WHAT IS EMDR ?

(EYE MOVEMENT DESENSITISATION & REPROCESSING)

Eye Movement Desensitisation and Reprocessing (EMDR) is a treatment whose theoretical base is information processing (i.e. how the brain 'deals with' information).

During EMDR the client brings to awareness past and present experiences which are then followed by sets of bilateral stimulation - most usually side-to-side eye movements, but sometimes alternating auditory (sound) tones through a headphone or tactile (touch) sensations through a thumb and finger pad.

Once the eye movements (or alternative) cease, the client is instructed to let material come to awareness without attempting to 'make anything' happen. This alternate attention to internal recollections and external stimulus is called 'dual attention'. This sequence of dual attention and personal association is repeated many times in the session.

SO WHAT HAPPENS IN THERAPY?

The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviours that will be needed by the client in future situations.

During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete.

Phases three to six involve a target which is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.

After this, the client is instructed to focus on the image, negative thought, and body sensations whilst simultaneously moving his/her eyes back and forth following the therapist's fingers (or a mechanical equivalent such as an EyeScan 2000) as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.

In phase seven, closure, the therapist asks the client to keep a note during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.

The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is to produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.

After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioural and personal change, which are further enhanced with standard EMDR procedures.