Founder, Description, Philosophy
Eye movement desensitization response (EMDR) is a treatment modality that was designed by psychologist, Dr. Francine Shapiro in 1987 to treat symptoms of post-traumatic stress disorder (PTSD); an anxiety disorder characterized by symptoms of re-experiencing the trauma (flashbacks, nightmares), emotional numbing, and avoidance. The approach is structured and integrates elements of other types of psychotherapies such as psychodynamic, cognitive-behavioural, person-centered, body-based, and interactional therapies. The theoretical basis of EMDR is that there is a natural mechanism in all human beings for resolving and processing disturbing experiences. For example, following an event a person talks about it, thinks about it may even dream about it. As this happens there is an adaptive resolution, “that was then, this is now”, or “I can learn from what happened without being trapped in what happened”. In time, you would not feel that same emotional impact as when it first happened. A ‘traumatic memory’ differs, in that the natural information processing system fails, and the memory of the disturbing event becomes stuck and is stored in a dysfunctional way as a, “right now” immediate experience. The system might fail because the event was so terrible that it falls outside and previous life experience, or there is a defense in place that prevents the person from fully perceiving and processing the memory. When a trauma occurs the nervous system gets locked with the original sights, sounds, thoughts and sensations. The eye movements seem to unlock the nervous system to allow the brain to process the memory. Such as what happens in REM sleep. It is important to know that the client is in full control, the belief is we all have the natural capacity to heal. However, when a trauma occurs individuals may feel flooded. EMDR is effective at promoting integration, helping clients unlock and clear the blockage. It is not the symptom, it is not the behaviour, it is the memory of the reactions to an historical event locked into memory that needs to be reprocessed.
What type of problems is this approach used to treat and what populations can it serve?
EMDR is mainly used for people with traumatic memories, such as people with PTSD. The treatment has been used with sexual assault victims, combat veterans, people who experienced child abuse, physical violence, natural disasters, accidents, and other traumas. It can also help with phobias, stress, sleep problems, complicated grief, addictions, pain relief, phantom limb pain, self-esteem and performance anxiety.
What does this approach look like in practice? What are some types of interventions?
There are typically 8 phases of EMDR treatment, with phase 3 through 8 repeated in most sessions. It can be done as a form of brief therapy or used as a part of long term psychotherapy. The therapist will explore the traumatic and vivid images, situations that illicit distress, and create targets for positive future action. Psychoeducation is typically part of EMDR as well as learning self-control, and emotional regulation. Therapists will often use visualizations of the traumatic memories and explore the negative beliefs associated with those images. Repeated eye movements are done with guidance from the therapist while recalling the traumatic memories in order to help neutralize the strength of the emotional responses and the vividness of the memories themselves. Other tools like hand-tapping or auditory stimuli can also be used to help process the memories along with eye movement. A significant part of the assessment phase of EMDR is Resourcing. Assisting clients to find what skill, strength, or resource they need to assist them in preparing for the trauma work. For many, often talking about the event may be too overwhelming. Resourcing is necessary to deal with the memory when there is flooding at the mere thought of reprocessing the traumatic memory.
The trained therapist uses resourcing, or stabilization such as locating an inner safe space to encourage ‘dual attention’, simultaneous awareness of present safety and past trauma. Finding a calm safe place is often difficult because of clients traumatic event(s), so a significant amount of time may spent building stabilization skills. For example, creating a container to hold disturbing memories during and between sessions may be important when clients are not equipped. Once stabilized clients may be ready to address the trauma and proceed to EMDR protocol.
Shapiro, F., Maxfield, L. (2002). Eye movement desensitization and reprocessing (EMDR): Information processing in the treatment of trauma. Psychotherapy in practice, 58, 933-946.