In 1987, Francine Shapiro went for a walk and discovered eye movement desensitization reprocessing (EMDR) as a therapeutic technique for traumatic experiences with lasting impact. Some thirty years later, with a substantial body of research confirming its efficacy, the mechanism of action remains a mystery. However, the treatment has expanded to focus on chronic pain, addictions, attachment trauma, among other areas. So, what is EMDR exactly? First and foremost, like every effective therapeutic approach, it revolves around building a relationship. Without the essential ingredient of trust, not much is likely to be uncovered, discovered, or seen in a new light.
The initial part of the eight-step process is devoted, in part, to nurturing a growing alliance between two people heading into an exploration with significant potential. During this period, the individual seeking help wonders if the clinician will be helpful rather than harmful, and, more importantly, if they are trustworthy with delicate information. Exploring and uncovering meaning in experiences typically involves difficult feelings that humans often expend a lot of energy to avoid. In an EMDR process, we propose actively lifting layers of defense against those feelings. The initial exploration to identify what needs working on is akin to dipping one’s toes into water that may be shark-infested with the hint of a tsunami just around the bend.
After initially exploring the story that brings someone in for help, safety is attended to by developing temporary internal resources. The theory behind this is an offering of respite from feelings that can arise in therapy, including fear, shame, guilt, grief, and anger. What works for one individual, of course, does not fit all. For some, this is a brand-new experience. Devoting an hour or more to the development of a place, a container, an ally, or a comforting creature—such as a crow, eagle, bear, or horse—can feel foreign and uncomfortable. For some, it is an exercise in tolerating a sense of peace or discovering non-anxious relaxation for the first time. Once a reliable respite is developed, a focal memory is agreed upon, and together, we see what comes up from there.
Unlike talk therapy, there is less directive guidance from the therapist. Instead, presence and suggestion are offered, while the individual follows the train of their mind, observing what comes up in a free association manner, with bilateral stimulation. This latter can be a light bar to follow with one’s eyes, handheld buzzers, knee tapping, among other techniques. While eye movements have been shown to be most efficacious, there are still only hypotheses about the underlying mechanism. I think of it as creating space to let your mind wander and make connections around memories that wouldn’t necessarily come up in conversation. As a depth therapist, this makes sense. It is one thing to understand this intellectually, but it is an entirely different experience to have your mind present that reality in a way that you feel it as an emotional truth—It wasn’t my fault after all; I am competent, lovable, worthy, and trustworthy.
The actual processing can take a long time depending on the traumas being addressed. However, once this phase is complete, installation, a body scan, closure, and reevaluation confirm anticipated changes associated with this therapeutic approach. New perspectives can include a deeply felt emotional recognition of the lack of control one had as a child or as a smaller, physically or emotionally vulnerable person. In addition to transforming a distorted sense of responsibility for injury into a newfound sense of self-efficacy, understanding, or empathy for the vulnerable person one was in a traumatic experience can be transformative. This is part of the work in a psychodynamic framework that seeks to help someone develop a solid sense of self, knowing who one is, feeling entitled to protection, recognizing imposition, and feeling empowered to navigate effectively without being overwhelmed by guilt, shame, or self-doubt. Integrating EMDR into a psychodynamic framework offers another pathway to understand ourselves, our relationships, while expanding choices that were previously hidden or inaccessible. It increases tolerance for difficult and painful emotions and experiences when they arise, as they do in an actively engaged life.
Maire Daugharty is an anesthesiologist.