Susan Brown, LCSW
 "No-nonsense to-the-heart-of-the-matter approach"

EMDR Therapy

EMDR Therapy

I specialize in a treatment approach called EMDR therapy. In my work as both an individual and a couples counselor, I have found it to be an invaluable tool for reasons that will be come clear in the sections below. I was in practice for 15 years prior to being trained in EMDR. Since incorporating it into my practice. I have watched clients heal more fully and more deeply than in all my years prior. It is a treatment approach well worth reading about.

EMDR is an acronym for Eye Movement Desensitization and Reprocessing. It is a comprehensive, phased treatment approach (developed in 1989 by psychologist Francine Shapiro), that has been extensively researched and proven to be effective for the treatment of trauma-based disorders. The most commonly known trauma disorder is Post-Traumatic Stress Disorder (PTSD). This disorder sometimes develops after a person experiences an event (or multiple events) so disturbing to them that they are unable to process what happened in a way that allows them to heal from it.

The kinds of traumatic experiences (Big T traumas) that can sometimes lead to PTSD are events including, but not limited to:

• Sexual assault
• Combat
• Physical assault (experiencing or witnessing)
• Childhood or adult abuse (physical, emotional or sexual)
• Extreme illness or the sudden death of a loved one
• Auto accidents
• Dog bites
• Natural Disasters

EMDR therapy is a formal set of protocols and procedures used to “desensitize and reprocess” memories that have been encoded in the brain and body as if “frozen in time” as a result of traumatic experiences. An EMDR therapist must go through extensive training beyond their clinical license to practice this method of psychotherapy. Make sure that your therapist has the proper certification and training in EMDR therapy before you accept treatment of this kind.

HALLMARK SYMPTOMS OF TRAUMA OR PTSD

Not everyone experiences the full spectrum of symptoms listed below, but if you are experiencing several (or all) of these, you may be experiencing a “trauma-based” disorder:

• Depression and anxiety
• Sleep disturbance (insomnia, nightmares)
• Intrusive thoughts (flashbacks to the scenes)
• Heightened levels of vigilance - being ‘on guard’ all the time
• Physical arousal such as being jumpy, irritable, and/or aggressive
• Substance abuse (the world’s most common ‘self-medication’ for trauma)
• Numbing (can’t feel emotions) or emotional outbursts (feel too much)

There are also not-so-obvious examples of experiences that we refer to as “small t traumas” or adverse childhood experiences. They are the more common life experiences, including (but not limited to): divorce, bullying, teasing, shaming, humiliation, or constant criticism. Experiences likes these usually accumulate over time from childhood. These are not usually thought of as traumatic, but to a child they can be. In the news we have seen school shootings that were linked to incessant bullying, teasing, and marginalization. We’ve seen teenagers commit suicide as a result of public shaming and humiliation shared on all forms of social media from both personal and anonymous sources. These are real-life tragedies, at least in part, a result of trauma inflicted on children.

When we are young we tend to take responsibility for everything, often leading us to believe negative things about ourselves that are not really true. We know it intellectually, but the beliefs feel true at a gut level. Common examples of these beliefs are: “I’m not good enough,” “I’m powerless” or “I have no choices.” Extraordinarily disturbing experiences can often have devastating consequences that can last a lifetime if not understood and treated in a timely way.

Over the last 26 years, EMDR has been found to be effective with a much broader range of disorders beyond just PTSD. They commonly share underlying trauma as a contributing factor. More research is being conducted every year with these other symptom presentations.


EXAMPLES OF PROBLEMS HELPED WITH EMDR

• PTSD
• Substance Abuse (and other addictions)
• Depression and Anxiety
• Panic Attacks
• Traumatic Grief
• Low Self Esteem
• Anger/Rage
• Phantom Limb Pain
• Performance Anxiety
• Performance Enhancement (athletes, writers, actors, etc.)

                      A frustrating aspect of trauma is that present day experiences that have nothing to do with the original events, have the power to activate an old, disturbing memory as if it were literally stuck in the brain. Thus a person can be triggered by ordinary daily events such as sights, sounds and smells reminiscent of the original event, leaving one in an extreme state of discomfort but for no apparent reason.

                      An indicator that this might be happening is if you seem to be over-reacting to a situation that even you think is ‘over-the-top.’ For example, three years after a sexual assault, a woman steps into an elevator and notices the smell of cologne. Suddenly, for no apparent reason, she is overcome with anxiety, heart palpitations, and shortness of breath (like a panic attack). The person in the elevator is wearing the same cologne as that of her original attacker and the scent has activated the memory network “holding” that horrific event, thereby setting off a minefield of physiological and emotional reactions (terror, fight, flight, freeze) - none of which have anything to do with the person standing in the elevator at that moment. This is a classic example of a traumatically stored memory that is vulnerable to being triggered into the present by an ordinary, everyday experience. It is unnerving and can make a person feel as if they are crazy - though as you can see in this example, they are not. This is simply a traumatic stress response to material that has not been fully processed into a more adaptive, present-oriented state.

                      HOW DOES EMDR WORK?

                      No one is certain how EMDR therapy works, nor do we understand how many other effective therapies work such as Cognitive Behavioral or Exposure Therapy. We didn’t know why aspirin worked either, but there was no argument that it did!

                      The brain is, without question, the most complex organ in the body. It runs and regulates everything. We are on the horizon of a new age of knowledge about the brain due to the development and increasing availability of technology that allows us to peer into the brain, such as fMRI and SPECT scans. The scans allow us to see the internal operations of different parts of the brain, enabling us to learn more about “which parts do what.” However, most people will agree that the field of neuroscience is still in its infancy.

                      What we do know is that when a person experiences an event that is extremely distressing and overwhelming, it is held in the brain with all the sights, sounds, thoughts, feelings and body sensations that accompanied the event at the time it occurred. Think of our brain as a data recorder that doesn’t miss a thing, registering all aspects of every experience we have, whether we consciously remember it or not.

                      When events are extraordinarily upsetting, the is brain sometimes unable to process the experience as it normally does, therefore the thoughts, feelings and sensations of the traumatic event can become frozen in the nervous system as if in a time warp, as in the example of the assault victim in the elevator.

                      EMDR therapy helps to activate the brain’s natural processing abilities very efficiently, thereby helping to process the disturbing material into a more adaptive state in order to heal more completely in present-oriented time. The ability of our brain/body/mind to accomplish this type of resolution is referred to as an “Adaptive Information Processing” system or AIP. 

                      The AIP is the theoretical underpinning of EMDR therapy and presumes that the brain, like the rest of our body, has an innate capacity to heal itself after being traumatized. When we get a cut on our finger, we don’t have to tell the body to send healing cells to the wound; it is done automatically by our organic healing mechanisms. Unfortunately it seems that with trauma, the natural mechanisms for processing experiences may stall and leave us re-living the event over and over again (known as “flashbacks” or intrusive thoughts). EMDR therapy is an efficient and effective treatment approach for activating that natural healing process.

                      FREQUENCY AND DESCRIPTION OF EMDR TREATMENT

                      In a typical EMDR therapy session a memory or issue is selected to be targeted for reprocessing, for example, a rape. The client focuses on the ‘most distressing part’ of the memory, identifies the ‘negative belief’ they hold about themselves (in the present) such as “It’s my fault.” The person then identifies the positive, more adaptive belief such as, “I didn’t do anything wrong” (which they usually know is true intellectually, but it doesn’t feel true). The emotions that come up around the memory are identified, such as fear, sadness, anger, etc. The person is then asked to notice and name where they feel the distress in their body, such as stomach churning or chest tightening. The client then attends to the distressing material (as a whole) in brief doses while simultaneously focused on an external stimulus that creates “bilateral” (side-to-side) movement, eye movements (the EM in EMDR), tactile tapping, sounds, or tones. The use of bilateral, dual attention stimulation is one of the unique aspects of the EMDR therapy protocol.

                      EMDR therapy uses an 8-phase, three-pronged protocol:

                      1) Past events that have laid the groundwork for symptoms are processed into a neutral or positive state
                      2) Current circumstances that trigger distress are targeted 
                      3) Future expected challenges are targeted to assist the client in acquiring the skills needed for adaptive functioning in the future.

                      Typically, an EMDR session lasts from 60-90 minutes. The length of sessions depends upon several factors, including the nature and longevity of the problem, the degree of trauma, its complexity, and the age at the time of occurrence.

                      History is usually done in 2-3 sessions, although continues to be collected throughout the therapy process. In some cases, where a single traumatic event is the focus of treatment, 1-3 sessions of EMDR processing phases may be all that is needed. 

                      In more complex cases the number of sessions required to process symptoms is determined by the complexity of the case and at what stage of life the traumatic experiences began. 

                      When the traumas or neglect a person endured lasted for years, longer-term treatment can be expected. However, with EMDR therapy, in contrast to more traditional talk therapies, treatment time is usually markedly reduced. Ironically, one can be in talk therapy for years and not be able to fully resolve these issues because they often cannot be “talked” out of the brain and body.

                      EMDR therapy can evoke strong emotions and sensations during a session. This is normal and to be expected since the method works to process those negative feelings and sensations when they are brought deliberately into the clients’ awareness for reprocessing. Usually the re-experiencing of these unpleasant feelings is brief and soon fades as processing proceeds.

                      With clients who are not yet able to tolerate the intensity of these feelings and sensations, there are extremely effective approaches within the Preparation Phase of EMDR therapy to first build internal resources, strength and stability before direct trauma work is done. In this way, EMDR therapy can be a powerful tool for clients needing to pace treatment more slowly and with more safety.

                      Although some people have dramatic responses to EMDR therapy in a very short time in contrast to traditional talk therapies, others progress more slowly. The basic premise is, the more complex the trauma history, the longer treatment will likely take. 

                      Comprehensive information about EMDR therapy and the research supporting it, can be found at www.emdr.com and www.emdria.org
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