The Definition of EMDR

Let’s start with a fairly circumscribed mild point. We need a new definition of EMDR, one that does not begin with “…evidence based …” or “…successful outcomes well documented …”, as occur in EMDRIA’s official definition. Those aren’t phrases you find in a definition, you find them in an evaluation or a press release. In addition, “evidence based” suggests that EMDR was developed from research demonstrating the effectiveness of its various aspects. It wasn’t, but more on that later.

I have a definition in which more is different from EMDRIA’s than just the absence of self praise. I don’t think my proposal is perfect, but so far it is the least bad one I know of. It should also be mentioned that a version of the one below was submitted to EMDRIA during the latest development of the EMDR definition and it was rejected. But, that doesn’t mean the discussion should be over, or that someone could not use mine if they needed one that focused on essential features.

And, here it is: Eye Movement Desensitization and Reprocessing (EMDR) is a method of psychotherapy in which aspects of a target associative network (usually a troubling memory) including visual images, thoughts, feeling, emotions, are identified, as are a preferred thought about the self when target memory is active. The believability of the preferred thought is rated, as is the level of distress felt as the troubling memory is activated before initiated eye movement.

With the painful aspects of the problem memory again brought to awareness, the client is asked to free associate while moving her or his eyes following the therapist lead, in a repeated pattern for a period of time, determined by client response, but usually about 30 seconds. After the set of eye movement, the client is asked to report on the current content of consciousness, and then eye movement is reinitiated. This pattern is repeated until distress associated with the target network is resolved, and, hopefully, adaptive associations are connected to the targeted event. In its most complete form all aspects of the target memory(ies) are addressed, including related past events and possible future situations which may elicit related psychopathological responses.

Therapist comments between sets of eye movement are limited to brief instructions, unless the client is not progressing by either becoming aware of new material or not having decreased distress. In these cases a variety of interventions, many typical of other methods of psychotherapy may be made before eye movements are resumed.

There are many variations to specific aspects of the above activities, including on what the client is supposed to try to keep in mind as em begins. These variations are determined by client response, experience and research.

As in standard psychotherapy practice negotiation of treatment contract, client evaluation, history taking, building of rapport, explanation of method, and development of stress management strategies are part of treatment.

And now a short dictionary/elevator definition:

EMDR (Eye Movement Desensitization and Reprocessing) – a method of psychotherapy which usually involves recalling a troubling experience and engaging in therapist led repetitive back and forth eye movements or other sensory/motor activity. The rest is commentary.

I was just kidding about the commentary part. This subtle reference to Rabbi Hillel’s effort to explain his religion while standing on one leg obviously doesn’t belong in a definition. However, it should also note that Rabbi Hillel is reputed to have also suggested that the commentary should be studied.

Response to a potential objection:

I can foresee objection to the phrase: “including on what the client is supposed to try to keep in mind as eye movement begins”. The allowance of the loosening of the protocol comes from clinical practice. Let’s say before the first set of eye movement, when the therapist asks the client to put in mind a picture of the worst part of the target memory, the client has an immediate strong emotional reaction, and the therapist then begins the eye movement. Since the client has already been prepared for eye movement at this point most experienced therapists I have asked would just begin it. Would this not be EMDR because most of the Assessment phase was skipped over?

There will never be a fully satisfactory definition of EMDR, and this is a problem with almost all terms in the mental health field including such basic terms as “mental health” and “psychotherapy”. So we have to pick compromises that are most useful and least problematic.

Understanding Psychological Trauma Through Literature (draft)

As a psychology graduate student, in the 1970’s, I came across an edited volume, The Abnormal Personality Through Literature, by Alan A. and Sue Smart Stone (1966), which presented long passages of great works of fiction to describe psychiatric syndromes and psychotherapeutics. I thought it a great idea then, and still do. The work you are reading attempts to apply their method more specifically, to just the destructive psychological effects of trauma and efforts to overcome them. The other variations from Stone and Stone include the use of shorter passages, and comments on changes in the way trauma has been recognized over the years, since it has been officially acknowledged in the Diagnostic and Statistical Manual (DSM) as the official United States standard.

A reasonably clean rough draft:

Thinking and Feeling About Forgiveness

This is a paper based on work with combat veterans over many years and addresses some of the most difficult and painful concerns people can have, the difficulty of which is magnified by involvement in war. It includes discussion of forgiveness of others and the self, with the decision to forgive, not all or nothing, and not a foregone conclusion.

Recently the phrase “moral injury” has been applied to some of the issues addressed in this paper.  While I’m glad the moral and emotional reactions to participating in combat are being  more fully considered by psychologists who used to only talk about the fear related to traumatic experiences, I’m not sure that the injury metaphor is most useful way to consider them. The term moral injury appears to be about what is already considered when we talk about guilt. Guilt people feel related to trauma, whether  it seems justified to others or not, or necessary or not, has already been subject of much psychotherapeutic work, written about for a long long time and undoubtedly considered even longer.

Structured Questionnaire for Trauma History: The GLEQ

The Great Lakes Event Questionnaire (GLEQ):

The Great Lakes Event Questionnaire (GLEQ) is a one page trauma history questionnaire initiated in 2000 aid in psychotherapeutic work with combat veterans. It was subsequently developed and refined to its current form. Key features include:

  • asking about broad categories of events in order to gently prompt consideration of both major trauma and significant less obviously destructive events.
  • subjective units of disturbance ratings of the effects of events to
    facilitate understanding of their relative impact and measure change.
  • a format that indicates that specifics are verbalized and disclosed at client discretion.

A second page can be included to briefly ask about client values and positive aspects of client lives. Clinical suggestions about when and how to use the GLEQ are offered in the attached paper. The GLEQ is in the public domain and can be modified to fit therapist needs.

 

Integrative Model of Psychotherapy – The Four Activity Model

The attached paper describes The Four Activity Model (FAM) of psychotherapy and its application to EMDR and other methods (just like the title suggests). The model is more fully elaborated in the book EMDR and Psychotherapy Integration.

Fighting the Last War: On Courage and Wisdom

This paper comes out of discussions of issues addressed in meetings with combat veterans in the Stress Disorder Treatment Unit at North Chicago VAMC, now named The Captain James A. Lovell Federal Health Care Center.

The Short Version:

The main psychological challenge while in combat is to, minute by minute, find courage to overcome fear and pain. The main challenge of civilian life is to find wisdom to define and meet long term goals. Knowing this is a big step toward overcoming the problems which come with mistaking civilian challenges for combat challenges. 

The Long Version: