Re:marketing emdr

Hi Leah:

Thanks for your patience in my getting back to your question. I'm juggling conversations with several different people on this forum and the issues that get raised are not simple ones. Plus, I have a day time job. So it sometimes takes time to get back to someone. Now, onto your question.

What do I mean by packaging? In general, I mean the various ways in which some people talk about EMDR in order to promote its dissemination that are not based on data. In other words, hype. There are lots of examples of this, but I'm going limit my examples to those that are easily available to me as I write this. So, let's consider some statements on the official EMDR Institute site. When you arrive at the website you, see some clips from newspapers, some of which I've reproduced below (in quotes) with my comments on why I find the comments to be hype.

"EMDR (Eye Movement Desensitization and Reprocessing) therapy has emerged as a procedure to be reckoned with in psychology....Almost a million people have been treated ....
Also, further research appears to support the remarkable claims made for EMDR therapy."
- Reported in The Washington Post, July 21, 1995

Comments: It is not clear which remarkable claims that are being supported by research. If those claims are that EMDR works better than waitlist, and about as good or somewhat better than relaxation, then it is true that those statements are supported by research. But, I submit, such claims are far from remarkable. If the claims are that EMDR in 1995 was being shown to be superior to other effective treatments for PTSD (e.g.., stress inoculation training, exposure therapy), or that EMDR operates through procedures and mechanisms not operative in other therapies, or that certain features of EMDR (such as eye movements) are responsible for some unique treatment effect, such claims are remarkable but not supported by evidence.

In another example of such hypeFor example, consider the statement by Macculloch & Feldman (1996): "We have already referred to a number of controlled trials which support the effectiveness of EMDR. Hassard (1993) makes another important point: EMDR works very quickly compared to other behavioural treatments such as graduated exposure, which typically requires six-eight sessions" (p. 572). How is it possible that Hassard in 1993 was able to make the point that EMDR was faster than graduated exposure when the first study to compare EMDR with any type of exposure was the Vaughn et al. study published in 1994, which found the two to be comparable, and the next study was published by Devilly & Spence in 1999, which found exposure therapy plus SIT plus cognitive therapy was superior? The first study to find EMDR superior to exposure therapy was published earlier this year by Lee et al.

Later in the paper, the authors state, in reference to the effects of eye movements in EMDR, "Until the serendipitous discovery of EMDR by Shapiro, no powerful relaxing (de-arousing) reflex was known which could be used in a focused way in either a clinical or an experimental setting" (p. 577). Yet, there is no credible evidence that eye movements serve a "powerful relaxing (de-arousing)" function and there is no credible evidence that eye movements improve outcome. This is all hype. Although I've seen proponents of EMDR site the M & F paper, I've yet to see a proponent of EMDR correct their inaccurate claims.

"Where traditional therapies may take years, EMDR takes only a few sessions."
- Reported in The Stars and Stripes, February 12, 1995

Comments: All of the treatments that have been shown to be effective in the treatment of PTSD are short-term therapies. There are no studies of treatments that took place over a period of years.

"The speed at which change occurs during EMDR contradicts the traditional notion of time as essential for psychological healing. Shapiro has integrated elements from many different schools of psychotherapy into her protocols, making EMDR applicable to a variety of clinical populations and accessible to clinicians from different orientations."
- Bessel A. van der Kolk, MD
Professor of Psychiatry, Boston University School of Medicine

Comments: As noted above, all of the effective treatments for PTSD are time-limited.

"EMDR assists survivors in the immediate aftermath of violent trauma by breaking through the walls of denial, shock, grief and anger..Ideal for those who have been unable to forget past traumatic life events, as it allow for a rapid processing of even deeply rooted memories, giving individuals back control of their lives and their emotions."
-Dusty Bowencamp, RN CTR
Disaster Mental Health, American Red Cross

Comments: There is not a single study of the effects of EMDR applied "in the immediate aftermath of violent trauma"; no studies of EMDR have assessed "walls of denial, shock, grief, and anger."

"EMDR is a significant component of treatment in the Trauma Recovery Program at the Menninger Clinic."
Bulletin of the Menninger Clinic

Comment: The fact that a particular clinic has adopted a particular treatment has no bearing on the efficacy of the treatment. Until a former colleague of mine moved to the Mayo Clinic, this prestigious institute only offered medication for OCD, even though research shows that exposure therapy with ritual prevention is as or more effective than medication.

"Francine Shapiro has made an enduring contribution to the field of psychotherapy."
-Jeffrey K. Zeig, Ph.D.
Director, The Milton H. Erickson Foundation

Comment: Don't you think that history should make the decision about how has and has not made an enduring contribution to a particular field? I think it's a bit early to be claiming that Shapriro has made an "enduring contribution."

"A lifesaving process for battered women...everyone who has experienced the psychological pain from abuse or knows someone who has should know about EMDR!"
-Lenore Walker, Ed.D. ABPP, Domestic Violence Institute

Comment: Lifesaving? What data are there that show even a single life has been saved by EMDR?

"EMDR provides a proven approach to address the trauma that can interfere with healthy grief and mourning following the loss of a loved one."
-Therese A. Rando, Ph.D., Founder and Executive Director,
The Institute for the Study and Treatment of Loss

Comment: There are no randomized controlled trials studying EMDR to help resolve grief following the loss of a loved one.

"EMDR is proving to be the silicon chip of psychotherapy; it allows people to process incredible amounts of material in a shockingly short time."
-Michael Elkin,Ph.D.
Director, Center for Collaborative Solutions

Comment: EMDR is the "silicon chip of psychotherapy"?!? Please...

"EMDR quickly opens new windows on reality, allowing people to see solutions within themselves that they never knew were there. And it's a therapy where the client is very much in charge, which can be particularly meaningful when people are recovering from having their power taken away by abuse and violation."
-Laura S. Brown, Ph.D.

Comment: The implication of the second sentence is that other therapies do not provide control over the therapy AND that not having such control is harmful. Again, there is no evidence to support this latter point.

"EMDR is the most revolutionary, important method to emerge in psychotherapy in decades."
-Herbert Fensterheim, Ph.D., Cornell University

Comment: EMDR is "the most revolutionary" and "important" method to emerge in decades? Please. There is no evidence that the unique elements of EMDR are important. What makes it revolutionary? What makes it more important than the devolpment of cognitive or interpersonal therapy for depression, exposure and ritual prevention for OCD, interoceptive exposure in the treatment of panic, Functional Communication Training (a specific application of operant conditioning) for reducing self-injurious and increase independent behavior in mental retardation or autism?

"EMDR is the most powerful and integrative intervention I have learned in the past five years."
-John C. Norcross, Ph.D., University of Scranton
Comment: I don't doubt Norcross believes this. But what is his belief based on?

Now consider the title of some books on EMDR:

"EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma."

Comment: Breakthrough?

"Emotional Healing at Warp Speed: Power of EMDR"

Comment: "Warp speed" is a reference to the speed of light. Please. According to our present state of knowledge, nothing can exceed the speed of light. By implication, can nothing exceed the speed with which EMDR works? Based on what data?

On the dust cover of Shapiro's book, there is an endorsement from Charles Figley: "This book and the treatment by Dr. Shapiro invented will force a paradigm shift in the way we conceptualize traumatic experiences."

Thomas Kuhn, a philosopher of science, introduced the concept of the paradigm in science and the paradigm shift. Kuhn believed that science operates under a paradigm, which is a consensus that specifies the problems, theories, and methods of science at any given time. After much work within a particular paradigm, problems crop up that cannot be solved by the existing methods and theories. Eventually, the number of problems that accumulate are enough to "break the camel's back" so to say. The old paradigm is discarded or dies with the old guard and a new paradigm emerges. A shift in paradigms is not a quantitative change. Rather, it is a qualitative change in which the whole world view of the scientists changes, including the assumptions they make, the procedures they follow, the questions they ask, and the kind of answers they find acceptable. A classic examples are the shift in physics from Newtonian physics to post-Einstein (i.e., the shift to relativity theory) physics. Isn't it a bit much to suggest that EMDR represents a paradigm shift?

I hope this gives you a flavor of what I mean by "packaging."

Replies:

Re:marketing emdr, by leah c, 11/04/02

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