EMDR

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment

which was designed to alleviate distress associated with traumatic memories. Adaptive
Information Processing Model (Shapiro, 2001) posits that this therapy moderates processing
and accessing of such traumatic memories and adverse life experience to an adaptive
resolution. The treatment aids in reliving affective distress and reformulation of negative
beliefs. The process focuses on breathing exercise and eye- movement focus which keeps the
patient attentive to their external stimulation while focusing on the emotional disturbing
material in brief sequential doses. The eye movement is sometimes alternated by hand-
tapping and audio stimulation. Shapiro (1995) hypothesized that EMDR therapy facilitates
the accessing of the traumatic memory network, so that information is enhancing with new
associations forged between the traumatic memory and more adaptive memories or
information.

During the practical class, there was an EMDR demonstration video shown the classroom for
existing EMDR Therapist to begin their learning of the process. The process was given by
Dr. Jamie Marich, assisted by Madelyn.
The first process is to ask the patient for the chief complaints (eg, general anxiety) and then
taking a brief history. The video comprised of instructions about taking a whole session for
history and information, prep skills and in the next session the counselor is supposed to
review it. The next step is to enquire general orientation to idea of minimal detail required in
EMDR therapy followed by asking the patien about choosing to address a specific incident
that they want to target rather than a broader theme. (Eg, In the video the patient mentioned
about being 6 years old and waiting for her father at a boat, she fell in the water and felt
extremely devastated and she felt extremely helpless. She now feels scared of being around
the deep water like in the sea, ocean or even swimming pools. She feels anxious being around
and cannot swim. However, she wished to).
The next step is to address the goals in the client’s history, it can help the counselor to guide
the larger process of EMDR therapy.
Phase 2 is preparation. She was asked about their existing coping skills to deal with stress.
She mentioned breathing exercises, pressure point pressing, stretching etc.
Instructions: Close your eyes and come to breathing pattern that works best for the client,
leading a mindful breathing strategy in preparation can help with attuning to client. She is
given sometime to follow through the breathing strategy for a while. After a while, begin
orientation client to language of “what are you noticing now?”. It is to understand what is that
they are most aware of. The client may reply how they feel about being in that particular
state. Then comes testing the speed of eye movement, where the counselor offers to either
follow the fingers horizontally or diagonally. They are instructed to begin the light stream
visualization exercise where they are asked to allow the light to come into focus. Such as
imagining it on top of your head, allow the light to begin moving through or over their body
according to their breath. Asked again, what are you noticing? Following the fingers for a
while and back to focusing on the breath. They are then asked to notice if there are any other
sensory details, such as any texture, color, temperature, smell or sound. They again asked to
follow the fingers and take a deep breath for a while followed by the what are you noticing
question. While they are relaxed, the therapist strengthens that feeling by prolonged eye
movement and breathing strategy. Next they are explained how the resource can be used in
EMDR therapy. (The light that they see can be made available to them whenever they wish
to, they can also stop it whenever they wish to). They can later have asked if they want to
name their light and focus on the eye movement again.
They are asked which pattern do they prefer. The next is to develop a stop sign whenever
they wish to for when they want to stop the process. Do a test set or faster stimulation before
you do the final set. The final EMDR is then taken place.
Phase 3 is the assessment about the targeted memory. They are asked to bring that into
conscious and asked about the worst part about that experience. Such as laying on the back,
watching the ocean and seeing the sunlight and pebbles underneath, where other things can
move but not her. She is asked about that image and it’s associated with her own negative
image of herself. Such as I am powerless looking at that image. She then asked for a positive
associated that she would like to believe instead of the negative such as ‘I am powerful’. The
next of assess the validity of the cognition rating. The items are asked based on a likert scale.
(Ex, how true at the gut level do you feel I am powerful’). Clarify the “now looking back”
concept feature in EMDR therapy. They are asked for the emotions that they feel about
feeling powerless looking at that image. The next scale is subjective unite of distress rating.
(What would you rate your distress at this moment when you see that image and hold that
belief). Assess the body sensation by asking how they feel about it.
Phase 4: Desensitization: Notice those body sensations together with that image and the
negative belief (I am powerless). Begin the eye movement stimulation at a faster speed while
the patient focuses on the sensation and image. Asked for ‘What do they notice now?’
They follow the continuous stimulation. After a while, ask them if they are okay to keep
going, this may work as a safety check at first sign of abreaction. If the client shows
difficulty tracking, the counselor can use the finger flicker technique. Again the question is
about if they can notice anything. Invite a pause (not a stop) as a grounding break to re-attune
with breath. Respond to patient’s request for a pause or stop.
NOTE: “What do you notice” should always be asked in between the process to keep a check
on the patient’s grounding and feelings.