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Monday, April 06, 2009

EMDR

Last one 'til after Passover.

Eye Movement Desensitization and Reprocessing

I used to think a more apt description would have been, Rapid Eye Movement Desensitization Reprocessing, but R-E-M-D-R just doesn't cut it, and the procedure isn't necessarily rapid, to tell the truth.

Years ago I heard of this woman, Francine Shapiro. This is the late eighties, I think 1987.

Legend has it that Francine got tired of whatever it was that was dragging her down; maybe the est* movement disappointed. So she plopped herself down on a concrete bench to watch the Pacific waves crash into the sand. Some of the crazier sounding innovations start in California, and then come to find, they're not so crazy.

She's chilling, trancing out as anyone of us might. The waves get boring, and she's thinking about some terrible thing that has happened to her.

Keep in mind there are probably better legends about Francine, this is just the one I heard.

Anyway, my version has her sitting back on a concrete bench (not far from the concession stand), relaxing. She randomly stretches out her right arm, points her index finger up and to the right, and slowly follows her finger with her eyes as she waves first to the right, then to the left. She does this several times, watches her finger as it waves left and right, all the while focusing on something in her mind's eye, something annoying, an annoying snapshot picture, one of her traumas associated with all sorts of negative emotion.

And voila! All of the negative emotion associated with the snapshot dissipates. Gone.

Francine's theory is that eye movement somehow has a desensitizing effect on the affect associated with trauma. She has determined, with her single case design, that we don't need to delete our memories, zap them with lasers. We need to delete the affect, the negative emotion associated with it.

We already know that flooding, revisiting traumatic memories over and over again, desensitizes. It worked for Viet Nam veterans. Why wouldn't EMDR work then, in much the same way, for everyone else? EMDR makes clinical sense.

I had to learn it.

So FD found his conference and I found mine with the official EMDR training gurus, and together we took a trip west, years and years ago. It never rains in San Diego, you know, but for us, it rained. They told us, This is the first rain we've had for as long as anyone can remember. All weekend long, it rained.

Anyway, there's much to learn about EMDR. It's not as simple as it looks (I may demonstrate one day) and I recommend that you don't just go waving your finger in front of your face, like Francine Shapiro allegedly did, if she even did. You could get dizzy or sick, or unstable. Just don't do this yourself. Go to a trained professional. The therapist I refer to on my side-bar has certification, but we do hope she doesn't do this particular procedure virtually.

If you're going into the biz, maybe get some officious training yourself.

The training is initially didactic. First you learn the theory and the many, many reasons not to use EMDR with certain people. You learn the particulars of how to do it effectively. You learn what to do before you do it, and what to do afterward to debrief the patient.

Then you get to practice on another trainee. To get a feel for the work, you find a partner and perform, or execute the procedure on one another. You give it and you receive it, EMDR. As the subject you have to think of something or another, some memory that is disturbing, one you can pinpoint. A snapshot.

This is supervised, of course, and at the very end of the conference you get a cool certificate.

So during the training, a trainee receives the treatment, or what we might call a very brief, condensed treatment for a traumatic event, one's own personal PTSD. That's how it worked way back when at least, in San Diego.

Most of us have experienced some sort of trauma, and if you read earlier posts, you might know that the worst thing that ever happened to my family of origin might have been an episode out of Without a Trace. I've never watched Without a Trace (a person has to protect oneself) but I imagine the show is about people disappearing.

In my junior year in high school, that's what happened to my older brother, just twenty. He disappeared. A medical student on campus downtown, he had a medical condition. So when he didn't return one night his concerned roommate called my mother and told her. She panicked, like any mother would, but remained outwardly calm. We're stoics in my family, some of us better at it than others, and it is amazing the degree to which parents can control their emotions to protect their children when they feel they must.

Except I wasn't exactly a child.

When the body washed up at Oak Street beach in late February, nearly two months later, we were devastated, of course. It took me years to even drive by that beach. What you picture, if you're me, is a person drowning, fully dressed as you saw him last, and that person is your brother.

Fix THAT, Francine.

Anyway, when it was my turn to describe a trauma, it didn't take long to think one up, although it wasn't something I especially wanted to do, repeat my construction of a reality that had happened so many years ago. I could see the supervisor worry about complications, melt-downs, that sort of thing.

But tick tock, we did the procedure. And hickory dock, it worked. I was totally shocked, but the affect, the emotion, the shock, the fear, the sadness associated with that construction, all dissipated. The event lost its power. Remember, I had had previous therapy, group therapy, and there's nothing more powerful than a good group therapy. Except maybe, decent exposure therapy, like EMDR.

So that was powerful, what happened to me in San Diego, and as a result, I still use the procedure today in my practice. I find it useful to the degree that the research predicts its usefulness, fifty percent of the time.

I think at some point, as we age, distress over trauma comes back with the usual suspects, the triggers. Like for me, all I have to do is see a drowning on television (and for some reason these are very popular) and I'm out of the room, although I'll see how far I can go with it. So these therapies might need reinforcement over the years. There's no magic bullet for trauma, not yet.

But not everybody needs therapy. (Did I say that?) As we age, the snapshot can lose its power naturally, with or without EMDR. What once triggered negative emotion isn't necessarily going to do that, because over the years we've naturally desensitized. What EMDR does in hours, age accomplishes over the years.

Depending upon different variables. Everyone is different. Our histories, I feel, round us out in perspective, determine who we are, the stuff we're made of, how we will cope with our package and how we will approach others with theirs. For some, history demands an intellectual philosophical quest, a search for meaning, the gestalt of it all. But ask a Holocaust survivor and you might not get much of an answer about anything trauma related. Even thinking of revisiting is out of the question. It's that painful.

And they would tell you they had plenty of exposure therapy.

For those who remember even better than before as they age, who "telescope", who remember things they had forgotten altogether in later years, it is likely that the membrane of their hippocampus is thinning out with age; memories are more accessible to the cerebral cortex, that place we think. That surely makes us vulnerable to emotion and philosophizing about it.

For some of us, talking about memories dismisses their impact nicely, quickly. The envelope full of sensory data is sent back to the proper file in the brain, back to storage. For others, talking is unthinkable.

As for me, hand me that remote, if you don't mind. Gimme a little control, here. Happy holidays, whatever you celebrate.**

therapydoc

I know, I know, it's a lot of intimacy. So in your comments, if you don't mind, try to talk about you or your thoughts on the subject, not me. Much obliged.

*Erhard Seminar Training, est is Latin for "it is"



**If you live in Chicago you'll celebrate a little decent weather.

23 comments:

blognut said...

So you're working with a snapshot memory when you do this? If the cause of PTSD went on for a long time, say over a few years, would a person do this over and over, with each thing they remember?

Yeah, I know. Be quiet and go look it up, right?

therapydoc said...

you could, depends

srose said...

Great post TD! I have had EMDR and it has worked for me some. I say some because it had allowed me to get past intellectualizing the trauma and feel it, but is is not altogether gone. I plan on having more EMDR sessions and I hope it helps to be rid of the neg. emotions attached to it eventually.
I do know other people who went through EMDR and it worked just like it did for you.

Rach said...

I was almost trained in EMDR in graduate school. I really really want to do it, it sounds so amazing. One day.....

But thanks for the great explanation of some of how it works.
Chag Sameach!

Aidan's mom said...

I wholeheartedly believe that EMDR pulled me out of my PTSD.

Trying to make a very long story somewhat shorter....

My son, Aidan, now 3 1/2 was born 12 weeks early due to sudden onset HELLP syndrome. I had a very scary last few weeks of pregnancy wondering if we would even get him to the stage of viability. Then a crash cesarean section under general anesthesia where he and I almost both died. Aidan was 1.5 lbs. I almost totally lost my ability to clot due to the HELLP syndrome and nearly totally bled out. After about 6 units of blood and some platelets I finally began to clot.

Aidan spent 15 weeks in the NICU, 7 of them on the ventilator. Lots of hurdles to overcome before he could come home and lots to worry about after. Would he meet his milestones on time? What would his future look like?

It wasn't until Aidan was 2 years old and had conquered all of his developmental milestones that I had a load of bricks dropped on me. Suddenly I was finally experiencing the fear and panic and depression and anxiety. It was as if my body had not allowed me to do so until I had gotten through those first couple of years.

After so-so results with talk therapy, my therapist suggested EMDR. Wow! I started seeing results only a few sessions in. The sessions were difficult and very draining, but after about 4-5 months I had finally filed everything away where it belonged instead of the jumbled pile it had been thrown into in some obscure corner of my brain.

Sigh....sorry so long. But I totally totally think EMDR is wonderful and sanity saving.

mother in israel said...

"But not everybody needs therapy."
What did you say?

therapydoc said...

Thanks all. As for mother-in-israel, FD always says, we don't choose our professions.

Syd said...

Have a good holiday. Interesting post on something that I knew nothing about.

porcini66 said...

I have heard that it is incredibly intense, sometimes painful, but that the results are there. In my mind, anything that helps to remove the pain around an event/series of events without compromising the health of a person (as alcohol/drugs do) is a step in the right direction.

I sometimes wonder if one day all of MY emotions are going to come screaming in full force, with or without EMDR/therapy. I did a pretty good job of not feeling them for so long...piece by piece, I am readjusting, but still wonder sometimes about that other shoe dropping!

Thanks for writing.

nashbabe said...

So is there a reliable place / web site from which to find referrals for this therapy? How does it (or doesn't it) interact with CBT?

Anonymous said...

I held my breath when I saw your first mention of EMDR - so sceptical sounding, I was worried...

I was really stuck in a ptsd place with close to 15 years of trauma, when I tried emdr - I no longer have flashbacks, body-memories, or really bad intrusive thoughts.

No longer, may be an exageration, but today, i can titrate - I get to decide if I am going to revisit a memory to explore/process - as it is relevant to MY recovery - not as something to keep me in a trauma place.

I follow up with talk-therapy, medication, recovery and support people, excessive journaling, however - it wasn't until emdr was attempted and completed, that i was capable of doing these things.

I do want to say - the beginning was rough going - it was like my brain was connecting for the first time, so there were a lot of 'issues' in thinking and processing... but near the end, i somehow 'shifted' into realizing, all the events not just the ones processed, were in the past. and the past was just that.

I know 3 other people who have tried emdr - for one, there was 6 months of sessions and she was completely transformed - another can use it on bothersome memories but no 'shifting' and the third was a complete failure - she met the guidelines to NOT use emdr.

Anyway.. long enough... once again, you've gotten me to reply.

therapydoc said...

thanks once again ANON

Bobsterz said...

I remember reading articles that Francine Shapiro was walking in the park and noticed her eyes moving and the effect it had. More like a spontaneous movement she noticed. Then she tried doing it on purpose and liked the results. Eventually she did a small research project with veterans with trauma. Last I read, it is the most-researched treatment for post traumatic stress disorder.

Though I provide EMDR, I also like to teach people mindfulness meditation and other practices with eye movement or sound that acts the same. I posted an experience you can try:

Mindfulness Meditation with Bilateral Sound
www.PsychInnovations.com/smpl_mindfulness.htm

Thanks for this really honest, raw post!

- Bob Yourell

therapydoc said...

NASHBABE,

Well, you know I'm biased about double licensure. So when you're looking for someone to help you, look for someone with BOTH family therapy licensure AND individual.

This way you get the whole enchilada, more bang for your buck, and many do EMDR.

Just a bias.

If any of you are in Israel there are probably a handful of these people within six blocks from wherever it is you live.

BOB--thanks for your great comment. Sounds like a wonderful booster for the therapy. AND you're in San Diego! I'm coming over!

Battle Weary said...

Can you explain a little about the people EMDR should not be used with? First you learn the theory and the many, many reasons not to use EMDR with certain people.

timethief said...

I have been considering EMDT and now that I have read your post I'm leaning more towards trying it. Thank you for demystifying the process for me.

woolywoman said...

regarding EST: I had a boyfriend whose mother did est training, as did,my mother. We cracked ourselves up endlessly by referring to it as Extremely Stupid Training.

Dr. Deb said...

What a monumental tragedy it must have been for you and your family.

I have wanted to train in EMDR. A colleague of mine is certified and has found it so meaningful in his work.

You've given me a spark to get going with this again.

Jew Wishes said...

What an informative post. Thank you.

Happy Pesach to you! Enjoy the last few days.

Culture Jam said...

Does EMDR address recent traumas? This may seem like a silly question, but is this something a recently heart-broken client would be interested in?

therapydoc said...

Culture, wait for the post on exposure, and maybe read over those of grieving. Broken hearts tend to be invisible, and EMDR is really for the snapshot memories, the ones you can see. Although I suppose you can "see" your last love over and over again in your mind, there are so many of these memories, usually, which makes me skeptical about EMDR in this case. For a long affair, it could be impossible, it seems to me.

AuthorMomWithDogs said...

Is this at all connected to NLP?

Sounds like it could be a great tool.

therapydoc said...

NLP gives it power (theoretically). I'm getting to the rest of the story. Maybe next week.