SUD at 0?

In my experience in both supervising and seeing many clients SUDs usually can come down to a 0. It’s a question that comes up a lot in supervision. What I find is that as therapists we often move on too soon to our Phase 5 installation of the positive cognition when the client gives a 1 or a 2. We are all trained that we can take an ecological 1 or 2. I think that gives us an easy exit. But let’s face it, when we have been working so hard on our desensitisation phase, often we want some relief and to move on to the next bit. So read on if you want to hear my reflections and the 4 top reasons why I try to get the SUDs down to 0.

There is often something deep and meaningful in the 1 or 2s.

I often use the analogy of layers of an onion to think about what regularly happens in my clinical room. Once we have dealt with one layer, we then tend to go deeper and deeper and keep on letting things out. Often emotions, memories, thoughts or feelings are deeply hidden in our subconscious.

Suds at 0

What I often find is that I am at a point when I think the SUDs are 0 so I ask and the client says they are 1 or 2. What happens time and time again is that we focus in on what is distressing, go with that, then other channels that are significant and relevant get worked through. It might be a surprising emotions. It might be a connection to another memory. We need to just trust in the Adaptive Information Processing (AIP) system and allow that natural healing. Connections in the system can be made. 

We have difficulty installing the positive cognitions. 

Many times if we move on to our Phase 5 installation of the positive cognition too soon we may struggle to install it. This is because the client has not finished processing the trauma memory. The client has not cleared all the channels of association.

When this happens, clients may rate the VOC low. Perhaps between and 3 – 5. What I usually find is that if we have cleared all the channels of association then the client tends to rate the VOC at 6 or 7. So really we are making life hard for ourselves at this phase if we have not completed the previous one.

We are asking the client what distress they feel now, not how they felt then.

Often I can sit with clients and think they are at a 0 SUDs but when I ask them they rate a 2. Does this happen with you too? So we try and process another channel and nothing seems to be happening. So we go back to the target, rate again and SUDs are still 2. I’m sat there thinking, this is strange, nothing is coming up what’s happening? I might ask what makes it distressing, what is that 2 about etc etc.

What I often find is that the clients are rating how they felt at the time it happened. They are not rating how they currently feel now. Sadly we know we can never change what did happen. We can never erase the memory of what did happen. But we can get to a position where we can remember how awful it felt without feeling that awfulness in the here and now. So I might simply emphasise. “At this very moment, as you are sat here with me, on a scale of 0 – 10 how disturbing does that memory feel to you NOW”. 

Clients are rating what will come next 

Similar to how clients often give us a rating of what they actually felt in the past, sometimes they are also giving us a rating for something that they are fearing in the future. So if we are working on a violent assault when we are asking for a SUD rating they may be rating above 0 because they are worried that something similar could happen in the future. We know that no one knows what is round the corner, there is very little certainty in this world. We can process this as a channel or we can do a flash forward if it feels a bigger issue.

But generally again we have to remember that we are rating how disturbing that past traumatic incident feels to the client in the here and now, at this very moment in time, as they are sat here with you. 

So even though you might feel that 1 or 2 is enough, my advice is always keep going because usually it will drop further. 

PS If you are interested in learning more about the standard EMDR protocol, have a look at my webinar series


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