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EMDR and Other Things

In 1987 Francine Shapiro went for a walk and found eye movement desensitization reprocessing as a therapeutic technique for traumatic experience with durable impact. Some thirty years later with a sizable body of research confirming efficacy, mechanism of action remains a mystery. But treatment has expanded to focuses on chronic pain, addictions, and attachment trauma among other things. So, what is EMDR exactly? It is first, like every effective therapeutic approach, a relationship. Without the essential ingredient of trust not much is likely to be uncovered, discovered, or seen in a new light. So, the first part of the eight-step process is devoted in part to nurturing a growing alliance between two people heading into an exploration with stark possibility. During this period the individual seeking help is wondering if the clinician is going to be helpful, not harmful, and, more importantly, are they trustworthy with delicate information. Exploring and uncovering meaning in experience typically involves difficult feelings which humans expend a lot of every to avoid. In an EMDR process we are proposing to actively lift layers of defense against those feelings. Initial exploration to identify what needs working on is akin to dipping one's toes in water that is possibly shark infested with the hint of a tsunami just around the bend.

After initially exploring the story that brings someone in for help, a sense of safety is attended to by developing temporizing internal resources. The theory behind this is an offering of respite from feelings that can come up in therapy and include fear, shame, guilt, grief, anger. What works for one individual, of course, does not fit all. For some this is a brand new experiences. An hour or more devoted to development of a place, a container, an ally, or a comforting creature in one's imagination- crow, eagle, bear, horse- can feel foreign and uncomfortable. For some it is an exercise in tolerating a sense of peace or discovering non-anxious relaxation for the first time. Once a reliable respite is developed, a focal memory is agreed upon, and together we see what comes up from there. Unlike talk therapy there is less directive guidance from the therapist. Instead, presence and suggestions are offered, while the individual follows the train of their mind observing what comes up in a free association manner, with bilateral stimulation. This latter can be a light bar to follow with one's eyes, handheld buzzers, or knee tapping, among others. While eye movements have been shown to be most efficacious, there are still only hypotheses about underlying mechanism. I think of it as creating space to let your mind wander and make connections around memory that wouldn't necessarily come up in talk. And as a depth therapist, this makes sense. It is one thing to understand this intellectually, it is an entirely different experience to have your mind present that reality in a way that you feel it as an emotional truth- it wasn't my fault, I am competent, I am allowed to be imperfect, I am worthy of love.

Actual processing can take a long time depending on the trauma(s) being addressed, but once this phase is complete installation, body scan, closure and reevaluation confirm anticipated changes associated with this therapeutic approach. New perspectives can include a deeply felt emotional recognition for the lack of control one had as a child, or as a smaller, physically or emotionally vulnerable person. In addition to transforming a distorted sense of responsibility for injury to a newfound sense of self-efficacy, understanding or empathy for the vulnerable person one was in a traumatic experience can be transformative. This is part of the work in a psychodynamic framework which seeks to help someone develop a solid sense of self, knowing who one is, feeling entitled to protections, recognizing imposition, and feeling empowered to navigate this effectively without being overwhelmed by guilt or shame or self-doubt. Integrating EMDR into a psychodynamic framework offers another pathway to understand self, our self in relationship, while expanding choices that were previously hidden or inaccessible. It increases tolerance of difficult and painful emotions and experiences as they come upon us, as they do in an actively engaged life.


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