Therapist Guide

What is EMDR And How Does It Work?

Hey, everybody. I am back with our favorite psychologist and trauma specialist, Dr. Alexa Altman. Thanks for taking time for us. – Love to be here. – So we are gonna talk about EMDR. I have talked about it, this is like years ago. I think it’s probably like four or five years ago I talked about what EMDR is, but as an EMDR specialist, Alexa here is going to debunk some of the myths, help us better understand and answer maybe some of those questions that we have about it, maybe reasons we haven’t started. Let’s get into it. – Yeah. – So for people who don’t know, let’s just open with what is EMDR? EMDR stands for Eye Movement Desensitization and Reprocessing.

She was walking, she had a distressing thought, and she noticed while she was walking, right, left, right, left, moving her feet, that as she was thinking about the distressing thought, that the distressing emotions and some of the sensations and some of her thoughts around what was distressing started to move down and come down in intensity. And so she started to experiment with, wait, what if there were something about this right, left movement of my walk that’s helping release some of the emotion charged with this distressing event?

So she started experimenting with her colleagues and some of her patients, and she put together this theory that there’s something about bilateral movement. In this case, it was eye movement. So she noticed, during the walk in the park, her eyes would move back and forth, kind of like REM sleep. And she thought there was something to the back-and-forth movement that happened involuntarily. – Interesting. – So she started to experiment and noticed that the eye movement back and forth created an opening in the nervous system and started to regulate the nervous system. There’s lots of theories as to why that eye movement regulates the nervous system.

One theory is that it opens a neuro fiber bridge connecting the right side of the brain and the left side of the brain. And we know, when traumatic events happen, that the thinking part of the brain shuts down. And so therefore, it’s very hard to reprocess an event that the thinking brain has been shut down. – fascinating, I could not think about it that way. But yeah, we do know that when our limbic system is triggered and our amygdala is running the show that our prefrontal cortex, all of the forward thinking, organized thought, offline. – Offline. – Like, adult part of brain, off. – That’s right, that’s right. So she discovered that the eye movement was critical in the reprocessing of traumatic events.

Interesting. – Mhm. – Okay cool so, that’s a little bit about EMDR and like I said I have a article where I walk through all the findings, like where it came from, how we do it, and we’ll get into more of that stuff as well. – Good. – But we’re gonna walk into some questions commonly asked questions. We’re gonna FAQ style – Yes. – So what’s the first most commonly asked question? – I think that I get the most in my clinical practice is “Will it erase my memory?” Because we are working with really traumatic memories or at time late traumatic observation, and it cannot erase a memory. What it does is it reduces the emotional charge or maybe the sensations attached to a memory or the triggers attached to that memory. So what people often report is that the memory becomes neutral.

It happened, and it’s in the past. – It’s like the way we talk about any regular day, right? If somebody asked about what I did yesterday like, “oh we cleaned out the garage, we packed some boxes,” it doesn’t have any, it just kinds of is. Right? – That’s right. – Or “I make breakfast, I watch TV”, nothing, neutral. – Right and the memory also has a beginning middle and end, and in traumatic memories oftentimes it doesn’t have a beginning middle and end it actually feels like it’s still happening.

So to really have a recognition that it’s in the past, I actually feel like it’s a consolidated memory. It’s in long-term memory where it belongs. – Yeah, yeah. – Another big one that I get is “Is it hypnosis?” -Oh yeah, because I have to be honest, I knew some people who thought about going to school and we studied together and they broke up. up going the hypnosis route, and I’m like mm-mm. You guys know I’m not, I mean don’t knock it, if it helps you it helps you, but I’m like, it’s not it, mm-mm, I don’t believe in it.

So EMDR is not hypnosis I would assume – It’s not hypnosis. I think hypnotic trance and altered state, sometimes people doing eye movement can feel like they’re in a hypnotic state, we would then alter, and we’ll talk more about that, different kinds of bilateral stimulation, but the goal is not actually to enter a hypnotic state. The goal of it is actually to support a relaxed state, a safe state, so you can safely process a traumatic memory. – Yeah so staying calm.

‘Cause I’ve talked with them a lot, my audience knows that if you dissociate a lot EMDR doesn’t, it’s not that it won’t work for you, but you have to be present, – Correct – to be able to do the processing. – That’s right, that’s right. – So we don’t want you in al alternate space – Right, EMDR they talk a lot about dual awareness, the idea of dual awareness is that you can have one foot in the present moment and one foot in the past. And we have to be able to have both, that dual awareness in order to process effectively. – Yeah makes sense. – You wanna lose yourself into the experience.

That is actually another question I get, “Will EMDR re-traumatize me?” – Yes because I have every time, I always like to approximate forward of time ‘etiology I could not know the answers to these, but I would think that EMDR could, if not done properly. – Mhm. – Which I feel like therapy can do the same. Like if I take somebody on as a patient, and they need more trauma work than I have the wherewithal to understand and do, I could push them too fast, make them talk about it too much, and potentially re-traumatize them? Is that true? – Mhm, yeah. So I think really what you’re getting at is right on which is the preparation.

And if EMDR is the right form of therapy and the right time in therapy. So an EMDR trained therapist will go through a very long extensive history with a person, to discover a trauma timeline, what kind of coping skills, their ability to be present in the moment, is the person safe? – Mhm. – Safe with themselves, or is their environment safe because EMDR therapy does illicit strong traumatic memories or strong emotional memories, and we really need to be able to have that kind of affect tolerance, the ability to tolerate really high affect states, and that’s really for the therapist to assess with the client.

There’s also some other conditions in which EMDR could potentially be ineffective or re-traumatize a patient. If somebody comes in and they are currently using, drugs or alcohol, if they are suicidal, unstable, it’s not a good idea to begin EMDE treatment in that way. – Well you can’t tap in to the trauma, you’re supposed to be present currently, and have a leg in past or where the trauma occurred. If you’re not even able to handle the present at all, how could you go back to something that feels worse? Do you know what I mean? – Right, that’s right. – Like that doesn’t, it’s counterintuitive. –

That’s right, I think about it often like a pool. Like a swimming pool, you’re not gonna swim to the deep end unless you can swim back to the shallow end. Right? – Yeah! – You don’t want to get in too deep. EMDR therapy has a history of people coming in thinking it is an incredibly cathartic therapy. It can be, it also can be done a little bit at a time I think pacing based on where the therapist feels a client’s readiness, to really go into the worst part of an experience. So it’s really a dance between a therapist and a client.

The other thing is preparation. Some clients need months of preparation. We’ll get into that a little bit later, but really to feel like a person can ground and feel safe in the present moment, and the rapport also with the therapist. – Yeah, and I know that from my audience, they’ve told me a lot of them are in trauma work or trying to do EMDR and they’re doing the prep work, and they’re frustrated because they expected it to go more quickly. And you know then they’re being told “Oh we can’t do EMDR today, I don’t think it’s right yet.”

And it’s like, but I want to get through this and I understand, like, I don’t want to feel like shit any longer than I need to, but you’re saying that it’s just, it’s part of that, what I always think of therapy as like an art form, because you do have to kind of read your patients also read your own ability to, you know, like where are we at, looking at their resources, assessing them, and like that push pull of “I’m going to challenge you, but I don’t want to push you past where you’re able to go.” – Right. – Like “I don’t want to push you too far in the pool, I want to make sure you can swim back.” – Right we have a range of resilience, and we have to stay in that range to get I think an optimal outcome.

People come in with the idea that, because early research in EMDR with one single incident traumatic event, in the research it had three sessions of EMDR. – Oh! – And there was significantly, you know statistically significant change, however, most EMDr treatment is not three sessions. And I don’t even, people ask all the time how long is this gonna take, which therapists don’t like that question, – No, ’cause you don’t know! – No, no, and you know it’s not like we’re trying to be evasive we really don’t know. – Everybody’s different. – So different. – Some people might take seven sessions we might take twenty-two, – Right, right. – Runs the gambit. – Does somebody process quickly? – Yeah. – You know do they have just a ton of coping despite their- – Their resilience.

Like I remember last time we filmed on the whiteboard, or no we did the paper, and making the resilience zone is like this middle and then this would be you know, like the fight, flight, and freeze state. And some people’s resilience zone is this big and some people’s resilience zone is this big. And it’s like- – Right, right. And you sometimes don’t really know that until you start working in a person’s system. – Yeah until you see how far they, how long they can withstand the stress, really. – Right that’s part of that dance. So I think setting some realistic expectations, I think is really helpful, anybody who’s thinking about starting EMDR therapy, it also can be used by itself. Some therapists really, I don’t know many that just do EMDR, it’s usually within a variety of different trauma modalities that we’ve talked about.

Somatic experiencing or brain spotting, psycho-motor sensory therapies, that I think not everybody can process with EMDR and so it’s nice to be able to work with somebody who might be able to offer some other strategies, other techniques – Yeah, definitely. Because as we know, when I was researching for my book about trauma, I learned that it’s usually a combination that’s best. Because we used to think talk therapy, putting it into a narrative form, giving it a beginning, middle, and end, super therapeutic, can be healing. Yes, but not for everybody. Some people need an additional component like in EMDR. Or, some people need a different modality like schema, somatic experiencing, you know, things like that.

I do have a question actually because recently someone asked me about brain spotting. Do you know what it is and how it’s different? – Yes. – ‘Cause I looked up a little bit, it was on my livestream if you guys were on my Patreon you know I looked it up and I said from what I can read, it sounds similar to EMDR. – Mhm, so I’m trained in brain spotting so I know quite a bit about it. It was created by David Grant, and it was, initially he developed it to enhance sport performance, but what he discovered is, I’m going to try to say it in a succinct way, is that the eyes are kind of the window to the soul right? That our eyes are also the window into our nervous system.

And Francine Shapiro who developed EMDR was onto something with eye movement. With brain spotting you actually find different spots within the visual field when a person talks about a traumatic experience you track where in the visual field holds the most charge. – Oh interesting. – So it’s a way into the charge of a traumatic event through the eyes. – Through the eyes, interesting. – And what I like about it is it can be less activating than some of the bilateral stimulation. – Okay. – You kind of get to hold people in that kind of charge a little bit longer and a little steadier.

And for some patients they just respond positively to it. – Well everybody’s different right? – That’s right. – Some people might respond more quickly to EMDR, – That’s right – Or versus brain spotting or vice versa. – But they’re very similar in that they have a similar approach to get into the memory network, which is what we’re doing in EMDR and brain spotting, and they have similar strategies as far as once you’re in the memory network, it’s a lot of free association. – Oh. Okay.

Which we can get into a little bit more – Yeah what are the other questions we wanna answer? – Okay, oh, EMDR is it only good for PTSD? – That’s a good question – Mhm. – My hypothesis would be that no, it’s good for a lot of things. – Yes. A lot of things. – ‘Cause I’ve even wanted to try it out myself. – Yes! (both laughing) – Well I think it’s a really good idea, because it can address common issues such as a stress response in response to maybe getting triggered at the office, by your officer and you don’t know why. Or panic attacks, or addictive disorders. – Yeah urges, impulsivity… – Urges, mhm. – Yeah and that triggered, because we always talk about it like we’ve talked about this when it comes to family members or other people where like I don’t know they just know how to push my buttons.

But like, why? And how do we not be as reactive? – Mhm. That’s right – Yeah. – Right and you can know better, – Doesn’t mean you do better. – Right. (both laughing) – You have a physiological response and maybe you know where it comes from and maybe you have some ideas about that. So EMDR is great at kind of, bringing that material up and un-charging it. I always think of it like draining a battery. – Oh, yeah. – Feels like it really drains the system of whatever that charge was, and sometimes like we’ve talked about in other articles that charge is like I go into fight or flight, or sometimes it’s wait I just space out. – I just- – Dissociate, yeah. – Go into freeze and dissociate.

EMDR, you can use EMDR is you dissociate we just have to work with again staying in that present, Total attention – Yeah, interesting. That’s good to know though because I think a lot of people have wondered “Oh would it help me with this or that?”And it’s not just that we’re talking to you in detail because there are a lot more implementations that way, it can also be applied in many other… – Another question that just came up for me is, “What if I don’t have a memory?” like a visual picture memory. – Yeah, repression’s real – Right. And then people worry that they’re then gonna be, memories are gonna be placed into their brain. – Yeah, yeah! – Which we know sounds crazy but we’ve heard about it.

This being a big thing. But yeah, what do… – So what we know is that, sometimes, there isn’t a visual memory. Maybe you have a sensation that comes up, or an emotion that comes up like when you’re with a person, right? And you don’t know why. The thing with EMDR and processing stored memory or stored traumatic experiences is sometimes I can process a whole piece with a person and it’s just somatic, meaning just sensation, there never is a full story. And, I mean we have a lot of different theories about that.

Some theories are it was a pre-verbal experience, Maybe birth, maybe within those first two years, and we can resolve a whole piece of work and never have the picture, the whole narrative, and it doesn’t matter. – Yeah, that’s interesting because I think a lot of people do struggle with that like, not having that full memory and feeling like they need to have it in order to process it. – Right, right, mhm. – But it’s almost just, in a way, the way that I think about it is like it’s not so important that we remember everything, it’s important that we resolve what’s bothering us now. – Right, that’s a great point. EMDR is very symptom focused in the sense that yes, it’s important that we know what trauma experiences you had but what are your symptoms that we’re really trying to relieve? And that’s what we’re tracking the progress, as much as we’re tracking “Did we drain that battery of the emotional pieces?”

At the end of they day that’s what we want, right? – Yeah ’cause we wanna feel better, that’s the goal which I think is why people find so much efficacy and so much… I don’t know if it’s like resolve or… Relief, from EMDR. – Right, yeah. I think that for me as a clinician what felt, when I first learned EMDR, what felt magical was just to witness something starting at a 10 or a 9, as far as subjective units of distress, and it moving to a 1 or a 0, within, you know a few sessions, I can’t say when the person’s totally relieved, (both giggling) but just to witness change like that in a therapeutic setting from a clinical perspective, I’m not even suggesting from the patient, but from a clinical perspective it was really profound to watch. – Yeah well ’cause we don’t get to see that all the time.

I think as a non-EMDR based therapist, it’s those a-ha moments where then you’re like, it’s funny on the therapist’s side of things you think like, I am good at my job! Because we can have really tough sessions with patients where there’s no progress, they’re very frustrated, we feel that with them. And then you have those, you “Yay!” You know, we knew to was working we just had to push a little bit harder. And so it can be really rewarding. – Uh-huh. – I think one question a lot of people have had recently, is because of Covid-19 and virtual sessions, can EMDR be done virtually, not in-person? – Yes, some of the challenges that can be with remote are I think it can take a little bit longer to build rapport with a therapist if you haven’t met with that therapist prior to being remote.

So that preparation phase might be longer, but you absolutely can do EMDR remote. And if you were in-person session the way that the therapist creates that bilateral stimulation is, the first kind of way we introduce EMDR is actually with the eye movement, which you can do remotely too via Zoom, it can be a little more awkward, so the eye movement, can I show you what it looks like? – Yeah, I’d love it! – Okay so we’re just going to turn towards each other.

Okay, I’m going to move you a little bit buddy I’m sorry. – So typically in a session, in a live session, if we were, we’ve already done the intake, and we already kind of have decided that you’re going to start EMDR therapy, the first thing we do is discover together what kind of bilateral stimulation you’re most comfortable with. – Okay! – So we try on a bunch of stuff. – Okay! – And you get to just see what it feels like and then also, we’re not married to any which one way. – You can like, switch in and out. – At at any point. So the first one I usually start with is the eye movement. And we would actually typically sit maybe not quite this close, but, a little bit further away. – But closer than normal therapy kind of not like across the room. – It is! It is closer. And if you’ve been in traditional talk therapy, that’s a big change. – Mhm. – So I’m just going to put my fingers right about here, and I’m just going to start very slowly, just to feel what that’s like.

And then you let me know- – I find it soothing in general. – Good. – But I think because it’s like I don’t have to focus on anything else.Yeah! And does my finger feel too close? – Mm-mm. – Okay. And how’s the pace? – It’s probably good but I don’t think I could go any faster. Is that normal? – Oh great! Yeah. So typically when we do the resource installation phase of EMDR, which is in the preparation, we do slower eye movements, – Okay. – and six to twelve. and the reason we start slow and short is we wanna stay in the positive, we stay too long and sometimes it can flip to the negative. – Gotcha, okay interesting. – Uh-huh And then the other direction we’re gonna try is diagonal. – Oh! – Yeah.

I didn’t even think about this, that it would be different. – Yeah, mhm. So just notice which one, – Yeah – the differences, your comfort. – Yeah. – What do you notice? – That one isn’t as comfortable, I don’t know why, but it’s just like I feel it here. Is that, I don’t know. – Right, right! Well that’s the thing is it’s just your un-subjectivity and where you feel like you can kind of sit in it a little bit deeper. The thing with eye movement is your eyes have to be open, so these other ways to stimulate that bilateral stimulation, you can close your eyes or open them, so it gives you some choice. The next thing we’re going to try on are these tappers. – Ooh the tappers! Let’s give ’em a go. – Okay. And similarly we can adjust the speed and the intensity. – Okay. I like them more intense I like it kind of you know, ’cause I can really feel it then. – ‘Kay – Oh yeah the lower, interesting.

I feel like… This is weird you guys and I’m just, I have no idea I’ve never actually done this before. But I feel like if it was lower, it forces me to focus on it more which I don’t know if that’s a good thing or a bad thing, it might be a helpful distraction. – So I tend to think of actually any of these different forms of stimulation as like anchoring and grounding of attention, people often describe the tappers, we’ll get to the other tones in a second, as like oh it gives me something else to focus on so I’m not all the way in the story. – ‘Cause if it’s too intense, then I don’t have to focus on it that much. – Mm, good. – I can focus on, you know? – Right, right, right. – So if it’s light then I have to, I don’t know it’s weird. That’s interesting – Yeah, yeah yeah. So that’s the tactile, the tappers.

And then another form, you get so many choices, is there’s auditory tone and then there’s auditory music. But sometimes you’ll hear an auditory beep, you know. – Oh okay. – It moves right, left, right, left. – Okay so is it just, oh it’s just moving the sound from one ear to the next. – Right – Interesting. – And so we can turn the volume up. – Again I think same with the tappers, it’d be a nice distraction if I had to focus on it, and if I had to like listen. (dog barking) One of my um, I know we wee you Liam. One of my favorite lines I read in Where the Crawdads Sing was “Squint with your ears.”

Sometimes I feel like when you really have to listen hard, I would like to like, squint with my ears more so that I could distract. – Right, stay in the here and now. – Yeah. – And in your senses. What I notice the bilateral stimulation does for me as a clinician or when I’m receiving EMDR is it does force attention to really stay in the here and now. – Yeah. – So whatever stimulation you feel more grounded, or most present with, that would be the one I would advise people to choose. – Okay, yeah I think I’d… I mean we’ll try the self one and then I’ll decide which one I think would be the best. – Okay. In an office, I’ll do one more version of tapping, in an office a therapist could tap on a client’s knees as another version, I’ll show you what that looks like. – Uh-huh – Okay. – And you have to get really close then that way, which might be uncomfortable for some people.

Yeah so what I was gonna, if you have a history of sexual abuse, or a history of any kind of physical assault, probably wouldn’t advise this way. While I think sometimes it can be very useful, if somebody’s had early developmental trauma and not had a lot of nurturing contact, sometimes that light touch can feel very nurturing. – Yeah very healing. – Yes, healing. – Interesting. – Mhm, right. So that’s very particular to the person. So the tapping, it just looks like this. And then you can tell me, lighter, softer, harder, faster. – I think that pacing is good. And the, I think the a good like, amount of touch I guess. Not harder or softer I think that’s nice. – Okay.

I still think I love, I like the eyes best. But yeah, this isn’t bad either. I think it’s kind of nice in the same way, we’ll have to see when I do it myself, but just that I don’t have to do it, is nice. – Mhm, right. – Whereas the eye movement, you do kind of have to participate so I don’t know there’s a lot of thought with, I’m sure I might switch between. – Right. – I could see myself being like oh today I feel like touch or taps or whatever. – Right or maybe a particular intensity of an experience, you really want something that like, keeps you here in a different way. – Yeah that’s interesting, I never thought about that at all. (Kati giggling) – Yeah! Right there’s so many, what’s helpful is very unique to the person, and that you can really have an experience of getting to know your nervous system also through that.

Oh this helps me soothe, oh this helps me calm. – Yeah. – It’s also an amazing strategy and skill to use outside of session. – Well yeah because then you could, okay let’s talk about how I can do it so that I can do it outside of session. And we can set this down. – Okay so what I might do in a remote session, is I would teach people the butterfly hug, and you can also teach this to children, or with children sometimes you can even do another version but I can show you that one. So the butterfly hug looks like this, you’re gonna cross your hands, and you’re just gonna tap back and forth on your shoulders. And then again you can play with pace and intensity, for some people if this feels uncomfortable and like tight, another, you could tap on your own knees, – Okay. – Just another version so let’s just see what you notice.

Yeah I think this does feel a little tight to me, I don’t know what it is, which I could see people finding it comforting, it’s almost like a hug, but I think the legs is better. Yeah and I still, the basic eye following your finger is actually I think the best for me, personally. – Great, great so it’s just, that would be, I think it’s just as far as like the prep, after the preparation, you know part of the preparation is establishing what kind of bilateral stimulation are we gonna do? So the thing that happens in a remote session because that’s where we’re kind of going, with the eye movement, sometimes the therapist on a zoom can do that. Or a client can pick two spots to move back and forth between. – Oh okay like lamp, keys. – That’s right. – Just boop boop boop.

That’s right. Before, you know this one caveat I have in doing an EMDR session in articles is please do not try EMDR at home by yourself without a trained clinician. – Mm, mm-hmm! – That, it really can open up material and it’s really helpful to have the setting, the person, the relationship, all the skills in place to safely process. – Yeah. – So what we can do at home though is really discover how to install positive resources, positive states. And that can be incredibly useful if you decide to move into EMDR therapy. – Gotcha, so when we are trying to put in those positive resources we’re still doing the tapping. Or whatever right? – Correct, yes. – And that’s how we’re like, putting them in. – Correct. Yes. – Gotcha. – Just for people to understand. – Installing them. – Yes, installing them is the word. Well thank you that was really helpful!

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