EMDR Therapy Quarterly

These flashcards are hot off the press and are a fabulous new concept to facilitate therapy for clients with complex PTSD, dissociative personality structures and those who simply have a strong investment in psychological defences that impair the standard EMDR protocol. This is an innovative approach to EMDR therapist training, a training course in a box if you like. Authored by Manuela Spadoni, an experienced clinical psychologist and EMDR consultant, and advised by Jim Knipe, an internationally respected therapist, trainer, and author. Jim is known for describing interventions, or tools, that can be useful in treating complex PTSD and dissociation. These flashcards are intended to offer therapists a structured, actionable resource to enhance their practice; they complement Knipe’s training and book (Knipe, 2019) and include Spadoni’s conference room method.  

Not dissimilar to the concept of the good old cookery cards in a box, these EMDR flashcards come up trumps if you are stuck with a clinical issue and don’t have time to delve into the stack of books on your desk or bookshelf. The box of flashcards is well put together and has a nice touch, in that there is a hole punched in the upper corner of each card, enabling multiple cards to be compiled using the metal ring that is provided. 

The flashcards are divided into eight useful chapters with an index and QR code which links to videos on how to use the cards:   

• Dissociation (including parts) 
• Present oriented part 
• Trauma reliving part 
• Conflict between the present oriented part and the trauma reliving part 
• Psychological defence part (including examples) 
• Perpetrator imitating part 
• The preparation/stabilisation phase (including how to describe processing to clients) 
• Treatment tools. 

I would have liked to have seen more diagrams on the cards as that is how I learn, but I am aware this project took three years of hard work to put together so that is maybe something for the next edition. 

On the front side of each card there is a question which relates to a particular type of problem or issue that can occur when treating complex clients with EMDR. On the reverse of the card there is the related answer, which includes one or more suggestions of how the therapist might conceptualise the problem, provide effective therapy, focus on a specific procedure, and provides information about how that problem may fit into a larger issue for the client.  

For example, my client told me sincerely that he really wanted to work on his touchstone childhood trauma, but then, when the time came, he could not bring himself to do that work (avoidance defence). The chapter on treatment tools describes various methods of working with avoidance defences. I chose the ‘level of urge to avoid’, asking him “What’s good about not working with this childhood memory today?”  “From 0-10 how much would you rather talk about something else?” “Whereabouts in your body do you feel that 10/10?” We processed the avoidance defence down to a zero after a few sets of bi-lateral stimulation, when he then said that he “realised nothing will change for him until he can process his childhood traumas” and he wanted to start the processing.   This allowed us to continue using the standard protocol. Another client was processing nicely using the standard protocol but intuitively this felt too good to be true, knowing my client had a predisposition to please others in a well-established adaptive child part. I felt she may be trying hard to please me by being the perfect client and saying the right things. I switched to using the ‘Loving Eyes’ protocol which can be found in detail in chapter eight. This helped the client to fully access the unresolved trauma and connect with her authentic split off or dissociated child part whilst maintaining present orientation and safety, ultimately leading towards personality integration. 

In complex cases, the standard protocol can be blocked or may appear ineffective, and therapy can be stuck. The flashcards offer effective guidance for therapists to successfully work in these and other similar cases.  

The flashcards also help to foster deep understanding of the therapy process with this complex client population and facilitate the retention of fundamental concepts and tools. I have recommended them to my supervisees, and I can imagine them using the cards with their supervision questions if they are stuck. They provide convenient access to foundational concepts related to dissociation and defences, thereby helping therapists identify specific obstacles to effective treatment. This includes recognising internal conflicts within the client, patterns of self-states or parts, and defences. 

More importantly, these flashcards provide useful suggestions for understanding your client, both at the beginning and throughout therapy. The primary strength lies in how they make complex issues easy to understand and memorise, because all information is split into question-and-answer format to facilitate rapid learning, retention and review.  

There are a couple of weaknesses which are mainly a function of the format. The flashcards break down complex issues into smaller elements. Consequently, the answers on each individual card may not be exhaustive, often spotlighting only one aspect of a larger problem. A comprehensive understanding necessitates reviewing all cards related to a particular issue. 

The flashcards are designed for practical guidance. Therefore, they are limited in directly citing authors and researchers or referencing specific studies or publications. To address this limitation, a comprehensive bibliography is included at the end of the deck. 

The Flashcard deck is quite pricey, retailing at £112, but given the depth of the information provided I think they are good value for money. They are available on Manuela’s website https://manuelaspadoni.com/flashcards/ and a discount code is available if anyone would like to contact me. I would say they are a useful tool for anyone after basic training has been completed. I admit to knowing the authors well as they are my supervisors. Because of this I am very familiar with the concepts and the style of presentation. 

Sonya Farrell is an EMDR consultant & psychotherapist in Norfolk.