The therapeutic modality developed by Francine Shapiro and referred to as eye movement desensitization reprocessing or EMDR, when embedded in the context of a wider lens, focuses on specific events and feelings with a view to overarching goals. We become who we are in a relationship, and specifically in our earliest relationship with a primary caregiver who shapes our worldview before we can give this active consideration. Subsequently, we develop core beliefs about ourselves and others with only partial awareness of origins, and often without ever exploring the validity of these ideas. EMDR addresses core beliefs arising from traumatic experiences, where trauma is defined as emotional overwhelm. Overwhelm differs in some important ways from a three-year-old’s world compared to that of an adult. A wider lens keeps an eye on the earlier assumptions developed in infancy and toddlerhood, in addition to trauma impacts.
EMDR allows us to bypass goal-directed verbal communication for a direct emotional experience. This often leads more readily to connections that would otherwise take more time to recognize, guided by an active listener keeping track of themes threaded throughout talk therapy. It also underpins an emotional experience critical to durable change. It is one thing to understand the limited ability as a child navigating what is imposed by adults; it is another entirely to re-experience this with one’s own adult perspective in mind. This is part of the dual awareness that is hypothesized to explain the contribution of eye movement. Bilateral stimulation is thought to keep one in the here-and-now perspective, while simultaneously following the tracks of memory as they arise. This can facilitate an emotional experience that alters one’s felt sense of the original conditions. It can also highlight how one remembers through a child’s eyes. One example given in Shapiro (2002) identifies, for a target, a clinician’s sense of horror and shame at squashing a frog which he recalls from childhood. Turns out, he identifies this as representative of feelings about a new baby sibling. His feelings of hurt and anger were experienced as perpetrating a random act of violence, a childhood fantasy developed in the normal context of being displaced by a new baby brother. Others might begin with an overarching sense of inadequacy attached to a specific memory, but in following the tracks of their mind begin to recognize the impacts of chronic criticism that occurred in childhood. The sting of criticism gradually recedes as the mind makes connections, evolving into a mature, more accurate assessment of self.
Some clinicians approach this with parts work, a more prescriptive adaptation of psychodynamic theory. Internal Family Systems, for example, labels parts, assigns them roles, and then uses these to help one understand what is happening. For example, when one feels suddenly explosively angry this might be approached by calling this a Firefighter part brought up to face a perceived threat. A Protector part might then be appealed to in managing these feelings less destructively. By contrast, a psychodynamic approach listens for an individual’s experiences, expectations, and assumptions developed over time and originating through the child’s eyes. The latter approach uses transference and countertransference or also known as implicit memory and pattern recognition, specifically in service of this exploration. One of the goals in a psychodynamic approach is to discover what is there, rather than assign a preconceived label. More specifically, trauma-oriented approaches discuss apparently normal parts (ANP) versus dissociated parts. This is a perspective more frequently applied to working with individuals struggling with dissociative disorders consistent with severe early childhood abuse. Another parts perspective elucidated by Winnicott observes a dichotomy between true and false self which we all feel to some extent. These are developed under pressure to be what a primary caregiver wants us to be, versus who one truly is. This brings people to therapy in middle adulthood with an interest in exploring who they really are, sometimes leading to a more authentic, individuated self, which is a goal of psychodynamic therapy.
So how does EMDR specifically contribute to this work? After developing resources one can begin to delineate what is referred to as a negative core belief (NC) arising out of an experience. Identified and reduced to their essence, these are distorted beliefs about self with pervasive negative impacts – I am not trustworthy, I am powerless, I am worthless, I am not lovable. The corollary positive cognition (PC) which becomes the goal in EMDR is often the opposite, but not always. I am trustworthy, I have agency, I am worthy, lovable. Identifying these begins the process in a dual awareness state towards change. It is important to spend some time talking about how one is feeling and how that shows up in the body to more readily recognize impacts of stress and tension. This also contributes to identifying when one is immersed in a negative cognition state. Use of resourcing in addition to this exploration harnesses a mind-body connection that contributes to perspective altered by new understanding.
Shapiro describes the process of change by her term adaptive information processing (AIP), which is just the observation that when given appropriate circumstances, the brain heals itself. This conceptualizes impacts of missing connections which are necessary to render a fragmented memory whole. This then becomes a more accurate and healthy perspective. As well as accompanying and witnessing, a critical component of mitigating post-traumatic stress disorders (PTSD), the EMDR therapist informs direction by choosing what to focus on between eye movements and uses interweaves to draw attention to pre-conscious ideas. A psychodynamic framework actively following themes expressed in intervening session work can contribute to richly informed interweaves. The idea that healing is an innate process is not new. This observation was noted, for example, by Clegg (1984) in work with children and adults which he referred to as the reparative motif. As it turns out, many ideas and approaches in therapy are not new exactly but built upon and borrowed from each other. Origins are rooted in Freud’s observations, a neurologist who practiced over a hundred years ago, well before the advent of imaging and other technologies that we have available today. These and ongoing studies continue to confirm much of what he observed then by spending time with patients.
We are all capable of healing given appropriate circumstances.
Maire Daugharty is an anesthesiologist.