What is EMDR?
EMDR is a form of therapy that integrates some new and unique techniques with many elements of traditional psychotherapies. In many forms of psychotherapy, clients are encouraged to explore past experiences which were distressing or even traumatic, with the goal of understanding how these experiences have affected them in the past in order to change how the experiences affect them in the future. In EMDR, the way the client works through or “reprocesses” earlier memories is unique, and from our experience, remarkably fast and powerful.
To understand how EMDR works, an analogy might be helpful. One of the brain’s main functions is to make sense of or “digest” our experiences, in a similar way that our stomach and intestines digest our food. Our digestive systems takes out nutrients from our food that our bodies need and then eliminates what we don’t need. In a similar fashion, the brain will take out what we need to understand or learn from our experience and then eliminate the rest – meaning we will discard or eliminate experiences that are not helpful to us. When an event or experience is particularly emotionally charged or traumatic, that event can be like a large piece of food stuck in our throats – it is too big to get down to the digestive tract. Psychologically, a similar thing happens with emotionally charged events, they are too large to be digested psychologically, and so they tend to remain “stuck” in our minds. EMDR is very helpful in getting charged experiences “unstuck” and ready for processing or being made sense of. EMDR also helps our minds understand old experiences in new ways, even if we did not believe that these old events were particularly emotionally charged.
In an EMDR reprocessing session, the client is initially guided to remember a distressing experience which affected the client previously, and which is related to the client’s current difficulty achieving their goals. Even though for many people the link between current difficulties and early experiences is not immediately understood, coming up with a relevant early memory to work on is usually much easier than clients expect. Once the client has a distressing memory in mind, they are asked a series of questions designed to increase awareness of what is in consciousness, as well as to assess the level and type of disturbance. Once the client is fully aware of the memory, bilateral stimulation (see below) is applied and the client is instructed to bring that memory to mind.
The client starts with their awareness of the memory and lets whatever comes to mind, come to mind. The client is typically mostly silent during an EMDR reprocessing session, sitting back with their eyes closed and simply observing the stream of images, body sensations, thoughts, emotions, sounds, and sometimes even tastes and smells that come to mind. Many clients describe the processing as being similar to watching a movie or TV screen. Sometimes it seems that forgotten memories are uncovered. Sometimes what’s there is extremely vivid and intense, at other times vague or distant. Scenes may shift perspective, and new insights may arise. The important part is that the client not attempt to control what comes to mind, not try to make anything happen or prevent or shift anything that is happening, but that the client “lets go” and allows whatever unfolds to pass through their minds. As processing continues, the way the memory is stored changes. Typically, it changes from something that is distressing to something that causes no distress; from something that caused negative feelings about the self at the time, to something that now brings up positive feelings about the self.
In order for EMDR to be safe and effective, it is important that the client and therapist have a strong and trusting relationship. In an EMDR reprocessing session, the therapist may interrupt periodically to ask something like “What do you notice now?” Often, the therapist simply listens to the client’s brief description then says “go with that,” instructing the client to continue processing. A key role of the therapist is to provide a safe base so the client can let themselves go wherever their mind unfolds. The therapist guides the client back to the original memory when the client’s processing takes them too far afield, intervenes with minimal necessary force when the client’s mind becomes “stuck,” encourages the client to make it through difficult material, and comes to the client’s rescue if they become overwhelmed by something unexpected, or by any emotions or memories the client feels are too much to handle. The therapist also keeps track of the time, and if it does not appear processing will complete spontaneously before the session is over, assists the client to leave off at a positive place.
What is Bilateral Stimulation? What do the headphones, hand buzzers, or eye movements do?
The client receives bilateral stimulation of some kind while they process distressing material. Bilateral stimulation is providing some kind of sensory input (sounds, touch, vision) that is given in such a way so that the information goes to the two sides of the brain in an alternating sequence. This may sound complicated, but is really as simple as wearing headphones and hearing a sound alternate between the left and right ears; or having a hand buzzer vibrate in the right hand and then next in the left hand and so forth. While not entirely clear why, it appears that this bilateral stimulation is an important component of the procedure. There are several hypotheses about the mechanism by which bilateral brain stimulation is helpful. One hypothesis is that by stimulating the right and left hemispheres of the brain in sequence, this encourages the two hemispheres of the brain to more actively communicate with each other and so produces a more integrated experience. A second hypothesis for why the bilateral stimulation is effective is that the bilateral stimulation promotes a sense of dual awareness – of keeping the mind in the present moment while at the same time it goes somewhere else. This may reduce the distress associated with what is being processed, as well as help the mind remain open to processing the material in new and different ways.
Can everyone benefit from EMDR?
No. EMDR is not recommended for people who are unstable, self-injurious, at high-risk of drug or alcohol relapse, or dissociative. It is not a recommended treatment for all mental health disorders, though we have often found it to be very helpful for the treatment of anxiety, depression, and anger problems as well as for working through trauma. We have also found EMDR very helpful for executive performance enhancement and personal growth. EMDR seems to not be effective for people who don’t feel much at all when they think of apparently distressing material, or for people who are extremely and easily overwhelmed by distressing material. Often, people who can’t feel anything or are too overwhelmed to do EMDR early in treatment become ready to do EMDR as treatment progresses in more traditional ways.
What are positive resources?
A new technique that developed as a component of EMDR therapy is the use of bilateral stimulation while the client relaxes and allows their unconscious mind to construct positive places, figures, qualities, and other positive associations. The bilateral stimulation seems to strengthen these positive resources so the client can bring them easily and vividly to mind in their daily life. When brought to mind, they bring up good feelings of calmness, safety, being loved, being protected, strength, courage and so on. Positive resources are very helpful for many people, and we may recommend them as part of many client’s treatment plans, whether or not we also recommend EMDR memory reprocessing.
Is EMDR similar to hypnotherapy?
EMDR and hypnotherapy are similar in that they both seem to get to the unconscious mind quite quickly and powerfully. One of the main ways that hypnotherapy works is by the therapist making suggestions to the client’s unconscious mind. The power of suggestion is not typically used in EMDR. While hypnotherapy can very occasionally induce false memories (if misused), EMDR does not, though EMDR may make previously distressing memories vague and difficult to recall. You don’t have to believe EMDR will help for it to work. We really enjoy working with clients who are completely skeptical about EMDR, only later to tell us how powerful it was!
Are there any risks to doing EMDR?
Yes, we are aware of two risks. First, distressing memories have a tendency to become vague and no longer distressing. If you will be testifying in a court of law about something distressing that has happened to you, you may need to talk with a lawyer about whether EMDR is advised prior to completion of your legal case.
Second, any traumatic experience you have had, even if you haven’t told anyone about it or even thought about it for a long time, has a tendency to come out. When something previously traumatic comes up, the memory can be extremely vivid, as if it were happening again in the present moment. Although it can be extremely healing to process any trauma from your past, we must both be prepared to do so. We don’t want you to be re-traumatized by reliving such an experience before you’re ready to handle the emotions and memories that arise. It is very important that you tell us before getting started with EMDR if anything traumatic has happened to you in the past. We will help you assess if you’re ready to handle this now, and if not, we can work together on giving you the skills and resources you need to reprocess the trauma successfully.