All opinions are not equal

I have been following this discussion with some interest and more dismay. It appears to be at cross-purposes because of differing views re the validity of different types of data. I published on this issue some years ago (Greenwald, R. (1996). The information gap in the EMDR controversy. Professional Psychology: Research and Practice, 27, 67-72.) and again more recently (Greenwald, R. (1999). The power of suggestion: Response to EMDR and Mesmerism: A comparative historical analysis. Journal of Anxiety Disorders, 13, 611-615.), but I haven't been able to straighten everybody out yet! So I'll try again...

First of all, let me expose my own potential bias: Much of my claim to fame (not all) pertains to EMDR. I was the first to publish a review concluding that EMDR probably worked (in 1994) and I have written a book on using EMDR with children. Although I like to believe that I am primarily interested in helping people, I understand that the fact that I have, for now, embraced what I consider an effective tool may be considered suspect.

Now to address some misconceptions:

1. EMDR is a "proprietary" treatment which has appropriated public-domain methods for the personal benefit of its proprietors.

I refuted this some years ago in Greenwald, R. (1995). Evaluating Shapiro's stance on EMDR training. OnLine Journal of Psychology, 1, 130-134. Modem 209-271-9025. (on line access: <http://www.childtrauma.com/pubstand.html>). Since then EMDR training has proliferated, with numerous independent trainers, EMDR being taught in over 30 universities, an independent professional organization with authority for accreditation of trainers and certification of practitioners, etc. Shapiro's private for-profit EMDR Institute regularly offers scholarships to researchers, and supports a humanitarian training and treatment program which has provided services worldwide. As for others prominent in EMDR, I'm sure that some are making good money from it. Speaking for myself, I recently quit my high-paying and enjoyable clinical position so I could devote myself to EMDR-related research at about 20% of my prior salary.

To me it seems fairly clear that although the EMDR community includes a wide variety of human beings, there is a commonality in the sense of service and mission in the development of EMDR. Those involved tend to view EMDR's potential in helping others as being more important than self-interest. While there may indeed be "turf" issues with EMDR as easily as with CBT or other approaches, I don't think it's fair or accurate to single EMDR out on that account.

2. EMDR proponents ignore disconfirming data.

I don't think that EMDR proponents can be lumped together. Speaking for myself (and I am far from unique in this regard), I have published comments to the effect that:

a) the jury is still out on the role of eye movements (if any)
b) EMDR may not be effective in reducing hyper-arousal in cases of multiple/chronic trauma (or it may be - don't have enough data to make sense of this yet).
c) EMDR's effectiveness has not yet been empirically tested for most of the non-trauma applications for which it is currently being used.
d) Many EMDR studies have flaws.
e) In some cases EMDR cannot match or replace in-vivo exposure.

These don't seem like earth-shaking concessions; however, they are at least the concessions that the data demands. I believe that if/when good data demands additional acknowledgments of EMDR's limitations, these will be forthcoming from a majority of so-called EMDR proponents. I believe that EMDR proponents are actually just clinicians and scholars who happen to have come to reasonable conclusions based on available data.

3. All EMDR studies are equal.

Yes it does seem silly to say it that way, yet that is the unstated assumption underlying much of the debate. In fact, to borrow from Orwell, some are more equal than others. My 1996 paper (cited above) outlined criteria for evaluating the apparently conflicting EMDR-related findings in the literature. It came down to 2 points:

a) People respond to EMDR more quickly, on globaly symptom measures especially, when they are suffering from fewer traumatic memories. This is because EMDR tends to work on one memory at a time, so single-trauma treatments are faster, and thus the effects are easier to capture in a brief study.

b) When EMDR is done well, the results are better. This analysis has been consistently reaffirmed within EMDR and more recently within CBT as well (see Maxwell citation in a recent post by Shapiro on this subject). This is why treatment fidelity is one of the "gold standards" of treatment outcome research.

4. Conducting a scientifically-couched smear campaign is a good thing.

There is a relatively small group of men who have indeed published almost all of the "anti-EMDR" literature, and many of whom have apparently made this their primary academic/scholarly endeavor for some years. Whereas the early critical reviews rested on good science and appropriate caution, in recent years this group has only been able to maintain their negative message by distorting data, selectively neglecting the bulk of the literature, applying different standards for EMDR vs. other treatments, and using Rush Limbaugh-style tactics such as distraction and ridicule. Peer review does not provide automatic protection against such poor quality publications, as they can sound very scientific and the reviewers may not be sufficiently familiar with the data to recognize the flaws. We have seen some of this smear approach, whether by design or not, in some recent posts on this forum.

This is not the same thing as a scientific debate, and it's very sad that it has been represented as such. It does considerable damage by contaminating the data base (as in poor-quality studies that purport to be good ones) and by propogating erroneous viewpoints based on overvaluation of bad data and neglect of good data. This leads to inordinate difficulty in obtaining funding for EMDR-related research, obtaining acceptance for EMDR in clinical practice, therapists obtaining EMDR training, and clients obtaining EMDR treatment.

Given the strongly supportive data on EMDR that is already available (and the supportive evaluations of such data by independent organizations such as the APA and ISTSS), the smear campaign against EMDR has clearly done substantial harm to many individuals who might have otherwise benefitted from EMDR treatment. Dishonesty is bad enough; dishonesty cloaked as scientific discourse can have far-reaching effects.

My intent here is not to accuse specific individuals of specific dishonest statements, or to assign motivations to those who are engaging in the smear campaign (it is possible that some of them are actually sincere, if misguided or misinformed). In fact, many anti-EMDR publications do contain some good points, things worthy of consideration, which tend to get ignored because they are so offensive overall.

My point is to emphasize that bogus so-called science can really hurt people; it's not just an academic exercise. What happens to those who could benefit from rapid and effective trauma treatment but don't get it? Some will get other effective treatment, though it may take longer and/or be not quite as effective as EMDR. Some won't get very good help. Some of these people will get sick, drive drunk, eat poison, hit a child, steal a car... How many lives are saved by EMDR? How many are lost by absence of EMDR?

What I would like people to seriously consider is the possibility that EMDR is as good as some people say it is. If that's the case, and evidence to date - when evaluated with some kind of discernment - supports this view, then what does all this mean? Can the development and dissemination of EMDR really contribute to the reduction of human suffering? What role do you want to play?

Replies:

Second thoughts, by Ricky Greenwald, 2/18/00 Re: Second thoughts, by Deb K, 2/19/00

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