Eye Movement Desensitization & Reprocessing [EMDR]
(Note: In fact, the name does not do justice to this technique: skin-tapping [tactile] or auditory stimulation on both sides of the body have similar results to eye movements. Some people use the terms “Bi-lateral” or “Bio-lateral Stimulation” instead of EMDR.)
Psychoanalyst David Grand calls this phenomenal and highly efficient new form of psychotherapy “Emotional Healing at Warp Speed“.
I was very dubious when I first heard this description but over the past four years of using EMDR an average of three to eight times a week, this flattering description appears to be quite justified! My colleagues who also have advanced training in EMDR and who use it, frequently, agree. In some cases, people have been in psychotherapy twice or thrice a week for many years without much alleviation of their suffering; often, after only one or two sessions of EMDR, their whole world can feel more comfortable, more friendly, more accepting, and much much safer.
From the field of Psychoanalysis concerns sometimes are expressed about psychotherapies that appear to work much faster to alleviate distress and specific symptoms: are the changes in the patient real and lasting, or do they just bring temporary relief at the superficial level, with the symptoms soon to be replaced by others?
EMDR is considered the most thoroughly researched form of psychotherapy yet. Through such modern developments as PET scans, we can actually see how effectively this therapy helps to process traumatic experiences in the brain as the activity of the brain shifts in the course of a single set of eye movements from the right hind brain area to the left and right frontal and temporal lobe areas. The changes in sensitivity to triggers, in conclusions about self and world and future, in the sense of security and safety of self, and in self-worth, appear to be permanent more than a decade after treatment!
How does it work?
Traditionally, the therapist sits quite close to the patient and, after a protocol of several questions, asks the patient to open his/her eyes and follow the therapist’s hand which is waved to and fro. The length of a set of eye movements is determined by different factors such as the patient’s level of distress, a certain length of time felt by some practitioners to be adequate, non-verbal signals from the patient suggesting a readiness for feedback, or indications of stuckness in a thinking-loop, etc.. In some situations practitioners use 24 to 50 movements to left and right each, as the basic set; sometimes the set can run for many minutes.
After each set, the patient is asked to give some feedback, which is written down by the therapist for later connections or reference.
Certain specific interventions called “Interweaves” that have a specific therapeutic stimulus quality, are sometimes added before the next set of eye movements commences. Very impressive results are obtained with specialised Hypnotic interweaves [see Maggie Phillips's work in this regard.]
The process continues until all aspects of the presenting problems situation are dealt with, or until a significantly lower level of distress is achieved. If this does not occur before the end of the therapy session, the patient is helped to access a safe and peaceful, conflict-free image or situation, which helps to contain anxiety and distress until the next session.
It is remarkable that during a session, often a single set of eye movements creates sufficient processing for the patient to feel immediately calmer in mind and in bodily symptoms of distress.
Some EMDR therapists do not use their arms to facilitate eye movements, but instead make use of machines with lights that flicker to and fro for the same effect.
For persons with lights-sensitive eyes, or blind people, one can also use auditory or tactile stimulation.
How long does it take?
The length of treatment is determined by many factors: for instance, whether the patient has had previous unresolved traumatic experiences, the age and personality of the patient, whether other persons had been hurt or killed, and especially whether there was a single-event trauma, or whether the trauma was of long and ongoing duration (such as physical, emotional, or sexual abuse over time).
Single-event traumata tend to be resolved quite effectively in 2 to 3 double sessions of EMDR, even such horrific for them to as being gang-raped, or being held hostage during a robbery with a limpid mine to one’s head, or being hijacked and shot, or having somebody throw themselves in front of your fast moving car or train…
For persons whose childhood was sufficiently traumatic for them to have developed a so-called Personality Disorder, 6 to12 months of once-a-week sessions can allow similar permanent changes to occur in the personality, as what may be found in three or more years of twice a week, or even thrice a week sessions of some of the psychoanalytically orientated psychotherapies. It must be noted though, that for such severe problems situations, one can only engage in the acceleration forms of therapy (like EMDR or hypnosis) within a stable therapeutic alliance, and when the patient has sufficient external support for the distress that might need to be managed. It might take several months, therefore, before one actually introduces the patient to EMDR, and there may be breaks of a week or more between consecutive sessions of EMDR, to facilitate processing and/or stabilisation of the patient.
What does it cost?
For adults it is often necessary to commence with one or two longer sessions of about 100 minutes each. Medical aids now allow for a double session per day. Even if the therapist gives a considerable discount for the double session, you may have to pay some extra money out of your own pocket for one or two sessions. Thereafter, it is sometimes safe to continue with normal 50 minutes or 60 minutes sessions.
Some therapists are prepared to work at medical aid rates but many psychologist specialists in EMDR are also prepared to offer substantial discounts, e.g. for cash payments. You may inquire about cost when you make initial telephonic contact.
What are the side effects?
Usually, for about one day after the first session you may find an increase in symptoms (for instance a patient who requires therapy for binge eating, may have the desire to binge even more than usual for a day or so after the first session, before the symptoms tend to be alleviated significantly). Many people also feel quite tired and drained, or may have a headache after the first session, mainly because they access strong emotions and may even cry quite a lot doing the session. A restful evening and perhaps some over-the-counter medication for headache tend to alleviate these side effects effectively.
I always advise my patients about what they can expect so that we can choose a time for the first session — and sometimes for subsequent sessions, when their lifestyle can allow them the necessary periods of recovery.
As with any psychotherapy, people might also feel strong emotions like anger towards persons who have injured them — which may be a problem if you are living in the same house, or working in the same office, as these persons. The therapist can help the patient to be alert for such reactions and to find ways of managing the situation until the emotions are processed. Fortunately, in EMDR and hypnosis, such processing can occur much faster than in some other psychotherapies. Irrationally strong emotions tend to abate very quickly during a few sets of eye movements.
Which problems can be helped with EMDR?
People who have had the opportunity to use the power of EMDR either as patient or as therapist, are in agreement that this is the most powerful form of psychotherapy for disorders like PTSD (Post-Traumatic Stress Disorder), every kind of phobia, loss and grief due to death or illness and even decision-making in the present. The healing that occurs both at symptom and deeper personality layers seems to be permanent. Using EMDR even after single-event traumata does more than just restore the patient to previous levels of functioning; the conclusions about self and world that change during EMDR, tend to generate to many other levels of conscious and unconscious experience, as evidenced by anecdotal report from patients, as well as by observations by clinicians, and friends and family of the patient.
Using EMDR in conjunction with other psychotherapies, such as Psychoanalytic Self Psychology, Client-Centred therapy, Schemata therapy, other forms of cognitive and/or behavioral therapies including group therapy such as Psychodrama, various forms of Hypnosis, body-orientated therapies such as Thought Field Therapy (TFT) and Emotional Freedom Technique [EFT], appears to speed up the process of healing dramatically and facilitate lasting strengthening and cohesion of the self.
I have found EMDR to be a powerful tool in just about every form of distress that clients have brought to my consulting rooms: anxiety and panic attacks, distress about arguments in the home, depression and mood swings, postnatal depression, decisions about things like changes in careers, whether to stay with or separate from a partner, physical illness of all kinds, recovery after surgery, preparation before surgery or other medical treatment, and all kinds of compulsive disorders including substance abuse, eating disorders and even Trichotillomania (hair-pulling). I must point out that there is not much literature on the successful use of EMDR in compulsive disorders, and for such disorders I always use it as part of an integrative psychotherapy approach for the specific problem and the specific patient.
Also note that EMDR is not a magic potion: it is not comfortable to work through and process the problems that have shaped us to the personality, with its specific defensive structures, that presents for treatment. EMDR sessions are anything but peaceful and calm; the work is painful and tiring for the patient. But the surgery we sometimes have to undergo for physical healing is also not fun: it can require the anaesthetic to make the pain manageable, as well as considerable recovery time. Compared to that, EMDR can be defined in terms of “a lot of healing in the long-term is worth a little bit of pain in the short term”.
You can find out more about EMDR in books by, for instance, Dr David Grand or by the originator of this remarkable psychotherapy, Francine Shapiro, or on the website for the EMDR International Association (www.emdria.org).
Clients in the Western Cape who wish to find an advanced practitioner of EMDR close to their home or work, can phone Reinette Steyn at her Milnerton practice
(Tel +27 021 555-4248 Office hrs; GMT +2)