EMDR Complex PTSD & Dissociative Disorders 3 — Questions and Answers
Question 1: In EMDR treatment of Dissociative Identity Disorder (DID), the recommended order of treatment phases follows the ISSTD phased model. What is the PRIMARY focus of Phase 1 (Safety and Stabilization)?
- Processing the earliest traumatic memory in each alter
- Fusion and integration of all identity states
- Building internal cooperation, safety, and affect regulation skills (Correct answer)
- Mapping the identity system and naming each part
Correct answer: Building internal cooperation, safety, and affect regulation skills
Phase 1 prioritizes internal communication, cooperation among parts, and stabilization skills before any trauma processing begins, as premature processing can destabilize the system.
Question 2: A client with CPTSD becomes suddenly silent, appears glassy-eyed, and stops responding mid-session. The EMDR therapist suspects a dissociative episode. Which intervention is MOST appropriate?
- Continue BLS and say 'go with that'
- Increase stimulation speed to re-engage attention
- Use grounding techniques such as the 4-5-4 breathing or asking orientation questions (Correct answer)
- Immediately end the session and refer to psychiatry
Correct answer: Use grounding techniques such as the 4-5-4 breathing or asking orientation questions
Grounding techniques help bring a dissociating client back to present reality; naming the room, touching a chair, or paced breathing re-establishes present-moment awareness.
Question 3: Which term describes the EMDR phenomenon where a client's SUD level does not decrease despite multiple sets of BLS, often seen in complex trauma cases?
- Cognitive interweave resistance
- Blocked processing or looping (Correct answer)
- Floatback stagnation
- Secondary traumatization lock
Correct answer: Blocked processing or looping
Blocked processing (or looping) occurs when SUD remains static or the client returns repeatedly to the same material, requiring a cognitive interweave or modified approach.
Question 4: The 'theory of structural dissociation' posits that dissociation arises from failure to integrate traumatic experiences. Which two theorists are most closely associated with developing this model?
- Francine Shapiro and Bessel van der Kolk
- Onno van der Hart and Ellert Nijenhuis (Correct answer)
- Colin Ross and Frank Putnam
- Richard Kluft and Judith Herman
Correct answer: Onno van der Hart and Ellert Nijenhuis
Onno van der Hart and Ellert Nijenhuis (along with Kathy Steele) developed the Theory of Structural Dissociation of the Personality, foundational to understanding complex trauma.
Question 5: In EMDR with complex trauma clients, 'parts-informed EMDR' typically involves which additional step before targeting a traumatic memory?
- Obtaining permission or cooperation from relevant parts before processing (Correct answer)
- Eliminating all dissociative parts through hypnotherapy first
- Selecting only the most dominant ego state to process
- Bypassing phase 2 to maintain treatment momentum
Correct answer: Obtaining permission or cooperation from relevant parts before processing
Parts-informed EMDR requires checking in with relevant internal parts and gaining their cooperation before processing, to prevent sabotage or destabilization during BLS.
Question 6: Which of the following trauma types is most likely to result in Complex PTSD rather than standard PTSD?
- A single-incident motor vehicle accident in adulthood
- Childhood emotional neglect spanning many years by a primary caregiver (Correct answer)
- A one-time assault witnessed by an adult bystander
- A natural disaster affecting a community for one week
Correct answer: Childhood emotional neglect spanning many years by a primary caregiver
Complex PTSD arises from prolonged, repeated trauma — especially involving captivity or dependency, such as chronic childhood abuse or neglect by caregivers.
Question 7: The 'Affect Bridge' technique in EMDR is particularly useful with complex trauma clients for which purpose?
- Reducing hyperarousal before BLS begins
- Connecting a current emotional reaction to earlier formative traumatic memories (Correct answer)
- Installing positive cognitions across all parts of the personality
- Measuring SUD levels at the start of each processing session
Correct answer: Connecting a current emotional reaction to earlier formative traumatic memories
The Affect Bridge follows an emotion felt in the present back to earlier memories where the same feeling originated, helping identify foundational trauma targets in complex cases.
EMDR Complex PTSD & Dissociative Disorders 3
In EMDR treatment of Dissociative Identity Disorder (DID), the recommended order of treatment phases follows the ISSTD phased model.
What is the PRIMARY focus of Phase 1 (Safety and Stabilization)?