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David Baxter

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EMDR: A Brief Description

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
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. Athough 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.

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.


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1Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York: Guilford Press.

2Shapiro, F. (2002). EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism. Washington, DC: American Psychological Association Books.
 

Thelostchild

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I didn't like EMDR. I didn't think it worked. She made me close my eyes and I can't close my eyes for anyone.(trust issue) and then they tap your knee. no no no no touchy. It just didn't do anything to me?
 

Banned

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I haven't tried it - my therapist wanted to and I refused. Sometimes I think about giving it a shot just to see, but then I read about it again and don't want to.
 

David Baxter

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Well, it's not a cure-all or anything. Some people find it helpful. Some people find it annoying. Some people don't react one way or the other.

I think a wise therapist should alway adapts tools and techniques to suit the client, rather than trying to make the client fit a particular technique.
 

Halo

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Thank you Dr. B. for the explanation of EMDR. I am seeing a Dr. right now who wants to do this with me. I am a little skeptical as I have tried it before (with someone else) and it didn't really work...although I now think that maybe I was not trying or giving it an honest try. Anyway, I am seeing my Dr. this afternoon and we will discuss it more.

Again thanks for the description.
Nancy
 

K9

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Hi Nancy,

Just a quick note to let you know I had EMDR twice.? ?It is a bit unusual.? I had to record things that came up for me after the sessions.? I trust my therapist and get on very well with her.? She said I could call her anytime if I had a problem.? As I mentioned in an earlier post though, hypnotherapy worked better for me as I am a very good candidate for it if I feel comfortable with the therapist. I had hypnotherapy many years ago for a phobia and didn't feel comfortable with the therapist.

Hope it works for you, take care.? K9 :)
 

Halo

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HI K9,

Sorry I am so late in responding to your post but somehow it slipped by without me seeing it. Anyway, just an update....I start EMDR tomorrow and I am scared stiff about it. As I said, I have done it before with another Dr. who I completely trusted but this is a new Dr and I am still unsure. She seems to think that I am a great candidate and says that it should help me alot. I am hoping but trying not to hope at the same time because I don't want to be disappointed. Anyway, thank you for your encouragement and I will keep you posted on how the first session goes tomorrow.

Take Care
Nancy
 
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