Emotional Avoidance is a very common symptom in clients with a history trauma. It's important to know that at one time, the avoidance was actually quite helpful. A client may have learned to avoid as a way to contain very intense emotional disturbances. This is very true in cases of complex childhood trauma, in which clients may have experienced emotional neglect.
What is emotional neglect?
Emotional neglect is when an individual's emotions and reactions to an experience are either ignored or invalidated. In my work as a trauma therapist, emotional invalidation has been one of the most significant forms of complex trauma. A client basically learns from childhood that their emotions either: a) do not matter, b) are not something to be tolerated, c) "there's something wrong with me for having emotions."
In EMDR therapy, I often find that clients with an NC (negative cognition) of "I cannot handle it" or "I'm not good enough" typically have histories of emotional invalidation. They learned from a young age that emotions were not meant to be tolerated. Instead, they contained or compartmentalized these emotions as a way to survive.
But the old saying always goes, "feeling buried alive never die". Those emotions have to be released somehow. Avoidance can breed anxiety and depression. The more we avoid something, the more we are telling our brains, "Stay away, that's dangerous!". Avoiding emotions consistently sends the message to our minds that emotions are a threat.
This is a problem because if we constantly avoid, we're going to always feel triggered whenever we inevitably have an emotional reaction to something. Human beings are not robots. While we mentally may be able to shut off our emotions, our body still needs to find a way to acknowledge it.
Signs of Emotional Avoidance
The following of signs of possible emotional avoidance. Often times, a client may be fully aware of the tendency to avoid emotions, but may feel stuck in being able to work through that. Other signs may include:
Difficulty managing anger
Chronic Physical Pain with no medical explanation
Behavioral reenactments of trauma (fight/flight/etc.)
How to Target Avoidance in EMDR Therapy
It's important in therapy sessions, for the therapist to bring to the client's attention the tendency to avoid. This helps to bring an awareness of the client's own urge to avoid and can facilitate a conversation about emotions in general. One of my favorite questions to ask clients is, "What is your perception of emotions?" That may start a conversation about emotions being safe, not useful, etc. In which case, my follow up question is usually, "Where did you learn that?" This helps give a more comprehensive history of possible emotional neglect.
Be careful not to challenge the avoidance. In trauma therapy, we often say "join the resistance." We want to honor the part of the client that learned to avoid as a way to survive abandonment and rejection.
The Avoidance Approach
The following approach should always be used with caution. It's a combination of Jim Knipe's Level of Urge Method (EMDR Toolbox, 2019) & Katie O'Shea's Affect Resetting Procedure (EMDR Solutions II, Robin Shapiro, 2009) and based on the structural dissociation model.
Always determine your client's readiness for using bilateral stimulation (BLS) and ability to maintain dual awareness.
Assessing for affect regulation and dissociation are usually good indicators for determining readiness.
The goal is to have the client work through maladaptively stored information that is perseverating the avoidance. Have a client target an emotion that they want to avoid, such as sadness and come up with an image that represents the emotion) Then, ask the client the Level of Urge to avoid this emotion (scale of 0-10, 10 being the highest urge to avoid.) Proceed with BLS, medium speed, always monitoring for affect change. You can proceed with standard interventions of checking for the LoU when there is positive material beginning to come up. Continue until the LoU decreases.
The ultimate goal of this approach based on the AIP model. We're trying to help clients process stressful information (memories) that are inhibiting integration. The end result is that a client knows it is safe to feel. You can then proceed to work fully on a traumatic memory, using the standard protocol, without the avoidance getting in the way.
About the Author
Dana Carretta-Stein is a Licensed Mental Health Counselor and founder of Peaceful Living Mental Health Counseling, PLLC, and Carretta Consulting in Scarsdale, NY. She specializes in clinical psychotherapy to treat children, adolescents and adults with anxiety, behavior and trauma difficulties.
She is a certified EMDR therapist, consultant in training, and Regional Coordinator of the Westchester EMDR Regional Network.
For more information, visit dana.carretta.com
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