Explanation of Theory
Eye Movement Desensitization Reprocessing (EMDR) first began as eye movement desensitization, a simple behavioural form of desensitizing anxiety, and moved to a more integrative model of accelerated information processing.
EMDR is based on the notion that when a disturbing event occurs it can get locked in the nervous system with the picture, sounds, thoughts, and feelings of the original incident. This material can combine factual material with fantasy and factual material with images that stand for the actual event or our feelings about it.
Although continuing research has yet to have conclusive data explaining why this treatment is so effective, EMDR seems to unlock the nervous system and allow the brain to process the experience. It is believed that this may be what is happening in REM or dream sleep—that the eye movements may help to process the unconscious material.
Borrowing concepts from psychoanalytic thinking, EMDR states that most current-day pathologies are the result of old, painful memories. It is believed that the ongoing influence of these early experiences is due in large part to the fact that present day stimuli call up the negative affects and beliefs contained in these memories and cause the client to continue acting in a way consistent with these earlier events. Further, there is a lack of appropriate assimilation in the present such that the client has not been able to learn from the experiences of the past.
The term processing refers to the array of associations, conscious and unconscious, that the client experiences during a set of eye movements. Processing may be associated with other concepts, such as free association or mindfulness. So with this process we are seeking appropriate beliefs by peeling back the onion as it were, starting with the present and going back in time for a look at feeder memories of, for example, anxiety. It is important to remember that it is your brain that will be doing the healing and that you are the one in control.
Critical to EMDR practice is the principle that there is a system inherent in all of us that is physiologically geared to process information to a state of mental health.
While the system may become unbalanced due to a trauma or by stress engendered during a developmental period, with this adaptive resolve the system is appropriately stimulated and maintained in an active state by means of EMDR. Negative emotions are relieved and learning takes place that it is appropriately connected and available for future use.
Explaining EMDR Therapy
The client may come into treatment because he or she is in emotional pain and because of information gained later in life, which informs him or her that change is possible to a more adaptive (adult) perspective.
EMDR is a complex, eight-phase methodology that integrates elements of behavioural, psychodynamic, hypnotic, and family systems elements within its structure. In using EMDR my model of integration is such that I maintain the theoretical structure of EMDR while assimilating other approaches with it.
With EMDR it is understood that it is the client’s brain that does the healing and that interpretation of any kind may inhibit this process. Doing so has the potential to take the client out of his or her process when he or she listens to the wisdom of the clinician. The suggested EMDR mode is for the clinician to remain quiet during processing and only use bilateral stimulation, as long as the information is moving toward resolution. The only time it is appropriate to become more active in EMDR is when the processing appears stuck and the clinician needs to enable the healing to proceed by linking a positive neural network with a dysfunctional one.
The eight phases, described by EMDR’s originator Francine Shapiro in her book Eye Movement Desensitization and Reprocessing, Basic Principles, Protocols and Procedures (1995, pg. 67-68), are: client history taking, client preparation, assessment, desensitization, installation, body scan, closure, and reevaluation.
Client history taking evaluates the client’s presenting problem, assesses client coping styles and abilities, and endeavours to trace back to the past history earlier trauma that may have contributed to the intensity of the present-day reactions.
In this phase, the clinician evaluates a client’s readiness to begin desensitizing his or her traumas. Only after this evaluation is made does the clinician move on to the second phase.
In the client preparation phase, the client is assisted in understanding the explanations of how EMDR can help, a safe place exercise is performed, a stress management technique is taught, and safety and control factors are preformed.
In this phase, the client tries different forms of bilateral stimulation to determine which one feels most productive. Although the eye movements are what EMDR is most known for, alternating sounds and/or tapping may also be used.
In the third phase, assessment, a memory is chosen to work with, the picture of the worst part is picked, and then the negative cognition the person currently holds is obtained, as is the desired belief. Then the desired belief is measured on a scale from 1 to 7, with 1 being completely untrue and 7 being completely true (VOC/Validity of Cognition Scale).
After getting the VOC, the clinician asks the client to link the picture with the negative cognition to elicit the painful emotions that are held in a blocked or frozen state. The degree of severity is ascertained according to SUDS (Subjective Units of Distress Scale) from 0 to 10, with 0 being no distress and 10 being the most distress. At this time the clinician asks where these state-dependent feelings are held in the body, and the next stage immediately begins.
This fourth stage is what EMDR is most associated with, desensitization, with caricatures of clinicians waving their fingers in front of the client’s eyes. In truth, the client starts with all elements of the assessment phase in his or her consciousness and the clinician administers sets of at least 24 alternating (bilateral) eye movements, tones, or taps to enhance the feeling state. The clinician breaks periodically to check in with the client to observe what he or she is experiencing. Once the memory is desensitized down to a 0, the next phase begins.
This phase, installation, deals with installing the desired belief the client wanted (this belief was elicited during the assessment phase). Holding the picture of the trauma with the new belief and instituting bilateral stimulation until the VOC score is a 7, the clinician facilitates the desired belief to be installed.
The next phase is the body scan; here the clinician instructs the client to hold the target memory of the trauma and the positive cognition and scan his or her body for any residual tension. If any occurs, more bilateral stimulation is applied until the tension subsides completely.
The seventh phase is one of closure. There are differing techniques used to close down a session depending on whether the trauma has been completely reprocessed.
The final phase, reevaluation, starts at the beginning of the next session to evaluate the client’s progress during the week.
Cognitive Interweave:
The Cognitive Interweave is an active intervention used when bilateral stimulation alone does not shift the client’s brain into a more functional way of processing dysfunctionally stored information. Here, the therapist uses knowledge of the client’s history and characteristics to enable the client to shift into a more adult mode, releasing him or her from the dysfunctional way of experiencing his or her problems.
There may be many causes for processing to get stuck. For instance, perhaps the person has a blocking belief that interferes with his or her brain’s ability to keep information moving toward resolution. Interweaves are considered to fall into three categories reflecting the client aspects of responsibility, safety, and choice.
The cognitive interweave appears to yield superior results because it keeps the client in his or her process rather than having to be taken into his or her head to listen to the wisdom of the clinician.