EMDR Chat #43 What about CBT and EMDR Therapy?

Is it possible to use insights from CBT to enhance your practice of EMDR Therapy?   In this episode, Curt and Michelle talk about how EMDR Therapy and CBT can complement one another with guest Christopher Schamber, LCSW, who will be teaching an advanced course about EMDR Therapy and CBT.

Transcript

SPEAKER_02 0:13

Welcome to EMDR Chat with Kurt and Michelle. I'm Dr. Curtis Roundsen. And I'm Dr.

SPEAKER_01 0:19

Michelle Gottlieb. Hey Kurt, guess what? What? We have a guest today. You never told me this. I know, it's a secret. I didn't want to tell you. Okay. But it was a surprise. I wanted to surprise you. Surprise!

SPEAKER_02 0:32

I know we have a guest. Go ahead, introduce this Jimmy. Thank you.

SPEAKER_01 0:36

So our guest is Christopher Schamber. And Chris is someone that I've worked with on his journey of becoming certified. His passion for EMDR therapy knows no bounds. But he has another passion as well, CBT. And you know, we often talk about EMDR therapy not being CBT, but did you know there's actually ways that that it can they can complement each other?

SPEAKER_02 1:01

Absolutely. A lot of it can be complemented. I'm really interested in hearing it. Because, you know, all of us old folks tended to come from a CBT orientation before EMDR came along. So that's really good.

SPEAKER_01 1:15

So, Chris, would you first just tell a little bit about your background and you know how how do these things complement each other? Yeah, who are you? Who am I?

SPEAKER_00 1:26

That's a great question.

SPEAKER_01 1:27

It's a philosophical question, I think.

SPEAKER_00 1:30

Yeah, yeah. I looked in the mirror and asked that earlier. So um, yeah, my name is Chris Chamber. I'm an LCSW uh practicing here in California. Um I have worked in a few different types of settings, um, close to seven and a half years working with LA County Department of Mental Health, worked with drug court, DUI Court, um, alternative high schools. Um, so there's a lot of different areas in which I practiced. And I guess, you know, my journey with these modalities was kind of interesting. Uh, like, like a lot of people, I was exposed to CBT in grad school. You know, I think that's one of those things where they they want to give you very concrete skills to sort of put you out into the world and start doing some some good work. Uh so initially, you know, that that yeah, that was that was kind of my exposure in in some ways with CBT was was like worksheets. And I found it like incredibly kind of frustrating and confining after a short time. So I was like, ah, you know, I don't know if this is this is for me. Um, but I kept hearing about EMDR. I had a professor um who was trained in EMDR and swore up and down about it. So I was like, okay, you know, that's something I'll I'll get to. Um and then I've I I moved on into the workforce. Um and uh through LA County, I had the opportunity to connect with an organization called the Academy of CDT. Um they are a pretty pronounced um organization in terms of training people on cognitive behavioral therapy. So I uh that that was that was a path that, you know, as I went further and further down, I was like, wow, this is this is really exciting. It's not just worksheets, you know. It's it's there's a lot more to it. There is room to be creative, there is room to kind of bring in all these different kinds of interventions as opposed to something super duper prescribed. Um, so I went down that road, became certified. Um, and then as time went on, I, you know, I working in the uh Department of Mental Health, um, you know, trauma was this thing I was constantly experiencing. Um and while I found, you know, CBT certainly has effective ways of getting to that, like exposure response prevention and all of that, which I did find helpful, I always was finding like I mean, I'm missing something. You know, I I couldn't quite touch some of the underlying wounds and and beliefs as as easily or as well as I wanted to. Um, so then you know, it was around that time I started reconsidering, okay, yeah, I remember this EMDR thing. You know, let me let me look into that. Um, I trained with you all, and it was a uh, you know, this is an extreme word, but a borderline religious experience, you know, just sort of like like kind of just being able to hear things from this other perspective that I I hadn't been exposed to, but it made so much sense. And it made so much sense in the work that I was doing every single day. So that really encouraged me, you know, kind of going down this path of becoming EMDR certified. I'm I'm a consultant in training now, hoping to get through that path as well soon. Um, and and similarly though, you know, I I was also still very much in the CBT world and kind of continued that, became a uh CBT trainer consultant, um, leading trainings, consultation groups on that on that. And I I I love that too. So it's it's been kind of a funny position, kind of being a a little bit split between two worlds. Um, so I'm I'm finding that I I do a lot of translation in my head and also in some of my consult groups of like trying to use like language or ideas in one area and and help move it to the other.

SPEAKER_02 5:22

Which is uh a great thing that we have to do when we have two have different paradigms. So I'm curious, as you I how do you translate that? How have you used CBT and EMDR to complement one another?

SPEAKER_00 5:35

Yeah, I think uh for for sure, it all starts with a solid understanding of both models. Like you really need to know what is the theory behind these things, because if you're not careful, it can become really dangerous in a lot of ways if things become too muddled. So for me, I uh initially, like one of the things I'm always asking myself is you know, first of all, I do a case conceptualization, like what is what is going on? You know, how is this contributing to maladaptive behavior, thoughts, feelings, whatever. And then, you know, from there I try to understand like, you know, what are my options here? How can I best understand the problem? And how can I uh use these different paradigms to make sense of it? And so I think from my standpoint, you know, there are areas of overlap, certainly. Um, you know, in the cognitive model, uh the AIP model, there are different ways in which we can kind of see them bounce off of one another. So I try to, both when I'm I'm doing my my uh direct services uh clinical work, as well as when I'm consulting with people, I I try to I try to keep that part in mind.

SPEAKER_01 6:50

Right. And this is kind of my question is, you know, we talk about, I mean, both CBT and EMDR therapy are research evidence-based modalities. I mean, there's probably the these two are probably the most evidence, you know, most research. Um, and what we know from the EMDR world, and I'm gonna guess the same for CBT world, is that um fidelity to the model keeps it the most effective. So how do you keep fidelity to each model um and still make them complimentary, right?

SPEAKER_00 7:22

Yeah, um that is a uh personal frustration that I run into a lot, is there's a lot of people out there that are um surely well-meaning, um, but they uh don't necessarily stick to the model. I mean, you know, certainly in in EMDR world, right? We we sort of encounter clients out there that say, oh yeah, I I I did EMDR for a little while. It was terrible. I just got I, you know, I felt worse and worse and worse. And um I had a colleague that was describing this to me. She was she had an experience where she went in to work on um, you know, a dog attacked her at one point. And so I I asked her more about her experience with EMDR, and like, man, it it sounded nothing like the standard protocol. I it was really something like, you know, do you know, kind of do like one set of bilaterals and talk about it for a while, and then and and so very quickly it it became obvious, like, okay, you know, this is this is part of the challenge of of this sort of work, I think, is you want to proliferate these great models, these great treatments, but there also needs to be some sort of standard of care, right? Because that that is what is researched, that's what we know is is effective. So certainly, you know, with with um CBT as well, CBT has um different ways in which we evaluate it uh at the Academy of CBT. Um there are there's this uh cognitive therapy rating scale. It was developed by uh Dr. Beck back in 1980, um, still is is used today, uh, which is an amazing thing. Um But I, you know, that that has like very specific, concrete ways in which, like, if I'm watching video of a therapist doing CBT, I'm kind of grading them in each of these domains. How how adherent, not not like how good the therapy is, but like how adherent they are. And I think some of those principles apply to EMDR too. You know, just like, you know, good therapy, that that is sometimes a subjective idea, but certainly we can we can measure how adherent they are to the protocol.

SPEAKER_02 9:32

Yeah, uh EMDR has uh uh uh uh f uh fidelity scales that's used in research also like that, so they you know, an outside observer can look and and say, see whether or not someone's actually utilizing the protocol as it was developed. Uh I'm curious, you know, because you know in EMDR therapy, part of one of the parts of uh phase three, the assessment or uh activation phase, is that you know we break down the components of the memory into it's the images, cognitions, emotions, sensations, and you know, the C part of that is cognitions. I'm curious, how does uh does the CBD, the background that you have, uh play a part in your helping uh elicit those irrational negative beliefs that are imparted at the time of the trauma?

SPEAKER_00 10:18

Yeah, yeah, absolutely. I think for me, you know, by the time we get to phase three, of course, we're wanting to move through that quite quickly, you know, in a handful of minutes. We want to kind of light up that target so that it is really tangible and working through the nervous system. So that sort of work I I try to do even in phase one. Part of my my idea around history taking, especially with some of my CBT background, is I'm trying to understand like what are the underlying beliefs? What is the core belief to use a CBT uh term? What is the core belief that has emerged from the exposure to these traumatic experiences? Because if I if I know that, um, first of all, that helps guide my treatment planning. Like, oh, I kind of thought that this one memory was connected to this, but like the core belief is totally different than everything else. So that that kind of adds a little bit of organization in my brain as far as like what what is on a treatment plan versus another treatment plan. But also once once that is established, and certainly there are different ways in CBT, there's there's things called like guided discovery or Socratic questioning that can kind of help dig underneath and and find those core beliefs. Um, once I find those, I kind of write them down on the top of my treatment plan. And that always is going to be part of my phase three. I'm I'm kind of asking, I'll give the the client an opportunity to be able to articulate and look for the NC. But if it if it's too too slogged down, if it's something that we're just not getting there for whatever reason, I'll I'll throw that out there. I'll ask, like, does that does that feel like that resonates? And and you know, 95 times out of a hundred it usually is good.

SPEAKER_01 12:02

You know, um, and Kurt, you're gonna be able to tell me all this in just a second. Shapiro wrote a book years and years ago, obviously, at this point, um, talking about how integrative EMDR therapy is. Um, and so I'm hearing you, and it's not just CBT, it's all kinds of different therapies that can be integrated into EMDR therapy. But I hear phase one and phase three can really integrate well with EMDR with CBT um in ways that again keep fidelity the model. Are there other ways that it's complementary?

SPEAKER_00 12:40

Absolutely. You know, phase two, I would argue, is an enormous part. If you're if you are thinking of utilizing CBT uh concepts with with your EMDR practice, uh phase two is enormous. Um you can even argue if you if you had a client that you'd been doing CBT with. Sometimes we we do this, right? Where we we're working in one model and then um the clinical picture changes or or whatnot, and then we we make a shift, right? That if if you were doing CBT with that person, that was phase two. You were that was part of the preparation for the the reprocessing that you're doing. So um that in a sense, in a sense, CBT is is is a phase two in and of itself. And also there are a lot of skills. There are a lot of skills that CBT has. Um, it is it is a funny model in the sense that it's it's a huge umbrella. There are so many different things that are connected to CBT, like DBT, of course, is is one that I I am trained in DBT. I I use some of those skills, certainly. Um they are great for distress tolerance, emotional regulation, you know, those sorts of things can be really helpful if a person has to stop during the reprocessing phase. You know, those are things that we could have taught and practiced and and hopefully turn to. Um, certainly when we're talking about um phase seven closure, you know, that's another way that we can kind of bring in. Um, you know, this these are things to kind of not as homework, EMDR doesn't give homework, but these are things to sort of practice if you need to, you know, over the next next week, like in terms of regulating yourself. So CBT has a lot of options around that. Um and I, you know, I I think that phase phase four, some of the cognitive interweaves as well, you know, there's there's a lot that if you can one of the hardest skills in CBT, I think is the guided discovery part, the Socratic questioning. It's it becomes very um, you know, can become very uh intellectualized, which is not always a great thing in EMDR, but it it is something that I find can really help with cognitive interweeds. If we've hit a stuck point, if we're looping for some reason, um I try to fit in one one question, you know, I don't want to derail the process, one question that can really help move the client, jostle the stuckness. And I I find that that's that's a CBT skill that translates pretty well.

SPEAKER_02 15:06

Yes, I can see that 100%. You know, and particularly uh cognitive interweaves, I find that we you know we teach that, of course, but your own experience and your own background often is very helpful in developing uh useful cognitive interweaves. So I can see that very uh powerfully affecting that. Good.

SPEAKER_01 15:28

So I have another question then. How do you know how do you make the decision, Chris, with the the the background, the wonderful, amazing, thorough background you have with both of these modalities of with a client, when do you do CBT, when do you do amateur therapy?

SPEAKER_00 15:45

Yeah, that's a great question. I think for me, and I I'd love to hear, I I you know, if other people kind of practice this sort of like dual, dual approach at different points, I'd love to hear other people's perspectives as well. For me personally, I I find that again, it all starts with like clinical uh formulation. What is the what is what is it that's happening, right? Um, what is the window of tolerance? Um I think that certainly in my mind, anytime there is any sort of somatic stuff going on, I'm like almost immediately thinking EMDR. Um that that is something that CBT has different ways over over the long run. It can affect that. But EMDR is such a clean way to really address that piece. So that that's that's one thing that I take into consideration. Um, there are a lot of people out there, though, that um and and you know, working in the community mental health field as long as I I I did, I saw a lot of people that just could not resonate with positive cognitions. Um it was it was like, you know, I I could I could give one to them, but that would be like give it like telling them a story that they didn't believe, right? So I I found that um with CBT, one of the things that I found helpful in terms of the cognitive restructuring and kind of using that sort of that sort of paradigm, I was able to kind of help people at least at least grasp or connect with the idea of a PC. Maybe not, maybe it's not something that's totally uh bought into. That's okay. I don't need them to be 100% bought into it. But I found that that that helped that that has helped me with the EMDR process on those particular cases, because if I can get them to sort of buy into that, like, okay, there is a chance of of the PC um having validity, then there then I'm able to oftentimes move through phase four and especially phase five more more successfully.

SPEAKER_01 17:53

Absolutely.

SPEAKER_00 17:54

Yeah, good.

SPEAKER_01 17:56

Um and you know um you and I talked about and thought about that oftentimes people who are trying to make that transition from fully CBT to EMDR therapy can make it uh can be difficult for people to do that. Can you speak I I'm gonna I'm gonna mention your training in just a minute, but um can you just speak a little bit about um you know that bridge?

SPEAKER_00 18:24

Yeah, it's it's a challenge, I think. You know, it's a challenge for a few different reasons. Uh for one, there's there's the very human element, right? Of it's hard to be in the learner's position sometimes. It's a very vulnerable place. Um, I'll like speak for my own experience. Like I always have this urge, I want to, I want to know everything, I want to be good at it, it's important to me, you know. So to try something new is it's just inherently difficult, you know, like there there is there is some some challenges around that. And there's also the fact that sometimes people, when they talk about switching from one model to another, um, there's there there are some concerns that a person might have. And I just want to validate that. Like it's good to have that if that's your your response of a little bit of worry when you're learning something new. I think to to a degree, that's a good thing, you know, because there is a lot of responsibility in that. Um I I think again, if you always know what you're doing and why, that that really helps. I, you know, I really I'm one of those people that I I just find that everything we know, everything we learn somehow connects to itself. Um I I you know I grew up more in like the arts area. That was kind of like an original uh passion of mine. And um, you know, when I started going into mental health, part of me initially was like, oh, you know, this is totally different. And then the more I did it, it's like, wow, it's it's all an extension, right? It's all an extension of itself. And I I think that when we talk about when we tell clinicians to bring your authentic self, I think that's part of what what we're saying is like you have like innately human, unique perspective. And there is something that is extremely therapeutic about it. Um and and what you say, like bring bringing the science on top of the human side is is something that is really helpful. So I I think, again, if you in terms of these different different models, I mean, if you know what you're doing and why, like trying to pick really build understanding of theory, um, of the practice, the different nuances of these different things, um, that's a really solid place to be. It's a little uh some this is a metaphor I use sometimes. It's a little bit like jazz. You know, you really have to have a solid understanding of music theory to successfully perform jazz. Jazz breaks all the theory sometimes. Not it, but it does it because you know exactly why you're doing it.

SPEAKER_01 20:58

Oh, it's a beautiful analogy.

SPEAKER_02 21:00

I use the same analogy, Chris, because uh that's where creativity and this whole thing. What I also love is that you're talking about two very research, as Michelle said earlier as as we began, two very empirically validated approaches and bringing them in and integrating them together, uh not only the effectiveness of what that brings, but the fact that people that are doing that know that they're doing empirically validated treatment. And that's what I really uh really approve of. That's wonderful.

SPEAKER_01 21:29

So we are about out of time, um, as I alluded to. Um Chris is doing an advanced training for us on April 17th. No, seriously, did you not know that? Oh, my God.

SPEAKER_02 21:41

I can't imagine us having someone on our our podcast that's going to be doing a workshop for us, Michelle. So it's almost like a marketing thing almost.

SPEAKER_01 21:53

So April 17th, um it's called The Cognitive Bridge strengthening your EMJ product practice through CBT Incidents. And again. I think for those people who are trying to make that transition, trying to figure it out, I think it's going to be really helpful for you. It will become an on-demand as well. As always, if you're a listener, scroll, you're going to find a 10% coupon so you can go uh listen to Chris some more. Uh, but Chris, thank you so much for all that you do and and all that you're continuing to do. Thank you.

SPEAKER_02 22:20

And this is a wonderful. Thank you so much for having me. It's a wonderful introduction for what we're going to get in that workshop. So thank you very much, Chris. Yeah. Absolutely. All right. Thank you. Until next time.

SPEAKER_01 22:30

Stay well, everyone.

SPEAKER_02 22:32

Go with that.