Dear Dr. Paulsen,

Certainly I meant no disrespect by using your first name. I am new to this list, but in my 7 years on the EMDR Institute Discussion list (for professionals only) "Dr." or "Ms." has rarely been used, and as I look around this site, e.g. the CBT forum, it seems to be the exception rather than the rule.

I recognize that ego state work is the focus of your interest and approach and wish to acknowledge your expertise in this area. I appreciate your taking the time to respond to my post. I would like to briefly comment on a couple of your points.

In terms of my workshop, I have given it about ten times since Dr. Paulsen took it, and after each, I do more fine-tuning. Though the evaluations have always been high for this training, it is an improved workshop now. The approach itself has been fine-tuned; and the workshop format now includes lecture with clinical examples, one live and two videotaped demonstrations plus several mini-demonstrations, small group discussion, and two practice segments. There is also a 150-page book that is included with registration. One of the challenges I find is that there is only so much that I can put into 13 hours. Sometimes the need for ego state work will come up with I-N; most often it doesn't. I trust that clinicians working with highly dissociative clients have the training and support for doing so. Dissociation and ego state work is not the subject of my workshop and so requesting . (That is Dr. Paulsen's workshop! Moreover, if my approach is used well, with sensitivity to the individual client, the actual need for ego state work (in the context of I-N) is very much minimized. I see no problem with shifting from inner child work to ego state work when needed.

Dr. Paulsen wrote:
"However, it delivers the "goodies," the attachment/nurturing goodies, through the vehicle of the adult self, in the voice of the adult self."

This is absolutely contrary to Imaginal Nurturing. The very first principle of I-N is that the therapist speaks directly to the externalized child as well as to the adult so that the client *hears* the nurturing words. This point is fundamental to I-N work. I take the time in the workshop to demonstrate the difference, having participants take a few minutes to imagine holding a young child and telling her that she matters, that her feelings are important etc. Then I ask them to imagine the child there again while I say a few things to that child. It is a different experience. One can't be in two places at the same time. If you are speaking you can't be receiving/hearing. People typically report that they feel nurturing while they are talking to the child and empowered when they are listening to me. With respect to the client who said "that's what I've always had to do, take care of my needs myself." ... I believe this is reflecting her need to receive which is exactly what happens with I-N.

Dr. Paulsen stated:
"For example, the reason a client might fear nurturing and feeling need is because her mother might have told her she doesn't deserve to live, let alone being nurtured or having feelings and needs honored. An introjected voice of a critical mother might stop any attempt at inner nurturing in its tracks."

I cannot go over all the principles of my approach here. I simply state that I work with this sort of thing all the time (with clients whose mothers ranged from critical to homicidal) using I-N and find it effective.

Dr. Paulsen wrote that two methods she likes are "remediating the introject" and "having another nurturing external figure provide the goodies". She wrote that in either case the client experiences it intensely and with enormous relief, and that it doesn't require extensive repetition. She decries the fact that Imaginal Nurturing is intended to be used again and again.

With I-N, the client may experience "enormous relief" from one session of guided imagery, and in some cases, there have been dramatic shifts. In other cases, the client may report that it was simply pleasant. Clients with dismissing attachment status naturally do not let as much in initially as the preoccupied-status client. An experience of enormous relief is a good thing, but it is a small part of the therapy. One of the main goals of I-N is to facilitate a new relationship with self over time. I do not believe that there are quick fixes for significant attachment issues. I know that two of the therapists I most respect for their work with highly dissociative clients have told me (and others) that they find I-N to be one of the most effective techniques for working with very fragile clients. I do find that the Developing a Secure Self approach (which incorporates the therapeutic relationship seen as an attachment relationship, Imaginal Nurturing, and emotional skills development) and EMDR for traumatic memories is a very focused and effective combination.

Of course, this approach is not the only way, and some clinicians are not going to care for it. For those who do, I have found that often clinicians benefit from some consultation after using this approach with clients for a bit. Like many things, it can take a while to get the hang of it. No, it is not simply inner child work.

Respectfully,
April Steele, MSc BCATR
Nanaimo, BC