What is EMDR?
David Ayers, Registered Psychologist
(3) How does EMDR Work?
(4) Getting Ready (5) During each Session (6) How does EMDR Progress?
EMDR is a quick and very effective way to help people reprocess the effects of trauma. It is safe, and the pace is controlled by the client. Trauma can underlie a large variety of mental and emotional problems. When the trauma is reprocessed, the mental and emotional problems disappear. Trauma occurs when we experience something very negative that happens unexpectedly and is out of our control. If you think about it, trauma is fairly common in many people's lives, especially when we are defenseless in childhood.
EMDR works to reprocess traumatic memories so that they no longer have the power to cause us distress. This happens fairly rapidly (in 3-30 sessions, with the average being 5 sessions for my clients). Healthy changes from EMDR are natural and permanent.
Return to top
EMDR is one of three or four newer therapies that are very effective for trauma and trauma-related conditions such as post-traumatic stress disorder (PTSD), anxiety, panic, phobias, as well as other conditions that can result from trauma such as excessive grief or guilt, victimization of various kinds, low self-esteem, relationship problems, some types of depression, and marital and sexual dysfunction. At the time of this writing (2006) there are more than 143 published scientific studies and thousands of anecdotal reports that document the effectiveness of EMDR for various types of client problems.
I have chosen to use EMDR because I believe it to be easier on clients and therapists than other approaches. It can also work more quickly and more effectively than traditional therapies for PTSD and related conditions.
EMDR stands for Eye Movement Desensitization and Reprocessing, a name given to it by its founder, Francine Shapiro, in 1989. Today Dr. Shapiro would instead simply call it Reprocessing Therapy, because its main feature has turned out to be the reprocessing of traumatic memories.
A traumatic memory is a negative memory that you re-live as you recall it. Even though that memory is not your true situation, your mind and body feel as though it is true here and now, whenever you remember it. Traumatic memories cause you pain and dysfunction. Reprocessing them is simply the process of allowing your own brain to store those memories differently, so that they can no longer take over your feelings and behaviors. Instead, they become just information to be used by you, like the rest of your memories.
Changes produced by EMDR are stable and lasting once they have been made.
Return to top
How does EMDR Work?
Your own brain does the reprocessing in EMDR. What the treatment provides is encouragement for your brain to work in a safe, properly focused and balanced way while you recall the events that were traumatic for you. EMDR will work regardless of whether or not you "get into" your memory in a lot of detail. Clients often experience that a specific memory can shift from "almost overwhelming" to "just information" within a single session.
During reprocessing, the key to proper focus is the conversation that you are having with your therapist. The key to safety and balanced processing is provided by your therapist in the form of bilateral stimulation. This is stimulation that activates first one side of your brain and then the other, back and forth, so that both sides become active in reprocessing the memory. This bilateral stimulation can take the form of eye movements, taps or sounds. Your own brain does the rest, reprocessing the old memory in whatever way is natural for you, fitting it into the network of the rest of your memories in a way that is healthy.
Safety automatically comes from bilateral stimulation because it forces your attention to be split between the traumatic memory and the task at hand. We are only re-traumatized when we focus 100% on the traumatic memory. Whenever our attention is split, we can safely bring up the traumatic memory without getting stuck there. This leaves your brain free to do the reprocessing that is needed for healing.
Return to top
EMDR is most successful when we take enough time to get ready for the treatment sessions. This phase usually needs between 1 and 3 visits. During these visits, we explore your history, including the problem areas you want to work on. We also look at your family, work, and medical history in areas that are important to the success of your EMDR treatment.
Then we develop a treatment plan and discover the inner and outer resources that will support you during your treatment process. We also practice various forms of bilateral stimulation to see which works best for you. Treatment starts whenever we both agree that you are ready.
Return to top
During each EMDR Session
Each EMDR session lasts about 1 1/2 hours. During that time,
We get ready for the session. We review any changes that have taken place since the last session. We check to make sure that any positive treatment changes have stayed in place. We select a traumatic event from your previous week or from your treatment plan and take the time we need to explore each of the following: What image best represents the event? How did that event leave you thinking about yourself in a negative way? How would you like to see yourself today (your positive belief)? How disturbing is it when you recall the event? What do you feel, and where in your body do you feel it?
We desensitize the trauma and reprocess the memory. Here, we use bilateral stimulation to reprocess the target memory and any associated material that goes along with it. We continue reprocessing until the target memory and all associated channels are cleared. We know they are cleared when you no longer experience any disturbance from the memory, and when your positive belief feels completely true to you. Sometimes this happens rapidly and sometimes it takes longer. It depends on what you need to reprocess this particular event.
Next we install your positive belief by using bilateral stimulation to strengthen this belief in connection with the old event and with any future events that are similar.
You can then scan your body for any areas of discomfort or unusual feelings. If you find any, we desensitize them.
Closure is the final part of the session, in which we make sure that you are ready for leaving the session and ready for the time between now and the next session. Once started, reprocessing can continue between sessions in the form of new insights, dreams, new memories, and so on. During Closure, we make sure that you are grounded and ready to drive home, that you have a strategy for using your tools to deal with any reprocessing that may continue between sessions.
Return to top
How does EMDR Progress?
The changes that EMDR brings about are very natural and organic. The changes feel so natural and suitable to you personally that you may not even notice that your trauma-based difficulties are disappearing. Often you simply begin having thoughts and feelings that are healthy and feel so natural to you, that it doesn't occur to you that you have not always had these healthy thoughts and feelings. Friends and relatives will notice, however, because your behavior will change in a way that they recognize as good and healthy. This "new you" that you may or may not fully appreciate is the person you would have been, had you not been traumatized. Fortunately, you get to be this happier, healthier person going forward.
Most often, EMDR works quickly and effectively. Studies show that the usual number of EMDR treatment sessions needed to clear single-event trauma is 1-3. Complex, long-term trauma is usually cleared in 3-30 treatment sessions, with the average being about 12 sessions. Kaiser-Permanente, a California managed care company, found that EMDR was twice as effective in half the time (a 4-fold gain) when compared to the standard type of treatment.
If your EMDR is working more slowly, we need to find out why. Most of my EMDR clients complete their treatment in 5 - 7 sessions. With about 12% of my clients EMDR does not work as rapidly as we expect it to. If, at the end of two treatment sessions you have not had a clear experience of successful reprocessing of one or more memories, we need to take a look at why. The main types of reasons are these:
We may need to adjust the type of bilateral stimulation that you are receiving in order to make it more effective.
You may need more opportunity for talking during the session. Classical EMDR is set up for people who need silence in order to reprocess. For some people, actual talking is needed in order to activate the left hemisphere in a controlled way. This is seen, for example, in the standard protocols for Critical Incident Debriefing.
You may be trying too hard. If your trauma has forced you to learn a survival style of strong mental effort to overcome pain or fear, it will seem unnatural to you to let go and trust in the process. EMDR is more of a passive process that works best when you are just a tourist, looking at your old memories as they drift past. If you are busy solving problems, your brain is preoccupied with this strong habit, and is not being allowed the leisure that it needs in order to reprocess your old memories.
You may need more opportunity to focus on your body's feelings and sensations. Trauma is almost always connected most strongly to these, and reprocessing is most needed here. Especially if you have learned to survive through analyzing things, it will help your EMDR progress to pay attention to the sensations in your body. You may need to do this a little at a time until you learn that EMDR protects you from being overwhelmed by your body's sensations.
Your trauma may be complex and ingrained. If you have lived with trauma that began very early in life and your reactions have become ingrained over a long period of time, it will take a while to unravel all of the channels and interconnected memories of events. Even though the process may seem long, it is only because we have come to expect that EMDR produces miraculously quick changes. For you, miracles take just a little longer.
Your style of improvement may be holistic. If you find that your memories are chaotic and "splattered" all over the map when you do EMDR, this just means that your neural connections are holistic. Your style of reprocessing is to work on everything at once, each session making a little bit of progress on everything rather than dramatic progress on one thing at a time. Don't worry, your treatment will complete in about the same amount of time that it takes for someone who is a very targeted and organized reprocessor.
Changes achieved through EMDR are
permanent. The longest follow-up studies that have been possible have
indicated no change from the original treatment gains. This means that you
can stop treatment for a period of time and then come back to it without losing
any of your progress. It also means that you do not have to try to
maintain your treatment gains - they are "self-maintaining" because your brain
has made what appear to be permanent changes as a result of your treatment.
In other words, when your treatment is completed, you can just get on with your
People complete at different stages of treatment. I have noticed that I have two types of EMDR clients, depending on their life circumstances:
The first kind begin EMDR with the time, resources, commitment and leisure to see it through to the end. These are folks who, for example, are retired or who have taken a stress leave from work and need to be completely healthy and emotionally strong before they can return to a toxic or threatening environment. These clients complete their treatment when they are 100% OK.
The second kind (the majority) have busy, over-committed lives. Their goal for EMDR is to "get functional and get going". These people leave treatment whenever they have improved enough to be able to cope along in their daily lives. This is usually at about the 70% improved level (my estimate). The good news is that these clients can just keep going indefinitely and still function quite well. The remaining traumatic thoughts and feelings that they do have are not disturbing enough to really slow them down. The further good news is that if these clients want to come back later and clear the last 30%, they can do so without having to back-track. They can just continue where they were in their treatment plan and finish quickly and completely.
For more information, here are some useful
links. If you do not live in mid-Vancouver Island in
BC, Canada and want to find an EMDR clinician in your area (in Canada or
internationally), you can find one at
www.emdr.com This site also contains a
detailed summary of research results that relate to EMDR. The
official site of the EMDR international licensing body, EMDRIA, is
Return to top