Eye Movement Desensitisation and Reprocessing
Empowering Healing Journeys with EMDR
I am trained and practice in several therapies, however, EMDR is in my top three favourite therapies. EMDR is not only endorsed as the first line therapy around the world for treating PTSD and trauma, but it is extremely effective for those with depression, anxiety disorders, addictions, phobias, eating disorders, self-esteem, chronic pain, to name a few. Transforming those maladaptive core negative beliefs that hold us back from being the best version ourselves, which is often the underlying cause for our issues.
Honestly, at times it really surprises me how quickly and easily we resolve some issues in therapy, especially when clients have previously been in therapy elsewhere for a long time and not getting anywhere.
The main reasons why I am so passionate about this therapy, and why clients have found it so unique and helpful is;
- most times it is a short term therapy resolving single traumas from 1 to 6 sessions
- there is no homework involved and
- while some other therapies can be re-traumatising as it involves talking about the trauma over and over,
EMDR has a clear structure which reduces re-traumatising the client.
What is EMDR?
Eye Movement, Desensitisation and Reprocessing is a therapy that Psychotherapist, Francine Shapiro discovered and developed in 1987.
It is an 8-phase therapy where bilateral stimulation (left-to-right), either tactile or eye movements, is used in session to unblock, activate and reprocess unresolved disturbing life experiences. The bilateral stimulation is what unblocks and allows the reprocessing of past events, beliefs and somatic symptoms to occur
There is actually no one specific theory as to why this therapy works as well as it does. One of the theories, which makes sense to me, has to do with how EMDR works by engaging similar brain mechanisms as those that underpin rapid eye movement (REM) sleep.
Sleep is comprised of five stages. The first four stages involve falling deeper and deeper asleep. The fifth stage, rapid eye movement (REM) sleep, is one of the most important as this is where we reprocess the day’s events, consolidating and integrating what is useful and get rid of what’s not. We dream and our eyes move rapidly under our eyelids.
“Just sleep on it, you will feel better in the morning”
We have all been there, where were troubled by a problem and the emotions are high just before bed. The following morning, after sleep, the problem is a distant memory and no longer a disturbance. Our wonderful brain has been working wonders through the night dreaming as overnight therapy.
By mimicking this process in a waking state, facilitating the bilateral eye movements while thinking of a disturbing event, feeling or belief, we activate the natural healing process.
What is trauma?
In EMDR terms, I explain trauma to my clients as a highly distressing event which overwhelms the natural coping mechanism. Due to the high level of distress at the time of a traumatic event, we are unable to process what’s going on and the event becomes frozen and trapped in our mind and body, along with the emotions and beliefs.
When this event continues to be unresolved, we become triggered when we later experience similar situations, thoughts and feelings. Our mind is trying to reprocess the earliest event thus we experience the similar feelings of anxiety, stress, fear, depression and related thoughts.
The trauma may be an isolated once off event such as an assault or a car accident or repeated events such as bullying or childhood neglect and abuse.
What can you expect in therapy?
EMDR in 8 Phases
Phase 1 – History Taking and Treatment Planning
This initial phase usually takes 1 to 2 sessions. Building good rapport and trust is extremely important in the client-therapist relationship especially since we are often treating repressed childhood memories that were too difficult to deal with in the past. Often caregivers in the past may have betrayed their trust or failed to protect them. Trusting that their therapist will not judge them and protect and guide them through the therapeutic process and emotions, will allow the process to move smoothly and safely with open and honest communication.
This phase involves administering a standard clinical interview, obtaining a history from the client and developing a plan. We will also discuss what the problems are which have brought the client to therapy and begin mapping significant life events from earliest years of childhood to current which have contributed to current problems. We will also identify positive events and associated beliefs and emotions throughout the client’s life. These are positive strengths and resources that will assist toI will also ask the client to complete any questionnaires or tests to obtain further information regarding presentation and diagnosis. Such tests will be to assess for dissociation, schemas, obsessive compulsive tendencies and PTSD severity.
Phase 2 – Preparation
This phase can take anywhere between 1 to 4 sessions depending on the severity and complexity of the client’s presentation. Safety and stabilisation techniques are learnt and strengthened so that the client has a sense of personal self-mastery and control. Identifying and strengthening a Safe or Healing Place through imagery and hypnosis, relaxation strategies, reduce unhealthy avoidance behaviours such as alcohol or drug use, encourage journaling, practice mindfulness.
Phase 3 – Assessment
We will identify which target memory we will be processing by stimulating the primary aspect of the memory. For example, John presents in session with long standing anxiety about driving which has recently worsened and impacting on their ability to drive to places. John is asked to target the earliest memory that elicits similar beliefs and feelings and recalls a time when he were younger and involved in a car accident. Recalling that event NOW may elicit negative beliefs of ‘I am unsafe’, ‘I am in danger’ and ‘I am not in control’. Current emotions associated are stress, fear, anxiety and frustration with physical sensations in the stomach and chest, and the level of distress being a 7 out of 10. The client will then identify what positive or more rational belief ACTUALLY corresponds with that memory now, such as ‘I am safe, it’s over’, ‘I can be in control’ and ‘I can keep myself safe’.
At this point, I will ask John to estimate how true the positive belief feel in relation to the target memory of the accident, using the 1-to-7 Validity of Cognition (VOC) scale. “1” equals “completely false,” and ” 7″ equals “completely true.” It is important to give a score that reflects how the person “feels,” not ” thinks.” We may logically “know” that something is wrong, but we are most driven by how it ” feels.” He says right at this moment it doesn’t feel believable, so a 2.
Phase 4 – Desensitization
We process the target memory with eye movement or tactile bilateral stimulation toward an adaptive resolution (a SUDS of 0-1 and a VOC of 7). I will sit opposite and to the side of the client to conduct sets of eye movements. I ask the client to bring to the forefront of their mind the memory, the worst image of the target memory we are processing, along with the negative beliefs, emotions and body sensations and location of these. I will log the client’s reported level of distress from 1 to 10, as well as the VOC. I remind the client of their chosen safe place where we can go if the distress is high, and a signal to stop if needed, such as saying ‘stop’ or to wave their hand.
I remind the client that during processing, which occurs in 30 second intervals, the client is only to observe and notice what they are thinking, seeing and feeling without forcing or changing what comes up. The goal is for the client to come to a natural resolution with new connections and insights without contamination by the therapist. I often warn the client that my role is to facilitate self-healing and to avoid disrupting their mind’s work by intervening and offering soothing words or comfort. These would be MY thoughts, not the client’s, and can be confusing when the client is not feeling or thinking this way.
After 30 seconds of bilateral stimulation, I will ask the client to take a deep breath and what they notice is coming up. The client then tells me briefly whatever thought, feeling, image, memory, or sensation comes to mind. I log this and we continue onto another set of 30 seconds. We continue this process until the client reports their distress to be a 0 or 1.
Phase 5 – Installation
During this fifth phase of treatment, that client’s positive cognition, “I am now in control,” will be strengthened and installed. This is also done with bilateral stimulation. How deeply the client believes that positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal is for the person to accept the full truth of his or her positive self-statement at a level of 7 (completely true).
Phase 6 – Body Scan
After the positive cognition has been strengthened and installed, I ask my client to bring the original target event to mind and see if any residual tension is noticed in the body. I will ask my client to close their eyes and scan their body from the top of their heads down to their toes and to identify if there is any part of their body that rejects the positive belief or any residual negative feelings. If so, these physical sensations are then targeted for reprocessing with bilateral stimulation.
An EMDR session is not considered successful until the client can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.
Phase 7 – Closure
Every session is closed ensuring that the client leaves at the end of each session feeling better than at the beginning. If we run out of time and the session is incomplete, we will contain the memory, feelings and anything else related into the container we identified in the earlier phases and assist the client in using a variety of self-calming techniques in order to regain a sense of equilibrium. Throughout the EMDR session, the client has been in control (for instance, the client is instructed that it is okay to raise a hand in the “stop” gesture at anytime) and it is important that the client continue to feel in control outside the therapist’s office.
I brief the client on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and what calming techniques could be used to self-soothe in the client’s life outside of the therapy session.
Phase 8 – Re-evaluation
the Re-evaluation Phase is vital in order to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment, as it is to complete an entire course of treatment with antibiotics. We will make sure that all negativity has been removed from the client’s memory of the event, but also that the positive self-beliefs installed in place of the negative ones are still present. We will make sure that the client regards the event itself in either positive and neutral terms, and any views of self the client now holds in relation to the memory are only positive ones. This is a sign that the EMDR process has been successful for that particular memory.