EMDR Theory and Trauma: The Strange, the Familiar, and the Forgotten

Shot of a young woman drinking a cup of coffee while looking out of a window“Memory is not a recording of an ‘image’ or a ‘trace’ but part of the process of knowing and understanding.” —Rosenfield, 1992; p.18

There are polarizing beliefs when it comes to eye movement desensitization and reprocessing (EMDR) therapy. On one end, it is viewed as a+ cure-all treatment for mental health symptoms. On the other, critics see it as a treatment akin to modern-day snake oil.

The protocol for EMDR therapy is comprehensive and detailed. Put simply, the idea is to transform disturbing input—process and decondition it—into an adaptive resolution and a psychologically healthy integration. The model is past-focused, meaning one is going back in time to recall events as opposed to addressing current life stressors (not that the two are mutually exclusive). This includes redefining the event, finding meaning in it, and alleviating self-blame while integrating new skills (Shapiro, 2001). The modality focuses on the core cognitions or self-referential beliefs individuals associate with the disturbing events. These often fall into domains related to personal responsibility, safety, and power or control. “Trauma in each of these domains is reflected by the client’s distorted self-referencing beliefs linked to the effects of unresolved memories” (Nickerson, 2017).

EMDR is an evidence-based therapy primarily used to treat posttraumatic stress (PTSD), but as it gains momentum in mental health circles, indications for its use are ever-expanding. The question for me is less about EMDR efficacy or benefit. The concern is the theory behind it and my general curiosity regarding its unique properties. There are aspects of the treatment that are altogether strange. Likewise, it contains components that are familiar to popular understanding of memory and a few things that tend to go overlooked or are forgotten.

Strange

EMDR was founded by Francine Shapiro in 1989. The legend is she was walking in a park and thinking about something distressing to her. She noticed that moving her eyes from tear duct and back to her periphery (i.e., side to side) lessened her distress. This was the early evolution of utilizing what is called bilateral stimulation. During the processing stage of EMDR therapy, the practitioner will use their fingers, tactile sensors, and/or auditory sounds that activate from left to right or vice versa. The theory is this process stimulates each hemisphere of the brain. The left hemisphere is primarily focused on language, linguistics, and narratives of our experience as opposed to the experiential aspect of the right hemisphere. In this manner, the person processing the traumatic memory integrates both the story and the felt experience. The bilateral stimulation is said to parallel how memory is consolidated during dream or REM (rapid eye movement) states when we sleep.

Fundamentally speaking, accelerated processing during EMDR splits the attention of the individual. During bilateral stimulation (i.e., finger movements, tones in the ear, or hand sensors), working memory is taxed because one must partially focus on the stimulation. This multitasking softens the emotional blow of recalling disturbing memories.

For those unfamiliar to the processing aspect of EMDR, practitioners are trained to sit close to the person in treatment. During this process, the therapist and person in therapy are cohabiting each other’s personal space, with one knee a couple of inches from the other’s. The direction is for the two people to be seated in an orientation “like two ships crossing in the night.” This unique approach to treatment creates an added level of intimacy and implicit vulnerability. It is strange and often overlooked when considering how the intervention benefits people in therapy. In a garden-variety individual therapy session, the two people are often sitting across the room from each other or at least several feet away.

Another oddity of EMDR is the historical context and initial hypothesis pertaining to trauma. In 1989, Shapiro questioned if trauma was essentially a disruption in the excitatory and inhibitory balance of the brain. This was two years after Prozac was introduced to the United States and a year before the Decade of the Brain. Mental health was beginning to be understood from a chemical or biological perspective. EMDR benefited from hitching the idiosyncratic trauma treatment to the biological wagon of mental health. EMDR’s individualized treatment would offer a correction to this brain imbalance akin to the overly simplistic solution for depression being a deficit of serotonin.

Familiar

Popular understanding of memory is that it is solely a brain function, with stored archives of our moments from the past organized in little synaptic shelves of neurons. This concept of memory as photographic snapshots stored in an album of existence is analogous to social and news media feeds displaying a history of ourselves across set positions on timelines. The click or swipe reveals the exact same image with no distortion. In Israel Rosenfield’s book The Strange, Familiar, and Forgotten: An Anatomy of Consciousness, he notes our false conception of memory based on Freudian ideas of the unconscious: “The problem is that we have tended to think of memories as unconscious items that one brings to consciousness, not as part of consciousness” (1992; p. 12). The false dichotomy of consciousness versus unconsciousness holds this misconception in place.

In Pixar’s animated film Inside Out, the main character’s memory process was portrayed in a similar manner. Her brain would produce marble-like spheres that rolled down a mechanical carousel to produce videos of previous experiences. The film portrays an exact reconstruction of past events as if these histories could be called upon via a brigade of emotional activity. This is not unlike the theory behind EMDR therapy. Disturbed memory channels in the limbic system are said to be clogging or inhibiting the individual from moving past the traumatic event. A subtle distinction is important to note: each time one thinks of a memory, they are essentially reconstructing or imagining what happened. This process creates tiny errors similar to the manner in which one copies a computer file. Over time, these little distortions add up and the factual elements of the memory are changed. The most salient and accurate memories are the ones we only rarely recall (like the original file before it is copied). The misconception of memory processes fits with Western culture’s ego-centric, fixed sense of self; “the conviction that memory is one thing is an illusion” (Eagleman, 2011; p.126).

The idea of having storage units or filing cabinets in the brain holding our past experiences aligns with current cultural frameworks (i.e., email, cloud technology, digital folders) and therapeutic modalities related to trauma and clogged memory channels (i.e., EMDR therapy). Rosenfield (1992) is explicit in drawing attention to this faulty neurology. When one remembers, they are referring to an event/object/person as they are represented based on one’s own subjective experience, “not mechanical reproduction” (p.42). Memory is less of a product of history or biological remnant, but a dynamic ability to integrate knowledge in a relational manner. The timestamp or notarizing of the event occurs within a conceptualization of who it is we think we are as a person.

Memory is rooted in our sense of time and part of the very structure of conscious knowledge. It is not an isolated phenomenon, but rather a manifestation of subjective states created by brain activities (Rosenfield, 1992). Therefore, failure of memory is not due to the loss of specific items “stored” somewhere in the brain, but rather a breakdown of the mechanisms of consciousness; “there are no memories without a sense of self.” As Rosenfield (1992) notes, “Without knowledge of one’s own being, one can have no recollections. How can I remember my parents, my house, if I am not sure I exist?” (p.41).

Forgotten

You need to remember EMDR therapy is an intervention that implies a Western understanding of the self or mind. It turns out the way highly educated, wealthy, democratic minds think is not representative of the entire globe. Most of us in the West do not think of ourselves as a body; we think we “have” a body. There is a notion we are the chariot drivers of our experience or, put another way, there is this little person inside our heads that has all types of likes and dislikes, proclivities, and things we retract from or avoid. This is an ego-centric perspective of the mind.

If you stop and pay attention to the present moment, one’s habitual patterns of cognition start to become clearer. The ego-dominating belief of our existence lying somewhere in the center of our skulls begins to be challenged. This is worth remembering.

By comparison, if you ask a Sri Lankan about themselves, they may describe their interpersonal relationships, family, and roles or responsibilities. This is a socio-centric version of the self with less of a demand on individuality. Watters (2010) articulates this distinction via several cultural specific examples in his book, Crazy Like Us: The Globalization of the American Psyche. He describes the 2004 Indian Ocean tsunami that killed around a quarter million people. Sri Lanka was one of the areas hit especially hard by this tragedy.

Western mental health practitioners rushed into these areas without knowledge of the culture. They did not know how to speak the language or have any awareness of local conceptualizations of trauma. This included benevolent EMDR therapists who assumed there would be an epidemic of PTSD. However, if you asked the Sri Lankans where their trauma resided, they generally did not point to their heads or speak of their minds being broken. For them, the damage was to the community and broken relationships. “Because Western conception of PTSD assumes the problem, the breakage, is primarily in the mind of the individual, it largely overlooks the most salient symptoms for a Sri Lankan, those that exist not in the psychological but in the social realm” (Watters, 2010; p.92).

The Westernized perspective is assumed to be a universal one. When one considers trauma, they must consider the time it happens and the cultural frame it occurs in. The consequence of an ignorant global construct for trauma is we remove the nuanced experience from other cultural narratives and beliefs that might give meaning to how the person suffers (Watters, 2010).

Self-Centered Awareness

David Foster Wallace (2005) hit on the margins of this notion—self-centered awareness—in his commencement address to Kenyon College titled This Is Water. He spoke about the choice of where we place our attention within conscious awareness (as opposed to relying on our “default setting” or autopilot) and how one can cultivate compassion within the banal aspects of daily life:

And the so-called real world will not discourage you from operating on your default settings, because the so-called real world of men and money and power hums merrily along in a pool of fear and anger and frustration and craving and worship of self. Our own present culture has harnessed these forces in ways that have yielded extraordinary wealth and comfort and personal freedom. The freedom to be lords of our tiny skull-sized kingdoms, alone at the center of all creation.

There is an ancient technology available to emancipate us from the constraints of these small, isolative worlds. To notice this ostensible imprisonment, all one need do is sit down in silence and observe where their mind goes. Who is producing this stimulation and is there a navigator of control? What happens when all you do is focus on the inhalation and exhalation of the breath?

Mindfulness and meditation practices will not cure individuals from the impacts of trauma or reoccurring disturbing memories. However, it is a prophylactic to inhibit self-centeredness or personalization of momentary experience (which tends to lead to the anxiety-provoking reoccurrences of mind).

When one has a thought, feeling, or sensation, it is often turned into a belief that becomes self-referential. A simple interaction with a partner or family member illuminates this silly human deficiency. If the person yawns during a conversation (the thought), this can lead to a belief (e.g., the person is bored) which is then internalized (i.e., “I am unlikable” or “unlovable.”). One falls down this self-deprecating rabbit hole all too quickly. The antidote is to just notice what is arising in terms of thoughts and beliefs before assuming a story about yourself.

If you stop and pay attention to the present moment, one’s habitual patterns of cognition start to become clearer. The ego-dominating belief of our existence lying somewhere in the center of our skulls begins to be challenged. This is worth remembering.

References:

  1. Eagleman, D. (2011). Incognito: The secret lives of brains (1st American edition). New York: Pantheon Books.
  2. Rosenfield, I. (1992). The strange, familiar, and forgotten: An anatomy of consciousness. New York: Knopf.
  3. Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd edition). New York: Guilford Press.
  4. Wallace, D.F. (2005). This is water. Transcript retrieved from https://web.ics.purdue.edu/~drkelly/DFWKenyonAddress2005.pdf
  5. Watters, E. (2010). Crazy like us: The globalization of the American psyche. New York: Free Press.

© Copyright 2017 GoodTherapy.org. All rights reserved. Permission to publish granted by Andrew Archer, LICSW, therapist in Mankato, Minnesota

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.

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  • ahbuddha

    ahbuddha

    June 8th, 2017 at 6:54 PM

    Thank you for your article. I feel like EMDR is “sold” as a cure all and that is simply not the case. At the end of the day, it gets down to what every other approach and technique depends upon, the therapeutic relationship (would you let someone sit that close?! Do you need someone to sit that close and hear you story?). EMDR is one tool in a vast toolbox and practitioners need to remember to remain flexible. Just because it should work, does not mean it will work; there is no “one size fits all”. A traumatized client can easily feel like a failure or defective when a “miracle cure” fails to work for them, when it may be a simple matter of individuality, culture, or wiring. I especially appreciate the discussion of culture. An east coast therapist once tried to suggest “brave” pioneers as a resource, forgetting his western client was part indigenous and only heard “genocide”. You needn’t abandon the technique because it fails to work immediately, but you need to be open, honest, and listen to your client. They are not being stubborn or obtuse, there are a multitude of reasons of which they are likely not even aware that one works and another doesn’t. Perhaps the protocol needs to be adapted or perhaps you take the resourcing and use it in concert with another approach. Remain hopeful, but cautious and creative.

  • Cheryl

    Cheryl

    June 11th, 2017 at 5:12 PM

    I must add that as a practitioner of EMDR, that this article has many inaccuracies and can potentially give a distorted view of what the essence of EMDR is. The author focuses on the “strangeness” without checking the accuracy of what he highlights, perhaps for dramatic effect? I do not think of EMDR as a “cure-all” and articles such as this are dangerous when taken without proper investigation or questioning.

  • ahbuddha

    ahbuddha

    June 11th, 2017 at 9:44 PM

    I don’t want to go tit-for-tat, but the author is an EMDR practitioner.

  • Grady

    Grady

    June 9th, 2017 at 10:22 AM

    It is when you have low self esteem to begin with that you begin to believe all of these things which are so obviously not true but feel like they are in the moment

  • John

    John

    June 9th, 2017 at 10:50 PM

    I am 59 years old and have suffered from anxiety,depression and complex ptsd. People that have known me for years that I have opened up to are surprised as I have become a master at hiding it. I am tired and exhausted and can no longer hide it. I am currently looking into EMDR therapy. Would love to know your opinion on this.

  • Jim

    Jim

    June 10th, 2017 at 8:54 PM

    I don’t know what your source or sources of information were regarding EMDR, but many of your statements are simply factually inaccurate. Moreover, these statements repeat critiques of EMDR that occurred in writings of critics of EMDR about 20 years ago, but have been largely debunked. You should have had a discussion with someone familiar with EMDR, and how it works, and what it’s known and accepted limitations are. And, incidentally, there are several hundred therapist members of the Sri Lanka EMDR Organization! (emdrsrilanka.org)

  • Katy Murray

    Katy Murray

    June 11th, 2017 at 6:03 PM

    I hope you will correct several inaccuracies in this article, as they reveal a lack of understanding of EMDR therapy and a significant amount of misinformation and faulty assumptions.

    (1) You mentioned, “The model is past-focused, meaning one is going back in time to recall events as opposed to addressing current life stressors (not that the two are mutually exclusive).” Actually, EMDR therapy utilizes a “3 pronged approach” which includes not only a focus on past (contributory) memories, but also focused reprocessing of present situations that continue to be triggering, as well as the development of an adaptive, positive template for the future.

    (2) “The modality focuses on the core cognitions or self-referential beliefs individuals associate with the disturbing events.” The focus in EMDR is on reprocessing ALL the components of an event, which leads to a shift not only in cognitions, but also emotion, body sensation, and sensory aspects of a memory. The change in cognition is a side effect of reprocessing, rather than the focus of EMDR therapy.

    (3) “For those unfamiliar to the processing aspect of EMDR, practitioners are trained to sit close to the person in treatment.” Actually, the proximity to the client is dependent on many factors. lF the therapist uses his/her fingers to guide the clients eyes, then the closer “ships passing” position is required. Other ways of administering the bilateral stimulation (BLS) allow for changes in proximity, including the use of mechanical devices (light bars, tappers, headphones) to produce the BLS. There is no research or evidence indicating that the closer proximity is essential in EMDR therapy.

    (4) You incorrectly attribute a 1927 theory by Pavlov as the basis of EMDR therapy’s understanding of mental health when you state, “In 1989, Shapiro questioned if trauma was essentially a disruption in the excitatory and inhibitory balance of the brain. This was two years after Prozac was introduced to the United States and a year before the Decade of the Brain. Mental health was beginning to be understood from a chemical or biological perspective. EMDR benefited from hitching the idiosyncratic trauma treatment to the biological wagon of mental health. EMDR’s individualized treatment would offer a correction to this brain imbalance akin to the overly simplistic solution for depression being a deficit of serotonin.” Actually, it was an information processing theory that Shapiro was positing. The Adaptive Information Processing (AIP) model does not suggest that trauma itself was “essentially a disruption in the excitatory and inhibitory balance of the brain”. She does make reference to Pavlov’s 1927 theory of psychotherapeutic effect and the basis of neurosis inn her 2001 text when she gives a nod to Pavlov’s theory: “Setting aside any notion of “excitatory–inhibitory” balance and of specific neural blockages inherent in Pavlov’s conception, there is little doubt that something about the trauma causes information processing to be blocked.” (Shapiro, 2001, page 334) Contrary to the notion that EMDR therapy is offering a simplistic notion akin to the idea that depression is caused by serotonin deficits, the theoretical roots of EMDR draw on the historical and emerging understanding of information processing. Only recently do we have ways to explore how this might actually be observed in the brain through the emerging field of neurobiology.

    (5) You state, “This concept of memory as photographic snapshots stored in an album of existence is analogous to social and news media feeds displaying a history of ourselves across set positions on timelines. The click or swipe reveals the exact same image with no distortion”, and state that EMDR therapy is based on this simplistic and faulty notion of memory. I have never seen anything in Shapiro’s writings that indicate that memory is akin to an electronically stored file. In fact, Shapiro states that “Clinicians should be cognizant of the limitations and distortions of memory itself before advising clients about the accuracy of any memory that emerges during EMDR.” (2001, p 299)

    (6) The entire discussion of memory and self-centered awareness conveys misinformation about EMDR therapy’s theoretical model. I suggest that the author read Shapiro, F., & Laliotis, D. (2011). EMDR and the adaptive information processing model: Integrative treatment and case conceptualization. Clinical Social Work Journal, 39(2), 191-200. (The full text article can be found at emdruddannelsescenter.dk/Artikler/10_EMDR%20and%20the%20Adaptive%20Information%20Processing%20Mode%20Shapiro%202010.pdf )

    (7) In regard to cross cultural issues, EMDR therapy has been found to be effective in other cultures, as it respects each client’s own values and focuses on the experiences that contribute to the client’s difficulty (not necessarily western notions of “trauma”), works with “perception” rather than objective “fact”, and by accessing the client’s innate system for processing experience. It has been successfully used in many cultures, and so it recommended by the World Health Organization. See who.int/mental_health/emergencies/stress_guidelines/en/

    For research on the use of EMDR therapy, as well as information about the theoretical model that guides EMDR therapy, please go to emdrresearchfoundation.org/what-is-emdr/for-professionals . For non professionals, I recommend Dr. Shapiro’s 2012 book “Getting Past Your Past”. Another great resource for more information can be found at emdr.com/what-is-emdr/ . Shapiro’s describes EMDR therapy in a 1 hour webinar/video at youtube.com/watch?v=lsQbzfW9txc
    Reference: Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd ed.). New York: Guilford Press. (The third edition to of this text will be released in the fall of 2017.)

  • Andrew Archer, LCSW

    Andrew Archer, LCSW

    June 12th, 2017 at 12:32 PM

    Thanks for all of the comments and the rich discussion here. To clarify, I have been trained in the EMDR’s Level 1 program and I’ve also went through the process as a client. I am by no means an expert on the theory or practice of EMDR. In addition, this article is not meant to be an academic paper, it is an opinion on the theoretical underpinnings of EMDR and meant to convey aspects of this therapy within the context of a very brief space (i.e., short online article). Part of the reason I wrote this was because I’m skeptical of universally applied paradigms, especially in mental health treatment. There is no doubt in my mind that aspects of this therapy are very beneficial and I’ve been the recipient as a therapist and a client. However, I think it is important to understand and critique the theory behind it, how it relates to various cultural beliefs of the mind and to place the origin in an historical context.

  • Katy Murray

    Katy Murray

    June 19th, 2017 at 12:06 PM

    Hi Andrew,
    You mentioned that: your article “is an opinion on the theoretical underpinnings of EMDR. I recognize that you didn’t intend to write an academic paper; but my concern is that the theories and assumptions that you are critical of are not representative of the theory of EMDR therapy. As mentioned previously some of your challenges reveal misinformation about how EMDR therapy is conducted.

    I appreciate you letting me (and the readers) know of your level of training in EMDR therapy. I have seen many EMDR “introductory” workshops (often just 1-2 days) that purport to teach therapists how to use EMDR with everything that walks in the door. It is my observation that these trainings do not provide adequate instruction in (a.) the theory of EMDR therapy that guides case conceptualization and treatment planning (the Adaptive Information Processing Model); or (b.) the client selection criteria that clinicians should use to determine when EMDR therapy is appropriate with a client, and how to determine when the reprocessing of memories in EMDR therapy should be initiated (c.) the importance of treatment focusing not only on past memories, but also present situations that trigger the specific issue and developing a positive template for the future (the “three pronged approach of EMDR”); and (d.) the research support for clinical applications of EMDR therapy. To be fully trained in EMDR therapy, a clinician should complete the entire EMDRIA Approved basic training in EMDR therapy (www.emdria.org) . It consists of 50 hours of training – and covers all that I mentioned above plus information on the eight phased, three pronged approach of EMDR (with practicum and consultation as well.) Unfortunately there are many unapproved trainings now available.

    I too, am critical of any therapy that purports to be a panacea for anything that walks in the door. (That is the reason that I serve on the board of directors of the EMDR Research Foundation; because we need more research on applications of EMDR therapy.) I directed you to the research literature to be clear about (1) what EMDR has been used for extensively with a significant body of research demonstrating its efficacy (PTSD or PTSD comorbid with other disorders) and (2) what issues EMDR therapy has some empirical support for; but not enough research to demonstrate that it can be the sole intervention for the issue.

    The EMDR Institute (www.emdr.com) teaches therapists in the EMDR basic training that EMDR therapy can be used when there are experiential contributors to a client’s presenting issue. EMDR therapy is often integrated with other evidence based treatments to treat conditions that do not meet criteria for PTSD, but for which there are experiential contributors to the clients current symptoms. You’ll see emerging research and applications in the use of EMDR therapy in the treatment of, for example, phobias, mood disorders, complicated grief, adjustment disorders, and addictions – to name a few. There are some studies that have found that EMDR therapy can be effectively used with clients who have a psychotic disorder comorbid with PTSD (to treat the PTSD.) In all cases, the eight phased approach of EMDR therapy is integrated with other interventions that are specific to the issue. So, for example, when treating phobias, techniques drawn from CBT are used in psychoeducation, teaching skills for managing anxiety, developing a contract for action to confront feared situations, along with the reprocessing of past contributory memories, past phobic experiences, current phobic experiences, and future focused imaginal work.

    In response to your criticism of theories that you mistakenly attribute to EMDR therapy, the following is a summary of the actual theoretical underpinnings of EMDR therapy – which I downloaded today from the EMDR Institute’s website at emdr.com/theory/ :

    “Theory:

    “Shapiro developed an information processing theory to explain and predict the treatment effects seen with EMDR therapy. This theoretical model also describes the development of personality, psychological problems and mental disorders. The following is a simplified description of Shapiro’s theory.

    “All humans are understood to have a physiologically-based information processing system. This can be compared to other body systems, such as digestion in which the body extracts nutrients for health and survival. The information processing system processes the multiple elements of our experiences and stores memories in an accessible and useful form. Memories are linked in networks that contain related thoughts, images, emotions, and sensations. Learning occurs when new associations are forged with material already stored in memory.

    “When a traumatic or very negative event occurs, information processing may be incomplete, perhaps because strong negative feelings or dissociation interfere with information processing. This prevents the forging of connections with more adaptive information that is held in other memory networks. For example, a rape survivor may “know” that rapists are responsible for their crimes, but this information does not connect with her feeling that she is to blame for the attack. The memory is then dysfunctionally stored without appropriate associative connections and with many elements still unprocessed. When the individual thinks about the trauma, or when the memory is triggered by similar situations, the person may feel like she is reliving it, or may experience strong emotions and physical sensations. A prime example is the intrusive thoughts, emotional disturbance, and negative self-referencing beliefs of posttraumatic stress disorder (PTSD).

    “It is not only major traumatic events, or “large-T Traumas” that can cause psychological disturbance. Sometimes a relatively minor event from childhood, such as being teased by one’s peers or disparaged by one’s parent, may not be adequately processed. Such “small-t traumas” can result in personality problems and become the basis of current dysfunctional reactions.

    “Shapiro proposes that EMDR can assist to successfully alleviate clinical complaints by processing the components of the contributing distressing memories. These can be memories of either small-t or large-T traumas. Information processing is thought to occur when the targeted memory is linked with other more adaptive information. Learning then takes place, and the experience is stored with appropriate emotions, able to appropriately guide the person in the future. A variety of neurobiological contributors have been proposed.” (Shapiro, F. 2017: “Theory”. Webpage downloaded from the EMDR Institute website: emdr.com/theory/ by Katy Murray on 6/19/2017.)

    If you go to the webpage, you will see links to more information about the mechanism of action and research that supports the AIP theory of EMDR therapy.

  • Bonnie C.

    Bonnie C.

    June 13th, 2017 at 6:56 PM

    Andrew,
    I am a certified EMDR therapist, Licensed Mental Health Counselor and Registered Nurse. In my role as a Registered Nurse I have engaged in many hours of medical research and I find your article sorely lacking in diligent research.
    I am extremely disappointed to encounter an article with such glaring inaccuracies and multiple faulty assumptions written by a Mental Health practitioner. You state you think it is important to understand the theory, which you obviously do not, based on your inaccurate information of the theory. How can you ethically critique a theory you obviously have not thoroughly researched and therefore do not understand?
    I agree completely agree with Katy Murray’s comments in response to your article. I find her response to be based on her accurate knowledge of the theory and practice of EMDR. I hope you possess the integrity to follow up and correct the inaccuracies in your article.

  • Bonnie C.

    Bonnie C.

    June 13th, 2017 at 6:59 PM

    as above

  • Bonnie Chaput

    Bonnie Chaput

    June 13th, 2017 at 8:56 PM

    Andrew,
    I am a certified EMDR therapist, Licensed Mental Health Counselor (LMHC) and Registered Nurse (R.N.). In my role as an R.N. I was continually exposed to reputable ongoing medical research with evidence based outcomes. Unfortunately, I find your article sorely lacking in diligent research.
    I am extremely disappointed to encounter an article filled with glaring inaccuracies and multiple faulty assumptions, written by a Mental Health professional. You state you think it is important to understand the theory of EMDR, which you clearly do not, as evidenced by the inaccurate information stated in your article. How can you ethically critique a theory you obviously have not thoroughly researched and therefore do not understand?
    I agree completely wth Katy Murray’s response to your article. I find her response to be based on her accurate knowledge of the evidence based theory and practice of EMDR. I hope you possess the integrity to follow up and correct the inaccuracies in your article.

  • Steven M Harris PhD

    Steven M Harris PhD

    June 13th, 2017 at 11:23 PM

    The findings of EMDR are impressive. However, while some people who are plagued with memories need to be addressed directly, I think the focus singly on memory is often the wrong focus of treatment. Trauma, at least traumas that become symptomatic later, frequently leave a “footprint” on a person. Trauma usually affects one’s view of oneself in negative ways and affects how they see themselves in the world. Many traumatic memories were born out in abuse (eg, abuse) and the healing seems right to take place in the context of a relationship. I would not say that EMDR should not be employed, but it seems most helpful as a tool in the context of a supportive and healing psychotherapeutic relationship–as an adjunct at most. Many patients feel intruded upon with EMDR. Overall, I think trauma that persists affects the self and the self should be the target the treatment, no the memory. Often individual memories are only representational of how one feels from their past (among a whole collection of memories that informs the person about how they feel about themselves, not a thing unto itself. In this manner, EMDR and its memory focus can be removed from the person. I think the EMDR focus on memory is overdone and a mistake. Memories must be addressed, I just would not make it the central focus of therapy. Even Freud would address memories in the transference, or the here and now with the analyst.

  • Katy Murray

    Katy Murray

    June 19th, 2017 at 12:44 PM

    Hi Steven,
    I hope you will read my response (left moments ago) to Andrew that outlines the Adaptive Information Processing theory that guides EMDR therapy. What you speak of – that traumas leave a footprint on the client – affecting one’s view of self and their responses to current experiences – is at the core of EMDR therapies theory. Your statement, “Often individual memories are only representational of how one feels from their past (among a whole collection of memories that informs the person about how they feel about themselves, not a thing unto itself” is actually consistent with EMDR therapy. This is the very reason why EMDR therapy does not focus just on past memories. Even when past memories are targeted in EMDR therapy, it is the sense of self *now*: including the core beliefs, feelings and sensations the client has *now* as they think of the past experience that are the content of the majority of reprocessing of memories. If the client is unable to access a sense of self *now* during EMDR reprocessing of a past experience, they do not have the necessary “dual attention” that is essential to EMDR therapy’s effectiveness. If any focus on a memory within EMDR therapy is, as you caution, “removed from the person,” then the clinician should take the necessary steps to help the person to be connected to themselves and the hear and now before resuming reprocessing.

    As I mentioned before, EMDR therapy uses a three pronged protocol which includes (a.) reprocessing past experiences (which may or may not be consider “traumas”) that have laid the laid the groundwork for current difficulties with the goal of “metabolizing” whatever thoughts, feelings, sensations, and sensory details are problematic while forging new associative links with adaptive experiences and information; (b) the current situations that continue to be difficult are then targeted in EMDR therapy – this aspect of the work is no less important than the past focused work; (c) finally, positive, adaptive templates of similar, future experiences (to the present triggers) are then the focus of EMDR reprocessing – in order to ensure that clients have the skills and internal resources to best respond to future challenges.

    As you have stated, if any therapy (including EMDR) focuses solely on past memories, then it is unlikely to lead to long lasting change. Unfortunately, too often, therapists who do not adhere to all eight phases and three prongs of EMDR therapy with fidelity will skip the important work of focusing on the present and future; doing a disservice to their client and limiting the effectiveness of therapy.

  • Steven M Harris PhD

    Steven M Harris PhD

    June 19th, 2017 at 5:28 PM

    Katy, I am most appreciative your response, both because it is informative, responsive and fair-minded. One could only hope that all dialogues in our field could be as informed, respectful, and helpful. Your approach is great for genuine dialogue but also keeps it going, rather than shutting it down. Thank you for the clarification.

    That said, it appears to me that you address my points well, but also tells me that I have not represented what I was saying very well. The difference in my approach to relational trauma and EMDR as I perceive it is that I utilize a psychoanalytic approach, meaning that for the purposes of relational trauma, the healing occurs directly through the relationship. While I am sure rapport, collaboration, trust, etc. are quite important for doing EMDR, psychoanalysis is very intense at the level of transference and counter-transference. There is also likely a population difference. People that I see could never do EMDR at least as they present themselves initially. For instance, one patient I saw experienced the techniques as sexual advances (how is that for transference?). Additionally, the self and its imprint (footprint) that I refer to have significant disturbances with trust and take a very time to work through with a person their projections, fears, etc. (transference) to free themselves up. I do not mean to say that they would never benefit from EMDR. In fact, I am quite sure that there are many persons who would not like my approach or do well with it but would be quite successful with EMDR. Elizabeth Howell’s book on treating DID is psychoanalytic, but addresses incorporating EMDR, hypnosis, etc. at times. You might say that in my cohort of patients that the healing is affected through the ability to have a relationship.

  • Andrew Archer

    Andrew Archer

    June 27th, 2017 at 9:41 AM

    My concern is that therapy modalities are becoming more like brands that need public relations officers to protect the image of the treatment. Whenever someone purports that the ’emperor is not wearing any clothes’ there is a strong response. This was the case several years ago when Irving Kirsch presented meta-analytic research on the placebo effect with antidepressant medication or Robert Whitaker’s critique of the history of psychiatry. However, it is quite dismissive and elitist to state that one needs an all-consuming training background to essentially understand or comprehend the vast complexity of a theory. It is this myopic, self-fulfilling hierarchical structure that is embedded into an ideology. The dynamic then trickles down to the ‘expert’ therapist who knows how to treat specific ‘dysfunction’, which is counter to the way I operate with clients. Thank you @StevenMHarrisMD for pointing out the healing that occurs in concert as well as consequential to the relationship (i.e., therapeutic alliance: link here: https://www.goodtherapy.org/blog/therapeutic-alliance-whats-love-got-to-do-with-therapy-1231154). The response I have not heard in reference to EMDR is where “memory is then dysfunctionally stored” and that was the thread I was attempting to pull at in this article.

  • Steven M Harris PhD

    Steven M Harris PhD

    June 27th, 2017 at 8:14 PM

    Thank you, Andrew, for what you have written about as well as the ensuing discussion that has unfolded. And thank you for the link to “What’s love got to do with it…” article. Thank you also to the rest of you for all of the other comments and discussion. Andrew, your raising the issue in reference to EMDR is where “memory is then dysfunctionally stored,” is something of great interest to me. I do not know if I will adequately address or get at what you wanting to explore, but here goes. The more embedded one is in the memory, or more importantly, their negative interpretations of it, the more the memory and it’s fated interpretation of the memory it is. I think that making a memory at the center of psychotherapeutic cure is a mistake. Memories are certainly part of therapy. I believe this because of what I believe are two fundamental facts. One, there probably is no such thing as functionally stored memory. No one has a video file of the memory (almost said video tape…showing my age!).
    Research indicates that the human person regardless of how “accurately” a memory is stored is constantly revising both the content and meaning of memories, regardless of whether trauma has occurred. I will not try to represent EMDR theory here because I am not an expert. However, to the degree that any approach to therapy attempts to correct memory or assumes reprocessing into a more whole or accurate memory as the center of therapy, it would seem to fail to address the person who constructs the memory, which I think is the at the center of therapy. Perhaps it is what EMDR does (so please forgive my ignorance here; please feel free to correct me), but reprocessing memories is not a cure. Learning to interpret the meanings of them, or as in some dramatic cases, the ability to regulate extremely high levels of arousal that persist from traumatic experiences is central. In other words, it is the person, their perception of themself, and their world that is what is central to psychotherapy. Again, EMDR can be a tool to aid in this process. I do not think that this should discount EMDR. Rather, it appears that what is at work is the interpretation of the memory, not the memory, be it dysfunctional or “functional.” The interpretation is made the person, whether interpreted through techniques such as EMDR, transference analysis, gestalt techniques, etc.

  • Andrew Archer

    Andrew Archer

    July 2nd, 2017 at 8:57 AM

    Steven,
    I completely agree that there is no such thing as functionally stored memory, but rather, a temporary dysfunctional construction (and reconstruction) of memories. This gets to your point of emotional regulation and how dissociation and hyperarousal impede or perpetuate that process. Like has already been mentioned, the tool to facilitate a healthy orientation to perceptions, feelings, sensations is fairly arbitrary and has more to do with the relationship(s) created within the paradigm. Thanks for the thoughtful comments and summaries.

  • Chris

    Chris

    May 16th, 2018 at 5:33 AM

    After spending several decades in what is laughingly called the mental health system it seems clear to me that the system is itself disordered as are many aspects of the culture around us and its all driven by blind self interest.

    Its always fascinating to read people justify or defend their own self interested positions such as those above in our market place of nonsense.

    reproducibility crisis anyone? dodo bird verdict? most talk therapy attempts to reduce the irreducible – go read some critics the Therapy Industry by Paul Maloney is a good place to start.
    We’ve got hundreds of so called talk therapies, a pile of drugs and stigmatizing claptrap disorders invented by the DSM task force with each new book of fiction produced- so have we better mental health?, improving mental health? better wellbeing? clearly not.
    Suicide and prescription drugs (taken as prescribed) are among the biggest causes of death.
    Like all therapies EMDR is a power game – people receiving the therapy will often people please the imagined ‘expert’. Much of the process explicitly advertises what is expected of the client namely for the ‘SUDS’ to reduce- scaling questions that include prompting to reduce the number are common- i’ve asked several clients right at the end of EMDR treatment to be absolutely honest with me about parts of the therapy – particularly the ‘processing’ element and many have told me it did nothing. However if you played the session back on tape it would have looked like a text book processing session or ‘treatment success’- what people usually then say is just having someone sit and listen to their suffering compassionately was helpful. I think its simply the placebo and mutual aid that helps.
    Its all completely oversold – what we need is a culture that meets human needs then we can kiss goodbye to the ever growing mental health industry.
    However I am sure sometime soon someone else will be walking through a park and discover how to pull a rabbit from a hat.

  • Steven Harris, PhD

    Steven Harris, PhD

    May 17th, 2018 at 9:09 AM

    Chris,
    While I share many criticisms of various therapies, your polemics and the citations you make appear to lack the muster of empiricism. Anecdotal evidence, while also potentially helping to call into question what went wrong with a procedure, is not evidence to debunk a technique. While I am not necessarily a “fan” of EMDR, and Dr. Shapiro’s broad-sweeping claims, many advances have been made to help people with EMDR. I myself do not do EMDR and rarely recommend it except in cases of simple trauma. So, I need to ask the following questions: (1) What is the evidence for your claims? (2) What is it that you find that all in the mental health system are driven by self-interest? (3) What evidence do you have that all (or most I presume?) mental health providers/experts are based on nonsense? (4) What evidence do you have for the mind being irreducible? (5) Where is the data that prescription medications (alone) are among the biggest causes of suicide? (6) What is it about your questions that make for empirical evidence against EMDR, and why have you not published your results? (7) How do you arrive at your conclusion that what we need is a culture that meets human needs (I am truly interested in this point)? It seems if you are trying to help, then your prescription needs to be outlined and made known. (8) When you say placebo to refer to “simply placebo,” are you saying that you think that it is fake, or that some other unrelated healing process has occurred? You seem far from disinterested with your points here.

  • Chris

    Chris

    May 21st, 2018 at 12:11 PM

    Hi Thank you for the feedback Steven.
    I don’t have much time to respond any more fully than this but here goes.
    I am curious when you say you are not a fan of EMDR and don’t usually refer people for it but you also believe many advances have been made to help people using EMDR.
     I wonder can you share some of these advances you speak of?
    1 my evidence comes from engaging in EMDR training and other training , reading about it, including critics, delivering it, talking to those ‘treated’ as well as colleagues and working in various services for many years.  Also from having my own, friends and families suffering to be with.
    2 Its not only the mental health system that’s driven by self-interest but so much else in the culture  – most have debts/ mortgages and myriad other responsibilities so asking hard questions about what we do is quite tough to do and most it seems just learn their technique/role/place and get on with it without much question but often with lots of moaning and suffering.
    Gallop did a massive piece of work on attitudes to jobs a few years ago – this took in hundreds of counties and millions of people – I can’t recall the exact numbers but they found something like 13% of people actually enjoy their jobs and find their lives are enhanced by it – the vast majority either hate it or are ‘sleep walking’ through it or are otherwise stressed by it.
    This is a massive source of suffering but where is the open debate about the many and varied harms caused by jobs? 
    There are many things to say about what is wrong but I’ve not the time or the energy to write about it here – but if you’re interested there are many interesting books critiquing aspects of therapy culture, these are just a few.
    amazon.co.uk/Power-Interest-Psychology-Materialist-Understanding/dp/1898059713
    amazon.co.uk/Tales-Madhouse-critique-psychiatric-services/dp/1906254753
    amazon.co.uk/Deadly-Medicines-Organised-Crime-Healthcare/dp/1846198844/ref=sr_1_1?s=books&ie=UTF8&qid=1526889017&sr=1-1&keywords=deadly+medicines+and+organised+crime
    amazon.co.uk/Therapy-Industry-Irresistible-Talking-Doesnt/dp/0745329861/ref=sr_1_1?s=books&ie=UTF8&qid=1526888953&sr=1-1&keywords=the+therapy+industry
    3 – Take the services I’ve worked in over the years where it is common to find high levels of burn out from major stress, from competing demands and silly targets based on empty notions of ‘recovery’-using tick box questionnaires such as the PHQ9 and GAD7 – no matter if the person’s life is falling in around them if enough people pleasing can be stimulated via psychobabble, power relations, cultural esteem of therapy etc and the scores fall below ‘clinical’ then we have a winner. These scores are (in the UK) linked to service funding.
    Most systems and therapy approaches are based ideas of personal pathology, some internal fault or disorder and they seek to somehow treat the person – the biopsychosocial model usually diminishes social causes of suffering to a mere trigger for these hypothosized personal pathologies.
    This is what I mean by reducing the irreducible because in the process they decontextualize and psychologise social causes of distress leaving us all vulnerable to harm as evidenced by the massive rise in harmful prescription drugs such as SSRIS’s so called anti psychotics, benzos etc and the general ill health of the population is on the increase. – we’ve had 100 years of clinical psychology with hundreds of talk therapies it has spawned and yet in the next few years the WHO tell us the cultural disorder known as depression will be the biggest cause of suffering on earth.
    something is very wrong here.
    So we have a mental (ill) health system that’s harming the mental health of its staff on mass while claiming to help others by pathologisng them. The others in this case (most everyone) are also often being harmed by their jobs, with missing connections to nature, meaningful work, community, agency, learning, exercise, reflection and so on.
    What evidence do you have for the mind being irreducible? I don’t think we have a clue as to what a mind actually is, let alone if we have free will nor what we’re doing here at all and all the issues of introspecton.
    5 when I said ‘Suicide and prescription drugs (taken as prescribed) are among the biggest causes of death’. These are separate issues but quite possibly linked in many cases – there are several voices on this here’s but one blogs.bmj.com/bmj/2016/06/16/peter-c-gotzsche-prescription-drugs-are-the-third-leading-cause-of-death/
     
    (6) What is it about your questions that make for empirical evidence against EMDR, and why have you not published your results?  The ‘reproducibility crisis’ highlighted over these last few years shows that most studies done cannot be reproduced and when they are their findings are greatly diminished or none existent.
    How is it possible to adequately control for all of the confounding variables in any psychotherapy research or blind them properly? What does this say about the existing research? Not to mention the bias and blind spots we all deal with as human beings.
    7) How do you arrive at your conclusion that what we need is a culture that meets human needs (I am truly interested in this point)? Take any animal and deprive it of what it needs to flourish and it will not flourish -I am sure you do not need me to tell you what needs are not being met in the culture as it is?
    But it would be interesting to see what others think so I’ll start – – many of us are disconnected from our  need to be in nature, to be in healthy supportive communities and families and in jobs that are meaningful, with control and agency – there are many others, anyone?
    8) When you say placebo to refer to “simply placebo,” are you saying that you think that it is fake, or that some other unrelated healing process has occurred?
    No but can we be honest that this mystery known as placebo can be stimulated in many ways but the techniques of therapy are not at all the technologies they are sold as.
    I find this mans testimony as to why he left being a therapist refreshing in its honesty youtube.com/watch?v=f0Fi32LbXHA
    This could well prove to be an interesting turning point for the mental (ill) health system as it seems to address the diminished context and power relations currently missing from most approaches except maybe narrative or systemic.
    madinamerica.com/2018/01/publication-power-threat-meaning-framework/

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