Mindfulness, EMDR therapy, and Telehealth: Lessons from the MET(T)A Protocol (Part One)

Welcome to my new blog series specific to the evolving pandemic and the as of yet unknown comet tail that follows.

My first thought is to thank all of my fellow mindfulness practitioners and teachers who are sharing their knowledge and practice online, as well as all those in the EMDR community who are rising to the occasion and sharing their wisdom in order to help therapists and clients deal with this unprecedented situation.

In my studies in the University of Pennsylvania Master of Health Care Innovation program, I am in the thick of the study of Behavioral Economics and about to start a lab class where I can work on my own innovations in collaboration with incredible colleagues from across the healthcare spectrum. We are learning about and brainstorming on the subject of Choice Architecture. This is where we help people to make healthier choices through the use of default choices, opt in versus opt out, loss aversion, and several other theories, principles and actions. The Choice Architect works on designing and implementing these mechanisms.

At this time we are at the mercy of an interim Lead Choice Architect: the COVID-19 pandemic. Mental health practitioners have been thrust headlong into Telehealth, a territory where some may have already begun their journey. Others have not. Regardless, for now, it is the new normal.

EMDR therapy (and a number of other trauma therapy modalities) have been amongst the most reticent to consider telehealth, and with very understandable arguments. Working directly on traumatic memories with a client who is not in the same room as you, from a safety perspective as well as related to the more complex and nuanced realities of the relational element of therapy, is a daunting prospect for many.

In full self-disclosure, I am actually one of those therapists who has long had the luxury of delaying the reprocessing phases of EMDR therapy while using telehealth. That was up until the last couple of weeks. The Interim Lead Choice Architect has fast tracked my/our journey.

That being said, I realized over the last number of days of transition to shelter-at-home that I have a number of resources to share.

I have a long history of utilizing technology to run my business, to provide coaching, and to provide therapy. I have had the opportunity to deeply investigate the role of mindfulness (something that can be delivered quite readily over telehealth) in EMDR therapy, particularly with my colleague and coauthor Dr. Jamie Marich. I have a long standing experience providing mindfulness practice to others over distance learning platforms. I have been an online learner and instructor myself since 2005, and a non-traditional learner and instructor since 1988.

For the last three years I have been the Head of HealthCare Innovation and Partnerships for DropLabs, where we have developed technology that is already being researched and implemented toward a number of health and wellness applications, including the delivery of EMDR therapy over telehealth.

Most importantly though in relation to this blog, over the last five years my team has developed and implemented the MET(T)A Protocol (Mindfulness and EMDR Treatment Template for Agencies). In approaching EMDR therapy as a complete psychotherapy, where we apply mindfulness, the 8 phase protocol and the AIP model to systems like addiction treatment centers, mental health agencies, hospitals, and wellness centers, we have been able to treat trauma more comprehensively. I believe that these same systems and the lessons learned so far will help us overcome some of what we consider to be the down sides to the remote application of EMDR therapy.

I look forward to sharing with you in this blog, in workshops and elsewhere that EMDR therapy using telehealth becomes easier to accomplish when mindfulness is in place and Buddhist psychology provides a foundation; when Janet’s three stage model of trauma treatment is honored; when the 8 phase Standard Protocol is our basic structure for practice of EMDR; when the Adaptive Information Processing model provides the guideposts; when cases are conceptualized through these models, principles and practices; and when modifications are made for telehealth primarily in the realm of safety, resource building, stabilization, preparation, choice of bilateral stimulation, and case conceptualization.

With all these in place the choice of platform and other technology becomes more of a simple logistical shift than an item of hyperfocus, or as a reason to panic and believe we need to change everything we have learned up until now. Modifications and innovation have already been in progress, and others will be made manifest. However, we do not have to reinvent the proverbial wheel.

Most of all, I look forward to our continued collaboration to find ways to ease suffering in this world. We all share the suffering of the human condition - these days, that is much more evident. And if anyone didn’t know for sure that our treatments need to move from trauma informed to trauma focused, I suggest to you - we know now.

Those of us in the mental health and wellness professions are in this for the long haul. We can make this transition safely and effectively. And we can do it right now, working together.

Stay safe everyone.
- Dr. Steve

C4 Webinar: Beyond Trauma-Informed Care: The MET(T)A Protocol

While the mental health treatment field has come a long way in acknowledging the role of trauma in presenting disorders by providing trauma sensitive and trauma-informed care, research indicates the need for a more actionable approach, with adaptive resolution of maladaptively stored trauma and adverse life events serving as the main goal of treatment. I presented a webinar titled Beyond Trauma-Informed Care: The MET(T)A Protocol, hosted by C4, to demonstrate this approach, which includes how to shift the treatment paradigm from trauma-informed care to trauma-focused care. This webinar demonstrates how the implementation of EMDR therapy as a complete system of healing and primary psychotherapy, the application of mindfulness as a key component throughout the treatment cycle, and the guiding structures of Buddhist psychology, Pierre Janet’s Three Stages of Trauma Treatment, and Dr. Francine Shapiro all provide the framework to apply trauma-focused programming as the main pathway and goal of treatment.

You can watch above, or click through to stream.

Mindworks Blog - The Psychology of Addiction

It is my conviction that we don’t become addicted because we’re stupid or “less than”; we become addicted because we want to survive. My talk on the Psychology of Addiction presented by Mindworks explores this concept and more. Please check out my blog post HERE.

Mind Trainer on Mindworks

I was honored to be asked by the creators of Mindworks to add some helpful content to their App. Mindworks is a non-profit created by some amazing meditators – check them out here. And please join me on the App for my talks The Psychology of Addiction and Insight is the Answer to Addiction.

ATS Podcast - Pizza Is Eternal

My talk may have not been so much about pizza and the eternal as it was about feeding ourselves through applying the 8 fold path in our lives and the impermanent nature of things, but pizza and the eternal were certainly part of how I made my point. The dharma was taught to me over the years as containing all things, and all things can be our teachers. Always glad to have the opportunity to sit with the Against The Stream sangha and to share some of that dharma.

Click through to download or listen.

Rebel Saints Meditation Society Podcast: The Dharma of Adversity

Last August I conducted a half day retreat at Seattle's own Rebel Saints Meditation Society. The talks were recorded and three of them are available on their website, iTunes and GooglePlay. It was the first retreat where I began talking about that which I now seem to land on consistently, the availability of practice in every moment, in every situation, in every thought, every feeling state. Reading the biography of Dipa Ma profoundly touched me, and linked in with my years of Zen training to remind me in the deepest of ways that this practice is not just about sitting on a cushion. This is a way of life. And so, in the face of adversity, in the face of dukkha, in the face of nibbana, we practice. 

Dr. Steve Returns to the "WTF with Marc Maron" Podcast!

Its been a few years since we talked with microphones on, but Marc Maron and I have never stopped talking to each other. Recently, we spent some time actually practicing mindfulness and working on his trauma, and then we sat down to have a conversation for a new episode of WTF. We talked about my new book, EMDR Therapy and Mindfulness for Trauma-Focused Care, trauma, recovery, Buddhism, the new world order and everything in between. I really enjoy talking with Marc in general, but with microphones on is a special treat for me. So glad to share some of the dharma, some of the trauma resolution and some of the ongoing banter that has been my life with Marc...

ATS Podcast - The Koan of the Wind and the Flag and a Lost Dharma Talk Revealed

Back in August I gave a talk at Against the Stream that just came out on the ATS podcast. I utilized the koan of the Wind and the Flag to establish a foundation for practice, and then went to my notes from my unrecorded November 9, 2016 talk to see what was still in play since then. I was being honest when I said that I don't remember much of that Wednesday talk after the discombobulating events of the night before... so the talk was finally given in the context of time having passed, and in the context of - is it the wind, is it the flag, or is it your mind that is moving. As the world continues to stay volatile, it seems that practice becomes more and more crucial every day if we are to end or transform suffering at all. Hope maybe this talk helps ease some suffering...

Click through for a listen...

Recap: The Dharma of Adverse Life Events Retreat at the Vajra in Seattle

It took me a minute, but here are a few words about the wonderful half day retreat I led at The Vajra on Tenth in Seattle at the end of August after the EMDRIA Conference. I say wonderful not to give myself a pat on the back, but because 25 practitioners stayed indoors on what might have been one of the last sunny days of a Pacific Northwest summer to sit, walk, listen and look within.

We focused together on the Dharma of Adverse Life Events, borrowing from the language of trauma therapy to describe all of those below-the-threshold of trauma instances and beliefs in our lives that can drive us to unskillful intention and action. A different option proposed on our retreat was to deeply investigate the nature of these events and beliefs and see their emptiness, allowing us to utilize that wisdom to set new intentions for our thinking, our speech, our day to day lives. "Right now it's like this" becomes the mantra, and from that acknowledgement, new potential unfolds.

Rachel and the rest of the sangha are doing a superb job of building a dharma community for their area. Many of the ATS teachers are coming through town, and there is a great energy and excitement about practice. I look forward to getting back up there sooner than later to spend more time with my Seattle spiritual friends...

ATS Podcast: Dharma Practice is Available in Every Moment

I have a new talk up on the Against the Stream podcast. I took the opportunity to look at all the opportunities we have for Dharma practice. Dipa Ma, a wonderful teacher from the Insight lineage, instructed that there is not one moment where practice is not possible. I am doing blog writing practice right now. I just concluded my listening to the Erev Rosh Hashanah service from ourjewishcommunity.org practice. I will soon move into my getting my daughter ready for school practice. In the midst of it all, I will do my formal sitting practice.

Mindfulness and concentration are engaged through setting of intention and then effort. Over and over again, we can reset that intention, and from a wise place, know what effort is called for at this moment. In these turbulent times, our effort to cultivate mindfulness and the lovingkindness and compassion that it engenders seems less like a choice and more like an absolute necessity. In that spirit, I set my intention this morning. And now, breakfast practice...

MET(T)A Method training for Orange County Therapists: The County Series on Topics in Spirituality and Therapy

I had the opportunity to present the MET(T)A Method to a group of over 80 therapists who work for Orange County. I was presenting at the invitation of the Therapy and Spirituality Committee that allows the County to invite a variety of speakers on subjects related to spiritual interventions. I was told that I was the first Buddhist, as well as the first mindfulness based presentation of the series.

My observation continues to be that there is quite the hunger, quite the thirst for this information. I mean this to include Buddhist based interventions like Refuge Recovery and the MET(T)A Method, and an integration with EMDR therapy with a focus on trauma resolution. My hope is that not only will people find their way to utilizing these modalities in their office, but also through MET(T)A will find ways to reimagine treatment centers and improve the delivery of services.

Some of the comments after the training reaffirmed my deep desire to find a way to bring MET(T)A Method to underserved communities. It may be that this type of structured approach could end up providing the best trauma treatment at a reduced cost and with an added benefit of having a long range plan for aftercare that is not just trauma informed, but trauma resolution focused. More and more theoreticians and practitioners are calling for this, and so why wait another minute?

I am looking forward to more opportunities to be of any assistance I can be to the therapists of Orange County, and my hope is to meet them again sooner than later. 

DOWNLOAD: Another DharmaPunxNYC night with Josh Korda

Josh and I have known each other a very long time... we have seen each other go through a number of iterations, and we have had many touchstone moments... playing as a rhythm section, our entries into recovery, officiating at his wedding 16 years ago, our individual journeys into the Dharma. I am liking this now yearly co-teaching at Dharma Punx NYC, so much so that maybe we will make it even more often... this time we address trauma from the Dharma perspective... I am loving that both our books are coming out in the same month, November 2017... his first book entitled Unsubscribe that I am in the middle of reading and loving it, and then my book with Jamie Marich, EMDR Therapy and Mindfulness for Trauma Focused Care... our long and winding road together continues...

Click here for a listen through download.

en route to present at EMDR Canada...

My goal was to write this post before my trip to Canada, so I am going to say that I made my deadline as I am still in US territory as I fly toward Calgary... there has been more progress in the use of the MET(T)A Method at Refuge Recovery Centers, and the list of those clinicians and treatment centers who are interested in the model continues to grow. The initial response to my new book (coauthored by Jamie Marich) has made it more clear that this is the right direction to take EMDR therapy on its own, but also emboldens our efforts at the Center to provide an improved addiction treatment experience to clients, as well as to staff.

When I present on Sunday, I will be highlighting some of the case examples from Refuge, and not just case examples of clients but also examples of the effect on therapists who are trained in this therapy and who work on a team using this method. So far I have not had any pushback or lost any clinicians due to our using this method of treatment. In fact, as we have accessed so far trainees from Antioch and USC, with other colleges to follow including Pepperdine and Pacific Oaks, potential trainees are seeking us out because they hear what we are doing. Some are aware only of the Buddhist mindfulness aspect, others only of the EMDR therapy aspect, and others of the whole of the method. New cover letters and resumes of those who want to train with us come in every week. Those trainees who have signed on and worked with us have either learned and implemented new skills or deepened already developed skill sets. For instance, one of our therapists was a very experienced yoga teacher who had some mindfulness background related to yoga practice, and now has a dedicated Buddhist mindfulness practice and an ability to share that with clients. She also has become a very effective EMDR therapist, drawing on trauma education in school, and then ongoing training, consultation and supervision at Refuge.

And then there is the team aspect. The clinical team works very closely together using the language of EMDR therapy and trauma treatment as it relates to addictions. We come from the premise that all clients are receiving Phases One and Two of EMDR for certain, and we talk about how to support the client's continued trauma recovery journey. So far what we have noticed as a team is that this common language and set of goals makes us much more effective. One signpost of possible effectiveness is that a vast majority of our clients ask to stay longer in treatment than they originally signed on for. Therefore, they might have increased time in a contained and supportive environment to get to and through some of their trauma work while still in treatment.

I am looking forward to sharing this all with the conference attendees. And yes, I am looking forward to driving through a national park to get to the conference center in Banff...

We are starting our descent... I will have more to say from the conference and after the conference... Until then...

The MET(T)A Method - Updates for EMDR Canada

It has been about a year now since Noah Levine and Refuge Recovery Centers gave me the go ahead to begin implementing my vision for a new approach to addictions treatment, now known as the MET(T)A Method. My thought was that with our having already established Buddhist Mindfulness as the base and foundation of the program, that integrating EMDR Therapy as the front line clinical intervention would be a natural fit. At that time I also started working on my upcoming co-authored book with Dr. Jamie Marich on EMDR and Mindfulness for Trauma Focused Care, within which are many of the principles, theoretical underpinnings and practical activities embedded in the MET(T)A Method. Finally, through both meditative consideration and practice in the field, I noticed that a significant aspect of the method should be that we look at the work of the agency as a whole using the 8 Phase Protocol and Adaptive Information Processing Model (AIP) of EMDR therapy as the way to vision, frame, evaluate, plan and deliver treatment. I had the opportunity to present these ideas and some of what has been gleaned from our experience at the 2016 EMDRIA Conference in Minneapolis. Having had the opportunity to present again at the 2017 Evolution of Addiction Conference, and having been asked to do the same at the 2017 EMDR Canada Conference in Banff this April, I now have the opportunity to provide some updates as the model and method have progressed.

At Refuge Recovery Centers, we have since doubled the number of trained EMDR therapists on staff to 10 (11 if you include myself), and that includes our founder Noah Levine. Our staff psychiatrist had to postpone his Part 2 training for scheduling reasons, but the hope is that he will find his way into a Part 2 training and join the fully trained team. Our supervision meetings are now running fully through the prism of the 8 phase protocol and the AIP model, with cases being discussed from the point of view of where the client is in the 8 phases, what resourcing work is being done, whether they are ready for transition into reprocessing, and discharge planning that takes all of this information into account. Addiction specific protocols are discussed and utilized as necessary, as are interventions specific to the variety of comorbid Complex PTSD issues we see at the center, but our main focus is this focus on the possibility of trauma resolution as part of the treatment - regardless of whether it happens at the center, at a lower level of later care, or upon discharge. By acknowledging that not all clients can be prepared and stabilized to that level where reprocessing can begin, but that all clients can go through a profound building of resilience and become familiar with the language and practice of EMDR therapy, we become able to provide trauma focused care while being distinctly not cookie cutter.

The mindfulness that the clients are practicing is that described by the historical Buddha delivered through the Refuge Recovery program, where the 4 Noble Truths and the 8 fold path are distilled into an addictions treatment modality. These practices are helping clients to move into the painful experience of their addictive minds and habits and build distress tolerance while also finding ways to cultivate positive states such as loving kindness and self compassion.  Supported by Mindfulness Based Relapse Prevention, Trauma Informed Yoga, Attachment Theory Psychoeducation, and other trauma informed and trauma focused modalities, Buddhist psychology has proven to be a powerful central organizing methodology for addiction treatment.  When paired with EMDR therapy, it seems we have a new level of possibility of ending the cycle of addiction.  We do this by ending the cycle of untreated trauma while treating the addiction, at the speed that the client is able to tolerate. There is a great deal of hope being generated by this approach, and a lessening of suffering that is profound.

In my next blog post, I will share some of what our clinicians are saying about our work, as well as some of what our clients have to say. Until then...

EMDR Canada: Updating Mindfulness and EMDR Therapy for Addictions

I have had two wonderful opportunities thus far at the conference level (EMDRIA 2016 and The Evolution of Addiction Conference 2017) to present the MET(T)A Method, the integration of Buddhist Mindfulness and EMDR into an addiction treatment setting. My next conference appearance currently scheduled will be EMDR Canada, taking place this year in Banff. I will present on the final afternoon, Sunday, April 23 at 130pm. I am so excited for this opportunity to continue to share that which has become my passion, utilizing the 8 Phase Protocol and the Adaptive Information Processing Model of EMDR therapy as a design for addiction agency treatment. As I continue to train more therapists in the model, and as those therapists (and I) work on case studies and other qualitative research, my hope and excitement grows for the possibility of trauma resolution for those that suffer from addiction. In the same spirit of reflection and action that I applied in preparation for EMDRIA 2016 back in August, I will be blogging regarding my thinking about this work, the growing anecdotal reports and case study evidence, the progress on generating quantitative research, and any other thoughts and actions that grow from considering this upcoming presentation...

Dharma Talk on Against The Stream Podcast

Back in August I gave a Dharma talk at Against the Stream on the relationship between impermanence and emptiness, after we investigated the Second Foundation of Mindfulness, Mindfulness of Feeling Tone in a guided meditation. ATS just posted it as an episode of their podcast.... click to have a listen...

Evolution of Addiction Treatment Conference - Upcoming Presentation

"Mindfulness Informed EMDR Treatment: A Treatment Planning Template for
Recovery Services" will be the topic of my workshop at the Evolution of Addiction Treatment Conference in Los Angeles at the LAX Sheraton. The conference runs from Thursday February 2 through Sunday February 4.  My workshop is from 4-6pm on Saturday, and I hope to follow it up with a book signing for Clinical Dharma, and perhaps a dinner party with interested others hosted by Refuge Recovery Centers, but more will be revealed on this page and others... This workshop will bring to light the two most important projects of 2017 for me... the publishing on Springer Books of EMDR Therapy and Mindfulness for Trauma Focused Care, co-authored by myself and Dr. Jamie Marich. More specifically the workshop addresses the MET(T)A Method (Mindfulness and EMDR Treatment Template for Addictions), developed by me for Refuge Recovery Centers and now spreading beyond to other treatment centers. I am excited to have this platform at this particular conference to bring the message of trauma focused care a little further into the addictions world.

Worldwide Insight - Dharma Talk (download available)

Worldwide Insight is a on-line Dharma practice group that offers meditation instruction, teachings, and live Q&A on video.

I had the great opportunity to do a talk as part of their Healing and Wellness series. Should you be interested in signing up for a free membership, below is a link that points to the recording of the talk, where I focused on a number of subjects including Clinical Dharma, EMDR and Mindfulness and trauma treatment in general from the Dharma perspective....

https://www.worldwideinsight.org/recorded-classes-healing-insight/

RECAP: Birmingham, Alabama

What a wonderful trip to Birmingham, Alabama! Spent a half day talking to clinicians about EMDR and Mindfulness, Clinical Dharma and Refuge Recovery... then lead a mini-retreat complete with a Refuge Recovery meeting the next day! Big thanks to Steve and Pam Moore and their Addiction Research Foundation for their generosity and invitation... I look forward to being down there again sometime sooner than later... and thanks to them for taking a number of copies of Clinical Dharma: A Path for Helpers and Healers to sell to their sangha and clinical colleagues!

Dharma Talk - A World Gone Mad

When I gave this Dharma talk at Against the Stream it seemed like the world was going mad... it does not seem to have abated, so until the tides change, you can possibly relate to this talk at any given time for the foreseeable future... hope it helps a little bit... how to practice in a World Gone Mad...

http://www.againstthestream.org/3231-2/