My work with people often drives me to explore themes that are currently showing up in my counseling practice. If you are a counselor, you know what I mean. You may have many clients or therapist consultees presenting with the same needs, perhaps some who are saying similar things of late. That’s not to say that these issues are the “same,” for they are not. Nevertheless, there are topics that may repeat themselves. I pay attention to these because I believe that there is much to explore and learn by being aware of patterns.

A pattern I have seen of late is related to eye movement desensitization and reprocessing (EMDR) work, specifically about the process of being “ready” to do EMDR. I have had a lot of therapists inquiring about their clients’ readiness to do EMDR. Keep in mind that if you are doing EMDR, you are always doing EMDR; it just depends on the phase you are in. If you are one of my EMDR clients or therapist consultees, you know how much I emphasize this as key to understanding the EMDR therapy model. Keep this in mind: EMDR is a process, a model, and not a technique.

EMDR’s preparation phase is phase two of the eight phases of EMDR. EMDR therapists look for people to have a minimum of two state-change skills as part of this phase. In phase two we are making sure that the client has the ability to not only tolerate emotion, but also to shift into a relaxed state, a para-sympathetic response. In other words, can the person bring up a disturbing event, be “in it,” but then also utilize a relaxation skill or calming technique to then change states if needed?

Keep in mind that the concept of changing states may be something that sounds easy, but for many it is not. Some folks seeking to utilize EMDR therapy as part of their trauma recovery may need more extensive preparation-phase support. This is especially true in the case of those struggling with dissociation and addictions.

In its simplest form, a state change means being able to utilize a relaxation skill to settle down one’s system. State-change skills can help the EMDR client to become calmer and more settled while still maintaining “dual attention”—i.e., being present while bringing up traumatic disturbance(s). In contrast, and though it may appear like it, the ability to utilize state-change skills does not mean changing states via dissociation. Certainly, one’s ability to dissociate may appear similar to a state-change skill, and is a survival skill, but dissociation keeps us “away from” traumatic material and from integrating the somatic, visual, emotional, and cognitive aspects of it to then heal.

For example, dissociation takes one away from the present moment because the past feels as if it is happening now and it feels safer to leave the present. But to be able to heal and integrate the traumatic material requires that state of being present. We just have to learn the dance between feeling the disturbing material and being able to shift into a contrasting, calmer state.

In exploring the concept of EMDR and state-change skills, addictions can also be explored as an attempt to chemically or behaviorally illicit a state change. I often explain to people that substance abuse is often driven by an ill-fated attempt to chemically dissociate. One can easily become entrenched in the vicious cycle of using addictive substances and behaviors to shift “out” of traumatic material in order to feel something, anything, and everything different from the pain of a traumatic history. And, for many people, addictions have become a way to change states, to feel away from and out of traumatic material.

The bottom line is that to heal, trauma histories beg to be accessed, stimulated, and reprocessed. The challenge can be in our making sure that EMDR clients are fully supported in having the state-change skills in place to be able to come back, to ground, and to stay present first. Therefore, creating and implementing these state-change skills can be the key to supporting EMDR clients in their recovery and throughout EMDR’s eight phases.

Next Friday, August 31, 2012, GoodTherapy.org is thrilled to welcome Dr. Laurie Moore, who will present Healing Betrayal Caused by Infidelity, a FREE CE teleconference for GoodTherapy.org members available with 1.5 CE Credits. We encourage you to join us for this exciting event, so if you have not already, register today!

Working with clients who are suffering from betrayal caused by infidelity is complex, including grieving stages, posttraumatic stress (PTSD), and additional factors. This article refers to infidelity as a breach in agreed emotional and sexual monogamy. Some couples agree to open relationships or polyamory, which is a different situation. Infidelity as defined in Wikipedia is “a breach of an expectation of sexual and or emotional exclusivity.” This involves a lie and broken promise, causing feelings of intense betrayal for many people.

Infidelity has become a common problem. Some infidelity statistics state that over 50% of both men and women engage in infidelity (Journal of Marital and Family Therapy, 2012) and others say 30% to 60% (Wikipedia, 2012).

Those suffering from infidelity betrayal commonly go through Kubler Ross’s well-known stages of grief:

1. Denial: This didn’t really happen or it’s not really as upsetting as I feel it is.
2. Anger: How could you?
3. Bargaining : If only I had communicated differently, this would not have happened.
4. Depression : I feel helpless. Nothing I can do changes this discomfort.
5. Acceptance : I have been hurt and disillusioned but I am at peace with myself.

The experience of grief due to infidelity includes additional factors that are absent from grief occurring from a death. Grief due to death is felt in a finite situation that contains an end. It is understood that the one who is gone is gone from the body permanently. Grief due to a breach in trust has no finite or predictable container. The one suffering finds him- or herself in unpredictable circumstances, which often feel very dismantling and excruciatingly unsettling.

Feelings that challenge self-confidence and worth are more common to infidelity betrayal than loss alone. Death is socially expected. Infidelity is shunned. The one who is betrayed is prone to feel guilt, shame, and embarrassment because the situation remains privately hidden or is condemned by a variety of reactions when exposed.

When death is the cause of grief, a solo journey is required. When betrayal is the cause of grief, two people are involved, so the situation is more complicated. Once one is lied to, the relationship is uncertain. This person can’t tell whether he or she is being lied to or told the truth. The one experiencing this challenge is often upset again in the aftermath of the partner relationship. This is different than the one abandoned by a death whose loss cannot re-emerge in a repeating scenario.

Clients with heartache caused by infidelity and betrayal can also go through fight-or-flight syndrome:

Fight: Arguing with, controlling, or managing the person who betrayed me will solve this.

Flight: Leaving will solve this.

Once fight or flight proves useless, a person will seek comfort in other ways. By assisting this person to fully meet the helplessness, sorrow, anger, anguish, disillusionment, and heartache that has come, peace can be found.

I have found that client-centered talk therapy, hypnotherapy, eye movement desensitization and reprocessing (EMDR), and the 12-step program are all deeply valuable for clients healing from infidelity. I also use my own Success Love Now (SLN) process effectively in these situations. Here is how and why each of these methods is valuable.

Someone who is suffering from loss and feeling isolated due to the taboo nature of this loss needs to be witnessed compassionately and caringly. This in itself helps to relieve the tremendous burden one carries from feeling alone. When being accepted within the context and emotions one is truly feeling, without being corrected or judged, peace can start to return. Acknowledging your understanding and compassion for a clients’ diverse set of feelings can be a profound help to a suffering client.

Because the shock of betrayal can be extreme, disrupting normal life in many ways, EMDR assists the hurting person to digest the deep emotions that are arising. Just getting through the day becomes a challenge for people who are betrayed. EMDR makes the healing time for this upheaval much faster in many cases.

Hypnotherapy allows the person who was hurt to re-find stability, meet parts of him- or herself that were hurting before the situation occurred, heal parts of him- or herself that are hurting now, and find a new basis for equanimity that is deeper than the circumstances. Taking a client into a deep, relaxed state in which the client can bring in peaceful parts of him- or herself to help the hurting parts enables a client to rebuild self-esteem and strength.

S-Anon Twelve Steps allow people to find the value in surrender, the gift in their challenge, and the support of others enduring similar pain. Twelve Steps also help the one who was betrayed to find out if addiction was involved in the betrayal, as commonly is the case. Letting your client know that S-anon is an option can be a valuable part of her or his healing process.

SLN provides a new framework for the person to feel empowered and at ease within the undesired circumstances. Encouraging the client to focus on what his/her purpose and aim are for him- or herself and gratitude for the good that is occurring within the context of the undesired happenings is beneficial. This will bring a client out of a victim mode and into a creative mode.

Of course, if the person who was betrayed plans to stay in the relationship, couples counseling and counseling for the one who was betrayed are necessary.

When working with clients who have been betrayed due to infidelity, it is important to understand the complexity of loss, mixed with PTSD, combined with humiliation–this situation causes a long period of overwhelm and readjustment. When the client is treated with compassion, the healing can go well.

Sources:

1. Infidelity statistics. (n.d.). Retrieved August 20, 2012, from http://www.statisticbrain.com/infidelity-statistics
2. Infidelity. (n.d.) Retrieved August 20, 2012, from http://en.wikipedia.org/wiki/Infidelity

Related articles:
Cheating
Can a Couple Recover From Infidelity?
In-Depth Map for Three of the Eight SUCCESS LOVE NOW Steps

As you may know, eye movement desensitization and reprocessing (EMDR) is a research- and evidence-based therapy created by Francine Shapiro, Ph.D., over 20 years ago. An integrative model, EMDR is comprehensive, including aspects of multiple psychotherapeutic approaches. With this in mind, equine experiential activities, such as those found in equine-assisted psychotherapy (EAP), support and help to facilitate EMDR’s eight-phased model, while also maintaining fidelity to standard protocol.

The EquiLateral™ protocol is brought with a deep respect and understanding of EMDR but also the power of equine-assisted therapy. I am constantly reminded that EMDR and equine-assisted therapy both have the ability to support and often deepen a client’s ability to access where those traumas are stored. In my 10 years of experience as an EMDR therapist, I am still constantly amazed and inspired by the depth of healing that can be reached through EMDR, let alone through horses, who are often our most powerful and forgiving teachers.

Current research emphasizes the importance of maintaining fidelity to EMDR’s eight-phased approach. Nevertheless, in doing so, EMDR “may be implemented in more than one way as long as the broad goals of each phase are achieved” (www.emdria.org).

EquiLateral™ is the first equine-assisted EMDR protocol. We are still doing EMDR but are incorporating equine-assisted experiences within the eight-phased, three-prong, standard EMDR protocol. For more information on this approach to healing trauma, please visit my website: www.dragonflyinternationaltherapy.com

Horses, Comfort, and PTSD
Horses are prey animals. What this means is that they are highly in tune with their environment, readily noticing changes in the world around them and being able to respond to what they notice and actively seek what horseman Buck Brannaman describes as their wanting to return to “peace.” When in this energetic state, their nervous systems are settled and calm. They can readily focus on just being in the world, in the moment, which for them means grazing, moving 20+ miles a day, and relating with herd members. In contrast, when sensing danger, their peace is threatened, and their nervous system becomes activated enabling them to react, primarily through flight, although sometimes through fight or freeze, for self-preservation.

If you are a trauma survivor or know someone who struggles with posttraumatic stress, perhaps you can relate. Our bodies have the capacity to do as horses do, react, respond, then calm down and return to “peace.” But, we humans often learned to “stuff,” “repress,” “deny” what happened when all the body really wants to do is release and move through those feelings and body sensations. Doing so actually helps the trauma memory settle in, to release the “charge” that the body stores about what happened. By nature, horses, like all animals, know how to do this.

But, when trauma is still locked in the body and blocked, our nervous systems don’t return to a baseline of calm and peace. Instead, the fight, flight, or freeze that was experienced at the time of the event continues to remain activated, leading one to feel on alert, hypersensitive, anxious, easily agitated, or constantly “on,” making it challenging and often nearly impossible to relax.

That said, horses know how to relax. But, they also instinctively know to be alert and flee when threatened. They are preyed upon in the wild and are really in tune to danger, of any kind, including that which threatens their physical and even emotional safety, and that sense of comfort and peace that is their baseline state of being. And if you are a trauma survivor, all you want is peace and comfort as well. And this is just the beginning of why the horse and the trauma survivor may just “get” each other.

In light of the powerful connection between horses and trauma survivors, I am consistently shown the power of horses to help heal humans, especially through the integration of EMDR and equine-assisted therapy via this protocol.

Keep an eye out for the Part 2 of this post coming soon!

Related articles:
EMDR: Symptoms and Phases
Common Therapy Approaches to Help You Heal from Trauma
How Trauma Impacts My Sense of “Me-Ness” – Part II

This article is part of a series that explores the ways that specific “clusters” of depression symptoms manifest to create different experiences of depression. The previous article in this series discussed the low-ambition experience.

Self-attack is my term for thinking mean, diminishing, insulting, and shaming thoughts about oneself. People often think of this as low self-esteem, but I think self-attack better describes what is actually going on. People who experience depression often think like this, but it is also possible to engage in self-attack and not meet the full criteria to be diagnosed with depression. Whether or not your self-attack is part of depression, this is a very painful, disabling, quality-of-life-reducing, and even life-threatening way to exist.

In fact, I believe self-attack is possibly the most common type of misery and symptom of depression. So many people frequently say things to themselves—whether they even notice or not—that diminish or shame them: “I’m a failure,” “I’m stupid,” “I’m lazy” “I’m unlovable,” (which may sound like “I’m fat and ugly”, or take other forms), “I’m a terrible parent, employee, friend, spouse…,” “I can’t do anything right,” I’ll never be good enough,” “I’m not worth what I have,” and so on.

It may surprise you that people attack themselves for good reasons. Many do it because it’s how they understand love—it’s how their parents “loved” them. Others think that shame is the only thing that motivates them. Once people learn to handle themselves this way, they practice it over and over and over, and learning to do something different is very difficult.

I often ask people who are plagued by self-attack, “What if someone were following you around all day saying these things to you?” Most people would yell at them, argue with them, stop them, fight back, or at least get away from them. But when it’s their own voice, they listen and believe it—and it’s devastating.

This can change. There are ways to change this on our own, and ways that psychotherapy can help. In either case, the key is to develop an internal parent who parents us the way good parents do.

How the Parenting We Experience Affects Our Brains
This is the most important thing to know about how to become a happy, well-functioning adult. Generally, when children are parented by caretakers who understand their feelings and needs and respond to them compassionately and protectively, children learn to respond similarly to themselves. Over time, children build skills in parenting from imitating their parents. This is how we know how to take care of ourselves as adults.

We now know from neurological research that we are hard-wired through special neurons to imitate our parents. Our brains learn how to act in the world by incorporating the things that we see our caretakers do when we’re children. It’s a great system when we have parents who act in nurturing, protective, and wise ways. It doesn’t work so well when our parents are abusive, neglectful, unhappy, or dysfunctional people themselves.

We also see that our brains are able to re-wire throughout our lives, so if this doesn’t go well when we’re children, we can usually still change what goes on in our brains when we’re adults. This is what psychotherapy and EMDR do, but there are also ways to work on this outside of therapy.

We also know that when we close our eyes and imagine something, the same pattern of functioning occurs in our brains as when we look at something. So if you see your best friend, then close your eyes and imagine your best friend, your brain will be doing the same thing. This makes guided imagery very powerful. Anything we do that involves imagining being parented, or parenting ourselves in a nurturing, compassionate, protective, wise, functional way, can actually help build the brain structure we need to be the adults we would have been if we’d had better parents.

The Experience of Parenting Yourself
There are many ways to do this, but let’s take a couple moments to try out one. Think of a problem that is upsetting you right now—nothing too upsetting. Now imagine you have a niece or nephew, four to ten years old, who comes to you for help because they are struggling with a similar problem. With the most nurturing, protective, compassionate part of yourself in charge, what would you say to them? Write this down.

What would you do for them? What do you think you could give them that would help them feel a little better? Try expressing your understanding of their feelings and needs. Normalize what they’re experiencing. Show them compassion. Offer forgiveness if they need it. Offer solutions or ways to get solutions. Offer to stay with them through the process. Comfort them any way you can imagine.

Of course, this exercise is just a beginning. But once you learn to do this, and can do it with yourself, you have access to one of the most powerful tools we as human beings have to be happy and functional.

Psychotherapy
Psychotherapy can help with this process in many ways. For example, my clients usual begin to heal when I treat them with respect, am very genuinely interested in them and amazed by who they are, reflect what I see as I come to understand what they’ve had to overcome and how, and encourage them without shaming them. Being consistent and compassionate, listening carefully and responding with insight,  is what parents are supposed to do with children so that they can develop into happy adults. Many parents don’t or can’t do it well—usually because their parents couldn’t do it with them.

By being treated this way, people learn to treat themselves and others that way. They learn to expect healthy relationships where they are treated with a similar respect. It helps people express the feelings they haven’t felt safe to express and to feel more capable of coping with painful feelings. It builds self-esteem and confidence. In this environment, depression usually recedes.

Self-attack is very destructive, but can be overcome by developing a compassionate, nurturing, protective parent inside.

Learning about the stages of healing can be distressing, motivating, upsetting, or uplifting. No matter how you feel, your reaction is not wrong. Acknowledging your emotional response to the stages of healing can allow you to harness your emotions’ energy and reach out to a trained therapist.

When looking for a therapist, it is vital to keep in mind that, regardless of what type of psychotherapy you pursue, your therapist should empower you and welcome you as a collaborator in your therapy, not attempt to impose control over you. Studies have found that individuals who are active participants in their therapy are more satisfied with the therapy. In addition, it is crucial that you feel safe in your therapeutic relationship.

There is no magical treatment that will heal you overnight, nor is there one form of psychotherapy that is right for everyone, but you should be able to find a therapist, as well as a therapeutic approach, that works for you. Healing is like a marathon. It requires preparation, repeated practice, courage, determination, and the support of others—including that of a professional coach or therapist.

While there are numerous therapy approaches, the purpose of all trauma-focused therapy is to integrate the traumatic event into your life, not subtract it. This article discusses the most common forms of trauma therapy. Each approach is described in its most pure form, but keep in mind that many therapists combine different types of therapies.

Pharmacotherapy

Pharmacotherapy is the use of medications to manage disruptive trauma reactions. Medications have been shown to be helpful with the following classes of reactions/symptoms:

• Intrusive symptoms [fat_widget_right]
• Hyperarousal
• Emotional reactivity
• Heightened arousal
• Irritability
• Depression

Taking medication does not make one’s trauma reactions and pain evaporate. Medications can only help make the symptoms less intense and more manageable.

If you decide to use medications, consult a psychiatrist and continue working with that psychiatrist for as long as you take the medications. Inform the psychiatrist of how the medications are impacting you. Some medications have side effects that may or may not be tolerable to you, and some people do not respond favorably to medications. Medications are most effective when individuals pursue therapy concurrently.

Behavior Therapy

The most common form of behavior therapy is exposure. In exposure therapy, one gradually faces one’s fears–for example, the memories of a traumatic event–without the feared consequence occurring. Often, this exposure results in the individual learning that the fear or negative emotion is unwarranted, which in turn allows the fear to decrease.

Exposure therapy has been found to reduce anxiety and depression, improve social adjustment, and organize the trauma memory. There are various forms of exposure therapy:

• Imaginal exposure: An individual imagines the feared event as vividly as possible.
• In vivo exposure: The exposure occurs in the therapy.
• Systematic desensitization: The individual is exposed to successively more fear-inducing situations. This exposure is paired with relaxation.

Exposure therapy is a highly effective treatment for posttraumatic stress (PTSD).

Another form of behavior therapy is Stress Inoculation Training (SIT), also known as relaxation training. Stress Inoculation Training teaches individuals to manage stress and anxiety.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is grounded in the idea that an individual must correct and change incorrect thoughts and increase knowledge and skills. Common elements of cognitive behavioral therapy trauma therapy include:

• Teaching individuals how to breathe in order to manage anxiety and stress
• Educating individuals on normal reactions to trauma
• Exposure therapy
• Identifying and evaluating negative, incorrect, and irrational thoughts and replacing them with more accurate and less negative thoughts

Eye Movement Desensitization and Reprocessing (EMDR)

Therapists who perform EMDR first receive specialized training from an association such as the EMDR Institute or the EMDR International Association. An EMDR session follows a preset sequence of 8 steps, or phases. Treatment involves the person in therapy mentally focusing on the traumatic experience or negative thought while visually tracking a moving light or the therapist’s moving finger. Auditory tones may also be used in some cases. Debate regarding whether eye movements are truly necessary exists within the field of psychology, but the treatment has been shown to be highly effective for the alleviation and elimination of symptoms of trauma and other distress.

Hypnotherapy

There is no one guiding principal for hypnotherapy. In general, a hypnotherapist guides the individual in therapy into a hypnotic state, then engages the person in conversation or speaks to the person about certain key issue. Most hypnotherapists believe that the emotions and thoughts that an individual comes into contact with while under hypnosis are crucial to healing.

Psychodynamic Therapy

The goal of psychodynamic trauma therapy is to identify which phase of the traumatic response the individual is stuck in. Once this is discerned, the therapist can determine which aspects of the traumatic event interfere with the processing and integration of the trauma. Common elements of psychodynamic therapy include:

• Taking the individual’s developmental history and childhood into account
• Placing emphasis understanding the meaning of the trauma
• Looking at how the trauma has impacted the individual’s sense of self and relationships, as well as what has been lost due to the traumatic event

Group Therapy

There are a variety of different groups for trauma survivors. Some groups are led by therapists, others by peers. Some are educational, some focus on giving support, and other groups are therapeutic in nature. Groups are most effective when they occur in addition to individual therapy. It is important for a trauma survivor to choose a group that is in line with where one is in the healing journey:

• Safety/victim phase: Choose a group focused on self-care and coping skills.
• Remembering and mourning/survivor phase: Pick a group focused on telling the trauma story.
• Reconnection/thriver phase: Join a group that aims to create connection with people.
• Educational groups are appropriate during all phases.

Any therapist, regardless of which type of therapy she or he works from, desires to help you grow and heal through your traumatic experience.

Together, you and your therapist will strive to acknowledge and identify:

• Where you are at in your healing journey
• Who you would like to be and what you would like to be doing when you enter into the thriver stage
• How you can get to that place from where you are now
• How to guide you through this healing work

As always, reach out for help and know that you do not need to go it alone.

Reference:

1. What is the actual EMDR Therapy session like? (n.d.). Retrieved from http://www.emdrresearchfoundation.org/for-the-public/what-is-the-actual-emdr-therapy-session-like

When a loved one hurts you through excessive criticism, put downs or abuse of any kind, you experience emotional and often simultaneous physical pain. But can emotional abuse be considered traumatic? Dr. Francine Shapiro defines two types of trauma—“big T” trauma and “little t” trauma. “Big T” trauma refers to what we commonly think of as trauma like war or natural disaster, “little t” trauma refers to incidents such as getting teased as a child or getting rejected by your first love. Most people experience “little t” trauma some time in their lives. People who live with and love someone emotionally abusive experience “little t trauma” on a daily basis. The experience of put downs, criticisms or whatever form emotional abuse takes, not only wears down self-esteem but also impacts the nervous system. Memories of the abuse can elicit negative feelings, tense physical sensations along with negative thoughts about yourself long after the abuse has occurred.

Human beings are born with a fight, flight, or freeze response. This is nature’s way of protecting us from danger. However, our minds can’t differentiate between the danger of let’s say the sound of a grizzly bear from the sound of the voice of someone who yells at you on a regular basis. In essence, prolonged exposure to emotional abuse can create similar symptoms to posttraumatic stress disorder experienced by a combat veteran. These symptoms include anxiety, depression, social withdrawal, and avoidance of situations or people that are reminiscent of the abuser, difficulty sleeping, flashbacks of abusive memories, difficulty focusing on the present or trouble concentrating. There can also be stress-related physical symptoms like migraines, digestive problems, fibromyalgia, or fatigue.

My work as a therapist is devoted to help heal those who have suffered from abuse. I believe the only way to facilitate deep and lasting healing is to treat the trauma associated with the abusive incidents. I do so with a technique called Eye Movement Desensitization and Reprocessing. EMDR has been well researched as an effective treatment approach to eradicate symptoms related to trauma. This technique can alleviate anxiety, depression, and other related disturbances resulting from emotionally abusive experiences. EMDR helps the individual eradicate any disturbance related to an abusive incident; the memory of the incident remains but the disturbing emotions and sensations associated with the memory are eliminated. Then, the person can move on in their life free from the “ghosts” of the past. EMDR can relieve symptoms fairly quickly.

Here’s a case example. “Jane” came to therapy lacking self-confidence in meeting men. When I took a look at her thorough history, it turned out she was mercilessly bullied by peers when she was a child. Jane agreed to EMDR treatment and after a few sessions, reported no leftover negative emotions or disturbances when she thought about the bullying. She reported feeling more confident and outgoing in the company of men. Even the way she carried herself changed; she held her head high with much better posture having an air of confidence.

You don’t have to suffer from trauma related to emotional abuse. You can free yourself of painful memories and move on with your life in a positive direction with the help of an EMDR trained therapist.

The alphabet soup of degrees, licenses, and various organizations related to all things EMDR (Eye Movement Desensitization and Reprocessing) is confusing to be sure, but it is imperative that you review your therapist’s level of training.

As I have addressed before, contrary to popular belief, EMDR is not an intervention, but rather a full and comprehensive modality, one that includes eight phases, each phase with its distinct functionality, process, and methods. An EMDR therapist will approach your case, treatment goals, and your progress through the eyes of that model as it were. EMDR is a way of conceptualizing what you are working on, how your arrived at the symptoms you want to change, and what you want the future to look like.

Knowing your EMDR therapist’s training level will also enable you to determine their experience and knowledge base regarding this modality. While this information may be a little dry, it will give you the tools to ask what you need to of a potential EMDR therapist. You will know what your therapist means when he or she tells you what their level of training is. Remember, most of all, look for someone who has attended an EMDRIA Approved Training.

The Basics

Prior to 2007, the EMDRIA standards for EMDR Basic Training came in the form of an independent two-part training model. EMDR therapists who are trained prior to 2007 would, therefore, identify having been trained at Level One or Level Two. Each workshop took a weekend to complete and in contrast to the current training standard, did not include any consultation hours in between trainings. The EMDR therapist was trained in EMDR and able to identify him or herself as being EMDR trained with just the Level One training, as the Level Two training was not required. Nevertheless, please keep in mind that being Level Two EMDR trained was strongly recommended. From a client’s perspective, Level Two heightened the EMDR therapist’s understanding, provided him or her with additional tools within the EMDR model, and provided skills for processing more complex trauma cases. If your EMDR therapist chose to complete both trainings, he or she would have completed 34 training hours in EMDR.

After 2007, as I previously mentioned in last week’s article, the EMDRIA training standards for EMDR practitioners evolved. What was once Level One and Two EMDR training became a Basic Training model, one that required the completion of both independent trainings in order to identify oneself as having completed the Basic Training that now constitutes 50 total training hours. The lecture and supervised practice portions are conducted over two weekends at 20 hours each weekend. What this also means for you is that your therapist can start using EMDR after Part I, and is encouraged to, while their Basic Training is still in process.

Furthermore, as part of this 50-hour Basic Training, and to receive a formal Certificate of Completion the therapist must also complete a total of 10 documented consultation hours. Five hours must be conducted after the first weekend, and the final five after the second weekend.

Considering Certification

For those seeking to refine their knowledge and utilization of EMDR, there is an option of becoming an EMDRIA Certified In EMDR. Essentially, the goal of the certification process is for the EMDR therapist to demonstrate fidelity to the EMDR protocol and increase his or her knowledge, expertise, and experience with the modality.

To become certified EMDRIA requires that a clinician who is EMDRIA Certified in EMDR has been licensed or certified in their profession for independent practice and has had a minimum of two years experience in their field. They have completed an EMDRIA approved training program in EMDR, have conducted a minimum of fifty clinical sessions in which EMDR was utilized, and have received twenty hours of consultation in EMDR by an Approved Consultant. In addition they must complete twelve hours of continuing education in EMDR every two years.

Working with a Consultant

The EMDR therapist seeking certification completes those 20 consultation hours with someone called an EMDRIA Approved Consultant in EMDR. Or, an EMDRIA Approved Consultant In Training can provide 15 consultation hours, and an EMDRIA Approved Consultant completes the remaining 5.

As an individual seeking EMDR therapy, think of an EMDR Consultant as one who helps EMDR therapists further enhance and assure their understanding of EMDR. To be classified as such, an EMDRIA Approved Consultant must already be EMDRIA Certified, have a minimum of three years experience with EMDR after completion of Basic Training, and have conducted at least 300 EMDR sessions. In addition, the Consultant must continue to obtain at least 12 CEUs, specific to EMDR, every two years.

Whew! Now, keep in mind, you may also run across someone who, on top of being an EMDRIA Approved Consultant in EMDR, is also EMDRIA Institute Facilitator, EMDRIA Approved Training Provider or EMDR HAP Trainer. EMDRIA Facilitators or HAP Trainers conduct and facilitate the actual Basic Training that therapists must complete to begin their EMDR journey. In addition to actually conducting the training, they also provide the consultation hours that are required in between the Part I and Part II of the Basic Training. For those completing the Basic Training through HAP an EMDRIA Approved Consultant or Consultant In Training can conduct those consultation hours in between Part I and Part II.

So, that all being said, I know it can be very confusing. But, I hope that this article has given you an idea of what those EMDR training levels mean! Best of luck to you as you travel your healing journey.

He called me, as most new clients do, to inquire about me, my practice, and my approach to helping. What made this call unusual was that I had to educate him about Eye Movement Desensitization and Reprocessing (EMDR), not because he was unaware of the treatment, but because what he had heard about it from his current therapist was inaccurate. Unfortunately this happens a lot with all kinds of therapy.

As I tell many folks, finding a therapist is like finding the right pair shoes. Some shoes look good, but they don’t fit. Some don’t appear to be a good fit or style, but they are. Just as many of the choices you make as a consumer are aided by research and experience, becoming an educated therapy consumer is a necessary part of your healing journey. When you contact a new therapist, the therapist, too, will wonder whether he or she is the right therapist for you, whether the type of therapy used will be in your best interest, and whether the therapist can offer the expertise that you seek.

With the potential new client on the phone, I found myself in a bind. On the one hand, I wanted to be respectful of the relationship he had with his therapist, but on the other hand, what he had been told about EMDR was not accurate and could possibly hurt him. I elected to educate him and tell him the truth about it, even though it was different what he had heard from his provider. With this information, he was able to better identify what he needed from a counselor and to determine when or whether to pursue EMDR.

EMDR Is Not a Quick Fix

We often look for a quick fix in this culture. Certainly, EMDR’s way of processing traumatic material can be rapid, intense, and highly effective, but it is no guaranteed quick fix, as the client on the phone had been told. Generally, when I first meet with a client to talk about EMDR, this is one of the first misunderstandings that comes up. EMDR is like a specialized surgery procedure, a laser beam of sorts that hones in on the material that is stuck in the nervous system causing distressing symptoms. I wouldn’t ask my surgeon to rush, nor would you. In fact, rushing may mean missing out on completing the eight phases.

More than Just Eye Movements

The name Eye Movement Desensitization and Reprocessing suggested to the client that the treatment involved little more than eye movements. This is a common misconception. If your EMDR therapist is talking only about eye movements and nothing else, it’s not EMDR. EMDR consists of eight distinct phases, which I will illustrate for you. If you are currently using EMDR therapy, you may already know where you are in the process. If not, I hope to reveal some of the mystery behind the treatment. Though the phases are intended to be completed in a particular order, transitioning between them, in a circular fashion, is not uncommon. We can go back to a phase at any time.

The Eight Phases of EMDR 

1. History Taking
   In this stage, your therapist will learn about you and your history and might conduct the standard assessments that he or she uses. This is the time when you share your story, get to know your therapist’s style, and set up initial treatment goals. The therapist should also be creating a target sequence plan, an overview of what affects you from your past and a template for your future. In this phase you are likely to discuss touchstone events, previous experiences that contribute to your current symptoms. You may be surprised to know that how you think and feel in this moment is linked directly to your past. As you review these events with your therapist, you may be asked to rate how disturbing things are to you on a scale of 0-10.
2. Preparation
   The next three phases are like a traffic light, and phase two is like the red light. At this point, you are learning more about EMDR, as well as identifying and ensuring your readiness to move further through the phases. You may be learning additional grounding skills, stress reduction skills, or state change skills, and your therapist will help create a safe-place image for you. You will also be asked to complete a brief assessment to identify if you experience dissociation. You will learn about bilateral stimulation (BLS), the back-and-forth eye movements, sounds, or tactile sensations that help the right and left hemispheres to process the traumatic material and activate the brain’s Adaptive Information Processing (AIP) system. In this phase, you may also hear your therapist talk about resourcing and using the BLS to help you access more positive experiences, thoughts, and images before moving on through the remaining EMDR phases.
3. Assessment
   This phase is like the yellow light on a traffic signal. In the assessment phase, you and your therapist will look at what you want to target when you move into the processing phase. Your therapist will ask you for an image, a negative cognition, and a positive cognition, and to rate how true your positive cognition feels on a scale of 1-7 and how disturbing the target is on a scale of 0-10, and to describe what you experience in your body.
4. Desensitization
   This phase is the green in our traffic light analogy. This is where the BLS really comes into play. Those who have used EMDR know that this is where what you are working on comes up. All of your senses become involved as you process the disturbance you are targeting. You won’t talk to your therapist during this process; you’ll have a brief check in, and then go back to moving your eyes back and forth, hearing the tones, or feeling the taps. This is where AIP comes into play, and your brain will recycle the material for your nervous system to release it as it did not get to at the time. In between sets of BLS, your therapist may also throw some things in for you to think about; these are called cognitive interweaves. The same 0-10 scale from the assessment phase will be used here to assess your level of disturbance. When the level of disturbance is rated at zero and the target truly feels neutral and not distressing, we move on to phase five.
5. Installation
   Next, we will install the positive cognition that you chose with the BLS, but before we do, we recheck to see if the positive cognition has changed at all. It often does because you have moved further on in your healing. We will also check to see how true that positive cognition feels to you, using the same 1-7 scale from phase three. We then keep using the BLS to see if anything is getting in the way. When you get to a 7, completely true, we move to phase six.
6. Body Scan
   Just as the name suggests, you will be asked to mentally scan your body to find any sensations or tensions that signal that something is still stuck regarding the target. If there are any lingering sensations, your therapist will continue with the BLS.
7. Closure
   This will look and sound different depending on if your session was complete or incomplete. You will close down the material and do a final check. You will also use various methods, including imagery, to contain the material that is still not processed. This may include returning to your safe place or creating a container to hold anything that may become to distressing in between sessions.
8. Reevaluation
   Though it looks like the last step, the reevaluation phase spirals back as if it were the beginning. Your EMDR therapist will do a check in at the beginning of your next session that will include reevaluating your disturbance level regarding the target from the last session. This helps to determine if your disturbance is still neutral and if your positive cognition still rings true. If the previous EMDR session was incomplete, the cycle begins again at phase four.

Ten years into being trained in eye movement desensitization and reprocessing (EMDR), I am still amazed by its ability to transform a life filled with trauma, anxiety, and hypervigilance into one of presence, mindfulness, and relief. Clients and clinicians often find themselves confused about EMDR, and I would like to address what is meant by symptom-based and eight-phased trauma treatment.

Symptom-Based Protocol
EMDR is a treatment modality that is research driven and well known for its ability to reduce symptoms associated with posttraumatic stress (PTSD), and your therapist may recommend it to relieve your symptoms associated with PTSD. EMDR clinicians around the world are finding, in clinical practice, that it is also effective for addressing an even wider range of symptoms, especially those rooted in the events of the past.

With this in mind, EMDR is what you could call a symptom-based protocol. This means that EMDR therapists focus on how your present experience is rooted in old stuff, even things that you think that you are over. We look at how the symptoms you have in the present mimic, or cluster, around those events in that past.

Trauma is tricky and can disguise itself as many things. An EMDR therapist will review your symptoms and review how your current thoughts, emotions, beliefs about yourself, and physical sensations may be related to disturbing life events and traumas from the past. Depending on when your EMDR therapist was trained, he or she may have different ways of asking you to prioritize and list what events are still contributing to your symptoms.

Even though you may not believe that those events from the past are really a big deal, they are still locked in your nervous system in what is termed a state-dependent form. Often, they are not completely processed and healed, like a record stuck in a groove. As time progresses, the record turns; it still plays, but the disturbance repeats itself over an over again, until the scratch is healed.

An Eight-Phased Treatment Model
Often mistakenly viewed as an intervention, EMDR is an inclusive treatment modality, one that includes eight comprehensive treatment phases. Each phase is a unique and necessary part of the approach. It is imperative that your EMDR therapist walk you through each of the eight phases. While they can be circular, and you may go back and forth between them, each phase will help you as you complete the therapy. The eight phases include history taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation. Unfortunately, EMDR has become known primarily for its desensitization phase, which is what people often confuse as the sole part of the therapy.

With this knowledge, those of you who are seeing an EMDR therapist can inquire where you are in the process, what phase you are in, or how you will prioritize the events from the past to work on them. You can also find out what symptoms you are focusing on and how the past relates to them. I often find that the more my clients know about each phase, the safer they feel and the more they feel they are part of the process.

If you have general questions about EMDR, please post them. Keep in mind that I can’t speak about your clinical work or therapy or provide clinical advice. I will try to cover your questions about the treatment in future blog posts.