Complex Trauma: Yes, EMDR Can Help, but It’s No Quick Fix

Woman sitting on beach swing facing the seaFourteen years ago, when I was first trained in EMDR therapy, there was less of an understanding of its benefits, as well as a lot of confusion about what eye movement desensitization and reprocessing actually was. One thing it’s never been is a quick fix. And while I make it a point to educate people about this reality, I have found there is another layer to that common misunderstanding: lack of awareness that the existence of complex trauma, as opposed to single-incident trauma, can make EMDR an even longer-term treatment.

When working with those with single-incident trauma—a survivor of a car accident, for example—the standard eight-phased, three-pronged EMDR protocol has the potential to guide the treatment process in a relatively straightforward manner. Treatment can also be more clear-cut and focused when there are multiple traumas that can be grouped into the same category. Someone who reports being raped at various times in their life would be an example of this. Neurologically, the traumas can travel down a similar “track” when processed.

However, it is usually the cumulative effect of multiple traumas, of multiple kinds and categories, that brings folks to my office. The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences—developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

Complex trauma is identified by Judith Herman and other leaders in the field of traumatology as “the existence of a complex form of posttraumatic disorder in survivors of prolonged, repeated trauma” (Herman, 1992). An example of a history of complex trauma would be a woman who was adopted at birth, experienced sexual abuse by her brother, experienced ongoing physical abuse by her mother, and perhaps had a series of abusive relationships throughout her teenage and early adult years. She has an extensive history of interpersonal traumas at various ages and developmental stages, and spanning multiple categories.

The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences, developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

As part of our healing journeys, we must pay attention to traumas of both omission and commission; both matter and can impact a person’s mental health. Neglect and abandonment, among others, are traumas of omission. Sexual abuse, physical abuse, and violence are clearly acts of commission. Perhaps a person experienced ongoing parental misattunements, significant attachment losses, a parent’s hospitalization or depression, or witnessed a mother grieving the loss of a sibling. These and myriad other experiences are examples of traumas that, at the time, impacted the person’s sense of emotional and physical safety and, more often than not, included caregivers. If they happened in childhood, they may greatly impact the person’s perceptions of the world today. All of this adds up to complex trauma.

Many leaders in the field of trauma treatment believe the newest diagnostic criteria for posttraumatic stress (PTSD), as outlined in the DSM-5, are not comprehensive enough. Although an improvement over the DSM-IV, the latest guide for mental health practitioners does not account for the full clinical picture when it comes to developmental trauma.

The term “complex trauma” didn’t even make it into the DSM-IV; instead, “DES NOS” (disorders of extreme stress not otherwise specified) was often used in clinical application. In the DSM-5, some of the symptoms of DES NOS, such as re-experiencing, avoidance, negative cognitions and mood, and arousal, were included in the PTSD criteria.

Which brings us back around to EMDR therapy. Yes, it is possible to heal from a history of complex trauma. Doing so just takes a conscious, methodical, and phased approach to treatment. If you are considering EMDR and have a history of complex trauma, I highly recommend ensuring that your therapist has experience in working with both. Make sure, also, that your therapist talks to you about extensive preparation and stabilization; these aspects will be a necessary part of your healing journey.

Reference:

Herman, J. (1992). Trauma and Recovery. New York: HarperCollins.

© Copyright 2016 GoodTherapy.org. All rights reserved.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 12 comments
  • Leave a Comment
  • Vera

    Vera

    April 25th, 2016 at 11:13 AM

    While EMDR has been very helpful for a couple of family members of mine none of those were seeing someone because of complex trauma issues so I had never thought for it to be used as a treatment for that.

  • Sarah

    Sarah

    April 25th, 2016 at 11:55 AM

    Yes Vera it can but with the caveat that dissociation must be addressed and extensive preparation work done BEFORE any trauma processing as EMDR alone is NOT a treatment for dissociation. Glad the article was informative and helpful to you!

  • Vera

    Vera

    April 26th, 2016 at 8:19 AM

    Thanks Sarah!

  • rowena

    rowena

    April 27th, 2016 at 7:41 AM

    nothing wrong with treatment going long if it is something that is helping the patient. we ll work on our own individual time frames.

  • Jacqueline

    Jacqueline

    April 30th, 2016 at 12:25 AM

    As a senior practitioner and experienced in the NHS system of healthcare in UK I inform all clients that I consider EMDR to be an integrative form of psychotherapy. Effective, powerful and even exciting and satisfying in how it enables adaptation and confidence in making change, it needs a skilled, right brain attunement from a creative and analytical thinking therapist . In my opinion ! J

  • Ashleigh

    Ashleigh

    April 30th, 2016 at 9:26 AM

    I think that it is a pretty safe assumption that there is no form of therapy that is going to be a quick fix. For most of us this is not going to be treatment because there is one little thing that has become harmful to us. This is going to be something that we seek out because there have been multiple layers of pain that have built up over the years and we need someone and something to help us penetrate those and get to the root cause of all of it. There will be times that are unpleasant but then there will be times that are very eye opening, and not matter what course of treatment you think will pose the most benefit or will offer you what you are searching for, I don’t think that any description of the process is going to be either fast or quick or even easy.

  • Sarah

    Sarah

    April 30th, 2016 at 12:11 PM

    I just LOVE all of the discussion that this article is bringing. I think that we all know that the deepest of work can take such courage, time and commitment, and energy, no matter what we are healing from. I also agree with Jacqueline – EMDR is an integrative therapy and in fact is really described in the literature, and EMDR therapists are taught, as such. So, by the nature of that, even with the extensive preparation that EMDR therapy clients may need before working on complex trauma, the model allows the integration of approaches that promote stabilization! Thanks for the thought provoking dialogue everyone!! ;)

  • Marlene W.

    Marlene W.

    April 30th, 2016 at 12:45 PM

    I had been treated for major depressive disorder with CBT since 1999 & didn’t have great relief but with medication functioned fairly well for 11 yrs. When my mother died unexpectedly in 2010 followed by my father’s dementia and death in 2012, my depression returned in full force with suicidal ideation. In Oct 2013 I found a psychologist certified in EMDR. He diagnosed me with complex grief, complex PTSD, and Dissociative Identity Disorder. To add to the mix, I was taking over 21 prescription medications including Ambien, Lorazepam, Cymbalta, Buspirone, Oxycodone, Fentanyl, etc. psychogenic drugs with unknown affects and interactions. I began having chronic disabling pain and my body was filling with tumors from a rare disease called Dercum’s Disease. It took ALOT of preparatory work to get me to the place where the EMDR work could begin. At the urging of my psychologist, I worked with a naturopathic dr and got off alot of pharmaceuticals so only have 5 prescriptions now. I was drinking way too much alcohol so stopped that totally. And we began using EMDR which is AMAAAZING! After 2+ yrs of using EMDR and CBT, I am much better, especially with dissociation. It is no longer my predominant defense against trauma since much of the trauma was now processed and integrated. I was also hiding behind a cloak of obesity so at the urging of my psych dr, I started a weight loss program and dropped from 299 down to 238 and still losing! EMDR is so fast for single trauma incidents. I processed a rape from my 20’s in just one session! However abuse from early development years through my entire childhood and beyond is not so easy to make go away. We are whittling it down though. My psych dr will be retiring soon so I am hoping to wrap this up within a few months. If something arises after he retires, I will find someone else well-trained in EMDR for help. Knowing what I know now, I think it is imperative that all training for psychologists and mental health therapists should include EMDR. Consumer clients will be demanding it in the future so training will be market driven.

  • Jeff

    Jeff

    February 26th, 2017 at 7:59 PM

    I’m interested in discussing this topic because I received a lot of emotional abuse over a long tine and starting at a young age. I’ve had so much stress for so long that it actually caused my eyes to diverge (strabismus) and the eye doctor doing the operation had to invent an entirely new operation to remove all the divergence, and I wouldn’t be able to sleep at all without my nightly prescription of seroquel, an antipsychotic. I tried just about all the “conventional” therapies (that all sooner or later ask “how does that make you feel?” including EMDR) and they all failed because of my severe alexithymia, the ONLY therapy that I’ve tried that worked after almost a decade of trying everything I was offered is infra-low neurofeedback which I’m still getting twice a week. If there’s some “preparatory” work that could get me ready for EMDR I’d sure like to know what it’s called and who to ask about getting it since I’ve been all over the internet and haven’t found what I’m looking for yet, and I’m quite sure I’ll be needing plenty of therapy beyond what neurofeedback can provide since my cluster B-loaded late mother always “set me up” and never even came close to telling me the truth about ANYTHING.

  • Minagrace D.

    Minagrace D.

    May 17th, 2017 at 8:56 PM

    I really appreciate the reminder that EMDR is part of an integrative approach. I find it helpful to keep it all client-centered, staying attuned to what the client brings into the room.

  • Ria

    Ria

    August 9th, 2018 at 3:14 AM

    edmr Along with bringing awareness to my anxiety and how it’s associated with past trauma, I’ve never had any other therapy that’s worked as well fast and as effective. My intrusive thoughts are gone, my anxiety is greatly reduced. I’m very impressed. I’m also well versed in attachment theory/styles, mindfulness for integration, etc.
    But I still had intrusive thoughts, and Anxiety. I knew that my current situation was activating my attachment injuries, but still I could not stop the intrusive thoughts. Since Edmr I’ve felt a relief from my anxiety, intrusive thoughts, flashbacks.

  • Greg

    Greg

    November 15th, 2018 at 12:44 PM

    Ria… you gave me more hope as I have intrusive thoughts and spikes of anxiety. thank you

Leave a Comment

By commenting you acknowledge acceptance of GoodTherapy.org's Terms and Conditions of Use.

* Indicates required field.

 

Advanced Search

Search Our Blog

   
GoodTherapy.org is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.org.