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EMDR with no backup Meds?


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So, I'm BPI. That is my primary diagnosis. However, I'm also OCD, PTSD, and have GAD. A lot of initials, none of which tell the whole story of ME. I have had a just devastating year - last year my father was diagnosed with cancer 2 months after my rescue pomeranian was attacked by a large dog. A month after my dad's surgery my pom had to have surgery as well. I ended up not resting or taking care of my emotional well being for too long and ended up in a massive Bipolar episode. I was prescribed a pharmacy full of various psych meds in order to try to bring me back down, and everything I took had a negative effect. Per my pdoc he does not believe there is anything he could safely put me on any longer, since last year it nearly ended up killing me I got so out of control.

So then I start doing a little better, and...My dog and my father died this year; one in March, the other in June. I watched it happen to both of them. That stress has combined to trigger my PTSD into overdrive. I have started having flashbacks from some massive traumas I had several years ago (sexual assaults). I am hypervigilant, cannot sleep any longer, do not rest when I do sleep, and my dreams are incredibly lucid. I woke up several days ago in a full blown panic attack. It felt like I was dying. My eating habits have gone to hell, I either eat nothing or eat and purge, and the cutting came back earlier in the week (but I have a bit of a handle on it now).

So, here is my main issue. As soon as I realized I was going back down the rabbit hole, and that this felt SO much different from a normal Bipolar episode, I immediately made an appointment to see a therapist. I got in that day and found out she specializes in (that is 80% of her practice) EMDR. From what I can tell from the research I have done, this is a very intense therapy. And some people seem to have increased flashbacks and symptoms of their PTSD (not to mention greatly worsening their symptoms). I can't tolerate meds. Not that I am anti-med, but I was pulled off of them BY my pdoc last year because it was that or I end up flaming out and going over the edge. So that means : EMDR with nothing to aid me.

Has anyone tried EMDR before for multiple traumas, and has anyone tried it without the use of meds? I am terrified to do it and know I truly need to.

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If your pdoc can't put you on anything safely, then I'd look at finding another pdoc or considering going inpatient so you can be monitored whilst starting medications.

EMDR can be intense for some people, but if your therapist knows what she is doing she should spend a lot of time working on ways for you to self-soothe and deal with the intense emotions when they come. YOU are in control of what you talk about, and you need to feel safe before you jump into talking about the hard stuff.

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I have been on Lithium, I have been on APs, AAPs, AEDs, Benzos, etc. Rather than help to moderate my moods or break the mania it ended up ramping up my symptoms to the point that I was completely out of control. Then I would get a hard hitting med that would turn me into a zombie (yet I still had the racing thoughts). These would then segue into uncontrolled mixed episodes. And that has been the case for years. Without the medication but constant monitoring I have been able to keep myself relatively stable. My mind simply cannot tolerate the meds. I check in with my pdoc so he can reevaluate; he knew it was unorthodox for someone with my dx to be pulled off of everything in a complete washout. He also knew that if I went IP I would then be given even MORE meds which would start it all over again, this is why I went on a medically approved washout.

Now the PTSD is rearing its head- I'm concerned of triggering bipolar episodes if it gets too bad. One of my best friends is a tdoc and has been working with me for quite some time now- he saw what happened with the situation last year and the previous times. He has me working on CBT (I am waiting for my workbook) and is doing tons of research on the EMDR. We are trying to build me up so it doesn't break me.

It seems anytime I mention I am not on anything rx wise I am immediately told that I HAVE to go on something. If there was something out there that I could handle, I would be more than willing. However, I am not going to forfeit my sanity and possibly my life just to try. That is not worth it. When my father was in end stage cancer, they refused his chemo. He asked for it anyway and was told : Yes, it might help you. But we know it has just as good if not better chances of hurting or killing you. So we are not giving it to you. " And that is almost identical to what happened with me. Had you asked me last October my Christmas plans, i could not have answered. Because I could not see myself making it that far. And almost didn't. So please no judgment. This is not a choice, it is a medical necessity which has been discussed between my pdoc, tdoc (several), family doctor, and myself.

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If you refuse medication, you are forfeiting your sanity and possibly your life.

There are a ton of medications you haven't tried. I went through over 60 before I found a cocktail that was both effective and tolerable in terms of side effects.

It is simply not possible to go unmedicated long-term with BP-I without suffering consequences including brain damage, worsening of symptoms, and IQ loss. If you want to have any chance of remaining independent through the duration of your life, you must be medicated.

Yes, most BP meds have shitty side effects. Over the long term, the alternative is worse.

To answer your original question, I think it would be unethical for a therapist to attempt this kind of work without you at least having some meds you can fall back on if you do flip out.

EMDR is common, well researched, and proven effective. Others can speak to this better than I but there is a risk of suppressed memories rising violently to the surface which can be pretty destabilizing regardless of what kind of mood disorder diagnosis you have.

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I think that we have to take you on your word about your experiences with meds. It is a rare person with BP that can exist without any medications. That you have trauma and behavioral issues too just compounds that; I have BP and BPD and it's hard to manage either without some chemical help. I have done years of therapy and have all the lifestyle/holistic self management going on. It's not easy. Moods feed trauma, trauma feeds moods, it's a mess.

However I am a person on the intertubes with no knowledge of your or your history, so it's not for me to say what you should do that way. Chemo is very different from how mental health medication works. Unless you have a severe allergic reaction or you suffer long term organ damage over time through lack of monitoring, psychiatric medication cannot kill you like chemo can. And people don't offer chemo or psychiatric medication unless the situation demands it. It is great to be the hero that refuses medication, until your brain tries to eat you alive and your life turns to shit. There are no prizes for stoicism.

I am hearing that you have had some bad experiences with medication, you are fearful of it and you have some misunderstandings about it. I get that, I have been there. But it's not for me to try and fix that.

If you want to do EMDR, many people have found it very helpful. However I would say that if you don't currently have any coping skills other than self harm and disordered eating, you really need a tdoc who will set you up with some distress tolerance and emotional regulation. Beacause EMDR requires telling your trauma over and over again, it is like resetting a bone. It is going to be very painful, so you will need some concrete skills that you practiced and you know or for you before you start.

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Of the 3 pdocs whom I have seen long term, each one has ended up discontinuing use of medication with me. This is after they have seen me going through major bipolar episodes (I tend towards manic and mixed only, depression is a super rare event for me). My general practitioner has had the same problem. The therapists I have been to when medicated versus the ones I have been to when I was unmedicated see entirely different sides of me. I know it's not normal. And I know that everyone seems to think that I can just go to the dr, get put on something different. Yet I have had 4 doctors pull me off of medication completely. They all acknowledged that the problem was getting progressively worse. Once I would begin a med washout, they would up my appointment frequency to ascertain how I was holding up. And the answer? Much better.

I am not a non-compliant patient. If my doctor told me to take something, guess what, I would. Yet my doctors, the ones who have seen me at my ups, downs, and absolute worst, have advised me that it is safer for me to stay off of medication than to continue it. I still see my pdoc so he can monitor my progress. He thinks I am holding up fine. So I am going with his advice.

I may not be a conventional patient but that does not mean that I don't actively seek treatment either. Which is why I posted this question on here. I have severe PTSD and could not tell from all of the reading I have done all over the internet what kind of difference was seen with patients who were on medication vs unmedicated when undergoing this therapy. My tdoc who is doing the EMDR told me that she prefers patients to not be on anything (mainly anxiety meds) so that they can fully tap into the past and complete treatment. I know my triggers, yet I know that this is supposed to be an incredible therapy as well. If I have a chance of it working, I want to try no matter how hard it is. I have another tdoc who is thinking I am not nearly strong enough. Who saw what happened each time over the past 14 years that he has known me that I have been medicated as a form of treatment. And who understands that is not an option. So while I am working on my coping skills with him, I am trying to reach out to anyone who has undergone this same therapy.

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It makes sense to me that the tdoc would prefer people to not be using benzos while doing EMDR because the benzos mute the anxiety and yet the point of EMDR is to bust through the anxiety.

That's different that whatever treatment your pdoc is doing to manage the mood disorder.

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I have done EMDR. I have severe, complex-PTSD. A certified EMDR practitioner is a must. The therapist must also be able to tell if you are stable enough for EMDR. It can make things much, much worse if you do not have the interim coping skills to help through the hardest parts. It is possible to completely decompensate during EMDR sessions. Additionally, it is not recommended for those who dissociate easily (which became my problem).

That said, the early days of EMDR were enormously helpful and productive for me, permanently healing parts of myself that had resisted years of other kinds of therapies. It is becoming the treatment of choice for veterans, and can have a 100% cure rate for single traumas. It's about 80% for multiple traumas. But, again, you have to be in a particular place with your PTSD to safely go through EMDR.

I am Bipolar, too, and my concerns for you are that flashbacks and nightmares might cause sleep deprivation, which can trigger manias. I won't speak to the medication issue, as you and your pdocs have a much better picture of that than we do.

Good luck.

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Thank you for understanding. I am not going against doctor's orders, I am not afraid of medications. I have willingly taken every last thing that has been prescribed for me. It has been the decision of each of my doctor's (not mine) for me to discontinue medication usage. Whatever my doctor's orders are, I follow. As they treat me and do this for a living, I am more than willing to follow their judgment.

That being said, I am working on reinforcing my coping skills. I am doing so both with two different tdocs and working on cbt. This is not a decision I am taking lightly. I do not want to try the therapy and not be ready for it. That being said, if it is in fact as life changing as I have heard, I would hate to pass by on the opportunity. Since I am in a very different situation in which the ONLY med I was prescribed at all (and that is for PRN usage) is Klonopin, and Benzos are not recommended during treatment, I have concerns regarding dealing with the potential aftermath of each appointment. Per my tdoc which is wanting to start me on this, the sessions may end with one of the traumas not resolved. Now according to her, by that time I will have my coping skills in place to deal with this. From what my own research has shown, this drastically increases the likelihood of flashbacks and other traumatic events. So I am trying to make an entirely informed decision- and the best way for me to do that is to learn what the experiences of others who have actually undergone this treatment resulted in. As every person is different so YMMV, I realize I cannot judge based on one or two or even a hundred experiences. But that is the best way for me to make an informed decision.

Thank you again.

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Your description is really accurate. I did take Klonopin during EMDR. My tdoc just wanted me not to have taken it before a session, but it and ambien were available to me (and used) for the duration.

Do you have a safety plan? Mine looks something like this:

Take rescue meds

Meditative breathing

Stroke emotional support cat

Wrap up tightly in blanket

Surf the emotion (DBT)

Draw madly on paper in lots of lines, until they turn into circles

Draw on myself (to avoid cutting)

Get on the internet (to depersonalize in order to avoid dissociating completely)

Then a list of family and friends (with numbers!) I can call who are helpful or can at least make me present and distract me.

After that is a list of all of my professional clinicians (with numbers!), from pdoc to tdoc to supervising psychologist to Bipolar group therapist to all the docs I've seen in hospitalization.

I have used this safety plan many, many times and it usually works to keep me from cutting (not always) or purging. It is very helpful to have ahead of time, because by the time you are in flashback mode, you can't think of these things.

Your list will look different, and you will change it over time, updating names and coping skills. My tdoc always had a copy of mine. I carried a copy in my purse, too.

EMDR really is an extraordinary forward movement in the treatment of trauma. I am really sad that I can no longer do it, but it brought out my dissociation, and it's been a point of no return. If you haven't already, www.EMDR.com is the place to go to read academic articles, lay descriptions, etc. about the process. I actually read Francine Shapiro's Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures, 2nd Edition.

You sound like you are knowledgeable and taking this process seriously, learning everything you can. I think that's the right approach to EMDR.

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Thanks so much for your honest response. Yes, I take this very seriously. This is my mental health that I am dealing with and I want to make sure I make an informed decision before jumping into anything. I spoke with my tdoc friend today for quite some time about this, he said he would definitely help me come up with a safety plan (and I am under strict orders regardless to call him at the first moment that I start to feel something wrong). I have a fairly strong support system both with friends up here and with my coworkers, so that is not a problem. And my puppies help to keep me grounded so I have that as well. I have my Klonopin already, so if that would be needed it is available to me. I am waiting to receive my PTSD CBT workbook so that I can get started on it, and hopefully by midweek next week he will have heard back from some of his associates (he sent a huge request to everyone he knows involved in the field to see what they know about EMDR so that he can more accurately determine if it is something I would be strong enough for. So I am slowly but surely getting there. I am just ready to get something done, it's been much too long already.

Thanks again.

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If you refuse medication, you are forfeiting your sanity and possibly your life.

There are a ton of medications you haven't tried. I went through over 60 before I found a cocktail that was both effective and tolerable in terms of side effects.

It is simply not possible to go unmedicated long-term with BP-I without suffering consequences including brain damage, worsening of symptoms, and IQ loss. If you want to have any chance of remaining independent through the duration of your life, you must be medicated.

It is great to be the hero that refuses medication, until your brain tries to eat you alive and your life turns to shit. There are no prizes for stoicism.

i agree comletely with velvet elvis and titania - i'm positive your med options have not been exhausted and while you may have had bad experiences with the ones you tried, doses tweaks can make all the difference between tolerable and untolerable experiences/side effects. that, and start-up reactions are usually not pleasant and one has to get through the difficult start-up phase before feeling relief. that said, there's also the med merry-go-round, which is sounds like you've been on, but surely have not exhausted your options. trial-and-error is a pain, but ultimately worth it. while i don't suffer from bipolar, i do suffer from a really bad anxiety disorder and my life medicated is so much better than non-medicated. i feel your pain, i really do, and i am trying to find the right combination of medications myself, but i realize that my disorders (severe gad/pd) require medication (in addition to therapy) so that my symptoms don't worsen over time, and can remain independent/regain independence, as velvet elvis pointed out, and so that my life is bearable.

perhaps finding a neuropsychiatrist or a psychopharmacologist who specializes in the treatment of bipolar disorder would be of benefit to you.

best wishes and hope you find the right combo of med(s) and therapy that will make your life immeasurably better.

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No hero complex here. I am following not one, but 4 doctor's orders. Each of my pdocs have had a minimum of 18 years in practice, and all have been picked specifically for their expertise in bipolar treatment. As they have my medical history and all notes from previous doctors, I have to believe that what my current pdoc has chosen for me is what he believes is the best route of treatment. While the vast majority of BP patients are prescribed meds, he told me last year that I am one of the few (but not the only one) he has treated who was unable to tolerate them. So, that is out of the way.

I have started work on my PTSD CBT workbook in conjunction with working with one of my tdocs ALL weekend. He is still doing extensive research on the EMDR so that he might assess if this is something I am strong enough to do. I have also put in a request for additional information from my uncle, who is a psychiatrist on the west coast, to see if he is familiar with it. The information I am receiving seems to say that although it works (nearly everyone says that) a LOT of people either could not finish on their own or were stopped by their tdoc. So it is still up in the air. Antigone, thank you for your information and for understanding that my situation is different- not by my choice, but as a result of my physiology, and that far from being antimedication, I am following strict doctor's orders from one of the highest regarded psychiatrists in my area.

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I think that we all agree that CB has a pro med stance, but this OP has clearly explained that she wants advice on EMDR, so could we keep this on topic? I don't think there is much to be said about meds that will be that helpful and the OP does need our help on the issue she posted about.

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We have discovered, through years of trial and error, that I am one of the "less medication is more" people. All of the hard core AAPs and mood stabilizers have made me decompensate completely, or caused EPS. The only use we have for them is during an acute psychotic/manic episode for short term treatment. Lamictal is mood stabilizer-lite, basically, and it helps me a lot.

I'm still not stable, but I'm not in a mixed episode from hell (WORST. THING. EVER.), or morbid depression or psychotic mania. I'm just very depressed. Plus all the other shit.

I hear you saying that you are med compliant, even if that is no medication for you. I don't know your age, and that may change as you age or as new medications become available. Nightmares can be treated by beta-blockers, if you haven't tried that.

Anyway, trying not to derail your thread completely. You have explained your unique situation well.

Cross posted, Titania.

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I'm a therapist who uses EMDR as my primary method and I've also personally had EMDR therapy for my anxiety (regular old anxiety), performance anxiety, and grief. As a client, EMDR worked extremely well and also really fast (just a few sessions) on my problems. Recently I read Dr. Shapiro's new book "Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR." Dr. Shapiro is the founder/creator of EMDR (but all the proceeds from the book go to two charities: the EMDR Humanitarian Assistance Program and the EMDR Research Foundation). Anyway, the book is terrific! It's an easy read, helps you understand what's "pushing" your feelings and behavior, helps you connect the dots from past experiences to current life. Also gives lots of really helpful ways that are used during EMDR therapy to calm disturbing thoughts and feelings. I recommend the book to all my clients, and to all my friends and relatives! I just want to add that in my experience as an EMDR therapist and as a facilitator in training other therapists in EMDR (certified by the EMDR International Association and trained by the EMDR Institute, both of which I strongly recommend you look for in an EMDR Level II therapist) I have used EMDR successfully with PTSD, mood disorders, anxiety issues, depression, grief, body image, phobias, panic attacks, distressing memories, and bad dreams. And probably more stuff that I can't remember at the moment. Other EMDR therapists are more proficient in using it for eating disorders, OCD, dissociative disorders, etc. It's a very gentle method with no "down-side" so that in the hands of a professional EMDR therapist, there should be no freak-outs or worsening of day-to-day functioning.

During EMDR you learn a lot of great coping strategies and self-soothing techniques, many similar to DBT, which you can use during EMDR processing or anytime you feel the need. You learn how to access a “Safe or Calm Place” which you can use at ANY TIME during EMDR processing (or on your own) if it feels scary, or too emotional. One of the key assets of EMDR is that YOU, the client, are in control NOW, even though you probably weren’t in the past or during the bad experience. You NEVER need re-live an experience or go into great detail, ever! You NEVER need to go through the entire memory. YOU can decide to keep the lights (or the alternating sounds and/or tactile pulsars, or the waving hand) going, or stop them, whichever helps titrate – measure and adjust the balance or “dose“ of the processing. During EMDR processing there are regular “breaks” and you can control when and how many but the therapist should be stopping the bilateral stimulation every 25-50 passes of the lights to ask you to take a deep breath and ask you to say just a bit of what you’re noticing. (The stimulation should not be kept on continuously, because there are specific procedures that need to be followed to process the memory). The breaks help keep a “foot in the present” while you’re processing the past. It doesn’t make sense to dissociate during the process especially if that’s one of your regular coping strategies. So if it is, that’s something you and your therapist need to discuss in advance: what’s helpful to you when/if it happens, what grounds you and brings you back. Again, and I can’t say this enough, YOU ARE IN CHARGE so YOU can make the process tolerable. And your therapist should be experienced in the EMDR techniques that help make it the gentlest and safest way to detoxify bad life experiences.

Unlike CBT, there's no homework. Unlike Exposure Therapy, you're not forced to relive the horrors of bad events without relief. I can't say enough good things about EMDR. It's changed my life both as a person/consumer, and as a therapist. It's so satisfying to have someone come in for help and then to witness them get through their issues and finish therapy relatively quickly (compared to regular talk therapy, it's like night and day). I am both humbled by and grateful for this wonderful method that heals suffering.

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drpjl, I'm really glad that you can speak so passionately and informed (informedly??) about EMDR. Thanks for adding that.

I also want to highlight, though, that no treatment is "risk free". There are potential risks and benefits for everything.

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anarchist wanna-be, you are so right! There are potential risks and benefits. Nothing is 100%. I also want to add that when I had EMDR for my anxiety and grief I was taking klonopin (love that med!) and it didn't interfere at all. It seems to me that a lot of therapists out there, especially psychiatrists/psychopharms, are not in favor of benzos. For me they were perfect, just what I needed to help get through that period of time. And made the EMDR processing easier.

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@ Pattijl - thank you so much for providing that information. That is the kind of thing I have been searching for. I fully intend to utilize the Klonopin following sessions so that my sleep pattern is not more thoroughly disrupted than it already is, as that is a major mania trigger for me. The benefits are what are keeping me locked into this search for more information, because it sounds like something I could definitely use. How significant are the risks involved? I realize each person is different so there is no definitive answer, but from your experience what can be expected? Again, thank you so much for providing that information.

@ Antigone- Your situation is nearly identical to mine. I am so glad you understand. At 33, I have been dx since 15 and have been through the ringer. Everything given to me to control mania is either activating into hypermania or throws me into major mixed episodes with nonstop ideation. Benzos don't have THAT much of an effect on me either, but I will definitely be using the Klonopin following therapy to try to alleviate any potential problems.

Thank you all so much for your help and understanding.

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pixyprincess, as long as you a) have a really experienced EMDR therapist with whom you have a solid, trusting relationship (and trained by the EMDR Institute, certified by the EMDR International Association, preferably at the level of Approved Consultant - check out www.emdria.com and "find a therapist" so you can look up "credentials"), b) have lots of coping and self-soothing strategies in place both during a session and between sessions, c) plan in advance for any worrisome experiences during or after the session, and d) consider having someone from your support system available to be with you after the session or easily contacted, then you should be pretty risk-free. One thing I can tell you is that I was always exhausted after a session so I never planned anything after that required me to use my brain ;-)

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Thank you so much for that website! I did a search and found my therapist- listed as Full Member, Certified Therapist, Active. Is 50 minutes per session about average for EMDR treatment? I have heard of 90 minutes for it, but she has told me ours will be 45-50 minutes each. I am supposed to have an additional 4 sessions with her before starting the actual EMDR treatment; as of now, I have had an initial "intake" type of appointment. It makes me feel much better that she was registered by the EMDRIA. Thank you again.

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50 minutes works well for many people (and their insurance), and others prefer 90 minutes. You'll see what suits you! The "actual EMDR treatment" includes what you're doing with her now in the first 5 sessions. It's the "front-loading" of resources and doing the a, b, c, & d that I mention above. Good luck!! Just remember that you are in charge!!

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PP, I have no coverage for private therapy, either. I did the first four intake sessions, which are standard. We did 50 minute sessions, but occasionally 90 or even 120 as we needed to cool down after the EMDR, which is actually the shorter part of the session. I ended up seeing this trauma therapist for 2.5 years, just as an aside.

My EMDR provider was also well certified. You definitely want someone that qualified. The EMDR wesite I referred you to also has a lot of the academic articles you might be interested in.

I'm going to weigh in and disagree that EMDR is appropriate for people with dissociative disorders, or at least for most, as it clearly states in the literature. My dissociation was well under control in the beginning, and like I said, I permanently healed some pretty broken parts of myself during that time. But I began decompensating (in part because of the unstable bipolar, too, and the bipolar meds lowering the threshold for dissociation) and that combination led to dissociation and switching during EMDR, uncontrollable flashbacks and nightmares, dissociation to the point of losing time, cutting for the first time in 25 years, loss of ability to drive or care for my children independently, and a lot of other consequences. I'm not saying EMDR caused all of that; I'm saying that being dissociative and unstable (with the bipolar and the PTSD) made EMDR impossible. At that point, EMDR would only have contributed to my decompensation instead of helping heal me. It is one of my most fervent hopes that someday I will be stable and integrated enough to do EMDR again, because I am convinced of the science and I know personally that it works.

So I do believe there are risks if you do not fit the right profile for treatment. It doesn't mean it won't be appropriate at some other time; it just means that you need to clearly fit the requirements for safe treatment. And I hope you do, or will sometime soon.

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Thank you for that Antigone. It is the decompensation aspect that has my tdoc friend worried- last year during my major manic episode I had almost total decompensation; I started falling apart rapidly and quickly declined. He is worried that that may happen again which is why both he and I are scouring everywhere for whatever information we can get - he is doing some major networking to get more detailed info. Since I am not on bipolar meds (being on them caused a MAJOR escalation of symptoms last year- just straight activation) - I don't have that aspect to worry about. I have no problem with cost, time associated, etc. I will do whatever is needed to get myself to a healthier place. The cutting is something that I have had problems with for years, and my EMDR tdoc said that and the purging were the first aspects of my coping methods that we would work on. Hopefully if that could get fairly well resolved then I could deal a bit better. I have a feeling that this therapy will be going on for a WHILE - even if each session deals with one trauma (with very little overlap) then I'm still looking at over a year's worth (I can only do once every 2 weeks). Hopefully when my tdoc sees me next week and is able to get more in depth with why I am going she will be able to determine for sure if this is right for me.

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