Karen Williams

EMDR Therapy

Eye Movement Desensitisation and Reprocessing, or EMDR therapy, was developed after the chance discovery by an American psychologist, Francine Shapiro, that bilateral eye movements helped her process the disturbance of negative thoughts and memories. This was in 1987, and over the following decade or so, she and her group in America crafted this discovery into an eight-phase protocol designed to maximise therapeutic benefit, and ensure safety and efficacy. Her book on EMDR therapy, Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures, first published in 1995, is now in its second edition.

A great deal of research has been done on EMDR therapy and its efficacy for the treatment of psychological trauma has been established beyond doubt (Bisson, Roberts, Andrew, Cooper, & Lewis, 2013). As a result, EMDR is now a recommended trauma treatment in many national and international guidelines, for example, those of the World Health Organisation, the International Society for Traumatic Stress Studies, the American Psychiatric Association, the UK Psychological Trauma Society, and the guidelines of the National Institute for Health and Care Excellence (NICE), which inform and guide healthcare services provided through the NHS.

You can listen to a BBC Radio 4 interview with an EMDR client by clicking here.

Training to practise EMDR is restricted to fully qualified mental health professionals. In the UK, the training is overseen by the EMDR Association UK & Ireland which sets the standards for training organisations, trainees and qualified EMDR therapists.

Low-cost EMDR therapy

Recently I completed training with Matthew Wesson at The EMDR Academy, an EMDR Europe accredited training. I am now working towards full accreditation with the EMDR Association UK & Ireland by accruing clinical hours using the therapy with clients. During this time, I am pleased to be offering EMDR therapy at a low-cost rate in London and Glastonbury. If you would like to find out more about this, please contact me by email, text or phone, or send a message through the form on the Contact page, and I’d be happy to answer any questions you may have.

What is psychological trauma?

Psychological trauma:  Anything that has overwhelmed an individual’s ability to process psychologically something that has happened to them is likely to be experienced as traumatic by that person. It is a very individual thing, and what might seem challenging or even exciting to one person could be traumatic for another. Many people these days have heard of post-traumatic stress disorder, or PTSD, but other diagnoses may be given when one or more conditions for PTSD are not present. It is not necessary to have a medical diagnosis of any kind in order to seek EMDR therapy. If you do have diagnosable PTSD, however, you may be able to get treatment through the NHS. NICE endorses both trauma-focused CBT and EMDR for treatment of PTSD. When thinking about trauma and treatment options it is always advisable to see your doctor to find out what is available in your area.

It is important to appreciate that most people who have experienced a traumatic event will recover naturally from the symptoms of trauma, given time and the right support and conditions. Treatment interventions have usually been reserved for those who do not recover naturally, or who develop symptoms some time after they appear to have recovered. Research shows benefits from early intervention with EMDR during the acute phase in the first four weeks after trauma. This helps to ameliorate symptoms and reduce the likelihood of developing PTSD (for example, see Brennstuhl et al., 2013; Buydens, Wilensky, & Hensley, 2014; Shapiro, 2012).

What are the symptoms of trauma?

You can have a traumatic stress reaction without having PTSD, but a diagnosis of PTSD would take all of the following into consideration:

  • Exposure to actual or threatened death, serious injury, or sexual violence
  • A time interval of at least one month since the traumatic event

and

  • Symptoms of intrusions, e.g. flashbacks or nightmares
  • Avoidance of reminders of the event
  • Psychological and/or physiological distress when exposed to reminders of the trauma
  • Negative cognitions or mood, e.g. anxiety and/or depression, shame, guilt, feelings of being useless or unable to cope, numbing of emotions and/or parts of the body
  • Marked alterations of arousal, e.g. hypervigilance, exaggerated startle response, sleep disturbance, angry outbursts, problems concentrating, reckless or self-destructive behaviour.

You may have some but not all of these, and for most people, such symptoms will gradually calm down within a few weeks or months after a traumatic event. For a few people, if symptoms persist for at least one month, it may indicate that PTSD has developed. When unrecognised or left untreated, a person may become sensitive to an increasing number of situations or things which were not related to the original trauma. They become related, however, through a widening network of associations with it.

When such symptoms occur in the first four weeks after a traumatic event, when it would be too early to diagnose PTSD, a diagnosis of acute stress disorder (ASD) may be given. Apart from this difference in timing of the diagnosis, in ASD there tend also to be more dissociative symptoms.

You can, of course, have a traumatic stress reaction without having all the symptoms of PTSD. In complex trauma, e.g. adults with a history of neglect or abuse in childhood, children or young people who may still be contending with abuse from carers, or people who have experienced ongoing abuse in adulthood, some of the above symptoms may also be present. Problems with anxiety, depression, anger, self-harm, suicidal thoughts, addictions, and relationship difficulties are not uncommon situations for traumatised people.

Symptoms do not necessarily develop immediately or soon after a traumatic event. Delayed onset PTSD may develop years after the original event, sometimes being triggered by something apparently unrelated.

“the most fundamental effect of trauma is dissociation . . . trauma is best defined as
‘the event(s) that cause dissociation’”
(Howell, 2011, p. 75).

Whether it’s the result of a single event or from complex trauma, traditionally this has been called soul loss. It might also be thought of as a part of us going off-line, or going into the unconscious, or simply going AWOL. And, of course, it takes the difficult or unbearable feelings with it so that the part that is left can carry on.

This issue of the link between trauma and dissociation is important from the transpersonal point of view.

The impact of psychological trauma is soul loss.

Soul: the essence of what it is to be human.

Miller (1980/1990, 1981/1998, 2001) equates soul to feelings, sense of self, and personal agency.

Firman and Gila (1997) argue that a “wound of non-being,” or loss of relationship with personal self/transpersonal Self, is caused by childhood neglect and abuse when there is no empathic Other who is attuned and responsive to the child’s emotional distress.  Empathic failure results in defensive splitting off of sub-personalities and a diminution of the remaining self which is still accessible to consciousness.

Ibsen’s (1896) concept of soul murder: “killing of the joy in life – or of the capacity to love – in another human being.”

In Tibetan energy healing it is the inner life force or bLa (pronounced “La”), lack of which is easily seen as a diminution of brightness or Yang in the person’s face, behaviour, and general way of being in the world.

Carl Jung developed what he called complex theory, through which he explained neurosis and trauma through the splitting off of autonomous psychic fragments into the unconscious. He observed that, “the essential factor is the dissociation of the psyche and not the existence of a highly charged affect and, consequently, … the main therapeutic problem is not abreaction but how to integrate the dissociation.” (Jung, 1966, para. 266).

Over half a century later, and with the benefit of much scientific research into understanding psychological trauma and its treatment, the internationally acclaimed psychiatrist, researcher, and founder of The Trauma Centre in Boston, MA, Bessel van der Kolk, writes, “if the problem with PTSD is dissociation, the goal of treatment would be association: integrating the cut-off elements of the trauma into the ongoing narrative of life, so that the brain can recognize that ‘that was then, and this is now.’” (2015, pp. 180-181).


This is what EMDR therapy does.

What can EMDR help with?

What can EMDR help with?

Single Event Trauma

Many forms of psychological trauma that are incompletely processed in your system may respond well to EMDR therapy. Following are some examples of the kinds of issues that may give rise to psychological trauma for some people. These things might have happened to you, a loved one, or you may have had exposure to them through your work.

  • Physical or sexual assault and/or injury, including rape
  • Motor vehicle accident
  • Other kinds of accident where you feared for your life
  • Natural disasters
  • War trauma
  • Medical trauma
  • Traumatic childbirth
  • Bereavement, miscarriage, stillbirth
  • Divorce or other loss

These kinds of things are known as single event traumas.

 

Complex Trauma

Another form of psychological trauma is known as complex trauma. This results from an accumulation of neglect, abuse, or other ongoing situations, and would include, for example:

  • Being bullied in childhood or adulthood
  • Abandonment, neglect or abuse in childhood
  • Domestic coercion, threats, intimidation, humiliation and actual physical violence

Event(s) that you feel you’ve never been able to fully come to terms with may also be an indication of psychological trauma.

 

Vicarious and Secondary Trauma

Vicarious traumatisation has been identified in some members of the helping professions that come into contact with trauma survivors through their work. They have not experienced the traumatic events themselves. Examples of professions subject to vicarious trauma include police officers, fire fighters, paramedics, other types of specialist rescue personnel, humanitarian aid workers, health care providers, social workers, clergy, journalists, and various types of workers in the justice system.

It is also known that people can suffer secondary trauma when a family member or someone else they feel an empathic connection with is a primary trauma victim. It’s possible this phenomenon might also be relevant to the acute stress reactions suffered by some people on exposure to media reports of traumatic incidents that they feel a strong emotional connection with.

Vicarious trauma and secondary trauma are not the same (Baird & Kracen, 2006). Vicarious traumatization refers to harmful changes that occur in professional helpers’ views of themselves, others, and the world caused by exposure to traumatic material. These are all cognitive changes and can result in decreased motivation, efficacy, and empathy. Secondary traumatic stress is a syndrome with a wider spectrum of symptoms that mimic PTSD and occurs as a result of exposure to the traumatic experiences of others.

 

Symptoms

EMDR was originally developed to treat PTSD and psychological trauma. It is also being found effective for an increasing number of symptoms which may or may not be easily attributable to trauma. So following are some symptoms and other conditions, rather than precipitating circumstances, which may respond well to EMDR therapy:

  • Anxiety
  • Phobias
  • Obsessive compulsive disorder (OCD)
  • Depression
  • Insomnia
  • Anger
  • Eating disorders
  • Self-harm
  • Suicidal ideation
  • Addictions
  • Somatisation of psychological or emotional distress
  • Medically unexplained symptoms (MUS)
  • Grief which does not process naturally (known as complicated or complex grief)
  • Some kinds of relationship difficulties
  • Some instances of chronic physical pain have a psychological component, for example, phantom limb pain, whiplash injury, and many others. These may also be amenable to EMDR therapy.

Where there is difficulty ameliorating any of these symptoms by means of the usual treatments for them, it may be worth considering whether EMDR therapy could help.

 

What happens in EMDR therapy?

Initial sessions cover the assessment process and agreeing with the client what they would like to work on. In subsequent sessions, the reprocess- ing is accomplished by working with images that relate to the trauma. These could be visual images but might also be sounds, smells, tactile memories or other things.

Bilateral stimulation facilitates the processing of an image, usually by following the therapist’s fingers with your eyes as they move their fingers to and fro in front of you for a short time. Other forms of bilateral stimulation may be used if more appropriate, such as tapping on the backs of your hands.

It is not yet fully understood how EMDR works but it is thought to facilitate processing of sensory memories into long-term cognitive memory. The traumatic event then takes up its rightful place in your biographical memory rather than continuing to distress you on a regular or even daily basis.

Maintaining distance

In EMDR therapy, it is not necessary to describe in detail to the therapist every step of what happened in the traumatic event being worked with. Nor is it necessary to relive the event over and over again as an essential part of the therapeutic process.

This is an important difference from some other forms of trauma-focused treatments.

For individual memories that you may find particularly difficult to talk about, it is possible not to tell the therapist anything about that memory at all, and still do an EMDR session on it. This would not be advised for all the aspects of an entire traumatic event perhaps, but it is a possibility for individual memories. This can help to maintain a greater sense of privacy and distance from the trauma.

How long does it take?

It’s really difficult to say how many sessions an individual might need. EMDR is usually a short-term therapy which could be something like six, twelve or sixteen sessions, for example, for single event traumas. Where there is complex trauma it could take considerably longer. Sessions are usually at a frequency of once or twice a week to allow time for processing between sessions. Individual sessions may be 50-90 minutes long, which can be discussed at the assessment stage. EMDR can, however, be embedded in a longer term, open-ended therapy, to be used in addition to other appropriate techniques.

For clients who are already working with a counsellor who does not practise EMDR, it is possible to see an EMDR therapist on a short-term basis to address a particular issue, and then return to one’s regular counsellor. This would, of course, need to be agreed with the client and both therapists beforehand.

Make an Enquiry

If you would like more information about psychological therapy and how we may be able to work together to address your concerns,
you are warmly invited to call, email, or message me through the form on the Contact page.

07801 273768 / info@karenjwilliams.co.uk

References

Baird, K., & Kracen, A. C.  (2006).  Vicarious traumatization and secondary traumatic stress: A research synthesis.  Counselling Psychology Quarterly, 19(2), 181–188.

Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C.  (2013).  Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults (review).  Cochrane Database of Systematic Reviews, 12. doi: 10.1002/14651858.CD003388.pub4.

Brennstuhl, M-J., Tarquinio, C., Strub, L., Montel, S., Rydberg, J. A., & Kapoula, Z.  (2013).  Benefits of immediate EMDR vs. eclectic therapy intervention for victims of physical violence and accidents at the workplace: A pilot study.  Issues in Mental Health Nursing, 34(6), 425-434.

Buydens, S. L., Wilensky, M., & Hensley, B. J.  (2014).  Effects of the EMDR protocol for recent traumatic events on acute stress disorder: A case series.  Journal of EMDR Practice and Research, 8(1), 2-12.

Firman, J., & Gila, A.  (1997).  The primal wound: A transpersonal view of trauma, addiction, and growth.  Albany, NY: State University of New York Press.

Howell, E. (2011).  Understanding and treating dissociative identity disorder: A relational approach.  New York, NY: Routledge.

Ibsen, H.  (1896).  John Gabriel Borkmann (M. Meyer, Trans.).  In H. Ibsen, When we dead awaken and three other plays.  Garden City, NY: Anchor-Doubleday.

Jung, C. G.  (1966).  The therapeutic value of abreaction.  In H. Read, M. Fordham, & G. Adler (Eds.), C. G. Jung: The collected works (Vol. 16, paras. 255-293) (2nd. ed.).  Hove, United Kingdom: Routledge & Kegan Paul.

Miller, A.  (1990).  For your own good: Hidden cruelty in child-rearing and the roots of violence (3rd ed., H. Hannum & H. Hannum, Trans.).  New York, NY: The Noonday Press.  (Original work published 1980)

Miller, A.  (1998).  Thou shalt not be aware: Society’s betrayal of the child (H. Hannum & H. Hannum, Trans.).  New York, NY: Farrar, Straus and Giroux.  (Original work published 1981)

Miller, A.  (2001).  The truth will set you free: Overcoming emotional blindness and finding your true adult self (A. Jenkins, Trans.).  New York, NY: Basic Books.

Shapiro, E.  (2012).  EMDR and early psychological intervention following trauma.  Revue Européenne de Psychologie Appliquée, 62(2012), 241-251.

Shapiro, F.  (2001).  Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd ed.).  New York: Guilford Press.

Tol, W. A., Barbui, C., & van Ommeren, M.  (2013, August 7).  Management of acute stress, PTSD, and bereavement: WHO recommendations.  The Journal of The American Medical Association, 310(5), 477-478.

van der Kolk, B.  (2015).  The body keeps the score: Mind, brain and body in the transformation of trauma.  London, United Kingdom: Penguin Books.