It was about 10 years ago when I first heard, in passing, of a new therapy for psychological trauma which sounded more than a little strange. As far as I could understand, the main principles were that you waggled your fingers in front of your client's face whilst they thought of their traumatic experiences, and somehow, their trauma no longer felt so traumatic. You can understand why I was a little cynical! Luckily, I didn’t allow this cynicism to get the better of me and I began to look into it. Eventually I trained in it myself.
'Bilateral Stimulation'
The name of this therapy? Eye Movement Desensitisation and Reprocessing, or ‘EMDR’ for short (memorable name, eh?!!). Developed by Dr Francine Shapiro in the 1980s, EMDR has taken off in the therapy world as something of a phenomenon with hundreds of thousands of therapists being trained worldwide. So, what’s it all about? Well, as per my initial insight into EMDR, the therapist does (sort of) “waggle” their fingers in front of their client whilst the client recalls their trauma. Or more precisely, the therapist skillfully guides the client through the memories, emotions, thoughts and sensations associated with their traumatic experience whilst systematically moving their fingers from left to right for the client to track with their eyes. Why would they do this strange thing? Well, the principle behind this is called ‘bilateral stimulation’ - the act of visually tracking the therapist’s finger causes the right and left sides of the brain to be alternately stimulated. (This is the ‘Eye Movement’ bit in the name EMDR - although bilateral brain stimulation can also be created other ways e.g. with hand taps or buzzers). This bilateral stimulation is thought to help in the processing of psychological trauma (and other emotional issues).
Trauma
Trauma is commonly defined as an event (or set of events) that overwhelms somebody’s sense of safety, stability or sense of self. By definition therefore, the experience of trauma is personal, and an event which is relatively neutral for one person maybe highly traumatic for the next (although there are, of course, events that would traumatise the majority of people). Whilst keeping this in mind, examples of what we call big traumas (‘big Ts’) include rape, bereavement, being a victim of a natural disaster or war, or being in a traffic accident (broadly speaking, events which involve threat to life). However, people might also become traumatised from many other life events e.g. divorce, emotional abuse, bullying etc. We call these types of traumas ‘small Ts’ - not because they are less traumatising but because they are more pervasive. Usually, they are linked to negative or upsetting interpersonal experiences. Often people experience several interrelated small Ts, and the effect of this is cumulative, causing at least as many trauma symptoms as big Ts.
Whatever the trauma is, a traumatic memory is often especially difficult for our brains to process. I’ll explain why this might be in a moment, but first, let’s think about how the brain ordinarily works using what’s called the ‘Adaptive Information Processing’ (AIP) model. This model suggests that our day-to-day experiences are digested and stored with associated old memories in the brain’s neural network. When a person experiences an upsetting event (destined to be non-traumatising), the brain hooks the memory up with associated memories, including more ‘adaptive’ (helpful/positive) experiences. For example: Jack’s girlfriend informs him that she no longer wishes to go out with him. This event hooks up with memories of Jack’s past relationships (which are mainly positive in his case) and, although he is upset, fundamentally, he is reassured that he is still a lovable person. In other words, the information processing in his brain is ‘adaptive’, and his brain has digested the event in a helpful way. A useful analogy might be to conceptualise the brain as a filing cabinet. The brain works to sort memories into the right file or folder (a process thought to be facilitated by REM sleep), and with non-traumatising events, the brain is successful in this task.
PTSD
However, according to the AIP model, certain experiences (those destined to be traumatising) cause the brain to become overwhelmed, making it impossible to digest (fully process) the experience i.e. the memory is prevented from being associated with more adaptive memories. Using the filing cabinet analogy, the memory (comprising of associated imagery, thoughts, emotions, sounds, physical sensations etc.) remains jumbled up in random parts of the cabinet. This is why traumatic memories seem so fresh and emotionally raw - as if they are frozen in time. It is also why imagery, thoughts and feelings etc. can intrude harrowingly into our current lives. It also helps to explain why people suffer from the kind of symptoms associated with Post Traumatic Stress Disorder (PTSD) e.g. flashbacks and nightmares.
Reprocessing
Thus the bilateral stimulation of EMDR (along with other therapeutic elements) is believed to help the processing of traumatic memories - essentially by sorting elements of the trauma into the correct place in the cabinet (thereby releasing the client of the trauma’s emotional toxicity). This is the ‘reprocessing’ aspect of EMDR. The way in which clients process their trauma as a result of EMDR is extremely varied. Sometimes it is through observing scenes in the trauma, as though they are watching a movie of their life. Sometimes it is through recounting emotions or physical sensations associated with the event e.g. “I feel pain in my stomach” then “it’s now in my chest”, or “I feel sadness” then “I feel shame”. Sometimes the processing seems so strange that neither the client nor the therapist knows quite what has occurred! Yet somehow, the processing happens, and memories, thoughts, feelings, and sensations start shifting. The client naturally progresses to thinking about, feeling or remembering, more adaptive material from some aspect of their life. This processing (or ‘filing’) seems to have the effect of removing (or reducing) the emotional component of the trauma. The person still remembers the event, but it is less painful. Indeed, the trauma is often transformed into a positive learning experience for the person.
We still don't fully understand the mechanisms of EMDR and there is considerable debate regarding the role of bilateral stimulation. Some argue that the effective element is exposure (or ‘desensitisation’) to thinking about the, otherwise avoided, trauma. However, the important thing is that EMDR does seem to be extremely effective in helping trauma. Indeed, there is now a considerable body of research that supports the use of EMDR, and it is widely used across the world to help with trauma and many other psychological conditions e.g. depression, anxiety.
Today, EMDR is one of the mainstays of my therapeutic work, and like many other therapists, I also recognise the value of EMDR for areas other than trauma. EMDR can be a valuable tool for working with children as well as adults - and it can be combined with creative approaches such as story-telling. Furthermore, EMDR can be particularly effective for helping children (or adults) for traumas that they either can’t consciously remember or can’t find the words to recount.
Ultimately, my scepticism has long since evaporated as I have consistently witnessed the positive effects that EMDR has had on the psychological well-being of many of my clients.
If you'd like to find out more about EMDR, or how it might be able to help you, please contact us at The Purple House Clinic. If your interest in EMDR is more general, please follow this link to the EMDR UK & Ireland website.
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A NOTE OF WARNING: Think EMDR sounds simple and considering giving it ago with your friend or relative? Think again! Whilst on the surface some of the principles of EMDR sound straightforward - in reality it is not a simple therapy. There are many additional elements other than those described above, and EMDR can only be implemented by an experienced and trained clinician. Working with trauma (with any type of therapy) is incredibly difficult and requires a wealth of knowledge and therapeutic skill. Unravelling a person’s trauma in the wrong way, and without the careful preparation required, can cause a person to be re-traumatised and to feel a whole lot worse than they did before.
