Kitchur’s “Strategic Developmental Model” for EMDR

An enriched approach to EMDR

by Tom Cloyd, MS, MA – Counselor / Psychotherapist – Bellingham, Washington (360) 920-1226 – email: tc (AT) tomcloyd.com (please read about content licensing)

Introduction

Remarkably fast, thorough assessment, organized around family structure; treatment planning structured around the personal events of psychological development, including the “memories one cannot recall”; and fast, comfortable, client-comprehensible implementation of the full power of EMDR protocols — these are the unmistakable hallmarks of the “Kitchur Model”. 

Most clients take to it like they already know about it (which in several important ways they do!), and for clinicians who learn the approach it usually becomes a preferred method. While best learned by attending  one of the trainings given by Maureen Kitchur, it is summarized here, and in a chapter in a new book (2005) – EMDR Solutions: Pathways to Healing¹.

For those not yet able to attend such a training, or those who need just a little more information before attending a training, here is offered an attempt to give a brief summary of some major aspects of Maureen Kitchur’s Strategic Developmental Model. It does not do justice to the richness of her full training workshop, but it hopefully does convey something of the breadth and power of her presentation.

In 1999, the “Kitchur model” began to draw wide-spread attention, as discussions began to emerge in several venues about the Strategic Developmental Model for use of EMDR, developed and taught by Maureen Kitchur, M.S.W., R.S.W., of Calgary, Alberta, Canada. Maureen is an EMDR Institute Facilitator, an EMDRIA-Approved Consultant, and a therapist with a reputation for successfully treating clients with whom no one else has succeeded. How she does this is the subject of her popular two-day training workshops. (For information on scheduled trainings, consult the training calendar of the EMDR Institute.) 

History and Background

For years, Kitchur did family systems clinical social work. By the mid-1980’s she was focusing on multiple aspects of child sexual abuse, working with child and adolescent offenders?often abuse victims themselves. She was much influenced by the work of Milton Erickson, and she developed a distinct appreciation for the importance of inducing a “healing trace”. From the beginning, developmental perspectives were important to her. Then she began incorporating EMDR in her work, and began getting results that she considered extraordinary. She found, among other things, that hypnosis was, comparatively, an ineffectual tool. Excessive abreaction was simply too common, and this did not facilitate the psychotherapeutic process.

She found that it was possible to move much more quickly in psychotherapy than had previously been possible, and this was necessary, since with many of her medical services only a small number of sessions were allowed. This forced the evolution of methods that have a high degree of efficiency. EMDR fit in, in this context, exceptionally well.

It was in a casual conversation with a professional friend that she learned that the way in which she was doing EMDR psychotherapy was rather different from the approach of other clinicians. She was asked to present her approach to local group of psychotherapists. That was her first attempt to teach others her model. She began formal trainings in her model soon after, in 1998. Trainees generally got excellent results, and the word spread in the EMDR community that there was a new, more efficient approach to EMDR psychotherapy. Demand for trainings grew significantly.

Assessment – an improved approach

The first major element of the Kitchur’s Strategic Developmental Model is a genogram-facilitated developmental systems assessment of personal trauma history. In Francine Shapiro’s original presentation of EMDR in her 1995 book, and in the trainings of the EMDR Institute, clinicians are left to come up with whatever assessment they think appropriate. There is no attempt to specify or recommend a specific assessment procedure for developing the targets for EMDR processing. Given the emphasis upon accessing targets in chronological sequence, in order to circumvent the problem of “feeder memories” (memories which provide primary disturbance to later memories, such that these later memories cannot be effectively desensitized), this is a bit odd. It can be accounted for, however, if one considers that leaving this aspect of EMDR psychotherapy unspecified probably had the effect of making it accessible to a wider range of clinicians.

Kitchur’s solution to the assessment problem derives from her family systems perspective. A traditional genogram is developed, with the client at the center. A focused set of assessment questions is asked of the people in the genogram. The result is an orderly, fairly complete set of targets for EMDR processing, developmentally ordered.

An added benefit of this approach is its ease of comprehension by clients. It usually is not hard, with the completed genogram assessment laid out in front of them, to account for the disturbances which bring the client into therapy. Psychopathology is thus “normalized” – reframed as a reaction to unhealthy environments and inadequate or injurious life experience. Psychotherapy has not yet begun, and most clients are already feeling better and having less disturbing thoughts about themselves.

Kitchur’s presentation on her assessment methods is rich in telling detail. She has a number of approaches she uses to keep the process moving along efficiently, while allowing the client to tell his/her story in a most-relevant way.

Treatment planning – the missing piece

The result of the assessment process Kitchur teaches is usually a ready-made treatment plan. Beginning with some special EMDR targets designed to access pre-verbal non-narrative memory (see this topic, below), and concluding with the last known traumatic events of the client’s life history, the conclusion of the treatment plan is a review of the symptoms that most clients come to therapy complaining about. By the time the last trauma memories are processed, these symptoms are significantly reduced or often have disappeared. This tends to be a convincing demonstration (and excellent documentation) of the fact that something very significant has indeed happened.

Treatment implementation – using the therapeutic relationship

The second major element of the Strategic Developmental Model is focused facilitation of the therapist-client relationship, by use of positive-expectancy-inducing language and careful attention to emotional attunement.

A. J. Popky, in his excellent DeTUR (Desensitization of Triggers and Urge Reprocessing)² protocol for EMDR, makes a strong case for focusing on positive goals rather than negative symptoms. Kitchur fully appreciates this, and grounds this concern in a focus on therapeutic language. One should note that both these professionals have training and decades of experience using the concepts, tools, and methods of Milton Erickson. Attention to language and the “theatrical” elements of the psychotherapy relationship thus come naturally to them.

She presents in her trainings a great number of mini-scripts for inducing positive expectancy in clients. For example, she might say “After you’ve healed from the effects of what happened to you when…”, thus presenting the assumption that healing will occur. The question of the efficacy of the psychotherapy about to start is thus artfully side-stepped. The therapist simply speaks honestly: we expect you to get better.

It is important to recall, in evaluating this aspect of her model, that there is a large, positive research literature on expectation effects in counseling psychology (also called “placebo” effects, in other research traditions). The conclusion is easily reached that positive expectancy, if justified by past successes with one’s methods, should always be induced, since it has such a strong positive effect on treatment outcome. Kitchur deliberately makes the most of this well-known, but probably underutilized factor in psychotherapy.

While inducing positive outcome expectations, she gives considerable attention to emotional attunement. Much could be said about this consideration, but probably the first important thing to note is that attentiveness of mothers to the emotional status of their babies and small children (“emotional attunement”) is increasingly considered crucial to the development of the affect management skills needed to be an effective and stable adult. Clients who have not received such attention from their primary parental caregiver will likely have dysfunction in their emotional self-management. Therapist attention to this client dynamic, and corrective interaction, when needed, conveys many constructive messages, and also teaches needed skills. Just as important, it sets up a degree of safety in the therapeutic environment that is essential to effective, efficient use of EMDR to heal traumatized minds.

Kitchur has a number of useful illustrations of effective maternal emotional attunement, and their correlates in therapist-client relationships. As an adjunct to induction of positive expectancy, this focus of hers allows a rich utilization of the potential inherent in the therapeutic relationship.

Inclusion of non-narrative memory

The final major element of Kitchur model, as I see it, is the systematic investigation of non-narrative childhood memory, using several specific clinical strategies (articulated in her detailed workshop handout “First Order Processing”©). Pre-verbal, non-narrative memory occurs because of the immaturity of the child’s brain, before roughly the age of 8 or so. The sensory-motor processing in the right brain is not well connected to the verbal processing of the left brain. Until this connection is in place, “memories that tell stories” do not occur. Little focused attention is given to this type of memory in most psychotherapy, yet it’s influence on perception, cognition, affect, and behavior can be enormous. 

Kitchur has given considerable attention to the development of clinical strategies for making sure that EMDR facilitated psychotherapy, as she does it, attends to this portion of memory. While these strategies are useful for addressing the “normal amnesia” of the human brain, they also are useful in certain other circumstances as well, which she details.

The clinical effect of processing trauma stored in non-narrative memory can be astounding, according to a number of anecdotal reports. These memories are doubly disturbing because of their developmental priority AND their invisibility. Many clients, instead of faulting what happened to them, can only conclude that they themselves are at fault, relative to their dysfunction, thus adding one injury to another. Failing to attend to these “memories you cannot remember” leaves this disturbance in place. The Kitchur model acts to insure that this does not happen.

Notes

¹ Shapiro, R. (2005). EMDR Solutions: Pathways to Healing. New York: Norton.

² Unfortunately, this source is no longer available on the Internet.