Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that was developed by Francine Shapiro to resolve the development of trauma-related disorders caused by exposure to distressing, traumatizing, or negative life events, such as rape or military combat. According to Shapiro’s theory, when a traumatic or distressing experience occurs, it may overwhelm usual cognitive and neurological coping mechanisms. The memory and associated stimuli of the event are inadequately processed, and is dysfunction ally stored in an isolated memory network. The goal of EMDR therapy is to process these distressing memories, reducing their lingering influence and allowing clients to develop more adaptive coping mechanisms.
Although some clinicians may use EMDR for other problems, its research support is primarily for disorders stemming from distressing life experiences, such as post-traumatic stress disorder. Dr. Kalayjian received advanced training and certification with Francine Shapiro, the creator of the training.
EMDR integrates elements of effective psychodynamic, imagined exposure, cognitive therapy, and interpersonal, experiential, physiological and somatic therapies. Distinguishing EMDR from other therapies, however, is the unique element of bilateral stimulation (e.g. eye movements, tones, or tapping) during each session.
EMDR uses a structured eight-phase approach to address the past, present, and future aspects of a traumatic or distressing memory that has been dysfunctionally stored. The therapy process and procedures are according to Shapiro
In the first sessions, the patient’s history and an overall treatment plan are discussed. During this process the therapist identifies and clarifies potential targets for EMDR. Target refers to a disturbing issue, event, feeling, or memory for use as an initial focus for EMDR. Maladaptive beliefs are also identified (e.g., “I can’t trust people” or “I can’t protect myself.”)
Before beginning EMDR for the first time, it is recommended that the client identify a “safe place” — an image or memory that elicits comfortable feelings and a positive sense of self. This safe place can be used later to bring closure to an incomplete session or to help a client tolerate a particularly upsetting session.
In developing a target for EMDR, prior to beginning the eye movement, a snapshot image is identified that represents the target and the disturbance associated with it. Using that image is a way to help the client focus on the target, a negative cognition (NC) is identified – a negative statement about the self that feels especially true when the client focuses on the target image. A positive cognition (PC) is also identified – a positive self-statement that is preferable to the negative cognition.
The therapist asks the patient to focus simultaneously on the image, the negative cognition, and the disturbing emotion or body sensation. Then the therapist usually asks the client to follow a moving object with his or her eyes; the object moves alternately from side to side so that the client’s eyes also move back and forth. After a set of eye movements, the client is asked to report briefly on what has come up; this may be a thought, a feeling, a physical sensation, an image, a memory, or a change in any one of the above. In the initial instructions to the client, the therapist asks him or her to focus on this thought, and begins a new set of eye movements. Under certain conditions, however, the therapist directs the client to focus on the original target memory or on some other image, thought, feeling, fantasy, physical sensation, or memory. From time to time the therapist may query the client about his or her current level of distress. The desensitization phase ends when the SUDS (Subjective Units of Disturbance Scale) have reached 0 or 1.
The “Installation Phase”: the therapist asks the client about the positive cognition, if it’s still valid. After Phase IV, the view of the client on the event/ the initial snapshot image may have changed dramatically. Another PC may be needed. Then the client is asked to “hold together” the snapshot and the (new) PC. Also the therapist asks, “How valid does the PC feel, on a scale from 1 to 7?” New sets of eye movement are issued.
The body scan: the therapist asks if anywhere in the client’s body any pain, stress or discomfort is felt. If so, the client is asked to concentrate on the sore knee or whatever may arise and new sets are issued.
Debriefing: the therapist gives appropriate info and support.
Re-evaluation: At the beginning of the next session, the client reviews the week, discussing any new sensations or experiences. The level of disturbance arising from the experiences targeted in the previous session is assessed. An objective of this phase is to ensure the processing of all relevant historical events.
During the processing phases of EMDR, the client focuses on disturbing memory in multiple brief sets of about 15–30 seconds. Simultaneously, the client focuses on the dual attention stimulus (e.g., therapist-directed lateral eye movement, alternate hand-tapping, or bilateral auditory tones). Following each set of such dual attention, the client is asked what associative information was elicited during the procedure. This new material usually becomes the focus of the next set. This process of alternating dual attention and personal association is repeated many times during the session.
When traumatic memory networks are activated, the client may re-experience aspects of the original event, often resulting in inappropriate overreactions. This explains why people who have experienced or witnessed a traumatic incident may have recurring sensory flashbacks, thoughts, beliefs, or dreams. An unprocessed memory of a traumatic event can retain high levels of sensory and emotional intensity, even though many years may have passed. The theory is that EMDR works directly with memory networks and enhances information processing by forging associations between the distressing memory and more adaptive information contained in other semantic memory networks.
It is thought that the distressing memory is transformed when new connections are forged with more positive and realistic information. This results in a transformation of the emotional, sensory, and cognitive components of the memory; when the memory is accessed, the individual is no longer distressed. Instead he/she recalls the incident with a new perspective, new insight, resolution of the cognitive distortions, elimination of emotional distress, and relief of related physiological arousal.
When the distressing or traumatic event is an isolated, single incident (e.g., a traffic accident), approximately three sessions are necessary for comprehensive treatment. When multiple traumatic events contribute to a health problem—such as physical, sexual, or emotional abuse, parental neglect, severe illness, accident, injury, or health-related trauma that result in chronic impairment to health and well-being, or combat trauma, the time to heal may be longer, and complex, multiple trauma may require many more sessions for the treatment to be complete and robust.
Although EMDR is established as an evidence-based treatment for PTSD there are two main perspectives on EMDR therapy. First, Shapiro proposed that although a number of different processes underlie EMDR, the eye movements add to the therapy’s effectiveness by evoking neurological and physiological changes that may aid in the processing of the trauma memories being treated. The other perspective is that the eye movements are an unnecessary epiphenomenon, and that EMDR is simply a form of desensitization.
EMDR also uses a three-pronged approach, to address past, present and future aspects of the targeted memory.
"In the end, we will remember not the words of our enemies, but the silence of our friends."