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A cognitive behavioral formulation of non-psychotic morbid jealousy
Treatment strategy utilizing eye movement desensitization and reprocessing
Shapiro (ibid) describes the technique as synclectic in that it involves elements of cognitive therapy, behavioral therapy, psychoanalysis, person centered therapy and cybernetics. Essentially, following a thorough assessment of the client and the problem, a full explanation of EMDR is offered. The client should be screened for dissociative disorder before being asked to sign a consent to treatment form, as it is explained to the client that the procedure may activate previous unprocessed traumatic memories. This done, the subject is asked to mentally visualize the worst part of the traumatic memory, whilst at the same time attending to a negative cognition which involves an evaluation of the self resulting from the image. Simultaneously they are encouraged to notice the physiological responses located in their body. The therapist then induces the saccadic eye movements, with the client being asked to 'let whatever happens, happen'. It should be noted that before commencing EMDR treatment, the subject is asked to think of a safe place (somewhere the client feels a sense of security and comfort) and this safe place is now 'installed' by the use of a saccadic stimulus before the therapy begins. The rationale being, that if the emotions generated by the reprocessing become unmanageable and the subject needs to rest they can 'go to their safe place' until they are willing to continue with the session.
This procedure usually provides the client with rapid symptom reduction and new adaptive cognitions are generated. However, in some cases, the images are so traumatic or the negative cognitions/beliefs so ingrained, that normal reprocessing appears to become blocked. To compensate for this eventuality, Shapiro (1995) developed a technique known as the cognitive interweave. The cognitive interweave is a set of strategies which assist the adaptive information processing system (AIPS) to shift or process an 'information package' held in dysfunctional states specific form, into more appropriate and functional form. The cognitive interweave (CI) can be used to stimulate healthy resources which are often already present within the subject so that they can link in with the dysfunctional material. Stimulating these healthy resources aids the AIPS to process the information package from a new perspective. Shapiro (1995) proposes that the cognitive interweave can be seen as a 'light touch'. A stimulation of these functional resources followed by eye movement is woven subtly into the eye movement. The cognitive interweave can be sub-divided into three broad areas, safety, appropriate responsibility and new choices. The therapist may use a variety of techniques to facilitate cognitive interweave, for example they may add present time or adult thoughts, add new information, alter the image, utilize Socratic techniques and even use physical sensations to bring about the desired reprocessing. It must be remembered that the cognitive interweave is not cognitive therapy added on to the eye movements. The client is simply asked to 'think about that' whilst the eye movement or hand taps are instigated. In other words, it is a way of jump starting the information processing system and not an alternative to the model.
Discussion and conclusion
There have been various theoretical approaches to morbid jealousy including a psychiatric approach, a psychodynamic approach, a systems approach, a behavioral approach, a social psychological approach and a sociobiological approach. The behavioral approach argues that often jealous subjects re-visit the scene of perceived infidelity. By this they mean that the subject has images of their partner engaged in sexual congress. This was certainly the case with the subject discussed in this paper and prompted the possible strategy of eye movement desensitization and reprocessing as a useful intervention. EMDR has been used extensively in the treatment of post traumatic stress disorder (Shapiro, 1995). Trials have demonstrated its efficacy in the treatment of PTSD (Sanderson & Carpenter, 1992; Vaughan et al., 1994). It has also been used to treat a myriad of other psychological difficulties from specific phobia (Muris, 1997) to morbid jealousy (Blore, 1997). When utilizing EMDR in this case study, it became apparent that cognitive interweave was required for full reprocessing to occur. Shapiro when considering the cognitive interweave argues that 'if the information offered by the clinician is accurate, a new perspective will be assimilated'. It would seem therefore that more research is required in this area, and it may be useful to conduct a controlled trial comparing EMDR, cognitive therapy and exposure therapy.
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