What is EMDR?

The amount of time the complete treatment will take depends upon the history of the client. Complete treatment of the targets involves a three pronged protocol (1-past memories, 2-present disturbance, 3-future actions), and are needed to alleviate the symptoms and address the complete clinical picture. The goal of EMDR therapy is to process completely the experiences that are causing problems, and to include new ones that are needed for full health. “Processing” does not mean talking about it. “Processing” means setting up a learning state that will allow experiences that are causing problems to be “digested” and stored appropriately in your brain. That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded. Negative emotions, feelings and behaviors are generally caused by unresolved earlier experiences that are pushing you in the wrong directions. The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.

Phase 1: History and Treatment Planning

In the first phase of EMDR treatment, the therapist takes a thorough history of the client and develops a treatment plan. This phase will include a discussion of the specific problem that has brought her/him into therapy, her/his behaviors stemming from that problem, and her/his symptoms. With this information, the therapist will develop a treatment plan that defines the specific targets on which to use EMDR. These targets include the event(s) from the past that created the problem, the present situations that cause distress and the key skills or behaviors the client needs to learn for his future well-being. One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of his disturbing memories in detail. So while some individuals are comfortable, and even prefer, giving specifics, other people may present more of a general picture or outline. When the therapist asks, for example, “What event do you remember that made you feel worthless and useless?” the person may say, “It was something my brother did to me.” That is all the information the therapist needs to identify and target the event with EMDR.

Phase 2: Preparation

For most clients this will take only 1-4 sessions. For others, with a very traumatized background, or with certain diagnoses, a longer time may be necessary. Basically, your clinician will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you are generally able to proceed to the next phase. One of the primary goals of the preparation phase is to establish a relationship of trust between the client and the therapist. While the person does not have to go into great detail about his disturbing memories, if the EMDR client does not trust his clinician, he may not accurately report what he feels and what changes he is (or isn’t) experiencing during the eye movements. If he just wants to please the clinician and says he feels better when he doesn’t, no therapy in the world will resolve his trauma. In any form of therapy it is best to look at the clinician as a facilitator, or guide, who needs to hear of any hurt, need, or disappointments in order to help achieve the common goal. EMDR is a great deal more than just eye movements, and the clinician needs to know when to employ any of the needed procedures to keep the processing going. During the Preparation Phase, the clinician will explain the theory of EMDR, how it is done, and what the person can expect during and after treatment. Finally, the clinician will teach the client a variety of relaxation techniques for calming himself in the face of any emotional disturbance that may arise during or after a session. Learning these tools is an important aid for anyone. The happiest people on the planet have ways of relaxing themselves and decompressing from life’s inevitable, and often unsuspected, stress. One goal of EMDR therapy is to make sure that the client can take care of himself.

Phase 3: Assessment

Used to access each target in a controlled and standardized way so it can be effectively processed. Processing does not mean talking about it. See the Reprocessing sections below. The clinician identifies the aspects of the target to be processed. The first step is for the person to select a specific picture or scene from the target event (which was identified during Phase One) that best represents the memory. Then he chooses a statement that expresses a negative self-belief associated with the event. Even if he intellectually knows that the statement is false, it is important that he focus on it. These negative beliefs are actually verbalizations of the disturbing emotions that still exist. Common negative cognitions include statements such as “I am helpless,” “I am worthless,” “I am unlovable,” “I am dirty,” “I am bad,” etc. The client then picks a positive self-statement that he would rather believe. This statement should incorporate an internal sense of control such as “I am worthwhile/ lovable/ a good person/ in control” or “I can succeed.” Sometimes, when the primary emotion is fear, such as in the aftermath of a natural disaster, the negative cognition can be, “I am in danger” and the positive cognition can be, “I am safe now.” “I am in danger” can be considered a negative cognition, because the fear is inappropriate — it is locked in the nervous system, but the danger is actually past. The positive cognition should reflect what is actually appropriate in the present. At this point, the therapist will ask the person to estimate how true he feels his positive belief is using the 1-to-7 Validity of Cognition (VOC) scale. “1” equals “completely false,” and “7″ equals “completely true.” It is important to give a score that reflects how the person “feels,” not “thinks.” We may logically “know” that something is wrong, but we are most driven by how it ” feels.” Also, during the Assessment Phase, the person identifies the negative emotions (fear, anger) and physical sensations (tightness in the stomach, cold hands) he associates with the target. The client also rates the disturbance using the 0 (no disturbance)-to-10 (the worst feeling you? ever had) Subjective Units of Disturbance (SUD) scale.

Phase 4: Desensitization

This phase focuses on the client’s disturbing emotions and sensations as they are measured by the SUDs rating. This phase deals with all of the person’s responses (including other memories, insights and associations that may arise) as the targeted event changes and its disturbing elements are resolved. This phase gives the opportunity to identify and resolve similar events that may have occurred and are associated with the target. That way, a client can actually surpass her initial goals and heal beyond her expectations. During desensitization, the therapist leads the person in sets of eye movement (or other forms of stimulation) with appropriate shifts and changes of focus until his SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). Starting with the main target, the different associations to the memory are followed. For instance, a person may start with a horrific event and soon have other associations to it. The clinician will guide the client to a complete resolution of the target.

Phase 5: Installation

The goal is to concentrate on and increase the strength of the positive belief that the person has identified to replace his original negative belief. For example, the client might begin with a mental image of being beaten up by his father and a negative belief of “I am powerless.” During the Desensitization Phase he will have reprocessed the terror of that childhood event and fully realized that as an adult he now has strength and choices he didn’t have when he was young. During this fifth phase of treatment, his positive cognition, “I am now in control,” will be strengthened and installed. How deeply the person believes his positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal is for the person to accept the full truth of his positive self-statement at a level of 7 (completely true). Fortunately, just as EMDR cannot make anyone shed appropriate negative feelings, it cannot make the person believe anything positive that is not appropriate either. So if the person is aware that he actually needs to learn some new skill, such as self-defense training, in order to be truly in control of the situation, the validity of his positive belief will rise only to the corresponding level, such as a 5 or 6 on the VOC scale.

Phase 6: Body scan

After the positive cognition has been strengthened and installed, the therapist will ask the person to bring the original target event to mind and see if he notices any residual tension in his body. If so, these physical sensations are then targeted for reprocessing. Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in motoric (or body systems) memory, rather than narrative memory, and retains the negative emotions and physical sensations of the original event. When that information is processed, however, it can then move to narrative (or verbalizable) memory and the body sensations and negative feelings associated with it disappear. Therefore, an EMDR session is not considered successful until the client can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.

Phase 7: Closure

Ends every treatment session The Closure ensures that the person leaves at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the person in using a variety of self-calming techniques in order to regain a sense of equilibrium. Throughout the EMDR session, the client has been in control (for instance, he is instructed that it is okay to raise his hand in the “stop” gesture at anytime) and it is important that the client continue to feel in control outside the therapist’s office. He is also briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and which techniques he might use on his own to help him feel calmer.

Phase 8: Reevaluation

The therapist checks to make sure that the positive results (low SUDs, high VOC, no body tension) have been maintained (at the next session of a completed target), identifies any new areas that need treatment, and continues reprocessing the additional targets. The Reevaluation Phase guides the clinician through the treatment plans that are needed in order to deal with the client’s problems. As with any form of good therapy, the Reevaluation Phase is vital in order to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment

Past, Present and Future

Although EMDR may produce results more rapidly than previous forms of therapy, speed is not the issue and it is important to remember that every client has different needs. For instance, one client may take weeks to establish sufficient feelings of trust (Phase Two), while another may proceed quickly through the first six phases of treatment only to reveal, then, something even more important that needs treatment. Also, treatment is not complete until EMDR therapy has focused on the past memories that are contributing to the problem, the present situations that are disturbing, and what skills the client may need for the future.

1. Have you received both Part 1 and 2 of the basic training?

2. Was your training program approved by EMDRIA or EMDR Institute?

3. Have you kept up to date about the latest protocols and developments?

4. How many people with my particular problems or disorder have you successfully treated?

5. Are you doing standard EMDR as it is (a) described in Dr. Shapiro’s text, and (b) been tested in research?

6. Will you discuss with me the way EMDR can deal with my obvious symptoms?

7. Will you also discuss with me the ways EMDR can be used to help me live a happier, more productive life by treating the other negative memories, beliefs, feelings, and actions that may be running my life?

EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy approach developed by Dr. Francine Shapiro to help people heal from trauma or adversities such as issues of abuse, bullying, domestic violence, grief/loss, attachment wounds, abandonment, PTSD, and many other complicated life issues. EMDR therapy is now validated as an evidence-based approach and included in SAMHSA (the Substance Abuse and Mental Health Services Administration) and the National Registry of Evidence-based Programs and Practices. In addition, EMDR therapy has been validated by over 20 randomized controlled clinical trials (see: www.emdrhap.org/emdr_info/researchandresources.php).

EMDR therapy integrates elements of many traditional psychological orientations and is based on the adaptive information processing model (AIP). The AIP model hypothesizes that there is an inherent information processing system in the brain that gets blocked when traumatic or adverse events occur, causing these events to get locked in the brain with the original picture, sounds, thoughts, feelings and body sensations. Whenever a reminder of the traumatic or adverse event comes up, those pictures, thoughts, feelings, and sensations can continue to be triggered. According to Dr. Shapiro, many emotional problems and disorders are manifestations of these unprocessed trauma memories that are stored in the brain. EMDR therapy works on helping the brain reprocess these traumatic memories, and as a result alleviating the emotional and psychological disorders.

EMDR therapy has been used with adults, children and adolescents with a wide variety of emotional and psychological problems including PTSD, anxiety, panic attacks, grief/loss, dissociative disorders, phobias, depression, eating disorders, addictions, sexual/physical abuse, neglect, emotional abuse, attachment disorders, etc.

Before we talk about what EMDR is let me tell you about what EMDR does. When we have yucky things that happen to us, we have many mixed-up feelings and many mixed-up thoughts. We do not feel good in our minds, bodies, and hearts. It is like carrying all of this undigested mixed up thoughts and feelings inside ourselves. When we are so busy carrying all of this undigested stuff, we do not have space in our hearts, minds, and bodies for the good feelings and thoughts. EMDR can help kids by making their undigested thoughts and feelings smaller or even to get rid of them so kids will have space for the good feelings and the good thoughts. Grown-ups have a rather complicated name for EMDR: Eye Movement Desensitization and Reprocessing but a very special lady came up with a cool name for kids: Eyes Moving to Digest and Recover!! Your brain is going to DIGEST these yucky mixed up thoughts and feelings.

When yucky things happen, the brain has a hard time putting all the pieces together and as a result, things that people say or do or things that kids see, hear, smell or touch can bring up the yucky memories, the mixed-up thoughts, feelings and body feelings connected to those yucky things. EMDR helps the brain put all the pieces together so the yucky stuff can leave us and the good stuff or the things we learned from it can stay so we get stronger. Then, the brain can chew up and digest all the mixed-up feelings and thoughts as well as the yucky feelings we may have in the body.

WHAT IS EMDR – FOR ADOLESCENTS

• Do you feel annoyed, angry or bored often?
• Do you isolate from others?
• Do you feel that you are not as good as others are?
• Do you have nightmares or have a hard time falling asleep or staying asleep?
• Do you have negative events that happened to you? Do you tend to keep things inside and not tell anyone?
• Do you use drugs or alcohol or do you do things to harm your body to numb or escape the uncomfortable feelings? Or do you do this to fit in because you don’t feel connected to others, or you don’t feel as good as others?

Well, believe it or not a lot of kids, teens and adults feel this way, and there is help for all of us!! There is a way to find hope and find our positive feelings again.

It is really cool that you are interested in finding ways that can help you get better. Let’s start by talking about what happens when we go through tough stuff in our lives:

When we have bad or negative events in our lives like abuse, bullying, divorce, accidents, losses and death of a loved one, violence in the home among others, the brain creates ‘files’ or ‘apps’ that contain all the feelings, thoughts, and body sensations connected to this event. When we have events that are not ‘too bad’, the brain has the capacity to work on these files/apps before storing them and locking them up as memories. What is stored has been sorted out and organized so the negative stuff has been let go, allowing us to keep the good stuff and learn from this experience.

However, when the event is really bad or has happened several times, these files/apps get overloaded and the brain can’t do the work of sorting things out and putting all the pieces of the event together. As a result, these files/apps are all messy, in pieces that are not put together and organized by the brain.

Different life events we call triggers can open up these files/apps or ‘click’ on them. A ‘click’ may be a classmate making fun of us, being ignored, not getting what we are asking for, parents asking us to clean up our room and so on. When these ‘clicks’ open up the files/apps, we start to have the negative feelings, thoughts, and body reactions we had when the bad stuff happened. EMDR helps the brain organize these files and put all the pieces together. When the files/apps are finally organized, the ‘clicks’ of everyday life won’t have the power to make us feel angry, sad or shameful or to think that we are not worthy or that we are not enough or to make us yell, become aggressive or do things we regret later. EMDR is not a ‘magic’ cure. It takes some work, but it is so worth it because recovering our ability to feel good is worth all of our efforts.

Being a parent is one of the greatest privileges we can experience, but it also requires great commitment and work. If you have a child with emotional and behavioral difficulties, the good news is there is help and there are many different therapeutic modalities that can help you and your child. EMDR is one of these therapeutic modalities. EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy approach developed by Dr. Francine Shapiro (for more information click here http://coonsults.blogs.nytimes.com/2012/03/16/expert-answers-on-e-m-d-r

EMDR is a psychotherapy treatment that is effective for resolving emotional difficulties caused by disturbing, difficult, frightening life experiences, trauma, abuse, bullying, domestic violence, grief/loss, attachment wounds, abandonment or other life issues.  When a child has a yucky thing that happens to them, they lose a sense of control over their lives. This can result in symptoms of anxiety, depression, irritability, anger, guilt, and or other behavioral problems. Even more common events such as divorce, school problems, peer difficulties, failures, and family problems can deeply affect a child’s sense of security, self-esteem and development.

When a yucky thing happens to a child, sometimes the event stays frozen or stuck in the child’s memory. The experience may return in a distressing and intrusive way and the child may respond in the present in a manner that is confusing to those around the child. For example, a child who has experienced a bad bicycle accident may have repeated nightmares, be fearful of trying new things and avoid things that are associated with a bicycle.

EMDR helps resolve the troubling thoughts, feelings and sensations related to the distressing memory so that a child can return to their normal developmental tasks and prior level of coping while strengthening the child’s sense of confidence, mastery and calmness.

Links for Parents:

EMDR International Association: www.emdria.org

EMDR Institute Inc.: www.emdr.com