Access to information important for clients and clinicians. The organizations listed on this website are well-established and professionally scrutinized to uphold the highest standards. EMDR is an Effective Form of Therapy for Trauma EMDR is a therapy that is listed in the new Department of Veterans Affairs & Department of Defense Practice Guidelines "A" category as "highly recommended" for the treatment of trauma http://www.oqp.med.va.gov/cpg/PTSD/PTSD_cpg/frameset.htm
It has received the highest level of recommendation by the mental health departments of Israel, Northern Ireland, United Kingdom, France, Sweden and so forth. For a full listing visit http://www.EMDRHAP.org/researchandresources.htm
EMDR is also listed as an effective form of therapy, backed by research, on a new National Institute of Mental Health sponsored website: Check under "Adult MH Therapist for Post-traumatic Stress Disorder" http://www.therapyadvisor.com/
Cautions for Clients and Clinicians
Choosing a Clinician
A Brief Description of EMDR Therapy
Training for Clinicians
Referrals for Clients
For clients and clinicians: Websites and authors that question the effectiveness of EMDR, or say there is little research, are long out of date. To view the list of research: http://www.EMDRHAP.org/researchandresources.htm
Other authoritative websites with research reviews are listed on the home page.
For clinicians: A great deal of misinformation has appeared in the professional literature. This published article compares inaccurate statements in the professional literature and compares it to the actual research data. http://www.perkinscenter.net
For clients and clinicians: Be cautious of other therapies that claim to "be like" EMDR or "use parts" of EMDR. EMDR is an 8-Step approach that contains procedures that have been thoroughly examined by research. A brief description of EMDR therapy [below] and visit the following website. http://www.emdria.org/general/index.htm
For clients and clinicians: According to American Psychological Association ethical guidelines, all prescribed therapies should be done according to the standardized procedures that have been examined by research. If clinicians claim to be using EMDR, they must be using the procedures described in Dr. Shapiro's 1995/2001 textbook. http://www.guilford.com/cgi-bin/cartscript.cgi?page=paci/shapiro.htm
The published research should be used as a guide for clinical practice. For instance, 84-90% of single trauma victims should no longer be diagnosed with posttraumatic stress disorder within 5 hours of processing. 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precisely the specific steps outlined in Dr. Shapiro's textbook during EMDR Phases 3-6. Fidelity to these steps is necessary to conform to the researched outcomes. http://www.emdria.org/general/index.htm
For clients: Make sure to ask your clinician if (s)he is using EMDR according to the training standards and guidelines of the EMDR International Association. http://www.emdria.org or EMDR-Europe http://www.EMDR-europe.net
Choosing a Clinician: Make sure that the EMDR training your clinician has taken is approved by EMDR International Association or EMDR -Europe. Clinicians may have unknowingly taken substandard training. EMDR should be used only by licensed clinicians specifically trained in EMDR. Take time to interview your prospective clinician. Make sure that he or she has the appropriate training in EMDR and has kept up with the latest developments. The basic course is at least 5 days of training over two weekends, or spans several months, plus supervision, consultation, and continuing education. While training is mandatory, it is not sufficient. Choose a clinician who is experienced with EMDR and has a good success rate. Make sure that the clinician is comfortable in treating your particular problem. In addition, it is important that you feel a sense of trust and rapport with the clinician. Ask each perspective clinician:
(1) Have you received both Part 1 and 2 of the basic training?
(2) Was your training program approved by EMDRIA or EMDR Europe?
(3) Have you kept up to date about the latest protocols and developments?
(4) How many people with my particular problems or disorder have you successfully treated?
(5) What is your success rate?
(6) Are you doing standard EMDR as it is (a) described in Dr. Shapiro's text, (b) supported by EMDRIA, and (c) been tested in research?
(7) Will you discuss with me the way EMDR can deal with my obvious symptoms?
(8) Will you also discuss with me the ways EMDR can be used to help me live a happier, more productive life by treating the other negative memories, beliefs, feelings, and actions that may be running my life?
A Brief Description of EMDR Therapy
8 Phases of Treatment The amount of time the complete treatment will take depends upon the history of the client. Complete treatment of the targets and the three-pronged protocol are needed to alleviate the symptoms and address the complete clinical picture. The goal of EMDR therapy is to process completely the experiences that are causing problems, and to include new ones that are needed for full health. "Processing" does not mean talking about it. "Processing" means setting up a learning state that will allow experiences that are causing problems to be "digested" and stored appropriately in your brain. That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded. Negative emotions, feelings and behaviors are generally caused by unresolved earlier experiences that are pushing you in the wrong directions. The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.
Phase 1: History and Treatment Planning
generally takes 1-2 sessions at the beginning of therapy, and can continue throughout the therapy, especially if new problems are revealed. In the first phase of EMDR treatment, the therapist takes a thorough history of the client and develops a treatment plan. This phase will include a discussion of the specific problem that has brought him into therapy, his behaviors stemming from that problem, and his symptoms. With this information, the therapist will develop a treatment plan that defines the specific targets on which to use EMDR. These targets include the event(s) from the past that created the problem, the present situations that cause distress, and the key skills or behaviors the client needs to learn for his future well-being. One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of his disturbing memories in detail. So while some individuals are comfortable, and even prefer, giving specifics, other people may present more of a general picture or outline. When the therapist asks, for example, "What event do you remember that made you feel worthless and useless?" the person may say, "It was something my brother did to me." That is all the information the therapist needs to identify and target the event with EMDR.
Phase 2: Preparation
For most clients this will take only 1-4 sessions. For others, with a very traumatized background, or with certain diagnoses, a longer time may be necessary. Basically, your clinician will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you are generally able to proceed to the next phase. One of the primary goals of the preparation phase is to establish a relationship of trust between the client and the therapist. While the person does not have to go into great detail about his disturbing memories, if the EMDR client does not trust his clinician, he may not accurately report what he feels and what changes he is (or isn't) experiencing during the eye movements. If he just wants to please the clinician and says he feels better when he doesn't, no therapy in the world will resolve his trauma. In any form of therapy it is best to look at the clinician as a facilitator, or guide, who needs to hear of any hurt, need, or disappointments in order to help achieve the common goal. EMDR is a great deal more than just eye movements, and the clinician needs to know when to employ any of the needed procedures to keep the processing going. During the Preparation Phase, the clinician will explain the theory of EMDR, how it is done, and what the person can expect during and after treatment. Finally, the clinician will teach the client a variety of relaxation techniques for calming himself in the face of any emotional disturbance that may arise during or after a session. Learning these tools is an important aid for anyone. The happiest people on the planet have ways of relaxing themselves and decompressing from life? s inevitable, and often unsuspected, stress. One goal of EMDR therapy is to make sure that the client can take care of himself.
Phase 3: Assessment
Used to access each target in a controlled and standardized way so it can be effectively processed. ? Processing? does not mean talking about it. See the Reprocessing sections below. The clinician identifies the aspects of the target to be processed. The first step is for the person to select a specific picture or scene from the target event (which was identified during Phase One) that best represents the memory. Then he chooses a statement that expresses a negative self-belief associated with the event. Even if he intellectually knows that the statement is false, it is important that he focus on it. These negative beliefs are actually verbalizations of the disturbing emotions that still exist. Common negative cognitions include statements such as "I am helpless," " I am worthless," " I am unlovable," " I am dirty," " I am bad," etc. The client then picks a positive self-statement that he would rather believe. This statement should incorporate an internal sense of control such as "I am worthwhile/ lovable/ a good person/ in control" or "I can succeed." Sometimes, when the primary emotion is fear, such as in the aftermath of a natural disaster, the negative cognition can be, "I am in danger" and the positive cognition can be, "I am safe now." "I am in danger" can be considered a negative cognition, because the fear is inappropriate -- it is locked in the nervous system, but the danger is actually past. The positive cognition should reflect what is actually appropriate in the present. At this point, the therapist will ask the person to estimate how true he feels his positive belief is using the 1-to-7 Validity of Cognition (VOC) scale. "1" equals "completely false," and " 7" equals "completely true." It is important to give a score that reflects how the person "feels," not " thinks." We may logically " know" that something is wrong, but we are most driven by how it " feels." Also, during the Assessment Phase, the person identifies the negative emotions (fear, anger) and physical sensations (tightness in the stomach, cold hands) he associates with the target. The client also rates the disturbance using the 0 (no disturbance)-to-10 (the worst feeling you? ve ever had) Subjective Units of Disturbance (SUD) scale.
For a single trauma reprocessing is generally accomplished within 3 sessions. If it takes longer, you should see some improvement within that amount of time.
Phases One through Three lay the groundwork for the comprehensive treatment and reprocessing of the specific targeted events. Although the eye movements (or taps, or tones) are used during the following three phases, they are only one component of a complex therapy. The use of the step-by-step eight-phase approach allows the experienced, trained EMDR clinician to maximize the treatment effects for the client in a logical and standardized fashion. It also allows both the client and the clinician to monitor the progress during every treatment session.
Phase 4: Desensitization
This phase focuses on the client? s disturbing emotions and sensations as they are measured by the SUDs rating. This phase deals with all of the person's responses (including other memories, insights and associations that may arise) as the targeted event changes and its disturbing elements are resolved. This phase gives the opportunity to identify and resolve similar events that may have occurred and are associated with the target. That way, a client can actually surpass her initial goals and heal beyond her expectations. During desensitization, the therapist leads the person in sets of eye movement (or other forms of stimulation) with appropriate shifts and changes of focus until his SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). Starting with the main target, the different associations to the memory are followed. For instance, a person may start with a horrific event and soon have other associations to it. The clinician will guide the client to a complete resolution of the target. Examples of sessions and a three-session transcript of a complete treatment can be found in F. Shapiro & M.S. Forrest (2004) EMDR. New York: BasicBooks. http://www.perseusbooksgroup.com/perseus-cgi-bin/display/0-465-04301-1
Phase 5: Installation
The goal is to concentrate on and increase the strength of the positive belief that the person has identified to replace his original negative belief. For example, the client might begin with a mental image of being beaten up by his father and a negative belief of "I am powerless." During the Desensitization Phase he will have reprocessed the terror of that childhood event and fully realized that as an adult he now has strength and choices he didn't have when he was young. During this fifth phase of treatment, his positive cognition, "I am now in control," will be strengthened and installed. How deeply the person believes his positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal is for the person to accept the full truth of his positive self-statement at a level of 7 (completely true). Fortunately, just as EMDR cannot make anyone shed appropriate negative feelings, it cannot make the person believe anything positive that is not appropriate either. So if the person is aware that he actually needs to learn some new skill, such as self-defense training, in order to be truly in control of the situation, the validity of his positive belief will rise only to the corresponding level, such as a 5 or 6 on the VOC scale.
Phase 6: Body scan
After the positive cognition has been strengthened and installed, the therapist will ask the person to bring the original target event to mind and see if he notices any residual tension in his body. If so, these physical sensations are then targeted for reprocessing. Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in motoric (or body systems) memory, rather than narrative memory, and retains the negative emotions and physical sensations of the original event. When that information is processed, however, it can then move to narrative (or verbalizable) memory and the body sensations and negative feelings associated with it disappear. Therefore, an EMDR session is not considered successful until the client can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.
Phase 7: Closure
Ends every treatment session The Closure ensures that the person leaves at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the person in using a variety of self-calming techniques in order to regain a sense of equilibrium. Throughout the EMDR session, the client has been in control (for instance, he is instructed that it is okay to raise his hand in the "stop" gesture at anytime) and it is important that the client continue to feel in control outside the therapist's office. He is also briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and which techniques he might use on his own to help him feel more calm.
Phase 8: Reevaluation
Opens every new session At the beginning of subsequent sessions, the therapist checks to make sure that the positive results (low SUDs, high VOC, no body tension) have been maintained, identifies any new areas that need treatment, and continues reprocessing the additional targets. The Reevaluation Phase guides the clinician through the treatment plans that are needed in order to deal with the client? s problems. As with any form of good therapy, the Reevaluation Phase is vital in order to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment, as it is to complete an entire course of treatment with antibiotics.
PAST, PRESENT, AND FUTURE
Although EMDR may produce results more rapidly than previous forms of therapy, speed is not the issue and it is important to remember that every client has different needs. For instance, one client may take weeks to establish sufficient feelings of trust (Phase Two), while another may proceed quickly through the first six phases of treatment only to reveal, then, something even more important that needs treatment. Also, treatment is not complete until EMDR therapy has focused on the past memories that are contributing to the problem, the present situations that are disturbing, and what skills the client may need for the future. Excerpts from: F. Shapiro & M.S. Forrest (2004) EMDR: The Breakthrough Therapy for Anxiety, Stress and Trauma. New York: BasicBooks. http://www.perseusbooksgroup.com/perseus-cgi-bin/display/0-465-04301-1
For another description: http://www.therapyadvisor.com
Eye Movements The benefits of eye movements used in EMDR are still under investigation. The Department of Veterans Affairs & Department of Defense Practice Guidelines http://www.oqp.med.va.gov/cpg/PTSD/PTSD_cpg/frameset.htm
have stated that evidence the eye movements are NOT effective is flawed. They also cite 8 controlled studies that show eye movements decrease the negative effects of emotions and imagery. These studies are:
Andrade, J., Kavanagh, D., & Baddeley, A. (1997). Eye-movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36, 209-223.
Barrowcliff, Gray, Freeman, MacCulloch (2004) Eye-movements reduce the vividness, emotional valence and electrodermal arousal associated with negative autobiographical memories. Journal of Forensic Psychiatry and Psychology, 15, 325-345.
Barrowcliff, A.L., Gray, N.S., MacCulloch, S., Freeman, T. C.A., & MacCulloch, M.J. (2003) Horizontal rhythmical eye-movements consistently diminish the arousal provoked by auditory stimuli British Journal of Clinical Psychology, 42, 289-302
Christman, S. D., Garvey, K. J., Propper, R. E., & Phaneuf, K. A. (2003). Bilateral eye movements enhance the retrieval of episodic memories. Neuropsychology. 17, 221-229.
Kavanagh, D. J., Freese, S., Andrade, J., & May, J. (2001). Effects of visuospatial tasks on desensitization to emotive memories. British Journal of Clinical Psychology, 40, 267-280.
Kuiken, D., Bears, M., Miall, D., & Smith, L. (2001-2002). Eye movement desensitization reprocessing facilitates attentional orienting. Imagination, Cognition and Personality, 21, (1), 3-20.
Sharpley, C. F. Montgomery, I. M., & Scalzo, L. A. (1996). Comparative efficacy of EMDR and alternative procedures in reducing the vividness of mental images. Scandinavian Journal of Behaviour Therapy, 25, 37-42.
van den Hout, M., Muris, P., Salemink, E., & Kindt, M. (2001). Autobiographical memories become less vivid and emotional after eye movements. British Journal of Clinical Psychology, 40, 121-130.
Training for Clinicians
EMDR International Association (EMDRIA): http://www.emdria.org
The EMDR International Association is a professional organization of EMDR trained therapists and researchers devoted to promoting the highest possible standard of excellence and integrity in EMDR practice, research and education for the public good. Purposes: (a) to establish and uphold standards of practice, training, certification, and research, (b) to provide information, education, and advocacy, and (c) to assist practitioners in fulfilling their responsibilities to the public. EMDRIA lists approved training programs, including university programs, and a database of its certified members for client referrals. It provides clinician resource materials, and an annual conference to share the latest clinical and research developments.
EMDR Institute http://www.EMDR.com
EMDR Institute is the oldest and largest training organization approved by EMDRIA. It was founded in 1990 by the originator of EMDR, Dr. Francine Shapiro. All senior members of the EMDR Institute faculty have been trained by Dr. Shapiro. Trainings are conducted in strict adherence to the researched protocols. It sponsors approved trainings worldwide. The EMDR Institute also provides access to 30,000 graduates of its programs for client referrals. Its website contains a list of commonly asked questions, latest research, and published clinical applications.
EMDR Humanitarian Assistance Programs http://www.emdrhap.org EMDR-Humanitarian Assistance Programs (HAP), a 501(c)(3) nonprofit organization, can be described as the mental health equivalent of Doctors Without Borders: a global network of clinicians who travel anywhere there is a need to stop suffering and prevent the after-effects of trauma and violence. HAP provides low cost training to non-profit agencies. HAP also provides a Traumatology Workshop to educate helping professionals and the general public about trauma and its effects. HAP's Disaster Mental Health Recovery Network coordinates clinicians to treat victims and emergency service workers after crises such as the Oklahoma City bombing and the 9/11 terrorist attacks. HAP is supported by tax-deductible contributions from the general public and by volunteer services of clinicians and others.
Clinical aids and manuals are available. http://www.emdrhap.org/store.htm
EMDR Europe http://www.emdr-europe.net/
With 14 member nations, this is the professional organization that is the counterpart of EMDRIA outside of the Americas. The website contains an overview of EMDR, research, and clinician resources.
Referrals for Clients EMDR International Association (EMDRIA): http://www.emdria.org The EMDR International Association is a professional organization of EMDR-trained therapists and researchers devoted to promoting the highest possible standard of excellence and integrity in EMDR practice, research and education for the public good. Purposes: (a) to establish and uphold standards of practice, training, certification, and research, (b) to provide information, education, and advocacy, and (c) to assist practitioners in fulfilling their responsibilities to the public. EMDRIA lists approved training programs, and a database of its certified members for client referrals.
EMDR Institute: http://www.EMDR.com
EMDR Institute is the oldest and largest training organization approved by EMDRIA. It was founded in 1990 by the originator of EMDR, Dr. Francine Shapiro. All senior members of the EMDR Institute faculty have been trained by Dr. Shapiro. Trainings are conducted in strict adherence to the researched protocols. The EMDR Institute also provides access to 30,000 graduates of its programs for client referrals. Its website contains a list of commonly asked questions, latest research, and published clinical applications.
EMDR Humanitarian Assistance Programs: http://www.emdrhap.org EMDR-Humanitarian Assistance Programs (HAP), a 501(c)(3) nonprofit organization, can be described as the mental health equivalent of Doctors Without Borders: a global network of clinicians who travel anywhere there is a need to stop suffering and prevent the after-effects of trauma and violence. It provides low cost training to non-profit agencies. HAP also provides a Traumatology Workshop to educate helping professionals and the general public about trauma and its effects. HAP's Disaster Mental Health Recovery Network coordinates clinicians to treat victims and emergency service workers after crises such as the Okalahoma City bombing and the 9/11 terrorist attacks. HAP is supported by tax-deductible contributions from the general public and by volunteer services of clinicians and others. In case of a natural of manmade disaster, clients can ask for direct referrals to participating agencies, or find out if a Disaster Mental Health Recovery Network has been requested in your area.