporating techniques from internal family systems or other parts-based therapies – can be very helpful for effectively working with ambivalent or avoidant clients. It’s important to create a safe space where all parts feel heard and respected and approach this work with curiosity, compassion, and non-judgement. There are no ‘bad’ parts.
Here are some strategies to consider:
Acknowledge All Parts: Begin by acknowledging the existence of different parts within the client. Help the client identify and perhaps name these parts, which can help them feel validated and understood. Remember that all parts developed for a reason and play a function in supporting the client’s adaptation from trauma, even if they may seem counterproductive. Communicating about the function of each part can help build empathy and compassion. Jim Knipe’s Blocking Belief Questionnaire (available freely online) can be a helpful resource to identify secondary gain issues or blocking beliefs that may be underpinning a client’s avoidance.
Build Trust and Cooperation: Work on building trust and cooperation between the parts. This involves understanding the fears and concerns of each part and addressing them with empathy and compassion. Identifying mutual therapeutic goals and developing a working alliance between parts is key to fostering collaboration rather than aiming to eliminate any part.
Pace the Therapy: Recognise that some parts may need more time and reassurance before proceeding with trauma processing. Be patient and allow the therapy to progress at a pace that feels safe for all parts. Developing inner curiosity about each part's function and addressing their concerns collaboratively can help in reducing conflict and fostering a safe therapeutic environment.
Transforming Resistance into Alliance
I encourage EMDR therapists to see working with fearful or avoidant parts as an important aspect of the therapy process. By shifting the perspective from viewing these parts as problematic to recognising them as valuable allies in the therapeutic work, we can transform resistance into a collaborative alliance.
These parts often have important insights and protective functions. By respecting their role and working with them, we can facilitate a more integrated and holistic healing process. This approach not only reduces ambivalence and avoidance but also empowers clients to engage more fully with their therapy.
Closing Reflections
Addressing client ambivalence and avoidance in EMDR Therapy requires a nuanced understanding of the client’s internal system and the various parts that comprise it. By integrating ego state or parts work into the EMDR process, therapists can create a more supportive and effective therapeutic environment. This approach helps clients move past their defences, engage with their emotions, and achieve deeper, more lasting healing.
Interested to Learn More?
If you're interested in enhancing your skills in using 'parts work' in EMDR Therapy, I offer two 3-hour webinars on this topic that you might find valuable. With your purchase, you gain immediate and lifetime access to the webinar recordings, so you can re-watch them anytime in the future. Feel free to check these on-demand webinars out here.
I'm Caroline Burrows, an Accredited EMDR Trainer and Consultant. I’m passionate about bridging the gap between EMDR training and clinical practice. If you're looking to learn EMDR Therapy for the first time, enhance your EMDR skills, or navigate challenges in your EMDR clinical work, I offer training workshops, on-demand webinars, and consultation. I would love to support your EMDR learning journey.
