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EMDR (1996)

A moment of your time, please:

First, nothing within these pages comprises, or is intended as, training in a therapeutic method, or therapy. Period.

Second, You are at the top level of a thought-piece on "Eye Movement Desensitization and Reprocessing" (EMDR). This effort is an intro to some of the concepts of EMDR and a glance at Francine Shapiro's Eye Movement Desensitization and Reprocessing--basic principles, protocols and procedures.

Please comment, querie, or adamantly criticize what you find here so that both of each of us can advance our learnings and understandings geometrically.

Thanks and welcome,

John Burik

Background

As in many other endeavors, EMDR, is in part an autobiographical experience of its creator. Francine Shapiro was walking one day and found herself processing negative psychological material, along with REM behavior. She wondered if this were replicable. That is, if one duplicated the REM behavior while attending to a distressing cognitive event, for example, an unpleasant internal visual image, would the event lessen in negative impact? Yes, claimed Shapiro, and developed a therapy based upon it.

However, does correlation imply causation?

Conceptual Underpinnings

As noted above, Shapiro originally conceived of the process--which she first called Eye Movement Desensitization, later adding Reprocessing--as consciously promoting a natural process, namely REMs, in order to release negative material or somehow integrate it. Later, Shapiro found that other movements, including auditory and kinesthetic stimuli, were equally, or more, effective, depending upon the particular individual involved.

She now, with the publication of her book (1995), articulates the process as Accelarated Information Processing.

Clinical Approach

Of utmost importance, is Shapiro's insistance upon adopting an ecological clinical approach. That is, included in her EMDR, is comprehensive training for licensed professsionals, and a strong emphasis on developing a treatment plan of which techniques are a part, but always looking toward the overall agenda and wellness of the individual as a whole.

I am thrilled and excited about the work of Shapiro and others who believe (as I do) in the health-and-wholeness-seeking capacity of the human being, and the firm conviction that change need not be as time-consuming or painful as was once thought.

EMDR consists of eight phases, which are not fully and explicitly addressed here. Major features appear below.

Presenting Problem

Virginia Satir is reported to have often said, "The problem is never the problem." That is, whatever it is that ostensibily brings someone, a couple, or family to a professional helper, is a symptom and not the disease. Little Jimmy ends up being brought to a counselor because of his acting-out behavior in the classroom. But the "real" problem may be dysfunctinal communication patterns within the family as a whole, and the "real" solution may be the family learning skillful communication behaviors.

Nevertheless, we want the bandaid where we see the broken skin.

But Shapiro insists that we look at how the presenting problem fits in the larger picture. What other things in the past are similar to the current problem? Was there a first significant event of this type? What is going on in life right now that is like the problem pattern? And what similar events are likely to occur in the future?

Only by addressing and viewing the context of which the presenting problem is one part can we effectively--and with some degree of permanence--address the "real" problem.

Treatment Plan

Shapiro insists that EMDR be part of a comprehensive treatment plan because only within such a context can hidden agendas, deeper difficulties, secondary gain, and so forth, be appropriately addressed. Shapiro is the first to state that EMDR is not for everyone, and that it emphatically is not a one-session wonder.

Negative Cognition

An important underpinning of the EMDR process, is the assumption that not only may particular incidents themselves stimulate discomfort, but there MUST be a cognitive piece involved--a belief about self. These beliefs take the form of "I'm no good, powerless,worthless..." or similar. Thus, an important piece of the resolution--and the reprocessing piece--is the incorporation of a desired, and positive, cognition. (Although it is imperative, Shapiro would point out, that desensitization must occur, first, and fully, before attempting the installation of the positive cognition.)

Subjective Units of Disturbance (SUD)

It hurts.

That's right, and on a scale of 1-10 how bad?

EMDR has patients rate their Subjective Units of Discomfort (SUD) at beginning of treatment, and during its course. Not only does this operationalize the presenting problem, but gives the practitioner a means of tracking progress. The rating of the presenting problem in an objective manner, also prevents the subject from denying the significance of positive change when it occurs .

An initial treatment goal--which I point out for those yet unfamiliar with the optimistic expectations of what I'll call "edge therapies"--is bringing even an SUD rating of 9 or 10 down to a 1.

Desired Positive Cognition (VOC scale)

EMDR has patients rate the power of their belief(s) on a Validity of Cognition (VOC) scale (1-7). For example, let us say that an individual has experienced a traumatic event involving a family member from which nightmares are still occurring years later. The individual rates discomfort (SUD) as a "nine"; and there's an accompanying negative belief: "I'm worthless." The latter sufferer may know rationally, and desire emphatically to believe: "I am a powerful and resourceful human being." But what EMDR wants to happen, is that the individual BELIEVES that with the conviction indicated by a strong self-rating, for example, "six," on the VOC scale. Again, the EMDR clinician wants a SUD of "one" or "two" before initiating work with the positive cognition.

Technique

In its simplest form, the technique itself, involves an individual 1) holding in mind a representative image (pictures, sounds, feelings) of "the problem," while 2) watching a clinician's left-right hand or finger movements in short sets.

After each set, the patient/client describes what happened. The original image (sound, feeling, etc.) may change. And the clinician tracks movement in a positive direction. There are several ways in which this "positive" movement may be determined.

A client may report that the original image significantly changed in a way that makes it less troublesome, for example, the image moved farther away, or changed from color to black-and-white. The client may report a decrease in SUD rating. The clinician might note a shift in nonverbal behavior, perhaps fuller, relaxed breathing, or decrease in muscle tension.

Again, the goal is a SUD of 1. As the targeted cognition changes and decreases in negative effect, other targets may surface. Each successive target is then exposed to the EMDR technique.

My Best Guess

My best guess is that the REMs Shapiro originally experienced have nothing--causally--to do with the successful spontaneous release (catharsis, integration or whatever) that occurred for her. I believe witnessing the REMs are predictive, that is, observing such profound nonverbals is indicative of some shift occurring. But not in any way, causative.

As a causal factor, my belief is that a number of factors may assist an indiviudal in releasing and processing negative material. Several explanations may prove valid. We'll explore several below.

S-R Revisited

Everyone remembers that Pavlov got the dog to salivate at the sound of a bell, after that sound was coupled with the presence of food. Straight S-R stuff. What people forget, is that presentation of a low-value stimulus present at the time of the original "programming," even when the primary stimulus was strong, will extinguish the programmed response (R). One explanation for the nominal eye-movement desensitization is that when the original event occurred (trauma or other example of the popularized "unfinished business") the eyes were moving, and therefore are a low-threshold stimulus which was contemporaneous with the original event.

The latter low-value stimulus now presented, may extinguish (potentially) even an originally traumatic response.

NLP

Another plausible explanation comes from the sensory-based cognitive model of Richard Bandler and John Grinder, Neuro Linguistic Programming (NLP). One phenomena Bandler and Grinder noticed was individuals' systematic eye movements in response to sensory-based questions. (Link to sidebar for more information.) Following the logic of NLP, assisting someone in eye-movements related to multiple sensory channels--as he or she cognizes a problem--may be akin to bringing more sensory modalities into play, and therefore, more resources to bear on the presenting problem.

Dual Hemispheric Functioning

Or, we might return to the "two brain" theories popular in recent decades. Alternating movements from left to right and back can be conceptualized as activating both hemispheres of the brain, and as in the NLP discussion above, brings (theoretically) more resources to bear on the situation, thereby promoting a solution.

Three Brains or van der Kolk's blown fuse

Another "brain theory" was proposed by MacLean in the eighties, the triune brain, based upon physiological development of visceral, limbic and neocortical systems. Very early (infancy and childhood), or very survival-oriented (primitive events) get stored in lower brain structures associated temporally or functionally with the type of stimulus and get "locked" in that part of the brain, below conscious control.

Van der Kolk's research with Post Traumatic Stress Disorder (PTSD) patients lends support to the theory. That is, overwhelming stimuli overload particular areas of the brain--acting like a circuit-breaker or fuse--and the incoming material is taken in, but at a level below the limen of consciousness, only later impinging upon our reality without our conscious effort or desire.

EMDR can be viewed in this scenario as assisting someone in re-opening the gates of the triune brain, or resetting the circuit-breakers of our neurology so that presenting difficulties can finally be processed.

Batesonian reprise

In all probability, some of all of the above has a glimmer of truth in it. We can look at two scenarios proposed by Gregory Bateson, and at this meta-level, all of the above suggestions fit.

One metaphor Bateson employed in a look at addiction was that of an arc, that is, a sliced-off piece of a circle. The arc is the relationship of the addict to one response that was successful in one limited context and over-generalized. The addict cuts himself off from the rest of the circle until the behavior is so habitual that he forgets the other part of the circle is there. By reconnecting the arc with the circle, there is access to other resources. Or in another conceptualization of Bateson, we could look at the addiction system, as being a small system or locked-loop within the larger system of the individual as a whole.

Whether completing the circle or opening up the closed system to the larger system of which it is part, the EMDR-type techniques seem to break up old patterns promoting access to possible solutions.

Conclusion--for now

Francine Shapiro's EMDR offers a good deal of hope to individuals experiencing a number of difficulties previously resistant to treatment, and certainly not amenable to short-term positive outcomes.

While the proverbial jury's still out, several peer-reviewed journals have published favorable articles in the past year.