This article by Andrew Archer is worth reading, especially if you are considering EMDR Therapy.

EMDR Theory and Trauma: The Strange, the Familiar, and the Forgotten

June 8, 2017 • By Andrew Archer, LCSW

There are polarizing beliefs when it comes to eye movement desensitization and reprocessing (EMDR) therapy. On one end, it is viewed as a+ cure-all treatment for mental health symptoms. On the other, critics see it as a treatment akin to modern-day snake oil.

The protocol for EMDR therapy is comprehensive and detailed. Put simply, the idea is to transform disturbing input—process and decondition it—into an adaptive resolution and a psychologically healthy integration. The model is past-focused, meaning one is going back in time to recall events as opposed to addressing current life stressors (not that the two are mutually exclusive). This includes redefining the event, finding meaning in it, and alleviating self-blame while integrating new skills (Shapiro, 2001). The modality focuses on the core cognitions or self-referential beliefs individuals associate with the disturbing events. These often fall into domains related to personal responsibility, safety, and power or control. “Trauma in each of these domains is reflected by the client’s distorted self-referencing beliefs linked to the effects of unresolved memories” (Nickerson, 2017).

EMDR is an evidence-based therapy primarily used to treat posttraumatic stress (PTSD), but as it gains momentum in mental health circles, indications for its use are ever-expanding. The question for me is less about EMDR efficacy or benefit. The concern is the theory behind it and my general curiosity regarding its unique properties. There are aspects of the treatment that are altogether strange. Likewise, it contains components that are familiar to popular understanding of memory and a few things that tend to go overlooked or are forgotten.

Strange

EMDR was founded by Francine Shapiro in 1989. The legend is she was walking in a park and thinking about something distressing to her. She noticed that moving her eyes from tear duct and back to her periphery (i.e., side to side) lessened her distress. This was the early evolution of utilizing what is called bilateral stimulation. During the processing stage of EMDR therapy, the practitioner will use their fingers, tactile sensors, and/or auditory sounds that activate from left to right or vice versa. The theory is this process stimulates each hemisphere of the brain. The left hemisphere is primarily focused on language, linguistics, and narratives of our experience as opposed to the experiential aspect of the right hemisphere. In this manner, the person processing the traumatic memory integrates both the story and the felt experience. The bilateral stimulation is said to parallel how memory is consolidated during dream or REM (rapid eye movement) states when we sleep.

Fundamentally speaking, accelerated processing during EMDR splits the attention of the individual. During bilateral stimulation (i.e., finger movements, tones in the ear, or hand sensors), working memory is taxed because one must partially focus on the stimulation. This multitasking softens the emotional blow of recalling disturbing memories.

For those unfamiliar to the processing aspect of EMDR, practitioners are trained to sit close to the person in treatment. During this process, the therapist and person in therapy are cohabiting each other’s personal space, with one knee a couple of inches from the other’s. The direction is for the two people to be seated in an orientation “like two ships crossing in the night.” This unique approach to treatment creates an added level of intimacy and implicit vulnerability. It is strange and often overlooked when considering how the intervention benefits people in therapy. In a garden-variety individual therapy session, the two people are often sitting across the room from each other or at least several feet away.

Another oddity of EMDR is the historical context and initial hypothesis pertaining to trauma. In 1989, Shapiro questioned if trauma was essentially a disruption in the excitatory and inhibitory balance of the brain. This was two years after Prozac was introduced to the United States and a year before the Decade of the Brain. Mental health was beginning to be understood from a chemical or biological perspective. EMDR benefited from hitching the idiosyncratic trauma treatment to the biological wagon of mental health. EMDR’s individualized treatment would offer a correction to this brain imbalance akin to the overly simplistic solution for depression being a deficit of serotonin.

Familiar

Popular understanding of memory is that it is solely a brain function, with stored archives of our moments from the past organized in little synaptic shelves of neurons. This concept of memory as photographic snapshots stored in an album of existence is analogous to social and news media feeds displaying a history of ourselves across set positions on timelines. The click or swipe reveals the exact same image with no distortion. In Israel Rosenfield’s book The Strange, Familiar, and Forgotten: An Anatomy of Consciousness, he notes our false conception of memory based on Freudian ideas of the unconscious: “The problem is that we have tended to think of memories as unconscious items that one brings to consciousness, not as part of consciousness” (1992; p. 12). The false dichotomy of consciousness versus unconsciousness holds this misconception in place.

In Pixar’s animated film Inside Out, the main character’s memory process was portrayed in a similar manner. Her brain would produce marble-like spheres that rolled down a mechanical carousel to produce videos of previous experiences. The film portrays an exact reconstruction of past events as if these histories could be called upon via a brigade of emotional activity. This is not unlike the theory behind EMDR therapy. Disturbed memory channels in the limbic system are said to be clogging or inhibiting the individual from moving past the traumatic event. A subtle distinction is important to note: each time one thinks of a memory, they are essentially reconstructing or imagining what happened. This process creates tiny errors similar to the manner in which one copies a computer file. Over time, these little distortions add up and the factual elements of the memory are changed. The most salient and accurate memories are the ones we only rarely recall (like the original file before it is copied). The misconception of memory processes fits with Western culture’s ego-centric, fixed sense of self; “the conviction that memory is one thing is an illusion” (Eagleman, 2011; p.126).

The idea of having storage units or filing cabinets in the brain holding our past experiences aligns with current cultural frameworks (i.e., email, cloud technology, digital folders) and therapeutic modalities related to trauma and clogged memory channels (i.e., EMDR therapy). Rosenfield (1992) is explicit in drawing attention to this faulty neurology. When one remembers, they are referring to an event/object/person as they are represented based on one’s own subjective experience, “not mechanical reproduction” (p.42). Memory is less of a product of history or biological remnant, but a dynamic ability to integrate knowledge in a relational manner. The timestamp or notarizing of the event occurs within a conceptualization of who it is we think we are as a person.

Memory is rooted in our sense of time and part of the very structure of conscious knowledge. It is not an isolated phenomenon, but rather a manifestation of subjective states created by brain activities (Rosenfield, 1992). Therefore, failure of memory is not due to the loss of specific items “stored” somewhere in the brain, but rather a breakdown of the mechanisms of consciousness; “there are no memories without a sense of self.” As Rosenfield (1992) notes, “Without knowledge of one’s own being, one can have no recollections. How can I remember my parents, my house, if I am not sure I exist?” (p.41).

Forgotten

You need to remember EMDR therapy is an intervention that implies a Western understanding of the self or mind. It turns out the way highly educated, wealthy, democratic minds think is not representative of the entire globe. Most of us in the West do not think of ourselves as a body; we think we “have” a body. There is a notion we are the chariot drivers of our experience or, put another way, there is this little person inside our heads that has all types of likes and dislikes, proclivities, and things we retract from or avoid. This is an ego-centric perspective of the mind.

If you stop and pay attention to the present moment, one’s habitual patterns of cognition start to become clearer. The ego-dominating belief of our existence lying somewhere in the center of our skulls begins to be challenged. This is worth remembering.

By comparison, if you ask a Sri Lankan about themselves, they may describe their interpersonal relationships, family, and roles or responsibilities. This is a socio-centric version of the self with less of a demand on individuality. Watters (2010) articulates this distinction via several cultural specific examples in his book, Crazy Like Us: The Globalization of the American Psyche. He describes the 2004 Indian Ocean tsunami that killed around a quarter million people. Sri Lanka was one of the areas hit especially hard by this tragedy.

Western mental health practitioners rushed into these areas without knowledge of the culture. They did not know how to speak the language or have any awareness of local conceptualizations of trauma. This included benevolent EMDR therapists who assumed there would be an epidemic of PTSD. However, if you asked the Sri Lankans where their trauma resided, they generally did not point to their heads or speak of their minds being broken. For them, the damage was to the community and broken relationships. “Because Western conception of PTSD assumes the problem, the breakage, is primarily in the mind of the individual, it largely overlooks the most salient symptoms for a Sri Lankan, those that exist not in the psychological but in the social realm” (Watters, 2010; p.92).

The Westernized perspective is assumed to be a universal one. When one considers trauma, they must consider the time it happens and the cultural frame it occurs in. The consequence of an ignorant global construct for trauma is we remove the nuanced experience from other cultural narratives and beliefs that might give meaning to how the person suffers (Watters, 2010).

SELF-CENTERED AWARENESS

David Foster Wallace (2005) hit on the margins of this notion—self-centered awareness—in his commencement address to Kenyon College titled This Is Water. He spoke about the choice of where we place our attention within conscious awareness (as opposed to relying on our “default setting” or autopilot) and how one can cultivate compassion within the banal aspects of daily life:

And the so-called real world will not discourage you from operating on your default settings, because the so-called real world of men and money and power hums merrily along in a pool of fear and anger and frustration and craving and worship of self. Our own present culture has harnessed these forces in ways that have yielded extraordinary wealth and comfort and personal freedom. The freedom to be lords of our tiny skull-sized kingdoms, alone at the center of all creation.

There is an ancient technology available to emancipate us from the constraints of these small, isolative worlds. To notice this ostensible imprisonment, all one need do is sit down in silence and observe where their mind goes. Who is producing this stimulation and is there a navigator of control? What happens when all you do is focus on the inhalation and exhalation of the breath?

Mindfulness and meditation practices will not cure individuals from the impacts of trauma or reoccurring disturbing memories. However, it is a prophylactic to inhibit self-centeredness or personalization of momentary experience (which tends to lead to the anxiety-provoking reoccurrences of mind).

When one has a thought, feeling, or sensation, it is often turned into a belief that becomes self-referential. A simple interaction with a partner or family member illuminates this silly human deficiency. If the person yawns during a conversation (the thought), this can lead to a belief (e.g., the person is bored) which is then internalized (i.e., “I am unlikable” or “unlovable.”). One falls down this self-deprecating rabbit hole all too quickly. The antidote is to just notice what is arising in terms of thoughts and beliefs before assuming a story about yourself.

If you stop and pay attention to the present moment, one’s habitual patterns of cognition start to become clearer. The ego-dominating belief of our existence lying somewhere in the center of our skulls begins to be challenged. This is worth remembering.

References:

1. Eagleman, D. (2011). Incognito: The secret lives of brains (1st American edition). New York: Pantheon Books.
2. Rosenfield, I. (1992). The strange, familiar, and forgotten: An anatomy of consciousness. New York: Knopf.
3. Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd edition). New York: Guilford Press.
4. Wallace, D.F. (2005). This is water. Transcript retrieved from https://web.ics.purdue.edu/~drkelly/DFWKenyonAddress2005.pdf
5. Watters, E. (2010). Crazy like us: The globalization of the American psyche. New York: Free Press.

© Copyright 2017 GoodTherapy.org. All rights reserved. Permission to publish granted by Andrew Archer, LICSW, therapist in Mankato, Minnesota

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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• ahbuddhaJune 8th, 2017 at 6:54 PMThank you for your article. I feel like EMDR is “sold” as a cure all and that is simply not the case. At the end of the day, it gets down to what every other approach and technique depends upon, the therapeutic relationship (would you let someone sit that close?! Do you need someone to sit that close and hear you story?). EMDR is one tool in a vast toolbox and practitioners need to remember to remain flexible. Just because it should work, does not mean it will work; there is no “one size fits all”. A traumatized client can easily feel like a failure or defective when a “miracle cure” fails to work for them, when it may be a simple matter of individuality, culture, or wiring. I especially appreciate the discussion of culture. An east coast therapist once tried to suggest “brave” pioneers as a resource, forgetting his western client was part indigenous and only heard “genocide”. You needn’t abandon the technique because it fails to work immediately, but you need to be open, honest, and listen to your client. They are not being stubborn or obtuse, there are a multitude of reasons of which they are likely not even aware that one works and another doesn’t. Perhaps the protocol needs to be adapted or perhaps you take the resourcing and use it in concert with another approach. Remain hopeful, but cautious and creative.Reply
• CherylJune 11th, 2017 at 5:12 PMI must add that as a practitioner of EMDR, that this article has many inaccuracies and can potentially give a distorted view of what the essence of EMDR is. The author focuses on the “strangeness” without checking the accuracy of what he highlights, perhaps for dramatic effect? I do not think of EMDR as a “cure-all” and articles such as this are dangerous when taken without proper investigation or questioning.Reply
• ahbuddhaJune 11th, 2017 at 9:44 PMI don’t want to go tit-for-tat, but the author is an EMDR practitioner.
• GradyJune 9th, 2017 at 10:22 AMIt is when you have low self esteem to begin with that you begin to believe all of these things which are so obviously not true but feel like they are in the momentReply
• JohnJune 9th, 2017 at 10:50 PMI am 59 years old and have suffered from anxiety,depression and complex ptsd. People that have known me for years that I have opened up to are surprised as I have become a master at hiding it. I am tired and exhausted and can no longer hide it. I am currently looking into EMDR therapy. Would love to know your opinion on this.Reply
• JimJune 10th, 2017 at 8:54 PMI don’t know what your source or sources of information were regarding EMDR, but many of your statements are simply factually inaccurate. Moreover, these statements repeat critiques of EMDR that occurred in writings of critics of EMDR about 20 years ago, but have been largely debunked. You should have had a discussion with someone familiar with EMDR, and how it works, and what it’s known and accepted limitations are. And, incidentally, there are several hundred therapist members of the Sri Lanka EMDR Organization! (emdrsrilanka.org)Reply
• Katy MurrayJune 11th, 2017 at 6:03 PMI hope you will correct several inaccuracies in this article, as they reveal a lack of understanding of EMDR therapy and a significant amount of misinformation and faulty assumptions.(1) You mentioned, “The model is past-focused, meaning one is going back in time to recall events as opposed to addressing current life stressors (not that the two are mutually exclusive).” Actually, EMDR therapy utilizes a “3 pronged approach” which includes not only a focus on past (contributory) memories, but also focused reprocessing of present situations that continue to be triggering, as well as the development of an adaptive, positive template for the future.(2) “The modality focuses on the core cognitions or self-referential beliefs individuals associate with the disturbing events.” The focus in EMDR is on reprocessing ALL the components of an event, which leads to a shift not only in cognitions, but also emotion, body sensation, and sensory aspects of a memory. The change in cognition is a side effect of reprocessing, rather than the focus of EMDR therapy.(3) “For those unfamiliar to the processing aspect of EMDR, practitioners are trained to sit close to the person in treatment.” Actually, the proximity to the client is dependent on many factors. lF the therapist uses his/her fingers to guide the clients eyes, then the closer “ships passing” position is required. Other ways of administering the bilateral stimulation (BLS) allow for changes in proximity, including the use of mechanical devices (light bars, tappers, headphones) to produce the BLS. There is no research or evidence indicating that the closer proximity is essential in EMDR therapy.(4) You incorrectly attribute a 1927 theory by Pavlov as the basis of EMDR therapy’s understanding of mental health when you state, “In 1989, Shapiro questioned if trauma was essentially a disruption in the excitatory and inhibitory balance of the brain. This was two years after Prozac was introduced to the United States and a year before the Decade of the Brain. Mental health was beginning to be understood from a chemical or biological perspective. EMDR benefited from hitching the idiosyncratic trauma treatment to the biological wagon of mental health. EMDR’s individualized treatment would offer a correction to this brain imbalance akin to the overly simplistic solution for depression being a deficit of serotonin.” Actually, it was an information processing theory that Shapiro was positing. The Adaptive Information Processing (AIP) model does not suggest that trauma itself was “essentially a disruption in the excitatory and inhibitory balance of the brain”. She does make reference to Pavlov’s 1927 theory of psychotherapeutic effect and the basis of neurosis inn her 2001 text when she gives a nod to Pavlov’s theory: “Setting aside any notion of “excitatory–inhibitory” balance and of specific neural blockages inherent in Pavlov’s conception, there is little doubt that something about the trauma causes information processing to be blocked.” (Shapiro, 2001, page 334) Contrary to the notion that EMDR therapy is offering a simplistic notion akin to the idea that depression is caused by serotonin deficits, the theoretical roots of EMDR draw on the historical and emerging understanding of information processing. Only recently do we have ways to explore how this might actually be observed in the brain through the emerging field of neurobiology.(5) You state, “This concept of memory as photographic snapshots stored in an album of existence is analogous to social and news media feeds displaying a history of ourselves across set positions on timelines. The click or swipe reveals the exact same image with no distortion”, and state that EMDR therapy is based on this simplistic and faulty notion of memory. I have never seen anything in Shapiro’s writings that indicate that memory is akin to an electronically stored file. In fact, Shapiro states that “Clinicians should be cognizant of the limitations and distortions of memory itself before advising clients about the accuracy of any memory that emerges during EMDR.” (2001, p 299)(6) The entire discussion of memory and self-centered awareness conveys misinformation about EMDR therapy’s theoretical model. I suggest that the author read Shapiro, F., & Laliotis, D. (2011). EMDR and the adaptive information processing model: Integrative treatment and case conceptualization. Clinical Social Work Journal, 39(2), 191-200. (The full text article can be found at emdruddannelsescenter.dk/Artikler/10_EMDR%20and%20the%20Adaptive%20Information%20Processing%20Mode%20Shapiro%202010.pdf )(7) In regard to cross cultural issues, EMDR therapy has been found to be effective in other cultures, as it respects each client’s own values and focuses on the experiences that contribute to the client’s difficulty (not necessarily western notions of “trauma”), works with “perception” rather than objective “fact”, and by accessing the client’s innate system for processing experience. It has been successfully used in many cultures, and so it recommended by the World Health Organization. See who.int/mental_health/emergencies/stress_guidelines/en/For research on the use of EMDR therapy, as well as information about the theoretical model that guides EMDR therapy, please go to emdrresearchfoundation.org/what-is-emdr/for-professionals . For non professionals, I recommend Dr. Shapiro’s 2012 book “Getting Past Your Past”. Another great resource for more information can be found at emdr.com/what-is-emdr/ . Shapiro’s describes EMDR therapy in a 1 hour webinar/video at youtube.com/watch?v=lsQbzfW9txc
  Reference: Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd ed.). New York: Guilford Press. (The third edition to of this text will be released in the fall of 2017.)