This page is devoted to some of the frequently asked questions about EMDR, the EMDR process, and how it compares to other forms of therapy. If you have additional questions about EMDR that are not addressed here, please contact Jane on 612 414 0383 or send an email through this website.
Because EMDR is so associated with posttraumatic stress disorder, many clients feel that it would not be an appropriate treatment for their specific concerns. Yet EMDR can be effective for all manner of issues, including anxiety, insomnia, conflict avoidance, or simply a tendency to get angry or upset in a way that is out of proportion to the issue at hand.
The key to finding relief from symptoms is to understand their root cause. While talk-therapy can hazard a guess at what may be at the bottom of our difficulties or over-reactions, the link will not necessarily be "logical" or obvious, which means that a considerable amount of fishing and hypothesizing may be required to get there. Furthermore, even if the root cause can be unearthed, the process of talking and analyzing is mainly carried out in the left-prefrontal cortex - the logical, rational part of the brain - as opposed to the limbic system where the data is actually stored. Thus, while talk-therapy enables clients to understand and explain the reasons for their symptoms, it is limited in its ability to enable permanent change.
EMDR, on the other hand, not only pinpoints the root cause of an issue with far greater efficiency and accuracy than talk-therapy, but also engages the limbic system in a way that leads to permanent and more adaptive changes in our automatic responses. As a result, the process of EMDR tends to be much quicker and effective, resulting in a shorter time in therapy with more noticeable results that are sustained over time.
What is the process for EMDR?
All clients - whether they are coming for EMDR, couples therapy, talk therapy, or whether they don't know quite what they're coming for - start out in the same way. Jane spends the first session taking a genogram - or family map - to learn about the relational and emotional legacies that each client grew up with, all of which provides helpful context for the therapy. In the second session, Jane works through the big intake form with the client, learning about their symptoms and the issues that brought them to therapy. This information is used to make a diagnosis, to create a treatment plan, and to form a baseline against which improvements can be measured.
The third session is when preparation for EMDR usually begins. The process will differ from client to client depending on the nature of the issue and the symptoms that the client is experiencing. Regardless of the situation, however, it is important that every client is equipped with resources that can be deployed when memory work becomes especially upsetting or daunting. To this end, Jane teaches a series of techniques such as containment, state-shifting, Thought Field Therapy, guided meditation and use of the Emwave® bio-feedback device.
In the case of a single incident, recent trauma, processing with EMDR will usually begin in the fourth session. Alternatively, if the issues are more pervasive, the fourth session is when a plan is created for targetting upsetting memories that may well go back to childhood. Again, the precise timing will depend on the client, the nature of the trauma being addressed and the level of the symptoms. Some clients prefer to spend several weeks talking and building a trusting relationship while others are chomping at the bit to get going.
In the case of a single incident trauma, the client is asked to bring to mind the most disturbing aspect of the event along with the emotions, bodily sensations and any beliefs about the self that were set in with the event. The client is also asked for a score on a 0-10 scale of how disturbing it is to recall the event. As eye-movement (or alternative bilateral stimulation, such as beeps in the ears or pulses in the hands) is added, the client will be asked to "focus on that disturbing aspect". Gradually, the brain pieces together all the parts of the event - some of which may have been forgotten - weaving the incident into a cohesive story that can be recalled with less and less disturbance as EMDR continues.
When there are a series of traumatic memories to be worked through, Jane has three different methods of devising a plan. The most effective (in her experience) is to have the client recall a recent incident where there was an over-reaction or strong sense of feeling. Jane then asks the client to notice any sensations they feel in the body when recalling the event. Provided that the client notices a sensation (not all do), Jane asks them to "float back" and allow the sensation to bring to mind any times where they might have felt the sensation before. Often clients find that a string of memories come to mind that they wouldn't necessarily have otherwise thought of. Jane then organizes the memories by chronology and by disturbance. Typically, she will then start EMDR with the first chronological memory, and when that is cleared, go with the worst memory. By organizing the process in this way, the disturbance of all the memories on the plan is typically reduced significantly.
Frequently, however, depending on the history and the nature of the disturbance, clients are unable to locate a body sensation, or they may have difficulty "floating back". Jane will then ask clients for their sense of which memories are most disturbing for them, or alternatively, for a timeline of events as far back as they can remember. Ideally, EMDR is most efficient if a memory can be found from when the client was between 4 and 8 years of age, but this is not always possible. Sometimes it is important to clear more recent or more disturbing memories first.
A small number of clients have difficulty articulating a specific issue, but suffer from a sense of needing to fight for survival. This sense can often be indicative of very early or even pre-natal trauma. If further discussion confirms that this is likely the case, Jane will utilize a sensory approach to allow the body to access any sensations or emotions from the pre-natal and pre-verbal years - a powerful intervention for many clients who may have experienced early abuse, neglect or separation from their primary caregiver. Sometimes the pre-natal and pre-verbal work is all that is needed; other times it forms the basis of more traditional EMDR work. Every client, and every story, is different.
How long does EMDR take?
This is a very common question and the answer is always "it depends". It depends on the nature of the issue, the working relationship of the therapist and client and the client's readiness to access disturbing material. Frequently, clients have read the literature on EMDR that discusses recovery from incidents such as the Oklahoma bombing, and as a result have the expectation of being completely healed within 2 or 3 sessions. It is true in cases of these "single incident, recent traumas" that healing can happen in just a few sessions if the client seeks EMDR right away and there has been no other trauma in the client's history.
More often, however, clients come to therapy because they are feeling stuck, or because they have "seen this movie before" but have no idea how to change it. Sometimes, a specific event - such as a case of sexual harrassment or an ugly fight with a spouse - brings up past life experiences that the client had long buried, and they don't know why. In other cases, the true nature of the trauma can be very gray, implicit and difficult to pin down, which is often why clients have allowed it to rumble around unaddressed for so long.
To return to the original question, Jane usually offers a ball-park of 9 months to a year for EMDR therapy, although significant improvements are felt much earlier than that. Sometimes clients ask if they can come for longer or more frequent sessions to "get better more quickly". While this is appropriate in the case of the single incident, recent trauma discussed above, Jane finds that most clients need room to consolidate all the information that emerges with EMDR, and that the time between sessions is as valuable as the sessions themselves. Many clients dream vividly during the course of therapy which Jane labels "free EMDR" and encourages clients to make plenty of space for that to happen.
Does EMDR work for everyone?
Theoretically yes, EMDR should work for everyone. In practice, however, there are a number of factors that need to be in place for EMDR to be effective, and sometimes, not all of these factors can be achieved. One of the key factors for EMDR to work is what's known as the "window of tolerance", whereby the client needs to be feeling some level of distress over the past event being targeted while still being able to remain grounded in the present. If the client is feeling too much distress and becomes flooded (losing the connection to the present), or if the client is numb to the event and feels nothing (unable to connect with the past), EMDR cannot be effective. It is important to realize that the shutdown that occurrs during flooding or numbness is not something that the client has control over - indeed brain scans comparing traumatized people with non-traumatized people show levels of brain activity to be significantly less for traumatized people, even when they are supposedly "at rest" *. It is simply a reflection of the severity of the trauma that the brain must go to such lengths to keep it out of consciousness.
In some cases, provided that the clinician is appropriately skilled and the client is willing, both the clinician and client can work together to help the client reach a point where "dual attention" to both the past and the present can be achieved without the physiological reactivity causing the brain to go into shutdown. Much of this work requires learning how to become aware of our emotions, and specifically, where we feel them in the body. This is a concept that many people are initially baffled by, but over time it does help to increase tolerance for negative affect, and thus enable the client to be helped with EMDR. This can often be a very gradual process, however, and both client and clinician need to be patient and willing to work at it. In cases where the client struggles with managing emotional regulation, a course of DBT (dialectial behavioral therapy) may be helpful before EMDR is attempted. In other cases, treatment with neurofeedback**, acupuncture or yoga can all help significantly in reaching a place where healing can happen.
* Lanius, R. A., et al (2005), cited by van der Kolk, B. A. "New Frontiers in Trauma Treatment". Institute for the Advancement of Human Behavior. Park Plaza Hotel, Bloomington, MN. 7 October 2011.
** van der Kolk, B. A. "New Frontiers in Trauma Treatment". Institute for the Advancement of Human Behavior. Park Plaza Hotel, Bloomington, MN. 7 October 2011.
If EMDR is so effective, why do so many organizations (including the VA) still promote CBT as the best treatment for trauma?
This is a big question, and one for which there is no straightforward answer. CBT, which stands for cognitive behavioral therapy, is a talk-therapy process that has been around since the 1950s. It is favored by government institutions, psychiatrists and health insurance companies, partly because it requires significantly fewer sessions than psychoanalysis (the main therapeutic alternative during the 1950s) but mostly because its standardized process allows results to be measured in clinical trials. Thus, CBT can be "proven" to work in the same way that medication can, and is therefore considered acceptable to the medical profession, especially since the majority of studies suggest that a combination of CBT and medication is the most effective treatment. It is important to remember, however, that many of the intangibles of therapy, such as the quality of the relationship between therapist and client, do not lend themselves to being easily measured in the clinical trial process. This doesn't mean that other therapies don't work; it simply means that they can't always be measured in a comparable way. It is also important to remember that many studies don't address the issue of whether the improvements are sustained over time, preferring simply to measure the results achieved at the end of a short course of therapy.
One of the strengths of EMDR is that it can be measured in the same way as CBT, and there are a significant number of studies that demonstrate that it is considerably more effective than CBT and medication in the treatment of PTSD. The gains of EMDR are also demonstrated to be much more sustainable over time than either CBT or medication*. But it can take many years for the prevailing scientific view to evolve, especially when new findings create challenges for what has always been understood. Because EMDR has only been around for 20 years as opposed to CBT's 60 years, the body of empirical evidence that "proves" it works still has a way to go to catch up. It is also important to note that the majority of funding for such trials is supplied by drug companies, who naturally have a vested interest in the continued need for medication. Since successful treatment with EMDR usually negates the need for medication on a long-term basis, logic would suggest that fewer research dollars would be donated for research on EMDR than for other forms of therapy where therapy and medication is indicated as being more effective, the net result of which is a fewer number of EMDR studies. Finally, it is worth pointing out that CBT lends itself to clean, rational explanations, which tend to gain greater acceptance in the scientific community than issues of emotion, sensory reactivity, REM sleep and finger-wagging - all of which make up the explanations for EMDR's effectiveness. Add to that issues of politics, finances, face-saving and job-protection and it can be very difficult for new procedures to be adopted, even if clinical trials have "proven" that they work.
The key explanation for why CBT cannot be as effective as EMDR in the treatment of trauma, however, is that CBT relies on the cognitive, rational part of the brain (the pre-frontal lobes) to over-ride the more instinctive, primitive parts of the brain known as the limbic system and the brainstem. Yet simply recognizing that a traumatic reaction is irrational does not make it go away. Traumatic reactions are intended to keep us alive, and therefore when triggered, will shut down the cognitive part of the brain so that we can react instinctively and rapidly to whatever threat presents itself, without pausing to weigh up our best option. In order to treat traumatic reactions, we need to re-wire the brain's protocol for responding to specific stimuli, which means working with the sensory and emotional parts of the brain as well as the cognitive parts. It is this integration of all of the parts of the brain that EMDR does so very well, and why it is so effective.
* van der Kolk, B.A. et al, 2007. A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68.
This page was written by Jane McCampbell, MA, LMFT to answer many of the questions that clients ask about EMDR. Please do not use any of the information contained on this page without explicit, written permission and appropriate citations. If you have additional questions that you would like Jane to answer on this page, please contact her through this website by clicking here.
© 2011, Jane McCampbell, MA, LMFT
EMDR Therapist and Licensed Marriage & Family Therapist
EMDRIA Certified and EMDR Institute Trained
Jane McCampbell Counseling Services, LLC
Minneapolis, St Paul, Minnesota (MN)