Eye Movement Desensitization and Reprocessing
Trained Providers at LFWC: Dr. Beth Johnson, Tammy Groszczyk, and Susan Ringle
Tammy Groszczyk
M.A., LPC
Marital Wellness Director
EMDR Institute, Inc. www.emdr.com
EMDR Network www.emdrnetwork.org
What is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach.
During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session.
Eight Phases of Treatment
Dr. Beth Johnson
The first phase is a history taking session during which the therapist assesses the client’s readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.
During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete.
In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.
After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist’s fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Although eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client’s report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.
In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.
Susan Ringle, DBT Trained Clinician
The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.
After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures.
Books
Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures
Francine Shapiro, PhD Guilford Press, New York, 2001 (2nd ed.)
EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress and Trauma
Francine Shapiro, PhD and Margot Silk Forrest BasicBooks, New York, 1997
EMDR as an Integrative Psychotherapy Approach
Francine Shapiro, PhD (Editor) American Psychological Association Books, 2002
EMDR and Psychotherapy Integration
Howard Lipke, PhD CRC Press LLC, Florida, 2000
EMDR in the Treatment of Adults Abused as Children
Laurel Parnell, PhD Norton Professional Books, New York, 1999
Small Wonders: Healing Childhood Trauma with EMDR
Joan Lovett, MD The Free Press, New York, 1999
Through The Eyes of a Child
Robert H. Tinker, PhD & Sandra Wilson, PhD Norton Professional Books, New York, 1999
EMDR in Children and Adolescent Psychotherapy
Ricky Greenwald, PsyD Rowman & LittleField Publishers, Inc., 2001
EMDR and the Relational Imperative: The Therapeutic Relationship in EMDR Treatment
Mark Dworkin, CSW-R Routledge, 2005
EMDR Solutions: Pathways to Healing
Robin Shapiro, LICSW, editor Norton Professional Books, 2005
