Frequently Asked Questions I Get About Therapy & EMDR

My simple goal for you is to help you achieve the results you want as quickly, easily, and safely as possible. I think the easiest way to explain what I do is to answer a series of the most commonly asked questions I get associated with psychotherapy and EMDR (eye movement desensitization reprocessing).

“Why do you like EMDR so much?”

My practice approach has always been a combination of self-exploration by you and supportive directive work by me incorporating aspects of psychodynamic, experiential, cognitive-behavioral, and systems therapies. Our work together will still use all of these approaches, however, simply put I’ve never seen anything that works as effectively, rapidly, easily and permanently as EMDR. EMDR is an interesting and complex approach to psychotherapy that incorporates much of the wisdom of other therapies. The fact is that EMDR is an accelerated form of information processing that includes an eight phase approach, numerous procedural elements that contribute to its success and bilateral stimulation. EMDR is used within a comprehensive treatment plan to promote your recovery.

“Why has psychological treatment-even with drugs-always been such a lengthy process and not always ended up working that great?”

In the past, all we had to go on was symptoms--we had no way to know for sure what was actually causing the symptoms. For most emotional issues that people want to change, there’s no lab work, x-rays, or anything else that can be done to actually identify the cause. So psychological treatment has always been somewhat of a “trial & error” process. The scary thing is--as I’m sure you’ve heard news reports of-- you can, for example, take three depressed people and give them all something like Prozac. One of them may get a great benefit with no side effects; another may get no side effects but no real benefit; and one of them may become suicidal or homicidal-- because “depression” can be caused by many different things! You’ve got the same problem with anxiety disorders, ADD and ADHD, and any other emotional pattern that a person might want to change. We now have the technology to pinpoint exactly what is causing your symptoms, so that we can create an individualized treatment plan that will be as fast and effective for you as possible. We now understand that there are six different areas of the brain that essentially control all psychological functioning. All emotional disturbances are caused by either too much activity or too little activity in one or more of these six areas. What makes it so complex is that when you add up all the potential combinations, there is actually several thousand different patterns of brain “mis-activity” that could be causing your symptoms!

“So what would be causing those parts of my brain to have too much or too little activity going on?”

All patterns (brain activity patterns, thinking patterns, emotional patterns, behavior patterns, communication patterns, relationship patterns)--both the good ones and the bad ones--are simply the result of an accumulation of experiences stored in your brain and nervous system. Most of the negative “patterns” people come to me wanting to change have been caused by one of two things, sometimes both. The first is something called imprinting. From the time you are born, maybe even earlier in the womb, your brain starts developing very rapidly, and how it develops is shaped tremendously by everything being pulled in through your five senses. This creates an “imprint” on your developing brain which becomes sort of a “default mode”--the conditioned way you will naturally tend to think, feel and act, unless other forces have somehow reshaped this imprinting later on. So early life experiences; even ones you can’t consciously remember)--especially experiences with caregivers and others close around you--have a massive influence on your personality development.

The second major shaping influence for these patterns is stress. Pretty much from conception onward, anytime you’re under any type of stress your brain triggers certain glands in your body to produce a large amount of hormones we can “stress hormones”- -things like adrenaline, cortisol, and some other things. During these periods of time, your brain does NOT process the information coming in through your five senses the way it normally does. This leads to a chain reaction of effects in your nervous system - it’s a little hard to explain, but it’s kind of like “undigested” sensory data that creates “blockages” in your nervous system, alterations to pathways within your nervous system and alterations to brain chemistry where your neurotransmitters; such as seratonin, dopamine, chetacholamine, epinephrine, nor-epinephrine, etc.) get thrown out of balance.

The bottom line is - it’s the build up of the effects of this “stress response” in your body, brain and nervous system that we believe to be the culprit behind most of the emotional difficulties that people experience. Basically, you’ve reached a point where certain things are triggering a pattern of neurological impulses in your body to fire off over and over again. The most challenging thing is that over time all these patterns get stronger and stronger--it’s like working out a muscle, the more you work it the stronger it gets (on a neurological level, it’s actually more like water running through a trench--the more water that runs through it, the deeper it becomes carved out until it gets to the place where it seems like everything flows into that trench much too easily!

“Can’t I just take drugs to correct my brain chemistry?”

Taking prescribed medication supervised under the care of a licensed psychiatrist/ medical doctor can be an adjunct to any psychotherapy treatment plan. The advantage of using EMDR opens the possibility to restore your body’s ability to self-regulate brain chemistry properly on its own. The research shows that EMDR has great success in helping people reduce and often eliminate their need for antidepressants, anxiety medications and ADD/ADHD medications to name a few. Working closely with your prescribing physician is an important part of the treatment plan. Let me underline that You should never alter your use of your prescribed medications and/ or stop taking prescribed medications without discussing it with your medical doctor.

“What are my options?”

That is where EMDR comes in. EMDR is the best thing I’ve ever found for changing emotional reactions, negative thought patterns, and entrenched habits (and often even physical discomfort) that people can’t just “think themselves out of” with the use of “traditional” talk therapies. EMDR has given us the ability to essentially reverse those negative patterns that have developed in your brain, body and nervous system. We know that when something traumatic happens to you, your mind may continue to hold onto it in a way that includes the original picture, sounds, feelings, sensations and/ or thoughts associated with it. It seems like the trauma is locked inside and it can be triggered by many different people, places or things that you encounter throughout the day. These old experiences can still cause a great deal of discomfort. At times you may feel helpless because you can not control what is happening in your mind and body. That is because you are experiencing the affects and sensations that are connected with that old experience.

“What are the key elements of EMDR?”

There are actually two key elements of EMDR treatment. The first is something called “bilateral stimulation”--which just means “two-sided stimulation”. You probably know that your brain has a right hemisphere and a left hemisphere and that each side of your body is “hard-wired” to a specific side of your brain. Creating a rhythmic, back and forth stimulation of each hemisphere of the brain seems to stimulate something we call the “information processing system” to go into a highly accelerated mode of functioning- -which is exactly the treatment effect we have to create to get the results we are after. There are several different methods that have been developed for creating the “bilateral stimulation” effect such as eye movements, tapping on the back of your hands, knee tap stimulation, thera-tappers (a pulsating device you hold in the palms of your hands), audiotory tones that create a sound in your ears and/or a combination of them to help you during the process. We will try them out and decide which one works best for you. I am sensitive about people’s “personal space” so if there is anything about this that is at all uncomfortable for you just let me know and there’s modifications we can make.

The second key element of EMDR treatment is sort of the “art and science” of how I have to prompt and guide your thoughts while we are “doing” the bilateral stimulation. I’ll explain this in more detail later, however, in a nutshell how I do this will be determined by a number of factors individual to your unique situation. The end result of EMDR treatment is to reduce and eliminate negative thoughts, feelings and behaviors to enable you to really be at your best in your life.

“I thought EMDR was designed for treating Post Traumatic Stress Disorder (PTSD) and I’ve never been through anything particularly traumatic......so how will it help me with my issues?”

Originally, EMDR was developed by Psychologist Dr. Francine Shapiro in 1987 to treat victims of Post Traumatic Stress Disorder. Since then, EMDR has evolved and today is used to treat PTSD/“Big T” complex trauma as well as PTSD/ “Small t” simple trauma. First, let’s talk about “Big T” trauma. ”Big T” trauma is defined as a type of anxiety disorder that's triggered by an extremely traumatic event. You can develop PTSD when a traumatic event happens to you or when you see a traumatic event happen to someone else. Many people who are involved in traumatic events or witness them have a brief period of difficulty adjusting and coping. But with time and some healthy coping methods, such traumatic reactions usually get better on their own. In some cases, though, the symptoms can get worse or last for months or even years. Sometimes, they may even completely disrupt your life. In these cases, you may have PTSD. PTSD may affect survivors of such traumatic events as sexual or physical assault, war, torture, a natural disaster or an airplane crash. PTSD can also affect rescue workers at the site of mass casualties or other tragedies. These kinds of events may cause intense fear, helplessness or horror. Signs and symptoms of PTSD typically begin within three months of a traumatic event. In a small number of cases, however, PTSD symptoms may not occur until years after the event. PTSD symptoms may include: flashbacks, or reliving the traumatic event for minutes or even days at a time; shame or guilt; upsetting dreams about the event; trying to avoid thinking or talking about the event; feeling emotionally numb; irritability or anger; poor relationships; self-destructive behavior, such as drinking too much; hopelessness about the future; trouble sleeping; memory problems; trouble concentrating; being easily startled or frightened; not enjoying activities you once enjoyed; and/or hearing or seeing things that aren't there. Now about “Small t” simple trauma”. According to the December 2005 Harvard Mental Health Letter (“Post Traumatic Stress Without Trauma”); experiences not usually regarded as traumatic can cause the characteristic symptoms of PTSD. The authors suggest that life events may increase overall psychological stress and distress, bringing on symptoms related trauma. Some examples of these life events are: childhood neglect, childhood attachment issues, family of origin issues, relationship problems, parenting issues, work problems, financial problems, school problems, health problems, significant losses or life changes.

Both “Big T” and “Small t” symptoms can come and go. You may have more symptoms during times of higher stress or when you experience symbolic reminders of what you went through. For example, some people whose PTSD symptoms had been gone for years saw their symptoms come back again with the terrorist attacks on the U.S. on September 11, 2001. When you have “Big T” and/or “Little t” trauma, you may relive the traumatic event numerous times, you may have upsetting memories, or you may see reminders wherever you go. For instance, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a rape, and feel again the horror and fear of your own assault. Or you may have difficulties with co-workers or in intimate relationships and negatively associate those people with people or situations from your past.

“Who develops these types of stress disorders?”

Not everyone who experiences these kinds of events goes on to develop traumatic stress disorders, however, it is believed as with most mental illnesses to be caused by a complex mix of: biology and genetics; your life experiences; your temperament; whether the traumatic event is especially severe or intense; if the event(s) was long-lasting; having an existing mental health condition; lacking a good support system of family and/ or friends; having family members with PTSD; having family members with depression, anxiety and/or other mental health issues; and changes in the natural chemicals in your brain.

Stress disorders can disrupt your whole life, from your job to your relationships to your enjoyment of everyday activities. They also may place you at a higher risk of other mental health problems, including: depression, drug abuse, alcohol abuse, eating disorders and suicidal thoughts and actions. Traumatic events may reduce your ability to cope with other kinds of stress. Both traumatic experiences and overall distress may increase the risk of developing post-traumatic symptoms after either a traumatic experience (“Big T”) or a non-traumatic (“Little t”) life event. Stress disorders are very common and can affect people of all ages, races, cultures and ethnicities.

“What other kinds of problems can EMDR treat?”

Clinicians have reported success using EMDR in the treatment of personality disorders, panic attacks, complicated grief, dissociative disorders, phobias, pain disorders, eating disorders, performance anxiety, stress reduction, addictions, sexual abuse, physical abuse, and body dysmorphic disorders.

“How well researched and scientifically proven is EMDR?”

For detailed answers to that question I would encourage you to go to www.emdr.com/ studies.htm or through EMDR International Association’s website www.emdria.org but here is a few quick answers:

EMDR is the most researched psychotherapy method for PTSD. There have been more controlled studies that have evaluated the effectiveness of EMDR in the treatment of PTSD than any other method.

EMDR has been judged as empirically validated and given a rating of “highest level of effectiveness” in numerous international practice guidelines including The American Association Practice Guidelines.

A study underwritten for the treatment of PTSD by Kaiser-Permanente of California found that EMDR was twice as effective in half the time when compared to the standard type of treatment.

The International Society for Traumatic Stress Studies has stated that EMDR is an “effective treatment”. EMDR is endorsed by the American Red Cross, the FBI, the International Critical and the Incident Stress Management Foundation.

Research presented in the Fall of 2003 by Dr. Bessel A. Van der Kolk, M.D. is showing EMDR to be more effective then SSRI’s (ie. antidepressants such as Prozac and Zoloft) in the treatment of trauma. Dr. Van der Kolk is a Professor of Psychiatry at Boston University Medical School, past President of the International Society for Traumatic Stress Studies (ISTSS) and has taught in universities and hospitals across the USA and Europe. Since the 1970’s, Dr. Van der Kolk has been a clinical researcher, published extensively on the impact of stress on human development and his book Psychological Trauma was the first integrative text on the subject.

“If EMDR is so great, why have I never heard of it before?”

EMDR has actually received a great deal of media attention in the last few years. Segments have been run on shows like Dateline and 20/20 spotlighting the speed and effectiveness of EMDR.

“How does EMDR work?”

Everyone is always asking how EMDR works. The truth is, we are not sure. Dr. Daniel J. Siegel is a psychiatrist who has taken an interest in this question about EMDR. Also, he is an Associate Clinical Professor at the UCLA Center For Culture, Brain and Development and author of The Developing Mind: Toward a Neurobiology of Interpersonal Experience and Co-author of Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive. Here are some of his thoughts on EMDR:

The mind which can be defined as the process that regulates the flow of energy and information, is encouraged to process memory and emotion in an efficient and therapeutic manner. As with other forms of psychotherapy, we do not yet know exactly how the healing process occurs in the mind or in the neural processes of the brain. Some authors have proposed that trauma involves an impairment in the integration of various forms of mental processes, such as memory, emotion, perception, and interpersonal communication, so that individuals may feel excessively constrained or at times flooded in the overall functioning of their minds. From a neural point of view, such an impairment in mental processes may be seen as due to a blockage in “neural integration”, the manner in which the brain brings its circuitry into a functional whole. From this perspective, healing in psychotherapy would involve the development of the circuits that enable neural integration to occur in the brain. Areas such as the prefrontal cortex, the hippocampus, the corpus callosum and the cerebellum are regions that may facilitate neural integration and thus are those that may be changing in effective therapy. EMDR may be particularly effective at promoting neural integration through the ways in which its phases activate distinctive processes in the brain, such as thoughts, emotions, memories, and bodily sensations. As the phases progress in EMDR, neural integration may be proposed to the brain process that is being facilitated during the various phases of treatment. The result of effectively promoting neural integration would be both the alleviation of symptoms and the development of an enhanced sense of well-being internally as well as more rewarding experiences interpersonally.

“What exactly is EMDR treatment?”

We have already discussed the use of bilateral stimulation (BLS). Before we start using BLS, however, EMDR has an eight phase approach to treatment. A brief summary of the 8 phases will help you understand the function of each phase and how you can support your own process. During Phase One I is the history taking phase. I will ask you questions regarding your problem, family, schooling, vocation, development, mental, psychological and physical history. The idea is to find out about ALL aspects of you so that you and I can best decide how to focus on beginning your healing process. Please let me know if there is anything important that I did not ask you. Phase Two is the Preparation Phase and probably one of the most important parts of your treatment. The idea of preparation is to make sure you have the resources you need to tackle your problem(s). When we talk about resources I am referring to coping strategies. Resources are ways we learn to soothe ourselves and handle distressing thoughts, feelings, or body sensations. This phase is crucial and may last one session or many sessions to make sure you can handle what ever comes up for you. During this phase the actual way (BLS) is done is introduced so that you know what to expect and can ask as many questions as you want. EMDR processing will NOT start until you and I are sure that you are ready. Phase Three is referred to as the Assessment Phase. This is when we clarify the problem we will work on by choosing the following: an image that represents it; how it impacts the way you think about yourself in a negative manner; how you would like to view yourself concerning this situation now; your emotions; and where you feel the sensations in your body regarding this situation. I will teach you how to measure the emotions and the positive belief about yourself so that we can judge together where you are in the process of changing your thoughts and feelings about the situation and yourself. The Fourth Phase is call Desensitization. This is where we use the bilateral stimulation on the targeted problem and any associations that go along with it. We also use two different scales to help us measure what is changing for you. The first is called the Subjective Units of Disturbance Scale (SUDS) and the other is called the Validity of Cognition Scale (VOC). The SUDS helps measure your level of discomfort with your problem and the VOC helps us evaluate how close you are to your goal. Sometimes this phase moves very quickly and sometimes it moves more slowly. When the SUDS reaches a 0 and the VOC a 7 we are ready to move onto the next phase. It depends on what you need to resolve your difficulty. The Fifth Phase is referred to as Installation. During this phase we connect your positive thought/resource with whatever is left of the targeted problem. In the sixth phase called the Body Scan we check out if there is any discomfort anywhere in your body. This is another way for us to make sure that all the associated material that is related to your problem is worked through. In EMDR, I am checking at every level to see that this occurs. It is important to process all material associated with the problem to assist putting it behind you. Closure is the Seventh Phase. We will do a formal closing of the session together using one of your resources learned and practiced from Phase Two. I am interested in making sure that you feel okay before you leave my office. If you are having any type of discomfort or feel disconnected from yourself I want to know about it so I can help you feel better or at least be grounded before you leave my office. It is very important for you to know that once EMDR has begun we have opened the door to the processing of material and the processing may not stop when you leave my office. With this in mind, I will ask you to write down any interesting or unusual changes in any part of your life during the time between sessions. For instance, has your mood improved? Or, are you engaging in new or different behaviors? Sometimes it may feel like you are back in the old problem. This is not unusual - one memory may trigger other memories. If you have any concerns or are very distressed due to material that arises during the time between our sessions, please call me to let me know so that I can help you. You are not alone in this process. The Eighth Phase called Re-evaluation occurs at the beginning of the next session after we have started EMDR. The idea here is to go over the information that you have gathered in-between sessions so that we can see if there is any new material we need to work on or to decided if we will move on to another problem area.

“What is the actual EMDR session like?”

After we have completed the preparation phase we will be ready to move into the EMDR assessment protocol and the desensitization phases (BLS). We will identify a specific problem/issue as the focus of our EMDR treatment session. I will ask you to call to mind the disturbing issue or event we have targeted to work on. I will then ask you what you saw, felt, heard, thought, etc. and what thoughts and beliefs you currently have about that event. We will then used BLS to stimulate your brain while you focus on the disturbing material and I will ask you to “just notice” whatever comes to mind without making any effort to control the content or direction it takes. You may think that you must hold onto the beginning image, emotions and feelings throughout the process but this is not the case. The image, thoughts, feelings and sensations all may change. LET THEM CHANGE!!! That is a sign that the process is moving. Just allow yourself to sit back and let the material move itself with you as the interested spectator - like sitting in a movie and watching a film. There is no right or wrong way of processing. Your job is to just let what ever happens to happen. Each person will process information uniquely based on personal experiences.

“What happens if I get scared or overwhelmed?”

I want you to feel safe at all times and it is important for you to know that we can stop EMDR at anytime. If material is too overwhelming it is okay to stop and ground yourself. Just put up your hand in the stop position and I will know that you want to stop. The reality is that when you are processing information during your EMDR session, it often feels like whatever you are experiencing is happening in present time. IT IS NOT! You are safe in my office with me. I will talk to you during the BLS to remind you that I am here with you, we are team, grounded in present time. If you can handle what is happening, please go with it, like pressing the fast forward button on the VCR and then pushing the play button to resume the show. Just allow yourself to sit back and let the material move with you watching as an interested spectator - remember it is just old stuff.

At certain intervals, I will stop the BLS and ask you something like “what comes up for your now?”. All I need to know from you is that your process is moving. What that means is all you have to do is tell me an abbreviated version of what has happened if you choose too or just that something has changed, for example you may say “my chest feels lighter” or “the image is fading”. In fact, you do not have to tell me about the content at all if it feels too embarrassing. The only reason I would need to know more is if you get stuck; and even then, we can keep it to a minimum. Getting stuck occurs when nothing is moving or same image, thought, feeling and/or sensation keeps coming up. This is not unusual. Just let me know and we will do something to get the process moving again. The bottom line is that EMDR is different than talk therapy. During an EMDR session I will encourage you to talk LESS - the idea is to keep the process moving! BLS is continued until the memory becomes less disturbing and is associated with positive thoughts and beliefs about yourself, for example “I am incompetent” to “I did the best I could”.

“What should I expect after my EMDR session?”

During EMDR, you may experience various degrees of emotions, body sensations and thoughts however, by the end of the session most people report a great reduction in their level of distress. It is important to know however that your brain continues to work on your problem and the related information after your EMDR session is over. You may have new insights and/or new disturbing information come to your attention in the form of images, thoughts, feelings or sensations. THIS IS NORMAL!!. Please write them down so we can discuss them the next time you come in. If things feel too overwhelming please do not hesitate to call me.

You may be tired at the end of your EMDR session. Please try and schedule your session so that you can have time to rest afterwards.

“Could our EMDR work change something I don’t really want to change?”

NO!!!! The really interesting thing about your brain is that it came “preprogrammed” to automatically do what you want it to do - it just has to be stimulated correctly. EMDR seems to help your brain get rid of what you don’t want and need and actually strengthen what you do want and need. It will not take away anything useful for you and it will not change anything you don’t want to change.

However, with all that said, EMDR has a tendency to make bad memories seem very distant. If we are dealing with something related to a legal case and you have to testify in court, you will want to talk to your attorney about the possible implications of your treatment - in other words you may end up as a lousy witness because your emotional reaction to the event will be lessened. In that case you may choose to postpone EMDR until after your case has settled.

As I also explained, EMDR has the ability to bring back a memory so strongly that you may momentarily feel the same intensity of emotion that you had at the time of the original event, so it is EXTREMELY IMPORTANT that during our history taking phase that you tell me about any significant trauma(s) you have experienced so we can have “emotional management” tools in place so you don’t have to be afraid of your feelings anymore.

Also, if you are in recovery for any form of addiction and “strong feelings” are one of your triggers - ”working a strong program” would be highly encouraged, along with a good relapse prevention plan in place.

“I am still not clear, is EMDR something like hypnosis?”

No, EMDR is very different than hypnosis in three important ways: (1) In EMDR you don’t go into any kind of “altered state” - you are totally aware of what is going on, you are totally in control of the process, and it’s nothing that somebody is doing to you. It’s your brain that’s doing the work; the EMDR is simply a catalyst for speeding up the benefits you get from psychotherapy. (2) EMDR does not have the capacity to create false memories. And, (3) EMDR is not at all dependent on the placebo effect; in other words, somebody can be totally convinced that it’s not going to work and it still works just as well, because it’s purely a biophysical process (it’s the biggest skeptics that I have the most fun with when we first start doing EMDR, because they’re athe most surprised at how well it works!)

“How long are EMDR sessions and how quickly can I expect to reach my treatment goals?”

Typical EMDR session are scheduled from 60 - 90 minutes. The type of problem, life circumstances and the amount of previous trauma will determine how many treatment sessions are necessary. EMDR may be used within a standard “talking” therapy session, as an adjunctive therapy with a separate therapist or as a treatment all by itself.

To begin, one or more sessions are required for me to understand the nature of your problem and to decide if EMDR is an appropriate treatment option. Once we decide that EMDR will be used, depending on the nature of your problem will impact how quickly you have resolution. You can help the process by following these lifestyle guidelines - get on a consistent sleep schedule, practice the resource exercises I teach you, get some form of exercise everyday, drink lots of water, reduce the amount of carbohydrates you eat, avoid the use of chemical depressants (like alcohol and marijuana) and restrict the use of chemical stimulants (like caffeine and nicotine).

Remember, what is most important is to take the time you need for your own recovery and healing.

 

 

 

 

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