A Guide to EMDR and Trauma
Have you or someone you know ever struggled to get past feeling hurt? Or maybe it’s that traumatic life experience you thought you had already worked through, but it still seems to cause issues. Sometimes people feel stuck; stuck with the same old job, the same fears, the same daily routine. They may feel deep down that they lack some sense of worth or capabilities, a sense of not being good enough.
These self-limiting behaviors could be after-effects of trauma and EMDR, Eye Movement Desensitization and Reprocessing, may be the right therapeutic treatment to see progress for you in healing from that trauma.
More people are hearing about EMDR lately, thanks to stories in the media. There is a spike in knowledge and popularity. It’s hit the mainstream on shows like The Affair on Showtime. Perhaps because of this, and because of its wide coverage in the press (and because it works!) more frequent inquiries about EMDR have been coming into our office. This is wonderful!
As a trauma-informed, strengths-based, systems therapist, I have firsthand experience providing EMDR. I first received training in EMDR in 2001. As an EMDRIA certified therapist and Approved Consultant, I am excited to be able to provide consultation for other licensed clinicians who have completed EMDRIA approved training.
I want to share what I know from my professional experience to help more people understand this therapeutic approach.
To understand EMDR, you first need to know a little about how we understand trauma.
Trauma Changes How the Brain Responds to Danger Signals
When something threatens a person’s survival and sense of safety, the whole body launches a stress response. The danger may come from a single event like an accident, illness or act of violence. Or the distress may be chronic and less visible, like years spent feeling rejected, bullied or overlooked at home or in school. It may come from a history of physical, emotional or sexual abuse.
During the stress response, the thinking brain shuts down. The brain stem, and the fight-or-flight center in the amygdala take over. They respond to signs of danger with a flood of stress hormones like adrenaline, and automatic reactions like a pounding heart and tight muscles.
These biological responses become memories, stored along with vivid impressions of feeling endangered or in emotional pain. With trauma, most times these memories form without the benefit of words. The body remembers the danger, without a sense of space and time that can put such memories in the past, using the thinking brain.
This is a simple explanation of how trauma can leave many people struggling with fears, flashbacks, or overwhelm, but without the higher brain’s awareness of how to cope with them. Only part of the brain remembers a terrible danger, but without knowledge of how to escape it.
Events others know are safe can cause great distress for trauma survivors. For example, fireworks can trigger terrifying memories of a life-threatening explosion, as if it’s real again. A loved one’s casual frown may trigger terror in a partner who grew up fearing a frown meant rejection or abuse is coming. Trauma hijacks the thinking brain and overwhelms the nervous system with alarms, stress hormones and sensations that may be easily triggered by everyday events.
This kind of trauma doesn’t respond well to reason, because the nervous system continues to respond in ways that bypass the thinking brain. It takes a special kind of treatment, what therapists call “bottom up treatment”, to connect the thinking parts with the trauma-altered survival system, so that one part of the brain can begin to soothe the others.
That’s where EMDR comes in.
What is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) is a form of psychotherapy developed by Francine Shapiro in the late 1980s. In EMDR, a person with trauma — the client — is treated with bilateral sensory input. The goal is to activate both sides of the brain with stimuli, such as side-to-side eye movements or hand tapping. These inputs mimic the rapid-eye-movement stage of sleep.
It takes the whole brain to help people process trauma. Processing allows trauma survivors to learn ways to manage the shutdown that can happen with traumatic memories. What’s more, it helps people learn to develop ways to stay grounded in the present moment, instead of feeling flooded by a body memory. Therefore, it enables someone with trauma to answer “yes” to: Are you safe now?
The Confusion About EMDR: Is It a Quick Fix?
Many people seem to believe that EMDR can treat trauma in a few short sessions. Is this true? Well, sometimes. But it totally depends on the patient, their situation and their history.
One of the myths surrounding EMDR is that it’s just a tool to process trauma. Actually it is a complete therapy model that includes eight phases of treatment.
These phases (which Shapiro describes in detail) are:
- Client History and Treatment Planning
- Body Scan
The first two phases are equal to stage 1 of Judith Herman’s 3-stage trauma processing model. Her model starts with safety and stabilization. For some clients, these initial phases may need to take place over an extended period of time before processing can occur in a safe and ethical way. This is why EMDR may work more quickly for some than others.
The EMDR Model
EMDR is not just a tool for processing trauma. EMDR is a comprehensive therapy model that a trauma informed therapist can use along with other therapies, such as Sensorimotor Psychotherapy, Internal Family Systems (IFS), etc. Sometimes results from EMDR are dramatic and can help clients progress quickly.
But as a therapist, you can’t just use EMDR as a trauma processing procedure. You must remember that phase 1 (History Taking) and phase 2 (Preparation and Relationship Building) of EMDR must happen first. And these, in turn, need to take place with the goal of stability. They are equivalent to stage 1 of Judith Herman’s trauma-informed model.
It’s necessary to incorporate safety and stabilization into a comprehensive therapeutic approach. Stability allows you to work with other models of therapy, depending on what the client needs, especially for those with a complex trauma history.
EMDR Needs to Include the Preparation Phases
In order for EMDR to work effectively, a person needs a solid, safe foundation from which to process the trauma. Their trauma history determines how quickly they are able to achieve this necessary foundation.
Tracy Ryan Kidd, my EMDRIA approved supervisor for over 15 years, said it perfectly:
“EMDR is an 8 phase, comprehensive form of psychotherapy. It involves a full history-taking and preparation phase to ensure that the client has the emotional regulation skills to cope with processing the trauma. For some adult single-incident events, like a car accident for example, preparation may only take a few sessions, but for childhood and complex trauma, preparation may need to be extended for a period of time. Most people aren’t aware of this and may be disappointed that it’s not a quick fix. However, if the client is properly prepared and ready to process, EMDR is the most powerful method of therapy I’ve come across in 25 years.”
Tracy Ryan Kidd, LCSW, EMDRIA Approved Consultant in EMDR (email communication, December 2018)
EMDR As a Treatment for Single Incident Trauma
If someone has a secure attachment style or doesn’t have a trauma history—and then they experience a traumatic event, like a car accident, a robbery or even going to war—EMDR may help them to resolve the trauma very quickly. This is because, without a complex trauma history, this person is more likely to already be in a stabilized place from which they can process the trauma, allowing phase 1 and 2 to move quickly.
EMDR as a Treatment for Complex, Developmental Ongoing Trauma (C-PTSD)
Complex trauma is identified by Judith Herman and other leaders in the field of traumatology as “the existence of a complex form of posttraumatic disorder in survivors of prolonged, repeated trauma.”
Essentially, complex trauma creates a long-lasting trauma imprint or response that impacts your brain and body enough to feel like it’s a permanent change. Using the example above, the neural pathways of the brain connect the sight of the frown and danger, for instance. For people with complex trauma histories, the mind and body may be in a chronic state of stress and hypervigilance, always waiting for the other shoe to drop. This is why I take a mind-body approach to trauma recovery.
Childhood trauma, attachment trauma and developmental trauma such as abuse or physical or emotional neglect will take longer to process with EMDR or any type of therapy. This is mostly because it takes longer to achieve a foundation grounded by emotional stability. It takes time to establish resources self-care, from which the patient can comfortably and safely process the trauma.
EMDR Should Not Re-Traumatize
EMDR is safe and effective, as long as the client achieves a consistent level of safety and stabilization first. It requires establishing a good, solid equilibrium through the first few phases of the 8 phase model.
A person who has survived a single incident trauma may already have a solid emotional foundation where they feel safe and grounded. However, a person with a history of complex or long-lasting trauma will have to build it. Again, you can’t begin to process trauma until safety and stabilization are present.
To be clear, EMDR is not exposure therapy — it’s not about having a person re-live the trauma and experience it all over again. Instead, the person must be able to view the event from a place of safety, in the present moment, while staying connected to their bodies. Without the ability to feel grounded and stay present (solid phases 1 and 2), EMDR could prove to be traumatic in itself by causing the person to re-live the trauma instead of experience it in a way that supports healing.
A Trauma-Informed Approach to EMDR
Because stability must come first, you don’t use EMDR to process trauma when a patient is actively abusively using alcohol, drugs, or something to help them feel less. You can’t effectively practice EMDR phases 3 – 8 with someone who has yet to experience a safe, trusting relationship. Without sobriety and trust between client and therapist, it is not reasonable to expect 1) that EMDR will work, or more importantly, that 2) EMDR processing will be in the best interest of the patient’s wellbeing.
You must remain in phase 1 and 2 of the EMDR model until safety and stabilization, including emotional regulation, can occur. This is why a trauma-informed approach is essential. Trauma-informed therapy and EMDR should be synonymous with phases 1 and 2 to achieve stabilization.
Unfortunately, when some individuals think of EMDR, they only focus on the reprocessing part, which includes phase 3 (Assessment, and forward). It’s important to know that, especially with complex cases of trauma, phase 1 and 2—safety and stabilization—could last quite a bit of time before phase 3 can even begin! The preparation phases are part of EMDR. EMDR can very nicely incorporate other therapeutic models, such as ego state work and somatic therapies.
Self-Regulation and EMDR
Before using any type of processing therapy, or tool, a trauma-informed therapist will treat each patient with a comprehensive approach to ensure they are within their window of tolerance. We have the knowledge and tools to help the patient learn to regulate changes in their nervous system and feel safe before taking any next steps. They will know they are worthy of self-care.
In my practice, we work with patients to help them expand their window of tolerance and regulate their emotions so they have better coping skills. These are part of a foundation from which to process the trauma.
In our approach, we incorporate EMDR and other treatment modalities to help clients process trauma. But we only use these modalities for processing after safety and stabilization have been achieved.
The trauma-informed approach is about building a relationship first, and then developing grounding and resourcing skills. From there, trauma can be processed and healed.
Is EMDR A Quick Fix?
I like how my colleague, Sheryl Aaron described EMDR:
“Is EMDR therapy transformative and capable of changing a person’s life for the better? Yes. Does it work more quickly than most other therapies? Yes. Are its results enduring? Absolutely. But EMDR therapy with complex trauma is a not a quick fix. It takes trust. It takes an understanding of the exceedingly nuanced nature of childhood trauma. It takes a firm grasp of attachment. It takes a client willing to use positive coping skills outside of sessions. It takes a very well-attuned therapist. And it does take time.”
Sheryl Aaron, LCSW, Certified EMDR practitioner (email communication November 2018)
Yes, while EMDR may work faster than other therapies to process trauma, getting to the place where the client is able to process trauma can take time. EMDR is a fabulous form of psychotherapy—but EMDR is not a quick fix!
For the record, I love when therapy and mental health awareness comes into the mainstream! Whether it’s mental illness being addressed on Broadway, growth after trauma being depicted on the big-screen, or EMDR being shown on The Affair, it all works to reduce the stigma around mental illness. This is a great time for mental health professionals to help more people understand available treatments.
- Complex Trauma: Yes, EMDR Can Help, but It’s No Quick Fix, by Sarah Jenkins
- Frequently Asked Questions, EMDR Institute – Eye Movement Desensitization and Reprocessing Therapy, EMDR.com
- Eye movement desensitization and reprocessing: A Conceptual framework by Sukanya B. Menon and C. Jayan
- What is the actual EMDR session like? EMDR International Association, Emdria.org
- What is EMDR? EMDR Institute – Eye Movement Desensitization and Reprocessing Therapy, EMDR.com
- Waking the Tiger: Healing Trauma by Peter Levine
- Trauma and the Body: A Sensorimotor Approach to Psychotherapy by Pat Ogden, Kekuni Minton, and, Clare Pain
- In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness by Peter Levine
- The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment by Babette Rothschild
- The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole by Arielle Schwartz
Blog Articles by Robyn E. Brickel
- Using the Power of Clinical Consultations for Therapists
- Good Self-Care for Therapists
- Understanding the Many Challenges of Toxic Stress
Tags: brain, childhood trauma, mental health, neuroscience, post-traumatic growth, Post-traumatic stress, PTSD, therapy, trauma