EMDR Therapy Quarterly

Introduction

We take for granted that every chronological adult has a cohesive adult state capable of relating, at least most of the time, with himself and with others in a healthful way. Unfortunately, in some cases this may be a lot to assume. Construction of the self and building a sound relational world entail two parallel processes which, through the integration of different affective systems, lead to the development of a cohesive and functional adult state. But this is a long and delicate process that can be easily disrupted by adverse life events. When all goes well, we have adults who can respond to both internal and external worlds, capable of being in contact with their own needs while being sensitive to others’ needs and to environmental demands. In other words, adults that have the capacity to act as such overtly and covertly. This requires the capacity to display external adult behaviours as well as internal adult regulation. When the process suffers disruptions, the resulting adults struggle with the demands of their outer and/or inner worlds.

“In every real man a child is hidden who wants to play” – Friedrich Nietzsche

We can think about psychological interventions as aiming at two interrelated processes in our clients: the ability to achieve a balanced relationship with the outer world and, at the same time, the capacity to achieve a balanced relationship with one’s own inner world. Both processes require a healthful and functional adult state in our clients.

Many clinicians presently work directly with the adult state. This article tries to offer a conceptual framework and some specific indications about how to foster this state in our clients. It is based on my own clinical experience and that of my co-workers and other colleagues, as well as on the work of renowned authors and insightful clinicians such as Arne Hoffman, Jim Knipe, Roger Solomon, Andrew Leeds, Dolores Mosquera or Francisca García, just to mention some. I suspect that nearly everything that is of interest in this article comes, directly or indirectly, from them. Mistakes should solely be attributed to me.

I will start by explaining internal states and how the optimal development of a child leads to a cohesive and healthful adult state. After, I will analyse the two most frequent types of breaches that can take place in this process and the expected outcomes in both cases. This will lead to the description of two groups of patients that could benefit from explicit adult state interventions, paying special attention to the second group, arguably the more difficult to identify. Finally, I will offer some specific indications about how to foster adult state development in therapy, concluding with a RDI for the adult state.

Internal states

Internal states can be conceptualised as mental representations that determinate inner activation and our cognitive and affective appraisal of situations. We process and react to external stimuli from these internal states. Behaviour, therefore, is largely directed by them. In different psychotherapy approaches, the term ‘child state’ is used, referring to an internal representational state whose cognitive and affective activation and behaviour patterns were learnt in childhood and have not been modified since. When this inner state gets activated in adult-to-adult interactions, it usually leads to counter-productive and dysfunctional behaviours. In a similar fashion, we can think about an adult state developed during a lifetime. When activated, this adult state permits the person a more adult appraisal of situations, and hence more adequate behaviours in response to adult interactions. For this adult state to develop, some requirements should be met in the child’s upbringing.

Development of adult states

As children grow in regulated and healthy environments, they are gradually exposed to the physical, and mainly relational, world that surrounds them, allowing them to test and develop new coping abilities. Ideally, this testing and development of new coping abilities occurs in a three-step process:

1. Step 1 – In a safe zone: the child is in familiar and unchallenging environments, comforted and calm, with regulated and regulating attachment figures. There is no acquiring of new coping abilities as such, but the child is secure due to an adult’s skills and buffering presence.
2. Step 2 – In a challenging zone: The child uses the adult caretaker’s presence as a safe base to explore slightly more challenging social and physical environments, going out of the comfort zone and into more challenging ones. The child has higher activation levels during this phase but, at the same time, is learning new coping abilities that help him/her face new challenges.
3. Step 3 – Back to the safe haven: Having acted in the world and tried out new abilities, the child returns to comfort and regulation, allowing her/his nervous system to de-activate and resume regulated homeostasis.

Seen through a Piagetian lens, Step 2, going out of the comfort zone and developing new abilities, leads to their assimilating them. But the child then requires Step 3, going back to regulation and calm, for the second Piagetian process to take place: accommodating those new abilities, internalising them and making them a part of the self. This dance, moving between the comfort zone and a more challenging one, is essential for well-being and healthy emotional and mental development. It enables the child to develop and integrate new coping skills and abilities, get used to facing different physical and social environments and to improve self-concept, self-esteem and feeling of agency. As much as Step 2 is important for acquiring new behavioural and relational capacities, Step 3 is essential for developing inner regulation skills and calmness that will, in turn, help internalise both sets of abilities in a cohesive internal representational state.  

Two key requirements must be met if the child’s contact with the world is to be constructive:

1. These ‘incursions into the world’ should be gradual and, using Vygotsky’s term, in the child’s zone of proximal development: exposing them to skills that the child can acquire with the help of a more experienced person.
2. These incursions should be limited in time, allowing the child to go back into regulation before feeling overwhelmed or tired and needing to suppress inner activation to continue coping.

Meeting these two requirements depends entirely on the presence, sensitivity and attunement of an adult caretaker, who acts as a buffer between the social and physical world and the child. Sometimes the adult will encourage the child to face challenges that he/she is not willing to face, while helping the child to stay in a regulated state. Such an adult may also help the child learn when to stop and return to her/his comfort zones, if the situation becomes too challenging, and will encourage them to try again only when ready to do so. A caring adult will also be understanding and promote self-compassionate behaviour if the child’s performance is not functional. Good-enough caretakers will also set limits to child behaviour, helping children to manage frustration and learn self-regulation. Last but not least, such an adult will have good relational and self-care abilities him/herself and thus provide the child with a model for both.

It is important to highlight that a good enough caretaker, through direct or vicarious intervention, helps the child to acquire external behavioural/relational skills and internal regulation abilities. Although partly intentional, this process is mainly achieved implicitly and is largely unconscious. Both sets of skills are internalised by the child as he/she grows and constitute the hub of the future adult state. This adult state, when developed, will be composed of two subsets of abilities: those related to external behaviour, that we can call the ‘external adult’, and those related to inner regulation, that we can term the ‘internal adult’.

Two types of breaches in adult-state development

What I have just described could be considered an optimal situation. But what happens if the child doesn’t have a good-enough caretaker?  We can consider two different types of outcomes, depending on the characteristics of the caregivers and the position that the child was forced to adopt:

1. Children that didn’t have the chance to learn and assimilate either good outer behavioural/relational skills or adequate inner regulation abilities. As adults they lack capable ‘external adults’ as well as functional ‘internal adults’ and will exhibit weak adult states and highly reactive child states.  
2. Children that learnt to behave externally as adults but didn’t develop internal strategies. They managed this by supressing their inner needs and emotions. As adults they will exhibit functional ‘external’ adult states but disconnected from, or opposed to, their inner child states. We can consider that they lack an ‘internal’ adult capable of dealing with their inner world.

Let’s now have a closer look at these two types:

Adults with weak adult states and highly reactive child states

We can deduce that as children, they will have lacked co-regulation, resulting in low self-regulation skills. This is frequently due to having had absent, negligent or abusive caretakers; quite frequently parents with reactive, childlike states themselves. These adults are neither able to help their children regulate nor serve as good models of self-regulation. Absent, negligent or abusive caretakers and their effects on children have been largely studied in psychology. In more recent years, it has become increasingly common to find this behavioural pattern in children who grow up with over-protective parents who fail to set appropriate limits. Such caretakers react to their children’s emotional states and solve situations for them as soon as difficulties arise, instead of letting the children face, and gradually develop, their own coping and self-regulation abilities. These parents also generally fail at setting limits for their children, often giving in to their demands.

Setting healthy limits is an essential component of good parenting: limits define the boundary between the easy option and things children don’t want to do, like go to bed, stop watching TV, eat less sugar, etc. They help children learn how to inhibit behaviour and self-regulate when their desires are frustrated. Such boundaries are also essential in helping them to face challenges, leave their comfort zone and learn new coping abilities. Setting limits has to do with the Social Ranking System as much as with the Attachment System, or maybe even more. Caretakers who don’t set proper limits disrupt the functioning of the Social Ranking System for children. As a result, such children frequently adopt dominating or submissive stances. This in turn prevents them from developing both external coping skills and internal regulation skills, becoming very reactive.

Over-protecting children hinders their ability to self-regulate

Such children will frequently grow into adults with child states that retain the same hyperactive, anxious, impulsive, demanding and/or angry behaviours they had as children and which, at least at short term, were useful strategies. They lack or are deficient in external as well as internal adult coping strategies. Their anger is frequently directed at their attachment figures for not solving their problems. It can also be directed at other adults, especially intimate others. In cases where this lack of setting appropriate limits was severe, these adults with child states can exhibit extremely defensive or even disorganised behaviours, just as we would expect from children who have experienced severe trauma. Here, the traumatic experience was itself the absence of regulation and limits, leaving the child exposed to their own hyper activation rather than the co-regulation of a present parent.

Their lack or deficit in internal and external abilities results in a low level of executive control in their adult state. The adult state is unable to sustain and calm child states, especially under stressful interpersonal situations. They have difficulties managing frustration and emotions, often making their behaviour reactive, impulsive and highly emotional (angry, demanding, afraid, etc). We all have child states that are activated in different situations, but these clients differ in that they seem to mostly function from these child states, which hijack their more adult reflective states as soon as stress or emotional activation rises. These are termed ‘weak adult states’.

Such clients tend to be very symptomatic and have conflictive relationships, as they usually respond from child states in adult relationships, appearing as angry, demanding, hurt, anxious, etc. From an attachment perspective, they exhibit more anxious-resistant strategies.

Adults with weak adult states tend to have conflictive relationships

Adults with ‘external’ adult states that are disconnected from their inner child states

We will often find that as children, adults with external adult states were forced to take responsibility for themselves at too early an age. They may have had physically or emotionally absent parents, caretakers that were demanding and critical, or were just stressed, over-occupied or had their attention directed towards another problem, for example a problematic sibling. These children were forced to depend on or take care of themselves, physically or emotionally. Sometimes they may even have had to assume the responsibility for other children or even for an adult attachment figure, assuming the role of regulating factor in their environments. Due to this, they were left too long in challenging zones and, despite developing external world coping skills, they lacked the inner regulation and calmness necessary to assimilate these skills.

As a result of being forced prematurely to behave as adults, that is, before they were able to develop the inner calm emotional state to do so, they coped with the demands upon them to be functional and effective by supressing and ignoring their inner activation. As children they may have appeared to others as unusually mature or even the ‘perfect child’, worried as they were of doing anything that might increase stress or dysregulation in their environment. Moreover, these behaviours were frequently reinforced, both socially and because of positive outcomes. Burying emotions can be a way of staying functional while remaining focussed on the external task to be done. Repeated in time, this becomes a pattern, and this disconnection from their inner world of feelings and needs creates a gap between external and internal skills.

As adults, they seem to have perfectly functional adult states, with a high level of executive control over overt behaviour, capable of functioning and fulfilling the duties of an adult in some or most spheres. They don’t react from emotional states and, on the contrary, appear as responsible, hard-working and emotionally under control. But, lacking inner regulation, they are frequently very self-demanding, self-critical, over-achieving and/or procrastinating. This is because they compensate for their lack of inner regulation by developing strong adult external behaviours, but without this behaviour emerging from an inner adult cohesive state. It almost seems as if they are really working hard to be an adult, suppressing their needs and feelings, partially disconnected from their inner world and/or being very harsh and critical towards themselves. We can consider that they have developed functional ‘external adults’ but not healthy ‘internal adults’.

As a result, their behaviour is frequently rigid, slightly exaggerated and lacking in flexibility and self- compassion. At times, it may even resemble a caricature, or exaggerated version, of actual adult behaviour. Similar to being ‘the perfect child’ when they were growing up, as adults they may assume too many responsibilities, taking care of or taking charge of others without taking into account their own needs. This trait can appear in any realm, making them ‘the ideal worker’ or the ‘perfect son in law’, as they do what needs to be done but often at great personal (emotional and energetic) expense. Yet they are often autonomous and unreceptive to external help.

Acting externally as an adult, without the inner calm to do so, can be strenuous, leading to exhaustion. The ‘tired caretaker’ is a particular example of this. Tired caretakers are parents who fulfil their parental duties but don’t enjoy parenting and are constantly tired and stressed. Although they may have some traits that would favour the development of secure attachment, they lack an essential aspect, “the pleasure and enjoyment” that according to Bowbly, as set out in his 1951 WHO report, was so necessary for a secure attachment bond to take place. But these traits are by no means limited to parenting and can appear in any realm: people function as external adults in the work realm for example.

Lacking internal regulation, they frequently develop counter-productive and compulsive or addictive regulation strategies as smoking, drinking, watching TV late into the night or not respecting healthy sleeping or eating patterns. They may switch from feeling capable of doing everything to feeling unable to cope, from being very hard working to procrastinating. They frequently become counter-phobic: denying their underlying anxiety and acting against their fears. They get used to functioning with high levels of activation or even needing such levels to be functional. Their difficulty to know their limits and self-regulate sometimes may lead to them falling ill, which in turn can be rewarded, because they sometimes need a socially accepted illness to allow themselves to stop and rest. On other occasions they may play victim or exaggerate physical ills for the same reason.

They can also switch from being extremely helpful to complain of giving much more than they receive. Sometimes they may exhibit anger towards others for not appreciating, caring or helping them, when it is frequently their inability to ask for and accept help or affection from others that plays a major role in the problem. This is also a natural consequence of a child-like, idealised, way of expecting other people to react: expecting to be praised for their hard work but incapable of taking in as adults the positive affect they didn’t receive as children.

These clients are tougher to identify than the previous type, due to their high executive control and their being very functional. The clients themselves are unaware of their difficulties and are convinced that they are acting from an adult state. Frequently, their therapists also fall into the same trap, considering that their behaviour is normal in their situation and is how adults should behave, without realising the inner difficulties of these clients. To quote one of my former patients that was also a colleague: “this inner girl of mine is so good at pretending to be an adult that even I get fooled most of the time!”

Maintenance of adult states once developed

So now we have these two scenarios where the harmonic development of the adult state has been disrupted. There are various obstacles to the spontaneous reversal of this state of affairs: 

Adult relations cannot satisfy childhood emotional deficits, unless expressed in an adult way

Adult-to-adult relations can never match the level of care, assumption of responsibilities and unconditional love and support that children ideally receive from their caregivers. Indeed, an adult relationship presenting in this way would be pathological. Adult relationships, however healthy, can’t fulfil the child’s unmet needs and expectations, unless there is an adult state mediating between the inner needs and the outer relational world.

For this to happen, the critical difference here is between the individual reacting from his/her child state or responding from an adult perspective. Reacting from the child state is powered by child fears, more than by child needs. The child fears can be various: ‘if I take care of myself, I won’t be loved’, ‘If I am not perfect, I will be abandoned’, ‘If I am not effective and very hard working, I will not be respected’, and so on. When lacking internal adult regulation, the activation of these fears fuels the ‘external’ adult behaviour, leading to functioning from a defensive instead of reflective state, being reactive instead of responsive.

There is a difference between reacting defensively from a child state fear and being in touch with one’s needs, and therefore responding from a more adult and reflective state. The former will usually result in conflict with others. On the other hand, an adult in touch with the needs of his/her inner child, is able to express those needs in an adult way which is tempered with the adult’s understanding of what is realistically possible as regards the meeting of those needs. The adult therefore responds from a place of awareness of his/her unmet child needs rather than being dictated by the child’s fears.

Adult states expect ideal responses from others

When child fears are activated, the behaviour that is exhibited seeks to elicit the idealised response from another adult, the response that, in fact, didn’t occur in childhood. Of course, these expectations are again dashed. Such dynamics are normal in vertical, adult-to-child relations, but not in horizontal adult-to-adult ones. Whatever the ‘other’ adult is able to do will inevitably fall short of the child state’s idealised expectation. This stance may often serve another psychological purpose. Expecting that others will respond now, in the way that their caretakers should have responded when they were a child, allows them to reject what happened (and therefore cannot be changed). It’s as if the inner child is still waiting for things to unfold in a different way than they actually did. The child doesn’t accept the childhood they had and, rather, feels that all is not lost because things could happen differently this time. Such unrealistic expectations usually condemn adult relations to failure.

The experience of having expectations of these childhood needs dashed in adult relationships often leads to an unhelpful conclusion: the person thinks that they have to grow out of these needs, concluding that: ‘It’s better not to need or depend on anyone’. However, this conclusion represents a shift from anxious to avoidant strategies. They may have served well in the past but do not represent secure adult attachment strategies. They force the individual to deny themselves universal human needs such as being loved, cared for or appreciated by significant others, further disconnecting them from their inner world.

These states have been very successful and are reinforced

Rather unhelpfully, society will often reward such strategies. In the short term, they are generally successful and therefore frequently reinforced. This is particularly true for external adult states which display traits of diligence, being very responsible and over-caring for others; it is easy to see why such traits in a client would be rewarded. The negative consequences are slower to emerge. Moreover, weak adult states really only succeed in the short term. While the person lacks more functional ways of coping, they are not going to change these old strategies, the only ones available to them. Acquiring and/or strengthening new strategies, requires activation of the inner adult state. Only through the calm and reflective state of the adult can a person look for new and more flexible ways to meet their needs.

Helping clients to develop the Inner Adult state

A great deal of what therapists do in psychotherapy is to help develop and strengthen the cohesive adult states of our clients. This, in a way, is what we are doing whenever we are promoting self-care, self-soothing without avoidance, coping abilities, nurturing a compassionate vision of oneself and one’s life history, conflict reduction and so on. Many of the Phase 2 interventions can be understood under this light, although we may not be doing it so explicitly. At the same time, processing and integrating traumatic or missing experiences helps strengthen the adult state. But the opposite is also true: strengthening adult states helps process and integrate traumatic events. There is therefore a strong case for developing Phase 2 interventions that help develop and strengthen adult states more explicitly.

It is important to emphasise that the adult state is not a continuous state. Nobody can be constantly in this state and act accordingly. But nearly every chronological adult can show some measure of adult skills sometimes. And, fortunately, some adults can function from this state most of the time. It is also important to acknowledge that probably all (or at least most) chronological adults have an adult state, external and/or internal, although it may not always be present. The frequency with which this state appears in our clients makes all the difference. If it is rare, we should help to reinforce/develop the adult state. And we can do this in many ways:

1. As a collaborative effort between therapist and client, it is important that therapy provides psychoeducation on what are the essential aspects of a cohesive and healthy adult state. This will help clients have more realistic expectations about themselves and others, one of the features of a healthful adult. It is very important not to underestimate psychoeducation as a therapeutic tool. It allows the person to learn new skills, but it also helps them to understand why they should be learnt, giving them the motivation to make changes. Also, providing information that helps clients to understand the roots of their difficulties has a calming and regulating effect, promoting self-compassion.  
2. Once clients understand which behaviours are associated with a cohesive adult state, it is important to help them to notice when they exhibit these behaviours towards themselves or others, both during therapy sessions or when they recount experiences in life. As awareness increases, we can reinforce these behaviours or install them using standard RDI installation. Andrew Leeds’ original RDI scripts can be downloaded from: Free Downloads Andrew M. Leeds Ph.D. (andrewleeds.net).
3. In addition to reinforcing and installing the skills they already possess, we can help by teaching specific adult coping skills, especially the ones the client lacks. These new skills, once assimilated, can also be installed with standard RDI, helping internalisation.
4. We can directly install an inner adult state using a RDI protocol that I will detail in the next section. But using this protocol without prior psychoeducation about what it means will not be as useful: it may help to calm our client temporarily but will not facilitate the development of the cohesive adult state.

RDI: The Adult State

Although both types of patients described will benefit from working with the internal adult, in the case of clients with weak adult states that have little executive control, it is convenient to have worked with self-regulation, conflict solving and other Phase 2 techniques, before directly using the adult state installation. These techniques will provide them with skills that can later be integrated into the adult state. Installation of particular skills, using RDI, is very useful. Attempting to install the adult state without clients having incorporated these skills can sometimes backfire, as the client perceives the adult state as unattainable. Clients with external adult states, on the other hand, often benefit from these types of interventions earlier, because the cohesive adult state helps them relax the control, inflexible and self-demanding behaviours, helping them create a healthful inner adult state.

In general terms, working with the adult state is safer than working with child states. The child states are frequently connected to memories and dysregulation, while the adult state is more connected to present and future templates and higher levels of regulation. We have found it very useful to reinforce the adult state before trying to work with the inner child, especially in complex cases with more childhood trauma or lack of regulation. In any of these complex cases, working with the inner adult and strengthening this state is very helpful before dealing with disturbed child states.

Psychoeducation summary

Traumatic experiences interfere with the development, and sometimes even maturation, of the nervous system. They can hinder the development of a healthy adult state, internally and externally. There are two groups of patients that could benefit from installation of the adult state:

1. Clients who, due to lack of regulation or lack of limit setting, have very active child parts (e.g. highly emotional, reactive, impulsive) along with very weak adult states that can’t sustain and calm these child parts. These clients act in a highly reactive and emotional manner. From an attachment point of view, they are more frequently associated with anxious-resistant strategies.
2. Clients who have had to take care of themselves or others and so were forced to behave as adults externally without having fully developed inner adult skills. These clients frequently have ‘external adult’ states, which are out of touch with their child states. These external adult states can be understood as child or adolescent parts that function as adults. They accumulate a lot of costs such as feeling very tired, angry, sad, hurt and lonely. This is due to them connecting with childhood fears. From an attachment point of view, clients with external adult state switch from anxious to avoidant strategies. They also can be anxious in their overt behaviour but more avoidant towards their inner world.

The adult state (AS) has skills to act as an adult externally and internally, and is therefore able to:

• Self-calm and self-regulate. Calm others and co-regulate. Be open to being soothed and regulated by others.
• Be in contact with his/her needs and empathic towards those of others. Be in touch with his/her emotions, without being overwhelmed by them. Attune to the emotions of others without being overwhelmed or avoidant.
• See and understand child states/needs in him/herself and in others. Not act under the child’s fears. Be compassionate and self-compassionate. Be realistic about what to expect from themselves and others.
• Be self-reinforcing and capable of reinforcing others. Receive reinforcement and positive affect from others. Ask for help and care and can receive both.
• Set healthy limits for themselves and others. Avoid being counter-phobic, tired, angry or hurt.
• Understand and admit mistakes, apologise and repair ruptures in relationship.

It is very important to emphasise that the adult state is not a continuous state. Nobody has all the previous traits and acts accordingly all the time. That is impossible. But nearly every chronological adult can show some of these traits sometimes. The items on the list above should therefore be seen as capacities that indicate when the inner adult state is active and in executive control rather than a comprehensive description of the inner adult. Helping the client to notice these capacities when they have recounted a recent demonstration, or when they demonstrate them in a session, is critical. Reinforcing and installing such moments, will help to make them more frequent and will strengthen the adult state.

Steps for Adult State installation

1. Through psychoeducation, help the client understand what the adult state is and how they might recognise its main features. Help them to understand that it is a discontinuous state characterised by the awareness and behaviours listed above. It is important to emphasise that everybody has an adult state, though it may not be present frequently or may not have much executive control over behaviour, overt or covert. In complex cases, do not be tempted to read out the complete list to your client as this is likely to make them feel even worse for ‘not being good enough’ or ‘not being adult enough’ and have an idealized vision of what it is to be an adult. Ideally the list of characteristics of the adult is best brought to the client’s awareness gradually, via in-the-moment interventions or through reflective practice during the course of therapy, identifying, reinforcing and installing whenever possible.
2. Ask to close eyes and:
   • Imagine their adult state: what is their gender, age, and how is he/she dressed? What is the body posture, facial expression? Let the client connect with this state; watch for non-verbal cues that indicate that they are connecting.
   • Tell the client that their adult state has a message for them that can be delivered in words but also through a look, a verbal expression, a feeling, etc. Ask them to pay attention and see what message is being delivered and ask the client to put that message into words. 
   • Once the person gets the message (that is frequently to ‘be calm’, ‘you are doing well’ or other positive messages) do sets of short installation type BLS.
   • Connect the AS’ message to the client’s feelings, body sensations and images that arise. Look for gestures that indicate integration (hand going to the chest, body relaxing, facial expression, …). Employ short sets of BLS while new material is emerging.
   • If negative emotions or other difficulties emerge (for example difficulty in imagining) focus on the difficulty and use BLS. Difficulties installation can be resumed. If there is no resolution, you can at least install the reduction of the difficulty (‘notice that now when you think about this adult, there is no negative sensation/emotion’). This usually helps and prepares the ground for future sessions, when you will be able to work more deeply and install the AS. Other option at this point is to identify the capacity or skill the person needs to come closer to her/his inner adult (calmness, sense of humour, etc) and use RDI to install that particular skill.
   • Comment and closure: What did you get from this exercise? The answer, if positive, can be installed with short BLS too.

*Don’t use this RDI protocol with DID or clients with high dissociative features. It can cause an imbalance in the inner world with these clients. In any case, normally it is more secure to work with the inner adult than with inner child states in these highly dissociative clients.

Follow on in later phases

Whenever clients exhibit some of the traits that can be associated with a cohesive adult behaviour, especially those that are new to them, it is very interesting to install these traits using the RDI protocol for EMDR (Leeds 1998; Korn & Leeds 2002). Andrew Leeds’ original RDI scripts can be downloaded from: Free Downloads | Andrew M. Leeds Ph.D. (andrewleeds.net).

If the Inner Adult RDI has already been used, those installed behaviours/feelings can be added to the adult state (“Now I want you to see your adult endowed with this resource…”). This expands the adult skills and integrates them in the self. Like the Calm/Safe Place, the more the adult state is called upon, the easier it is for the client to connect with that state.

The adult state, once installed, can be used in future templates of situations that are potentially conflictive for clients. It is easier to install the adult state in a calm setting and later on call upon that state to face a stressful and conflictive situation, enhancing adult behaviour in this future setting.

The adult state can also be used to accompany child states while processing memories that are especially difficult. Adult states can also be called upon to manage the child states while working with parts.

Once our client understands the characteristics of an adult state, we can help them to  understand what happened in their life that resulted in them not developing the traits they were lacking. Learning about the setting in which a client learned to behave or not behave in a particular way will uncover new targets that otherwise would not be considered. These new situations can now be desensitised and reprocessed using Standard Protocol. 

Dr Arun Mansukhani is a Clinical Psychologist and Sexologist. He is an EMDR Europe Accredited Consultant and Facilitator. He is currently Vice Director at the IASP Centre in Malaga leading a team of psychologists working with trauma and attachment.