EMDR Adaptations for Brain Injuries with Dr. Michelle Morrissey | E20

Dr. Michelle Morrissey of the Morrissey Institute explains how she has adapted EMDR therapy to safely and effectively treat patients with concussions and brain injuries. She details the eight phases of EMDR treatment and shares her approach of clearing small traumas first to create capacity for healing bigger ones.

• Dr. Morrissey has 20+ years of experience as a trauma-informed mental health professional specializing in EMDR therapy.
• Traditional EMDR with fast eye movements are not indicated for people with brain injuries, but there are ways to adapt the therapy.
• Adaptations include slowing bilateral stimulation to match brain oscillation speeds (0.75-1.5 Hz).
• Alternative forms of bilateral stimulation like tapping, auditory tones, or tactile stimulation are safer than eye movements.
• Using "small-T" trauma processing before addressing bigger traumas creates more capacity for healing.
• The brain after injury operates at different oscillation speeds compared to an uninjured brain.
• Depression from brain injury may not respond to antidepressants because of neurological differences.
• Improved diagnostics like diffusion tensor imaging (DTI) can now show neural disorganization after concussion.
• EMDR improves sleep, mood, cognitive function, and even physical symptoms like hyperacusis and dizziness.
• Telemedicine EMDR is effective and accessible 

If you're interested in finding an EMDR therapist trained in Dr. Morrissey's specialized approach for brain injuries, contact the Morrissey Institute directly for referrals in your area.

Links for Dr. Michelle Morrissey:

The Morrissey Institute Website: https://www.themorrisseyinstitute.com/ 

Questions to ask Prospective EMDR Therapists: Watch Video
The Morrissey Institute YouTube Channel

EMDR International Association (EMDRIA) website

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Chapters

• 0:00 Introduction to Dr. Michelle Morrissey
• 7:42 Origins of EMDR in Dr. Morrissey's Practice
• 16:39 Understanding the Eight Phases of EMDR
• 23:24 Working Memory and Trauma Processing
• 36:51 Adapting EMDR for Brain Injuries
• 47:12 Telemedicine EMDR and Resources
• 53:16 Advanced Diagnostics for Brain Injuries
• 59:51 Clinical Outcomes and Closing Remarks

Transcript

Dr. Ayla Wolf: 1:10

Today's guest is someone whose career and contributions speak volumes, not only in the field of mental health, but in the lives of the countless individuals and professionals she's supported along the way. In this episode, Dr Michelle Morrissey, founder of the Morrissey Institute, explains how EMDR can benefit those with concussions, and discusses how she has made important adaptations to basic EMDR to make it safe and effective for people with brain injuries. She has developed advanced curriculum specifically for EMDR practitioners wanting to learn these techniques so that more therapists are equipped to serve this population of people. Dr Morrissey has a PhD in marriage and family sciences, specializing in trauma, military families and first responders. She is an EMDRIA approved EMDR basic training provider, consultant and sought after speaker, and has received numerous awards and grants for her work. I thoroughly enjoyed this conversation, and I hope you do as well. If there are any topics you would like to hear more about, please send us a text through the link in the show notes, or email us at life after impact@gmail.com Welcome to Life after impact, the concussion recovery Podcast. I'm Dr Ayla Wolf, and I will be hosting today's episode where we help you navigate the often confusing, frustrating and overwhelming journey of concussion and brain injury recovery. This podcast is your go to resource for actionable information, whether you're dealing with a recent concussion, struggling with post concussion syndrome, or just feeling stuck in your healing process. In each episode, we dive deep into the symptoms, testing treatments and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology and rehabilitation to share their wisdom and strategies. So if you're feeling lost, hopeless or like no one understands what you're going through. Know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact. Dr Michelle Morrissey, you have over 20 years of experience in the field of trauma informed mental health, and you are an expert in EMDR, I am so honored to have you on the show today, why don't you start out by talking a little bit about what got you to where you are today.

Dr. Michelle Morrissey Ph.D.: 3:43

It was actually a happy accident, and I don't believe in coincidences, so I know the universe was guiding me in that path. So started out as a public school teacher, did that for about six years, went to Department of Corrections, did that for close to 15 years. It just wasn't it. So I quit, and it's like, I'm going to go back to school, I'm not going to get another bachelor's, I'm going to get a master's. And at the time, I was thinking, social worker, right? Because it was so prevalent, moved to Reno for the master's program, because they didn't have the MFT program in Colorado at that time. And so it's like, yeah, you know, it'll take a while for you to get into the social worker program. It's your typical brick and mortar. It'll take four years. And I'm like, not interested. But I remember back in my Bachelor's program, I had two classes in marriage and family therapy, and I loved it. It made sense to me, so I went with that program. And in that program, one of my professors was a Vietnam veteran, and he's like, you know, EMDR is like, the stuff, and I'm like, All right, so I've tried object relations, I've tried group therapy. Like I come from a trauma background. I had a lot happen to me as a kid. Tried the usual stuff, and it only took me so far, right? So when he talked about EMDR, I read a book that Francine put out. And it wasn't the training book. It was like a novel of other people who've experienced EMDR and how it helped them after that, it was like, I've got to have this done. I've got to see if this will make those changes. Had it done. And it was like, Oh my gosh, I've got to learn how to do this. So the day after my classes ended, before I went into my internship, I was on a plane back to Denver getting trained in EMDR, and it's just been wonderful since then, I had a wonderful female boss down in Walsenburg who hired me and loved the EMDR, very supportive. Guided me to get local grants that would help me become certified, and after certification, become a consultant. And I didn't know any of that existed. So I got trained by an institute trainer, and the Institute is here, and then Andrea is here, right? So kind of. Separate, and their paths don't really intertwine, so I didn't know that. And I had another Vietnam veteran come up from another state and say, My insurance will only pay for somebody who's certified. And I'm like, What's that? So got involved with Andrea, got certified, got another grant to become a consultant, and then after that, it's like, I have to teach this, not I want to. It's a I have to. It was like a deep drive within me. So that's kind of the journey. And along the way, they were rural communities, and you have to be able to treat almost everybody in a rural community, because the majority of the population was Medicaid back then, they did not have Medicaid transportation, like they do now, right? And so if they couldn't afford to travel two, three hours away to get treatment, they weren't getting treatment, right?

Dr. Ayla Wolf: 7:07

Yeah.

Dr. Michelle Morrissey Ph.D.: 7:09

So I took advanced classes. I read every book that was out there. I learned about children and dissociation and addictions, like everything and anything I could, and the one theme they they had in common. And these were, I call them the OGS, right. They were trained by Francine, so we're talking Bob Tinker, we're talking Jim knipe, and we're talking AJ popki, all doctors, all trained by her. And the thing they hadn't, all of them had to say, start at your lowest, and you work your way up. So when I got some kids who had concussions, and it had been six months post concussion, and they're depressed, they're suicidal, their grades have dropped. They're isolating all of that stuff. It's like, well, let's start working with them.

Dr. Ayla Wolf: 8:04

And when you say lowest to highest, you're talking about little T trauma and big T trauma.

Dr. Michelle Morrissey Ph.D.: 8:10

Yes, ma'am, yeah. And so the way you're taught is to jump in at the biggest thing, like we were talking about before the show, starting at the top of the mountain and working your way down. We have too much complex trauma to do that. That would scare too many people away, right? And so that same philosophy I applied to working with brain injuries and saw phenomenal results. So started with all the small T's, and then like, do you know about the EMDR continuum?

Dr. Ayla Wolf: 8:42

No, fill me in my so my EMDR experience is that I worked with therapist Chris Denton in Bend Oregon, for EMDR, and you know, you talk about the eight phases of treatment. Well, as the person on the receiving end, I had no concept that there were eight phases. You know, he seamlessly, just wove his way through the eight phases without me knowing there was a phase to anything. You know,

Dr. Michelle Morrissey Ph.D.: 9:09

So with EMDR. The continuum is Francine started out with EMD. She was just desensitizing, right? And then she went to the capital R, or the big R, which was reprocessing, okay. And so the way the brain works is we have neural networks that link up, right, via thoughts, images, emotions, body sensations. So you can activate many neural networks when the client isn't ready or prepared, and that will overwhelm them. And if they're overwhelmed, they're not processing, and they get they shut down, or they dissociate, or they're scared, and they just stop. Right? It's too much. So the spot in between is EMD, little r. So you start out with desensitizing, and then you just reprocess that event. And then if there's more of one of those events, once that is reprocessed, then you go into EMD, big R.

Dr. Ayla Wolf: 10:10

And can you break down kind of again, what EMDR stands for, and then what desensitization is versus reprocessing? Because I think a lot of people, they can't just immediately pull a definition for these terms. Yeah,

Dr. Michelle Morrissey Ph.D.: 10:25

so Francine started with eye movements. And if you watch any of her old videos, she is doing it like this fast, okay? And she just started with desensitizing. Desensitizing what an image looks like, desensitizing the emotions. It's kind of like when you put on a new watch or ring, you notice it for a week or so, and then after that, your body's desensitized to that. And you're like, oh my gosh, where's my watch? And you're like, Oh yeah, it's on me, right? Kind of what happens with EMD? You're desensitizing only.

Dr. Ayla Wolf: 10:59

From a traumatic memory.

Dr. Michelle Morrissey Ph.D.: 11:02

yes, ma'am. So then you can move into the reprocessing part, which is now you're opening up that neural network. Work. So people can look at different aspects or facets of what happened, and they can see it more objectively and removed, because now the images or the emotions or body sensations don't bother them, so they can stand to look at it, right? Yeah,

Dr. Ayla Wolf: 11:26

yeah. It's that idea of if every time you think of a memory, you start crying, you know, you've really attached all of those emotions to the memory, and they're very much intertwined. And my experience of EMDR was I got to disentangle the emotion from the memory so that I could just deal with the event without experiencing all the emotions that came with it, and that would allow me to have much better control over my emotions and to be able to approach things with a more rational perspective,

Dr. Michelle Morrissey Ph.D.: 13:04

exactly. So that's the continuum I follow in all of my treatment, as well as with brain injuries. More importantly, with brain injuries, it's kind of like, do you want to turn on the faucets in your bathroom and your kitchen and the house all at once, full blast, or do you just want to open it up and let it trickle and deal with the trickle and then open it up more as the client is more capable of dealing with things, right?

Dr. Ayla Wolf: 13:31

Yeah. And certainly, when it comes to people with brain injuries. You can have some people that actually have trauma from their past before they even got the brain injury. Then you can have people who have trauma associated with the brain injury, and then you can have people who are highly traumatized as a result of having the brain injury, and then try and how that disrupts their life. So yeah, there's a lot to untangle with, like all of that as well.

Dr. Michelle Morrissey Ph.D.: 13:59

Yeah, and so it's kind of like, could you go in and remodel a house without checking the studs in the foundation first? Right? If you do, it's possible that some walls could cave in because there's dry rot somewhere, right, or termites, and if you go to do something, that whole part might collapse, right? So by going back in time to earliest memories, you are treating the foundation and the walls of the house so that when you get to the inside stuff, they have a strong foundation to stand on.

Dr. Ayla Wolf: 14:38

And would would now be a good time to maybe talk about kind of the eight phases of treatment, because, like you said in videos, Francine, who was the founder of EMDR, EMD to start, would move her fingers back and forth very fast. And so a lot of people, when they hear the words EMDR, they think, Oh, is that? That thing where you move your eyes back and forth, and there's so much more to it. So I think when you talk about the eight phases, that kind of brings to light the fact that this is not just about, oh, let's talk about traumatic things and move our eyes back and forth. There's so much. There's so much involved in this.

Dr. Michelle Morrissey Ph.D.: 15:16

Yes, a lot of finesse and skill goes into it, even though those who do it and have done it a long time make it look so seamless, like you're saying with Denton.

Dr. Ayla Wolf: 15:28

With Chris, yeah.

Dr. Michelle Morrissey Ph.D.: 15:32

eight phases, and you're right, clients don't know it. And that's when I teach people. That's what I tell them. They don't know if they're automatically going to Phase Five. During Phase four, they're ready for it, instead of like, oh, well, wait a minute. We've got through these in order, right? So phase one is history taking you're looking at everything. I look at it as a reverse engineer, right? You were coming to me as a completed project. My job is to figure out how you got here. How did you develop the anxiety? How did you develop depression? Where did the PTSD come from? What's going on with the headaches and the sleep issues and the high blood pressure and the CPAP and all of that, right? So I take you as a completed project, and I go through the maze backwards to figure out starting points. So the history taking is very important, and you also develop your targeting sequence plan at that time. So as I go through symptoms and events, I have clients rate them on a Sud scale, subjective unit of disturbance, right? 10 is the worst, and zero is the calmest. And so as we go through when they're handing me a number for everyone now, I can look at it and go, Okay, this is where we're going to start. The least disturbing. Now, there are occasions when somebody is so blocked that they've stuffed something down so bad that their big T's they say are only a three. And once you start, I call it poking that neural network, when you start pulling on those strings, some things are going to unravel, and that score is going to shoot up, right? So then you still have to. Look at it and go, Okay, clusters of small T's, teasing and bullying, great place to start, unless it was pervasive and in the family for years and not just like a couple of kids at school, right? Phobias are a great place to start. Moving around a lot is a great place to start. So any of those small car accidents, minor car accidents, slipping and sliding on snow or ice, dirt roads, fishtailing somebody, rear ending you, but nobody's really injured. All small T's, right? So you would clear those out, kind of doing that switch back, working your way up to the bigger T's. So what I'm finding in all the research I've been doing behind this as to why it makes so much sense, and it's a great computer analogy. You've got a computer with, let's say, 16 gigs of ram your random access memory, right? And then it has a terabyte of storage. And you think, wow, I can do anything on this computer because it has a terabyte. People look at the terabyte, which would be akin to, like all the space you might have in your basement with all the plastic tubs organizing your stuff, right? The important part is the RAM. How much RAM Do you have? And that's where we look at our own working memory, as that RAM on a computer, if your RAM is full, you are not going to be able to process. Your computer. Processor won't work. It's going to be slower. It's going to do the little what the dead swirl like? Oh, it's buffering, right?

Dr. Ayla Wolf: 18:58

The rainbow wheel on the Mac,

Dr. Michelle Morrissey Ph.D.: 19:00

yes, yeah. And so it's the same thing in our brain when our working memory is full of all of our past trauma and all of our present triggers and trauma, you don't have the capacity to do as much as you could when once that's cleared up. So when you do all those small T's and you clear them out, you are freeing up that working memory so that as you get into deeper and deeper or bigger and bigger traumas, they're able to handle it and have the space to deal with it. Yeah,

Dr. Ayla Wolf: 19:32

you know, just recently, in January, I was having a massive amount of stress just related to insurance stuff and running my practice and yada yada yada, and my brain started to malfunction in the exact same ways that it did when I was very much in my post concussion syndrome, in terms of being forgetfulness, making little cognitive errors, and just like, not, you know, just being very not present because I was stuck in all the miscellaneous stress of the job. And it just really struck me as, like, wow, stress by itself, without even a trauma associated with it, really is shutting my brain down and affecting my working memory. And so it was so obvious to me how that was, you know, how, just like an increase in stress manifested in that way, in terms of the the working memory piece.

Dr. Michelle Morrissey Ph.D.: 20:26

Yes, and what I've learned recently is the way I was conceptualizing it previously, is all these neuro chemicals and the stress hormones are affecting us, and when we do EMDR, and you clear that out, it allows those stress hormones to start to decrease, so that people can get balance or homeostatic functioning in the brain, right? So you take that and you look at it a little bit different, and you go, Oh my gosh, all this stress, not trauma, just stress, right? The stress hormones increase. It can be a cortisol issue your HPA axis, hypothalamus, pituitary, adrenal cortex, right, which can then throw off your cortisol rhythms, affecting your sleep, or you could be producing too much cortisol at the wrong times of day, which can affect body temperature, irritability, problem solving, capacity, all of that. And so now I'm looking at it as a more fuller or deeper picture as it goes so much more beyond what I thought it did previously,

Dr. Ayla Wolf: 21:32

well, and it's such a big testament to how our mental health is absolutely so intertwined with brain function, endocrine system, sleep, mood, all of the things,

Dr. Michelle Morrissey Ph.D.: 21:45

hormones. Yeah, male hormones, yes.

Dr. Ayla Wolf: 21:49

And you know, I test working memory in my clinic, and many people after a concussion have difficulty with working memory. I think what you're highlighting is that the solution is not always, let's just do a cognitive exercise to work on working memory. It's also, Hey, we gotta free up the RAM. We have to clean up all of this mental clutter and stress and trauma to actually get the brain in a place where. It can handle cognitive loads like you were having good working memory.

Dr. Michelle Morrissey Ph.D.: 22:19

Yeah, So when I was doing research for my PhD, what I found is that when people have PTSD, their prefrontal cortex shuts down. It goes offline. Where does CBT appeal? What part of your brain does CBT appeal to prefrontal cortex? Yeah, exactly. So we're giving them something to do that we know that they aren't capable of doing because they're in this post traumatic stress state, right? And then we're wondering, as providers, why aren't you doing your homework? Why isn't this working? Uh, why aren't you taking the time? Why aren't you putting yourself first, which then sounds very blaming to clients, right? And then they start to beat themselves up more. I don't know why. Why can't I do it? I'm just sitting here. I can't think. I can't function. What's wrong with me, right?

Dr. Ayla Wolf: 23:10

Yeah, well, and then if you add in the layer of you know, so many of the people I work with are women, and they have children, and so they have concussions, brain injuries, stress, trauma, and they're putting their children first, and and they have this decreased activity within this prefrontal cortex. And then, yeah, you're, you know, no wonder they can't find the time to do their eye exercises or their cognitive exercises, or their CBT exercises, and you know, it's so I just, I, I'm such a believer in the importance of EMDR and allowing people to decrease the effects of trauma and stress on their nervous system. Because when that isn't addressed, it's really like trying to move forward with therapy with the brakes on,

Dr. Michelle Morrissey Ph.D.: 23:58

yes,

Dr. Ayla Wolf: 24:00

and I imagine, do you see? Well, let's talk first about, you know, one of the things that you've, I think, worked really hard at, because you do train other EMDR providers, is that you have also made adaptations of EMDR specifically for people with concussions and brain injuries. And I would love for you to maybe dive into that first, and then we can talk about my other question. Or part two of that was, I imagine that when you're working with people that you see a lot of other symptoms get better that you're not necessarily directly treating, for example, maybe some dizziness or vertigo or dysautonomia type symptoms, or, you know, other things. I imagine that as the nervous system becomes healthier, some of these other symptoms actually just organically improve.

Dr. Michelle Morrissey Ph.D.: 24:47

Yes. So before we do that, we didn't get to the other phases.

Dr. Ayla Wolf: 24:51

Oh, yes.

Dr. Michelle Morrissey Ph.D.: 24:51

This name phase two is like resource installation, breath exercise, ego state, container, light stream, calm place like you, prepare the client with things they can do. I also include what I call parasympathetic nervous system hacks. Hulking is one of them, because if you Hulk, and you think of the Hulk, right, you are activating your vagus nerve from your iris to your anus, and we have 50 sphincter muscles along that route, which will then shut down that stress or anxiety response in the moment. So you grunt and hold for the count of five, relax and breathe. Do it again. For the count of five, relax and breathe. Do it again if you need lemon juice. So anything that's tart that will make you pucker will shut down that stress response. So put a squeeze of lemon in your water. Have a tart candy to suck on. So I teach people like other skills that they can do. Phase three should technically only take about three to five minutes, so the rest of your session is in phage phase four. Phase three is the assessment of the event you're working on. What's it look like? What thoughts go with it? What emotions, where do you feel it in your body? How much does it bother you? Kind of a brief assessment. Phase four is where the majority of your therapy is, and it can be done with eye movements, auditory tones, bilateral tapping. You can draw and use what the drawing protocol as well. I've been very creative for the neurodivergent where you can get foam balls and they can squeeze them. You can have clicky pens, right? If you've got one on each side, they can click. So there's a lot of different things, ways to deliver EMDR phase, can I?

Dr. Ayla Wolf: 26:46

Can I interrupt and ask you a question? You mentioned that phase three, where you're actually identifying the the trauma you're going to work on in that session is only about three to five minutes. I think a lot of people, one of the things that maybe holds them back from doing EMDR is that they're like, they're gonna make me, like, relive my trauma for an hour during therapy. And am I understanding you correctly and saying that the identification of the trauma is kind of a three minute process?

Dr. Michelle Morrissey Ph.D.: 27:14

Yeah, yes, it's like skipping a rock on the water, right? Every time it skips seven times across the water. All we need is, what does it look like? Is it in color, black and white? Is it still or moving? Is it clear or cloudy, right? Is it close or far? And then what do you think? So? Yeah, you were just doing the the tips of the water, when you're skipping it, the real processing occurs in the person's brain with the depth, like you throw a rock in the water, it may ripple on top, but what does it do under the water? Right? EMDR, is a lot of what happens under the surface, and that is everybody's personal journey. Okay? So yes, it's relatively quick. You don't want people to talk about it, because then they're going to get too activated. They're used to that in talk therapy, telling you all the details. It's like, no, no, I don't need that, right? This is all I need.

Dr. Ayla Wolf: 28:11

Yeah, I think that's really important for people to realize, is that you know you're not going to go to a session like talk therapy where you have to relive the trauma as you sit there for an hour. It's actually this kind of quick check in. And then we do phase four, which I'll let you get back to,

Dr. Michelle Morrissey Ph.D.: 28:28

yeah, phase four is like after phase three, the way Francine did it. Is it? It's alternating left brain, right brain, right you have an image we created in the right brain. We have a thought that's left brain, so she's activating everything the memories are storing on each side of the brain. So what we need is activated or lit up and ready to go right into reprocessing. Okay, which means I want you to just notice more mindful, notice that image, that thought, the emotions and where you feel it, and if you're doing the big R, let whatever comes up with it to come up. If you're doing EMD, I just want you to notice the image and the emotions in your body, right? So you're containing what they're allowing themselves to bring up or to notice, which keeps them safer, okay? And I'm all about client safety. You should not feel like you are doing prolonged exposure right in order to get benefits.

Dr. Ayla Wolf: 29:32

I think that's really important for people to recognize, because that might be, I think one of the reasons why people are a little bit fearful of, you know, going in and trying it in the first place,

Dr. Michelle Morrissey Ph.D.: 29:42

yes, yeah. And I look at it because I'm, I labeled myself a sumo wrestler, of EMDR, you see the sumo wrestlers, right? Big dudes, right? They you're strong, you're heavy, you're doing the heavy lifting. That's the kind of trauma I've treated my whole career. I also treat the light stuff, but if you know how to do the sumo wrestling, it's easier to do the light stuff. Like someone's coming in for one car accident, or they didn't get a job interview or the job they were hoping for. Still traumatic, but lower on that scale. So to the the kids who've been raped and molested at two, three years old, the domestic violence, the murder suicides, and the families who have to survive the home invasions like I do that heavy lifting, and so it's all about client safety. Otherwise they wouldn't be able to make the progress that they make. So after phase four, they reprocess. You get that Sud, that subjective unit of disturbance, down to at least a two or below. Then you move into Phase Five. You're going to basically phase four is cutting the electrical wiring in the brain, and we have now cut it from the emotions and the images and the body, and Phase Five is we're going to flip it now when we're going to rewire that for something positive. So now, every time you think of which, you don't think of it often, but if it comes up, oh yeah, that wasn't my fault, and you are able to let it go when it does come up. And then phase six, you're you're scanning the body. If you go back into that original image with the new thought, I can handle this or it wasn't my fault. Is anything coming up in your body that would signify that statement isn't true? If so, you go back into Phase four, you reprocess a couple of sets and clear it out, and then phase seven, you are either closing down the session if it's incomplete, with a container, calm place, if it's completed, I like to go. So what was your experience like? What insights did you gain today? If it's positive, reinforce it right? And then just kind of talk about it, shut it down, set them up for the next time. Phase eight, I use when they come back. What did you notice in the past week? What shifted? What's changed? And it's also used for, like, completing treatment, so my case conceptualization and. Treatment plan. It's like that living document. We have now done six of your eight traumas. How are things going for you? How's your sleep? I'm always checking in, noticing the changes. If something's lingering, I'll go back and clear it out, right? And so then you conclude therapy when they've reached their goal. EMDR, can be client like you go into a restaurant that is an ala carte, right, and you're going to pick and choose what you want on your plate, or it's a sit down menu where you can get a seven course meal. And so I asked the clients, you've got all this in your history, if you're just coming for this job issue, then we'll clear out all the channels with this job, and then they're done. They've reached their goal. They've got the changes they want, or they can come and go. You know, I've got the job thing cleared out, but I see where it started, and now I want the benefits in my relationships with my kids or my spouse, and I want to be free from more anxiety or these thoughts that I'm not good enough. And then you can go deeper with that. So there's a couple of different ways to approach it. Okay? So there's the eight phases, and we can kind of cross that off, and then move on to what you were asking. If I hope you remember where you were at.

Dr. Ayla Wolf: 33:35

Oh, man, I don't

Dr. Michelle Morrissey Ph.D.: 33:38

Rewind this.

Dr. Ayla Wolf: 33:40

It'll come back to me. One of the questions I do have is that, you know, going back to, how are you adapting this for people with concussions? And you did mention that you've got the different options, because sometimes the ocular motor system is affected by the brain trauma, and so moving your eyes quickly back and forth is not the best way to activate the system. And so other people that you work with, you're going to use, like you said, the squishy balls or tapping, or even a pen clicking or buzzers. And so is that just, you know, that's one of the ways in which you're adjusting. It is the the bilateral stimulation. There's lots of options.

Dr. Michelle Morrissey Ph.D.: 34:21

Yes, eye movements are generally not recommended for brain injuries because so I usually find out, where were they hit? I found the people who've had strokes, which are also brain injuries. If they it wasn't anywhere in the occipital lobe, they can tolerate the eye movements. If they've had concussions where they hit the back and the front of their head, they cannot most of the time. It causes them headaches, eye aches. You don't want that. So I think it depends on the the brain injury, but I would say 90 some percent of the time don't use eye movements.

Dr. Ayla Wolf: 34:59

And then my experience has been when I've referred out, when I've recommended EMDR, my patients will call around town, and they'll talk to a few people, and then as soon as they say, Well, I've had a brain injury, the therapist says, Oh, well, then I can't work with you. I don't do that, so tell me what's going on there.

Dr. Michelle Morrissey Ph.D.: 35:17

It's very I'm glad that they know that's beyond their scope of practice, because I get a lot of calls from all over the United States and other countries. Of this is what's happened. This is what the therapist thought they could do. Oh, I'll just jump in and try it. They did eye movements super fast. People have been not only dysregulated, but a dysregulated. Brain injured person means they don't feel safe, they feel suicidal, they feel like they did the day or two after their brain injury. Some have been hospitalized psychiatrically because of it. So I am glad that those therapists know it's beyond their scope.

Dr. Ayla Wolf: 35:59

Is there a specialty within EMDR that's really just focusing on, how do we work with this population of people?

Dr. Michelle Morrissey Ph.D.: 36:06

That's exactly what I'm doing. Is this is how we work with this population of people. So... the... boy it's like there's so much to it... So if we use, and I love analogies and metaphors, because people can get it if you're a generalist doctor, right? A medical doctor, and you know some internal organs, you know stuff, right? But somebody comes to you with some endocrine problem, you're not gonna you're gonna refer them out to an endocrinologist, because it's not your area of specialty, despite your having the basic knowledge, right? Same thing if you're a surgeon, right? A general surgeon can take out your appendix, your gallbladder, but if you need spinal surgery, you want to see a neurosurgeon, right? And that's kind of what's going on here. They have the foundation to understand the body and the medical knowledge. So if they wanted to specialize, they would just have to do whatever training and practice in their new field, right? Yeah. EMDR is basic. You don't learn all the ins and outs about the brain in a basic training. You're just getting the foundation. So if you were to try to jump in and treat a brain injured person without the foundation of the brain, you can mess them up. Okay, so in the class, I teach about the oscillation speeds of the different organs in the brain, right? How to figure out what that function of that part of the brain does that got injured? Let's say it's your balance, right? Your your speech, you find out where the head injury is. You know, what's in this lobe? You know what this controls? You know, oh my gosh, this is what's going on. Maybe I need to make these adaptations, or those adaptations, or this part of the brain oscillates at this speed. So if I'm coming in, not that you would be doing eye movements, but just so you could see how fast you are going to overwhelm them and they're going to shut down. So the research that I found from all over the world is, despite Francine doing this and people teaching as fast as possible, that is not the ideal speed with which to make changes. They're finding it's between point seven, five and 1.61 point 7.75, to 1.5 is the ideal speed. Which one pass like if you start in the middle, one pass per second is one hertz, right? Okay, so that means we're going slower than that per second, okay? And that slower speed, the best I can liken that too, is like a trickle charger, which also occurs during REM sleep. The rest of the brain goes offline. That part of the brain during REM sleep is functioning between point seven, five and 1.5 accessing the information it has, consolidating memories. What isn't generated towards future use gets dumped, what is then gets stored to a different part of the brain for long term use. Right? So that's the speed I approach EMDR with with brain injuries is we want to do it at a slow enough pace that it is more like the trickle charger, like REM sleep would be, to help realign the organs of the brain that are off. And I know a lot of generations don't understand. I grew up with clocks, cuckoo clocks, grandfather clocks, watches that you had to whine, right? So if you look at anything like that, you've got big gears, middle sized gears, small gears, and very tiny gears. The smaller the gear, the faster it has to spin to keep up with the big gear, right? And that's kind of conceptualizing what's going on in the brain. One is going to function at 40 hertz, it's going to spin like crazy. One is at 10 hertz, so it's a lot slower. One may be at two hertz, which is even slower than that. You get a brain injury, and it's like bumping those gears, and they're off. And now what's supposed to be spinning at 40, spinning at 10, which should be oscillating at 10s, at 30, which should be oscillating at two, is at 15, everything seems to be off. That's the best way I can explain it.

Dr. Ayla Wolf: 40:43

Yeah, well, and I think that's also why a lot of people develop the light sensitivity with like fluorescent lights, because all of a sudden their brain is oscillating at different hertz frequencies, and then you have fluorescent lights that are vibrating up here at 60 Hertz of a minute, and your brain is like, I can't handle that anymore.

Dr. Michelle Morrissey Ph.D.: 40:59

Yes, I'm overwhelmed. Same with the sounds music. It's all the same. It's all a vibration. It's too much. I can't handle it, right?

Dr. Ayla Wolf: 41:09

Yeah. So have you seen hyperacusis improve with EMDR?

Dr. Michelle Morrissey Ph.D.: 41:13

Yes- hyperacusis,

Dr. Ayla Wolf: 41:14

Awesome.

Dr. Michelle Morrissey Ph.D.: 41:16

So the just about everything improves with the brain injuries. The caveat to that would be the people who have had successive brain injuries in short periods of time, and the older the client with the higher number of brain injuries, they still seem to have some memory issues. So maybe that is more the age 50 something, 60 something menopausal, right? That is making it worse. So it could be hormonal adding to that. But that's one thing that I found. It doesn't mean it's impossible to learn the younger person, teenagers, 20s, 30s, they haven't seemed to have had a problem with their memory like the older people do,

Dr. Ayla Wolf: 42:01

sure, and going back to this idea of initial EMDR, uses very fast lateral eye movements. You are slowing it way down, including when you're using say, tapping. Or squeezing or clicking a pen, or you're having people also do that much slower than is typically practice. Yes, okay, and then the Morrissey Institute is your institute where you're actually teaching this advanced EMDR for brain injuries. Is that correct?

Dr. Michelle Morrissey Ph.D.: 42:34

Yes, okay, yeah. So I offer consultation and the training so that they have a foundation to receive the information, and then they can treat clients if they want to specialize in it, then they have that foundation to receive. Why am I making these adaptations? And then, oh, it's just in this case, then I can go back to using the standard protocol, and it's like, no, you need to follow this out with the clients, right? Because something was off. So

Dr. Ayla Wolf: 43:04

yeah. And are your courses for EMDR therapists, online, in person? Are you writing a textbook? I thought I read a blog somewhere that you mentioned writing a book,

Dr. Michelle Morrissey Ph.D.: 43:15

yeah, and since then, like, family members have died and some personal stuff. So that's really slowed that down. Louise Maxfield, before she left as editor in chief of the Journal of EMDR, practice and research, she had sustained a brain injury, and she goes, I would love it if you would write an article. And I started to do that, and then life happens, right? I've been invited to conferences like Andrea, Canada and USA to speak on it. And so I'm looking at it as in, if you write an article or a book and you give the adaptations, my fear is people will just use the adaptations without knowing all the underlying information that they learn in the class. Sure, and then would I be doing them a disservice, and then their clients would have a disservice. So I'm trying to figure out, how do I put the information out there into a book and encompass everything that they would need to know, right? So I'm really struggling with truthful I'm struggling with what to do and getting the information out there without people thinking, Oh, if I just follow this decision tree, everything's going to be fine, and you need more information than that. So

Dr. Ayla Wolf: 44:37

I think that is the conundrum of all teachers who are teaching in the space of brain injuries, is that it is such a complex topic, and you don't want to give people one slice of the pie, and then they go off and they think they've got the whole pie, and then they get themselves into trouble.

Dr. Michelle Morrissey Ph.D.: 44:54

Yes, yeah. So I keep a list, like an Excel spreadsheet, of everybody I've trained worldwide, so that when people contact me from other countries or states, I can refer them to the people in their state who have been trained in using it and in my evaluation at the end, before I put them on my referral list. I ask them, How comfortable do you feel using EMDR to treat this or specialize in this? And if they respond, this was great information. I don't plan on specializing. I just wanted to treat this one client. I don't keep them on my referral list because that's for the people who need to have people coming back to them.

Dr. Ayla Wolf: 45:38

Got it? That's very helpful to know that there's the the additional training is such an important piece of this, and that there's different places at which people are operating with EMDR and utilizing it. So I think that's so helpful to understand. And this list of practitioners that have been trained by you. Where can people find that list? If they're looking for somebody,

Dr. Michelle Morrissey Ph.D.: 45:59

I don't publish it. It's just an Excel spreadsheet I keep of all the people. So usually they find me on EMDRIA, and then they'll write to me and ask me, and then I'll email them the practitioners in their state or country who have been trained, got it,

Dr. Ayla Wolf: 46:16

and what are your thoughts on doing EMDR through telemedicine, where you're not physically in the room with the person?

Dr. Michelle Morrissey Ph.D.: 46:25

That's all I do. So I was face to face, and I've done it face to face for years, and I've done virtual before, COVID, but on a more limited basis. And since COVID, that's all I've been it was the beauty of COVID, which I hate, is this whole licensing thing. Right during COVID, I treated people in California, Utah, Kansas, Nebraska, anywhere they were calling because the veil was down. Now that COVID is over, everybody's going back to you've got to be licensed in our state. So imagine a therapist who has to apply in 50 different states and pay two to $300 every year to be licensed to treat somebody that's just, it's ridiculous. Like, why is that? I'm frustrated with that. So now. I'm back in my borders of my state, and it became, oh my gosh, we have to have this list of people in other states who can get the help. And so I'm also doing a the past year, a telehealth state law that I also have in an Excel spreadsheet of what states will allow you to practice in their state? Some say you got a limited time, like 30 days. Some will say you've got 15 sessions, and some demand that you are either you submit an application and it's good for a year, it's like $15 for a year, and you can treat people in that year. And every year you have to renew other states. Know, you just have to be licensed. Yeah,

Dr. Ayla Wolf: 48:02

it's too bad that it became more complicated after COVID ended, because I do remember that during COVID, they said, people need help. We're going to, like you said, lower the veil. You can work with anybody in any state, in these different disciplines, and a lot of people utilize that, and it was very helpful.

Dr. Michelle Morrissey Ph.D.: 48:20

Yeah, because people won't be able to afford to fly to Colorado, stay in a hotel or or a bread and breakfast or something for a couple of months while they get treatment, Right? And so it's, it's sad, yeah,

Dr. Ayla Wolf: 48:36

and a lot of people now that telemedicine is becoming so much more widely utilized there, they are really seeking that out for therapy, in addition to kind of biomedical stuff too. And so that is great that EMDR can take place effectively over telemedicine.

Dr. Michelle Morrissey Ph.D.: 48:54

Yes, and I do, I treat everybody, all over the state of Colorado, rural areas, there is a site. The gentleman's name is Yannick, so I'm not sure if he's and Yannick, if you ever listen to this, I apologize. I'm not sure if he's Swedish or or from Switzerland, but I know he's from another country. And he developed bilateral stimulation.io which has auditory tones. You can do the eye movements for people without brain injuries. And then he recently added where people can buy a tapper and plug it into the USB drive on their computer, and they can get the vibrations in the hands as well. So it's a phenomenal site, and I use it all the time for EMDR that I do virtually.

Dr. Ayla Wolf: 49:42

Great. So the client gets to get access to this tool. They can choose which form works best for them, and it's all very seamless. It sounds

Dr. Michelle Morrissey Ph.D.: 49:52

Yeah, great. Yeah,

Dr. Ayla Wolf: 49:55

wonderful. Well, that, yeah, definitely clears up that question that I had about, you know, where, why are my patients kind of running into this wall of people saying, No, I don't do that work. I like what you said about people understanding what their scope is and what they're comfortable with, and that that's really important, and that it's a good thing that if people haven't done the additional training, they just say, Yep, I don't, I don't work with people brain injuries for a specific reason and an important one. So that's great to have people understand that piece of it,

Dr. Michelle Morrissey Ph.D.: 50:26

right? Because that we take the same oath medical doctors do a first do no harm, right? And so if you know that you can't do it, please tell them you can't do it, right? Yeah. And I tell people that when they ask, they're like, I'm bipolar, I'm schizophrenic, that my training program did not include how to treat people who were schizophrenic or psychotic. So it's like, I'm sorry that is out of my scope. And like, you need to keep looking for somebody else, because I can't do that, right? Yeah,

Dr. Ayla Wolf: 50:58

is there anything else that we haven't talked about that you feel we should include? And

Dr. Michelle Morrissey Ph.D.: 51:03

the other thing is that the brain, the depression that comes with a brain injury, does not respond to antidepressants, because it's not your typical depression, so, and they put them on it, and they're like, I'm not noticing anything different. Nothing's coming up. And that's one reason why they said is it's not your typical depression, so it's not responding.

Dr. Ayla Wolf: 51:30

Yeah, and it's too bad that things like transcranial magnetic stimulation are only covered by insurance after you've proven that you've had to fail all of these other depression treatments in order to receive it.

Dr. Michelle Morrissey Ph.D.: 51:44

The other part of the trauma is the people they go to for help afterwards can be a part of their trauma. I've heard from clients, their neurologists have told them there's nothing wrong with your brain. Your scan showed you're fine. You're just malingering, right? Or it's been a year, you should be better by now. You shouldn't still have those symptoms, right, as if you're faking it. So the medical community, in whatever way, can be a part of the traumatic experience. Experience for a lot of patients I've seen, when you go to the hospital and you're looking for like, confirmation, right? They're going to do an MRI or a CT scan, right? Those only show brain bleeds and fractures to your skull. They do not show what happens with a brain injury, so they're using outdated methods to diagnose or not diagnose. No, you're fine. No, no. Head injury. Don't worry about why do I have the headaches? Why am I sleep? Why am I feeling depressed, etc, right? It's called an MRI-, DTI, diffusion tensor imaging. And if I could share the pictures with you, if I could figure out a way I've got it pulled up, is it there is so much disorganization that occurs that they can see it's like color coded, and it lets them know this is all out of whack, and you can see what's wrong with the brain,

Dr. Ayla Wolf: 53:16

And now diffusion tensor imaging was kind of isolated to the realm of research for a very long time. Is it now making its way into clinical practice more frequently? Yes,

Dr. Michelle Morrissey Ph.D.: 53:26

yes. We have three or four places in Colorado that are now doing them for diagnosing of brain injuries, and then the fractional anise and aside anisotropy that they use with that so they can tell what parts of the brain are affected. And it's not that people need it to get therapy or get treatment. If you say you've got post concussive syndrome or you've had a brain injury, you can get treatment without it, but it's like talking about how we aren't using what we need to use to actually diagnose, instead of sending somebody home from the ER going, you're fine when they're not

Dr. Ayla Wolf: 54:07

right, right? Yeah, well, and I think between, you know, quantitative EEG spec scans and now the DTI, there are some phenomenal tools out there to get much better information on brain function. And so I do think that we are finally moving towards better diagnostics in this realm, but it's been a slow process.

Dr. Michelle Morrissey Ph.D.: 54:28

Yes, and in the class I have like future research, there's a place in Texas that is looking at they're hoping within five years, and that was three years ago, so I'm hoping it comes out soon, where they're analyzing the chemicals that come out of our breath when we exhale, and they found we have 1500 different chemicals we exhale. Oh, and they're isolating brains that haven't had a brain injury versus those who have. So they can come up with a breathalyzer and they can write on the field right at it after an accident, they can do the breathalyzer and diagnose a brain injury right then and there. Incredible,

Dr. Ayla Wolf: 55:11

yeah. Do you can you remember what that center was called, or was it associated with a university?

Dr. Michelle Morrissey Ph.D.: 55:18

So it is the Southwest Research Institute at the University of Texas San Antonio, that are analyzing breath for specific biomarkers for brain injuries. Okay,

Dr. Ayla Wolf: 55:32

I will have to look into that. Sounds fascinating.

Dr. Michelle Morrissey Ph.D.: 55:35

Yeah, I can send you the link as well, if that will help, and then you can go from there, yeah, yeah. Like, definitely looking at all that stuff. Great.

Dr. Ayla Wolf: 55:44

I do know in France, they have approved a blood biomarker test in an emergency room where they're looking at three different blood biomarkers together to say if all of these are elevated within the first 12 hours of a brain injury, then it's much, then it's likely this person has had a brain injury. So France is, I think, one of the countries that's finally developed like a blood biomarker panel. And there's still some nuances to that, but, you know, I think that there's a lot of exciting things that are coming down the pipeline. Yeah,

Dr. Michelle Morrissey Ph.D.: 56:17

awesome. I'm gonna have to look that up. Thank you very much for sharing.

Dr. Ayla Wolf: 56:20

I'll send you I'll send you that link. Yes, wonderful. Well, thank you so much for coming on the show and sharing all of this really important information. And I think that you cleared up a lot of confusion about how the field is operating, what's out there for people. And I, I'm so pleased that you have your institute and the work that you're doing to train up more EMDR therapists to be able to offer this to people, because it really sounds like your clinical experience. You've seen amazing, wonderful things happen with your patients?

Dr. Michelle Morrissey Ph.D.: 56:56

Yes, yeah, Speech improves. Sleep Improves, moods improve. Capacity to deal with things improves. It's just like taking a record and playing it backwards and they're like, or rewinding something. It's like they're getting their life back. And to me, that's that's the most amazing thing.

Dr. Ayla Wolf: 57:16

Absolutely, and when people feel more in control of their emotions, they are much more likely to engage with other people, and so the isolation piece can improve.

Dr. Michelle Morrissey Ph.D.: 57:24

Yes, exactly. Wonderful. Thank you

Dr. Ayla Wolf: 57:35

Yes, well, we can always do a part two down the road.

Dr. Michelle Morrissey Ph.D.: 57:38

Great, yeah, great, wonderful. Take care. Okay?

Dr. Ayla Wolf: 57:41

Thank you, Dr. Michelle. Medical disclaimer, this video or podcast is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice diagnosis or treatment, and consumers of this information should seek the advice of a medical professional for any and all health related issues. A link to our full medical disclaimer is available in the notes you.