I specialize in a treatment approach called EMDR. In my work as both an individual and a couples counselor, I have found it to be an invaluable tool for reasons that will be come clear as you read about the treatment in the sections below. I was in practice for 15 years prior to being trained in EMDR. Since incorporating it into my practice (not that it is used with everyone), I have watched clients heal more fully and more deeply than in all my years prior. It is a treatment approach well worth reading about.
EMDR is an acronym for Eye Movement Desensitization and Reprocessing. It is a phased treatment approach (developed in 1989 by psychologist Francine Shapiro), that has been extensively researched and proven to be effective for the treatment of trauma-based disorders. The most commonly known trauma disorder is Post-Traumatic Stress Disorder (PTSD). This disorder sometimes develops after a person experiences an event (or multiple events) so disturbing to them that they are unable to process what happened in a way that allows them to heal from it.
The kinds of traumatic experiences (“Big T traumas”) that can sometimes lead to PTSD are events including, but not limited to:
• Assault (experiencing or witnessing)
• Childhood or adult abuse (physical, emotional or sexual)
• Extreme illness or the sudden death of a loved one
• Auto accidents
• Dog bites
• Natural Disasters
EMDR is a formal set of protocols and procedures used to “desensitize and reprocess” memories that have been stored as a result of traumatic experiences. An EMDR therapist must go through extensive training beyond their clinical license to practice this method of therapy. Make sure that your therapist has the proper certification and training in EMDR before you accept treatment of this kind.
HALLMARK SYMPTOMS OF TRAUMA OR PTSD
Not everyone experiences the full spectrum of the symptoms listed below, but if you are experiencing several (or all) of these, you may be experiencing a “trauma-based” disorder:
- Depression and anxiety
- Sleep disturbance (insomnia, nightmares)
- Intrusive thoughts (flashbacks to the scenes)
- Heightened levels of “vigilance” - like being ‘on guard’ all the time
- Physical arousal such as being jumpy and irritable
- Substance abuse (the world’s most common ‘self-medication’ for trauma)
- Numbing (can’t feel emotions) or emotional outbursts (feel too much)
There are also not-so-obvious examples of experiences that we refer to as “small t traumas”. They are the more common and ubiquitous among us including (but not limited to) divorce of parents, bullying, teasing, shaming, humiliation or constant criticism. Experiences likes these usually accumulate over time from childhood. These are not usually thought of as traumatic, but to a child they can be. In the news we have seen school shootings that were linked to incessant bullying and teasing. We’ve seen teenagers commit suicide over “My Space” from public shaming and humiliation. These are real-life tragedies, at least in part, a result of trauma inflicted on children.
When we are children we take everything on as “truth”, often ending up believing negative things about ourselves that are not really true. We know it intellectually, but the beliefs feel true anyway at some gut level. Common examples of these beliefs are: “I’m not good enough” or “I’m powerless” or “I have no choices”. These types of experiences can often have devastating consequences that can last a lifetime if not understood and treated in a timely way.
Over the last 20 years, EMDR has been found to be effective with a much broader range of disorders than just PTSD, but they seem to have underlying trauma as a common factor in their manifestation.
EXAMPLES OF PROBLEMS HELPED WITH EMDR
• Substance Abuse (and other addictions)
• Depression and Anxiety
• Panic Attacks
• Traumatic Grief
• Low Self Esteem
• Phantom Limb Pain
• Performance Anxiety
• Performance Enhancement (athletes, writers, actors, etc.)
A frustrating aspect of trauma is that present day experiences that have nothing to do with the original upsetting events have the power to “activate” an old, highly distressing memory as if it were literally “stuck” in the brain. Thus a person can be triggered by ordinary daily events such as sights, sounds and smells reminiscent of the original event, leaving one in an extreme state of discomfort but for no "apparent" reason.
An indicator that this might be happening is if you seem to be over-reacting to a situation that even you think is ‘over-the-top’. For example, three years after a rape a woman steps into an elevator and notices the smell of cologne. Suddenly, for “no apparent reason” she is overcome with anxiety, heart palpitations, and shortness of breath (like a panic attack). The person in the elevator is wearing the same cologne as that of her attacker and the smell has activated the memory network from that horrific event, thereby setting off a minefield of physiological reactions (fight, flight, freeze) - none of which have anything to do with the person standing in the elevator at that moment. This is a classic example of a traumatically stored memory that is vulnerable to triggering by a normal, everyday experience. It is unnerving and can make a person feel quite crazy - though as you can see, they are not. This is simply a traumatic stress response to material that has not been fully processed into a more adaptive state.
HOW DOES EMDR WORK?
No one is certain how EMDR works, nor do we understand how many other effective therapies work such as Cognitive Behavioral or Exposure Therapy. We didn’t know why aspirin worked for a long time either, but there was no argument that it did!
The brain is without question the most complex organ in the body. It runs and regulates everything. We are on the horizon of a new age of knowledge about the brain due to the development and increasing availability of technology that allows us to peer into the brain itself, such as fMRI and SPECT scans. The scans allow us to see the internal operations of different parts of the brain, enabling us to learn more about which parts do what. However, most people will agree that the field is still in its infancy.
What we do know is that when a person experiences an event that is extremely distressing and overwhelming, it is stored in the brain with all the sights, sounds, thoughts, feelings and body sensations that accompanied the event at the time it occurred. Think of our brain as a data recorder that doesn’t miss a thing, registering all aspects of every experience we have, whether we consciously remember it or not.
When events are extraordinarily upsetting, the brain is sometimes not able to process the experience as it normally does, therefore the thoughts, feelings and sensations of the traumatic event can become frozen in the nervous system as if in a “time warp” such as in the example given about the rape victim in the elevator.
EMDR helps to activate the brain’s natural processing abilities with great efficiency, thereby helping to move the disturbing material through the nervous system, allowing the person to heal more completely. The ability of our brain/body/mind to accomplish this type of resolution is referred to as an “Adaptive Information Processing” system or AIP.
The AIP presumes that the brain, like the rest of our body, has an innate capacity to heal itself after being traumatized. When we get a cut on our finger, we don’t have to tell the body to send healing cells, it is done automatically by our natural healing mechanisms. Unfortunately it seems that with trauma, the natural mechanisms for processing experiences may stall and leave us re-living the event over and over again (known as “flashbacks” or intrusive thoughts). EMDR is an efficient and effective intervention for activating that natural healing process.
FREQUENCY AND DESCRIPTION OF EMDR TREATMENT
In a typical EMDR session a memory or issue is chosen to be worked on, for example a rape. The client focuses on the ‘most distressing part’ of the memory, identifies the ‘negative belief’ they hold about themselves (in the present) such as “It’s my fault”. The person then identifies the positive, more adaptive belief such as “I didn’t do anything wrong” (which they usually know is true intellectually, but it doesn’t feel true). Then the emotions that come up around the memory are identified, such as fear, sadness, anger, etc. The person is then asked to notice and name where they feel the distress in their body, such as stomach churning or chest tightening. The client then attends to the distressing material (as a whole) in brief, sequential doses while simultaneously focused on an external stimulus that creates “bilateral” (side-to-side) movement, eye movements (the EM in EMDR), tactile tapping, sounds or tones. This is one of the unique aspects of the EMDR protocol.
EMDR uses a three-pronged protocol:
1) Past events that have laid the groundwork for symptoms are processed into a neutral state;
2) Current circumstances that trigger distress are targeted; and
3) Future events are targeted to assist the client in acquiring the skills needed for adaptive functioning in the present and future.
Typically, an EMDR session lasts from 60-90 minutes. The length of sessions depends upon several factors, including the nature and longevity of the problem, the degree of trauma, its complexity, and the age at the time of occurrence.
History is usually done in 2-3 sessions, although continues to be collected along the way. Then in some cases, where a single traumatic event is the focus of treatment, 1-3 sessions of EMDR may be all that is needed. In more complex cases the number of sessions required to “clear” material is determined by the complexity of the case and at what stage of life the traumatic experiences began.
When the traumas a person endured lasted for years, longer-term treatment can be expected. However, with EMDR, in contrast to more traditional talk therapies, treatment time is usually markedly reduced. Ironically, one can be in “talk therapy” for years and not be able to fully resolve these issues because sometimes they cannot be “talked” out of the brain. Then it is helpful to be able to process them through differently.
EMDR can evoke strong emotions and sensations during a session. This is normal and to be expected, since the method works to process those negative feelings and sensations when they are brought deliberately into the clients’ awareness. Usually the re-experiencing of these unpleasant feelings is brief and soon fades as processing proceeds.
With clients who are not yet able to tolerate the intensity of these feelings and sensations, there are extremely effective protocols utilizing EMDR a bit differently to first build internal resources, strength and stability before trauma work is ever done. In this way, EMDR can be a powerful tool for clients needing to pace treatment more slowly and with more safety features built in.
Although some people have dramatic responses to EMDR in a very short time in contrast to traditional talk therapies, others progress more slowly. The basic premise is, the more complex the trauma histories, the longer treatment will likely take. A single incident trauma such as an auto accident or dog bite could take only a few sessions (after history is taken and the client is prepared).
For complete information about EMDR and its research base, please visit the websites at www.emdr.com or www. emdria.org.