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EMDR Within a Family

System Perspective
Anita Bardin

ABSTRACT. EMDR is a method used to help the individual trauma victim process the psychological aftereffects of trauma (PTSD). The effects
of traumatic experiences, however, spread throughout the victims family.
The case presented here describes the treatment from three perspectives:
individual, family, and social context (eco-social). EMDR, used with a
nine-year-old stabbing victim, was integrated into wider therapeutic work
within the family. This integration widened the focus from the IP to other
members of the system, allowing the use of EMDR to spread to four out
of the five family members. The effects of the trauma on the family and its
members were most effectively treated by a combination of individually
and systemically oriented interventions. [Article copies available for a fee from
The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:
<docdelivery@haworthpress.com> Website: <http://www.HaworthPress.com>
2004 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Trauma, PTSD, EMDR, family therapy

Eye Movement Desensitization and Reprocessing (EMDR)
Treatment of a child victim of a traumatic event is most generally and
appropriately individually oriented. The goal is to help the victim proAnita Bardin, past Director of the Shiluv Institute for Couple and Family Therapy, Jerusalem, Israel, is a certified supervisor of Family Therapy and a certified EMDR therapist, currently in private practice, 19 Kfar Etzion Street, Arnona 93392, Jerusalem, Israel
(E-mail: bardin@netmedia.net.il).
Journal of Family Psychotherapy, Vol. 15(3) 2004
2004 by The Haworth Press, Inc. All rights reserved.




cess his experience through work with his memories and resultant
A relatively new technique for working with PTSD symptoms is
EMDR. Although research has shown it to be effective when working
with PTSD after a one time traumatic experience, such as will be presented in this paper (Wilson, Becker, Tinker, 1997), there has been criticism of the research methods and therefore of the positive findings
(Herbert, Lilienfeld, Lohr, Montgomery, ODonohue, Rosen, Tolin,
2000). This controversy and confusion in the published literature on
EMDR has also been studied (Perkins, Rouanzoin, 2002). After considering the criticism, there still remains an impressive body of research
confirming the efficacy of EMDR (Chemtob, Tolin, van der Kolk,
Pitman, 2000). For many clinicians, like myself, the use of EMDR in
our practice over many years has confirmed its efficacy in many cases.
EMDR is a psychological treatment for PTSD symptoms that is focused and structured in its application. It uses eye movements, as well as
other forms of bilateral stimulation of the brain, while the client concentrates on the traumatic memories and the concurrent emotional and
physical responses (Shapiro, 1995). This apparently enhances the processing of these memories.
EMDR is not a short-cut to resolution. After a traumatic incident,
. . . people have been found to go through a recovery process. . . .
Clinical observations and the experience of hundreds of therapists
show that the EMDR client goes though the same phases of recovery, but at an accelerated rate. Dysfunctionally stored information
that is unable to process is at the core of trauma symptoms (van der
Kolk, 1996; Herman, 1992). By processing the dysfunctionally
stored information, EMDR allows the information to move toward
adaptive resolution. Hence, rather than skipping recovery stages,
EMDR enables a natural progression. (Solomon, 1998)
Bilateral stimulation is usually effected through eye movement that
follows the therapists hand moving back and forth, but is also accomplished through other methods, such as a small instrument held in each
hand, connected to a battery, that pulsates alternately from hand to
hand. Both of these methods were used in the treatment presented here.
Experience has shown that children often respond quickly with
EMDR work. Lovett has confirmed that EMDR is most likely to work
quickly and completely in a healthy, well-adjusted child who experiences a single, time-limited, traumatic event (Lovett, 1999). The stan-

Anita Bardin


dard protocol, or procedure, for EMDR has been adapted in different

ways to meet the needs and understandings of children at different ages.
In the case presented here, the use of story-telling of the traumatic
event (describing the event from start to finish chronologically as remembered) was used initially. Later, the more usual procedure of focusing on the most difficult part of the event was incorporated.
Family System
For the many therapists today who understand the significance of the
systemic approach to families, it is clear that work with the trauma victim
must include an evaluation of the way the family of the victimespecially
a childhas been changed by the trauma (Riggs, 2000). The Trauma Unit
of the Shiluv Institute for Family and Couple Therapy that I work with
integrates its individual experience treating trauma victims, especially
through EMDR, with systemic and contextual family therapy. We see the
victim, his traumatic experience, and his symptomatic behaviors as being part of, and affecting, his family system. The family may offer support and help. It may, however, also burden and complicate the victims
recovery. The family, and any of its individual members, may suffer from
secondary effects of the trauma, thereby carrying their own post-trauma
symptoms. The family also needs to be seen within its social context.
That context, or larger eco-system, can be a source for support, but it can
also be a source for depleting the family of its own strengths.
The case presented here was referred to the trauma unit by the school
psychologist. Two boys in a family of five had been stabbed, and the
youngest, the nine-year-old boy, was exhibiting PTSD symptoms. The
initial focus of the treatment was on the symptom-bearer, but the reactions of the other family members indicated the need to widen the focus
to include them as well. The parents intense fears, and feelings of helplessness, inhibited their sons attempts to overcome their own fears, or
to feel protected. Parental guilt and weakness, as well as disagreements,
interfered with effective care. In order for the parents to help their sons
recover they needed help to recoup their own strengths.
The context of the family, and the traumatic incident that it endured,
were complex and crucial. This is the case of an immigrant family, in Israel only five months, in the first stages of major readjustments. Coming
from a patriarchal and traditional culture, the family entered a western
culture that relates to teenagers and young adults, as well as to the hierarchical roles of parents, in a different manner. Israeli culture gives
much emphasis and support to the development of the individual and his



independence. This often causes conflict in very traditional homes, the

more so when the homes have many other systemic and structural
changes following immigration. The reliance of the father on his sons to
be his translators, and therefore his buffer between himself and the authorities, challenges his status, role, and self-image. In addition, the father in this family had lost his work role, his ability to provide
comfortably for his family. He had changed from an independent small
businessman, to an underpaid and embarrassed dishwasher. And then,
in addition, he felt he had failed to protect his sons. The older sons were
also confused seeing their father change. They were embarrassed for
him. Seeing his weaknesses that they had not seen before, they felt the
need to be strong and compensate.
The change in family structure due to immigration is itself traumatic.
However, it is recognized, expected, and often time-limited as the family finds its way. During this period, the family is very vulnerableand
the members feel dependent on their surroundings, including the authorities. Within this context, it is possible to postulate that the care
given to this family after the attack contributed to the rapid success of
the treatment. The school psychologist sought out an appropriate treatment facility. The childs teacher and the welfare worker prepared them
for the home visit of the therapist. A volunteer immigrants organization provided partial payment for the treatment. And the therapist came
to their home, provided direct, active and focused treatment for their
most vulnerable member while including everyone. The contextual
caring of the authorities of the familys new country contributed to the
fertile ground in which treatment took place. The EMDR itself, the supportive social and official network, the parental caring, and presence
during the first session, all enhanced the treatments effectiveness.
Yoav, a nine-year-old boy, together with his 17-year-old brother,
Zack, were attacked and stabbed in their apartment in the middle of the
day. They had opened the unlocked door, expecting their brother to
come home from school. The attacker was unknown and has not been
apprehended. Both boys were stabbed 2-3 times and both required
emergency medical care and hospitalization of a number of days.
Two weeks after the attack, Yoav was at home, afraid to go by himself to any room (including the toilet) in the familys small apartment.
He was afraid to sleep in a room without his mother, and screamed un-

Anita Bardin


controllably in the middle of the night. He was unable to describe the

dreams and had no recollection of screaming. He refused to leave the
apartment by himself. He said that he did not remember the face of his
attacker nor the content of any of the frightening dreams.
Zack (17 years old), who had been in charge of his youngest brother
while the parents were at work, presented himself as functioning fine
and being symptom free. He was very concerned about his brother. The
father, however, in the first family meeting, expressed his own concern
that Zack was at the age where he wouldnt admit to being afraid.
The third and middle son, Mann, 14 years old, arrived home from
school on the day of the stabbing to find police, ambulances, and general confusion. He spent that first traumatic day with relatives. The parents each sat with a wounded son in the hospital. Each boy had been
stabbed near the heart and was lucky to be alive.
The parents, in their forties, came from a poor society, carrying with
them great hopes for their new home. They are warm and caring and had
functioned adequately, raising and providing for their three sons. However,
they were in a vulnerable stage of the absorption process of immigration,
with poor language skills, a drop in work status, and limited resources. They
were dependent on the authorities and the society around them. After the
attack they were exhaustedboth physically and emotionally.
The school psychologist from Yoavs elementary school knew about
the newly created Trauma Unit. The unit is staffed by four advanced
EMDR-trained therapists who are all experienced family and couple therapists. The unit provides short-term focused therapy, using EMDR as its
main modality, for the treatment of PTSD after a traumatic experience.
The family had been prepared for my home visit by the area social
worker and the school psychologist. The parents wanted help for their
frightened son and organized themselves to be at home, with the decision that the two older boys would translate between their native tongue
and Hebrew.
Meeting in their home was not an easy decision for us. The question
of working with the after effects of a traumatic attack in the very place
where the attack took place, with the offender still not apprehended,
raised questions for me and my team. The apartment itself brought back
memories. We decided that we had no choice but to try because Yoav
was still not physically well enough to travel and transporting the



whole family to our clinic would be too expensive for them. It turned
out that working in their home was a wonderful opportunity.
The First Session, Friday, with the Whole Family Present
After talking to the family and hearing the story from them, I learned
more of Yoavs symptoms. I also got a sense of the warmth and caring
among the family members.
Yoav was eager to try my special help and chose to use the hand
pulse instrument first. Later we also used direct eye movements. Yoav
and I sat near each other, with the rest of the family circled around us.
We established a safe place, a visual image of a place where Yoav had
been and which was associated with lovely and calming feelings. (The
use of positive and calming imagery is important in case the EMDR
work brings out strong emotional reactions from which the patient may
need to take a break [Shapiro, 1995].)
As Yoav could not recall his screams and nightmares, I decided to
start with the retelling of the traumatic event (Lovett, 1999). Yoav held
the hand pulse and told me his story. He talked quickly, quietly, at times
with inappropriate smiles, in simple and confused Hebrew.
Yoav: I came from school to home and my brother told me to eat.
Therapist: Which brother?
Yoav: Him (points to Zack). She (points to mother) in work, he (father) in work. Me and him we were at home. When I came in, we
left the door unlocked . . . that someone may come.
Therapist: Which door? To the apartment?
Yoav: Yes. After I came, we made food. And someone suddenly
knocked at the door. I forgot that father was at work and wont be
coming and I said that it is father . . . Come in. and someone
came and asked where is . . . I dont remember.
Therapist: Your familys name?
Yoav: No. A different family. And Zack came and said, What do
you want? and he said the family so-and-so, and I was at the table,

Anita Bardin


and suddenly, Do you have a phone? We said no. Can I look out
your window?
Therapist: Zack wanted to close the door?
Yoav: Yes. Suddenly he came and stabbed me and pushed my
brother. I was in shock and saw his knife do this and that. When
Zack said, Mommy, Mommy, he left. I got up.
Therapist: He stabbed you?
Yoav: Yes. Both of us. He stabbed Zack and then me.
Therapist: Where?
Yoav: In the arm, near the heart. He stabbed Zack three times. The
police came.
He concentrated and cooperated. We continued as he described the
ambulance, the hospital, the doctors, the pain of the treatments. My interventions were questions aimed at both slowing him down so that he
could concentrate on all the details, and connecting him to his feelings
of fear and sadness that began to appear on his face. It was hard for him
to express those feelings. For instance, after describing the stabbing of
his brother in detail:
Therapist: You saw your brother full of blood?
Yoav: I saw his back with blood.
Therapist: What did you feel when you saw it?
Yoav: Nothing.
It was also difficult for him to describe details. This first version of his
story was brief and quick. Details only came in response to my questions.
Throughout Yoavs telling of his story, the family sat in absolute silence, listening. There was pain on each persons face.
When Yoav finished, I spoke with each family member in turn to hear
his story and his own reactions to that traumatic experience. (I did not use
EMDR with them at this point.) Each member spoke with feeling, and each



one was listened to by the others. The feeling of tension and sadness in the
room was accompanied by concern and caring. The strengths and ties of
this family were very clear. The first to speak was the oldest son, Zack.
He described the attack, his feelings of responsibility, but insisted that he
was now fine. Dad spoke of his own terrible feelings of guilt. He looked
depressed and broken. He had brought his family to this new country, and
had been unable to protect his children. He had almost lost them. He was
questioning his whole world view, his religious beliefs. Was God punishing his children because of anything he, father, had done?
Father: I say to myself my son is nine years old, where was his father, where was I, that this happened? What was the boys fault?
Mom also expressed her confusion. She also questioned her basic beliefs.
Why had God punished her boys? However, she was able to express the positive feeling that, although wounded, her two sons had escaped death. Mann,
the 15-year-old, described his arrival home at the scene, and the confusionwith ambulances and policethat he found. He also expressed his concern for his younger brother, but insisted that he was functioning well.
The family united around the subject of Yoav and his fears. His fears
and symptomatic behaviors provided a target for the family systems
great concern and worry, thereby allowing each member to minimize or
avoid his own fears and anxieties. Helping Yoav work through his anxieties would not only be strengthening and enabling for him, but it would
also help free the other family members for their own therapeutic work.
So I returned to Yoav and asked him to imagine approaching the bathroom. How far could he go? Two steps. He was asked to try nowand
he got almost to the room. Then he called to his mother, Im afraid.
We then used eye movements for concentrating on the fear, on where he
felt it in his body, and on what would help.
Using eye movements, we went on.
Therapist: Imagine seeing the bathroom at night. Tell me about it.
(He is following my finger for eye movement processing.)
Yoav: Someone is coming.
Therapist: Think about that someone. . . . Who are you afraid of?
Yoav: Thieves! But I am afraid!

Anita Bardin


Therapist: Think about the fear . . . Where do you feel the fear in
your body? . . . Does it hurt anywhere?
Yoav: Doesnt hurt anywhere.
Therapist: Right now . . . think about what you are afraid of. What
you feel . . . It is night, you are afraid.
Yoav: Yes. That someone will come.
He was quiet. He continued with the eye movements, following as
my hand went back and forth across his field of vision. After some
quiet, I decided to probe for coping strength.
Therapist: What will help you to feel less afraid?
Yoav: Dont know. If I go with mommy, brother, father. If there is
no one to go with me, I am afraid.
He was again quiet.
Therapist: Stay with that thought.
He concentrates, and remains quiet.
Therapist: Is there anything else that can help you?
Yoav: Someone will come and stab me, and me and my brother
will be in the hospital.
Therapist: Think about that.
He is quiet. He continues eye movements.
Yoav: In the hospital the doctor will take care of me.
Therapist: Think about that.
Yoav: One more day and I will be home. One more week I go to
school. . . . Thats it. No more.



Therapist: Anything else comes to mind?

Yoav: Nothing.
Therapist: Nothing?
Yoav: Wait. (Closes his eyes very hard.) I go to school, I have
friends, thats it.
The EMDR processing has helped Yoavs own positive strengths to
re-emerge. His desire to overcome his fears is clearly stated now. His
fears are not gone, but his positive beliefs appear stronger.
A friend of Yoavs arrivedand offered to wait in the other room.
Yoav, naturally, became restless and soon said, Enough. He wanted
to play with his friend. He and his little friend soon said goodbye and
went out the door. The father quickly said goodbye and left. I was talking to Zack, when I saw the father return and talk to Mom. They explained to me that Yoav hadnt wanted father to accompany him and his
friend. Father was so fearful himself that Mother had to hold him back.
This was the first time Yoav had left the apartment without a parent
since his return from the hospital. Both parents were surprised. Apparently, Yoavs positive beliefs were indeed getting stronger.
My telephone follow up a few days later, revealed that Yoav was no
longer screaming in his sleep and had slept though the night. This was
an impressive change indicating, again, that processing had occurred
within Yoav. And this change allowed the family, especially the
mother, to get some sleep. However, Yoav now had frightening dreams
in the morning which woke him up. He was still fearful, but had returned to school and, although needing an adult escort on the way to
school, was cheerful while there.
Second Session the Following Tuesday; Mother and Yoav
My second home visit found mother and Yoav waiting for me. As
soon as Yoav saw me he cried out proudly, I went to the bathroom
alone! However, he was still afraid to fall asleep at night.
EMDR work with Yoav was done with the hand pulser again. As the
initial target for Yoav to concentrate on, I asked him to think of the
worst part of the story. This techniqueconcentrating on the worst, most
frightening memoriesis used when the client appears strong enough. It
often leads to faster progress and change. Again, my interventions were

Anita Bardin


aimed at slowing Yoav, getting more details, and trying to connect to

feelings. Yoav described seeing the knife going into his brothers back.
I helped him to describe this in detail. He got restless. He, again, could
not picture the face of the man. In response to my probing for possible
self anger, or anger towards his brother, he expressed denial.
After a break, he chose to work with eye movements, while I asked
him to tell me what he would like to do to the man if he were here. Hit
him. Hit him hard.
As I worked with her son, Mom listened intensely, and the pain on
her face deepened. When Yoav and I finished, I asked her if she would
like to work with me too and she readily accepted. It turned out that she,
too, was suffering from nightmares. I gave her the hand pulsers. Her
work followed the standard EMDR protocol (Shapiro, 1995) where the
client chooses the negative image, describes the negative feelings about
himself that the image brings up, where in his body he feels it right now,
and rates his own feelings of stress and distress. The client then states
how he would like to feel about the trauma (e.g., I did the best I could
or Its over). Her negative feelings about herself as a mother that had
failed her children came out with great feeling and tears. While expressing deep feelings of self-blame and crying painfully, she continued to
hold the pulsers. With some cognitive interweaves (Shapiro, 1995)
from me, her own strengths and inner resources brought her to the acceptance that she is a good mother, that things happen for which we cannot find satisfactory explanations. She felt much relieved and stronger
after the session and did not desire more EMDR work. She encouraged
me to work with her husband as well.
Being in the house provided me with the opportunity to work directly
with Yoav on his fears about going to the kitchen, and going down the
stairwell alone. I role modeled ways of encouraging Yoav to move forward in small steps. We all applauded him as he approached the kitchen
alone! And when Yoav accompanied me down the gloomy stairwell and
out to my car, he was proud of himself indeed!
In the follow-up telephone call, I learned that Yoav had experienced
some nights with no screaming and no nightmares.
Third Session, Friday (One Week After Our Initial Meeting)
In the third home visit, Yoav told me about two dreams, both of
which showed attempts at self-defense. In one dream he fought back
and ran after a bad man. The second dream also showed his continued
(and understandable) anxiety about being protected. In that dream



mother will become sick. Although bad dreams returned occasionally, Yoavs general mood and functioning remained improved.
During the following three weeks, the sessions were held at the Institute, with different sub-systems.
Fourth Session, Monday (Four Days Later)
The whole family came together to the Institute. We divided the session between individual EMDR work with the father and work with
Yoav. The father was able to start with his negative cognitions of himself as a father now. He went on to question how he feels he must have
sinned. (The sins of fathers are visited on their sons.) It became clear
that, although associating and verbalizing spontaneously and with a lot
of affect, he found it very hard to concentrate on the eye movements and
the efficacy of the EMDR was certainly not clear. He would concentrate
and follow the eye movements and then break off to talk to me directly.
He spoke at lengths about his responsibility for bringing his family to
this place that had hurt them. He spoke of his family, his change in role
and status in this new country. He spoke of home and of his brothers
who had moved to America. Although the session seemed to be diffuse,
it was cathartic for him and he felt some relief after. Towards the end of
the session, I used the eye movements to install and strengthen his inner
resources, his positive attributes, and his strengths as a caring father. He
left feeling calmer.
Individual Sessions with the Oldest Son, Zack
The oldest son, Zack, came at his own request. He had seen the improvement in his family members. Despite his proclamations to the contrary, he very much wanted to work with me on fears. We were able to
do a full protocol and he expressed feeling much more positive afterwards. Without the presence of his family, Zack was able to express his
feelings of being afraid, feeling weak and small, especially when out of
the house. He, too, used the hand pulser and was able to focus on these
negative feelings that he has been experiencing since the attack. He
shared his associations during the processing. He expressed his anger at
what had happened, at being in Israel and leaving his native country. His
pained affect accompanied his detailed description of the attack:
Zack: The man hugged me tight and stabbed me in the back. I fell
to the floor. I saw his feet go to Yoav. Yoav didnt make a sound.

Anita Bardin


He described the hospital: First time I ever saw my father cry, and
his feelings of responsibility: I did wrong. It was because of me . . .
but after further processing, he said: It was not really my fault. We always left the door unlocked when Mann was expected home.
His eyes had been closed for most of the processing. Now he opened
them and said, I feel better. I feel that it is over.
In his second and last session (the following week) Zack said he continued to feel better, felt no need to do EMDR work. He was less afraid
and it was clear to him that he couldnt have successfully fought off a
man armed with a knife. Zack was involved with his work and school
and making plans for the future.
Final Session
In the last family session, I worked part of the time with the parents
together and part of the time with Yoav and Mann.
Father did not want to work individually. While meeting the parents
together, they both described improvement in Yoav, yet disagreed on
how to proceed. Mother was able to express her fears, and her recognition that she needed to, and could, control her fears in order to allow the
boys to feel safer. She was angry at her husband for being fearful around
the boys (e.g., calling home 6 times a day to check on them). Fatherdepressed, and suffering more from his new immigrant role and low-status
workneeded more help. We worked together in the session on how to
help them function better cooperatively so that they could provide reassurance and support to their sons. Father was able to accept his wifes
criticism and spoke of how he would deal with his fears better. Both
were encouraged to help Yoav build on his strengths. He was ready now
to be encouraged to let go of some of the dependent behaviors that had
developed as a result of the trauma. Yoavs own glee when he moved towards independence was a clear message for the parents.
In Yoavs part of the session, in the presence of his brother Mann, we
again used EMDR, focusing on a dream that expressed more of his fears
and feelings. The processing of the dreams brought him to more positive and confident feelings. He was able, at the end, to say that he has a
little fear left in his body, but also believes that what happened is finished and over.
Treatment was ended with each member feeling more confident, and
more able to put the incident in the past.



A follow-up call with the school psychologist, a month later, informed me that Yoav had finished the school year successfully. He exhibited good mood in school and was active socially.
Follow-Up with Family
My last contact with the family was a telephone follow up call two
months later. Yoav answered and said he wanted to tell me that he had
walked alone in the neighborhood streets! He was proud and sounded delighted. Mother got on the phone to confirm that he had gone alone to his
summer day camp. He was generally fine. She felt they all were. They
had also decided to move to a new apartment. Zack came in to the Institute to get a letter for the army about the treatment he had received. He
wanted to make sure that nothing I wrote would interfere with his being
drafted. This too indicated how successfully he had overcome the trauma.
EMDR treatment for PTSD symptoms of a child after a one-time
trauma was used in an approach that integrated the individual work with
the family and general systems approach. Each method enhanced the
other. The boys ability to process his fears and reactions was supported
by a caring family that participated in his treatment. This participation enabled the family members to observe the strengthening of their youngest
and most vulnerable member. Yoavs distress had been acute and had
worried everyone. It had also provided the family with a focus point. The
family system began to reorganize around this point, enabling each other
member to avoid working through his own reactions to the traumatic incident. These reactions were intensified because of the overall vulnerability
of the familys position as new immigrants. As Yoav got stronger, the family members were able to widen their focus to include each other and themselves. In turn, each one then asked to receive help. In addition to the
EMDR work, we worked on parental differences about how to handle their
own fears in a way that would allow their children to recover. We also
worked on ways to reinforce positive behavioral changes, thus enabling
the parents to move from confusion and sympathy to active support.
EMDR works with the inner processing of traumatic memories of an
individual. The family net that surrounds that individual has also felt the
trauma. The individuals experiences, and the familys experiences,
both direct and secondary, are, as we know, intimately interwoven.

Anita Bardin


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