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What is EMDR
EMDR is a multimodal, multiphasic methodology of treatment specific to the reprocessing of traumatic stress, engrained in specific neural brain circuitry. It is an Information Processing Psychology, whose function it is to safely reactivate the brain’s innate capacities to heal from the wounding of traumatic experience(s). It’s aim is to not only release this stress but to link more adaptive ways of being in the world. Another way of saying this is that when a person becomes symptomatic due to dysfunctional *traits* (whose function is to ward off painful affects, emotions some of which are dissociated into the implicit memory system unconscious), this methodology can be used to empower the client to live more productively, and content in the world.
EMDR’s “metapsychology” (term used very loosely) is based upon the recent advances in the neurosciences that shed light on neural functioning, internally and interpersonally. EMDR has been termed “synclectic” by Dr. Shapiro because it does integrate, in a synergistic way, functional elements of other therapeutic methods. In doing so, it is keeping in concert with Stricker and Gold’s concept of psychotherapy integration at the “assimilative” level.
EMDR has 8 specific phases, each with its own specific function.
Phase One – Client History Taking and Treatment Planning; It has many functions; specifically to assess symptoms of present day dysfunction, and link them back to old traumas. A client’s state of functionality in the world with both useful and dysfunctional *traits* needs to be taken into account. Core negative beliefs, ego strengths, gaps in ego strength, available resources, specific goals, states of physical health, and cultural and gender issues need to be accounted for in order to make as thorough an appraisal of the client’s unique problems and qualities as possible. As many of you know I have created a Trauma Case Conceptualization Questionnaire to empower the clinician to have as full a picture as possible.
Phase Two – Preparation; It’s function is to test Affect Tolerance, and Body Awareness, as well as to “front load” coping strategies such as the Safe Place exercise. In doing so, the clinician tests the client’s abilities to have self soothing strategies, and abilities to tolerate high levels of abreactive experience (should they occur). During this phase, using the DES (Dissociative Experience Scale), the degree of dissociation of the client is assessed. It has been rightly noted that there will be a type of client whose functional abilities may require additional strategies to prepare for the more active trauma processing aspects of phases 3-6. Conversely, there have been findings that clients with Complex PTSD (Post Traumatic Stress Disorder) may benefit from the Standard Method without an enhanced period of preparation. Probably degrees of “hardiness” or past positive experiences, both in and out of the consultation room may account for this. These ego enhancement strategies have been elaborated recently in our discussions. Another important element is the explanation of these active phases to the client, to be clear about what to expect (in the overall scheme of treatment). Roles and responsibilities of each participant, clinician and client, are spelled out. While Dr. Shapiro calls EMDR “client centered,” I would add that EMDR is a co-participatory method.
Phase Three – Assessment; This term is used for the beginnings of active trauma work. A memory is chosen to work on; this needs to be carefully negotiated by the clinician and client, and following the procedural steps outline, the target must be focused on clearly. As picture and negative cognition are described, a trauma activation sequence begins. There have been enormous accounts of client activation into “State Dependent Memory” from just these two first parts. Next comes the PC (positive cognition) and VOC (Validity of Cognition Scale), followed by the emotions that get triggered and how intensely disturbing this memory is (SUD, meaning Subjective Units of Distress Scale) and the location of this distress in the client’s body.
Phase Four – Desensitization; This is the phase of active trauma processing of the traumatic events, and their associational channels. It is acknowledged that it is the brain of the client that does the healing, through the “mechanisms” of bilateral stimulation and dual attention. The role and function of the clinician is to “stay out of the way” as long as “the train is moving down the tracks.” When obstacles arise in session, meaning that productive processing stops occurring, an active form of intervention, named by Dr. Shapiro as The Cognitive Interweave is employed. It’s function is to link more adaptive neural networks to the dysfunctional networks which are blocking procesing.(This concept has been expanded by Gilson and Kaplan 2000, to give the clinician more options in restarting the brain’s innate capacities. Their Title is called, “Therapeutic Interweaves.”) In doing so, the clinician is reactivating the information processing abilities of the client to continue to resolve the pain and dysfunction of state dependent memories (or memory networks, with the sights, words, emotions and sensations dysfunctionally stored during the developmental epoch of the trauma(s)).
Phase Five – Installation; Once the trauma is desensitized down to a zero, the PC and VOC are again assessed, and unless contraindicated (by which I mean that the clinician’s assessment is that there is more trauma present) the clinician “installs” the positive cognition until it reaches a seven at least 2 times. (Frankly, the term Installation jars me a bit; I have come to nickname this phase, “Linking to the Adaptive Perspective”)
Phase Six – The Body Scan; This is another checkpoint to assess whether trauma processing with all its associational channels has been completed. Holding the PC and the target memory, the clinician instructs the client to scan their bodies from head to toe, to self assess for any residual trauma, or associational trauma links. When sensation is noted the client is instructed to open their eyes and process whatever sensation arises. There will be times when old trauma links are experienced on a sensory motor level. The clinician and client then have further trauma processing to do. There are times when pleasant sensations arise; in this case sets of eye movements (EM’s) can enhance the “installed” lessons a client has learned (on their own).
Phase Seven – Closure; This phase happens with sufficient time to spare at the end of the session, whether active trauma processing is completed or not. The client is “debriefed” and instructed in journaling, and other exercises that may enhance the work done during the session. The client is also made aware of the clinician’s availability if too much negative arousal occurs during the times between sessions.
Phase Eight – Reevaluation; This phase begins at the next session following any active trauma processing session. The client’s journal is reviewed, progress is noted, and in a co-participatory manner the next memory to be processed is decided upon and dealt with.
For the most robust outcomes the complete method needs to be employed (Maxfield and Hier 2002)
Dworkin, M (2005) EMDR and the relational imperative:the therapeutic relationship in emdr treatment NY, Routledge.
Maxfield and Hier (2002) The relationship between efficacy and methodology in studies investigating emdr treatment of ptsd, J. of Clinical Psychology v 58., n. 1., p. 23-42
Shapiro, F., (2001) Eye movement desensitization and reprocessing: basic priciples, protocols, and procedures (2nd edition) NY, Guilford
