Listen in as we begin answering some questions that we have been sent by our Patreon members. In this episode we answer questions on the topic of EMDR Therapy with Borderline Personality Disorder and Schizophrenia. 

Q: One question I have is about EMDR with borderline personality disorder and if you have any information on combining it with DBT. I am also wondering about EMDR with schizophrenia when the patient does not have an extensive trauma history and whether hallucinations could be desensitized?


EMDR with Borderline Personality

     Case Conceptualization:

     -Creative manifestations of attachment and trauma history

     -Trauma: Too much too soon, too much for too long, or too little for too long

     -Trauma has the most direct and powerful link as far as organizing neural networks 

     -Personality Disorders are creative manifestations of the nervous system 

     -Borderline= between psychosis and neurosis 

     -Trauma narrative can get highly agitated in a therapeutic relationship

     -Important to shift the way that you are conceptualizing Borderline Personality Disorder, the healing journey becomes about offering safety


 Blending EMDR with DBT:

     -The goal of the behavior is about finding nurturance and attachment 

     – The symptomatic behaviors can also become a self fulfilling prophecy, creating the rejection that they severely fear

     -Common held belief “It’s not safe to feel safe”

     -Alternative to Calm Safe Place is a Neutral place. Look for resources creating neutrality.

     -Install successful experiences found through DBT

     -Take time to have them notice the relationship and attachment between them and us as the therapist. This is reshaping their nervous system. 

     Attachment work and Borderline Personality Disorder

     -Look at developing attachment figures (real or visualized) to retrain their attachment and nervous system responses

     –Resource: 3 Pillar Model of Dan Brown and David Elliot Attachment Disturbances in Adults Treatment for Comprehensive Repair

     –Resource: Attached: The science of adult attachment and how it can help you find and keep love

     -Make to sure to pay close attention to behaviors that they have observed in their parents

     -Personality Disorders are reactionary

     -Not often that you can do rigorous trauma processing with this population.

     -Target focused approach does not get at the root of the problem, we need to focus on the mechanism (the attachment figure) in which they work through the trauma. 

EMDR with Schizophrenia Disorder:

     -There are unique aspects of working with this population

     -Delusions and hallucinations are expressions of the nervous system. With this being said, we can not be dismissive or overly focused on these. We still need to see them as a human, not just as their symptoms. 

     -Don’t get distracted by the manifestations of the symptoms

     -One of the most vulnerable and wounded populations 


     –Resource: EMDR Therapy for Schizophrenia and other psychosis by Paul Miller

     -EMDR is either incredibly helpful or neutral….research did not find any evidence that it is detrimental 


     -The nervous system already had a predisposition “back door”

     -Schizophrenia is linked with dopamine, using and being fed by dopamine to increase the creativity of their response

     -The nervous system is so pressured that it has to create out of nothing representations of their sadness, pain, etc.  

     -Delusions and hallucinations are the face that they have put on a faceless fear. It is representative and symbolic. 

     What do we target?

     -The client does not connect with the stories of their lived experience

     -There must be a crisis point that triggered the onset of symptoms

     -It is beneficial to target the hallucinations 

     -The target is simply a doorway into their neural circuitry

     -The therapist does not have to understand what is happening. 

     -We need to honor their process wherever they are. 

     -Consultation is always recommended if you are not an expert with this population.