EMDR

July 2015

Since writing the introduction to EMDR below, I have finally managed to break the “EMDR barrier” by experiencing EMDR for myself, as a ‘client’, and by facilitating EMDR sessions with my clients. Based on these experiences, I can now speak about EMDR with a clearer voice.

The EMDR process requires a preparation which identifies a target experience and brings it back clearly into mind and feeling, followed directly afterwards by left-right eye movements that simulate REM-sleep pattern. Although formalistic EMDR technology names 8 phases, I believe the description of the process could also be reduced to a basic two-step experience: preparation and implementation.

My personal experience is that the obstacle to so much trauma therapy is the inbuilt resistance of the client or ‘seeker after healing’ to allowing intense feelings to break through. Once that breakthrough happens, the trauma work is fairly uniform across several styles of therapy. The examples I’ve experienced of rapid eye movement following a structured preparation have shown me that the EMDR system can cut through that resistance in a way that feels almost automatic. And that even when there isn’t any dramatic emotional release, various kinds of neural integration seem to happen in the subsequent days.

If and when there is an emotional release, the processing of the material and debriefing afterwards is standard trauma therapy and will depend on the nature of the therapeutic relationship and skill of the therapist. The EMDR system of SUDs and VoC scales can offer a useful extra debriefing tool.

TRAINING : in terms of training in EMDR, I refer the reader to the link at the bottom of this page “Skeptics Evaluation of EMDR”. Because training is difficult to get in Australia, I trained myself using the descriptions that I have included on this page. All that was missing was the opportunity to practise the 8 steps, and this opportunity finally arrived by utilising my peer supervision group. Since it is clear to me now that the steps of EMDR are quite uniform and easy to understand, the only thing I can think of that would require the extensive training and certification now required by the EMDR Association, is in follow-up therapeutic skills needed by a practitioner. An experienced trauma therapist would already have those skills to help the client work through the issues arising from the eye movements.

INTRODUCTION

There are many reputable websites about EMDR which discuss this treatment option. I recommend Justine Shapiro’s original book EMDR for a fascinating description of how she discovered this process of neural integration. My personal take on EMDR is that it probably reproduces the process of activating implicit memories, becoming aware of them and moving them via left-right eye movement across to the left hemisphere for processing, making sense of and consolidation into explicit memory. This is precisely the process that underlies all successful trauma therapy, and can be carried out within the other treatment modalities listed under the “The Healing Journey” tab. But EMDR seems to take a survivor of trauma through this process much faster.

This faster approach would be most useful, I would think, for people who have PTSD, rather than Complex PTSD, due to the extensive re-programming of the neural network that healing from childhood trauma entails. For survivors of childhood trauma and abuse, a combination of approaches is most effective, and I would recommend that EMDR be part of the trauma therapist’s toolkit.

The following “Steps of an EMDR therapy session” was taken from the Net many years ago, and I apologise that I do not know the name of the site, and have not been able to find it again. This extended description is followed by an abbreviated one which I compiled from Shapiro’s book EMDR. At the bottom of this page are links to articles that discuss EMDR in other contexts: a Powerpoint Presentation on the phases of an EMDR session, which includes some extra points not found in the other two descriptions, a look at the use of EMDR in resolving trauma, and an article by Cathi Malchiodi discussing how the “bilateral” process of EMDR can also be delivered using hands-on art making.

THE STEPS OF AN EMDR THERAPY SESSION:

EMDR Step #1: History and treatment planning

If you choose to try EMDR therapy, your first session will likely involve the therapist taking an initial client history. The therapist will probably ask you about the problems, behaviors, and fears that have provoked you to try therapy. However, one difference between EMDR and many other therapies is that you don’t need to discuss traumatic events in detail. The emotions and physical sensations surrounding the event are what’s important, not the details about the event itself. Once the therapist has developed a treatment plan for you based on this initial assessment, the process of EMDR can begin.

EMDR Step #2: Preparation

The preparation stage involves the therapist teaching you some self-care techniques, so that you can handle strong emotions that may arise during or between sessions. EMDR places a strong emphasis on self-care. This stage is also important for developing a sense of trust with the therapist. He or she will explain the theory of EMDR in more detail, and talk about what you can expect in the following sessions.

EMDR Step #3: Assessment

In the next few sessions, the therapist will ask you to identify three things:

A target – the visual image of a traumatic memory and the associated emotions and bodily sensations. You probably will have already discussed your target in your first session, but at this point you will clarify the visual “scene” or “picture” related to the trauma you experienced. You’ll also be asked to rate the intensity of the sensations you feel when you focus on this target.
A negative belief about yourself related to the memory, which you will rate depending on how true you feel this belief to be
A preferred positive belief about yourself.

EMDR Steps #4 & 5: Reprocessing, Desensitization and Installation

Once you’ve identified the target, negative belief, and preferred positive belief, the therapist will help you recall the target image while leading you through a series of rapid eye movements (or audio or tactile processing and or a combination there of). This is known as dual processing, which enables you to access positive ways of reframing the original trauma (reprocessing), and to release the body’s stored negative emotional charges around it (desensitization). The goal is that you’ll then be able to recall the traumatic event without the anxiety or sadness you once experienced, thereby “digesting” the trauma until it no longer holds a “negative charge.”

After each set of rapid eye movements, the therapist will check in with you and will later assess your level of disturbance regarding the target image. During this process, you will continue to “digest” or process the feelings, images and beliefs that occurred in relation to the trauma target. You’ll be asked again, to rate the negative and later positive self-beliefs surrounding your trauma target which gives the therapist concrete measures of how you are progressing.

What is unique about EMDR is how rapidly new beliefs about the self and interpretations of the trauma replace old beliefs. New possibilities emerge that were never before considered. These new insights are used as the starting points for the next set of eye movements, continually helping you to process the trauma in healthier, more manageable ways. EMDR therapists also monitor their clients’ reports on the intensity of their symptoms between sessions to ensure that progress is being made and maintained.

EMDR Step 6: Body scan

After being able to replace your negative beliefs surrounding the trauma with the preferred positive belief, the next step is to focus on any physical sensations in the body that may have emerged. The therapist will ask you to think of your original target and concentrate on your body, noticing any tension or other sensations that may occur. Once the trauma has been worked through, you may notice positive bodily sensations that replace the negative ones originally noted when the session began. EMDR practitioners believe that there is a “physical response to unresolved thoughts”. In other words, emotional pain can manifest itself as physical pain and by changing our beliefs we may also change the way our body reacts to our thoughts.

In order for EMDR therapy to be successful, the goal is for you to be able to think or talk about the original target without feeling any body tension. According to the EMDR Network, “positive self-beliefs are important, but they have to be believed on more than just an intellectual level.”

EMDR Steps #7: Closure

One of the goals of an EMDR session is for you to leave feeling better than you did before you got there. There may be times the self-care and calming techniques taught in the preparation phase may be used in session and will be recommended between sessions. In EMDR, the client is the one in control and using techniques such as journaling or imagery helps to provide a sense of mastery between sessions.

EMDR Step 8: Reevaluation

At the onset of the next session, your therapist will assess the positive belief and or level of disturbance regarding the initial target to insure consistency with the final processing of the last session. This is initiated to assure that positive results have been maintained, and to note if any additional processing has occurred, or to determine if there is a need for additional reprocessing.

EMDR often leads people to feel better very quickly, but it is important to experience the entire 8-phase process to ensure the most beneficial results.

An EMDR therapy session – Adapted from Justine Shapiro

SUDS Scale : a scale that makes a subjective assessment of how strong and intense a memory/feeling is.

VOC Scale: a scale that makes a subjective assessment of how true the preferred belief/feeling is.

HISTORY TAKING

A. Any medical problems, heart problems?

B. Identify ‘Targets for treatment’

C. Probe for childhood wounds (10 most distressing events in childhood)

Questions

Rate each one on SUDS scale 0 – 10
What words come to mind that describe your feelings about yourself or behaviour in the situation of this memory? (ask for the most disturbing events)
If words are negative about self, select this event for processing
Note: client doesn’t have to give all the details of the event.

PREPARATION

Explain what EMDR is, theory, history, give handout, relate to PTSD. Explain what client can expect
Teach relaxation techniques for calming self.
Teach client to create a ‘safe place’ to calm self.
Choose a word and gesture that means ‘STOP’.
Teach ‘dual awareness’ – being able to observe self in action, being able to observe memories and not get lost in them.

Carry out the 6 steps to prepare for eye movements.

ASSESSMENT OF TARGET EVENT

Choose specific picture, moment, scene that best represents the memory
Choose a statement that encapsulates the negative self-belief associated with the event. (Note: the negative self-belief is a verbalization of the disturbing emotion still existing from the event)
Identify the negative emotion that goes with the target memory (and/or self-belief), and the physical sensations that go with it.
Rate these feelings and sensations 0 – 10 on SUD Scale.
Choose a positive self-statement that you would prefer to believe. (Positive self statement can reflect the reality of present-time)
Rate positive statements 1 – 7 VOC Scale for how true it feels.

DESENSITIZATION – EYE MOVEMENT WORK

Follows directly on from assessment.

Begin with chosen negative self-belief while simultaneously targeting chosen memory of event. Therapist begins finger movements.
Client follows finger movements & reports feelings, thoughts, memories as they arise.
Therapist waits for a significant statement from client that will move the process along the memory network.
When this happens, stop the finger movement and allow client to elaborate. Therapist focuses on a significant self-statement with which to enter the next set of eye movements. Say “Stay with that phrase or sentence”, and resume finger movements.
Process may be long and intense, but resembles a primal session, as emotional and memory connections are made.
As each self-belief statement is finished processing, rate emotional distress re the target event on SUD Scale.

5. CLOSURE, INCLUDING BODY SCAN

ARTICLES ABOUT EMDR & ASSOCIATED TECHNIQUES

Skeptics evaluation of the EMDR Movement

eSkeptic, Wednesday May 21st 2014. Rosen, G.M., McNally, R.J. and Lilienfeld, S.O., Eye Movement Magic: Eye movement desensitisation and reprocessing.
Link: http://www.skeptic.com/eskeptic/14-05-21/

Other descriptions of EMDR delivery

I recommend the “Phases of EMDR” description by Gary Peterson, M.D. (2013), and “Resolving Trauma with EMDR” by Graham Taylor

Peterson’s “Phases of EMDR” can be found via this link:
Extracts from Peterson’s Powerpoint Presentation, 2013.

Link to Graham Taylor’s “Resolving Trauma with EMDR”

Cathi Malchiodi, world expert in art therapy, has published an advance peek into her forthcoming book, in Psychology Today online. Malchiodi looks at possible alternatives to the eye movement tracking of EMDR. It is already recognised that tapping and sound can be used in place of the finger tracking. Now there is consideration that the use of two-handed art making, or ‘bilateral drawing’, might have a similar integrative function.
Link to Cathi Malchiodi, ‘Bilateral Drawing: Self-regulation for Trauma Reparation’