CHAPTER 1
WHAT IS EMDR, AND HOW DOES IT DIFFER FROM THE PSYCHOLOGICAL TREATMENT METHODS THAT PREDATE IT?
EMDR stands for Eye Movement Desensitization and Reprocessing:
Desensitizing the intensity of the emotion felt while recalling the traumatic event.
Reprocessing the memories of the traumatic events that did not undergo the needed processing in real time.
Eye movements were originally used to make sure that the two hemispheres of the brain took an active part in the processing procedure (see chapter 2 for how EMDR works). Today, additional methods are used, such as earphones playing sounds intermittently to both sides of the brain, or palm vibrations firing off intermittently.
The method was developed by Dr. Francine Shapiro, a psychologist, in 1987.
As mentioned, the method was originally used to treat post-traumatic events for American servicemen dealing with traumatic memories after the Vietnam War. Later on, the method was used in other traumatic circumstances as well. Since the treatment of traumatic events is funded mainly by governments and insurance companies who require definitive proof of its effectiveness, EMDR is among the most thoroughly researched psychological methods, and many studies attest to its effectiveness within just a few therapeutic sessions. Only after EMDR had time and time again shown its effectiveness in difficult cases it was then used with less difficult situations.
Remember, EMDR is a psychological method in every respect. This means that only therapists trained in mental health therapy (mostly requiring a Masterâs degree as a minimum), and who have been specifically trained in how to administer EMDR, are licensed to treat using this method. EMDR is recognized by leading associations such as the American Psychological Association and the American Psychiatric Association.
And yet, it is different from all psychological methods that pre-date it.
First, compared to previous methods it is usually found more effective (better results, or equivalent results in a shorter time period). Such differences in duration of treatment and degrees of effectiveness are unprecedented in the history of psychotherapy.
Second, defining the problem and the possibility of treating it, and the focus of the therapy, are different from all other forms of psychotherapy. In EMDR, the negative beliefs, the emotional suffering, and the ânon-advancing internal storyâ (what is called paradigms in the personal development field) are not the problem. Those are the symptoms of an experience, or previous life experiences, that our brains did not manage to process in real-time. Those unprocessed memories are the problem.
At certain times in our lives, events took place that overwhelmed us, whether because we were not at our best at the time, or because of the severity of the event; our brain was âfloodedâ and could not properly process the event when it happened. The result was that the impressions of the event â thoughts, feelings, body sensations, pictures and smells â were kept unprocessed, in raw form, by the brain.
When a present event connects to such a traumatic event from the past, it serves as a trigger for the activation of the unprocessed contents. These contents, which were kept in their raw state â thoughts, feelings, emotions â rise up again in their raw state. In such a situation, we feel in the present as we did while the past event was happening.
With EMDR, we locate the traumatic memories that are responsible for our present-day distress (in EMDR understanding those connections can be done very quickly, and it usually takes 1-3 sessions), and then we begin to reprocess them.
Once the event has been reprocessed, new events in the present will not serve as triggers for the same feelings that were experienced in the past. The reactions in the present stop being the result of the unprocessed events from the past. In accordance with the basic assumptions of the therapy, once the reprocessing has finished, the symptoms of the negative beliefs, or negative internal emotions that lead to the negative feelings, will disappear. The treatment with EMDR includes an abundance of insights and âfalling chipsâ, but unlike most other methods, the client achieves these insights on his own because of the process, and just as importantly, he does so in a very short time.
In EMDR, we do not provide tools to deal with the problem, but rather remove the problem. When the problem is removed, the symptoms cease to exist. You can think about it like this:
A man was walking along a riverbank. As he was walking, he noticed people in the water who were drowning, so he began to reach in to save them. He kept saving until one day he got up and left. When he was asked, âWhere are you going? Who will save all these drowning people?â the man replied, âI am going to see who is throwing them off the bridgeâ.
There are therapy methods in which the basic principle is to create an awareness of responses, and the triggers that set them off. Slowly but surely clients are helped to become aware of the fact that, not only are there âpeople in the waterâ (i.e., there is a problem that must be solved), but there is also âsomeone who is throwing them into the waterâ (past events).
Different therapy methods focus on changing the response. With these methods, clients learn how to âbetter help the people in the waterâ (representing distress or inhibitions at present), to more quickly realize that someone is about to drown. Therefore those methods try to improve swimming techniques, to quickly get that person out of the water so that the time in the water is not too long â meaning, that the clients are provided with tools to deal with the times that they feel distressed. For example, a client suffering from exam anxiety will practice relaxation techniques when he becomes anxious, or techniques to fight off the anxiety-causing thoughts.
In contrast, the EMDR approach works on changing the stimulus â so that the circumstance will no longer provoke negative emotions to begin with. We do not provide the tools, but rather remove the âhooliganâ who threw the people off the bridge (while working via a focused, fast, efficient method to neutralize the effect of past events, so symptoms are not activated in the present).
A demonstration of the differences between treatment methods on a common type of performance anxiety, such as exam anxiety:
Exam anxiety, in its narrowest sense, is an anxiety that appears in students when tested, either orally or in writing, by someone at an educational institution. In its wider sense, a person could experience such anxiety at job interviews, evaluation centers, presentations in front of an audience, and even during sex. Therefore, those who survived the time in school and thought they had left such anxieties behind them, often find out that this is not the case.
In traditional therapy, the therapist, alongside the client, tries to find the source of the anxiety. Focus is put on the past; they are helped to understand how their parents pressured them, and how their self-esteem was based on âdelivering the goodsâ. In this way, ultimately, the client becomes aware of the sources of his anxiety. Unfortunately, mere awareness does not help it disappear.
In the biofeedback method, clients are helped to acquire tools to monitor the anxiety, so that when they feel it is coming near, they can relax it; using such methods as breathing, etc.
In Cognitive-Behavioral Therapy (CBT), clients are taught to argue with the âdistorted thoughtsâ, such as the thought that they must âdeliver the goodsâ, and to find an alternative way of thinking every time the anxiety strikes. The premise is that in this way the anxiety will fade. At the same time, clients are exposed to exam-like situations in order to practice.
In EMDR therapy, clients locate the key events that caused these sensations and made the connection between an exam state and the anxiety and then reprocess them. After processing the key events related to the source of the anxiety, the person will not feel anxious about exam situations in the future. This means that the client will not acquire tools to deal with the anxiety that is brought on by the exam state, like those in the previous two methods discussed, and will not get homework like in CBT, but will rather undergo a quick and focused process that will lead to the exam no longer provoking anxiety.
The unique aspects of EMDR can be summarized in a sentence I heard from a client in her late 20âs who had been in other forms of therapy prior to starting EMDR for almost 15 years (!) without achieving real progress. For her, what could not be attained in 15 years using the traditional methods, such as Psychodynamic and Cognitive therapies, could be attained with EMDR in just a few months. Towards the end of our sessions together, she told me, âIn the past, when the therapist told me that something that happens to me is because of my past, it would cause me to get even more depressed. What can I possibly do about my past? Itâs not like I have a time machine. Today, every time I find out that something that bothers me is because of my past, I am really glad, since I know that I can bring it up at the next EMDR session, and it will not bother me anymoreâ.
For whom is the treatment appropriate?
As mentioned, originally, the method was developed for treating post-traumatic stress. The first clients were veterans of the Vietnam War, as well as sexual assault victims. The findings were quite different from findings of previous treatment methods; people who had suffered for years and decades, some taking part in therapies which were of no help, recovered from the post-trauma symptoms within a few sessions. Before that, post-trauma was considered a chronic and ongoing disorder.
After having been found effective time and time again EMDR was expanded in three different directions:
First, for people whose condition was less severe than that of post-trauma. For example, people suffering from anxiety, depression, phobias, life crises such as divorce, difficulties in establishing intimate relations, low self-esteem, etc.
Second, for people who wished to improve achievements in various areas. EMDR was found to be effective in improving academic achievements, including treating exam anxiety, working with athletes before competitions or during recovery from injury, working with performers such as musicians and actors, businessmen, dealing with business crises and removing internal inhibitions from business and personal growth.
Third, for people with severe mental and emotional disorders, such as those suffering from addictions, severe psychiatric disorders such as bi-polar disorder and schizophrenia, dissociative disorders, and even people with mental retardation who underwent trauma. In such cases, EMDR could be incorporated, preferably with more extensive therapy. This book will focus on the first two groups.
For what ages is EMDR appropriate?
EMDR can be used to treat children in whom treatment was found to be faster when compared to adults. At very young ages, the treatment is done in the presence of the parents.
No one is too old for EMDR therapy, as long as the individual has the ability to cope. I have personal experience treating clients in their 70âs, and have heard from colleagues overseas, and in Israel, about the success of EMDR therapy for people in their 80âs and 90âs.
Summary: In which kinds of situations is EMDR useful?
Eliminating internal obstacles to achieve your personal best such as: Athletes looking to boost their performance results before a big race; students before exams, SATâs, etc.; artists before performances and auditions; business people looking to improve their ability to mount successful presentations and negotiations, and improve their self-worth before a request for a raise or promotion.
Dealing with life crises such as: Betrayal, divorce, unemployment, birth trauma, etc.
Changing repetitive behavioral patterns such as: Difficulty forming intimate relationships, recurring bad decision making, tantrums, etc.
Dealing with anxiety and phobias such as: Fear of public speaking, performance anxiety, driving anxiety, fear of dogs, dental phobia, recurrent nightmares, etc.
Dealing with traumatic events such as: Sexual assault, physical assault, car accidents, terror attacks, death of a loved one, etc.
Suffering or inhibitions can be the result of medical or biochemical conditions and/or the result of life experiences that have been experienced in the past or being experienced today. When it comes to mental suffering or internal inhibition caused by life experiences, EMDR can be helpful.
How is it that EMDR can be used to treat so many types of problems?
Despite, of course, the differences in the details, the neuropsychogenic mechanisms causing the distress in the present because of events in the past, are mostly the same. In EMDR it is not the role of the therapist to scratch his beard or give commentary, or give advice based on personal experience. His job is to help complete the processing of the events that are at the heart of the present inhibition or distress. The details come from the client, not the therapist. I will explain more about this in the next chapter.
âI am 40 years old, married with 4 children. I live in a small village with my family. I work and happily raise the children, surrounded by family and friends; trying to catch up with time. Two years ago I gave birth to my youngest son, a fourth pregnancy that started with the calmness of a mother who had been through three pregnancies and thought she knew everything.
In the 24th week, in the middle of a family vacation, I started feeling pressure from labor pains and was put on a very long bed rest⌠weeks of lying in bed worrying about the little baby inside me. I made daily calculations and was incessantly worried about his weight, his chance of survival, birth defects and other endless concerns and...