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EMDR

Life after trauma

During one of my visits a storm occurred and I was a witness to how an existential fear can be a terror in someone’s life. She had endured a severe lightning experience in her early childhood, during which the whole family had to evacuate the house when it was hit. Her therapist recommended EMDR (Eye Movement Desensitization and Reprocessing) therapy because no other method so far had helped. During four sessions it became clear to her that this deep fear was not only connected to the lightning experience, but went much deeper. She saw visions of the Ku Klux Klan members who burned a cross in her front yard, after it became known that she was one of the first black students in Birmingham, Alabama, to be granted a scholarship to the famous Cornell University.

During the sessions with her therapist the scenario of this frightening event changed and she discovered what she, being an academic deep at heart, had really wanted to do. She had wanted to go towards this gruesome bunch of men and women, dressed in white caps and dresses, and try to have them come to their senses. She had wanted to convince them black people were human too. After the EMDR sessions she discovered much to her surprise during the next thunderstorm that she could just let the lightning be. After that she was able to use her closet for its intended purpose.

The positive outcome of my friend’s therapy made me curious about this apparently successful method in which one’s eye movements seemed to play the main part. I myself had undergone several therapy-methods to overcome my paralyzing fears of confrontations, without any memorable results up till now. Developed in the U.S., EMDR has been used by a growing number of therapists, and has been found to be especially helpful for people with a post traumatic stress syndrome.

In this article I would like to describe to you the way EMDR-therapy works. While undergoing it myself as well as studying literature about the method, I tried to look at it from a women’s perspective.

By accident

EMDR: discovered by accident

On a sunny day in 1989 the psychologist Francine Saphiro walked in the woods with a troubled mind. She had been diagnosed with cancer. After surgery and radiation she had been told she was okay, but also that there was no guarantee the cancer would never return. This started years of intense research in any and all healing methods. In this context she was taking the now famous stroll in the woods. By accident she discovered that if she moved her eyes back and forth frequently her negative thoughts vanished and turned into positive ones.
She herself says she does not even remember what exactly she was thinking of at the moment, she was ‘just having one of those nagging negative thoughts’. (EMDR. The breakthrough Eye Movement therapy for overcoming Anxiety, Stress and trauma. By Francine Saphiro and Margot Silk Forrest, 1997).

Being a therapist herself, she tried this with a few of her clients who had suffered traumatic experiences. After a couple of years she wrote her thesis about the subject and got her PHD. She works as a senior research fellow at the mental Research Institute in Palo Alto, California. Since then the EMDR therapy method has become known worldwide, especially with the treatment of Vietnam veterans, people with phobias, rape victims and people who were victims of an accident or kidnapping. It even scored high with patients who were scared to death of a dentist or were present during a severe earthquake.

The best results, with only one or two sessions, were reached with people who had suffered from a single traumatic experience, but incest-victims also appeared to feel better after a few EMDR-treatments.

Procedure

Procedure

What is EMDR about? In the US Katty Butler wrote an article: “Too good to be true”, in which she describes what EMDR is based on. During a EMDR session, the client is asked to remember an event that the current fear is connected with. The client doesn’t have to describe this event at large. It is important to visualize a situation and the feelings and physical sensations that are connected with it. The client is asked to rank the level of the fear on a scale from 1 to 10, ten being most frightened. At the beginning of the session he/she is also asked to create a positive affirmation (e.g. I am free to do what I want) and rate this as being true on a scale of 1 to 7. The fear marks high, the affirmation low at the beginning of the therapy.

After reading and hearing about such positive results, I decided to have a few EMDR sessions with the American therapist, Rosie Bleyer, in Connecticut.

Session

My second session with Rosie Bleyer offers the best example of how EMDR can work. After I describe in short the picture I see, Rosie asks me to mark it on the scale. It ranks up to 9: I can physically feel the fear running through my veins. My positive affirmation, connected to this experience is: “I am lovable”, but it doesn’t seem to feel true at all. I rank it a “2”.

She sits on a chair opposite of me, behind her I face a blank wall. I follow her two outstretched fingers, which move slowly from left to right, with my eyes while I try to keep my inner eyes on the memory of me sitting in an old Volkswagen with my brother. I am eleven years old and we are on the way to the bus station to pick up a friend. He asks me to touch him. After a sequence of movements Rosie stops and I tell her what I see, feel, and what sensations run through my body. Then she starts moving her fingers again and I almost feel dizzy trying to keep on track with them.

I can see myself, shrinking away from my brother, who gets harsher in his commands. The sensation is so real that I stop the session. “Okay”, says Rosie, “go back to that moment. What do you see?” While my eyes move back and forth I can see the traffic lights and concentrate on them. At the next pause I share how my fear manifests: it seems there is a huge rock where my heart is supposed to be, which almost suffocates me. I feel like an object locked up in that car. I tell Rosie: “I don’t feel any love. I am scared but I have to do what he says, otherwise he will severely punish me”. “Is there anyone you can think of with whom you can be safe? “asks Rosie. “Yes, my Godmother. She has been the refuge of my young life.”

In the next session of eye movements, I can’t really reach her. In stead I see my brother’s threats come true: humiliate me in front of my brothers and sisters. “Okay”, says Rosie, “keep that picture clear in mind. Look at what they are doing to you."

And then I see myself, inside the bathroom with the door locked. Outside I hear my next of kin yelling to open the door, threatening to hit me with a chair if I don’t obey quickly. I can see the patterns in the granite floor, see the leaking water tank and the porcelain toilet. I don’t do as I am told, but keep the door locked, waiting for my mother to come home from work.

“Keep your godmother with you in the bathroom,” Rosie suggests, “see what happens next.” In the next set I realize that it isn’t going to help me to open the door with my godmother next to me. My family respects her, so they will just postpone hitting me. All of a sudden I see myself doing something really unexpected: I let her spirit glide inside of me, which makes me feel really strong.

While my physical eyes move back and forth, I visualize myself peeing in the little potty next to the toilet, taking the brush and I feel: whoever dares to come near me gets it! So when Rosie Bleyer next asks me to keep my aunt near to me, I look at her and say relieved: “I don’t have to. I opened the door already and I threaten to sprinkle pee on anybody who dares to come near me.” I am really surprised when I see them leave one by one in the next set of movements. Then my mom arrives home. She tells me in the kitchen, “I am here for you when you need me”. Then I can rate the affirmation with a five.

I know it would be too simple to say that from now on I will be without any fear in similar situations. But the vision of myself, swaying the toilet brush is still really vivid and can be recalled in frightening moments in my present life. I visualized myself into a powerful end of a terrifying experience en disentangled so the connection my brain makes in these circumstances.

Physiological changes

Physiological changes

Researchers assume the eye movement causes a change in the brain-tissue of the client. In scientific literature this phenomenon is compared to what happens during REM-sleep, when rapid eye movement’s play an important part in putting daily events into the right place. If traumatic experiences have not been worked through, they are frozen and they keep playing a part in the background. This causes the Post Traumatic Stress Dysfunction.

Possibly the EMDR can disentangle the connection between the trauma and the daily events that resemble it, so they can be put into a more normal perspective. This way everyday experiences are no longer connected to the frightful ones, they are “desensitized”. Although the therapist plays a leading part in an EMDR session, the client is in charge. The therapist stimulates the client to rewrite the script of a traumatic experience in her/his life. EMDR is an interactive method , which is more complex than what first meets the eye. Thus: only therapists, well trained in this method are capable of conducting such sessions.

Success

EMDR is known to be really successful, due to these physiological changes in the synapses of the brain. In scientific literature hardly any fall back is mentioned, even in the long run. It may be true that the fact that clients really are such active participants in the session, and feel totally in charge the whole time, is the reason why the next time a client thinks about the traumatic event, no feelings of fear appear.

The EMDR organization though, strongly recommends therapists who want to work with this methods to be trained thoroughly. The research reports show clearly that results depend on the skill of the therapist with the EMDR method. Even with EMDR-trained researchers, validity checks should be performed on their use of the method, since training alone does not guarantee competence and treatment integrity. There has been prove there is a positive correlation between how well the method was used and the magnitude of the treatment effect.

Perspective of Women’s Health Care

Within the Women’s Health Care movement a therapy must meet certain standards to be called suitable for women. When I look back at my own experience with this particular method, I come to the following conclusions:

• EMDR reevaluates a client’s self-esteem, by rating the positive and negative feelings at the beginning and the end of each session.
• EMDR hardly offers lengthy verbal communication between the therapist and the client, which works well with clients who have a hard time talking about their traumatic experiences. It is, therefore, also a suitable method for refugees who don’t speak the language.
• It is known that restructuring a deep trauma helps the same person to cope with other painful experiences. It is remarkable how fast the method seems to have effect: sometimes one session is enough, but it depends on the complexity of the trauma. Next to the fact that this makes mental health care a lot cheaper, it also prevents the development of a dependent relationship with the therapist.
• With EMDR the client ‘s social and cultural background plays a part in the scenario and the client is the director of the scene. This develops the feeling that one is in charge of one’s own life and can recreate one’s life from the power, existing within oneself.
• When the client feels overwhelmed by emotions, she can stop the eye movement at any moment. This creates the sensation of having control over what happens. The client does not need the approval of the therapist.
• The therapist always asks the client to create a safe place to hide (visually) when things get too scary so she learns there is always a refuge.

Conclusion

Conclusion

Looking back at my own experience with EMDR and the literature I read about the method, I think I can state that EMDR can be a useful addition to the existing therapies for people who suffer from Post Traumatic Stress Disorder (PTSD), especially for women worldwide.

Although EMDR was discovered in the US, a country where it seems to be normal for everybody to have a “shrink”, may be the fact that a woman gave birth to the method, is the reason why it fits so wonderfully well within the vision of Women’s Health Care.

Thanks to Erik ten Broeke, clinical psychologist Almelo, and Ad de Jong, psychologist and dentist at ACTA, Amsterdam , Netherlands

Literature:

• Katty Butler: “Too good to be true”, Networker, USA ,1993.
• EMDRIA: the EMDR International Organization has a list of trained therapists. PO Box 140824, Austin, Texas 78714-0824 Also for: Handbook EMDR for therapists.
• S. Wilson, Becker and Tinker: Journal of Consulting & Clinical Psychology 1995 Vol. 63 No. 6 -928-937: A controlled study randomly assigned 80 trauma subjects (37 diagnosed with PTSD) to treatment or delayed treatment EMDR conditions and to one of five trained clinicians. Substantial results were found at 30 and 90 days and 12 months posttreatment on the State-Trait Anxiety Inventory. Effects were equally large whether or not the subject was diagnosed with PTSD.
• Boudewijns, Stwertka, Hyer and Sperr (1993) A pilot study of 20 chronic inpatient veterans who were randomly assigned to EMDR treatment.
• Jensen (1994) Controlled study of the EMDR treatment of 25 Vietnam combat veterans suffering from PTSD. As compared to a nontreatment control group.
• Levin, Grainger, Allen-Byrd and Fulcher (1994). A controlled study of 45 hurricane Andrew (Florida) survivors.
• Shapiro (1989 a) The initial controlled study of 22 rape, molestation and combatvictims compared EMDR and a modified flooding procedure that was used a placebo to control for exposure to the memory and to the attention of the researcher.