EMDR FORUM ARCHIVE, 2000
Re:associations?
Cahill · 11/02/02 at 10:47 PM ET
One of the topics that came in this threat up was the role of "free association" in EMDR. This is one feature that is used to distinguish it from other exposure treatments, which tend to be more focussed on specific target memories. Moreover, when multiple memories are targeted in exposure therapy, they are usuallly treated sequentially, working on one memory until there is adequate "habituation" before moving onto the next memory. Now, if you go back to Louise's post, point #3, you will note that she (1) acknowledges there is no research to demonstrate this is an important feature of EMDR and she (2) wonders about the comparison between standard exposure therapy (with its restricted focus on specified target memories) vs. conducting exposure therapy that incorporates free association. I responded by providing information about the relevant research on this question. The result of that research was that, although exposure therapy with free association was helpful, free association did not improve outcome. If anything, the trends suggested the opposite, that it may have slightly reduced the effectiveness of treatment. If adding free association to exposure therapy failed to improve outcome, then this study provides no reason to think that it will improve outcome EMDR. Then you come along and offer some post-hoc explanations of why the Boudewyns study is not relevant and suggest that I'm discussion apples when the topic is oranges. But, given the history of this thread, I think you can see my comments were directly on point. But if I'm comparing apples and oranges, then it's because Louise asked me to. Now, I'm not saying that free association does not add to outcome in EMDR, because I don't know that to be true. However, there is no evidence in support of that hypothesis and the only available evidence fails to support this hypothesis. Therefore, the burden of proof for the proposition that free association contributes to outcome in EMDR has not been met. If people want to assert that this is one of the active ingredients of EMDR, then they need to provide the relevant data. Conceptually, it is a pretty straight-forward study with three groups: WL, standard EMDR, and EMDR restricted to the target memory. For those who want to assert that EMDR operates through different mechanisms than exposure therapy, the study could address this by including two more groups: standard exposure therapy and exposure therapy utilizing free associations to determine the content of the imagery. If standard EMDR was superior to EMDR without free association AND standard exposure therapy was superior to exposure therapy with free association, then you would have an important empirical finding, called a double dissociation. Such a double dissociation shows that the same manipulation has opposite effects on treatment outcome for EMDR and exposure therapy. This pattern would permit a strong inference that the two treatments operated through different mechanisms. However, if free association had the SAME effect on both treatments (regardless of the direction of that effect), then the most parsimonious explanation would be that EMDR and exposure therapy operate through the same mechanism. Of course, we can't know the outcome of this study design until someone is interested enough to conduct. In the meantime, the method of science is to assume two things are the same (i.e., EMDR and exposure therapy operate through the SAME mechanism) until proven otherwise. The reason we assume sameness is because it is logically impossible to prove two things are the same (this is essentially a restatemtn of the point that you can't prove the null hypothesis I have made in previous posts). We can try to match two things on as many dimensions as we can think of, but it is always possible that the two things differ on some dimension of which we are not yet aware.
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