I was skeptical when I first heard about Eye Movement Desensitization and Reprocessing (EMDR). By training and temperament, I’d identified with the analytic branch of psychotherapy. I’d been very suspicious of short-term therapy and this, I thought, was another wham bam substitute for slow, steady, and thorough change. I was wrong. I have come to respect the depth and efficiency with which this technique accesses traumatic injury and enables healing. For me, a session of EMDR is like a trip out of real time into my client’s very particular associative universe. We follow the elegant working of the mind/body as it processes stored traumas and integrates them into the safety of real time consciousness.

I first learned of EMDR from a client. Our work on a mild depression was going very well, but when faced with a move to her hometown — which meant daily contact with her extended family — disturbing feelings of inadequacy and powerlessness surfaced. Using psychodynamic techniques, we worked on the issue, but it became clear that the moving date would arrive before a resolution. After some discussion, we terminated our work and she began an intense treatment with a local EMDR practitioner. She wrote to me six months later to report that she was happy in her new home and able to interact with the family comfortably. I was intrigued and signed up for EMDR training, where I ended up working on a minor trauma of my own and was able to turn an anxiety-producing memory to one that was simply appropriately sad. I then decided to learn all I could about EMDR.

EMDR was developed in the mid-eighties by Francine Shapiro, PhD, and can be used to process post-traumatic stress disorder (PTSD) or “small t” traumas, such as rejections, humiliations, disappointments, grief and failures. During EMDR, guided bilateral eye movement stimulates connections in the brain, which enable processing and integration of traumatic memory.

PTSD and addiction frequently present together, and because integrated treatment appears to be more effective than separate approaches to these illnesses, EMDR is a powerful therapeutic tool. There also are protocols designed to meet the particular needs of the chemically dependent client.

The work begins with a thorough client history, including a screen for dissociative patterns and a careful resource assessment. The screen gathers information and also offers an opportunity to begin focusing the client on his/her own inner experience, and begins a conversation about chosen ways of handling stress and defending oneself from danger and discomfort. The resource assessment evaluates the amount of support the client can count on during the EMDR work.

Next, the client names the issue or event and identifies associated images, thoughts, emotions, and physical sensations. This step engages clients on all the levels of awareness through which they experienced the trauma. This also is an opportunity to educate the client on the multiple aspects of his/her humanity and validate physical and emotional memory equally with cognitive functions.

Often, it will surprise a client to realize that enfolded in the memory of the event is a belief such as, “I’m stupid” or “I’m not good enough” or “It was my fault.” The negative belief feeds the trauma and spills over into other situations. Although not true, it is believed to be true and we rate the strength of the belief. We also identify the positive belief the client would like to be able to hold about himself.

The work of finding the most accurate negative and positive cognitions can be challenging because they reach into the depths of the wound. I have spent an entire session trying to clarify the negative belief, worried that I’d wasted time, only to find at the next session that the exploration had set the client’s process in motion, making accurate beliefs more accessible.
Our work is well under way by the time we begin bilateral stimulation. With the target image, belief, feeling, and physical sensations in mind, my client follows my hand in the eye movements. When necessary, other types of stimulation like hand taps or alternating tones can be used. From there, the brain takes over and we try to stay out of the way.

During the eye movements, I use intuition and observation to track the client’s progress. Often, subtle changes in the client’s eyes and face indicate an intensification of the work before he/she can consciously report it. I am verbally supportive and occasionally insert a comment designed to break through a dead end or to reassure the client of his/her safety in the present.

The work takes unexpected twists and turns and strong emotions may emerge. Ideally, the client can continue eye movements through an abreaction, but he always has the option of stopping and stepping back to a pre-agreed upon “safe place.” Between sets of movements, I check with the client about what is coming up emotionally, cognitively, and physically. We find unexpected memories, seemingly random thoughts, and subtle body sensations. All are noticed and the eye movement resumes.

When the distress level of the original target has fallen to zero, we install the appropriate positive belief. Once the client can affirmatively say, “I am ok” or “I am a loving person,” the session is complete. Integration and reorganization in the brain continue and subtle improvements in ego strength appear gradually in clients during the following weeks.

As I mentioned earlier, EMDR can be effective with chemically dependent clients. The preliminary work, especially education in managing feelings, may require more time. EMDR assumes the ability to tolerate strong affect and, therefore, requires the client to be stable, well prepared, and grounded in an adequate personal support system. Clinicians can then use eye movements to install positive resources/goals up front and to help the client imagine a safe place where he/she can soothe oneself during the work. An adaptation of the standard EMDR protocol focuses on some useful desensitizing triggers. Also, EMDR can target both emerging memories and difficult between-session experiences as the client begins to feel more emotion.

The intelligence of the human organism goes far beyond the intelligence we associate with our conscious minds. Using EMDR, we can tap into that larger intelligence and often save our clients months or years of pain and frustration. With this method, I have been touched to witness the deft and subtle workings of the mind/body as it finds the most organic and appropriate resolution to its stresses.

Emma Mellon, PhD, is a psychologist in private practice in the Philadelphia suburbs. Eye Movement Desensitization and Reprocessing is one of the Techniques she uses in her practice.

This article is published in Counselor,The Magazine for Addiction Professionals, June 2005, v.6, n.3, pp.30-31

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