Toronto Psychologist
Dr. Ralph Bierman's
Psychotherapy Services
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Dr. Ralph Bierman's Psychotherapy Services |
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To help you make the emotional and relationship changes you want, I’d like you to know about a special procedure I might suggest we use together from time to time as needed. The short name for this process is EMDR. The long name is a mouthful — Eye Movement Desensitization and Reprocessing.
EMDR was developed by Psychologist Dr. Francine Shapiro in the late 1980s. It
is more inclusive than the name suggests, pulling together many successful
elements from a range of therapy approaches in a comprehensive and detailed
treatment approach.
I have found this procedure very helpful in accelerating the processing of
painful material. EMDR could help you get unstuck from painful memories,
negative beliefs about yourself and emotional distress that have been limiting
your life — and pretty quickly to boot.
Often, when something very painful or traumatic
happens to us, it seems to get locked
in memory with the associated images, sounds, thoughts, feelings, and so
on. Since the experience is stuck there, it continues to be triggered whenever a
reminder comes up. Such reminders can be very subtle, so we don’t even realize a
present event connects with a past hurt. This can be the basis for a lot of
discomfort and sometimes a lot of negative emotions, such as fear and
helplessness, that we can’t seem to control. This can also be the basis for a
lot of negative thoughts about ourselves, thoughts such as we’re “not good
enough” or that we’re “bad” or that we “don’t matter”, that plague us. These are
really the emotions and thoughts connected with the old experience that are
being triggered.
EMDR seems to set a natural self-healing process into
motion. The important thing to remember is that it is your own inner
processes that will be doing the healing and that you are the one that is
in control.
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A session of EMDR lasts 60 or 90 minutes, depending on your processing rhythm.
Specific steps I would guide you in include:
In preparation. The very first thing we will do is to establish ways in which you can maintain your emotional safety and stability during the work. We will agree on a “stop” or “time out” hand signal by which you can signal to me that you want to pause. We will also work on developing a “safe place” in your imagination that you can use for a temporary rest during processing, as a way of regaining emotional calm at the end of a session, and as an emotional oasis between sessions. As well, we will discuss your availing yourself of social-emotional support to help between our sessions.
I would then ask you to think about an issue or memory you want to work on and to come up with an image from the incident. You would then choose a current negative belief about yourself that goes with the image.
While concentrating on the disturbing image and the associated negative thought, you describe your emotions and rate their level of disturbance on an 0-to-10 scale. You also describe the physical sensation of your emotion.
Reprocessing. While keeping 3 elements in your awareness -- (1) an image standing for the worst of the event, (2) negative belief about yourself and (3) distressing body sense -- you would also pay attention to several sets of alternating left-right stimulation of your senses. The bilateral stimulation may be: following with your eyes while I repeatedly wave my fingers from left to right; listening to alternating tones; or feeling alternating left-right hand taps on your knees or palms. You and I talk over the feelings and new images that appear during this process, rate their intensity, and move on to a second set of two sided stimulation. We repeat this process until you report significantly reduced emotional distress to the image.
In the course of this procedure, distressing, unresolved memories might surface before you get relief. You may experience reactions during the treatment sessions that you did not expect, including a high level of emotion or physical sensation. If these do not subside by session’s end, I will be careful to bring closure to the session by bringing you back to emotional stability with the “safe place” we established earlier or with other relaxation techniques you have developed.
Strengthening positive belief in yourself. When your emotional distress associated with the image has diminished, you then receive bilateral stimulation as you think about the image and a positive way you’d rather think about yourself. When you report substantially greater belief in the positive statement, often accompanied by new insights or memories or even a change in the original image, this phase of EMDR ends.
Between sessions. After a treatment session, the processing of incidents or issues may continue, and other dreams, memories, flashbacks, feelings, etc., may surface. You would write down related thoughts, images, and dreams that occur from day to day after the session so we can address the most important ones at the next session.
EMDR often consists of no
more than 10 to 20 sessions. For treating an uncomplicated reaction to a
traumatic life event, EMDR can take as little as 4 to 6 sessions.
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The EMDR method remains controversial because it was accidentally discovered rather than emerging from theory, because we do not yet understand how the two-sided stimulation works and because of skepticism about reports that EMDR works so rapidly. However, based on a review of carefully controlled scientific studies, the Division of Clinical Psychology of the American Psychological Association has already recognized this fairly new treatment method as “probably efficacious” for overcoming civilian Post Traumatic Stress Disorder (PTSD). After examining additional published controlled studies, the current treatment guidelines of the International Society for Traumatic Stress Studies designated EMDR as an effective treatment for PTSD.
EMDR seems to set a natural self-healing process into motion. It seems like the “stuck” memory gets re-filed from a fear center of the brain to normal verbal memory areas of the brain as happening “then” instead of “now”, bringing the big relief of — “It’s over!”. The person can stop overreacting to reminders of the painful event, feeling calm, more in control and better able to cope.
The EMDR therapy procedure also has potential emotional risks. Approaching feelings or thoughts that you have tried not to think about for a long time may be painful. You are likely to experience uncomfortable feelings such as sadness, guilt, anxiety, anger and frustration, loneliness and helplessness. Psychotherapy often requires discussing unpleasant aspects of your life. Distressing, unresolved, even forgotten memories might surface before you get relief. You may experience reactions during the treatment sessions that you did not expect, including a high level of emotion or physical sensation. I will certainly try to ensure that you do not leave a session in a distraught state by guiding you in emotional soothing procedures. After a treatment session, the processing of material may continue and other memories, dreams, flashbacks, or feelings might surface. Making changes in your beliefs or behaviors can be scary, and sometimes disruptive to the relationships you already have. You may find your relationship with me to be a source of strong feelings. It is important that you consider carefully whether these risks are worth the benefits to you of changing. Most people who take these risks find that the EMDR therapy procedure is helpful.
Post Traumatic Stress Disorder or PTSD describes a condition suffered by
persons who are having prolonged trouble coping with their emotions and
relationships after witnessing or experiencing a terrifying traumatic event
including
Signs that a life threatening event survivor or witness is having trouble digesting the shock and could be developing a prolonged “post-traumatic stress disorder” (PTSD) are that the person:
Listen to Gen. Romeo Dellaire describe his military PTSD
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The book “Eye Movement Desensitization and Reprocessing: the Breakthrough Therapy for Overcoming Anxiety, Stress and Trauma” by Dr. Francine Shapiro and Margot S. Forest. Published by Basic Books, 1997. An introduction to EMDR written in non-technical language. See especially chapters 1, 2 and 4 for the foundation of the EMDR therapy procedure. The remaining chapters cover different applications: combat trauma; phobias; panic attacks; sleep disorders; childhood trauma; attachment disorders; rape; grief; addictions; facing disease, disability and death. Appendix A gives information about EMDR resources such as choosing an EMDR therapist. Appendix B reviews the efficacy of EMDR.
The audio CD or tape of "Calm and Confident based on EMDR" by Mark Grant which I will suggest you listen to regularly if you are needing to reduce high levels of psychological stress or anxiety.
The audio CD or tape of "Pain Control Based on EMDR" by Mark Grant which I will suggest you use regularly if you are needing to cope better with chronic pain.
The audio CD or tape of "Imaginal Nurturing" by April Steele which I will suggest you use for help in establishing a new, more nurturing relationship with yourself.
The EMDR Institute web site provides much information including: descriptions of EMDR; background of Dr. Shapiro, the originator of EMDR; publications, controlled studies, efficacy of EMDR and a bibliography of references; and books and videos about EMDR.
The EMDR Association of Canada web site provides a general description of EMDR, a review of treatment effectiveness research, links for choosing an EMDR therapist in your area (just type Toronto in the City field), a bibliography of reference articles, a summary of controlled studies with conclusions about the effectiveness of EMDR and endorsement by leading professionals.
Tom Cloyd's EMDR Resources for Clients on the web discusses many aspects of EMDR including: the range of problems EMDR can treat; how to decide if EMDR is right for you; as well as a question and answer section covering issues such as the difference between EMDR and hypnosis.
The web site of The American Academy of Experts in Traumatic Stress provides an international registry of professionals with expertise in treating traumatic stress, in which I am listed. The site provides many on-line professional articles on treating traumatic stress and links for ordering materials such as for preventing and responding to school trauma.
David Baldwin's Trauma Information web site is an award winning site providing information about trauma.
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Send mail to ralphbierman@NoSpamtorontotherapist.com with questions or comments about this web site.
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