It is possible to address the past, the present and the future at the same time during a therapy session. Sitting in your therapist’s office, it is possible have a second chance to view painful events in a way where you feel like an observer as well as a participant. It’s possible to form new conclusions about these past events, and from these new conclusions to alter your beliefs about who you were in the past, who you are in the present and who you will become in the future.
As a therapist for over 20 years and a survivor of family of origin abuse, if I had to choose only one modality to work with for treating PTSD based symptoms, EMDR- Eye Movement Desensitization Reprocessing, created by Dr. Francine Shapiro would be my choice. And as a consumer of therapy, if I had to choose only one modality for my own healing, EMDR would be my choice.
How does EMDR work?
There are several steps to the EMDR process. First the patient and therapist discuss a specific memory to work with. The patient is given opportunity to visualize the memory. Then there is a discussion of how the patient views themself, how they would like to view themself. Following that the patient visualizes a “safe space” or image.
From a clinical standpoint, EMDR is rooted in aspects of three separate psychological theories:
- Carl Roger’s Person Centered Therapy, (where the patient has their own answers within them)
- Sigmund Freud’s Psychoanalytic theory, (where unconscious conflicts are leading to distress)
- Albert Ellis’s Cognitive Behavioral Therapy, (where the patient is disturbing himself by what he is telling himself). With this synergy of three main psychological modalities, the patient is able to access and provide his own authentic answers by visualizing key events with the cognition of an observer and the clarity of visiting and revisiting the event.
Imagine going back to your most traumatic event and watching it play out several times at different speeds, being able to pause and get clinical feedback, direction before resuming the process. The patient sits with the therapist and follows a metronome or pointer with his eyes, or wears headphones with alternating beeps, and may also hold tappers that alternate in each hand.
EMDR takes place within a therapy session, and does not require preparation or homework. The pace, timing and focus of sessions will vary to accommodate the state of mind and emotions of the patient. There is a base line process that relies on specific tasks done in a set sequence. The first goal in the process is establishing a safe place that can be easily pictured as needed, a visual, sensory image that is typically a memory, but can be created by the patient if there is no ideal memory. Unlike a set recipe in the kitchen, it is impossible to predict exact results at each interval and establishing a safe place image gives the patient the power to, at will, utilize a comfortable, chosen image whenever he feels the need to self soothe on the spot, impromptu and perhaps, unexpected.
Once identifying the safe place image, the clinician may do some preliminary EMDR “sets”. While sets can be done with tappers, where a patient feels an alternating pulse in each hand, or through alternating beeps via headphones, visual stimulation done by a therapist moving a pointer horizontally back and forth with the patient following the pointer with his eyes is the most common and most effective. The visual stimulation may also be done through a metronome where the patient follows the light on the screen in front of him. During these sets, the therapist will prompt the patient to picture his safe place, follow the stimulation and become familiar with the process of following the stimulation while accessing the chosen image.
The patient and therapist next decide on a memory to focus on, along with a positive cognition about how the patient would like to feel, as well as a negative cognition about how he feels in the present moment. The positive and negative cognitions are identified from a standard select list of positive and negative cognitions that the therapist reviews with the patient. The patient then visualizes the memory and follows the therapist’s pointer with his eyes, typically moving from one side to the other at a steady pace.
There can be an added tapper that the patient holds in his hands or beeps from a headset. The therapist will stop at their discretion and ask the patient how he is or what he sees. The patient response will most likely be leading towards a new interpretation of the memory and the therapist will reply something encouraging, like “Go with that”, and resume the process.
Picturing a subway train, the eye movement, tapping and beeps are all like the fuel used to transport the patient from one memory to the next as the insights will become about multiple memories that are similar and so on the same memory line.
In a way, actual time in therapy can be boiled down to the processing of memories. It’s our memories that effect how we interpret new situations, ourselves and life in totality.
The opportunity to revisit our old events– with the altered feel of a spectator, allows us to form new interpretations about what originally took place. In gradual increments of EMDR “sets”, new specific interpretations lead to new conclusions about life beyond the events. Our pasts serve as an ongoing and comprehensive frame of reference.
However, the feel of future events will now be based on the most recent, newly established frame of reference. Because EMDR is self-driven, in that the therapist provides the structure, but the patient does the visualizing, any normal limitations of the therapist are kept out of the process. In sum, EMDR allows the patient to access their memory bank, rework what was harmful, and draw new conclusions without unintended disruption from the therapist.