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  • Writer's pictureMaire Daugharty, MD MS

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 energy to avoid. In an EMDR process we are proposing to actively lift layers of defense against some of 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 experience. 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. And 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. 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 more deliberate or goal oriented talk. Sometimes connections or realizations come as a surprise and this is one of the rewards of hard work in therapy. As a depth therapist, this makes sense. It is one thing to understand intellectually. It is an entirely different experience to have your mind present that reality felt as an emotional truth- it wasn't my fault, I am competent, I am allowed to be imperfect, I am worthy of love. For some these are life altering realizations.

Actual processing can take a long time depending on the trauma(s) being addressed, but once this phase is complete, phases of installation, body scan, closure, and reevaluation confirm hoped for 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 physically or emotionally vulnerable person. In addition to transforming a distorted sense of responsibility for one’s injury, new empathy for the vulnerable person one actually was in that traumatic experience, can be transformative. True of many therapeutic frameworks this is a part of the work we do in a psychodynamic approach. While EMDR helps understand and lay to rest distorted core perceptions about self, depth work seeks to help someone develop a more formed self: boundaried, entitled to protections, recognizing imposition and feeling empowered to navigate this without being overwhelmed by guilt or shame or self-doubt. Integrating EMDR into a psychodynamic framework offers another pathway towards self understanding, our self in relationship, while expanding choices that were previously hidden or inaccessible. And it increases tolerance for the difficult and painful emotions and experiences as they come upon us, in an actively engaged life.


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