Integral EMDR contd ...
NT: Of the theories that do exist to try and explain the underlying mechanisms of EMDR, can you say a little about how you understand it to work?
If I back off enough I can simply say that what we're doing is activating an information processing mechanism that's inherent within all of us. And this information processing system is geared to take us to a level of functioning that promotes mental health. So, something happens to us that bothers us: we have a fight with someone at work, and we have a high level of arousal and negative self-talk and all of the things that go on with it . Then we walk away and think about it, talk about it, dream about it, until it doesn't bother us any more. It has arrived at an adaptive resolution. It's been digested, if you will. The appropriate information is learned and it's stored with appropriate affect and it will guide us in the future. What's useless is what's able to be let go and discarded. If we're looking at this in the same way as a digestive system, it is geared to go towards mental health but a variety of things can cause it to be disrupted trauma, high levels of disturbance during developmental windows, high levels of stress. So we could have high levels of early childhood disturbance which are ubiquitous experiences, but for some they define the person for life in that, if you ask them to think of it, you find they still have the physical sensations and emotions that were there at the time. These are what need to be processed. So, what we're looking at with EMDR is preparing the client in a certain way, accessing the earlier event and then activating this information processing system and keeping it dynamic so that it is able to move to that resolution. Now, the procedural elements of EMDR that I have already spoken about serve those functions and the stimulation appears to assist in stimulating that information processing. So, whether it turns out that it's because it's bilateral or rhythmical or simply an alternate stimulation is really yet to be defined. But, as you mentioned, there are earlier studies that have been done, which have shown correlations between shifts in cognitive content and eye movement.
There are theories now, like Robert Stickgold's of Harvard, who are saying that it is linked into the same processing that occurs during REM sleep. It doesn't matter whether it's eye movements or hand tapping that's being used. It's still the attentional shift. The orienting response has been suggested by a number of researchers as contributing to this. And so at this time, as with any form of therapy, it's impossible to define the neurobiological causes for the effect, but there have been studies by Van der Kolk that show neurological differences pre and post EMDR treatment. So, after the EMDR treatment you have different brain structure activation.
NT: When you talk of an information processing system, the question immediately arises: Surely this is an approach which has potential for a far greater variety of conditions or problems than presently is the case? It seems to be restricted in the literature to PTSD (Post-Traumatic Stress Disorder).
You're absolutely right. That's true about the controlled studies. The concentration has been primarily on Post-Traumatic Stress Disorder. But the clinical work and certain case studies that have been published have gone beyond that because it is exactly what you said. You are looking at being able to target earlier life experiences that are contributing to any current complaint. So, for instance, there was a sequence of seven consecutive cases of body dysmorphic disorder published in a journal in the UK. And they found that in five of the seven cases, the body dysmorphic disorder disappeared after one to three sessions of EMDR. They processed the earliest memory that the person had of a distorted view of his or her body. And, even though cognitive behavioural therapies have not been very successful with this disorder: again one to three sessions of EMDR were sufficient in five out of seven cases, because, apparently, this earlier experience of shame and humiliation was stored in memory along with the emotions and physical sensations intact. So, given the dysfunctional storage, this cognitive, affective and physiological content is what keeps coming up for the person. We find that it can be the same with depression. Very often rather than a biological deficit, it's really earlier experiences that contain feelings of helplessness and hopelessness that are involved. We find it in application to substance abuse. It's been reported that 30 percent of those who have tried to remain abstinent have chronic relapses. But, we've found that among that group there appears to be a perceived life-threatening event and when it's processed with EMDR they stop relapsing.
NT: EMDR has been spoken of as one of the "power therapies". I'm not sure I understand what that means, but it seems to suggest that it is a dramatically more effective approach than, for argument's sake, exposure therapy, for use with PTSD. How do you understand the term "power therapies" and what does it mean? Is this the emergence of a more potent therapeutic approach?
Well, I think the term "power therapy" was really marketing hype. It really isn't an appropriate professional term at all. It's been primarily used by marketeers. I think it's inappropriate to try to link dissimilar therapies with dissimilar outcomes in most domains. We need to understand differences as well as similarities if clinicians are to have the very best set of alternatives to customize their treatments to the needs of each client. These types of terms obfuscate, rather than clarify. EMDR is simply a distinct form of therapy. It is distinctly different from exposure therapy, from cognitive therapies, from psychodynamic therapies and from the newer therapeutic approaches. It's an integrated form of therapy and it has very efficient, robust and powerful effects. I think that it assists in honouring all of the different psychological orientations. I think the notion of the integration is extremely important.
NT: Suppose I am a dyed-in-the-wool psychoanalyst and I discover EMDR and think this is quite an amazing new approach to incorporate. I might be inclined to just use eye movements as a way of loosening association, if you like. If I believe in free association this might be something to which EMDR might lend itself. What is your comment about people who adopt EMDR in that manner?
Well, EMDR is being used now at Menninger's Clinic, which has a distinctly psychoanalytic orientation. They have moved over to the use of EMDR because they find it very compatible with their thought and they use it depending upon the need. For instance, if a person has a primary complaint like PTSD or a primary complaint like body dysmorphic disorder or whatever, then they will generally use the standard EMDR protocols and procedures as devised. Then, at other times, when they are having more psychoanalytic or interpretive conversations, they may then simply use the eye movement. But I think it's pretty agreed that when it's come to the focused problem areas, you would use the standardized EMDR procedures as they have been set out.
NT: If there is anything I should have asked today and didn't, what would that be.
Well, my primary interest at this point is the EMDR Humanitarian Assistance Programmes (www.emdrhap.org). We have clinicians - and I also think of this as an integration process - who are integrating EMDR with its synthesized orientations into different cultural views worldwide. And one of the emphases is upon stopping the cycle of violence. It is clear that most perpetrators have in their own background types of experiences that push them in that negative direction. We've been finding that when they have been processed with EMDR the dysfunctional behaviours stop and they start to move into a positive direction. I think if we can find ways of integrating the psychological orientations and also increasing the degree of understanding of how individuals develop and then honour the wisdom of the different cultural traditions, I think we will be in much better shape worldwide.
NT: If there is one book you could recommend to those unfamiliar with EMDR, what would that be?
Shapiro, F., & Forrest, M. S. (1997). EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. New York: Basic.
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