EMDR

What is EMDR? 

EMDR stands for Eye Movement, Desensitisation and Reprocessing. It is a well-established type of therapy that utilises specific techniques to reach insight into problems and promote positive change. The main technique consists of performing fast Bilateral Stimulations (BLS) on the client, in the form of asking the client to follow the therapist’s hand as it waves from one side to the other at a short distance of the client’s eyes. However, the therapist and client might decide that alternatively tapping the client’s knee feels more effective. There are also other methods of BLS, but the principles and the aims behind BLS are the same. 

What symptoms/mental health issues is EMDR used to treat? 

EMDR was originally developed to treat Post-traumatic Stress Disorders (PTSD), which is a psychological syndrome that people might develop following a traumatic experience, during which they felt that their own or other people’s integrity and safety were at risk. What qualifies as traumatic experience is being the witness of or being directly involved in the following events: collective disasters (i.e.: earthquakes, war, tsunami, flooding, fire, etc); emotional, physical or sexual abuse; road traffic accidents; life-threatening medical procedures and so on. 

People with PTSD usually present with the following symptoms: severe anxiety when remembering the traumatic event; intrusive memories of the event, such as flashbacks and nightmares. Moreover, they tend to avoid any reminders of the traumatic event and are hyper-alert and vigilant when it comes to any sort of real or perceived danger (i.e.: a sudden loud sounds, etc). 

However, throughout the years, EMDR therapists found out that EMDR is also effective when used to help clients with other psychological issues, including: phobias, depression, social anxiety, interpersonal problems, sexual issues, OCD, relationship problems, and other clusters of psychological symptoms. 

The applicability of EMDR to other problems beyond PTSD can be explained by referring to the following concepts: big ‘T’ traumas and small ‘t’ traumas. The big ‘T’ traumas refer to events that are typically regarded as the cause of PTSD (see above). The small ‘t’ refers to other very negative, unpleasant experiences that – despite not being always objectively traumatic for everyone – can still have a subjective traumatic impact on some people. The small ‘t’ traumas include: a difficult breakup, parental divorce, the sudden natural death of a loved one, etc. Small ‘t’ does not mean that these experiences are less important than the big ‘T’ traumas, as the emphasis is on the subjective experience of the person. 

Aside from helping people to process trauma, what are some of the ways EMDR can make a difference to someone? 

EMDR is a type of therapy that helps with processing traumatic experiences, but as I described above, not all people that go through traumatic/unpleasant/negatives experiences develop PTSD, as they might end up presenting with anxiety, depression, etc. EMDR can be very effective when it comes to other presentations other than PTSD. 

EMDR connects the right and left side of the brain? Why is it so important that these sides speak to each other? 

One of the most popular theories behind EMDR is that the brain can keep alive the emotional aspects of traumatic/negative events as though they were frozen in time, even after many years. So they can feel as they keep happening ‘here and now’. One good example is experiencing flashbacks, during which the person feels and reacts as if they were back in the trauma. 

The right hemisphere of the brain is where the emotions are stored and processed. When a traumatic event takes place, most of its emotional and perceptual/sensory (hearing, sight, smell, touch) elements might be stored in the right hemisphere in a fragmented and not fully comprehensible format. For example, a person who has had a car accident might vividly remember the smell of smoke and the screams of people in an accidental way. 

The left hemisphere is where our language abilities are based. Language is what we use to make sense of the world and put things in order in our heads. Therefore, the suggestion is that stimulating the client bilaterally will allow the right and left side of the brain to communicate, therefore words and emotions/perceptions will finally meet. 

If the client can put into words what has happened to them, they will be able to create a narrative of the negative events and they will understand them better. This will lead to better insight and empowerment, and will ultimately enable the person to incorporate the negative experience into their storyline. If a negative event becomes part of a coherent storyline, it will not have a ‘here and now’ nature and will no longer affect the person. In other words, the negative event will become just ‘a negative memory’, rather than a memory that has a negative emotional grip on the person. 

EMDR has been referred to as talk therapy on speed? Is this an accurate description? 

EMDR tends to bring about amazingly positive results within a shorter period of time relative to other traditional talking therapies. I regard the phrase ‘talk therapy on speed’ as a catch-phrase used for marketing. Such phrase can be misleading and easily misinterpreted. It could be disappointing for a client to find out that changes during therapy are not quick and/or evident. Clients need to be prepared for the possibility that changes can be slow, subtle and at times not so linear or straightforward. 

How quickly does EMDR start to effect? 

I do not believe that this is a question that can be easily answered, especially in light of what I wrote in the previous section. EMDR, like all other respectable therapeutic approaches, is a very subjective process and therapist and client need to agree on what to be on the lookout for to make sure that changes are happening. 

I can only say that – anecdotally and clinically speaking – clients tend to notice more or less evident changes between 10 and 20 sessions. However, I have worked with clients who required much less time and others that required many more sessions. This very much depends on the client’s preparedness to embark on EMDR, which in turn depends on their history and background. I find that the more difficult and emotionally troubled their stories, the longer it might take for clients to obtain major positive changes in their issues. However, this is not a rule of thumb. 

Is this treatment something of a last resort or could you approach it without having done any talk therapy? 

First of all, it is important to highlight that EMDR is not a ‘non-talk’ therapy. I appreciate that during the BLS not many words are typically exchanged between the therapist and client, however there are conversations to be had during the assessment and preparation phases, and in between the sessions when BLS is used. In other words, assessment, preparation, BLS, debrief and future planning are all essential elements of EMDR. 

To answer the question whether EMDR is a last resort, the answer is simply, no. Based on my experience, people often seek EMDR because other therapies seemed not to have fully helped them or reached the core of their issues. However, this does not mean that EMDR cannot be used as a first intervention, even on clients who have never seen a mental health professional before.