Table of Contents
Introduction: Protocol, Resources and Set-up . . . . . . . . . . . . . 7
Chapter One: Acute Recent Trauma: Suicide of a Loved One . . . . . . . 23
Case of Thea
Chapter Two: Profound Depression: Fighting the Darkness . . . . . . . . . 43
Case of Sam
Chapter Three: Rage Attacks: The Dilemma of Clark Kent . . . . . . . . . . . 63
Case of Trevor
Chapter Four: Self-Sabotage in Business: Real Women Can’t Do Math . . . 109
Case of Taffy
Chapter Five: Submissiveness: Love Without Garter Belts . . . . . . . . . 123
Case of Danielle
Chapter Six: Despair: The Ravages of Maternal Narcissism . . . . . . . 167
Case of Ryan
Chapter Seven: Couples Therapy: Interlocking Pathologies . . . . . . . . . 211
Case of Will and Stacy
Chapter Eight: Social Anxiety: They’re Laughing Inside . . . . . . . . . . . . 237
Case of Melissa
Concluding Remarks: Why EMDR? . . . . . . . . . . . . . . . . . . . 287
Appendix A: Submissiveness: Follow-up Session . . . . . . . . 297
Appendix B: Despair: Follow-up Session . . . . . . . . . . . . . . 315
Appendix C: Social Anxiety: Follow-up Session . . . . . . . . . 339
Bibliography of Books Cited . . . . . . . . . . . . . . . . . . . . . . . . 359
About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Introduction to Therapy at Lightning Speed
I am passionate about EMDR. Passionate enough to write a book about it. This book provides case studies of actual EMDR therapy sessions conducted with clients in my practice. I believe that a book like this will offer you the inside story about why I am so excited about this work and the powerful positive impact it is having. It allows you to go “behind the scenes” to see what really happens in an EMDR session as if you are right there in the room watching as the process unfolds. You will be able to witness the therapeutic process firsthand from beginning to end. You will see people changing right before your eyes, as I did, in a radically short time frame. EMDR has the capacity to resolve in one processing session issues that could take years using traditional approaches. After more than forty years of experience as a therapist and extensive training in a diversity of methods such as Gestalt therapy, psychodynamic therapy, conjoint family therapy, and hypnotherapy, I can state unequivocally that EMDR is the fastest and most transformative therapy I have ever seen.
This is not a textbook of EMDR theory and methodology. To get the full story about Eye Movement Desensitization and Reprocessing, I strongly recommend you go to the source and read what Dr. Francine Shapiro, the originator and developer of EMDR, has to say about it. You may also want to look at the work of my teacher, Dr. Laurel Parnell, and at the EMDRIA website for a large collection of articles on EMDR theory and research. Given that EMDR is the most researched methodology on trauma, you can expect to see an impressive amount of scholarly material. It is not my intention to do a review of the literature here.
However, I do see the need for a brief general introduction to the topic of the book so that you are able to orient to what I am talking about when I refer to EMDR terminology and you have some basic knowledge of the concepts that are essential to the work.
Eye Movement Desensitization and Reprocessing was discovered in 1987 by a research psychologist named Francine Shapiro who was taking a walk in a park. As she walked, she was thinking about a personal matter that was bothering her. She happened to notice that her eyes were going back and forth and that, as they did, her level of disturbance went down. Intrigued by this discovery, she began the extensive research and formulation that culminated in EMDR theory and methodology.
In the beginning, it was assumed that eye movements were essential to the process. Then tapping on two sides of the body was found to be effective and, finally, alternating audio stimulation through headphones and a scanner. What is common to all these different modalities is that they all constitute bilateral stimulation – that is, stimulation on two sides of the body.
Why is bilateral stimulation effective? The bottom line is: there is no definitive, finally agreed upon explanation at this time. However, what makes sense to me is that bilateral stimulation seems to allow trauma to process through in such a way that it no longer produces a high level of disturbance for the client. What we mean by “trauma” is an experience or pattern of experiences that are overwhelming to the coping structures that are available to the client at that moment in time. As a result, trauma of this sort gets locked away in the nervous system and cordoned off in certain areas of the brain that are only minimally connected to the rest of the brain and its circuitry.
The use of bilateral stimulation allows this traumatic experience to become connected with the bulk of experience and learnings that have been developed in the course of the client's life history and stored in the other parts of their brain. Consequently, the client will no longer continue to experience the recurrence of such traumatic experience(s) in their nervous system and limbic system exactly as if it were happening again. With lowered disturbance and new understanding, the bilateral processing enables them to convert compulsive behavior patterns into decisions based on choice. We will see how this change emerges in every case study that follows. Each individual client's processing will be different from every other in as much as each client's learnings and life history are different. Therefore, although the fundamental principles are the same, each case study will be unique.
I know that every therapist works differently and I am not implying that every therapist should work the way I do. I have been trained and certified as an EMDR therapist and I believe that my work is compatible with acceptable EMDRIA protocol. But not every EMDR therapist works the way I do. I realize that there is no one "right" way to proceed. I am happy if what I do works for the client.
What motivated me to write this book is that the results I am getting seem almost like a miracle, even to me. People have been asking how it is possible to resolve an issue using only one processing session - not just once (as if it were a fluke) but repeatedly.
To use an analogy, it is as if I threw down seeds in my garden and then sat back and watched them sprout and bloom right in front of my eyes, not over a period of months or weeks or even days, but in just two hours. It's impossible, isn't it? I would have said the same as a therapist about resolving clinical issues. But it is happening consistently in my practice.
Let me be very clear. I am not saying that two hours is the total time I spend with each client – as if they were to walk into my office for the first time and then walk out two hours later healed. That would be impossible. The Eight phase model for EMDR requires a psychosocial assessment, development of rapport and a therapeutic alliance, as well as an explanation of EMDR theory and practice. The EMDR model I use begins with a one-and-a-half-hour preparation session and ends with a one-and-a-half-hour follow-up session. However, the actual healing process – i.e. the processing time for each trauma – is two hours, not a series of twelve to twenty sessions as has been reported in the literature. That in itself is remarkable enough.
I was trained in EMDR in 1997 and have been using it regularly in my practice since 2003. I developed the format I will outline here in the last four years. In my results to date using this format, (with one possible exception) all of my EMDR clients have successfully resolved the issue they were working on within this time frame. Client follow-up forms indicate that the results are holding. None of my EMDR clients have returned to work on the same issue again.
Unlike many other EMDR trained therapists I have talked to, I do not do twenty or thirty minutes of EMDR during a one-hour counseling session. I follow a very definite structure as to how I utilize the time. My time structure is:
1. a one-and-a-half-hour preparation session,
2. a two hour processing session,
3. a one-and-a-half-hour follow-up session.
I do not believe I could get the same results in a shorter period of time.
Understanding the process I will present in this book does not mean that you will thereby be ready and able to use it with clients yourself or on yourself as a client. If you are a licensed therapist, you will need to be trained in an EMDRIA approved Basic Training course. You can find information about this training on the EMDRIA website. If you are not a licensed therapist, you should not use the methods on yourself or on anyone else. You should seek out a properly trained EMDR therapist to work with. Listings of EMDRIA approved therapists are available on the website or in the EMDRIA Membership Directory which is updated annually.
I have modified the protocol somewhat over the years that I have worked with it. I use the same basic ingredients, but have changed the order and added some precision that I felt was helpful. I will indicate these modifications as I go along.
I have to acknowledge that my work does not always adhere to the precise specifications taught in the basic EMDR training. As a seasoned therapist, I tend to follow my therapeutic instincts as to what will move the process forward for each client. Reviewing transcripts of what actually occurs in my EMDR sessions brought some of these details to light. For example, I do not return regularly to the target to assess the current level of associated disturbance unless I feel a need to check in with where the client is at. Similarly, I do not remind the client to breathe after each experience of bilateral stimulation. It is not that I have any objection to this procedure. It is simply not something I have incorporated (or remembered to incorporate) in my practice. Overall, I would say of my relationship to my EMDR training what Salvador Minuchin says of his relationship to the work of Carl Whitaker:
When I copied from Carl Whitaker … – I was not impersonating Carl; I was incorporating him, with a Spanish accent and subtleties that were mine, not his. I like to think that I have “incorporated” EMDR in much the same way. I utilize the invaluable insights of EMDR theory in combination with my own style of doing therapy.
It is generally agreed that all therapy begins with a psychosocial assessment. I would never bring a client in off the street and start doing EMDR with them. I would have to know about their current functioning as well as their past history and, in particular, what past traumas might be triggered by our work. I also have to develop a therapeutic alliance with the client. We have to have mutual agreement on our goals.
For each case study, I will first give background information that places the EMDR work in a context and orients you to the issue that is being addressed. It is not depression or anxiety in general that is the subject of the work, but this particular client's depression or anxiety that I am working with. Just as each client is unique, each client's EMDR work will be unique. We may see themes, but we must never lose sight of the individual.
From Chapter One: Acute Recent Trauma:
Suicide of a Loved one
Case of Thea
When one thinks of EMDR therapy, one often thinks of acute traumatic experiences such as rape, molestation, physical assault, armed robbery, murder, multiple horrors of war, tornadoes, fires, earthquakes and floods. One thinks of trauma with a capital "T." These are not the minor defeats and challenges of ordinary life, but events that make headline news.
Historically, EMDR was first identified in the literature as a treatment modality for Post-Traumatic Stress Disorder. Certainly much of the energy and attention of EMDR therapy and research has been directed toward these catastrophic events and, of necessity, continues to be. There are trained therapists with the International Association for EMDR who go to troubled areas and help train local therapists to provide services for the masses of people affected by natural and human disasters around the globe.
Given this association, it seems fitting to begin with a case of acute recent trauma in one person's life. I think you will agree that this woman had a devastating experience that no one would handle easily.
Thea was a thirty-two-year-old hairstylist who came to see me within a couple of weeks of her traumatic experience. She had lost her significant other to suicide.
Thea reported that, since the death of her partner, she was having difficulty falling asleep at night and she would wake up very early in the morning. She felt compelled to go through the trauma she had experienced in detail in her head every morning before she opened her eyes. Then, she would cry for an hour or more before she got out of bed.
She told me that she had been eating less since the traumatic event and had lost some weight. She took no pleasure in activities that she had previously enjoyed such as bike riding. She felt exhausted all the time and was unable to make a decision. She did not know what she wanted to do in the future. She complained that she was just "going through the motions" in her life.
Immediately following the traumatic incident, Thea had quit her job and left the town in Colorado where she lived when the suicide occurred. She never returned to the house she and her partner had lived in together. With the help and support of her parents who were visiting her at the time, she moved to Santa Barbara and was staying with her mother and stepfather (whom she called "Dad").
Thea's biological father was an alcoholic. Her mother had left him when Thea was three years old. She had regular contact with him during her childhood with the exception of the two years when he was in prison for armed robbery. Apparently, when he was drinking and using cocaine, he had held up bars where he was known to the bartenders. It was no surprise that he was caught. She described him as a "nice guy," but she did not feel close to him. He married a woman who, she said, talked and swore incessantly. Her father had continued to drink and smoke pot, although "less than he used to."
Thea had been married when she first met her partner, Tom. They had socialized as couples and then, when her marriage broke up, she started dating Tom. Then, they moved in together. Thea acknowledged that she and Tom had been drinking heavily during the time of her divorce. However, she quit drinking and Tom kept on.
"I never realized how big a problem with alcohol Tom had," Thea lamented. He had seizures when he tried to stop drinking and was in and out of hospital. She got him into a residential program and he did well for six months. Then, he started drinking again. She called his father and got him into an outpatient program for two months. According to Thea: "It was on and off after that." The last time, nine months prior, she had taken him into Detox in hospital. He remained sober until he died.
"I was in charge of his life and I didn't realize how huge his problems were," Thea said. She felt guilty and responsible." We were codependent and that was my pattern in every relationship. I 'took it on' and didn't see what was coming."
As well as his problem with alcohol, Tom was unemployed and unable to find a job. Thea said he felt rejected because, no matter how hard he tried, no one would hire him. It was very upsetting to him that he could not fill the provider role. Thea owned the house they lived in and the car they drove. Tom had made a lot of money in the past and felt like he needed a job to be a man. She knew this was very depressing to him. Consequently, she "had him in therapy" and on medication. She thought it was helping his depression. "I never thought he would do this!" she lamented repeatedly.
Tom was in a good mood that day. They went for a walk and "it was good," Thea reported. She went to work at 1:00 p.m. and talked to him on the phone from work. Tom came over at 4:30 p.m. to bring her cigarettes and told her he loved her very much. At 6:30 p.m. they talked on the phone about dinner and decided to order pizza that night. At 8:00 p.m. she called and he didn't answer so she texted him. He did not text back. At 8:30 p.m., she got "a sinking feeling" and ran home.
She walked up the stairs and found him hanging. "I tried to lift him, but I couldn't. Then, I got scissors to cut the rope. He dropped. I called 9-1-1 and started CPR, but he was gone. The police came, but it was too late."
Tom left a note that Thea showed me. It was addressed to his mother, his sister and "especially" her.
"Love you all. Sorry for the shame. I dropped the ball and only I can be blamed."
Then, he added a note to Thea's parents:
"Here's your girl back. I know she'll be a mess but get her on the right path."
Thea was hoping our EMDR therapy would help her get on that right path.
From: Chapter Three: Rage Attacks:
The Dilemma of Clark Kent
Case of Trevor
Trevor was a mild-mannered man. He spoke softly and his affect was generally flat. That is the reason he reminded me of Clark Kent, the mild-mannered, geeky journalist for the Daily Planet who acted as the front for Superman. Except that in Trevor's case, it was not a hero for social justice who lay hidden behind his quiet and pleasant facade. It was, instead, a man of seething resentment who erupted, apparently without warning, with explosions of rage and anger. These outbursts were deeply disconcerting to his wife and, no less so, to Trevor himself. Trevor came for therapy because he could not understand what he was so angry about.
Trevor described himself as a "geek Dad." He had worked in technical services for some years but was now "retired" and stayed at home to care for his four-year-old adopted daughter while his wife went out to work. Trevor was forty-four years old.
Trevor reported that he had had "lifelong" depression and anxiety. His doctor reported that he had chronic hypertension. Trevor was on a regimen of Lexpro for depression and Ambien for insomnia prescribed by a psychiatrist he had been seeing on and off for ten years. His wife (whom we'll call Amy) questioned the effectiveness of this treatment. While Trevor agreed that his psychiatrist was "pretty passive," he himself liked this quality about him - perhaps because he and the psychiatrist had this trait of passivity in common. He likely would have continued with the same therapy indefinitely.
The catalyst for his coming for EMDR therapy was Trevor's rage. Both he and his wife were concerned about the future impact on their daughter if the rage attacks continued unabated. According to Trevor, the episodes seemed to be triggered by situations that were not planned or chosen by him. For example, one time his wife's sister decided spontaneously to spend the night at their home with her kids. Trevor was enraged. Another recent incident was during a barbecue they were hosting at their house. Trevor said: "I don't like parties anyway and I always have to do all the work." He became surly and irritated and was not polite to his guests. The issue, he concluded, was “control.”
Growing up, Trevor had always been a "good boy." He was in the honors society at school and never got into any trouble. Apparently, his sister got into enough trouble for them both with her stealing, drug trafficking and drug abuse that sent her in and out of rehab and jail. He was very close to his mother whom he described as warm, caring and nurturing. His father was the Food Services Director at a university and an entrepreneur on the side. Trevor said: "He worked all the time." He referred to his father as "a piece of work" and "an asshole in some ways" – i.e. arrogant and intimidating – because of his verbal authoritarianism and self-importance. "I can hear his voice when I discipline my daughter."
According to Trevor, neither of his parents was strict or gave him much direction. In his senior year, he dropped out of college and worked instead. He felt this was a big disappointment to his father. When he later tried to go back to school, he missed the exam and never completed his courses. As a result, he never got a degree. "I was smart enough but just didn't do it," he said. Trevor lived with his parents until after college when he left home to move in with his wife.
Trevor and Amy tried for three years to have a child despite the fact that he was "not really big on having a kid." "It was Amy's wish, not my choice," Trevor admitted. When their attempts to conceive were unsuccessful, they decided to adopt a child from a foreign country. "I was very reluctant to adopt and still have times when I resent it," Trevor said. It was decided that Amy would continue in her job and Trevor would be a stay-at-home Dad. "She's the one who wanted the child and I get to deal with her."
Unfortunately for Trevor, his wife's job involved some travel, so he was left as the sole parental figure for periods of time. He expressed feeling "abandoned, over-burdened and overwhelmed" when she was out of town. He had a deep despair and anger at the unfairness of his role. When his wife gave him "grief" about not working, he was deeply resentful since, he argued: "She needs me at home to go on her trips." Then, he repeated a comment his daughter had made that obviously struck a nerve: "My mommy goes to work and my daddy cleans the house." The stigma of this role reversal deeply affected him. Trevor was stuck in a martyr position.
From Chapter Five: Submissiveness:
Love Without Garter Belts
Case of Danielle
Danielle and Nils had been married for seven years at the time of her EMDR therapy. It was the third marriage for her and the second for him. Nils had been a dentist in Minnesota and then developed a business selling medical supplies in California. He had left his first wife of many years because she was alcoholic. He had two (now adult) children with her.
Nils was twenty-four years older than Danielle “if,” she added, “we believe that he is the age he says he is.” She herself was forty-nine years old. Previously, she had done therapy regarding her relationship with her father, particularly the sexualized nature of his behavior with her. He walked around the house naked until she was twelve or thirteen years of age. He commented on her tight jeans and, she said, “creeped me out by looking me up and down.”
Danielle was a striking woman. She had auburn wavy hair and a pretty face. But what one noticed most about her was her height, set off by her long shapely legs and well-proportioned butt. No doubt, that was what her husband, Nils, noticed about her too. He loved to see her dressed up in slinky outfits when they went out together. He enjoyed seeing the envious looks of other, less fortunate, men who were not out with her – so long, that is, as she paid attention only to him. He definitely did not appreciate her being even casually friendly to other men. At home, he pressed her to dress up in sexy attire and parade in front of him. She said he particularly liked it when she put on stockings with a garter belt, stiletto heels, and no panties. It was a constant turn-on for him.
Danielle complained that Nils wanted sex all the time. He resented it when she had work-related meetings or social plans with friends on weekday evenings or at any time during the weekends. He wanted her to give all her spare time to him. And most of it he wanted to spend in bed. He had a notebook where he kept track of her orgasms and rated them for quality and intensity. He would sulk for days and give her “the silent treatment” if she took any time away from him, so it often seemed easier to her just to go along with his demands. Or he would tease her mercilessly, knowing she was not comfortable being teased. Despite her angry protests, he would persist, seeing from her reaction that it really got under her skin. She believed that he did it in order to punish her.
Every Friday night was date night and Danielle would drink, frequently to excess, to “get in the mood.” She felt enormous pressure to be sexually responsive and innovative with him. She both loved the sexual attention and hated feeling reduced to a sexual object. Clearly, she was in conflict about this.
While she loved her husband, he was a source of perpetual frustration to her. As his business declined, she became the primary breadwinner of their family. Yet he resented the fact that she had to work. And she, in turn, resented the fact that he would not take any steps to get out of his business and find alternative work. He spent most of his time at home, but he resented helping with housework. He would commit to do tasks in their household and then not do them. Although he had been at home all day while she was working, she would come home day after day to find they still had not been done. Nor would he allow her to hire someone to do them. Although she made most of the money in the relationship, it appeared that he got to decide how the money was to be spent.
According to Danielle, Nils would resist changing virtually anything that bothered her – from the crumbs on the kitchen counter to racist jokes in social settings. It was particularly upsetting to her that he watched so much pornography on line and that, to make matters worse, he would leave it on the computer used by his kids. He seemed to believe that cooperating with her would be the same thing as being controlled by her. And he wasn’t going to let himself be controlled. Thus the only possible ending to a conflict would be if she gave in. Eventually she would have to appease him, she felt, because being in conflict wore her down. She wanted to stay in her marriage without having to submit to his rule and lose her sense of self.
The irony in this case was that this woman was somewhat of a business dynamo. She seemed to have no trouble asserting herself in the professional world. In fact, she had at times been characterized as “forceful” or even aggressive, and she could be perceived as intimidating in her outspokenness. More than once, she found herself the target of harsh criticism from other staff members and from superiors. She had strong opinions and had to learn discretion in how and to whom she stated them. We spent many hours in therapy figuring out how she could manage the political in’s and out’s of the non-profit world she moved in. One would certainly not have guessed that this tailored woman in a business suit by day would, at night, be prancing in stiletto heels and garter belt to please her sexually demanding husband.
From Chapter Eight: Social Anxiety:
They’re Laughing Inside
Case of Melissa
Anxiety is one of the most common presenting problems in our therapy offices. Human beings, it appears, have the distinctive ability to visualize the future in either excited anticipation or in fear and dread. Other animals can prepare for the future as, for example, squirrels that bury nuts for the winter. But it does not appear that squirrels worry about their supply of nuts drying up, or their fellow squirrels judging them for gathering too many, or ostracizing them for their particular nut-gathering behavior. This type of worry seems to be the distinctive domain of human beings.
We humans not only worry about the future. To make matters worse, we also worry about our worry about the future. Will we be so anxious that we can’t speak? Will we act like a fool? Ruin our chances of impressing the other - whether that other be a potential employer, lover or friend? The most prevalent type of anxiety that brings people into therapy is social anxiety – the obsessive concern about how other people will receive and judge us. At bottom, it is a fear of rejection and the loss of approval and love.
The case of Melissa is a dramatic example of how social anxiety can cripple a person’s confidence and block their ability to connect with other people. The messages inside Melissa’s head paralyzed her from behaving in a natural and spontaneous manner in social situations. She went through her life with very little contact with anyone. In her therapy sessions, she sat up very erectly on the edge of her seat, poised as if ready to jump up and run at the first opportunity. In all the months I worked with her – and I worked with her for almost a year - I never saw her settle into the cushions of the couch and look as if she was comfortable and at ease. She came across as withdrawn and reserved, rarely initiating conversation and responding minimally when addressed. Her answers were most often clipped and to the point, reminiscent of the one-word answers of resistant teenagers. While her attitude was not inherently oppositional, she was perpetually guarded, as if expecting she might need to defend herself at any moment. Perhaps she rationalized that the less she put out, the less there was to attack. So, she put out very little. There were long pauses when she said nothing.
To keep the conversation going, she needed to be coaxed and coached, prompted and prodded. It required an unusually high degree of intervention on my part. I found myself explaining, paraphrasing, and repeating myself on a frequent basis. I had to draw out her thoughts with accompanying messages of continuous support and reassurance. It seemed clear that something had gone wrong in her early mirroring to create such blockage in her ability to communicate. I felt like I was trying to make up for the attunement and validation she had somehow missed.
Melissa was nineteen years old and in her first year of community college when she came for therapy. She had been living with her father, her father’s girlfriend (who barely spoke English), and her grandmother during the previous semester. She succinctly summed up her current living situation with the words: “I don’t enjoy it.”
She had very little contact with the adults in the household. She ate her breakfast in the car on her way to school and her lunch in the car at school or on her own in the cafeteria. The only meal that was shared with her family was Sunday dinner. She described the conversation with her family as “nothing deep or too personal.” They rarely went out together or had any shared activities beyond watching TV. She spent most of her time at home with no one to talk to.
Nonetheless, this living arrangement was, in her view, a vast improvement on her previous living situation with her mother. Since Melissa’s parents had divorced when she was seven years old, she had wanted to live with her father, but her mother would not allow it. In Melissa’s mind, this was because her mother was afraid she would be lonely without her daughter’s company. However, Melissa and her mother had what she described as “a very bad relationship.” She depicted her mother as “rude, opinionated, high strung, and a racist who talks trash and blows up at the smallest thing.” Her brother had moved out of the house when she was fourteen, leaving Melissa as the target of her mother’s rage. She wondered if the negative thoughts in her head had any relationship to her mother’s extreme negativity.
Melissa reported that she had been anxious “ever since (she) was little.” She had some friends in public school, but they had gone in different directions, and she found herself isolated in high school. She didn’t like the high school or the other students at the school. Her saving grace was gymnastics that she loved and excelled at. She focused all her attention on gymnastics and socialized, to the degree that she did, with the kids who were involved with that activity. Unfortunately, when she had not won the scholarship she wanted for college, she had to quit gymnastics. She rarely, if ever, saw any of the friends she had had in gymnastics. “It was my whole life,” she said, “but there is no club here and it’s time to move on.”
Moving on was proving difficult for Melissa because of her social anxiety. She found it hard to talk to people at school. Sometimes she would stutter or slur her words or forget words, she reported. Sometimes she would say things backwards and not make any sense. She was so worried that something like this would happen that she avoided talking to anyone. She lived a very lonely life.
In the months before our EMDR work, we had trained Melissa in self-hypnosis so she could put herself in a relaxed state at will. We set up a hierarchy of situations at school that were increasingly difficult for her, and did hypnotherapy to allow her to experience managing them without anxiety. We identified the negative messages she was giving herself and taught her how to fight them. She dutifully did all the work I proposed, but she remained socially isolated. We looked at resources for her to explore in order to expand her contacts, but she did not follow up on the suggestions or found some reason not to pursue them. Then, one day, she asked: “Is there anything else we haven’t tried?” I reminded her that we had not yet tried EMDR, although I had suggested it. It was as a last ditch effort that Melissa reluctantly agreed to do EMDR regarding her social anxiety.
From: Concluding Remarks: Why EMDR?
I have detailed the process of working with nine different clients on nine different issues. You have been given an inside view of EMDR therapy with each of these cases. You have seen how they all started out in a stuck place characterized by negative beliefs and feelings and behavior patterns that were adversely affecting their lives. And you have watched as they transformed these beliefs and feelings and behaviors to move forward in the direction of the goals they had set for their therapy. How could one doubt that change is possible? You have been an eyewitness to the intimacy of the drama as the change process unfolds.
But, you might wonder, how long will the change last? I, too, felt a need to track this for myself, just to be sure. So, I sent out an EMDR follow-up form to eighteen of the EMDR clients I had worked with at least six months after their work. Ten of the eighteen responded. Here are some sample questions I asked and the results I received:
Do you feel that you accomplished the goal you had for this work?
not at all ____ somewhat __1__ most definitely __9__
Would you recommend this therapy to others?
never ____ maybe ____ most definitely __10___
Overall, what is your level of satisfaction with the EMDR therapy you received?
dissatisfied ____ satisfied __1___ very satisfied __9___
Why, we might ask, does this therapy work so remarkably well? I believe there are two elements to be taken into account in response to this question.
The first lies in the EMDR theory itself and, specifically, in the elements of the protocol. Even when I was not making explicit reference to the protocol during the processing with a client, it was always there in the background, informing the work and, so to speak, lighting the path. It is the substructure on which the work is grounded.
In the protocol, the issue provides the focus. It defines the contract we have with the client and what they are there to address. The issue tells us where the client is lost or stuck and where they hope to end up. If the issue is defined too broadly, we can open up a myriad of channels – much like different paths in the woods – each heading off in a different direction. Following a jumble of paths may keep us wandering around for a much longer time than is helpful or necessary. Since time is deliberately condensed in my model, maintaining focus on the issue is critical.
The target gives us an X-ray of the difficulty. What is causing the block? What is holding this person back? What needs to be released so that the client can move forward in the direction they want to go?
The feelings flesh out the form in which this difficulty is experienced by the client on both the affective and somatic levels. They are touchstones we can turn to in order to assess our progress. Have we taken steps in the right direction, or are we going around in circles? Are we still lost in the woods, or is there an end in sight?
The level of disturbance, as represented by the SUDS, indicates the depth of the difficulty experienced by the client at the starting point. It operates as an indispensable gauge - a way of calibrating our progress. I tell my clients: you will know it is working when the level of disturbance goes down. At bottom, that is the litmus test for success of the process.
The positive cognition represents the goal of the work as understood at the outset and, possibly, as modified at the end point. The level of truth as expressed in the VOC is like the inverted correlate of the level of disturbance. As the former goes up, the latter goes down.
Thus, we are not left to wander aimlessly in the woods looking for proverbial breadcrumbs. The territory can be charted, measured and appraised by the key ingredients of the protocol. They form our guidebook for the change process.
I think of myself as a companion and guide for the process. I would call my approach “interactive.” It can be non-directive when the client’s process is moving forward readily, as in the case of Sam. When the client is stuck and looping, or has difficulty seeing options as, for example, in the case of Trevor or Melissa, I will make suggestions which they can accept or refuse. I prefer not to call my style “directive” in as much as I offer suggestions rather than commands. In the end, it is the client’s process that determines the direction of change.
The other factor that accounts for the effectiveness of EMDR is, undoubtedly, the bilateral stimulation. It allows our brains to make new connections that move us forward. It supplies an energy that fuels the process of change. Once I had a client who doubted that the bilateral stimulation was making any difference. I readily agreed to turn the scanner off. Within a few moments, she noticed an appreciable difference. Her doubts allayed, she asked me to “please, turn it back on again.”
Whatever explanation finally comes to dominate our thinking about what makes bilateral stimulation effective, the fact that it is effective is self-evident to anyone who has experienced this work, either in the client or therapist role. What may look like “ordinary therapy” in a transcript is actually powered by the bilateral stimulation that accompanies it. Bilateral stimulation galvanizes the work and takes it to a new level.
In the more than forty years I have been a therapist, I have never experienced a methodology as fast and effective as EMDR. Consider this book as three hundred pages of testimony in response to the question: “Why EMDR?” The inescapable conclusion is that Eye Movement Desensitization and Reprocessing allows us to find a way out of deep personal suffering at lightning speed. It is an elixir of change.
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Excerpts from Therapy at Lightning Speed
Santa Barbara Therapist and Author
Dr. Rachel B. Aarons LCSW
Dr. Rachel B. Aarons LCSW