Eye Movement Desensitization and Reprocessing

EMDR Frequently Asked Questions

This section was developed in response to participants’ questions

specific to PESI’s training, EMDR: the Complete Overview

(Not an EMDRIA-Affiliated Course)

Question: I am considering signing up for your EMDR Course and have a question: After this seminar, am I ethically authorized to use EMDR in therapy with my patients or is further training and certification required? If your seminar teaches the essential points of EMDR and we are allowed to use it in therapy settings afterwards, that would be wonderful.

Answer: Regarding Certification: Certification in EMDR is-to say the least- misunderstood. Certification is offered by several organizations, including EMDRIA and Evergreen Certifications; and, it is completely voluntary. (*Review EMDRIA's requirements for certification here and/or *Review Evergreen requirements for certification.

Regarding being “ethically authorized” to use EMDR in therapy: EMDR is an efficient and effective tool for treating clients who have had traumatic experiences and continue to suffer from the aftereffects. Although touted as a complete, complex psychotherapy in and of itself, this particular training treats EMDR as a modality, i.e. one of many trauma processing modalities to be added to the skilled clinician’s repertoire. Using EMDR for trauma processing requires that the competent clinician learn, practice and implement this modality into his/her current clinical population and setting. Training and practice are essential; certification is not.

Question: What’s the difference between EMDR:RDI Resource Development and Installation protocol developed by Korn & Leeds (2002) and Parnell’s Resource Tapping™?

Answer: “RDI refers to a set of EMDR-related protocols which focus exclusively on strengthening connections to resources in functional (positive) “memory networks” (Leeds & Shapiro, 2000; Shapiro, 1995) while deliberately not stimulating dysfunctional (traumatic) memory networks. The addition of bilateral stimulation differentiates RDI from earlier hypnotic ego-strengthening methods in the hypnotherapeutic tradition. Again, the inclusion of the bilateral stimulation in the protocol appears to lead to spontaneous, rapid increases in affective intensity within an initially selected memory network and to rich, emotionally vivid associations to other functional (positive) memory networks. These increases in intensity of positive emotions and new functional associations bring additional ego-strengthening material into consciousness. Patient reports of these changes during RDI lead to other RDI procedural steps that may further reinforce the patient’s ability to access affective, cognitive, and behavioral coping skills linked to these functional memory networks when the patient is later confronted by stress-related stimuli.”*

The term Resource Tapping™ a.k.a. Tapping In was coined and written about by Laurel Parnell in her book of the same name. Tapping In is using a combination of imaginal resources and alternating bilateral stimulation (in this case, tactile stimulation, where the client taps on his or her own knees or collar bones—first on the left side, then on the right side, then the left side, then the right side, etc..) The clinician instructs the client to bring up positive imagery of comfort, nurture, empowerment, connection, etc.. Once the client has the image up, s/he is instructed to experience it as fully as possible, while noticing the emotions and body sensations that accompany the positive imagery. As the client experiences the positive imagery, emotions and body sensations, s/he is then instructed to begin tapping alternate sides of the body (the tapping is added to bring on the relaxation response.)

*Citation: Korn DL, Leeds AM. Preliminary evidence of efficacy for EMDR

Question: What is EMDR Early Intervention (EMDR EI)?

Answer: EMDR Early Interventions (EIs) are EMDR-based procedures that were developed to treat individuals and groups after a recent traumatic event. They are used to address the fragmented nature of memories of recent events, before the memory is consolidated into an integrated whole. The interventions are usually provided as short-term treatments, and can be administered in an intensive (e.g., daily) manner, as group therapy or individual therapy. …a number of research studies have shown that EMDR EI treatments significantly reduce traumatic stress, and there is preliminary evidence that they may foster resilience.

The most commonly used and most researched interventions:

EMDR Protocol for Recent Critical Incidents (EMDR-PRECI) and EMDR Integrated Group Treatment Protocol (EMDR-IGTP) Jarero and Amame

Shapiro and Laub’s Recent Traumatic Episode Protocol (R-TEP) and Group Traumatic Episode Protocol (G-TEP). Elan Shapiro and Brurit Laub in Israel

https://emdrearlyintervention.com/special-interests/

Question: What is the Flash Technique?

Answer: According to its developer, Philip Manfield, Ph.D.:

“Flash is a fairly simple technique1 that is used as a brief precursor to standard EMDR or PC. Briefly, in the EMDR version, the client is guided to a) concentrate on a safe place or other feel-good image, then b) flash past the trauma memory so quickly as to not even be sure they did it, then c) return to the feel-good image; all done during slow eye movements (Manfield et al). In the PC version, the client is guided to identify a beginning and ending to the trauma story – as is standard in preparing a memory for PC – and then concentrate on the beginning, flash past the trauma memory, and concentrate on the end, while the therapist counts aloud from 1 - 10 (Greenwald, 2017).”

Question: What is Progressive Counting (PC)?

Answer: According to its developer, Ricky Greenwald, PsyD:

Progressive Counting a recently developed trauma treatment, based on the counting method, that is already supported by several published studies. As per the research and clinical experience to date, PC appears to be well tolerated by clients, about as effective as EMDR, more efficient, and relatively easy for therapists to learn. Briefly, PC involves having the client visualize a series of progressively longer "movies" of the trauma memory while the therapist counts out loud (first to a count of 10, then 20, then 30, etc.).

Question: What is Image Transformation Therapy ImTT?

Answer: According to its developer, Robert Miller, Ph.D.:

ImTT is a gentle therapy that releases the pain, fear, guilt, and/or shame of trauma and other experiences without the person needing to intensely experience the feelings.is totally unique because the person does not have to experience the intense pain, terror, guilt, *and/or shame. In fact, the person is specifically instructed to not experience the feelings. In ImTT, experiencing the feelings actually interferes with the release process. Instead, the person is instructed to view the feelings as if from a distance. Then the person is guided through the Pain/Terror Release Protocol (P/TRP) which gently and very effectively releases the feeling.

After the feeling is released with the P/TRP, the vivid memory of the trauma is deconstructed using the Image De-Construction Protocol. *The result is that the person will, of course, remember the event but only as a distant memory with no power to hurt or terrorize Image Transformation Therapy (ImTT) is a break-through treatment for trauma, anxiety, OCD, phobias, depression, and relationship issues. In addition, the protocols for processing are also used in the treatment of addiction using the Feeling-State Image Protocol.

ImTT utilizes a new psychological model called the Survival Model of Psychological Dynamics in combination with breathing and visualization protocols. The result is that the person is freed from the grip of painful or terrifying memories. The long-term result is that new, more positive images and behaviors emerge naturally..

Question: What is Feeling-State Image Protocol?

Answer: According to its developer, Robert Miller, Ph.D.:

The FS treatment breaks the fixation between feeling and behavior. This fixation is the cause of addictions. By identifying the exact feeling and behavior, the fixation can be processed using a modified form of the 'EMDR protocol. Once the fixation is broken, there are no further cravings or urges that have to be controlled or behavior that has to be managed. In fact the person is able to perform the behavior as appropriate.

Because any feeling can become fixated with any behavior, identifying the exact feeling and behavior are crucial steps in the FS treatment procedure. For example, shopping has many different sub-behaviors such as going into the store, having people wait on you, trying on clothes, buying the items etc. any one of these parts of shopping may be behavior that creates the most intense positive feeling. The behavior that creates the most intense positive feeling is the particular behavior that has to be identified.

In addition to identifying the exact behavior, the exact feeling also has to be identified. A shopping compulsion might be connected with the feelings of power, status, relaxation or being special. Whatever the feeling is, FS treatment requires the the intensely desired positive feeling underlying the compulsive fixation be identified.

Once the exact feeling and behavior has been identified then the ImTT processing protocols are used to process the fixation. The exact number of sessions varies due to the fact that more than one feeling may become fixated with the same behavior in order to completely eliminate the compulsive fixations, all the feelings must be processed.”

Treatment of Behavioral Addictions Utilizing the Feeling-State Addiction Protocol: A Multiple Baseline Study

Question: What Is VirtualEMDR?

Answer: According to the website:

The program is developed and tested extensively with practitioners. It is specially designed to:

Use at home without a therapist

Suit both beginners and experienced EMDR users

Provide easy, interactive step-by-step guidance

Utilize latest technology to deliver effective Eye Movement processing

Address all interaction preferences through customizable multimedia options

Require only a computer or tablet, no special equipment needed!

Question: What Is remotEMDR?

Answer: According to the website remotEMDR is a patent based platform, that uses a unique technology, in order to equip EMDR therapists with holistic solution for online EMDR therapy. It enables the therapist to control and monitor the presentation of the BLS remotely, while it runs synchronously on both his computer and his client’s computer. Virtual EMDR is an online, self-guided mental health treatment program based on the established science of Eye Movement therapy.

It is a full remote EMDR therapy platform, featuring:

A wide variety of visual and auditory BLS stimuli

Client management system

Embedded video-chat

Secure HIPAA compliant solution, including BAA

Continuous software updates

Full support - by email and online meetings

Question: I have a question about the legal issues surrounding the EMDR process. Could you explain more about why EMDR is not indicated when working with a client who is involved in an active legal case? I have one particular client who still has an open case for a sexual assault 2 years ago, but who is interested in doing EMDR. When I was doing the assessment for readiness with her, that one came up as a potential reason to not move forward, but I was not sure exactly why this is the case. I hope that you can give me some insight into this, and help me decide whether or not to pursue EMDR with this client.

Answer: The gyst is two-fold:

1. If someone is accusing somebody of a crime, the accused's lawyer can bring into question the validity of his/her testimony~they can say it's been impaired due to the EMDR processing (also with hypnosis).

2. If somebody has a civil case, you want them to know that symptoms go away after EMDR. (If they are going to be awarded damages/money, they will no longer have the PTSD symptoms for which they are seeking compensation)

Question About Products: Would you kindly remind the name of your books? Can I get it on Amazon?

Answer: The books are:

TRAUMA COMPETENCY: A CLINICIAN'S GUIDE

101 TRAUMA-INFORMED INTERVENTIONS

Sometimes you can get it on Amazon, but lately it’s price seems to be extremely inflated! Please do not ever pay more then the cover price because you may always get it through PESI.

Question: Initial installations are showing large positive gains for my trauma clients. I did discuss with you (and have read in the training manual) using the installation process as a stand alone treatment protocol for affect regulation and distress tolerance. My Client of over 2 years is experiencing a sense of mastery unknown to her before...so yes...I am developing an even stronger interest in "multi-sensory" trauma work. I have read over the manual about 6 times now...so if you want a recital just ask!) in keeping in mind that the "processing" is a late-stage intervention is there any inherent risk in beginning installation earlier on in treatment for trauma clients? ( I suspect this would be beneficial and low risk for the following reasons)

Positive resource installation can provide immediate relief for painful affect states and distress (experienced by so many of my Clients throughout treatment)

Resource installation benefits experienced by the Client can foster a stronger sense of trust in the therapist and hope for recovery early on in treatment.

Resource installation and "utilization" by Clients earlier on in therapy, can strengthen these coping skills, reinforce their efficacy for behavior/emotion management and arguably be more accessible and "stronger" if and when trauma processing is approached as a later stage intervention. Your thoughts?!

Answer: Of your statements above, we are in agreement.

Question: The internal support offered by installation (by the way I am finding that applying the ABS for every experienced sense "sight, sound smell, taste, touch, body sensations, emotions and anchor word) AS LONG AS THE SENSATION AND CORRESPONDING AFFECT IS COMPLETELY POSITIVE during installation is even more effective than experiencing these sensations sequentially, "holding them" and then applying ABS as originally instructed. Again, I feel this type of experimentation is safe and ethical because we are working with positive resources and not processing traumatic material. I also find that repeated positive ABS and corresponding "checking in" ensures a greater sense of prevention from any unwanted contamination during the installation process.

The installations themselves are so vital for my current clients (lower income DV client's with complex trauma histories) because the options for external support (typically abusive or non-approving families, limited "friends who don’t use" and sometimes horridly run support groups rife with re-traumatization opportunities etc) really makes the internal resourcing all the more valuable. I had one CPTSD/DV Client who recently had a severe automobile accident describe the installation as "better than morphine" Of course...I informed her that this new resource was in no way shape or form a substitute for Rx and 'Doctor's Orders' :) My questions to you are these:

What is the next training I should attend?

Is there an additional EMDR training that would be beneficial?

Or should I just stick to recommended readings (I know you strongly recommended Parnell) to reinforce the basics.

Answer: I'm happy to hear your enthusiasm! For resourcing: Parnell's, "Tapping In" is a Must Read read. Get it! :) Tapping In: A Step-by-Step Guide to Activating Your Healing Resources Through Bilateral Stimulation... And for everything else:

Parnell's, A Therapist's Guide to EMDR: Tools and Techniques for Successful Treatment

Question: Regarding frequency and intensity...is it best to use the same "strength" of vibration with "installation" as we would use for pending reprocessing?

Answer: Intensity and frequency are client's choice for resourcing (you need not change either one during resourcing, as the Theratapper is on only 5-10 secs). Reprocessing-same thing for intensity client's choice, but frequency you will be altering constantly.

Question: I have gotten the Theratapper out and been playing with it and have read through the manual a few times now and nowhere in there can I find what I remember which is that we were regularly turning the pulse rate knob as we were doing the rounds of abs (alternating bilateral stimulation...right?) Am I remembering wrong?? Aren't we supposed to be doing that -- varying the pulse rate so that the brain can not attenuate to it?

Answer: Essentially, we vary the rate of the tactile stimulation so that the brain-that fantastic organ of pattern detection and prediction- is forced to keep orienting toward this novel stimulus (the buzzing in the hands). The brain is forced to keep paying attention (consciously or unconsciously) to novel stimuli. If we leave the rate alone (i.e. forget to continuously turn the rate dial) the brain quickly picks up its simple pattern, i.e. the pattern of buzz...buz ...buzz.....buzz.....buzz.....buzz.....buzz.....buzz.....buzz.....buzz..... buzz.....buzz.....etc. becomes quite predictable; once predictable, there is no reason to-consciously or unconsciously- pay attention to it. Why orient toward or attend to something so mundane? Since the buzzing (the stimulus) is neither new, dangerous nor interesting, the brain is once again free to attend exclusively to the traumatic memory. However, if we continuously vary the rate, the pattern of: buzz............buzz...buzz.....buzz.............buzz....buzz..........buzz....buzz...buzz.. (you get the picture) is not so predictable, thereby insisting that the brain keep orienting toward the stimulus and keep trying to predict a pattern. It will fail, but that’s the point; it must keep paying attention to the tactile stimulus (which, notably, is in the here and now). The brain tries to figure out this "dis-tracting"stimulus’ pattern, while simultaneously attending to the traumatic memory (which, notably, is in the there and then), the memory is unable to gain “traction”, allowing the brain to be changed.

Question: I’m going over the notes I took, and you mentioned that the CBS Farmer’s Market Tragedy was on your website, but I’m not finding it. I would really like to have this particular broadcast to show to my superiors as a means of informing them of the treatment in order to get their blessings on my using your techniques and the thera-tapper.

Answer: Here is the URL: http://www.youtube.com/watch?v=zBtqWrs2-K0

Question: I am seeing a 20-year-old female, with a history of fibromyalgia and seizures...docs have told her that these are both epileptic and non-epileptic however cat scans do not show any abnormalities...one doc called them 'startle seizures' another says they are her being dramatic ... wonder if they are psychogenic and trauma related but the client reports no real traumas prior to seizures (onset at 15yo)...my question is...should I avoid EMDR with this young woman because of the seizures?

Answer: Addressing your immediate concern, my answer is: not necessarily. As her clinician, you need to contact her neurologist and have them sign off on it, i.e. say it's okay with him/her. It's not just a cover your ass move, it may well be a helpful consult not only to get information from him/her but an opportunity and to educate him/her about trauma and its sequel. Again, if (s)he doesn't know what EMDR is, I’d recommend looking for a new neurologist :) You may want some references from physicians (just saying) to pass on regarding traumatic stress and subsequent health issues. For that I will refer you to the leading authorities:

The two articles listed below are from: the ACE Study website (This is an extremely helpful study linking adverse childhood experience to poor health in adulthood. The two articles below do are helpful, but please visit the site as well)

Anda RF, Felitti VJ, Walker J, Whitfield, CL, Bremner JD, Perry BD, Dube SR, Giles WH. The enduring effects of abuse and related adverse experiences in childhood: a convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neurosciences 2006; 56(3):174–86

Corso, PS, Edwards, VJ, Fang, X, Mercy, JA. Health-related quality of life among adults who experienced maltreatment during childhood. Am J Public Health 2008;98:1094–110

Two of my favorite books for clinicians regarding stress, trauma and disease:

Bob Scaer's book, The Trauma Spectrum: Hidden Wounds and Human Resiliency. The book is a must read for anyone working in the field of traumatic stress. (Scaer specifically touches on seizures, kindling, etc.)

Peter Levine’s In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness