Even fellow clinicians ask, “what is it that you’re doing in there?!” referring to the use of EMDR therapy. And then I might confuse them further when I tell them that EMDR stands for Eye Movement Desensitization and Reprocessing. What a mouthful. It can be hard to understand what it is and why this targeted psychotherapy works. My colleague, Jennifer Fights, describes the 8 phases of EMDR treatment in the 60 second video above. I will expand on this to give you a basic explanation of what this evidence-based practice is and how it can be beneficial as a therapeutic intervention.
What is EMDR?
Originally discovered in the late 1980s by Francine Shapiro, EMDR was developed to help with the treatment of PTSD. In its continued evolution and with much research around its use, we know now that it can be used to target various traumas, phobias, intense emotional responses, complicated grief, stress, pain relief, and “stuck” areas or beliefs for a client.
When things are going along swimmingly in our lives, our bodies and minds regularly manage new information and experiences without our awareness. Much of this happens during the rapid eye movement phase of sleep. The difference, though, when something happens that we perceive as a Trauma (the distinction between a big T or little t trauma is explained here), is that our natural coping mechanism gets overwhelmed. The disturbing experience or negative belief then gets “stuck” and unprocessed in the limbic system of our brain in an emotional form. When the raw emotion is trapped in this way, the traumatic memories or associated feelings can be repeatedly triggered when similar experiences occur. There is always a negative cognition/thought linked to the event and emotion (i.e.: I’m not good enough, I’m unlovable, I’m not safe, I should’ve done something, I’m trapped). This belief is what is being targeted through EMDR -- not focusing on the quality or accuracy of memories, but constructing an adaptive cognition.
Through bilateral stimulation -- which can include the use of eye movements (the client follows the therapist’s hand back and forth), hand tapping, lights, pulsars, or auditory stimulation -- EMDR replicates the rapid eye movement process that happens when we sleep. This allows the clinician to facilitate “engaging the client’s attention to an external stimulus while…simultaneously focusing on internal distressing material,” as explained by the EMDR Institute, Inc. Through this process, the block is removed and the brain can then process the trauma naturally by clearing the maladaptive belief and making room for an adaptive and positive belief. It changes the way the memory or problem is stored. EMDR will not erase any memories, but will decrease the emotional intensity, reduce the physiological response, reformulate negative beliefs and increase adaptive cognitive insights, and make the trauma simply a neutral memory like any other that is processed appropriately. This helps clients live fully in the present and to learn to cope effectively on their own.
What is a typical EMDR session like?
Before beginning EMDR treatment, there is always a thorough assessment and “setting up” process wherein the client and therapist will identify target events or feelings along with the associated negative core belief. The therapist will also teach the client self-soothing and grounding techniques to use in and out of session. Eye movements, tapping, or pulsars are then used to bilaterally stimulate the client’s brain for just a short while at a time. After each round of this, the therapist checks in with the client to have them share what they noticed as far as any thoughts, images, feelings, sensations, or memories that arise. The client chooses how much detail to report. Along the way, the therapist helps facilitate a measure of progress for the client as far as any decrease in intensity or shift of emotion, as well as the client’s ability to hold the new positive/adaptive belief as true. There are also typically three points to this treatment -- past, present, and future -- to allow for creating new links, dulling current distress, and securing skills needed for successful functioning moving forward.
A summary list of some of the benefits of EMDR:
It can be done alongside continued work with a client’s regular therapist since it is more of a short, “surgical” interaction around a specific trauma or core belief versus diving deeper as in talk therapy.
It is not intellectual (again, less talking or detail sharing if that’s what the client desires) and more neurological to allow for adaptive processing.
It is rooted in foundational practices of mindfulness, grounding, and self-soothing to empower the client to notice and allow what is happening, teaching them to trust and support themselves.
There is no homework between sessions.
The client is not asked to relive the trauma intensely and over a long period of time. The emotion comes up briefly and dissipates rapidly.
Depending on the complexity of the client’s history, one can see a reduction of symptoms in as few as 1 or 2 sessions. A single incident trauma can typically be resolved in about 5 sessions and more complex traumas may take up to 12 sessions.
It is less about the clinician’s interpretation and more focused on the client’s processes-- this is very empowering!
Your brain “keeps working” between sessions - processing and sorting - and while this may increase the experience of dreams or memories, the client has been taught techniques to move through this successfully.
It can also be done with kids, using art and other techniques (I even have bongo drums for the bilateral stimulation!)
Among many other examples, through the use of EMDR, I have witnessed sexual assault victims who have been stuck in fear and self-blame move to the secure belief that “I survived it and I’m okay as I am” which has led to healthy intimacy and confidence. I’ve also seen the shift for kids who had a fear of eating certain foods due to a choking incident who now have all foods back in their repertoire and a secure belief that “I can trust myself to keep myself safe.” As described by the EMDR Institute, in using this powerful treatment method, “the meaning of painful events is transformed on an emotional level… wounds have not just closed, they have transformed.”
The mind CAN heal from psychological trauma!