I’ve already described the role EMDR can play in trauma treatment and given you some specifics about what the 8 phases look like. Even so, maybe you still have some questions or concerns. Let’s face it, EMDR sounds a bit odd when first described! It makes sense to have questions and do your research before considering an unfamiliar technique. If you are already in therapy, this is a good conversation to have with your therapist.
I really appreciate that some of my readers have shared their questions about EMDR because I believe they illustrate some common questions others may have as well. and I plan to answer them here and share concerns of my own too.
As with any type of therapy, EMDR is only as good as the therapeutic alliance. Creating a collaborative therapy relationship requires trust, something that is understandably problematic for many trauma survivors. This is one issue that needs to be worked on before beginning EMDR. Every client is unique; only you know when you are there. If you do not yet feel safe enough in your therapy relationship, it may be premature for you to consider EMDR. What feeling safe means is also a big topic! For our purposes here, consider the following: Can you say no or let your therapist know something isn’t working? Are you able to ask for extra help or contact your therapist if in crisis in between sessions? Are you able to honestly report your feelings, thoughts, sensations in the moment? These are examples of the kind of safety in relationship needed for EMDR.
Good preparation to me means that before starting EMDR I want to work on basic Phase I trauma treatment stuff: safety in the form of establishing a collaborative therapeutic relationship and stabilization in the form of basic distress reduction/management skills (grounding, relaxation, self-soothing). Clients who have significant issues with dissociation ( not just but certainly including those who have Dissociative Identity Disorder [DID]) may need to work first on getting and staying present, more internal communication and cooperation between internal parts before considering EMDR.
EMDR can be used to help with some of the stabilization process. Part of the prep work for EMDR involves building coping skills to tolerate the feelings that may get stirred up. One of my readers addressed this issue with the following question:
“I’ve heard that EMDR can sometimes increase the anxiety – short term – of the trauma therapy, possibly overwhelming the patient. Is there any merit to this?”
My answer is that if the client is overwhelmed by anxiety during or in between EMDR sessions, enough preparation may not have been done! It is normal and an expected part of the process that strong feelings, sensations and traumatic images will arise during EMDR. You may expect to have dreams, feelings, insights occur in between EMDR sessions and it helps to keep a log of these to discuss. A skilled clinician helps you develop skills for coping with these before you get to the “overwhelmed” level. You will have learned techniques for coping with distress in between sessions. At the end of each session of EMDR, the therapist will help you get some closure:
The Closure ensures that the person leaves at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the person in using a variety of self-calming techniques in order to regain a sense of equilibrium.
EMDR works best when the protocol is closely followed. One of my concerns is that some therapists may claim to provide EMDR without having completed the training. Or without an in-depth understanding of trauma treatment overall. Ironically, as I started this series I got linked to by a site claiming to provide treatment using “parts of EMDR”. This is a red flag to me and something I’d urge trauma survivors to avoid. If you want EMDR, make sure to ask your clinician if (s)he is using EMDR according to the training standards and guidelines of the EMDR International Association or EMDR-Europe.
Why are establishing a good working therapy relationship, initial preparation and seeing a therapist who has had proper training so important? Because you can have a bad experience otherwise! Another reader illustrates what can go wrong when these things are not in place:
“I’m afraid my experience was not good, although I still believe EMDR would be an appropriate therapy for me. The problem was not the process but the therapist. She was a chronically late person. We never started our sessions on time and would frequently not get started on actual work until my appointment time was half over. Then we would run out of time. So we would have started the process and have me to say 5 on the scale and she’d say, “Oh, I’m sorry. My next client is here. But you can finish this yourself. If you have a crisis, call me any time, you have my number.”
In my opinion, a therapeutic alliance requires that the therapist hold up her/his side of the bargain. Being consistent about the therapy frame is part of this. This example also illustrates for me problems with following the 8-phase protocol: there is no closure! EMDR is not a “do it yourself” sort of technique!
Finally, I think it is crucial that therapists using EMDR have a good overall knowledge of trauma and trauma treatment. Since so many trauma survivors experience dissociation, this includes the ability to at least screen for the existence of dissociative disorders like DID. Another reader asked:
Can you possibly discuss how this might work in a DID patient? There are so many variables in dealing with DID, I can’t seem to wrap my mind around how that might look.
Great question! there is so much to say about the treatment of DID in general I think that needs to be its own series of blog articles. For now, let me say that a therapist providing EMDR to someone with DID needs to be knowledgeable about the treatment of DID overall. Safety and stabilization is crucial in the treatment of DID as with any complex trauma work but with the addition of focus on helping the client gain awareness of their internal system. Developing internal communication and cooperation is crucial before embarking on trauma processing of any kind. In the ideal situation a dissociative client would already have developed the ability to negotiate with other parts to reach consensus about processing a part traumatic event.
I hope this EMDR series answers at least some of your questions about this form of trauma treatment. As always, I welcome more comments and questions on the subject!