Re:A Dialogue with Francine Shapiro

Francine,

I am a general practitoner (GP, or "Family Physician" in the North American lexicon)of 20 years standing. I have been using EMDR in that part of my practice which is exclusively psychotherapeutic (about a third) for over a year now. I have already expressed my gratitude to you for the rigour of your training process and I hope to undertake the second level of training in the near future. I can tell you now that I will also one day seek to become a trainer.

Having practiced Obstetrics for the first 12 years of my work as a GP, I have seen a great deal of the human experience of distress from the cradle to the grave. I state this at the outset, as I believe that my clinical experiences (not to mention my own life experiences!) allow me to recognise the comprehensive nature and significance of EMDR. In response to your wonderfully clear and concise interview I would like to focus my response on the following passage:

"The clinical observations of EMDR treatment effects seem to dovetail with conjectures by van der Kolk and others regarding memory storage. That is, when a memory of a past event is functionally stored it is in declarative or narrative memory. If it is dysfunctionally stored it is in motoric memory and retains the physical sensations and high level of affect that was there at the time of the event. With EMDR, we see clients start at a high level of affect and physical sensations and after treatment that is no longer there, and learning has taken place."

It appears to me that the work of Bessel van Der Kolk and his colleagues (with the introduction of the diagnostic category "PTSD" into the DSM) represents a fundamental shift in psychiatry. Essentially, this is a shift away from a focus on symptomatology to a focus on aetiology.

I feel that it is no accident that Donald Nathanson comes up in your interview. Having read his book "Shame and Pride", I have come to consider that pretence (the ability to feign affect) is the first form of control that we learn as infants. Whatever trumatic experiences (phsycial, psychological and social) we may experience along the way, becoming "real" is something that we can only master much later, with the help of others who recognise it's importance and when it has become safe to do so.

The value of your system lies in the fact that you very carefully address the problem of assessing the degree of "affective load" that is present in the patient (I still prefer that word to client, as most of my clients have to be very patient with me!) through your promotion of the use of the DES and IES scales. This ensures that the level of affective load and the capacity of the patient to contain it is carefully identified in the course of therapy, or at least before EMDR is used.

In conclusion, EMDR provides me with the missing link that I have long awaited to address the task of helping patients (and myself) to "process affective load". In short, EMDR has become my "PAL"!

Thank you again,

Darra.

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