For a more
Q & A section.
Exclusive Interview with
Anthony J. Zongaro, Ph.D. Philadelphia, PA
Bio: Currently the Clinical Director of Wives Self Help Foundation; Eleven Years as Chief Psychologist at Family Court of Philadelphia; Private practice (13 years) both independently and with a private firm; Consultant for City Police and Fire Counseling Service (12 years); Consultant for Philadelphia Police Department's Peer Counseling Program (13 years); Certified Police Instructor at Philadelphia Police Academy (11 years); Instructor at Holy Family College (12 years); Forensic Psychologist at Family court of Philadelphia (15 years); Intake Interviewer at Philadelphia Youth Study Center (4 years); Field Probation Officer at Family Court (8 years); Consultant Specializing in the management of Chronic Pain (13 years); Ph.D. in Psychology from Temple University (specializing in Child Development); Currently a post-doctoral student at Drexel University in the Professional Certification Program in Neuropsychology; Licensed to practice as an independent psychologist in the state of Pennsylvania since 1987.
TOAC: Doctor Zongaro, thank you for joining us today and agreeing to talk with Tears Of A Cop. Let me begin by asking if your patients are primarily sufferers of Post Traumatic Stress?
Dr Z: No. I'm a general practitioner with a special interest in trauma victims.
TOAC: Could you give us a brief description of PTSD -- and how it develops and manifests?
Dr Z: PTSD is generally anxiety produced by extraordinary major life stress. The events are relived in dreams and waking thoughts. The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone. For example the serious threat of one's life or integrity; serious threat or harm to a loved one; sudden destruction of one's home or community; or seeing a person who has been critically injured or killed. The traumatic event is persistently re-experienced in at least one of four ways: 1- Recurrent and distressing recollections of the event. 2- Intrusive, recurrent and disturbing dreams of the event. 3- Sudden acting or feeling as if the event were recurring as in flashbacks or hallucinations. 4- Intense distress at exposure to events that symbolize the trauma. Another marked symptom is avoidance of stimuli associated with the trauma such as: efforts to avoid feelings, activities and situations associated with the trauma; Inability to recall an important aspect of the trauma; Markedly diminished interest in significant activities; Feeling detached or estranged; Restricted range of affect -- unable to have loving feelings; Sense of shortened future -- does not expect or anticipate a long life or goals, etc. Emotional symptoms will include at least two of the following: Difficulty falling or staying asleep; Irritability or angry outbursts; Difficulty concentrating; Hypervigilance; Exaggerated started response; Physiologic reaction upon exposure to events that may trigger a resemblance to the trauma, for example an officer who had his life threatened by a man wearing a denim jacket may break out in a sweat when seeing a man wearing a denim jacket.
TOAC: Are you involved with counseling law enforcement professionals?
Dr Z: Yes. Our agency receives a lot of referrals from Police Employee Assistance Program and I see quite a few officers who have been involved in shootings, who are under investigation, or who have self-referred for stress, depression, etc.
TOAC: Please tell us a little about EMDR therapy... it's history, how it works, etc.
Dr Z: EMDR stands for Eye Movement Desensitization and Reprocessing. It was originally developed by Francine Shapiro in the late 1980's to treat people suffering from PTSD. It's a procedure in which the central component is the generation of rhythmic, back and forth saccadic eye movements by the patient as they are helped to concentrate on a specific, troubling memory to be desensitized. The therapist structures and sets up the eye movement procedure by first helping the patient to contruct an imaginary representation of a troubling memory. This mental image is maintained while the patient is guided in eliciting a presently held, negative self-referencing belief about the incident. Next, an alternative or positive self-referencing belief is elicited. The patient is asked to rate their degree of belief on a scale of 1 to 7, then the patient is helped to verbalize their current negative emotions and rate their intensity on a 0 to 10 scale. They are also asked to report any associated bodily sensations felt while thinking of the memory, the image or the negative self-referencing belief. Finally the patient is asked to hold all of the above in mind while simultaneously tracking the therapist's index and middle finger as they are moved rapidly back and forth from side to side in sets of anywhere from 10 to 50 or more finger sweeps. After each set of therapist directed eye movements, the patient is asked to share "what came up". The main therapeutic goals are to eliminate the "negative emotional charge" associated with the incident; to replace the Negative cognition with a more functional and adaptive self-belief by repeatedly pairing the Positive belief with the targeted memory after the original negative emotional reactions have been desensitized and alleviated. At that point, the patient is guided to hold the memory of the troubling event in mind along with the positive-beliefs, as the therapist directs repeated sets of eye movements. The objective of the EMDR procedure is to bring the negative emotional charge associated with the trauma down to a level of 1 or 0 and the felt validity of the Positive belief up to a 6 or 7 level of confidence.
TOAC: Doctor Zongaro, how did you become involved with EMDR therapy? And how long have you been practicing the procedure?
Dr Z: An employee assistance program worker from SEPTA told us about it and the agency sent me for the extensive training sessions in New York. I've been helping patients using EMDR therapy for about a year.
TOAC: How long do the therapeutic results last? In other words, are follow-up sessions (twice a year, once a year, etc.) recommended? Or are the first round of sessions all you need for treatment to clear out the emotional baggage associated with PTSD?
Dr Z: So far I haven't had any remissions, although some patients fall victim to trauma from as yet uncovered material. So far none have had flashbacks from previously treated trauma. Follow-up sessions are not usually necessary although it can initially take many sessions especially in people who have suffered multiple trauma.
TOAC: Can EMDR be practiced on an on-going basis? (ie: Could sessions be conducted weekly/monthly, as a preventive measure for P/O's so they do not get to the point of developing PTSD?)
Dr Z: EMDR can be used to install "positive resources" to help in performance situations, but I don't know of any research dealing with EMDR being used as a preventive treatment.
TOAC: Hmmm... interesting. I suppose that's something we'll have to look into! Is EMDR safe? Any physical or mental side-effects?
Dr Z: EMDR can only be used by skilled clinicians who know how to bring a patient down from a bad reaction. It is not taught as a therapy which stands by itself. Another problem is if the patient suffers from a dissociative disorder and their personality fragments. I, myself, screen patients for dissociative disorders prior to treating them. If a therapist has extensive experience with dissociative disorders, then there is no problem. At times patients continue to process material after leaving the office but they are debriefed about it and it's usually just a "gut reaction" that they go through.
TOAC: What are some advantages of EMDR therapy versus traditional counseling?
Dr Z: EMDR, as I have already said, is not used by itself -- it is combined with other therapy techniques. The advantage is that it helps the brain process traumatic material much more rapidly than other forms of treatment. Some Vietnam Vets who have been treated unsuccessfully for thirty years have benefited from just a half dozen EMDR sessions.
TOAC: Are you involved with any other type of *new* therapies which focus on brain processing in relation to movement or sound -- like dance, music, etc.?
Dr Z: Oddly enough, EMDR is inappropriately named because it isn't just accomplished through eye movements. One can also use hand taps (touch) or alternating sounds (tones) to each ear to establish the same effects. The only other alternative therapies I use which are not really "new" are guided imagery and hypnosis.
TOAC: Can you give us your thoughts on how EMDR may be implemented in the future -- perhaps where it would be practiced in schools or homes?
Dr Z: There are many possibilities. EMDR could be used to install positive resources for pupils who have motivational or learning problems. It can be used to enhance sports performance, to help overcome stage fright, etc. In the future they may develop ways to use EMDR on oneself in a limited way, but for traumatized individuals a skilled person would have to do it.
TOAC: How would one go about finding a qualified therapist who practices EMDR?
Dr Z: Contact the EMDR Institute in Pacific Grove, California. Their phone number is 831-372-3900. Or fax them at 831-647-9881.
TOAC: Dr Zongaro, one of our goals at Tears Of A Cop is to help others who are suffering stress related pressures so that they may seek advantageous therapies to prevent the possibility of developing PTSD, as well as eliminate the chances of suicidal fantasies. I believe that you have helped us in our goal to educate people about this cutting-edge option available to those suffering stress or trauma. I would like to thank you for your time and for sharing your knowledge with us.
Interview conducted by Cheryl Rehl-Hahn, Executive Director of TOAC. Special thanks to Elizabeth Rehl for collaborating with Dr Zongaro and getting his agreement for this interview.