The Eyes Have It

A therapist waves two fingers back and forth in front of a client's eyes, and suddenly the client is no longer troubled by painful thoughts from a past trauma. It sounds like something out of a children's' fairy tale, or perhaps like one more kooky thing that found its way out of California. In fact, this is the newest type of therapy being used ever more widely by clinicians trained by Dr. Francine Shapiro in the technique of E.M.D.R. (Eye Movement, Desensitization and Reprocessing) for the treatment of traumatic memories and many other anxiety based conditions. In this technique, clients follow the therapist's fingers back and forth with their eyes, almost like you would follow the windshield wipers in your car. And for many, long painful memories no longer have the harmful effects they once did.

EMDR has been heralded by its supporters as a technique second to none in the treatment of Post Traumatic Stress Disorder, and those claims have been based upon a combination of research and case stories. EMDR also has its detractors who say that there is not enough research to validate the claims which seem so exuberant. Besides, they suggest, the face validity of the approach is questionable -- what do waving fingers and eye movements have to do with trauma? I have to admit,it sounded strange to me at first.

What is the truth? The truth lies in knowledge rather than rumor or innuendo. First, EMDR is not the simplistic waving of fingers in front of someone's eyes. EMDR has a protocol, a procedure which consists of eight phases, utilizing techniques similar to other styles of therapy, to build a framework within which the eye movements accelerate the work of processing painful material stored and stuck in memory. Many people who have tried to use EMDR by waving fingers in front of someone's eyes, simply are not aware of the professional protocol which lends power to the procedure, and also implements safeguards. EMDR is a procedure which should be practiced only by professionals who are experienced and licensed to practice, and who have received approved training in the procedure (for the first several years, Dr. Shapiro personally trained thousands of clinicians).

What do the eye movements do? It is thought that the EMDR eye movements are similar to those in REM (rapid eye movement) sleep which many researchers have found to be associated with dreaming, which itself is postulated to be the way that we process information and emotion in our sleep. We don't know for sure how to explain the phenomenon, and that is consistent with the state of knowledge about brain functioning and its connection to thought, feelings, and cognitive/emotional problem solving -- there is a lot that specialists don't know. Unlike many of the fly-by-night therapies that make their appearance and disappear, EMDR has an ongoing research emphasis which continues to demonstrate that the procedure works for many people. Explanatory theories hopefully will follow the supportive findings.

EMDR is based upon the premise that painful traumatic material gets stuck in the maze of brain cells that actually do the processing of our experiences. The rapid eye movements of EMDR break the "logjam" of stuck neurons and synapses (the "logjam" perhaps created at the time of the trauma by the chemicals secreted by the nervous system to deal with the crisis), and thereby allow normal neural processing to occur. In effect, several sections of the brain are made newly accessible to help process the traumatic material, integrating the trauma with other life experience so that it no longer has its solitary powerful effect on our daily lives. In the short space of this article, justice cannot be done to the full theoretical position which goes to explain the EMDR procedure, however, persons interested can get further information from an EMDR practitioner, or through reading of published material.

In the full procedure, the clinician will first interview the client to determine the nature of the situation. EMDR can be effective for most types of trauma, and also for other anxiety based disorders like phobias, generalized anxiety, performance anxiety, etc. Before anything is done, the therapist will then help the client develop a procedure for finding a safe place (supportive people or a plan for stress and anxiety reduction), in the event traumatic material comes up so painfully (called abreaction) that the client becomes very uncomfortable. Then, the client is asked to identify an image of some event which is connected with the trauma, and a "negative cognition", which is an underlying negative belief or maladaptive self-assessment connected with that image. An example of a negative cognition is something like, "I am stupid," or "I'll never be able to get it right," or "I am now damaged for life," or "I don't deserve love." Then a "positive cognition" is obtained -- something like "I can act responsibly," or "I did the best I could". The therapist will then ask the client where in their body do they feel the stress -- some feel it in the chest, or the gut, or the neck, or over the eyes, etc. Physical sensations are often generated by the thought or cognition, and are a big part of existing response to past trauma. Finally, the therapist will ask the client to rate the cognitions on a numerical scale, and this is one way that both clinician and client will be able to know how much progress is being made.

The above information gives just a brief picture of some of the phases. No attempt is being made here to teach the phases or prepare anyone to perform the procedure. In fact, it could be dangerous to use the procedure without adequate preparation and training. When all of the above things have been done, and a few other things as well, only then does the part of the procedure begin where the client's eyes follow the clinician's fingers in motion, while keeping in mind the image, the cognitions, and the identified body sensation. There is both knowledge and art in the movements of the therapist's hand, and in the assessment of response between sets of eye movements.

It sounds fantastic, and it certainly can be. Clinicians trained in the use of EMDR have experienced the procedure firsthand during training. In my time with Dr. Shapiro, she asked all of us to think of a few issues which were personally painful or bothersome (we were asked not to use any major issues which might transcend the time available during our weekend workshops). I selected my issues, and with healthy skepticism, participated with other workshop attendees as we EMDR'd each other, while watched closely by a one of a cadre of Dr. Shapiro's associates. I watched as other clinicians, in a room full of clinicians, wept quietly as the procedure unfolded their issues. And I, too, wept with my issues. Later, a showing of hands informed us all that every person had experienced a positive change with his or her issues.

Is there anyone with whom EMDR doesn't work? Sure. One thing that must be explored with anyone is something called "secondary gain." This means, simply, that maybe there are some reasons why someone would, consciously or unconsciously, not want to get better. What, . . . not feel better? Who in the world would that be? Well, . . . maybe someone who was receiving financial benefits for a disability, might, at some level, at least be ambivalent or fearful about losing their benefits. Or maybe someone would lose their "special" position in the family if they suddenly were without symptoms. Or maybe someone is afraid to face the world on an equal footing --failure no longer has an acceptable excuse. Does it sound harsh to think of some people this way? It is somewhat harsh, yet it is a reality for a small percentage of people, and if not addressed, it dooms them to their painful reality for a lifetime.

Who usually responds very well to EMDR? Persons with a trauma (physical, emotional, or sexual abuse, victims of violence, victims of horrifying accidents, disaster victims); persons with disturbing memories (witness to horrible crimes, adult children of alcoholics, memories of hurtful put-downs, not quite abusive, by people in your past); persons with incident based fears (bit by a dog and now fears dogs, in a car accident and now won't drive, etc.); persons with fears of performance (intense anxiety during play of a sport makes you so tense that you do less well than your skills would otherwise allow, "choke up" during tests).

Are there any dangers or reasons not to use EMDR? Persons with a history of any seizures should first consult their physician. Also, the memory of painful events can cause intense emotional distress in the present, and in-between EMDR sessions -- this is not a bad thing, as the purpose of EMDR is to accelerate the unlocking of the disturbing images, thoughts, and feelings so they will lose their emotional power, however, the person should be properly prepared by a qualified therapist. Some persons have reported eye pain from the eye movements, and in those cases, EMDR should be stopped. Finally, EMDR may effect recall of events or details that might have consequences in court testimony.

Who can practice EMDR? A licensed therapist ( Ph.D., LCSW, M.D., LPC) who has had Level I and Level II training through Dr. Shapiro. Each level of training consists of a weekend workshop composed of didactic teaching, demonstration, and supervised practice. EMDR is usually practiced by a therapist as one of many techniques to be selected and used as appropriate with a particular patient. It is not a magic wand to wash away any and all problems. Research is continuing, and so far, lends support to the practice of EMDR.

Joseph L. Just, Ph.D. Coastal Counseling Center 757-436-0605