Kim Howard 00:04
Welcome to the Let’s Talk EMDR podcast brought to you by the EMDR International Association or EMDRIA. I am your host Kim Howard. In this episode we’re discussing EMDR therapy and military personnel and veterans. Today’s guest is EMDR therapist, Dr. Jamie Zubukovec. Jamie is based in Dallas, Texas and has extensive experience working with clients who are active duty personnel or veterans. Let’s get started. Today we are speaking with an EMDR therapist and approved consultant Dr. Jamie Zubukovec about working with military personnel and veterans. Jamie has worked in primary ambulatory care and medical specialty clinics, including chronic pain clinic, mental health, homeless and PTSD units during her VA career. An EMDR Institute facilitator since 1991, Jamie provided EMDR training within the VA Vet Center and Department of Defense. She is an author, speaker, trainer, facilitator and consultant. Thank you, Jamie, for being here today. We are so happy that you said yes.

Jamie Zubukovec 01:05
Well, Kim, thank you for the invitation. And for all of us service members, veterans and EMDR therapists who work with these individuals. Thank you for your service. And of course we can’t leave out the family. You know, thank you for your service, too.

Kim Howard 01:20
Yeah, I was a military brat. So I know all about that commitment, not just a service member, but from the family who was connected to that service member. It’s big. It’s a big deal.

Jamie Zubukovec 01:31
Oh, absolutely. It really affects all the systems of which that person is apart. And I also just want to mention that we’re going to be referring to all branches of the service. So that includes the Marine Corps, the Navy, the Army, the Air Force, National Guard, Coast Guard, and also the Space Force.

Kim Howard 01:50
Okay, that’s good. Thank you for the disclaimer, let’s get started. So tell us a little bit about your journey to becoming an EMDR. Therapist.

Jamie Zubukovec 01:57
Before I began to work with veterans and service members, I was a family child and adolescent therapist at Warren Township Youth Services in Gurnee, Illinois. I had been trained in cognitive behavioral therapy, client centered therapy, Gestalt hypnosis, and a number of different family approaches. You know, I did outdoor adventure trips with teens and their families. And we also did a transition to high school group with at risk youth, so many of our clients experienced trauma. And I began to understand their behavior in the context of trauma. And also got the idea that, you know, you needed to use whatever worked with them. So maybe that kind of also, let me be a little bit more open the EMDR, I worked on the stress disorder treatment unit at the North Chicago, VA, which is now FCC level. So I got exposed to the different perspectives of a number of very talented clinicians. So Jim Moore focused on family relationships, Skip Shelton, Orville Lips, yes, that is his real name. James Besner, Howard Litke, Al Botkin, Jenny Goldstein and Bob McFarland is so all of these approaches included cognitive behavioral therapy, rational emotive therapy, strict behavior therapy, couples and family therapy, and of course, stress management. In addition to trauma processing groups, I did a group on human sexuality, guilt group relaxation group and a rational emotive therapy type group where veterans would present an issue and the entire group would work through it challenging automatic thoughts and determining other maybe more appropriate courses of action, instead of just going off on people. That doesn’t work well. No, but you know, when you’re stuck with a particular way of thinking or believing that you can end up kind of filling in the blank for different events that can occur and you can react in a certain way, and then later on you go, why did I do that? So we really tried to help them to find other ways of thinking, and other ways of behaving in situations that were problematic. So back in December of 1989, there was an article that came out about the flagship VA American Lake VA’s 90-day treatment program for PTSD. And they presented the results of a survey that indicated that about 26.6 perent of the veterans who attended that program, a 90-day program felt that they benefited from it and they used a variety of approaches. They did flooding, relaxation, training, dream analysis, and in just a lot of state of the art at that time, the treatments for post traumatic stress disorder. Now around the same time, Francine Shapiro published an article saying that 80 percent of the clients she worked with felt better after just one session of what was then called EMD. Pretty striking differences in the results. So of course our staff being the people that we were we read the article, we tried it on each other. And we discovered that it worked. So then we asked for volunteers from the stress unit and saw some amazing results. And I was actually trained by Shapiro in EMDR in 1990. But I was pretty skeptical about it at first, and one of the first clients that I worked with talked about a recurring nightmare he had when his chopper was shot down, and he felt helpless. So he would have this nightmare where he would see the smoke, and he would realize the engine cowling was on fire. And he would wake up in a sweat. So we decided to target that nightmare. And he started with the highest blood level, I think about an eight on that zero to 10 scale. And after each set, he reported that his son level decreased, he actually began to remember additional parts of the event. And remember that after the chopper hit the ground, he had a weapon. He wasn’t as helpless as he thought. So his SUD level went from an eight to a five to a three, to a point five, to a point one, to a point 001.

Kim Howard 06:11
That’s great!

Jamie Zubukovec 06:12
When I asked him what it like kept it from being a zero. He said, I got to be a little resistant. Later on, I asked him if he had ever remembered those additional parts of the event that came up in the session. And he said no. Which again, I thought was this is really interesting. And this happened in one session. So comparing that with maybe the more traditional approaches, I thought, Gosh, I wonder how long it would have taken me to help him to get to that part to resolve that nightmare. And he continued to report while he was on the 90-day program, that he did not have that nightmare again.

Kim Howard 06:47
We hear stories like that all the time about people who have come to EMDR therapy and found a solution that helps them so it’s good to know that it’s

Jamie Zubukovec 06:55
Absolutely right, Kim Yeah,

Kim Howard 06:56
What’s your favorite part of working with EMDR therapy?

Jamie Zubukovec 06:59
I was gonna say, you know, just seeing the the change in the client coming from the client’s own brain and experience. But what popped into my mind is it’s kind of like riding a bucking bronco. So, you know, you never know what’s going to come up what you think might come up, or how the client might respond is different. But what what is really cool about it is that, you know, it fits with the client, it comes from that client’s own brain, their own experience. And another aspect is that just, you know, I remember that cycle analyst would always talk about how the symptoms made sense. And certainly that really fits with the EMDR approach and adaptive information processing model. You know, you start to think: Where did this symptom come from? Did it come from trauma? What kind of trauma trauma? From the military? Trauma from childhood? More recent trauma? Or whether it’s a big T or small t, you know, you start to look at the symptoms and context and where they came from. When I’ve been working with clients, I often find myself thinking, gosh, you know, if I was the best therapist ever, not saying that I’m not but you know, if, if I was the best therapist ever, maybe I could get the client to accept one of those alternative beliefs, one of those positive self statements that they come up with in in order to resolve a traumatic memory. But it’s it’s so interesting, because the client comes up with those beliefs. And it doesn’t take them years to do that. The other thing I want to say that, I think, is one of the things that I really love about EMDR therapy, is that doing cognitive behavioral therapy or cognitive processing therapy, so many veterans would come in and say, ‘well, Doc, it makes sense to me here and they would point to their head. But it doesn’t make sense here’ and they would point to their heart. So that ending belief that positive cognition that we install, is the clients and it feels congruent for them. It’s not just something that makes sense in their head, but in their heart and throughout their body.

Kim Howard 09:10
That’s a good perspective to that. That’s a good segue to the next question, which is what successes have you seen using EMDR therapy for veterans and military personnel?

Jamie Zubukovec 09:19
Back in 1992, Kim, when I was at the North Chicago VA Howard Lipke, Al Botkin and I presented a small research study in which we asked the veterans to predict how successful they thought EMDR was going to be. And then also had them attribute what percentage of the trauma was related to one something that happened to me to something I did three something I saw someone else do, or for something I should have done and didn’t do. Now. So I guess back then we’re talking about kind of moral injury as a part of the trauma. But the important thing that came out of that small study was that it didn’t matter if didn’t matter whether or not somebody thought EMDR would be effective, and what the percentage of trauma was due to those various attributions, they got better. So, of course, you know, I have a lot of other stories, a lot of anecdotal instances that indicate successful outcomes. You know, I had one client who wrote me up for an award that said that if he had met me 10 years earlier, I probably would have saved his marriage. Now, I don’t know if that would actually be true. But…

Kim Howard 10:30
that’s a big burden to carry on your shoulders.

Jamie Zubukovec 10:32
Right. But it sure meant a lot to me what he said and showed just how meaningful that treatment had been to him. That’s great.

Kim Howard 10:41
That’s very good. Are there any myths that you would like to bust about EMDR therapy in this population?

Jamie Zubukovec 10:47
Yes, actually, I had a couple other stories, I wanted to share absolutely successes. You know, when I worked on the homeless domiciliary, most of the veterans had some kind of guilt about something. It was something some way in which they were stuck so that they couldn’t move in a positive direction in their life. So for instance, one of the veterans that I worked with felt he just did not deserve. And he couldn’t get a job, because he felt like he didn’t deserve to be interviewed. I mean, he didn’t even feel like he could, that he deserved to enter a store, enter a building, etc. So I mean, you think about how that might impact someone who’s trying to get out in the work, work world and also to find a home, certainly that would prevent it. So in exploring this with him, I found out that the did not deserve went back to when he was a child. And he and his family were migrant workers. He always felt less than and, you know, when he would be in an interview, and he would be questioned about stuff, he would act out in anger, which only added to his difficulties getting a job. But once we began to target the incidents related to the migrant worker family, moving from situation to situation and never feeling like they belong, he began to change. He continued treatment while in the homeless DOM and was able to get additional training and a job. So so many things, you know, not only did I deal with PTSD, but also medical issues, including chronic pain. And during the 10 years, I worked in the chronic pain clinic. I had many veterans whose life lives improved from EMDR. One fellow ended up coaching his son’s soccer team, another was able to visit his in laws and able to manage his pain during that situation, which was an accomplishment for him. But story that I like to tell is that one of my first patients that I did EMDR with was a chronic pain patient, and he didn’t want to deal with his PTSD issues. He wanted to deal with his pain. So we focused on his pain. Now, I know a lot more. And I realized, boy, that pain could connect directly to one of those traumatic incidents. But back then again, it was one of my first EMDR patients. So he decided he wanted to work on the pain. And I asked him, you know, what image symbol or picture represented that pain to him, and he said, burnt orange corduroy, and he reported it was a sort of eight. And then we did a couple sets. And he reported that it was his son level was three, and he had the image of cool results. So a big change. When I asked him what it would take to make a three zero, he responded, I need some pain, so I won’t overdo it or hurt myself. Obviously, that was about blocking belief that needed to be targeted, but to have that happen in one session. After working with chronic pain as long as I had that was pretty incredible. I had another veteran with phantom limb pain, who had difficulty adjusting to his prosthesis, so he had a prosthetic leg, and they had to continue to modify the prosthesis and also, for lack of a more euphemistic term they had to modify his stump that the prosthesis was attached to and he was very angry with the prosthesis. He was angry at having to use it, it didn’t feel a part of him, and so he just was really having difficulty adjusting. So we worked on the phantom limb pain, and he began to view his prosthesis differently. He also brought in several family members to meet me and so that they could see what he was doing. I guess they needed to check out and make sure I wasn’t doing anything additionally to hurt him. Later on. He was crossing some railroad tracks and his prosthesis got stuck. Yes, and so several veterans actually lifted him out and helped him to get out safely. And when I asked him about that he didn’t seem to be distressed about it. He just said the prosthesis was due Wondering what it was designed to do, which was to be like a leg for him and he was more focused on the veterans who had helped him get out. Probably one of the most touching stories that I have, though, is that I was referred a veteran who had stage four throat cancer. And he was referred to me this fellow had problems, even sitting still long enough for them to determine where they needed to aim the radiation treatment. So they would get him down on the table, and they would put a mask over him and connect the mask to the table. And then they would try to get him to sit still so that they can again, figure out where’s the source of the cancer? And where do we need to aim that radiation treatment, and he had tried everything from cognitive behavioral therapy, to really heavy doses of anti anxiety medications, he was so anxious, that didn’t matter, he would still have a hard time setting on the table. And then after he left the clinic, he would go home and sleep for days, because that’s when the anti anxiety medications would take effect. So they tried cutting the mask open so that he would find it easier to breathe. But that didn’t work either. So finally, one of the psychiatrists on the medical side of the house decided to refer him to me, thinking maybe I could do hypnosis, or maybe even EMDR, on a near drowning incident he had from childhood that they thought made it difficult for him to tolerate the mask. But I’m going to tell you that near drowning incident was the only one of so many traumatic incidents that this person experienced. You know, in talking with me, I discovered that in addition to a horrible childhood, the cancer itself, the diagnosis, the responses of medical providers, etc. Were also very traumatic to him. You know, one of the things he said, How do you go from nothing to stage four cancer in a year, and when he couldn’t sit still, the radiation technician also chastised him saying bone college just wasn’t going to be happy with him. So again, that’s another kind of trauma related to the treatment and the cancer, another medical staff member told him that the anxiety he was over, that he had was overcoming the huge doses of medications he was given. So he gets referred to me, and I know, time is really of the essence for this fellow, they needed to get his treatment going. So you know, I’m finding myself thinking, as I’m conceptualizing the case, well, what do I do with this person, they have so much trauma, and I decided, because of the limited time that we had together, that I would do a combination of resource development and installation and a future template. So I asked him what skills or abilities what behavior he might need to have in order to be able to undergo the test and treatment, and he said he would need need to be able to sit still. So I asked him if he ever experienced having that ability. Now we look for those mastery experiences. And he responded that I know you’re gonna think this is crazy, but I used to love to dance. And one dance I used to do was the Pop Lock. So you just kind of freeze, you know, so he demonstrated that in session, and we installed that and used a future rehearsal. Um, he also said that it would help if I was there with him, and if they played music when he was undergoing the test. So that’s what we did. I went with him to the oncology clinic, we played music for him, and he was able to stay still long enough to determine whether radiation treatment would be most beneficial. And eventually he used that skill to undergo treatment.

Kim Howard 18:36
Those are good success stories. We like to hear that. So do you want to talk about any myths that you’d like to bust about EMDR therapy in this population?

Jamie Zubukovec 18:44
Absolutely. You know, one of the big benefits is that military trauma is only about blood and guts. No, and I think that scares some people off. They’re like, ‘How can I work with the military? If that’s the case.’ But really, there’s so much more. You know, there are so many other types of traumas that people can experience in their service. And that can include betrayal, trauma, moral injury, sexual trauma. You know, individuals can have issues with sleep, addictions, harassment, medical issues, everything from issues with dealing with command and authority, motor vehicle accidents, parachute accidents, to dealing with relationships before, during, and after deployment. I think it’s Camille Zeiter who’s done a presentation at one of the EMDRIA conferences on dealing with transitions in the military, including after deployment and just how to how to work with that. Individuals can be concerned about what they were exposed to during their period of service. So toxins, smoke, water, gas, and the impact on their children and family. So you really have to listen to the client to learn how they’ve changed. And when that happened. And, another thing I’d like to mention, Kim is that, you know, I was talking with a colleague just the other day, and one of the subjects came up was that we all assume that service members know about PTSD, and accurately know what PTSD is. But that really isn’t true. You know, there are a lot of servicemembers and veterans and family members who don’t know or understand what PTSD is. And it may seem surprising, but you often have to teach the service member and their family about what it is, I can think of a Marine, who know had full blown symptoms of PTSD, but he wasn’t having it that he had PTSD, because his view of that was that PTSD was something that people came up with to get out of some of their job duties. You know, they didn’t want to go out on patrol while they were having PTSD, maybe they get sent home. So, you know, you have to look at what is their understanding about what PTSD is and figure out? How am I going to work with this person. Another big myth is that no one in the VA system does EMDR. And I hear this all the time. I mean, here it is, like 32 years, since EMDR, has been introduced to the VA, it really isn’t true that no one in the VA system does EMDR. We have over 600 clinicians who are part of a monthly VA Vet Center and Department of Defense conference call. And, that’s not the only conference call within the system. There are other monthly calls for employees that VA in that center, a VA has also has what they call their EMDR SharePoint, which if you are an EMDR, trained clinician, you can access it and it contains articles, templates for progress notes, etc, that can be accessed by VA and vet center staff. So those are the myths that I would really like to bust.

Kim Howard 22:00
Those are good points, I was at a presentation. And I can’t remember who the speaker was, or what the subject was that it was somehow related to military service and PTSD. And the speaker said something about, you know, I learned very quickly that not all VA locations offer EMDR. Which is likely true, right? It really depends on who is on staff there and whether they offer it but the way that she made the statement made it sound like it wasn’t common knowledge in the VA, and then people in the chat were like, ‘That’s not true.’ You know, this is this is something that it’s it can be found in the VA, if people are offering this services, that’s what that statement is not exactly accurate. And so it’s good to, for you to reinforce that for people to to know that. And I also think going back to your comment about the Marine who had PTSD and had all the symptoms and didn’t recognize it or didn’t want to recognize it. I think sometimes there’s even within the different branches of military, there is a level of expectation about how they are and who they are, where they serve, you know, like, this branch is the toughest, and this branch is this and this and so they they take that mentality, and they look at things like being sick or PTSD or anything like that, that impacts them in their health. And they’re like, ‘Well, that, that can’t happen to me, because I’m a Marine, you know, I’m the toughest of the branch on the first end or whatever.’ And so I think there’s a little bit of that mentality happening with service members that it can’t it that happens to the weaker branches, not me, you know, and so I can see how he would think that.

Jamie Zubukovec 23:41
Yeah, I’m a Marine. I’m, tough.

Kim Howard 23:43
Yes, I’m a Marine. I’m the toughest. Yes, that’s not who we are.

Jamie Zubukovec 23:47
The I’m special forces. I was a Navy SEAL. You know, it’s not going to happen to me. It happens to people who have a weakness, but early on Ray Winker from the Murfreesboro, Tennessee, VA had said every human being has a price. And he said, you know, it doesn’t have to do with weakness, there are just certain things that can affect us. And so we really have to find ways to present information to the backs and service members so that they can accept what it is that they’re experiencing and allow you to work with it.

Kim Howard 24:26
And you truly don’t know. I mean, my dad was in the Army. He was a lifer. And he did two tours in Vietnam, and he passed away in 2019. And you really truly don’t understand how you’re going to respond in a wartime situation, or a conflict situation until you’re put into it. And so you really don’t know what how it’s going to impact you until you’re in it or after it. And then that’s when people realize you know that saying that war is hell is not an understatement. And and what it does to someone’s psyche to be involved in that kind of situation. Even if they didn’t necessarily encounter something that was horrendous or horrible that they did, or somebody that they know did, they’re in that really stressful situation and, you know, trauma that they’ve had in the past, childhood teenager, young person, trauma can all kind of bubble up to the surface, and you have no idea how that’s going to impact you. And then all of a sudden, you’re, you’re in that situation, or you’re, you’ve come back from the deployment, and you’re like, Well, my life is not the same. And I’m not the same and what happened. And so that’s good that, thank God, there are resources out there for military personnel and veterans. So thank you for doing what you do.

Jamie Zubukovec 25:36
Thanks, Kim.

Kim Howard 25:37
Are there any specific complexities or difficulties with using EMDR therapy with veterans and military personnel?

Jamie Zubukovec 25:43
Well, certainly active duty personnel, you have to consider, you know, the possibility that you might have to report back to someone in higher authority, depending on what your position is, if you’re in the Department of Defense, you may have that mandate where you have to report back to someone from command. But you certainly would want to make sure that you have consent form signed by your client. Another important consideration is just how much time do you have to work with this veteran or service member? Why is the person in treatment? And why did they come into treatment? Now, one of the difficulties that people often report is that it can be difficult for the client to buy into looking at earlier childhood are developmental events that can be contributing to their current issues. And so you have to, you have to figure out how you’re going to do that dance of that therapeutic alliance to try to get them to understand that this is part of a bigger picture. But again, if you don’t have that much time to work with the individual, and you’re going to have to consider other approaches, or even if the person is so adamant about not wanting to deal with childhood stuff, or if there’s a sense of urgency about needing to deal with current triggers, then you could still use EMDR some aspects of it by dealing with current triggers, future template, or even using EMD. You know, so more restricted processing, just focusing on a particular event. And can sometimes veterans report experiencing numbness about a particular experience? And so therapists often are, you know, confused about what what do I do with that? You know, I asked them what emotions they’re experiencing, and they say they feel numb. Well, you can you can go with that. It’s like, where do you feel that numbness? Where do you notice that in your body? How distressing does that numbness feel to you? When did you first experience that? You know, and sometimes tracing that numbness goes back to earlier childhood stuff, you also have to consider secondary gain, because it can be a factor in working with this population, you know, how will improving that veteran or service members situation, impact disability compensation, you know, whether or not they go out on deployment, legal issues, or even their role in the family and ask for the therapists. I guess, this also relates to complexity. I can’t stress enough. And some of this, I know that I wrote about go with that magazine, the military issue. But I just really want to stress that because I think it’s so important that first of all, the therapist really needs to be aware of themselves and their own belief systems. So asking yourself, Why Why am I working with this population? Now? What is your family history, just as you have family history with some military background? Were there are there veterans or service members in your family, and as a therapist, you really have to be aware of what you bring into the session. You know, in the olden days, we used to talk about transference and countertransference. But it still can be a meaningful discussion. So it’s important to be aware of your own stuff and how it can affect treatment. For instance, a clinician might view themselves as being very positive and very supportive of veterans and service members. But you have to look at the flip side of that. How is that view going to impact the therapeutic alliance and what the client is going to share with you? Or, you know, how you might view what they say, what might you miss or downplay if that’s who you are. Your client may have difficulty telling you about some horrible things they may have done, because that could impact how they view you. And again, you just have to be genuine. Sara Haley, back in 1974 talked about that the establishment of that therapeutic alliance is the therapy is the treatment. So I can’t emphasize that enough. You have to have good therapeutic alliances with that client also remaining neutral without judgment, you have to be connected and compassionate with your clients. Again, that client may have some horrific things to share or something that they’re very ashamed about. So you really have to listen, you want to respect the service member, the veteran. And one of the important things is don’t try to pretend you know or understand when you don’t, you know, you might have to take time to learn about that service about that particular particular war deployment, that unit or squad, you really need to take time to understand that service member of veterans unique experience. And they are all unique, just as you know. E.C. Hurley, Jan Click, and I did a presentation for EMDRIA one year and we were talking about how, when you work for one VA, you work for one VA, they’re all different. And the same is true for the veterans and service members, even if they’re a part of the same branch, or even if they’re part of a special unit or group, they’re very different. So you need to tune into what those differences are. The last thing I want to say for therapists says you really have to make sure you take care of yourself. Again, I think that article and go with that magazine. I mentioned self compassion and self care. But really, you’re going to be hearing some very intimate, very horrific things, and you need to take care of yourself.

Kim Howard 31:30
Those are great tips for therapists. Thank you. Thank you. I’m going to switch gears just a little bit. I’m going to ask you, how do you practice cultural humility as an EMDR therapist?

Jamie Zubukovec 31:39
Yes, first of all, you have to be aware of military culture. And then you know, it’s like an onion, there are other aspects of other cultures related to the groups of which the service member or veteran is apart. So again, when we think about culture, what are we talking about? We’re talking about values and ideals, you know, so Marines, you know, Semper Fi, forever faithful. You know, so that’s a big, that’s a big ideal, but sometimes that doesn’t hold true with people’s military experience, beliefs, the worldview, what is the world like, you know, the real world are back in, you know, back home where everyone’s safe? How is it different from, you know, what you have to deal with when you’re in an war combat situation? How does it affect their worldview? Know what interests are common to that culture, and what behavior and customs and of course, special language. So when you meet with someone from the military, or a veteran, you know, they can talk in in slang terms.

Kim Howard 32:41
So acronyms, so many acronyms. Like, what does that mean, again?

Jamie Zubukovec 32:47
Yeah, so sometimes I get caught up in that, too. I know, I think I’ve referred to some abbreviations in some of the presentations that I’ve done. And people are like, Well, what does that mean, you know, and I kind of, had assumed that they understood, but, but they didn’t, that special language. So learning a little bit about that, when I started on the stress unit, nor Chicago. So this is back in 1987, when I was an intern, they actually gave us like a list of common Vietnam terms, and what they meant. So it was, that was very helpful. But you know, as time has gone on, continue to see how that special language develops. The other thing about culture: It helps us define what is normal, what’s accepted, you know, what emotions were okay to express, you know, whatever emotions are okay to express. Now, culture helps us to find our place. And it helps us define who we are and how we relate to others. And, as Shapiro, it’s an even Brene Brown, nobody likes to be cut off from the herd. And so people may do things to try to adapt to the culture that may not fit for them. And so that can be a potential target for treatment. But the most important thing is you have to ask, ask about culture when you’re interviewing the client, you know, race, ethnicity, gender, spiritual beliefs, pref