Whether it’s trauma from cops killing innocent black people, trauma from our country deploying the military against its own people or trauma from a global pandemic that’s already claimed more than 109,000 lives, it’s an undeniably traumatic time to be an American. As we brace ourselves for what’s next, the only outcome that seems certain is just how fucked up we’re going to be for the foreseeable future.
With all of this collective trauma then, there’s been renewed interest in Eye Movement Desensitization and Reprocessing Therapy (or EMDR), a form of trauma counseling that’s garnered both praise and skepticism in recent years, mostly because it works a little too well. Though more traditional techniques like psychodynamic therapy can take years to address trauma, EMDR takes about six to 12 sessions to produce results on average, sometimes even fewer.
The seemingly simple method has patients visualize, and to some extent, relive past trauma while participating in what therapists call “bilateral stimulation,” which basically means engaging the brain in a right-to-left rhythm. Therapists often do this by having clients follow a dot, but it can also be achieved with sounds that alternate between left and right ears, or tapping knees or shoulders in a right-to-left motion. This right-left pattern helps decrease psychological arousal, increase focus and create distance from trauma, but experts suspect it also helps repair the brain by recreating the rapid-eye-movement process, or REM cycle, during sleep. In REM sleep, the brain processes and consolidates memories, which helps with learning and mood regulation. The difference is with EMDR, people can choose what particularly painful memories to work on.
It seems so easy that a lot of people think they can perform EMDR on themselves, but it’s much more complicated than moving your eyes while thinking of something sad. “If one tries to implement EMDR on the self, it will probably work about as well as trying to fill your own cavity,” clinical psychologist Nancy Irwin explains. “Traumatized patients are rarely in the position to treat themselves. The danger is they’re not thinking clearly and can re-traumatize themselves.”
The risk of doing more psychological harm than good is so great that some therapists refuse to provide EMDR even through telehealth. Erring on the side of caution, the logic is that they need to be in the same room with a patient in case the process takes a dark turn. “In my opinion, EMDR shouldn’t be done at home,” psychotherapist Christine Muska warns. “I’ve had clients who experienced repressed memories and needed assistance with grounding and self-soothing. Another reason is risk of dissociation in which a client might separate from the current time, which, for obvious reasons, could be overwhelming and scary.”
Still, as coronavirus continues to spread with no vaccine in sight, pausing trauma treatment indefinitely might not be a practical or safe solution either. As such, in April, the EMDR International Association gave the greenlight on telehealth and issued guidelines for virtual sessions. And many therapists, like Cassidy DuHadway, have started to adapt with caution. “The biggest challenges I’ve seen and experienced in doing EMDR virtually are the inability to be present when someone is being triggered or dissociates and technical failure during important parts of the session,” DuHadway explains, adding that she’s treated numerous patients who traumatized themselves flying solo before finding their way into her office. Thus, DuHadway will only provide virtual EMDR to patients she’s determined are able to do it safely at home.
To understand the distinction, it’s worth noting the eight-steps in the therapeutic process…
History taking. Similar to most mental-health assessments, this is where a therapist learns about why a person is in their office and what they want to work on. During this time, patients identify significant life events that have contributed to their current problems and symptoms. These are their “targets” to focus on.
Preparation. This is exactly as it sounds, therapists explain how to do bilateral stimulation, and teach a number of grounding techniques such as deep breathing in case a person starts to get agitated or upset. They also create a “safe space” in the mind that functions as sort of a waiting room if clients begin to dissociate. The goal is to stay in the present, but if that isn’t possible, a patient can retreat to this calming place until they can continue the session or end it in a safe way. They might also visualize a container, where they can put any intrusive thoughts to deal with at a later date.
Assessment. The therapist asks for positive cognition (e.g., “I am worthy” or “I deserve love”), and negative cognition (e.g., “I am not good enough” or “No one cares about me”), as well as a rating of how true the patient thinks both are on a scale of one to seven. This is really where a therapist will determine if a person is in the right headspace to engage in EMDR. If someone is already upset — they had an argument with a significant other before the appointment or are just in a particularly fragile place psychologically — any EMDR treatment might have to be postponed.
Desensitization. After a brief check-in to review what they’ve been over, the client will start a series of bilateral stimulation sets ranging from 24 seconds to several minutes, focusing on a disturbance identified during the preparation stage. After each set, they will rate how distressing the memory is on a scale of one to 10, and repeat until the memory is no longer upsetting. The priority is to avoid dissociation, so the grounding exercises are often repeated when things get too intense, or repressed memories start to surface.
Installation. The therapist will check in about a client’s positive cognition, and provide the option to change it, as their feelings about themselves may have shifted. Maybe at the start it was something vague about being worthy, but after getting a handle on a painful memory, it might change to “I’m strong.” What’s important is that it’s positive before they rate how much they believe the statement on a scale of one to seven. If a client doesn’t land on a seven right away (most don’t), they will repeat sets of bilateral stimulation, while the therapist may ask questions about what’s preventing that from happening.
Body Scan. A client will scan their body for any lingering tension. If any are identified, they’ll have to complete a few more sets of bilateral stimulation until they can fully relax.
Closure. The therapist and client will discuss how the process went. It’s pretty common for sessions to feel incomplete at first. If that’s the case, the patient will visit their safe space one more time to see if anything has changed, and potentially take inventory of what they put in their container for later.
Reevaluation. Similar to “history taking,” the client will talk about what traumas are still causing them problems and what they want to work on next. Since trauma is rarely resolved in one session, they’ll also reflect on how they feel about the current target.
All that said — and as much as therapists caution that no one should try EMDR alone — Muska and DuHadway agree that there is a paired down-version that individuals can do on their own by using bilateral stimulation, breathing and visualization exercises. The difference is that people should only do so to deal with the present, not the past. So, if you’re having trouble unseeing the horrifying footage of Derek Chauvin’s knee in George Floyd’s neck, many of these strategies may be effective. But if you’ve endured police violence directly, even in recent weeks, these strategies, though helpful in the short-term, probably won’t be sufficient.
Whether it’s at home or not, most people who are successful with EMDR attend regular talk-therapy appointments as well. Which is to say, EMDR isn’t a magical quick fix, but part of a multifaceted approach to feeling better that involves many different techniques. And again, with so many different things at play, it’s most beneficial to seek some professional help along the way.