Eye Movement Desensitization and Reprocessing
EMDR Made Simple
Questions from EMDRIA Consultant, Jamie Marich, Ph.D. to Linda A. Curran
~Excerpted from the article,
To say that Linda Curran is a controversial figure amongst EMDRIA members is an understatement. Curran is responsible for developing the two-day training in EMDR and EMDR-Related Techniques offered by PESI, LLC, a continuing education company based in Eau Claire, Wisconsin. EMDRIA’s disdain with the PESI training is well-documented on the EMDRIA website and in versions of the membership newsletter and the monthly email news briefings. The major criticism voiced by EMDRIA is that because the two-day training is not teaching EMDR, according to the EMDRIA definition, it should not be advertised as EMDR training (EMDR International Association, 2008). However, those who attend Curran’s PESI training actually learn the traditional 8-phase EMDR protocol as developed by Shaprio (2001), in addition to Curran’s experiential practice knowledge on how to modify the protocol to be more appropriate to real-world clinical settings (Curran, 2009). Interestingly, others like Laurel Parnell (2007) published modifications of the traditional protocol that are based on practice knowledge, a valid form of intellectual inquiry in the social sciences (Crotty, 1998). Moreover, others have published variation EMDR protocols that have little or no formal basis in research, most notably, Popky’s (2005) DeTUR protocol, yet these variations have been accepted for presentation at EMDRIA conferences for EMDRIA credits (EMDR International Association, 2009).
Jamie Marich, the interviewer, publically criticized EMDRIA on the association’s blog (2009) for overtly condemning trainings that do not meet EMDRIA standards, when EMDRIA-approved standards have no basis in research. Although the traditional Shapiro protocol has been validated for certain populations and presentations (Maxfield, 2007), there is no known research on the effectiveness of training EMDR therapists (Greenwald, 2006; Marich, 2009). Marich, a qualitative researcher and EMDRIA member, has long embraced a concept expressed by philosophers like Paley and Spencer, and also embraced by great writers and thinkers like Chaucer, Emerson, Edison, Einstein and Hemingway: ignorance results from contempt prior to investigation (Keyes, 2006). In this spirit, Marich set out to investigate the merits and deficits of the PESI training by first attending the PESI training, reading Linda Curran’s training manual, and then talking to the developer of the two-day training, Linda Curran. The interview was conducted in September 2009:
JM: Can you tell me a little but about when and where you were trained in EMDR and what your experience was in implementing it?
LC: I was trained by the EMDR Institute at the Doubletree Inn in Philadelphia circa 2002. I was employed in a community mental health setting while attending post-graduate training at The Gestalt Therapy Institute of Philadelphia. One of the directors of the Institute, a master Gestalt therapist with a specialty in trauma, suggested that given the traumatized population with whom I worked, that it might be a good idea to be trained in EMDR. Always the rule follower, I did what I was told and spent a month’s salary on the Institute training. The last sentence, although sarcastic with regard to my need to strictly adhere to authority’s counsel, there is neither sarcasm nor hyperbole with regard to the cost of the training proportional to community mental health’s financial compensation package. Incidentally, although I was level one and level two trained by The EMDR Institute, because of the controversy surrounding my PESI training, the Institute has removed my name from the “Find a Clinician” page of the website.
JM: I completed my approved trainings and most of my EMDRIA Certified Therapist consultation while working for a community agency, so I relate. How would you describe your current clinical practice and your personal approach to psychotherapy
LC: I completely identify with old school trauma therapy, a.k.a. Gestalt therapy. Gestalt therapy is a humanistic, present-centered, relational psychotherapy with an emphasis on contact, body/somatic awareness, and the working through of unfinished business. As PTSD (both simple and complex) is the quintessential disorder of unfinished physiologic, emotional and cognitive business, Gestalt therapy lends itself perfectly. In terms of EMDR, I do EMDR, but I am not an EMDR therapist.
JM: What led you to develop your two-day EMDR training?
LC: I once heard that, it is never what you do that makes you neurotic, but what you don't do. I developed a two-day training for PESI, LLC, a company offering various continuing education programs for helping professionals, at the request of program director Mike Olson. I agreed to develop the training as result of an informal needs assessment I conducted, which included multiple interviews with psychologists and psychotherapists who had been formally trained in EMDR. I was intrigued by the findings and saw a way to improve client/patient care. In the assessment, the things that stood out were that of those clinicians who had been trained, despite the time and capital expenditure, some had never (or no longer) used EMDR with clients. The reasons most cited for this were fear of further harming clients (imbued in the facilitator at the training or developed subsequently while attempting to reprocess traumatic material with clients who did not respond as expected, e.g. the client abreacted or “got worse”), and lack of support due to insufficient peer supervision once the clinician began to use the technique.
JM: Can you explain the general structure of your two-day training?
LC: The general structure of the two-day training follows directly from the results of the needs assessment. Those identified issues are explicitly addressed within the training. That is, fear of harming clients and the problems that are likely to arise post training are preemptively addressed. To that end, the structure consists of an initial comprehensive explanation of the neuroscience of Trauma 101: how it is experienced primarily physiologically and secondarily cognitively and psychologically, followed by the best practices for treating traumatized individuals. For me, the biggest difference between this training and other trainings is the unambiguous differentiation between simple PTSD and complex PTSD. This training’s emphasis within “Trauma 101” explicates the absolute necessity of prior completion of the stabilization phase of therapy before any attempts are made to work through traumatic material. This is different than imbuing fear about utilizing EMDR with this population; it is a reminder to clinicians that reprocessing trauma, regardless of modality, is dangerous when done prior to client stabilization. Further, the training identifies ample resources for the clinician to employ for undertaking client stabilization (including alternating bilateral stimulation in conjunction with multisensory imagery) prior to the reprocessing of trauma. Once participants have been presented with a thorough elaboration of trauma, the training proceeds with resource development and installation: explanation, demonstration and experiential portions using alternating bilateral stimulation with multisensory imagery. Day two encompasses an explanation, demonstration and experiential portions employing alternating bilateral stimulation for reprocessing traumatic material. I teach participants the Shapiro 8-phase protocol in addition to Parnell’s modified protocol.
JM: Many people assume that you are anti Francine Shapiro or anti-EMDRIA. How do you respond to that?
LC: Why would anybody think that? It couldn’t be farther from the truth. Francine Shapiro is a brilliant scientist, researcher, clinician and philanthropist. She has accomplished a feat that very few folks ever attempt, and deserves acknowledgment and appreciation for her enormous contribution to psychotherapy. Shapiro has earned and is entitled to recognition for her skill, adeptness and ability to have conducted the required research that has gained EMDR its credibility. In addition, she possesses clinical acumen from which her clients and students benefit greatly and a charitable spirit that guides EMDR Humanitarian Assistance Programs. If I am in the business of facilitating healing, then how could I be anti that?
JM: Francine Shapiro and others in the EMDRIA community have been increasingly insisting that EMDR is an approach to psychotherapy. What is your view of this?
LC: Without vehemence, I simply disagree. I believe that EMDR is a modality that has proved efficacious in both internal resourcing and reprocessing traumatic material. There should be no need for me, or any other clinician, to renounce his/her chosen discipline to utilize EMDR as a modality.
JM: You call the training that you do for PESI "EMDR for the Real World." What is the reasoning behind this?
LC: Most clinicians came out of grad school ill-equipped to treat trauma, but in the Real World see lots of it. Most of us want training to effectively treat even the most traumatized clients, but in the Real World, time and money are scarce. In the Real World, clinicians work in community mental health settings, prisons, state hospitals and rehabs. Given the salaries and benefits that come with these positions, the time and capital expenditure required for certification (forty-hours of training and ten hours of paid consultation) are a bit unrealistic, not to mention elitist. In the Real World, clinicians have clients with abuse histories, attachment issues, multiple traumas, very little trust, and a marked inability to tolerate affect or distress. Their primary need is safety, yet to process their most personal and traumatic moments, we should refer them to a certified EMDR clinician who they have never met? In the Real World, clinicians don’t claim to be trauma specialists, but clients with trauma show up on their caseload anyway.
In the Real World, clinicians are currently seeing clients with trauma and do the best that they can. EMDR for the Real World is a training for those clinicians. Interestingly, about one-quarter of the people who sign up for my trainings have already undergone level II training by the EMDR Institute or another EMDRIA-approved provider.
JM: There seems to be a general sense amongst EMDRIA members that because your training is two days it is somehow inferior. In fact, many of the EMDRIA members I’ve spoken to seem know only about your training from reading the pamphlet. How do you respond to this criticism?
LC: Well, members of EMDRIA have accused me of being unethical, to which I take umbrage for obvious reasons, including the fact that I am very proud of the training. What further offends me is that not one of them, although invited, has attended the training. That is, except for you, Jamie
JM: Well, I saw coming to your training as the right thing to do in order to be properly informed. I, personally, cannot tolerate contempt prior to investigation amongst educated people. When I sat in on your training, I observed that you encourage your trainees not to fear bilateral stimulation. What is the reasoning for that?
LC: Alternating bilateral stimulation is not dangerous. If it were, wouldn’t it follow that we should all abreact when walking, snapping our fingers, or playing Miss Mary Mac? Bilateral Stimulation is not dangerous, nor is EMDR as a modality. However, when administered by clinicians without prerequisite knowledge to effectively address and treat trauma’s sequelae, the EMDR protocol proves challenging, fear-inducing and, oftentimes, traumatizing for clinicians and re-traumatizing for clients. So there’s no misinterpretation of the last sentence, the EMDR protocol is not dangerous. However, any type of trauma work that deliberately activates traumatic memory networks without insisting that client and clinician are adequately prepared to tolerate the effects of that activation is dangerous and irresponsible. Throughout trauma treatment, the clinician must continuously and vigilantly attend and re-attend to client safety and stabilization. Regardless of the type of trauma processing employed, there can be no substitute for the following: the therapeutic relationship, clinical assessment and judgment, an explicit crisis plan, and instruction in (and acquisition of) skills for affect and emotion regulation, arousal reduction, and distress tolerance prior to trauma work.
JM: What opportunities for continued support do people who take your trainings have following the trainings?
LC: The first hour of the training is about networking. I insist that participants wear nametags, identify themselves, their affiliations, client populations, etc. I explicate the need for continued support post-training, and have facilitators create opportunities for participation in a listserv (on which I am included). Angi Dahl from San Francisco has developed a national Linkedin discussion group for all those participants who are interested in joining. I encourage those who are geographically able to meet in person for peer supervision. I inquire who works with people already using the technique and encourage getting consultation and support. In addition, I offer my website as a portal for connection with everything related to trauma (www.integrativetraumatreatment.net).
JM: What is your overall reaction to the controversy that your training has generated amongst those who are EMDR traditionalists?
LC: Bob Dylan said it better than I: Admit that the waters around you have grown…for these times, they are a-changin’. You get the picture.
JM: How do you see EMDR and other EMDR-related techniques evolving in the future?
LC: My ultimate fantasy is to be put out of my job as therapist, i.e. in an optimal world I’m unnecessary, as there are no clients. Since this isn’t looking very promising, a more modest hope is that I get put out of this job: traveling around the country teaching seasoned clinicians something that they should have been taught in graduate school, if not sooner. And on an even smaller scale (or shorter timeline) I hope that these trainings continue to co-exist for the benefit of those affected by the sequelae of psychological trauma and those clinicians who have made it their life’s work to treat them.
JM: Linda, thank you for your willingness to be interviewed. My hope is that people will read this interview and see that your intentions are not evil; rather, that you are taking a different approach to teaching EMDRIA which stems from the reality that you do not exclusively identify as an orthodox, EMDR therapist. Obviously, there is a need for it or people wouldn’t be signing up for your trainings. I find it especially interesting that such a high percentage of your trainees have already been trained by an approved provider, like the EMDR Institute. At very least, whether people condemn you or not, this shows that something has been missing in the approved training programs and/or in the availability and feasibility of EMDRIA continuing credit programs. The whole issue of training therapists in EMDR is something that I have long believed needs to be better investigated, and I know that there are others out there who are concerned about achieving a proper balance between good standards and exclusive orthodoxy when it comes to EMDR. So thank you for being a part of my desire to learn more.
LC: I would like to say thanks for coming to the training; you only made me a little nervous. But, I sincerely thank you for putting yourself out there in an attempt to present a more balanced portrayal of my training. You’re not only a rock star; you are a brave rock star. You remind me of the guy who the Church said was “vehemently suspect of heresy," forced to recant, and spent the rest of his life under house arrest. You know that guy, Galileo? All because he really believed that the earth was not the center of the universe.