"Principles and Procedures for Enhancing Current Functioning in Complex Posttraumatic Stress Disorder with EMDR Resource Development and Installation."

Andrew M. Leeds, Ph.D., Private practice
The EMDRIA Newsletter, Special Edition. December 2001. pp 4 -11.

Note: This article contains an updated version of the RDI protocol together with explanatory material originally written for the Appendix of Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing, Basic Principles, Protocols and Procedures. (2nd ed.). New York: The Guilford Press. Due to space constraints, the explanatory material had to be omitted from Shapiro (2001). This updated version of the RDI protocol is the same as that which appears in Korn & Leeds (2002, see below). This updated version benefited greatly from Dr. Korn's rewording of the early more conceptual version (Leeds, 1997) to a more user friendly version in which key phrases can be selected and read verbatim by the clinician.

Introduction
Stabilization and the consensus model

When developing a treatment plan, clinicians need to be able to recognize not only the specific effects of trauma but to consider symptoms reflecting limited capacities for emotional self regulation. Such problems are often found when client histories include significant childhood neglect or other disruptions of early childhood attachment (Damasio, 1999; Schore, 2000; Siegel, 1999). Clients with a history of insecure attachment appear to be more vulnerable to PTSD (Alexander, et al., 1998; Muller, Sicoli, & Kemieux, 2000) and initially need to be addressed with procedures different than those for trauma specific symptoms. Therefore in the consensus model of posttraumatic treatment (Brown, Scheflin, & Hammond, 1998; Chu, 1998; Courtois, 1999) clinicians are urged to focus on clients' personal safety, stabilization, and the development of client capacities for tolerating and modulating strong affect in the early phases of treatment.

Indeed, the complexity of problems with affect regulation in survivors of early neglect and abuse have led to calls for a new diagnosis of Complex PTSD (Herman, 1992) or Disorders of Extreme Stress, Not Otherwise Specified (DESNOS) (Pelcovitz et al, 1997). A new diagnostic framework for DESNOS, spanning DSM axes I and II, was evaluated in field trials (Roth, et al., 1997), and was ultimately included in the DSM IV but only as a set of associated features of "simple" PTSD (American Psychiatric Association, 1994) and not as a separate diagnosis. Further, some have suggested that individuals meeting criteria for Complex PTSD (DESNOS) may not be able to tolerate trauma focused therapy at all and should only receive psychoeducation and therapeutic interventions aimed at building affect regulation skills such as in the approach proposed by Linehan (1993a, 1993b). This article proposes that with some individuals who meet criteria for Complex PTSD (and for Borderline Personality Disorder) it may be possible to strengthen affect regulation capacities and to resolve traumatic memories with an approach to treatment that begins with an EMDR related procedure known as Resource Development and Installation."

EMDRIA Members may view this article online from the December 2001 special issue. Log into member area and click the Newsletter link.
EMDRIA Member may order this special edition for US $7.50, non-members for US$10.00 from:
EMDR International Association
Phone (512) 451-5200 Fax (512) 451-5256
e-mail

Preliminary Evidence of Efficacy for EMDR Resource Development and Installation in the Stabilization Phase of Treatment of Complex Posttraumatic Stress Disorder.
Deborah L. Korn, Psy.D., Private practice,
Andrew M. Leeds, Ph.D., Private practice
Journal of Clinical Psychology. (2002).
Volume 58, Issue 12, pp1465-1487.

Abstract
This article reviews the complexity of adaptation and symptomatology in adult survivors of pervasive childhood neglect and abuse who meet criteria for the proposed diagnosis of Complex Posttraumatic Stress Disorder (Complex PTSD) also known as Disorders of Extreme Stress, Not Otherwise Specified (DESNOS). A specific EMDR protocol, Resource Development and Installation (RDI), is proposed as an effective intervention in the initial stabilization phase of treatment with Complex PTSD/DESNOS. Descriptive psychometric and behavioral outcome measures from two single case studies are presented which appear to support the use of RDI. Suggestions are offered for future treatment outcome research with this challenging population.

View this article online.

Address reprint correspondence to:
Deborah L. Korn, Psy.D.
240 Concord Avenue, Suite 2
Cambridge, MA 02138
e-mail

Reprints may also be ordered for US$5.00 from:
Andrew M. Leeds, Ph.D.
1049 Fourth Street, Suite G
Santa Rosa, CA 95404



EMDR and Resource Installation: Principles and procedures for enhancing current functioning and resolving traumatic experiences.

Andrew M. Leeds, Ph.D., Private Practice
Francine Shapiro, Ph.D., Senior Research Fellow, Mental Research Institute, Palo Alto.

Chapter 16, pp 469-534 in John Carlson & Len Sperry (Eds.), (2000) Brief Therapy Strategies with Individuals and Couples: Zeig, Tucker, Theisen, Inc. Publisher, Phoenix AZ.

Introduction
"This chapter presents an overview of EMDR, a research validated treatment for posttraumatic stress disorder and a related set of procedures known as Resource Development and Installation which have been reported to be useful in ego strengthening and stabilization. First, the extant research on EMDR, its theoretical model and the eight phases of EMDR treatment will be sumarized. The principles and theoretical foundations of Resource Development and Installation will then be discussed. Two cases will be presented. The first case illustrates a simple application of Resource Development and Installation to supplement the standard EMDR PTSD protocol in the brief treatment of a marital crisis. The second case summarizes the brief, strategic use of Resource Development and Installation to stabilize a patient with complex posttramatic stress disorder referred for collaborative treatment and to build a foundation for comprehensive EMDR treatment."

Reprints available for US$3.00 from
Andrew M. Leeds, Ph.D.
1049 Fourth St., Ste G
Santa Rosa, CA 95404


"Lifting the burden of shame: Using EMDR Resource Installation to resolve a therapeutic impasse."
Andrew M. Leeds, Ph.D.

Chapter 11 pp 256-282 in Philip Manfield, Ph.D. (Ed.), (1998)
Extending EMDR, A case book of Innovative Applications, W. W. Norton, New York.

Chapter 14 pp 320-346 in Philip Manfield, Ph.D. (Ed.) (2003)
EMDR Casebook, expanded second edition, W. W. Norton, New York.

Note: This was the first published description of Resource Installation. I do not have reprints of this chapter. The entire book remains a useful resource for EMDR trained clinicians.

Introduction
"Meredith was in her early twenties when she first came to see me. She was a slender woman with pale skin and sorrowful eyes. During her initial sessions, she emphasized concerns with depression, social isolation and a sense of hopelessness about her life. As I worked with her over time I found that the clinical tools available to me were inadequate to helping Meredith fully resolve her depression. Eventually I developed a new clinical tool which turned out to be the missing piece I needed to help her move through her impasse."