Do you get stuck in old reactions and beliefs when you are triggered? Are you frustrated by a conflict between what you know is true and what you feel? Are you curious about methods other than talk therapy to help with your concerns?
While people often move through traumatic experiences on their own, sometimes the feelings, sensations, and beliefs get stuck. You may feel like you are not able to react as you normally would to reminders of this distressing experience. This can create problems in your relationships or job—or cause you to avoid new situations altogether. You may have tried traditional talk therapy before, but you didn’t experience significant or lasting change.
You are not alone in these experiences, and there are other types of therapies that can help you to clear out old patterns and develop new ways of living your life. EMDR Therapy is an evidence-based approach to repairing trauma and dysregulation. Below, I give more information about the process of EMDR and share success stories from some of my clients.
EMDR stands for Eye Movement Desensitization and Reprocessing, and it is a type of therapy used in treating trauma or PTSD, anxiety, panic, phobias, and a wide variety of disorders. EMDR was created in 1989 by Francine Shapiro as a therapy for addressing trauma, particularly trauma from a single event. In a single-event trauma (like a car accident or a one-time assault), the therapist and client work to target the beliefs, emotions, sensations, and distress that go with the event of the trauma. The therapist guides the client through sets of bilateral stimulation or BLS (done by methods such as eye movements or using tappers) while the client focuses on the targeted material. The client’s brain processes the traumatic event and moves through change until the distress around the trauma clears up and the client gains a new perspective on the trauma. As EMDR therapy has evolved, it has come to be applied to chains of events such as ongoing abuse, as opposed to just one-time events.
EMDR therapy is based on the theory that the human brain is very adaptive, but traumatic material can sometimes get stuck, forming a “maladaptive neural network.” When that neural network is triggered, the person does not feel their same resourcefulness and may replay the thoughts, feelings, and sensations of the event as if it is happening currently. They may be overwhelmed with negative core beliefs about their worth, their guilt, their safety, or their ability to have control.
The good news is that these stuck or maladaptive patterns can shift and be reintegrated with the more adaptive networks. During EMDR, the client experiences connection to the elements of their trauma and moves through change to a place of new learning where they can hold a new positive core belief and feel the distress level go down in their body.
The EMDR protocol consists of the following 8 steps
1. History taking. The therapist and client work together to get a thorough history of the trauma that the client has experienced. The therapist will look for patterns and key events that indicate the start of the trauma.
2. Preparation. The therapist and client further go over the process of EMDR, and the therapist can guide the client through grounding exercises that may be used to lower distress during EMDR or at the end of a session.
3. Assessment. During assessment, the client and therapist bring up the selected traumatic event, which results in the client connecting with the beliefs, emotions, and sensations around this event.
4. Desensitization. Once the targeted material is brought up, the client is ready to reprocess it. The therapist has the client notice their beliefs, emotions, and how the client feels in their body, and then starts with a set of bilateral stimulation. The therapist pauses the BLS at points to check in about what the client is noticing and then returns to “sets” of bilateral stimulation. The client’s brain moves through the material with each set, and the therapist notes the change. The therapist is there to gently guide as needed if change is not occurring, but the client’s neural networks set the pace of the process. The idea is that the client’s brain is integrating the previously stuck information, bringing it back into the mainstream of the brain. This phase continues until the client’s distress decreases to what I call “as neutrally as one can feel about a bad event in the past.” This phase can be as short as part of a session, or can last over multiple sessions.
5. Installation. Once the client’s distress is down, the client gauges whether the once traumatic event can be seen with a new positive world belief. For instance, a positive world belief might be “I am safe now” or “I am able to makes changes in my life.”
6. Body Scan. The client scans through the body for any lingering distress that may be at the sensation level of the body. If there is lingering distress, the therapist and client work to process it until the client feels a sense of neutrality in the body.
7. Closure. This stage is used to reorient the client after a session, including a session that is still in stage 4. The therapist may help the client to reorient or do a relaxation or containment exercise so that the client feels more regulated before leaving the office.
8. Reevaluation. After a target is completed, the therapist makes sure that the positive results from completing a target are still in place before moving on to other past traumatic events, current triggers, or how the client may face future events that might be related to the traumatic material.
Examples of EMDR in Therapy
While it is important to know about the EMDR protocol, the following case examples illustrate the effects and impact of therapy with EMDR (identities have been edited, and case studies are composites of my work with different clients in order to protect confidentiality):
Clara is a single woman in her early 30s with three young children. She sought counseling for the first time after two big and related events in her life. She had been the victim of a crime and was contemplating making a report. Soon after the crime occurred, she started having nightmares and memories about how her mother verbally and physically abused her growing up, scapegoating her for problems in the family and comparing her unfavorably to her sisters. Through exploration of her history, Clara understood connections between the abuse by her mother and her feelings of being worthless and “less than” other people. She was hesitant to speak up and assert her needs, and she did not believe that she had valuable things to contribute. She also found herself feeling critical toward her children and desperately wanted to treat them with more love and care than she had received.
During EMDR, we targeted early experiences where Clara’s mother had singled her out and conveyed that she was worthless. After several key events were cleared out, Clara noted a number of changes in her life. She was more compassionate to her mother, but she was also able to express boundaries because she believed she was a worthwhile and valuable person. She found that she could make decisions about whether or not to report the crime, and her distress and frustration around her children eased up. Clara expressed that she was very relieved by the changes that occurred in her life.
Leo is a bisexual male in his early 40s. He is an avid researcher and pursued graduate work in the social sciences. Leo had difficulty with making friends and feeling confident to approach male or female partners. He felt socially isolated and frustrated about his hopes for developing meaningful relationships. During our work, Leo and I traced his distress and anxiety back to being rejected for his physical appearance as a teenager. We started work with two targets in which Leo felt that he was different and ugly, which led to his current difficulty in starting new relationships. Through EMDR, Leo experienced a shift about his worthlessness and physical appearance. He could consider several reasons that people might want to be in a relationship with him and accept that rejection was not a fatal condemnation of his worth. Leo expressed surprise that he could shift and began to work on the patterns of being more open to starting relationships.
You may be curious about seeing an EMDR therapist, but you may have some questions…
What is bilateral stimulation?
Bilateral stimulation refers to the process of stimulating both sides of the brain and body, in an alternating manner. In the beginnings of this therapy, bilateral stimulation took the form of eye movements. Typically, the client follows the therapist’s finger or a path of light in a horizontal manner back and forth a number of times. While eye movements work for most people, a therapist may also suggest other methods such as tappers or headphones that alternate sensation or sound from one side of the body to the other, particularly if the client has a history of health concerns like migraines or seizures.
Bilateral stimulation sounds weird—how can moving my eyes back and forth really help me?
It does seem a little weird, and it is essential to EMDR. We do not know exactly why it works, but research on EMDR effectiveness indicates that the process does not work when bilateral stimulation is removed.
There are many theories about why BLS is needed. I tend to gravitate toward the idea that the BLS functions a lot like the process of REM (rapid eye movement) sleep stages. During REM, we consolidate and make sense of the material in our brain, and we even get “smarter” in that we are better able to remember things after REM sleep. In EMDR, we do the same thing, in that we consolidate and integrate the dysregulated material into our bigger, and more adaptive, selves.
Are there risks or times when EMDR is not a good idea?
As with any intervention, there can be risks associated with EMDR, especially under certain conditions. Some common risks are:
Feeling temporarily distressed as you come back into contact with the traumatic material. After an EMDR session, some of my clients have felt this increase in distress, and may report feeling lower mood, more hypervigilance, increased irritability, or difficulty sleeping. In my experience, this lasts 1–2 days max, happens rarely during the client’s course of EMDR, and does not significantly interfere with functioning. I encourage my clients to contact me sooner if they are experiencing marked distress after EMDR, but I have not found that clients have needed to make that contact.
You should let your therapist know if you have migraines, seizures or other neurological disorders, heart disease, or eye conditions. While that may sound odd, the therapist may want to alter the type of bilateral stimulation because eye movements can trigger seizures or neurological symptoms if someone already experiences them. Also, the therapist may need to coordinate care or follow-up with your other healthcare providers.
EMDR is not recommended while people are psychotic, have a severe dissociative disorder like Dissociative Identity Disorder, or cannot generally soothe themselves. EMDR would be too overwhelming and potentially harmful in these circumstances. EMDR therapists are trained to screen for these conditions during the history-taking and preparation stages.
EMDR is a highly effective treatment for moving through trauma and integrating places where you feel stuck. I have been an EMDR therapist since 2011 and have used it to help my clients clear out old patterns and distress. Please contact me today to learn more and to set up an appointment.