The Five Patterns of Chronicity: A Practitioner Reference – The British Board of Integral Eye Movement Therapy (IEMT)

IEMT MODELS

A detailed account of five patterns used within IEMT to examine how difficulty can persist during attempts to help.

A practitioner model for examining interactions and responses. The labels are not diagnoses or personality types.

What the model addresses

The patterns of chronicity concern the continuation of difficulty in the presence of intervention. They address what may be happening during attempts to change, rather than providing a general account of how a problem first developed.

Using the model requires attention to the actual exchange. A pattern name does not explain an outcome simply because a client remains distressed. The client’s circumstances, the practitioner’s conduct, the suitability of the work and the evidence for an interpretation remain relevant.

1. Testing for the problem rather than for change

This pattern concerns attention directed towards confirming that a problem still exists while differences in the current response are overlooked. The relevant distinction is between repeating the established account of the problem and examining what happens when the original experience is accessed again.

Retesting asks the person to return to the memory or feeling and report the response available now. It does not ask them to agree that change has occurred. The same question must permit a report of no change.

A continuing problem in daily life and a change in one accessed memory can both be reported. Keeping those observations separate prevents a local change from being overstated as complete resolution.

2. The Maybe Man

This name refers to qualified or non-specific reporting of internal experience. In the IEMT description, an answer may be shaped by what the person thinks the practitioner expects rather than by a clear report of what they notice.

The focus is the quality of elicitation. “Maybe” in ordinary conversation is not enough to establish this pattern. Genuine uncertainty can be the most accurate answer, and the practitioner must leave room for it.

Clarification concerns the experience being discussed and the meaning of the person’s words. It should not turn into pressure to produce certainty, a particular rating or a favourable result.

3. The Three Stage Overreaction

Signal

Increased intensity

Threshold response

Within this model, an expression of dissatisfaction can function as pressure for the other person to change their behaviour. The initial signal is followed by a more insistent expression if the expected response does not occur. Beyond a threshold, the reaction may function as what the model calls punishment for non-compliance.

The sequence can redirect a session away from difficult experience and towards changing the practitioner’s behaviour. This may occur without conscious intention. An objection can also be justified: the practitioner may have misunderstood, acted inappropriately or failed to listen.

Acknowledgement recognises the reported feeling. For example, “I’m very uncomfortable with your tone of voice” may be met with “You’re feeling very uncomfortable,” followed, where appropriate, by exploration of its strength and familiarity.

The words “That’s right” are not a complete intervention. Used respectfully, they can acknowledge experience. Used sarcastically or to dismiss a concern, they invalidate it. The model does not justify provoking escalation or disregarding withdrawal of consent.

4. The What if question

This pattern concerns a continuing use of hypothetical exceptions to reject a broader proposition. Each possible exception can generate another without resolving the original question.

Its relevance depends on the function of the question in the exchange. A request about risk, suitability, consent or a genuine uncertainty requires an answer. The words “what if” do not make a question illegitimate.

The practitioner distinguishes useful examination of an exception from an unresolved series of hypothetical objections. That judgement should remain open to correction by the person asking.

5. Being at effect rather than at cause

This distinction concerns the person’s experience of having no influence over an emotional response, with that response attributed entirely to other people or circumstances.

In IEMT, the related question is whether the person can recognise influence over any aspect of their experience. Physiological state accessing cues provide one area in which changes of bodily configuration and access to a state can be examined.

Influence over part of a response does not imply responsibility for another person’s behaviour or control over external circumstances. Continuing danger, illness and practical constraints must not be erased by a language of personal agency.

Use the model with specific evidence

Useful distinction	Avoid collapsing it into
A particular interaction	A fixed judgement about the person.
An observed response	An assumed motive.
A provisional interpretation	A diagnosis or proven cause.
An opportunity to explore change	An obligation to report improvement.

When the work is not helping

The Association’s standards recognise no change, mixed change and deterioration as legitimate outcomes. They specifically caution against explaining non-response as resistance, lack of commitment or a chronicity pattern without evidence.

The model is one part of professional understanding. Review of the intervention, scope, communication, consent, supervision and alternatives remains necessary.