What is a Grief Target in EMDR?

In EMDR, unprocessed memories are selected by the therapist and identified as a “target”, or type of memory to be processed. When a person is grieving, the disturbance related to this is called a grief target. This allows a therapist to be able to identify associated positive and negative cognitions with this intrusive memory and work with grief-related cognitions. It allows us to identify a place in the brain where we can work on a specific memory focused on a specific symptom.

In an EMDR session, the material that the client is asked to focus on is referred to as a target. A target can be a specific memory, an experience, a disturbing image, a person (real or imagined), or an event or circumstance that is past, current, or projected into the future. This is the heart of the EMDR three-pronged protocol. Targets can also include an aspect of the experience, such as a thought or a body sensation (Shapiro, 2001).

When processing these targets, there’s a specific symptom associated with the target that we are processing. In EMDR, we use this information to be able to “reprocess” this information to adaptive resolution. This means that we can be able to effectively resolve this. Some of the emotions are connected with us in the body in motion. This can leave the patient with a sense of acknowledgment and understanding for the process that they are going through in their death loss.

When we work on a death and loss target, we take information from my certification with the Association of Death Education And Counseling. They have six indicators and clinical themes regarding looking at grief and loss: 

• Dying: The physical, behavioral, cognitive, and emotional experience of living with a life-threatening/life-limiting illness, living with a terminal illness, the dying process, and caring for the terminally ill.
• End of Life Decision Making: Aspects of life-threatening illness/terminal illness that involve choices and decisions about actions to be taken for individuals, families, and professional caregivers. Exploration of decision-makers vs. decision-takers.
• Loss, Grief, and Mourning: Physical, behavioral, cognitive, and social experience and reactions to loss, the grief process, and practices surrounding grief, and commemoration.
• Assessment and Intervention: Information gathered, decisions made, and actions taken by professional caregivers to determine and/or provide for the needs of persons who are dying, their loved ones, and the bereaved.
• Traumatic Death: Sudden, violent, inflicted, and/or intentional death, shocking encounters with death.
• Death Education: Formal and informal methods for acquiring and disseminating knowledge about dying, death, and bereavement.

In this context, we begin the history-taking phase in EMDR by reviewing some of the following information:

• Circumstances of the death, including the events that led up to and followed it
• Nature of the loss and the meaning of the client’s impact
• Cognitive, emotional, physiological, and behavioral reactions to the death
• What has changed in the client and life since the death?
• Assessment of the client’s functioning
• Coping skills and strategies, and daily life functioning
• Reactions of others in the client’s life and degree of support received (and is still receiving)
• History of prior losses and how they have impacted the client before this loss and now
• Emotional difficulties the client has experienced before this loss and how these issues are impacting the client now
• Trauma history

(Solomon, 2018)

As therapists, we can look at what has changed in the patient’s life since the death and assess their current functioning, in addition to coping skills. In EMDR Phase One, it is important to know the history of prior losses can activate other components of memory and create significant decompensation. We must be mindful to mitigate the activation of additional memory networks while looking at any emotional difficulties or challenges.

Phase 2 of preparation is setting the stage for the grief target. We are looking at issues that tell us if they’re fully prepared, in addition to monitoring our negative beliefs and positive beliefs as we are services consider treating these patients.

As we look at these patients, we are looking at issues and half of the ego states that can help the patient strengthen their self-regulation skills and monitor interventions to create more adaptive information in their nervous system. This is often accomplished through the therapeutic relationship and emotional trust and safety with the therapist. We then begin educating on grief mourning and begin with my processes of vocabulary and begin orienting them to various terms. Here are some examples of clinical skills: 

• Educate on EMDR therapy; Evaluate/strengthen self-regulation
• Relationship - rapport, establish emotional safety; Establish a therapeutic alliance and safety
• Education on grief, mourning, and bereavement processes
• Develop and enhance affect management skills to ensure the client’s stability throughout treatment
• Dual awareness between past & present, and manage emotional states in between sessions and discussion of treatment effects.
• What is the client’s grief theory framework?
• How does this intersect with the clinician’s grief theory framework?

We do this while we’re reassessing the baseline and looking to see if the baseline measures are reduced with queuing. We look at treatment effects to be able to determine the effects of the intervention or treating the intended target.

As we continue to prepare, we install resources such as a safe place light streamer attachment figure to be able to normalize intense reactions. In phase 3, we're able to identify key memories that were targeted with EMDR, and we begin working with the selected grief target.

We begin creating targeted sequence plans and identify targets to be processed, organizing them into clusters by theme, relationship, or negative beliefs. Marina Lombardo shares how to organize information in a targeting sequence to be able to create a consistent treatment plan.

We then look at how we know if a patient is ready for phase 4. The client should have learned, with your support, these concepts before processing the target:

1) Notice our body

2) Notice our emotions

3) Notice our thoughts (Positive Cognition/Negative Cognition)

4) Notice where the mind goes (time travel, various memories)

5) Stay in the room with the therapist (dual awareness)

6) Report to the therapist if these things are happening/ not happening

We look at these issues before processing the target and continuing to phases 5-8 to install positive cognition and obtain a clear body scan, closure, and re-evaluation.

When we are identifying the components of the targets, we must use clinical reasoning and identify with the patient in front of us. Some patients present differently, with different symptoms from the same experience. We must be able to take into account clinical considerations and connect EMDR and Grief-related targets by understanding the various themes within a target. The additional considerations, as recommended by the Association of Death Education and Counseling, are as follows:

• Cultural/Socialization
• Religious/Spirituality
• Historical and Contemporary Perspectives
• Life Span Issues
• Institutional and Societal Considerations
• Family and Individual Consideration
• Professional Issues

In this way, we engage in metacognition, thinking about the way we think regarding Grief and Loss Targets. We must consider those clinical issues as we consider treating patients. We are able to look at the intersecting parts of the patient’s experience and validate the moment that is distressing for them in their experience, rather than assuming their reactions based on their story of grief. We honor them as a griever and are better able to identify their multi-faceted experience with better clinical skills than with EMDR alone.

If you would like a full training and more information, you are welcome to visit my site for upcoming training https://www.rewired360.com/or you can purchase for my on demand training. EMDR with Grief and Loss Targets. 

No time for training? Purchase my Case Conceptualization Kit for Death, Dying and Bereavement.

Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2^nd ed.). New Your: Guilford Press.

Solomon, R. (2018). EMDR Treatment of Grief and Mourning. Clinical Neuropsychiatry, 15(3), 137-150.