Re: Double talk and double standards

I have heard that Rothbaum's was a well-designed study but haven't had a good look at it, will look forward to it. I happen to be enthusiastic about Exposure as well, in fact I've been teaching it every day this week (and regularly over the past couple of years). I think it has a significant advantage over EMDR in that it is much easier to teach, and easier for therapists to do well. I believe that over the past decade CBT treatments for trauma have been improving (certainly for kids, my specialty area) and I think that's exciting. My latest (edited) book includes the first controlled study of CPT for teens with PTSD. I regularly refer trauma cases to excellent therapists who use CBT and not EMDR. In short, EMDR is not the only good news that interests me.

Based on my clinical experience as well as my assessment of the still-incomplete literature, I do think that, compared to Exposure, EMDR is more effective, more efficient. But I don't need that to be true. If findings such as Rothbaum's (or even Devilly & Spence) eventually outweigh the findings of Vaughan et al, Lee et al, McFarlane, Ironson et al, Powers et al, Jaberghaderi et al, etc., then I will be first in line to say so. I already teach, based on the literature, that EMDR is not the treatment of choice for spider phobia; that in-vivo exposure is preferred.

This is supposed to be about getting better at giving people the help they need. So I don't mean to emulate Mister Rogers or anything, but is it too much to ask that we make an effort to be honest and respectful? Even get along? I'm not talking specifically about you, but the atmosphere in recent years re EMDR and CBT has gotten pretty rough sometimes. I think we'd be better off to acknowledge:

1. That EMDR has borrowed quite a bit from CBT, and will be even better when it borrows even more. (I'm specifically referring to practices leading up to and following the "exposure" or "trauma resolution" phases of treatment).

2. That there is something different going on in EMDR that doesn't seem to occur in other types of trauma treatments. This, not "clever marketing" is most likely what accounts for the positive research findings as well as the popularity of the method among therapists and the public. EMDR has not faded away like NLP or other methods that initially captured the imagination but did not survive scientific scrutiny.

3. That bad manners and selective neglect of the literature do not help anyone's cause (regardless of whether they happen to prefer EMDR or CBT). It only gives them a bad reputation.

I am very interested in learning when, how, and why PE and/or EMDR do better sometimes and worse sometimes. This is why I so appreciated the Maxfield and Hyer study I cited a post or two ago, in which they found an explanation: that (for EMDR as well as CBT) studies of higher quality - particularly re treatment fidelity - led to improved treatment outcomes. There may be other reasons as well, perhaps including superiority of one treatment over another, perhaps moreso for some clients than others. As more studies are reported, I'm sure this issue can be profitably revisited.

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