Re:Questions about EMDR

I'm sorry your experience was so painful. Your post has many important -- and complicated -- questions in it. I will try to answer some of them here. Understand that I can't comment on your specific case, and my comments are necessarily general answers.

A comprehensive treatment plan is based upon a careful and thorough assessment. Depending on the outcome of that assessment, different components of treatment are included. The components may be as variable as psychotherapy itself is, and may be psychodynamic, cognitive behavioral, ego-state therapy, or many others. It often involves ego strengthening, resource development, skills building pieces, that sometimes (not always) include the bilateral stimulation of EMDR.

The standard EMDR piece is about processing unresolved earlier experiences (with maladaptive learning outcomes), until those experiences are transformed to neutral or, better, to a positive meaning in some cases.

EMDR pacing is variable depending on the client. Rarely is EMDR used every week. Typically, people need some sessions to talk and do other work than EMDR. Pacing also includes the period of rapport building, ego strengthening, and ego state work that is preparatory for some/many people.

EMDR training on these subjects has evolved over the last 12 years. It has always emphasized safety, and the cautionary statements have been elaborated over time to refer to pacing, ego strengthening, and much more.

One of the most important safety precautions for EMDR therapists to use with clients (again here I'm not referring to your case specifically and don't know if this applies to you) is the screening for dissociative disorders. All EMDR therapists should screen for a dissociative disorder before conducting EMDR with ANY client, using one of several screening methods. This is a critical safety step.

Dissociative clients may or may not remember early trauma, but they exhibit signs of amnesia for important personal information, feeling unreal, absorption in fantasy, or other cues that indicate there may be traumatic material contained beneath awareness. EMDR has a knack for lancing those "containers" and bringing things to awareness in the middle of processing. It needs to not be a surprise, which is why we screen up front. That way the preparatory steps can be conducted prior to EMDR.

This doesn't mean EMDR is contraindicated for dissociative conditions, only that a special approach and protocol is indicated to proceed with safety and caution. All the information about EMDR and dissociative disorders is based on clinical experience, not controlled studies. Cautionary information about screening for dissociative conditions has been included in EMDR workshops since 1992 or 93. Level II workshops include particular information about EMDR and dissociative conditions. I have published an article on this subject that is available to practitioners for free on my website www.paulsenconsulting.com.

As to whether the material that emerges in EMDR is true or false: All human cognitive processes, including memory, are subject to errors and distortions. EMDR is no different. I like EMDR because the material emerges from the client without my coaxing it or suggesting the content, so to me it seems LESS likely to create false material than some methods. Typically, after people have completed their work, they have a sense of what they think is true for them, but some people never know for sure.

Although struggling with whether something is real or not doesn't itself prove something is real (or false), it is very very typical in cases of forgotten early childhood trauma, as in dissociative disorders, to struggle with whether something happened or not.

Your question as to whether denial can interfere with processing of memories is right on point; it most certainly can. This is because the part of the self that is in charge of keeping things safe and stable by saying, "no it didn't happen" or "don't talk about it" or something similar is not permitting the EMDR to complete. So it loops, and loops and loops. EMDR therapists use the word "looping" to describe stuck EMDR processes.

In my opinion, looping is always a sign that the material that needs to come up next is being held away from awareness (dissociated or disowned by the conscious mind).
When the client's trauma is limited to adult or single traumatic experiences, the looping is readily solved by a number of methods the therapist may use. When the client's trauma is related to severe, chronic, inescapable trauma that is being held out of awareness by complex self systems and/or a dissociative disorder, the EMDR needs to stop. It shouldn't resume until or unless sufficient ego strength is present, but also until ego state therapy has been used to bring the relevant parts of the self on-board with the treatment plan.

This is a high level summary of something very complex. If you have specific questions about your case, you may wish to contact a second therapist, experienced with not only EMDR, but also with complex trauma histories and, best, accomplished in how to screen for and rule out dissociative disorders (www.issd.org). Clients who aren't very dissociative can then proceed at their own pace with EMDR therapy. Clients who are very dissociative must be paced more slowly and with more preparatory work.

Sandra Paulsen Inobe, PhD
Walnut Creek, California

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