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Maria is a psychologist, naturopath and EMDR therapist who has 15 years experience working with families (CBT, PBS, ACT). Maria is also a parent to 3 young children, the youngest of which completed her family through permanent care. Maria explains how EMDR is one of the 7 scientifically approved treatments that is covered by Medicare in Australia and how she uses a safer form of EMDR with children called flash. By working with children in identifying parts of the body that keep the score, even when our memories aren't there (for example with developmental trauma), Maria can get to the source of emotions and the brain with EMDR (Flash). Maria also highlights that EMDR is not a treatment that she uses alone. CBT and skills development, particularly emotional regulation and supporting adults to support children are important too. She has used EMDR to treat abuse, anxiety, depression, eating disorders, grief, pain and more. She explains the 8 parts to EMDR and the things that she truly believes resonate with and help children, from reward charts to practicing self regulation techniques and the golden rule of connection before redirection. Normalising experiences and role modelling are important aspects for parents to work on. Challenging children's thoughts too with questions like "would you still love me if I ?" and being curious about how to problem solve with children so that next time something occurs they might come to you to feel safe or use the strategies you have discussed. Finally, Maria suggests finding ways to get the heart rate up and teach strategies in those moments, so that children learn to manage coming down from being stressed in a positive environment. Simple things like snap and pie face can help teach these skills. Some great tips and therapy that must feels like fun! Enjoy!
00:00 - Start 01:09 - Who is Maria? 03:12 - What is EMDR? 04:30 - How the Triune brain works 07:14 - Trauma and narratives 13:00 - EMDR and memories 13:56 - EMDR therapy is one of 7 treatments approved under medicare, so it is safe! 16:07 - EMDR sits alongside other therapies, not in isolation and is great for fears, anxiety, depression, disorders and loss 17:36 - Getting started - Work out what to treat first by working out what children think about themselves and what families see and then target negative beliefs 20:19 - Developmental trauma can be treated too as the body "keeps the score" 23:35 - How the therapy builds skills and the 8 stages 26:15 - Its important to teach about all emotions, not just positive ones, so that disassociation is avoided. Feeling angry is actually normal. 32:03 - Asking questions like "Would I still love you if you did this?" and reinforcing the love is always there is important. 35:12 - Curiosity and practicing emotional regulation after the heart rate goes up by playing snap and pie face 38:04 - Examples of where this has been used with families formed by adoption, permanent care or kinship care 41:15 - Frequency, intensity and the 8 phases and recommended treatments: rule of thumb is 3 session per memory 44:16 - Parents and carers can help by working on providing an attentive home environment with safety, stability, nurturance and acceptance. Plans, structure and realistic limits, with activities like scouts and clubs are important.
This is Sonia Wagner, representing PCA Families in one of our recordings designed to capture lived experience and best practice research based learning that assist kinship, permanent and adoptive parents/carers in supporting young people. We are a child safe organisation. We pay respects to elders past and present, acknowledge the traditional custodians of the land and express our intention to move together to a place of justice and partnership.
Being able to learn from peers and connect with those who may help us is particularly important. Today we are discussing how to help the brain recover from trauma with Eye Movement Desensitisation and Reprocessing Therapist Maria Marshall.
Maria is a naturopath and psychologist who has a background working with vulnerable children, adults and families for over 15 years. Maria draws on a variety of therapeutic approaches including Cognitive Behaviour Therapy (CBT), Schema Focused Therapy, Acceptance and Commitment Therapy (ACT) and Positive Behavioural Support (PBS). Three children one from PC. Maria is also a parent to three children and has completed her family through permanent care. Maria also practises EMDR, the subject of discussion today. Welcome Maria.
01:09 Would you like to introduce yourself also Maria?
Hi everyone! As Sonia said, I’m Maria.
I am a parent to three very wonderful children and our youngest joined our family through permanent care.
I work as a psychologist in rural Victoria.
I initially became interested in psychology as I was working in the disability and out of home care sector as a support worker while studying to be a naturopath.
And I loved working with children and adults who were experiencing behaviours of concern or what is commonly known as behavioural issues.
I really enjoyed trying to understand where the behaviours came from, what to do about them, how to support the individual in those situations and how to support their support people. Which led me to wanting to work as a behavioural specialist, so I started studying psychology. Along the way I realised that developmental trauma and childhood adversity played a large role in people’s behaviours and, my partner and had I always wanted to do foster care and started going down that track. But after a consultation with a foster worker, she suggested permanent care sounded more suitable for us. So I started trying to learn as mu has I could about developmental trauma.
And here I am today.
And, as Sonia said, I am here to talk about EMDR. I should also say that, although I am a massive fan of EMDR, I have only been practising EMDR for a year so am very new to this. I will do my best to represent EMDR as accurately as possible but apologies if I don’t convey things perfectly.
03:12 What is EMDR?
EMDR stands for Eye Movement Desensitization and Reprocessing, and it’s a therapy that is best known for supporting children and adults to recover from trauma. Trauma can take many forms, physical, sexual, or verbal abuse, neglect, bullying, racism, homophobia, war, natural disasters and so on.
The theory behind EMDR is that sometimes the brain experiences something so traumatic that it overwhelms our brains capacity to cope which doesn’t allow our brain to process what’s happened and so this memory gets stuck in our emotional brain. These unprocessed memories are understood to contain the emotions, thoughts, beliefs and physical sensations that occurred at the time of the event. When the memories are triggered these stored disturbing elements are experienced and cause the symptoms of PTSD and/or other disorders. EMDR therapy focuses directly on the memory, and is intended to change the way that the memory is stored in the brain, thus reducing and eliminating the problematic symptoms.
But, if it’s ok, I am going to give you the explanation that I give to children, which goes a little bit more into brain functioning.
04:30 How the Triune Brain Works
Our brains are divided into 3 parts; the human brain, the dog brain and the Dino brain.
At any one time, only one of these guys is in charge. If the human brain is in charge, the dog and Dino brain are also on board. But, when the dog brain takes over, the human brain shuts down. And when the Dino brain takes over, the human and the dog brain are out of action.
The human brain is unique to humans. No other animal in the world has this part of the brain. So anything that you can do that your dog can’t do, is because of this part of the brain. It lets you think things through, use language, be rational, make good decisions, be motivated, use your imagination, problem solve, to be able to tell the time as in am I here right now or is it five years ago and also take in and learn information. So being in the human brain is essential for learning in the classroom.
So if your human brain is offline, you cannot do any of these things, no matter how much you want to!
Then we have the dog brain; this is where our emotions live, it’s our fear centre, and also the home of our memories. Now a very important job of the dog brain is to look around the environment and identify anything that is dangerous. Some dangers are really obvious, like a lion chasing you. But some dangerous are less obvious, but perceived as equally as dangerous to our brain like feeling socially accepted, like we belong.
And this process gets extra complicated because, when we are in a dangerous situation, like if someone is yelling at us, we could encode that person as dangerous. But we could also encode characteristics of that person as dangerous, like if that person has a moustache, we might encode moustaches as dangerous, or their tone of their voice as dangerous or a phrase or words that they repeat to us or we can even encode things in that environment as dangerous like if it’s raining, then rain becomes dangerous, if there’s the smell of vanilla, then that smell becomes dangerous and so on.
So we have all these things that are encoded in our brain as dangerous. And, if you are a child that have experienced trauma, you will have many, varied things encoded and you wont even know what these are. So you can be baking in the kitchen with your parent or carer, they pull out some vanilla to put into the cake, and your are in full fear mode and suddenly your are hitting or crying or running away or have a terrible feeling in your belly and you don’t know why.
07:14 Trauma and Narratives
The other really important thing that happens in this part of our brain is that we all have a narrative of ourselves, the world and other people. These narratives or stories are really important because they help us make sense of our entire world.
If you have a loving, positive environment, with safe and responsive care givers, your narrative/story will be I am a good person, people can be trusted, the world is a safe place. However, if your carers aren’t responsive and your environment isn’t safe, you will develop different narratives. As children we are programmed to think of our care givers as good and safe; it’s too dangerous for our brains to even contemplate that they are anything but safe and so, if our care givers are good and safe but they are yelling at us, then it must be our fault. So, if my parents hit me it’s because I am bad. If I don’t get attention it’s because I am unlovable. If I am bullied in the school yard, it’s because I don’t belong anywhere.
These narratives, are like a pair of glasses that you put on and you cannot take off. If you had glasses with blue glass in them. The whole world would be blue. There are thousands of other colours around you, but you can see them because of your blue glass. So, if you have a narrative of ‘I am a bad kid’ this is how you will interpret every interaction, how you will interpret the world. Your parent sighs and says ‘mate, where are your shoes?’ and you hear ‘you are a bad kid that never gets anything right’.
And now, our dog brain yells ‘Danger!’ and releases a stress hormone called cortisol putting our Dino brain is in charge.
The Dino brain has no interest in good decision making, preserving relationships, following rules, doing the right thing. The Dino brain has one job, to keep you safe. And it does this in 3 main ways; Fight, Flight and Freeze. Sometimes people add Fawn to that list. And there is another, more primitive part of the brain that has a function called faint; which is the part responsible for disassociation but I think that’s a whole other discussion so, for the purpose of this talk, we are sticking to fight, flight and freeze.
When you are in your dino brain; you cannot talk about things, you cannot rationalise, you cannot reason, you cannot think about ‘how do I keep my parents or carers happy’ you can fight, flight and freeze. Fight; is yelling, screaming, hitting, breaking things, kicking people and objects, telling your family you hate them and so forth. Flight; running away; hiding under your bed, moving out, putting yourself under a table in the class room. And freeze, you literally are frozen on the spot. No words, your body’s not moving. You can’t do anything.
This state is a hyper state; your heart beat is racing, your breathing is fast, there’s adrenaline coursing through you, your hands are sweaty, those thoughts of ‘You’re in danger! You’re in danger!’ Are going at a million miles per hour! You might feel queasy and sleeping is impossible.
So right now, in this state. Your child might start yelling at you. Which can trigger your stress response and so, you are both effectively dinosaurs. And dinosaurs cannot reason. Be rational. Be reasonable. Or make good decisions. It’s impossible! Reminding your child that they are making bad choices, that this is unacceptable behaviour, it heightens their fear response so their behaviour gets worse and you get more distressed. And it ends in disaster.
So, just a quick deviation from EMDR, when your child is in the dino brain. Or you are in the dino brain. You need to get back to your human brain before you can do anything else. Remember that golden rule ‘Connection before redirection’.
Play their favourite song and start dancing. Offer them a hug. Bring out some playdough and put some out for your child. Put on a chicken hat and pretend you’re a chicken. Yell ‘lets be robots’. Give them time to get their human brain back online and then talk about what happened.
13:00 EMDR and Memories
Getting back to the EMDR, we work on the memories that led to those lenses developing., which at the time served a function to keep us safe and understand the world but are now constantly switched on or triggered and impact on how we operate in the world and impact on our relationships and people that are actually safe.
We find the memories, we find the thoughts they have developed about themselves, the world and other people, we process them using something called bi lateral stimulation which traditionally was the client following the practitioners hand movement with their eyes but we now know that there are lots of other ways we can do this and this allows the memory to move from the dog brain to the human brain, and engaging the eyes (in this example) which is in the human brain, both at the same time thus moving it from one to the other. Don’t get me wrong, the memory is never going to be good, or positive. But it no longer has this massive sting every time the child thinks of it. The child can apply logic, rationality, language to it. Can see that this isn’t their fault of their doing.
13:56 Is EMDR therapy safe for children? Yes its Medicare approved!
16:07 What situations would you treat with EMDR or FLASH and how do they contrast with or complement other therapies?
I think it is really important to note, that at least for myself as a prac, I don’t see EMDR as a replacement for other therapies, I see it as a wonderful addition. I don’t use EMDR instead of CBT or emotional regulation, or skills teaching, I use it alongside these.
So I still work with children to teach ideas like how our thoughts influence our feelings and how these in turn effect our behaviours. Why and how certain situations can be triggering for us. What to do when we are triggered. Fun ways to self-regulate. How to communicate your needs more effectively. What are emotions and why do we even have them and so forth.
The evidence base for EMDR is definitely strongest for PTSD and trauma, but there is also research to support it’s efficacy in a number of other areas. It can be used for
Anxiety, panic attacks, and phobias
Chronic Illness and medical issues
Depression and bipolar disorders
Dissociative disorders
Eating disorders
Grief and loss
Pain
Performance anxiety
Personality disorders
17:36 How do you work out which areas to target first with EMDR therapy?
The process starts with one or two intake sessions with the parents or carers to get a good history of the child as well as learning wonderful things about them; their likes, dislikes, passions, things they’re great at, things they struggle with, as so forth.
When you are going through these sessions, you are listening and identify moments or behaviours that sounds significant and, I am normally trying to formulate or think about how this may have influenced the child’s development or thinking or how it may be influencing some of the behaviours we are seeing. You’re forming a little bit of a timeline or a map of events that occurred and themes or thinking that could have developed as a result.
The next few sessions I normally have with the child; some children like to have their safe person in the initial sessions, but I do find that many kids are hesitant to share those underlying beliefs they have about themselves, the world or other people. I think this is because they don’t want to upset their parents or carers but also because they think that if they share these negative self-beliefs that their carers might reject them.
In these sessions we play games, do drawing, some kids just want to talk. I always explain how the brain works and try to start working on self-regulation techniques.
And it’s my job to elicit some of these belief systems during our time together.
I think my most effective tool for eliciting how children may have interpreted an event and what beliefs they formed around this is saying something to the child like ‘you know, sometimes I work with kids that have been through some really hard things, like you have. And, this might not be right for you at all, but they tell that, when they think about that event they think ‘I must be a really bad kid for that to have happened to me’. Do you ever have any thoughts like that?’ And kids that relate to that will often look at me like with a startled look and will nod and might say ‘yeah, I get that or I did feel like that’. And other times kids will say ‘nah, that’s completely wrong- this is what I think’.
And then I go back to the explanation of that, when you went through this event, it was like putting on those glasses. So now you might find yourself often seeing the world through this lens. Like, you drop something and, even though your parents or carers tell you its ok, its just an accident, your brain is telling you that you are a bad kid. And the problem with being a bad kid is that you might then feel really scared that you parent or carer will reject you or might not love you. Especially when they find out this secret about you.
We also have some measures that we use in emdr;
20:19 What if the cause of the issue is developmental trauma, that is not a recognised memory?
There is a fantastic book called the body keeps the score which talks about trauma being stored within us on a cellular level. So you might now be able to recall an event, as in bring it to mind, but your body remembers. Rats who are exposed to a random electric shock in the first few days of their lives will still have a trauma response when put back into the same environment, even thought they failed to show any recognition of the environment.
23:35 How does the therapy build skills?
The second stage of EMDR is called the preparation stage.
Here we work on learning skills for self-regulation, ways to ground, try to identify strategies that might wok for this particular child.
My favourite activity it the calm place; where you create a place- real or imaged- where you feel calm
We read books that normalise emotions. And talk about how we might apply the strategies that we just read about.
I have some wonderful games that I purchased on this great platform called teachers pay teachers that help kids practise skills in a really great way.
We make posters so kids and families can easily remember the techniques and bring them to mind.
We practise the techniques together.
Make rewards charts for using said techniques.
Create self regulation tool kits.
A massive part of this process is also psychoeducation and normalising experiences. This is how your brain works. This is why you might be behaving this way. Yeah, heaps of people feel just like you do in these situations.
Here is an explanation of why we practise these strategies. Here’s what they do on a brain-based level.
26:15 I understand the therapy incorporates teaching of emotions or how to respond to emotionally charged situations. Can you tell us a little more about that?
I think lots of people, children and adults alike, feel a lot of shame around emotions, especially the ones that are often referred to as negative or bad emotions. Kids and adults will have often heard messages about their emotions ‘stop being angry’ ‘you have nothing to be sad about’ ‘there’s no reason for you to feel like that’. And children with a trauma background may have also learnt to disassociate from the sensation in their bodies and brains as these were just too painful.
So teaching children things like; this is what joy, anger feels like; this is
And these emotions, they are good, they are all healthy, they are all really important.
So we read books, we talk about their content, practise the strategies, we do drawing of emotions for kids who find words hard (definitely works best if you do this with them, including at home), we have some simple charts or posters that kids use for check ins. Parents and carers are asked to normalise what they think and feel; so coming home and saying ‘wow, I had a really tough day at work, I felt really frustrated when the photocopier didn’t work. I could feel my face getting hot and my tummy making me feel spewy. So I knew there was some anger brewing there to. So I went to the kitchen, and I made a cup of tea, and then I looked at the family photos from our last holiday. Then I felt my anger dissipating. And I asked Sally for some help with the photocopier because she’s good at fixing it. Did you have any big emotions today?’
And I really like teaching the idea that emotions and behaviours are different. So, I can feel really angry, and that can be a really healthy, safe choice. But I need to learn skills that help me deal with my anger in a way that keeps everybody, including myself safe. And then the very important lesson that even though sometimes parents and carers do get frustrated with our behaviours. That doesn’t stop them from loving us. They love us all the time. Even when our anger is very, very big.
32:03 Asking questions like "Would I still love you if you did this....?"
I used to read this fantastic book with my son called ‘I love you stinky face’ and its about a little boy asking his mum ‘would you still love me if…. And he comes up with all these crazy scenarios like, if I was a swamp monster and made you slimy and so forth’. And at the end of the book, I would ask him, when are times that I don’t love you? And he had so many scenarios; and simple scenarios too; if I break something, if I yell at you, if I can't find my shoes…. He’d say something like ‘nobody loves little boys who break things’
And I would respond with ‘im sorry that you feel like that, that is so tough but, from my end, you could break everything I own and I would still love every bit of you. You would have to clean it up and do jobs to help me replace them. But my love would not change one bit’.
And responding to emotionally charged situations; we come back to the golden rule; connection before redirection. Offer to make a drink together and talk about the ingredients, start re-enacting a scene from their favourite movie; purchase the 52 break cards and follow their ideas; dress up and dance, suggest splashing cold water on your faces, blow bubbles, get out some birthday candles and see how many they can blow out at once, ask them to imagine that they are in rocket ship, blasting off into a distant, wonderful planted. Get them to describe what they see when they land. Pat the dog together. Remember that you are trying to engage and use the human part of the brain which will then be in control and not the dog brain.
And, then, once they are calm, ask them what was going on for you there? It looked like you had some pretty big feelings coming up.
35:12 Be curious, ask questions, pretend you are detectives who need to solve the case of the anger. And, as the parent, try to figure out what was happening before hand and why it was happening? The idea that every behaviour is a communication; it happens for a reason. Like you are piecing a story together and trying to understand the characters motivation.
Workshop what to do next time this occurs. How do we problem solve this together? What can I do next time to help you feel safe?
A great thing to do when they are calm is to actually do things that evleate their heart rate in a positive way so that they can then regulate that down; the game pie face is my favourite for this. Having scare offs. Jumping on the trampoline or shooting some hoops.
38:04 Have you used this in families formed by kinship, adoption or permanent care? Perhaps you have some specific examples you could share with us of where this has had an impact in a child’s life?
Maria to respond
41:15 What is the frequency, intensity, severity, duration or otherwise of treatment?
EMDR is quite structured in how it is run and has 8 phases.
And different children might need different amounts of time in each phase but
I will just give a general overview:
Phase 1: History and Treatment Planning
2 sessions @ 1 hour each = 2 hours
Phase 2: Preparation
Working on skills for well being and self-regulation
Phase 3: Assessment
Phase 4: Desensitization
3 sessions per memory @ 2 hours each
Phase 5: Installation
Strengthen the positive belief that the person has identified to replace his original negative belief using the Validity of Cognition (VOC) scale.
Phase 6: Body scan
Incorporated into Desensitization and installation phase
Phase 7: Closure
Incorporated into Desensitization and installation phase
Phase 8: Re-evaluation
Incorporated into Desensitization and installation phase
44:16 Does EMDR involve parent or carers also or how do you include them in the process?
Absolutely.
The work we do in these sessions can only be successful if the child is going home to a safe, attentive, responsive environment. If parents and carers know how to regulate the child when they are distressed. If they know their triggers and can speak to those. If they can model and normalise emotions.
The child must be getting their core needs met;
Secure attachments to others (safety, stability, nurturance, acceptance)
Autonomy, competence & a sense of identity
Freedom to express valid needs and emotions
Spontaneity and play
Realistic limits & self control
And kids need a supportive home and school environment that can meet those needs. Joining clubs or activities that will give kids a sense of belonging.
Putting in places structure, routine, predictability. I am giant fan of routine tick sheets- you have a picture of what needs to get done and it has a box that you tick once it’s done- And I recommend and use these for every process of the day so the child can know exactly what to do, what order to do it in, what’s expected of them and then linking that in with a reward.
Right, so we get our morning routine done by this time and then we have time to do this fun thing together. Or, if there is no time in the morning, if you get all the ticks for the day, we do something really special together after dinner. And for most kids, really special is playing a board game together or drawing something together.
Writing these with the child so that they have ownership over it.
Writing down family rules and expectations and getting the whole family involved in that. Asking everyone what is important to them as a family. What makes them feel special, safe, important? And putting that up somewhere in the house to remind everyone of good behaviour.
It’s essential for parents to model the behaviours they want their children to adopt and, like I said earlier, when they feel distressed calling it out and telling the child what they will use to calm down. If you make a mistake, then own it, apologise, you are teaching them skills by modelling.
Using reward systems; formal and informal; So often we want kids to do things simply because we have told them to but kids might not see any inherent value in what we have asked them to do. Max have a shower, might be met with lots of resistance but Max, while your having a shower, I am going to set up our favourite board game so that we can play once your done. Do you want me to put the water on for you?
Practise techniques like meditation, calming strategies, self-regulation together when the child is not distressed so that, when they are distressed, this skill is second nature to them. My rule of thumb is that if you have practised a self-regulation technique 500 times when you are calm, you will then be able to use it effectively when you are actually stressed. Having posters around the house to remind us all to use these techniques or coming up with a list of techniques that your child loves so that every one is on board and knows how to help this child regulate.
So, part of seeing a therapist is for all of us to learn those skills together.
Sometimes this involves trial and error. We must find a technique that are right for you and your child. And what one child loves, another will hate. I have been working with this wonderful child for a fair few months now and we practise emotional regulation through an exercise that I really love called calm place; and I always say to kids its fine if you don’t like this, we can try something different but this child didn’t voice that so, about six months in, this child has admitted that they absolutely can’t stand this exercise and doing it makes them more stressed. So we workshopped other idea and came up with listening to audio books and practising martial arts.
Maria to respond (exercises for parents, an environment that supports the neurological age of the child – may be that the school needs education or a move of schools if child’s needs can’t be met)
Thankyou so much.
For anyone else who's making the time to listen to this podcast thank you for giving up your valuable time too if you're a permanent care adoptive or kinship family needing support please contact permanent care and adoptive families on 9020-1833 until next time have an amazing week
Marias Email : maria@modernmedicine.com.au
Bessel Van Der Kolk The Body keeps the Score
Book - How do I feel by Rebekah Lipp
The Human Dog and the Dino Brain
Managing Big Emotions by Maria Marshall
