Michel Sylvestre drew on his wealth of experience of integrating his learning from work as a family therapist to his practice as an EMDR therapist in this informative and engaging presentation. Michel explained how, in his practice, he has embraced doing both family and individual work, rather than adopting an either/or position, where the family may be seen all together or the child seen for individual work. He eloquently describes this as ‘not one or the other – you have to do one and the other’. Michel reminded us of Pierre Janet’s (1929) comment that ‘Narrowmindedness and specialisation are never a good thing, especially when dealing with psychology’. 

Michel explained that the rationale for integrating systemic family work with EMDR is because trauma leads to different types of trauma wounds. Michel argues that while individual work may address the individual wound, there is also a need to offer intervention for the relational wounds that occur after trauma; failure to do so has been linked to poor outcomes for family relationships. Difficulties with relational difficulties can impact the child’s affect regulation and the child’s experience of their family as a safe base. Asking questions about what has changed for the family since the trauma, and whether family routines have continued, can offer the therapist insights into these relational shifts. When integrating the individual and relational wounds, Michel spoke of the importance of maintaining a developmental perspective and the adaptive information processing model in co-regulation. 

Michel explored how both parents and child as can be mutual triggers within their relationship. Where this is apparent, he argues that it needs to be the starting point of the work, as it is important that parents can act as containers when they think of their child, to enable the ‘relationship to act as an emotional scaffolding’ and keep parents within their own windows of tolerance. Michel is an advocate for one therapist working with the whole family rather than referring different therapists to work with individual family members. In this regard, the role of the therapist becomes a ‘stable anchor’. 

In planning intervention, Michel advocates for completing the family work first before moving to individual EMDR. After the initial family meeting and evaluation of the dynamics within relationships, he decides whether to work with the parents, the family or to work with the child and/or siblings. Key points in evaluating the family dynamic are consideration of safety, early attachment rituals (such as bedtime routines, mealtimes), reviewing whether the family hierarchy is functional (i.e. appropriate boundaries between parent and child), determining what is the quality of the attunement between parents, and the consistency of narrative stories within the family. 

Work on the family narrative might include ensuring that all family members are able to talk about what they know about the problems and encouraging no secrets to be kept. Advice may be given on increasing family presence in daily routines to enhance attachments. 

Michel spoke of the importance of all the family being regulated during the work, so the therapist might switch between appointments for different members simultaneously rather than completing one intervention before moving on to start with another family member. Much time is spent in phases 1 and 2, understanding safety and dynamics in the family relationships. Then, after individual work is completed, the therapist views in phase 8 how well the child is getting along within the family. 

Michel illustrated his skill at integrating family work with EMDR through his clinical practice with numerous clinical cases. He shared photos to illustrate the use of family drawings and GTEP in sessions and the importance of understanding the quality of relationships between siblings as well as between parents with the child. 

The audience asked a range of questions. Have you worked with families where there is sibling abuse and how do you approach this? Michel discussed the importance of perpetrators recognising that abuse has occurred and preparation work in the family. He advised against bringing together victims of domestic violence and abuse with perpetrators where there is not recognition of what has occurred as abuse. 

When working with a couple and the treatment is the same, do you follow an individual or group protocol? Michel responded that while a group protocol could be used, this approach has been developed for use with groups of children so he would use an individual protocol with both adults. 

Do the family members have the same safe place and containers? Michel explained that each will have their own, according to their level of development, with children able to observe parents completing their own safe place and containers first. He then completes installation together. 

How might you involve parents where they have a difficult relationship such as following a difficult divorce? Michel explained that there is an increased level of complexity in seeing children with each parent. Sometimes it is appropriate to also offer to parents a joint session to explore their caregiving responsibilities. 

Further reading 

Silvestre, M., Tarquinio, C., L., (2022). Systemic family therapy and EMDR therapy: an integrative approach. European Journal of Trauma and Dissociation 5, 100196. https://doi.org/10.1016/j.ejtd.2022.100291