Dr. Sophia Reid

Dr. Sloan Bruan Lorenzini

Welcome back to the Sloan Continuing Education interview series. I'm Dr. Sloan Bruan Lorenzini, and today I'm joined by Dr. Sophia Reid, who is an EMDRIA-certified therapist and an approved consultant and trainer in EMDR therapy. Sophia, thank you so much for being here. I've been looking forward to this conversation for a while now.

Dr. Sophia Reid

Thank you, Sarah. I'm really glad to be here. EMDR with complex trauma is something I'm deeply passionate about, and I think there's a real hunger in our field right now for practical, clinically grounded guidance on how to adapt the standard protocol for the clients who need it most — the ones carrying layered, developmental trauma histories.

Dr. Sloan Bruan Lorenzini

Absolutely. And that's exactly what I want to dig into today. For clinicians who completed their basic EMDR training and are now encountering clients with complex presentations — chronic relational trauma, disorganized attachment, maybe early neglect — where do you see them getting stuck?

Dr. Sophia Reid

Great question. The most common thing I see is clinicians jumping into Phase 4 — the desensitization phase — too quickly. The standard protocol is beautifully designed for single-incident trauma. You have a clear target memory, a well-defined negative cognition, and the client has enough affect tolerance to stay within their window. But with complex trauma, the picture is fundamentally different. These clients often don't have a single discrete target. Their trauma is woven into their relational templates, their sense of self, their nervous system baseline. So when a clinician says, "Let's identify the worst part of that memory," the client may either shut down because there is no single worst part — it was all of it, all the time — or they flood immediately because the network is so densely interconnected that touching one node activates the entire system.

Dr. Sloan Bruan Lorenzini

That's such an important distinction. So it's not that the standard protocol is wrong for these clients, but that it needs to be scaffolded differently?

Dr. Sophia Reid

Exactly. I often use the analogy of a house. The standard eight-phase protocol is the architecture — you don't abandon it. But with complex trauma, you may spend considerably more time on the foundation before you start putting up walls. Phases 1 and 2 — history-taking and preparation — might take weeks or even months rather than one or two sessions. And the preparation phase in particular needs to be much more robust. We're not just teaching the client a safe place exercise and moving on. We're building an entire repertoire of self-regulation capacities: containment, grounding, resourcing, parts awareness. The client needs to demonstrate that they can modulate their arousal before we ask them to deliberately activate traumatic material. Otherwise, we risk retraumatization, and that erodes the therapeutic alliance in ways that can be very difficult to repair.

Dr. Sloan Bruan Lorenzini

That leads perfectly into what I wanted to discuss next — the resourcing and stabilization work. Can you walk us through your approach to that phase with complex trauma clients?

Dr. Sophia Reid

Of course. The first thing I want to emphasize is that stabilization is not a lesser phase. It's not the appetizer before the main course. For many complex trauma clients, learning to regulate their nervous system, to notice internal states without being hijacked by them, is itself profoundly therapeutic. I start with psychoeducation — helping clients understand their window of tolerance, what hyper- and hypoarousal look like in their body, and why their nervous system responds the way it does. That alone can be incredibly validating. Then I move into what I call layered resourcing.

Dr. Sloan Bruan Lorenzini

Can you explain what you mean by layered resourcing? That's a term I think some of our listeners may not have encountered.

Dr. Sophia Reid

Sure. Traditional EMDR preparation often relies heavily on the safe or calm place exercise, which involves bilateral stimulation paired with a positive, soothing image. That's fine for many clients, but for complex trauma survivors, the concept of safety itself can be triggering. They may never have had a safe place. Asking them to imagine one can actually increase distress. So layered resourcing means building multiple resource states that address different regulatory needs. I typically develop at least four or five with a client. We might have a containment resource for managing intrusive material between sessions, a grounding resource tied to sensory anchors for when dissociation starts to pull them away, a relational resource — maybe an internalized figure of safety — and a competency resource connected to a felt sense of mastery. Each one is installed with bilateral stimulation and practiced until the client can access it reliably under moderate stress.

Dr. Sloan Bruan Lorenzini

That's a much more comprehensive toolkit than what most basic trainings cover. How do you assess readiness to move into active reprocessing?

Dr. Sophia Reid

I use several markers. First, can the client notice distressing material and return to baseline within a session? That's critical. If they activate and can't come back down, we're not ready. Second, do they have the capacity to observe their internal experience with some degree of dual attention — can they hold the awareness that "I am here in this room, and I am also noticing something painful from the past"? That dual awareness is the engine of EMDR. Third, and this one is often overlooked — is the therapeutic relationship solid enough to tolerate what reprocessing might bring up? Because processing complex trauma is not smooth. There will be sessions where the client feels worse before they feel better, where things surface that neither of you expected. The alliance needs to be strong enough to hold that. I also look at outside stability — are they safe in their current living situation? Do they have adequate social support? Are there any major life transitions pending that could destabilize them? Reprocessing in a crisis context is generally contraindicated.

Dr. Sloan Bruan Lorenzini

Let's shift to the reprocessing itself. One of the biggest concerns I hear from clinicians working with complex trauma is managing dissociative responses during Phase 4. What are you seeing in your consultation groups around this?

Dr. Sophia Reid

This is probably the area where clinicians feel the most anxious, and understandably so. Dissociation during reprocessing can look very different depending on the client. You might see classic freezing — the client goes still, their eyes glaze, they stop responding to your voice. Or you might see what I call "performative processing," where the client appears to be tracking and reporting, but they've actually left the building, so to speak. They're giving you content, but they're not emotionally present with it. The bilateral stimulation is moving, but nothing is actually being metabolized. Both of these are signals that the client has left their window of tolerance. The first thing to do — and I cannot stress this enough — is to stop the bilateral stimulation. Do not push through dissociation. That is not therapeutic; that is simply re-exposure without processing, and it can consolidate rather than resolve traumatic material. Once you've stopped, your job is reconnection. Use the client's name. Invite them to orient to the room — "Can you feel your feet on the floor? Can you tell me something you see right now?" Use whatever grounding resources you installed during Phase 2. This is exactly why we build those tools ahead of time.

Dr. Sloan Bruan Lorenzini

What about ongoing reprocessing once you've reoriented the client? Do you pick up where you left off, or do you recalibrate entirely?

Dr. Sophia Reid

It depends on the clinical picture. If the dissociation was brief and the client can clearly articulate what happened — "I just got overwhelmed for a moment" — you might be able to return to reprocessing with a shorter set of bilateral stimulation and more frequent check-ins. But if the dissociation was significant, or if the client cannot recall what just happened, I typically close down the session using containment and we process the dissociative episode itself in our next meeting. What triggered it? What did it feel like from the inside? Was there a specific part of the memory or a particular sensory channel that pulled them out? That information is clinically invaluable because it tells you about the structure of the trauma network and where the protective barriers are.

Dr. Sloan Bruan Lorenzini

That framing of dissociation as information rather than failure seems really important for clinicians to internalize.

Dr. Sophia Reid

It is everything. If we pathologize dissociation or treat it as a setback, we miss what it's telling us. Dissociation was an adaptive response — it kept the client alive during events that would have otherwise been psychologically annihilating. Our job is not to override it. Our job is to help the client develop enough safety and regulatory capacity that the dissociative response is no longer the only option available to them. And that takes time. With complex trauma, reprocessing is rarely a straight line. It loops, it pauses, it sometimes needs to go back to stabilization for a while before moving forward again. That's not a failure of the protocol. That's the protocol working as it should with the population it's being applied to.

Dr. Sloan Bruan Lorenzini

Sophia, this has been such a rich and clinically useful conversation. Any final thoughts for practitioners who are working with these presentations and feeling the weight of that complexity?

Dr. Sophia Reid

Trust the process, but more importantly, trust your client. They will show you what they need and when they're ready. Our job is to listen carefully enough to follow their lead. Thank you for having me, Sarah.