Cynthia Kong, L.M.F.T., Certified EMDR Therapist, EMDRIA approved EMDR Consultant, Facilitator for EMDR Institute Trainings, and Trainer with the EMDR Humanitarian Assistance Programs
This article is not meant to replace therapy by a licensed professional. Each individual is unique, and cases and situations vary. Permission is granted to print for personal use only. All publication rights reserved by the author.
If you are a survivor of abuse, a loved one of a survivor, or a professional treating a survivor, you already know the potentially long-lasting and devastating effects that earlier experiences can have on a persons mind and body. Even though human beings seem to have ways to deal with disturbing experiences so that we learn what is useful from them and discard or file away the rest, when experiences are traumatic they may not get processed and integrated into our memories in the usual way. They may leave us with very upsetting images, thoughts and feelings, which may be there all the time or may get triggered by things that remind us of the past. On the other hand, we might not have particular images or thoughts, or even conscious memories of some of the experiences, yet be very much shaped by them in terms of our ways of being and coping in the world.
EMDR is a psychotherapy approach that helps a person to complete the stuck or incomplete processing of upsetting experiences, including abuse and other trauma. It includes certain distinctive features, such as the use of eye movements or various other forms of bilateral stimulation (BLS), to facilitate the persons own innate healing processes according to certain researched and standardized protocols. However it is important to understand that EMDR is a complete therapy approach with several different phases.
The earlier phases of EMDR treatment (History Taking and Preparation) include aspects that resemble other forms of therapy. The important tasks of the initial phases include getting to know the client and his/her history, developing a safe and trusting relationship between client and therapist, and making sure the client has the internal ability as well as enough support in his/her present day life to be able to manage the potential emotional intensity of the trauma reprocessing part of EMDR. For some clients, considerable time may be needed to help them develop or strengthen these abilities and resources so that they may safely work with the traumatic experiences.
Unlike other forms of therapy, during these early phases of EMDR, the therapist is also forming a plan of what past experiences need to be reprocessed, and in what sequence. Other targets for processing are also identified, including current situations, and skills and behaviors that may be needed in the future. Various themes may be identified, experiences might be grouped together for more efficient processing, and the relationships between past experiences and present-day problems and concerns are spelled out.
When it is determined that the client is ready for the trauma reprocessing stage of the therapy, the therapist helps the client to highlight the chosen "target" (memory or situation to be processed). This includes identifying images, beliefs, emotions and sensations connected to the event. Then the client is instructed to attend to his/her internal experience of the target and at the same time is guided to engage in the bilateral stimulation.
The BLS might simply involve the therapist guiding the client to move her/his eyes quickly from side to side in a rhythmic motion. Or it might involve the client listening to gentle sounds alternating from one ear to the other through a set of headphones. The client is instructed to notice whatever arises in their experience, without judging or censoring. Throughout the process, the client is reminded to keep one foot in the present and one foot in the past, in other words to be aware that any disturbing thoughts or feelings are simply stored bits of information about the past.
With successive sets of these BLS, the client will typically start to notice changes in what comes to mind when they think of the memory. Eventually, in a successful processing session, the memory will become less and less upsetting. Negative beliefs about oneself will change into more positive, realistic and useful ones, and unpleasant sensations in the body will subside and perhaps be replaced by more relaxed, expansive, or otherwise pleasant or neutral sensations. Although the processing of particularly disturbing memories, such as those of sexual or ritual abuse, may take a good number of sessions to complete, the general course of the processing will tend to move in this positive direction.
Although the processing of past trauma is a key component of EMDR, the therapy is not complete until the client also has the opportunity to work on any current triggers - elements in their current life that still elicit any kind of distress related to the past traumatic experiences. People, places, situations, or objects that bring up any upsetting feelings or thoughts and that have not been spontaneously neutralized by the trauma reprocessing must now be dealt with in a similar fashion to the trauma work.
A final important stage involves helping the client to develop what are called Future Templates. These are imagined situations in which the client sees her/himself as being able to face or handle once-difficult or upsetting situations from a new perspective with a sense of her/his full, realistic, adult capacities. Standard protocols that include BLS are used here to enhance and integrate the more adaptive and realistic perspective.
It is usually advisable for a well-trained EMDR therapist to be the primary clinician for the survivor so that the clients overall progress can be more effectively monitored. It is easier to gauge when to proceed with the different phases of treatment. In fact many EMDR therapists will only work with a client in this way. However, if you already have a strong, long-standing relationship with a therapist who is not trained in EMDR but who is supporting or even recommending EMDR as part of your treatment, it might be possible to find an EMDR practitioner who is comfortable and skilled at working collaboratively with your primary clinician. The EMDR therapist will likely still need to spend some time with the beginning phases of EMDR treatment, followed by the trauma-reprocessing portion of your therapy at the appropriate time.
I stress the importance of timing because it is not advisable for survivors of severe abuse to rush into working directly with the trauma memories with EMDR before adequate preparation and stabilization are done first. This is particularly true for survivors who dissociate to a significant degree as one of their coping mechanisms. Although for many people EMDR may shorten the overall course of treatment, it should not be looked upon as a quick fix for abuse survivors. The trauma reprocessing aspect of EMDR can be very powerful and should not be used by an unskilled therapist, or before a client is ready.
Another very important factor to be considered regarding EMDR with survivors of abuse is the possibility of brainwashing or hypnotic programming against revealing information about the abuse. It is common for victims of any type of abuse, particularly in childhood, to be threatened with harm to themselves or others if they disclose what the perpetrator(s) did to them. In ritual abuse involving a cult, the programming may take on particularly heinous threats to the well-being of the survivor or other people to whom they reveal any information about the cult or cult-related experiences. The victim may have been programmed to harm her/himself, if at any time even far into the future if (s) he discloses such information. In some cases there might be a threat against even allowing the information to surface to the clients own conscious awareness.
Negative reactions may occur during the course of therapy if programming is not taken into consideration and managed along the way. This is not an issue unique to EMDR, but is true with for any therapeutic approach that may involve deep changes in abuse survivors. The therapist must be aware of and prepared to deal with this phenomenon. On the positive side, it may be possible for EMDR to be used to help deal with the programming itself.
Many creative therapists have integrated EMDR with other therapeutic tools and methods, such as art therapy, play therapy, writing, movement and body/somatic work, verbal expressive work (such as in Gestalt Therapy or Voice Dialog), as well as more transpersonal/spiritual orientations. Your EMDR therapist might suggest homework between sessions in the form of relaxation, meditation, visualization, journal writing, physical exercise, or a number of other activities to reduce stress and to help you integrate the shifts that occur in the sessions.
To learn more about EMDR, there are a number of good books on the subject, as well as several useful websites. Some books are more oriented towards potential clients and the general public, while others are specifically written for mental health professionals.
One of the most reliable and well-respected websites is that of the EMDR Institute in Northern California founded by Francine Shapiro, Ph.D., the California psychologist who is the originator of EMDR. The Institute has trained the majority of the EMDR therapists in the United States, as well as having played a major role in helping to get EMDR established in other countries. Another is the website of EMDRIA, the professional organization in the U.S. that creates guidelines for training and for the ethical and competent practice of EMDR. Both of these websites can point you to the multitude of scientific research on the effectiveness of EMDR for treating the effects of trauma.
To choose an EMDR therapist, I would suggest that in addition to the kinds of qualities you would want in any therapist, it is important to choose one who has at the very least completed both Part 1 and the Part 2 of the EMDR Training. Hopefully, you can find one in your area with sufficient experience as a therapist in general and with EMDR in particular to sensitively and appropriately manage some of the unique aspects of doing EMDR with abuse survivors. This may include working with dissociation (including, but not limited to Dissociative Identity Disorder). If you are a ritual abuse survivor, your therapist would be well advised to know or learn about the unique features of ritual abuse. It is important that they can comfortably and skillfully work with the very disturbing material that may come up in your therapy sessions.
Both the EMDR Institute and EMDRIA are potential sources for finding an EMDR therapist in your area. EMDRIA has lists of Certified EMDR Therapists and EMDRIA Approved Consultants who have gone beyond the basic trainings to demonstrate greater levels of competence in EMDR. There are also Facilitators and Trainers who are therapists involved in teaching EMDR. The EMDR Institute can help you locate some of these, as well as other therapists who have completed the basic EMDR training. Being in any one of these categories does not guarantee that a particular therapist will be right for you, so it is important to talk to one or more potential therapist and use both your mind and heart to help you find a good match. Additional suggestions about choosing an EMDR therapist may be found in books on EMDR in the Client Resource List.
In the fourteen years since I was originally trained in EMDR, I have found it extremely satisfying and inspiring to be able to work with trauma survivors using this approach. When successful, EMDR seems to allow people to actually change how they feel and think in a deep and lasting way. Rather than having to tell themselves not to be afraid of something, they stop being afraid of it. Rather than having to repeatedly convince themselves to not feel irrationally guilty or ashamed about things that are not their fault, they actually no longer feel the inappropriate feelings. Rather than having to push away upsetting thoughts and images from the past, these memory fragments can change in significant ways so that they are no longer disturbing, or don't even intrude the way they did before. I often find that as people shed the distress remaining from their histories, they move from feeling trapped by fears and self-limiting beliefs to revealing the beautiful, loving, and creative beings they were born to be.