Why So Many People Are Choosing EMDR Therapy
An Intervention, Psychotherapy, or Both?
So often, clients have asked me, “Can we do EMDR next week?” Umm, always yes! First and foremost, I am always encouraged when clients advocate for themselves. After all, this is your time, and a distant second is the thoughts that activate the clinical networks of my brain (I often avoid diving into these network activations during social situations – no one cares that I think part of their personality is likely a survival behavior from a developmental trauma…a difficult interpersonal lesson to learn for a trauma therapist) and I start to conceptualize where we should go while using the requested EMDR intervention.
I am always jolted out of this when reminded that EMDR is client-led, so I can clinically guide while trusting the client knows what he/she needs to work on, and I am honored to be that guide; but what are we guiding clients through?
What is EMDR therapy?
EMDR (not to be mistaken for EDM, Electronic Dance Music – this is a hilarious and common mistake) stands for Eye Movement Desensitization and Reprocessing Therapy. It is a specific approach to healing traumatic memories and stress.
From its creation in 1987 by Dr. Francine Shapiro (you will see her quoted throughout) to present-day clinical practice, it has grown in popularity (shown in Prince Harry’s recent interview on Good Morning America) and is now used to address many maladaptive behaviors beyond a specific Post Traumatic Stress Disorder (PTSD) diagnosis.
EMDR is housed in the Adaptive Information Processing (AIP) model, which conceptualizes that unprocessed, emotionally charged, distressing memories are the root of all pathology, including the subsequent survival-oriented behaviors that innately follow and generalize throughout a person’s life.
The AIP model is a framework that allows EMDR to be applied to many maladaptive behaviors outside of traditional PTSD symptoms. Behaviors such as disordered eating, aggression, obsessions or compulsions, substance abuse, insomnia, and many more are oftentimes rooted in a traumatic experience or memory.
If you have ever taken the GRE or a similar adaptive test, you may understand how the concept of “generalization” occurs as a result of trauma, as referenced via the AIP model. The GRE adapts as you move through the exam questions, feeding the test-taker the next exam question based on whether or not the current question was correctly or incorrectly answered.
So, if you get it right, the test gets harder; if you get it wrong, the test typically gets easier, making it so no student takes the same GRE. Trauma and subsequent survival behaviors can be experienced in a similar way as our brain networks and capability to evolve creates generalization of trauma symptoms not just in the moment but also throughout our lifespan.
For one person, an experience of shame or abandonment in development registers as traumatic stress, and for another, it could be on par with a catastrophic car accident.
As described briefly above, EMDR is an approach for finding, activating and reprocessing past trauma to resolve and move past these stuck points, survival behaviors, and memories. EMDR as a specific intervention, does this through a series of phases and bilateral stimulation (back and forth eye movements, tapping, or buzzing – with children, I call them “buzzies”) that allows our brain to reorient and absorb the otherwise stuck traumatic moments and move forward with move adaptive beliefs about ourselves and the world around us.
All EMDR is basically the same with minor variations, variations in applications (e.g., group EMDR vs EMDR with children), clinical nuances (e.g., when to do a body scan vs. how many seconds to apply the bilateral stimulation (BLS) – the tapping or eye movements), or how the phases of treatment in any given protocol are laid out.
Typically, however, the tenants, conceptualization, and delivery do not vary a ton. The Standard Protocol developed by Francine Shapiro (and team!) is what most practitioners refer to when they say “EMDR,” and it is the basis for the majority of other protocols such as chronic pain (many options here on EMDRIA.org), recent or ongoing traumatic events (R-TEP research found here), eating disorders (reference list here on EMDRIA.org) and many more.
Is EMDR Psychotherapy Or Only An Intervention?
There has been some recent back and forth about EMDR as only functioning as an evidence-based intervention specifically and only for the resolution of traumatic stress versus it being implemented also as an overarching psychotherapeutic approach for treatment, similar to Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Solutions Focused Therapy, etc.
At The EMDRIA Annual Conference: Changing Lives (2023) this year, awareness of the challenges we face as trauma therapists were brought to the forefront. Specifically, how do those in charge and people making the decisions come to understand better and recognize the profound effects EMDR has on client healing and society as a whole?
Healing the world was Dr. Shapiro’s goal for her life’s work; helping clients and survivors to process unprocessed traumatic experiences stuck in the brain that then obstruct the memory network, leading clients only to remember and see the negative in life, about themselves, in the world, and of others.
EMDR is not only a vital intervention to unstick the stuck but is also an evidence-based psychotherapy that can support clients through the identification, healing, and dismantling of those negative memory networks.
EMDR Therapy as Distinct Intervention
If I were to describe this in metaphorical food terms, I may say think of it as an add-on, an a la carte menu item, or a side dish like mashed potatoes to supplement your main course – the main course being general psychotherapy or talk therapy.
While in the course of general counseling or therapy, EMDR can be utilized as a tool to apply to stuck points, moments of trauma or hold-over survival behaviors that are no longer serving a client.
Typically, this may look like general talk therapy with pops of EMDR sprinkled in as needed. If EMDR is sprinkled in in this way, we would see distinct EMDR targets identified (the thing we choose to work on or to “target”) and the course of Phases 1-8.
This is the traditional way EMDR has both been thought of and utilized and is a very appropriate and evidence-based intervention when applied this way. When I think of EMDR applied this way, I think of distinct treatment episodes of EMDR Phases 1-8.
This is an amazing tool and can work wonders for clients. Utilizing it this way works very well with clients who have a distinct goal for counseling, have an intrusive memory arise through the course of therapy, or have a pervasive negative self-belief system (we call this ‘negative core beliefs’). It is more than appropriate to be utilized this way; this is actually Shapiro’s intended application.
You may see clinicians offering this as a course of EMDR treatment, EMDR intensives, or EMDR in a group psychotherapy format.
What Are EMDR Therapy Side Effects?
The most common side effects are person-specific and related to the nature of their individual healing journey and trauma. Given that EMDR is, by definition, client-led (the client determines what they focus on and work on throughout the intervention), the side effects are not as vast as some other evidence-based interventions. Some common side effects may include:
Your network has been working hard during the bilateral processing and so many clients need a break or time to rest afterwards. It is common to feel drained and tired during or afterwards.
There are five major ways we can experience the desensitization and reprocessing that occurs during EMDR intervention.
- Body/somatic sensations (e.g., dizzy, nausea))
- Olfactory sensations (smells)
- Memories (remembering something)
- Images (sometimes clients even see colors)
- Strong Emotional Response
I prepare each client for this potential in advance, but experiencing sensations in each area is likely during EMDR. You have to remember that at the time of the traumatic experience, your body froze and filed that format into your network. Therefore, reprocessing these experiences is likely to bring up the sensations of the moment that froze along with it. I remind clients that we’re moving them through it and not leaving them in it!
Recognizing Positivity Between Sessions
As your negative network organically dissolves during the intervention, your brain will start to build a more accurate and fluid narrative of the event or series of traumatic experiences, leading clients to recall more positive details often.
For example, remembering the nice person who tried to help them after the assault as beforehand that detail was overtaken by the traumatic stress. Remembering these pieces aids healing and helps clients move forward with new and more positive networks (positive networks about themselves and their world, not necessarily about the trauma itself because traumatic events are neither acceptable nor okay).
Your network has been turned on via the intervention, often leading to more processing while you are asleep. We typically experience vivid dreaming during Rapid Eye Movement (REM…see the parallel here) sleep, and so continued processing may occur during this time. It is all part of the process. I advise clients to write their dreams down and bring them into the next session so we can discuss them as they continue to heal.
Clients experiencing certain medical conditions and seeking EMDR as an intervention should be cleared by a physician (e.g., Traumatic Brain Injuries), and as long as these contraindications are avoided and/or handled with medical care, other side effects should not occur. It is important to note that applying EMDR as a psychotherapy could be a great alternative for clients with medical contraindications.
The very nature of how trauma weaves itself into the fabric of our brains and behavior makes it difficult to unravel distinctly. Sometimes, we need to use not only EMDR as an intervention but also as a broad conceptualization system to help work with and treat trauma and attachment wounds.
How Can EMDR Help Me Achieve My Health Goals?
A few years ago, I attended a 40-hour training with Dr. Bessel van der Kolk, where I recall him asking the crowd how many of us have ever had a client come in with only one traumatic memory or event and nothing else. No one raised a hand. Rarely do clients come in with a single experience as the root of their pain and nothing else. There is almost always more.
You can use the AIP Model (referenced above) to guide your conceptualization, treatment and intervention with clients. It provides a compassionate and comprehensive framework for understanding present-day client distress.
So much of the value we add through psychotherapy comes from helping clients comprehend, organize, become familiar with, and build a narrative around what they are experiencing. The AIP model, when applied through various stages of EMDR or on its own, offers this organization. To see the relief on a client’s face when I conceptualize something they have been doing for years as survival behavior is unmistakable. Clients seem to feel seen, heard, and accepted.
When attempting to decide where yourself as a clinician may fall or how to distinguish how you use EMDR, it can be helpful to think of clients with complex trauma, dissociation (dissociation is not a dirty word, we all do it to varying degrees!) or complicated grief and loss experiences as good candidates for a more comprehensive EMDR psychotherapy approach. The more the mentality and framework is infused in your general talk therapy sessions, the more it seems to ‘prime’ hearts and minds in pain towards healing.
One major distinction between the two approaches is that if you are not delivering distinct Phase 1-8 treatment or adding in processing speed BLS, you do not have to have clients sign a special consent form. You do, however, ethically have to disclose your treatment modality as including EMDR as a psychotherapy in your treatment disclosure.
The AIP model resonates strongly with me as a clinician, and so I do identify as a therapist who uses EMDR as a psychotherapeutic modality rather than only an intervention. I have clients I work with whom we apply EMDR distinctly. I have done EMDR treatment episodes with clients of other clinicians who are not certified or specific treatment episodes (e.g., children in foster care), or EMDR intensives and it works well for them; but mostly I am conceptualizing our counseling sessions through my EMDR AIP lens to some degree and therefore infusing it into our sessions.
Take good care and remember…