EMDR

Developed by Francine Shapiro in the late 1980s. EMDR, or Eye Movement Desensitization and Reprocessing is a type of psychotherapy that encompassess principles, procedures, and protocols. EMDR uses the AIP model  (adaptive information processing, or how our brains store and process information) for conceptualization and bilateral stimulation ( usually tappers, bilateral music, or lateral eye movements with a light bar) to process "targets" or distressing experiences. EMDR comprises 8 phases and has 3 prongs (past targets, present triggers, and future rehearsal).

Important note -  EMDR is much more than "follow the light bar and talk about what hurts." I will work with you in Phases I and 2 to ensure you have built the window of tolerance (coping skills between sessions, insight, curiosity, and resilience) to safely reprocess experiences in Phases 3, 4, 5, and 6  (the phases that most people commonly associate with EMDR). At the end of each session, Phase 7 - Closure is used which consists of grounding, breathwork, and other tools to ensure you leave each session regulated. Phase 8 is used to measure progress between sessions and ensure safety and stability.

Rooted in neurobiology, the AIP model posits that people have the intrinsic capacity and wisdom to reorganize their responses to disturbing events. When a non-traumatized individual experiences a stressful event, the person will experience a baseline state, stressed state (hyperarousal), and processing state (a time where one may process by talking about what happened or going for a walk, etc), then an adaptive state (the person is not stuck in fight, flight, or freeze, but able to enjoy life and maintain adaptive beliefs about themselves and the world).

However, when an individual experiences chronic stress or trauma, new experiences become linked in associative memory networks to reinforce previous experiences. In other words, a person who has undergone chronic trauma may have multiple triggers and may be in a perpetual state of dysregulation (stuck in fight/flight/freeze or collapse). The person may not be consciously aware of the origins of these triggers, as associated memories may be repressed. EMDR helps by uncoupling (separating the trigger from the behavioral response), and addressing the root of the issues, leading to lasting change and transformation.

Bilateral stimulation strengthens communication between the 2 hemispheres of the brain. The mechanism of action is analogous to REM sleep.Bilateral stimulation helps the thalamus (the part of the midbrain responsible for relaying and organizing motor and sensory information), reorganize information across cerebral hemispheres, leading to lasting growth and change. Additionally, the eye movements overtax the working memory, making the components of the memory less distressing to be with.

• Phase I : History Taking and Treatment Planning: this stage is used to gather biopsychosocial information, establish a therapeutic alliance, and obtain an EMDR treatment plan.

• Phase 2 : Preparation - this phase is used to gain informed consent for EMDR, provide education about the modality, address hopes and fears about the process, and to resource (develop internal and external coping skills necessary to sit with potentially distressing content without causing overwhelm). During this phase, I will use an integrative approach to therapy to best meet your needs.

• Phase 3: Assessment: During this phase, you will be asked to briefly recall components of the distressing memory. This is the fastest phase (approximately 1 minute or less) to ensure there is not too much distress.

• Phase 4: desensitization: This is the phase commonly associated with EMDR. You will use the light bar or tappers which along with the AIP drive reprocessing and help the memory be less distressing. You will be asked to return to the original experience until the memory is no longer difficult to recall.

• Phase 5: Instillation: During this phase, the bilateral stimulation is used to instill a positive belief about yourself and the world.

• Phase 6: Body Scan: You will be asked to scan your body head to toe to ensure any residual distress is cleared.

• Phase 7: Closure: This phase ensures that you leave the session feeling oriented, calm, rooted, and grounded. Various methods can be incorporated including breathing exercises and grounding.

• Phase 8: During this phase, you will be asked to keep a weekly log charting any progress or disturbances. We will review this record at the beginning of each session to make adjustments as needed.

People with seizure disorders, conditions predisposing them to seizures, and certain other medical issues.

According to the EMDR International Association, “EMDR therapy is recognized as evidenced-based treatment for PTSD and other trauma and stressor disorders in treatment guidelines published by the International Society for Traumatic Stress Studies, the World Health Organization, and a growing number of national and international organizations. Other benefits include:

• Less reactivity
• Enhanced sleep
• Increased confidence, resilience, and improved relationships

EMDR treats any issue with an identifiable cause.

For most people, the most difficult symptoms resolve after processing the most difficult memory or the first memory associated with a difficult experience.

Yes! Detur protocol and Feeling State Protocol help clients process triggers associated with substance use and uncouple urges from behaviors. I am not currently using these protocols for substance use disorder, but am happy to provide referrals.

This depends on the individual and is case by case. Some people require a longer time spent in Phase 2 to ensure they have sufficient resources for later phases of EMDR.

EMDR can be broadly applied to various issues. It is tailored in ways that best suit your needs. Here are the typical applications: 

• Comprehensive plan: used when the person has a wide window of tolerance to ensure that the issue has been thoroughly addressed. This typically requires more time and more memories to work with. 
• Symptoms focused plan: used when the window of tolerance is narrow or current day symptoms are causing significant impairment to one's day to day functioning.
• Inverted protocol: this is often used for complex trauma. Benefits include enhanced insight and confidence due to starting with processing future events, rather than starting with reprocessing  past memories.
• EMD and EMDr: these are used when one is able to be with selective distressing experiences without requiring too much exposure to unrelated , distressing memories. It allows you to process mildly distressing material without causing overwhelm. 

No. I will spend the time necessary tailoring a treatment plan to your needs in Phase I and helping you identify effective coping skills in Phase 2. We will only begin reprocessing after all needs, questions, and concerns have been addressed and you are well resourced to begin reprocessing in later phases.