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 the member organization EMDRIA; it is completely voluntary; and according to EMDRIA’s executive director, only about 5% of all those trained in EMDR go on to become certified (personal communication, 2009). (*See below for EMDRIA’s requirements for certification). For further questions regarding EMDRIA and this question, see section below: Questions from EMDRIA Consultant, Jamie Marich, PhD
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.
*EMDRIA Certification Requirements (from EMDR International Association’s website)
1) EMDRIA Approved Training: Submit evidence of having completed an EMDRIA approved Basic EMDR Training program. A copy of your certificate of completion is required.
2) License/Certification: Show evidence of a license/certification/registration as a mental health professional. A photocopy of your license/certification/registration to practice independently is required.
3) Do you have at least two years experience in your field of license/ certification/ registration? Answer yes or no on the application form and then attach notarized documentation supporting this statement. You can write out the statement as it is written, "I have at least two years' experience in my field of license", or something similar and then have it notarized.
4) Have you conducted at least 50 EMDR sessions with no less than 25 clients? Answer yes or no on the application form and then attach notarized documentation supporting this statement. Again, you can write out the statement as it is written, "I have conducted at least 50 EMDR sessions with no less than 25 clients", or something similar and then have it notarized. You may combine statements #3 and #4 on one sheet of paper and have the document notarized once for your convenience.
5) *Have you received 20 hours of consultation by an Approved Consultant in EMDR? Answer yes or no on the application form. Then you will need to obtain documentation from the Approved Consultant(s) you received your consultation from, verifying the number of hours you have received from him/her and how many of those hours were individual consultation and how many were group consultation. If you have received consultation from more than one Approved Consultant, you will need documentation from each. At least 10 of these hours must be obtained through individual, EMDR-focused consultation. (Provisions will be made for those therapists who practice in isolated areas and lack the convenient proximity to an Approved Consultant). The remaining 10 hours may be obtained through small group consultation. Groups that meet for consultation cannot exceed more than 8 participants at a time.*Only consultation hours received AFTER completion of an EMDRIA Approved Basic Training program can be applied towards this requirement.
6) Attach letter or letter(s) of recommendation from one or more Approved Consultant(s) in EMDR, regarding your utilization of EMDR while in the consulting relationship.
7) Attach two letters of recommendation regarding your professional utilization of EMDR in practice, ethics in practice, and professional character. These can be obtained from colleagues or peers.
8) Attach certificates of completion of 12 hours of EMDRIA Credits (continuing education in EMDR). The Basic EMDR Training is not awarded EMDRIA Credits - only EMDRIA Approved Credit Programs in EMDR that are completed after the basic training can receive EMDRIA Credits and be used towards this application requirement.”
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.)
Question About Products: Would you kindly remind the name of your books? Can I get it on Amazon?
Answer: The books are:
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: What is the difference between your CD (the one on your website) and PESI’s DVD’s (looks like they’re on your website and PESI’’s)?
Answer: The "CD": EMDR Essentials is the CD that was available @ the seminar. This CD download is the only product that sold by my company, Integrative Trauma Treatment, LLC, the others are PESI products- (starring me :)- but distributed by PESI. You may obtain the EMDR Essentials easily from the website as a digital download-meaning you download all the files in pdf format (which contain all the forms listed below) and then they're yours forever; once you've downloaded them, feel free to print them out and distribute them to whomever you like.
My recommendation is to fill it out regardless of whether you intend to consult with me or not; it will be helpful in clarifying what you want/need. In addition, in conceptualizing case(s) and developing more precise questions you may just answer your own questions and/or you may come up with additional questions.
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, 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:
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:
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 (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. . European Archives of Psychiatry and Clinical Neurosciences 2006; 56(3):174–86
Corso, PS, Edwards, VJ, Fang, X, Mercy, JA. . Am J Public Health 2008;98:1094–110
Two of my favorite books for clinicians regarding stress, trauma and disease:
. The book is a must read for anyone working in the field of traumatic stress. (Scaer specifically touches on seizures, kindling, etc.)