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  1. 1. klonopin weedd wnipn lk ee oo advertisement We d ne s d ay, J une , 20 11 6 :0 0 PM Po s te d b y Sup e rb Site Klo no pin f ro m Fo re ign Purchase any medication from reliable foreign pharmacies. No prescription Required. Save upto The Mysterious Case of the Disappearing 80% . Enjoy secure online... foreign- drugstores- online.com Tic Klo no pin 2m g x 30 pills $ 119 By Judith Acosta Buy Hight Quality Pills Without Prescription! We accept VISA, E- Check. EMS/USPS, Express Airmail delivery 5- 8 days $34 Introduction terrameds.net KLONOPIN ONLINE! BEST Every now and again, we are presented with Buy Cheap KLONOPIN Online cases that require us to think out of the box, without Prescription! Dosages 0.25, 0.50, 1, 2mg. Fast Worldwide cases that push us to hone skills more in Delivery. Plus DISCOUNT 20% !... health- pharma.net line with detective work than clinical technique.These cases, while complex and sometimes confusing, are also the cases that can lead us to the " ah- has" many of us originally signed up search the web for. PDFmyURL.com
  2. 2. The following case report describes a young patient who came into the office with her diagnosis alreadydelivered on a silver platter: Tic Disorder NOS. She had been so diagnosed and subsequently medicatedby a competent and respected neurologist and it did not occur to me at that early juncture to question it.However, as the case evolved over time and I saw improvements with the use of hypnosis I began to wonder. FinanceWhat if this werent a Tic Disorder, but a Conversion Disorder? HotelsPresenting Problem FurnitureJJ was a pert, bright, athletic 18- year- old female. She expressed some urgency about seeing me when she Gamescalled. Her recent breakup with a long- term boyfriend left her with an intolerable increase in anxiety and tic Insuranceactivity. JJ presented with a tic that manifested as massive and uncontrollable twitching on her right side Carsonly, affecting her right eye, head, neck, shoulder and arm. MoviesWhen it occurred (approximately every 5- 10 minutes), JJ was highly conscious of it and often became Mapsembarrassed and angry at herself for having it. She was put on Klonopin the previous summer and, whilethe tic was diminished, by September shed become irritable and moody. LoanShe herself found the changes disturbing and asked to be taken off the drug. Her family did not object. Her Musicneurologist agreed, hoping for the best, but by December the tic had rebounded back with even greater Travelintensity.Patient and Family HistoryJJ came from an upper middle class family consisting of her father, who was a successful businessman, hermother, who worked as a secretary, her younger sister, who was a student in a neighborhood public schooland her older brother, who had been in extensive treatment for multiple drug addictions. When speaking ofhim, she became irritated.She felt he had taken up most of the familys attention for the last several years and had been almostpleased at how her mood changes on the Klonopin had put her in the spotlight for a change. PDFmyURL.com
  3. 3. " It was pretty amaz ing at how I could scare people. It was a new feeling for me," shed said.The tic began in 4th grade and developed gradually. By 5th grade, she had an MRI for eyelid flutter andsome disturbing head movements. She remembered that at the time the tic disappeared when the focus wason her, e.g, when the doctors examined her. The tic only occurred on the right side. By 8th grade, however,she began to suffer from more flagrantly out- of- control head movements. She recalled having had fightswith schoolmates and that there were a lot of cliques, making her feel unhappy and unwanted.Around 12th grade, the tic manifested mostly during major events (e.g, SATs, graduation) and wasassociated with stress and sleep loss. In college, the tic got worse and at one point was so violent, she feltlike she dislocated her shoulder.She said to herself, " I better stop or Ill get hurt." And as if on command, it stopped- though only untilSeptember of that year. She stated, " I know I said I wanted attention, but I dont want to injure myself."She was more complex emotionally than she presented. She could express anger, but had more difficultwith weeping, fear, tenderness, and sorrow. She had frequent nightmares, some numbing and dissociation.Interestingly, whenever she came into session, she " forgot" to close the door, a habit that continued formonths.Because of the centrality of the voluntary nervous system, the secondary gain of the tic (e.g., " it was prettyamaz ing how I could scare people" ), and the presence of other symptoms suggestive of early trauma, Ibegan early on to explore the possibility of a diagnosis of Conversion Disorder and PTSD even though herneurologist had already made the determination of tic disorder.Description of TreatmentAll treatment came from the modality of holistic psychotherapy. Initial sessions strongly utiliz ed an object-relations model of psychotherapy with an emphasis on establishing a " frame" and offering support whileinformation gathering. My emphasis on ego strengthening is supported a great deal by the work of Dr. M.Phillips (AJCH 2001) on the use of hypnosis and EMDR for ego strengthening. Dr. Phillips research has PDFmyURL.com
  4. 4. also suggested that the healing relationship may in fact be the most significant aspect of all recovery fromtrauma, in whatever form that relationship takes, whether with a professional, a friend or a pet.The importance of providing this patient with a safe environment becomes even more clear when we seeJJs vigilance and anxiety as she comes to session. Rarely did she close the door entirely. While from timeto time I mentioned it, I did not move to close it. (In time, she did.) At the same time, because Verbal First Aid,clinical hypnotherapy and NLP would be utiliz ed, special attention was always given to the patients use oflanguage as it expressed unconscious conflicts and needs.JJ discussed a persistent need for control, a desire for attention, and alluded to underlying shame, a senseof not being " right." We established rapport and acquired an understanding of her general metaphoricalframework: She used numerous allusions to trains, circuit boards, energy, " kicking the rail into position" ," knowing where youre going" , surefootedness, the " right track."Her language suggested a blockage or a short circuit. Retrospectively, I can see that it may have also beenthe unconscious clues that led me to thinking of EMDR as a tool for disentangling the psychological traumafrom the physiological response. Although NLP technique, formal trance induction and hypnoticinterventions were used throughout as indicated, for the ease of review I have labeled those sessionsdiscussed herein as #1, #2, #3, etc...Hypnosis Session #1/ Week #3Objectives:*To begin the practice of hypnotic trance, deep relaxation.*To increase somatic awareness and encourage comfort in being in her own body.*To assess the metaphorical import of the right sidedness of the tic. Script for Somatic Awareness andMetaphoric Import: " And everyone knows how to look into rooms and closets with a flashlight- so you cansee what you need to see, see the separate items- the boxes, the clothes, the furniture, the places you want PDFmyURL.com
  5. 5. to go, the places you want to avoid, the places to step into, the places to leave alone...looking far and deepwithout having to actually go in, until you know youve got your flashlight on your side and any side is yourright side...looking down deep and far in...Looking into body to see what you can see...starting way at thetop of your head or way at the bottom of your feet, wherever youd like to shine the light..."Session ProcessJJ revealed a blocked area on her right side. She said she felt horribly trapped and proceeded to reveal along history of trauma primarily on her right side. In exploring her history further, she made the connectionthat her tic started approximately 6 months after a serious arm break when she was a young girl. She hadbeen playing in a backyard jungle gym and fell from a height of approximately 5 feet, landing square on herright hand and rigidly positioned arm.At the moment preceding impact she could recall having said to herself: " I better do something if I dont stopthis."Interestingly, she consciously meant to say, " I better do something TO stop this," but it came out with a twist.To compound the traumatic injury, which resulted in a shattered arm, an adult relative came out when shewas in mid- fall and proceeded to yell at her angrily. " I didnt even get a chance to scream," she said.Subsequent exams revealed no concussions or brain damage and her injuries eventually healed, althoughshe has had some residual rheumatic pains in her right hand.At age 2 JJ also broke her right collarbone when she went down a flight of steps on a toy. At age 4, she gota hanger caught in her right eye and went to the hospital. After the session, it seemed to this therapist thatJJs tic was " a scream waiting to happen," and that she had held not only the trauma, blocked and short-circuited, inside her right side, but had repressed her own fear, vulnerability, and pain.Hypnotic Session #2/Week # 7Objectives: PDFmyURL.com
  6. 6. *To more deeply explore the tics meaning.*To begin delivering therapeutic suggestion for release, smoothing out, rewinding and taping over.*To reinforce somatic integration and depotentiate traumatic experience using Verbal First Aid.ScriptAt this point, we began to embed indirect and direct suggestions, utiliz ing metaphors of channels/tracks." And you can see yourself, feel yourself now in a safe and comfortable boat, feeling the water licking upagainst the sides of the hull, smoothly gliding, effortlessly leading you through a series of canals with signsposted to guide you...so you can choose where you want to go...and on each channel you can see yourway to those experiences in your life that hold the key to your current problem. And any channel youchoose is the right one and the curious thing is how smooth your boat is..."In order to lead her to the site of the tic activity, we said, " Whichever canal you take, whichever channel youfloat way down into, way down comfortably floating, you can take the right one, and you choose the rightside, making the right choice. Thats right. Because there is something waiting to happen."During the trance, we spoke in highly descriptive and sensory- rich language and encouraged JJ to go intoeach scene she chose. She could experience each one, then depotentiate it by using various hypnotictechniques, such as the " dimmer switch" and " control room" . We also explored the thoughts, statements,and sensations she has held onto and repeated from each experience. I asked her, " How have you learnedfrom them so you can let them go and move on."We exaggerated each somatic movement, repeating the statements and thoughts out loud.Session ProcessJJ reported a marked decrease in tic behavior within 1 week, with only " a few" incidents all week. She wasvery hopeful, though still scared of being " too" hopeful.Hypnotic Session #3/ Week #6 PDFmyURL.com
  7. 7. Objectives:* Explain and explore the nature of imprinting;* Correct and " re- wire" JJs response pattern;* Anchor JJ to an internal " safe place."Script:I explained imprinting to JJ in the following manner:" Before and during each twitch, each tic, there is an internal feeling reminiscent of your body- state justprior to your injuries. The body remembers what it needs to know. Once youve been in a fire, you neversmell it the same way. You smell it faster. But it doesnt tell you its siz e- whether its a wastepaper basket ora house thats burning. Its the law of negative interpretation- the physiology of fright. If were afraid,anything that can be interpreted in more than one way will be interpreted negatively. It exists to protect us.The processing is instant for fear. For pleasure it can take upwards of three seconds. We need to knowabout danger faster than we can think. Youve had a series of traumas, all of which happened in seconds,and anything that reminds your body/mind of that state will initiate a reaction to that danger." Its the same with certain drugs. Benz odiaz apenes can cause amnesia. Imagine that theyre given tosomeone who takes a plane ride to another city and then goes to a business meeting, where he meetssomeone he doesnt like at all.However, when he gets home, he doesnt remember much about the meeting or anyone he met there. Lateron, he meets one of the people he disliked at that meeting and without knowing why instantly dislikes her.Some things stick in our minds until we learn how to slide them off..."I anchored her to her adult self and had her express that in one part of her body (she chose her left hand)thus: " Now, your problem has some interesting, really revealing characteristics...ones that your PDFmyURL.com
  8. 8. unconscious mind is very familiar with...so that as your conscious mind floats now... your unconscious mindcan begin to consider a safe, strong space in your solar plexus, a vessel for feelings your conscious mindmay not be considering...and Im going to suggest that you feel this safe space now....feeling it clearly...andletting me know by lifting your yes arm...and it may surprise you how automatic that response is..."Then we went back in time to before the incident and back up through time to the minute right before falling.We used ideomotor signaling and I used my hand to pick up each finger of " yes" and " no" with each onesignaling the message to deepen trance. At that point, in trance, I spoke to her adult self and asked heradult self to come back with me to observe the incident on the jungle gym.She was able to recall it in striking detail. " I couldnt scream. It was too fast. But it was so slow, too. Iremember, oh, my God, I have to stop this or Ill die. Then, he came in, he screamed at me, didnt know howbadly I was hurt."I asked her: " Is there a body memory, a part that you feel is a match to the tic process?" She nodded andran her left hand over her upper right side. The rest of the session was spent on " re- wiring" and smoothingout the right side.Session Process:By self- report within 2 weeks, JJ experienced a 70% reduction in symptoms. We used scaling questions toconcertiz e her improvements.On a scale of 1- 10 (1 worst, 10 best), we determined where she was for her two major complaints- herinability to sleep and the persistence of the tic.Sleep scaling: When began: 2 Current: 7Tic scaling: When began: 1 Current: 8JJ maintained her improvement until around the 5th month, when she experienced a reversal she attributedto a breakup with a boyfriend. We did a graph of her tic incidents, accounting for sleeplessness, emotional PDFmyURL.com
  9. 9. upset (on a scale of 1- 10), and nutrition (3 meals). We found that behavior modification, with specialattention to sleeping eight hours a night, ameliorated tic activity about 30% .R e ve aling t he Me nt al C hat t e r wit h Ho list ic Psycho t he rap yFor the next month, we used trances weekly, combining deep stress and somatic release with images ofstillness, reconnection, and smoothing the communication between neurons. Numerous sessions werespent on her subtle " mental chatter" - " Im not good. Not good enough hair. Not tall enough." I gave herregular assignments throughout: meditation on stillness for no more than 3 minutes twice a day (a.m. andp.m.) and automatic writing with her right hand.Hypnotic Session #4/ Week #26Objectives:* To establish readiness to be tic- free;* To continue exploring the tics imprint(s) and correct for it;* Explore dissociation process.Script:" Now youve said that you want to get rid of that tic, that you no longer have any use for it and, everyoneknows that when something is of no use, it starts to diminish...until it disappears..."Ideomotor signals were established and regression was initiated to locate the imprint: " Way, way down,thats right...and now time moves differently, comfortably, smoothly, effortlessly...And it can go this way orthat...forward or back...yesterday or tomorrow and who knows what time it is...when its okay with yourunconscious mind to go back in time and review the time that is most important in the birth and developmentof this tic problem...and your first review can be a little detached like watching a movie, an old tape youalready know...and the birth of any thing is usually a small thing, a seed that takes root and later with timeand fertiliz er grows into something else..." PDFmyURL.com
  10. 10. Suggestions were given for correction: " If its a plant you want, then you want to tend it carefully, helping itto flower, to fruit. But if its a weed and its gone wild, we need to pull it out by its roots so what you dontwant and dont need stays out and never comes back..."Each imprinting scenario was reviewed by having JJ go into each scene, state to herself or to me (using allfive senses) what she experienced (or, in some cases, watched herself experience), signal me to indicatethat shed finished her review, then return to it to review it not just somatically but emotionally.Finally, we future- paced JJ to a time that she could see herself as tic- free: " You might begin to notice aparallel, now possible universe, a world, a life with no tic, with only smooth lines, clear lanes, easytransmission, and only the plants you truly love to have there with productive, beautiful fruits..." We closedthe session with post- hypnotic suggestions for a deep, refreshing, natural sleep, a significant dream, and atic free week.Session Process:After this session, she revealed that she was angry with herself for having the tic and scared to leave theoffice for fear it would come back.I had her go back into a light trance and gave her two suggestions:1. That she doesnt need the punishment (of the tic) to be a good person.2. That if the symptoms return they can go to her right hand pinky. While in trance, she suggested that sheneeded to put a sling back on her arm, as if the injury had just happened. I answered, " Good idea, wear itat night and let the healing and dreaming happen together."Her report one- week post- session was that she had slept well, recorded her dreams, and was tic- free forone night. Overall, her symptoms decreased but stayed in the same range, up 1 or 2 points, then downagain. PDFmyURL.com
  11. 11. Int ro d uct io n o f EMD RAt this point, we seemed to have reached a plateau, with hypnosis alone serving to ameliorate but not effecta resolution. Why would hypnosis produce these results, even if they were variable, in what was supposedto be a neurologic case?Clearly, the diagnosis of a conversion disorder and PTSD was indicated, though the symptoms seemedquite intense for a fall from a stool. Perhaps there was another layer of trauma beyond those that hadalready emerged? Pacing a patient towards their treatment goals is always a delicate balancing act, butperhaps nowhere more so than in cases of traumatic injury in which trust and vulnerability issues play suchcentral roles.How do we move them towards disclosure without overwhelming them? How and when are we sure thereeven is a trauma in cases that strongly suggest repression and conversion but in which the client eitherhas no conscious memory or is unwilling or unable to make the connection or reveal the full story?In this case, I believe that it may have been the more open- ended, perhaps tentative and less- direct natureof the hypnotic sessions I created that postponed the resolution of JJs problem. Of course, another way ofinterpreting the psychological " stall" is that the patient was simply not ready and that each step, everycomponent in the process was a necessary one, contributing towards JJs overall well- being in exactly theway she required. This would imply that JJ unconsciously set the pace for treatment, a notion neo- analystshave promoted for many years and which Erickson masterfully appreciated, understood and never failed toutiliz e.Pre p aring t he Pat ie nt f o r t he N e xt PhaseWith this in mind, we discussed the possibilities and promise of EMDR in the treatment of trauma. Due to theclients tendency to be analytic and anxious, we induced a light trance first, utiliz ing imagery that hadproved successful in prior trances. Hypnosis, in that way, served as the safe room in which the tool of EMDRwas utiliz ed. PDFmyURL.com
  12. 12. T he R e ve lat io n at T he C o reIn our first EMDR session, while the client was in a light trance, when asked what presenting issue ormemory shed like to work on, she revealed for the first time that she had been molested as a young girl byan adolescent relative for approximately a year. She remembered it clearly and felt " disgust," " violated,"and " responsible for it."As she related her thoughts, she experienced a number of tics in her shoulder and neck. When asked whatshed like to believe about herself now instead, she said, " Im in control of my body." She only rated thebelievability (validity of cognition) of that statement at a 2 on a scale of 1 to 7 where 1 is completely falseand 7 is completely true.She rated her " Subjective Unit of Disturbance" (SUDS) at a 7 on a scale of 1 to 10 (1 being no disturbanceand 10 being highest disturbance) and located the disturbance in her right side and arm. We proceededwith the rest of the EMDR protocol using my fingers to initiate the saccades/bi- lateral eye movements.During the process, which we repeated for about 30 minutes overall, she experienced pain in her arm, alittle comfort, then anger, then confusion, religious angst (" please help" ), need, disgust, fear, pain in thelower arm, uncomfortable, blank, worried, pain in elbow and hand, pain in leg, " afraid to move" , and finallyshe said she felt tired as her SUDS level dropped to a 2.When we installed the positive cognition, which links the desired positive cognition with the original memoryor incident, she moved from rating it at a 2 to rating it at a 5, indicating that she was already feeling more incontrol.After completing the first EMDR, she still experienced some somatic discomfort on her right side. Thus, wedecided to repeat the process. The second and third EMDR sessions were conducted in the same way(using a light trance), but focused on two other incidents: In the second EMDR session, she revealed that aboyfriend had disclosed to her that he was gay. In the third session, she described how (being so deeplyattached to him) she had gone with him to a club and watched as he picked up men. PDFmyURL.com
  13. 13. Her negative cognitions for both memories were reminiscent of issues to which she had alluded in earliersessions: " Ill never be able to trust people again," " Im not right. Theres something wrong with me," " Illnever satisfy a man."Her desired positive cognitions were: " Ive come so far and built so much up that he destroyed," and " I havethe ability to please." She rated the believability of the positive cognition at a 4 (1- 7) and her SUDS was a 9(10 being the highest). She felt the disturbance all over her body. Interestingly, in these 2 sessions usingEMDR within trance, she felt comforted by the diagonal saccades and responded very quickly to them,moving the SUDS from a 9 to a 7 to a 5 to finally a 1. When we installed the positive cognitions, she felt thestatements still " fit" and rated them on a scale of 1 to 7 (7 being completely true, 1 completely false) at a" 6+" .Outcome of Case Using Holistic PyschotherapyIn reviewing my own notes, it is still quite startling to see the almost utter absence of tic behaviorsubsequent to the combined hypnosis/EMDR sessions. Subsequent sessions focused more on issues ofcontrol, anger management, negotiating long- term intimate relationships, and work. She has since becomesuccessful in business, has married, and has in every way demonstrated a full recovery. In the 10 yearssince the combined hypnosis/EMDR intervention, she has had almost no tic activity despite the stress ofcareer changes, marriage, and moving (twice). Her progress continues and she comes in for a sessiononce in a while to brainstorm on one issue or another. She always closes the door behind her.O b se rvat io ns/D iscusso nWhen hypnosis is used for ego strengthening and EMDR for both continued ego strengthening anduncoupling, they can offer clinicians a formidable toolbox for both generating and therapeutically utiliz ingthose " unexpected responses."It occurred to me in preparing this case that JJ had made her subtle request for EMDR in the initial stagesof her therapy if only I had been listening more attentively. Her unconscious references to " tracks," PDFmyURL.com
  14. 14. " channels," " blocking," were all terminology used to describe and metaphorically explain the EMDR processby Shapiro herself (1995).Also of great interest, and perhaps worthy of further study, is how only in the EMDR sessions were theincidents involving early childhood sexual abuse and her later humiliation by her ex- boyfriend disclosed.This author wonders whether the more structured process of EMDR was what allowed for this revelation.While I had naturally assumed that the right- sided tic was a function of the physical trauma, it seemed tohave been interlocked with more complex psychological and sexual trauma.While hypnosis and NLP perhaps laid the foundation, JJs symptoms only subsided after EMDR exposed,then released the deeper layers of trauma she had buried for so long. Clearly, there was " a scream waitingto happen," only not the scream I had assumed. To this writer, JJs case reaffirms the value of therapeuticflexibility and an eclectic or holistic stance when dealing with the mystery- and poetry- of the mind/bodyconnection.c. Judith Acosta, 2009. All rights reserved.Judith Acosta, LISW, is an author, licensed psychotherapist, crisis counselor and homeopath in privatepractice in New Mexico. Specializ ing in the treatment of trauma, she is the co- author of The Worst Is Over:What To Say When Every Moment Counts, hailed as the " bible of crisis communications." She lecturesaround the country on Verbal First Aid, trauma, stress, animal- assisted therapy, and intuition development.She may be reached at her website (http://www.wordsaremedicine.com).klo no p in we e d Inf o rmat io n PDFmyURL.com
  15. 15. d wnipn lk ee oo We d ne s d ay,J une , 20 11 6 :0 0 PM Po s te d b y Sup e rb Site This case report presents a conversion disorder disguised as a tic disorder and its disappearance in response to the combined use of hypnosis, Verbal First Aid, and EMDR. It illustrates the effectiveness (and limits) of each technique over the course of treatment and suggests the importance of more eclectic approaches to the problems commonly faced by psychotherapists and hypnotherapists in clinical practice. CO PYRIG HT (C) 20 11 SUPERBSITE.INFO . ALL RIG HTS RESERVED. KLO NO PIN WEED | PRIVACY PDFmyURL.com
  16. 16. PDFmyURL.com