EMDR Therapy Phase 2.5: Honoring a Wider Context for Enhanced Preparation by Jamie Marich, Ph.D., LPCC-S, LICDC-CS, REAT, RYT-200
As an EMDR educator, people are constantly asking me what I think of the latest trend in EMDR therapy. In the last year or so, Phillip Manfield’s Flash Technique has become all the rage. My students will tell you that I am not easily impressed by the latest spin on the standard protocol or twists on time-honored strategies for resourcing and regulating affect. I’ve long maintained that if you learn the standard protocol well and have a sense of how to mindfully modify with respect to special populations, dissociation, complex trauma, and the art of embodied resourcing, you have what you need. To be clear, I do not oppose use of the Flash Technique if it makes sense to the therapist using it and the technique helps the client. I also want to make my assessment clear that the Flash Technique, like many other trends that have captivated the attention of EMDR practitioners, is not a panacea or a quick fix. Indeed, it can prepare more complex clients for full reprocessing. Yet Flash is not the fullness of complete reprocessing and it is not a substitute for EMDR Phases 3-6. Indeed, there are many other strategies, especially from the tradition of embodied mindfulness, which can also engender more active preparation for reprocessing. Explaining my assessment of flash in this larger context led me and several colleagues on the Institute for Creative Mindfulness faculty to coin the term EMDR Phase 2.5.
Interventions that are more robust than traditional EMDR therapy preparation (Phase 2) that get a client fully ready to handle the affect that may emerge in Phases 3-6 belong in this critical middle ground. Many others and I have long taught that in working with complex trauma and indeed with most clients, doing one Calm Safe Place exercise is grossly insufficient. While the popularity of Resource Development and Installation or RDI (Korn & Leeds, 2002) and Resource Tapping (Parnell, 2008) inspired EMDR therapists to expand their scope on how to conceptualize preparation, many trauma-focused EMDR clinicians see that there are still other needs to be addressed. Namely, how do we help clients not just to stop, pause, or return to equilibrium when they abreact or when a session is due for closure; rather, how do we help prepare them for intensity? The intensity of affect release and shift that can help EMDR therapy to be so effective can also make it so scary for clients who have long been phobic of both affect and mindfulness.
This phobia of both affect and mindfulness develops as a legitimate response to unhealed trauma and dissociation (Forner, 2019), especially if a person was imprinted with negative cognitions such as: “I cannot show my emotions,” “It’s not safe to show my emotions,” “Showing emotions makes me weak,” among others (Marich, 2011; Marich & Dansiger, 2018). I’ve long taught trainees that even though their tendency may be to get nervous when a preparation skill like Calm Safe Place or container doesn’t seem to work, the client is still getting something valuable out of the exercise if you handle it well. These traditional preparation skills, if you follow the textbook, are supposed to bring about pleasant and resource-worthy experiences. Yet if they “go bad,” you now have an opportunity to guide a client through an experience in distress tolerance. For me, teaching a client that they can sit with unpleasant experiences for a time and/or use other resources to shift the focus is the best possible preparation skill that we can give clients in advance of moving into the reprocessing Phases (3-6) where discomfort will happen. For me, this is the essence of EMDR therapy Phase 2.5.
Our program and my approach to EMDR therapy is known for its focus on mindfulness. While Dr. Shapiro herself was a practitioner of mind-body healing modalities and studied with renowned west coast meditation teacher Stephen Levine, many EMDR therapists are not sufficiently grounded in the fundamentals of mindfulness and embodiment. Having these fundamentals is just as important, if not more important, than knowing an advanced preparation technique like Flash. Especially because Flash is not full-proof; many students and consultants have reported to us that it can “go bad” or open up into full reprocessing before a client is ready. As my colleague Dr. Stephen Dansiger and I explain in our 2018 book EMDR Therapy and Mindfulness for Trauma-Focused Care, the standard EMDR protocol is filled with invitations to mindful awareness. Use of questions like what are you noticing now? (Phase 4), when you scan your body from head-to-toe, what are you noticing? (Phase 6) and prompts like Go with that give us all the evidence we need that Shapiro developed EMDR therapy in a mindfulness context. Often defined as the practice of coming back to non-judgmental awareness, many have posited that mindfulness is one of the potential mechanisms of action in EMDR’s success (Logie, 2014; Shapiro, 2018). Yet if the first time a client is asked to be mindful or embodied is during their first run through the protocol, it may be too late.
As Christine Forner (2019) explains in her brilliant new article on connections between dissociation and mindfulness, dissociation is essentially a state of missing mindfulness. Mindfulness is about connection and dissociation is about surviving disconnection. Thus, many individuals who have spent their entire lives dissociating are literally phobic of mindfulness, and in the standard EMDR protocol we are asking them to be both mindful and embodied. This request is not necessarily a bad thing because learning to be mindful and processing mindfully is a major component of what can help us heal. As EMDR practitioners, we must do a better job of preparing clients for what the standard protocol expects.
Mindful and embodied EMDR therapy preparation requires more than just reading a script out of a book on mindfulness or showing a client a video. While I make several video resources in this area available online, I urge that EMDR practitioners must have a personal grounding in mindful and embodied practices to help clients deal with difficulties when the scripts don’t flow as planned for the client. Complex trauma and dissociation is messy and while we can do our best to give you a step list of what to follow for teaching these skills, drawing from your own personal experiences will help you to respond in the moment and guide clients through distress tolerance as safely as possible. In the Institute for Creative Mindfulness curriculum, we teach trainees to offer skills in all of these areas as part of Phase 2 preparation:
While we are not alone as a training program in teaching this widened scope, we see active exploration of these resources and the problems that they can bring up for the client as real opportunities to work with distress tolerance and engage in EMDR Phase 2.5. If a skill “goes bad,” we work with it to help a person notice the affect it creates or return to the present moment from any shut down that it caused. If a client protests, “I can’t do it,” we ask them how we might be able to modify a skill, which can include shortening the length of time that we spend in a skill.
A particularly strong skill from the mindfulness tradition that, in my view, should be taught by every EMDR therapist as part of EMDR Phase 2.5 is Mindfulness of Feeling Tone. Mindfulness of Feeling Tone is the second of four primary foundations of mindfulness. In this meditation, we ask the client to bring up their present-moment experience, scan the body briefly, and ask them if what they are noticing is pleasant, unpleasant, or neutral. Too often we have to orient clients to the language of what are you noticing now and if you’re doing it once they are activated in Phases 3-4, it’s too late. Many of our clients lack the vocabulary and practice with feeling or sensation to begin to even answer this question. This exercise is an elementary yet vital start to the process for it gives them three words to start with that are similar to the EMDR therapy constructs of adaptive, maladaptive, and neutral. You can take Mindfulness of Feeling Tone a step further by deliberately asking a client to bring up some association they would describe as pleasant and then guide them through noticing how they experience pleasant in the body. Do the same thing for unpleasant, which will be more challenging, yet ultimately more preparatory for what is to come in later Phases of EMDR Therapy. They don’t have to sit with the unpleasant experience forever; thirty seconds may suffice. Then you can move on to neutral and if needed, shift back to pleasant, strengthening that adaptive resource with DAS/BLS if appropriate. To watch a video demonstration of me guiding this exercise, please click HERE.
A resource such as Mindfulness of Feeling Tone is similar to the processes of titration and pendulation that Peter Levine actively calls upon in his creation, Somatic Experiencing®. I’ve trained many individuals well-schooled in both Somatic Experiencing and Sensorimotor Psychotherapy® and indeed one of the biggest criticisms they have of EMDR therapy is that we can blast a client in too quickly to the heart of the trauma without easing them into it using processes like titration and pendulation. Titration calls for a slowing down and only working on small pieces of a trauma at a time and then retreating into resources. While this process may go against what many EMDR therapists believe, stringently following Shapiro’s (2018) teaching that “preparation is not processing,” (p.36) I argue that for some complex clients titration is warranted. To me, this is where the Flash Technique is filling a gap in enhanced EMDR therapy preparation. For many years I have addressed this gap, if it appears with a client, by asking them what part of a target memory are they willing to work on first, even if it’s not necessarily the image or worst part. If needed, in the spirit of titration, we retreat into resources and then go back into this gentle test of processing. Sometimes the process of going with what we set up leads us to the worst part, other times it does not and we have to go back and set up the target again to address the worst image or worst part. My modification is another example of an EMDR Phase 2.5 that can lead into full Phase 3-4 that may be appropriate for complex clients. Yet in and of itself, the modification would be incomplete for optimal resolution of the memory.
The Flash Technique also seems to be helpful in the process of pendulation. Levine describes pendulation as the shifting of body sensations or emotions between those of expansion and those of contraction (Levine, 1997; Payne, Levine, &Crane-Godreau, 2015). A key principle of pendulation as practiced in Somatic Experiencing® is that a resilient nervous system is one that can move back and forth between alertness/action and calm/rest without getting caught in the extremes. Pendulation invites a fluctuation between resourced states and activated states as a mechanism for training our nervous system, which can help with long-term integration.
The Flash Technique, as described in this wonderful review by Ricky Greenwald (2017) (click HERE for the link), resonates for me as a practice of pendulation. This makes the Flash Technique a more robust form of EMDR preparation and thus meets my classification of it as EMDR Phase 2.5. I have long felt that EMDR therapists have much we can learn and integrate from Somatic Experiencing® and Sensorimotor Psychotherapy® and I believe that Manfield has given us a way to bring in some of these ideas, especially through the visual channel.
However, Flash Technique is not the only way to prepare our clients more effectively for the intense affect and embodied shifts that will inevitably happen once EMDR Phases 3-6 commence. Some of the mindfulness and embodiment skills that I covered in this article are a mere overview of what EMDR therapists can learn to more effectively prepare clients. I’ve long admired that the flexibility of EMDR therapy Phase 2 allows practitioners to bring in other modalities or approaches that they feel can strengthen the skills a client acquires in preparation. On my team, in addition to traditional mindfulness work, my faculty members and I make use of yoga, dialectical behavior therapy, expressive arts therapy, 12-step strategies, well-established work like Seeking Safety®, and creative interventions offered to us by other leaders in the EMDR therapy community like Jim Knipe and Ana Gomez.
All of these strategies are available to you and to your clients! Learning them and implementing may not feel as simple as reading a script or following a simple set of steps. I know that many EMDR therapists want these steps spelled out and this is natural for adult learners. However, it seems that every few years I talk to therapists who get caught up in the latest trend without learning the context that surrounds it and this is problematic. Even more problematic is if practitioners believe that the latest thing will replace their need to do other, more comprehensive resourcing. There are no short cuts in EMDR therapy; it takes hard work and personal commitment to become fluent and responsive. Committing to the expansion of your skill set using some of the other strategies we described here and your own personal practice with many of these skills means that you will excel at working in EMDR Phase 2.5!
Please, let’s make this an active blog. Share in your comments if this “2.5” concept resonates with you and what you have done to foster this level of preparation other than using the Flash Technique. I look forward to hearing from you.
Special thanks to Institute for Creative Mindfulness team members Amber Stiles-Bodnar, Dr. Stephen Dansiger, Suzanne Rutti, Adam O’Brien, Ramona Skriiko and several others for their contributions to this piece.
Forner, C. (2019). What mindfulness can learn from dissociation and dissociation can learn from mindfulness. Journal of Trauma & Dissociation, 20(1), 1-15.
Greenwald, R. (2017). Flash! Trauma therapy just got easier and faster. Trauma Institute & Child Trauma Institute Blog. 28 November 2017, available at www.childtrauma.com/blog/flash/
Korn, D., & Leeds, A. (2002). Preliminary evidence of efficacy for EMDR resource development and installation in the stabilization phase of treatment of complex post traumatic stress disorder. Journal of Clinical Psychology, 58, 1465–1487.
Levine, P. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.
Logie, R. (2014). EMDR- more than just a therapy for PTSD? The Psychologist- The British Psychologist Society, 27 (512-517).
Marich, J. (2011). EMDR made simple: Four approaches to using EMDR with every client. PESI Publishing (Premiere): Eau Claire, WI.
Marich, J. & Dansiger, S. (2018). EMDR therapy & mindfulness for trauma-focused care. New York: Springer Publishing Company.
Parnell, L. (2008). Tapping in: A step-by-step guide to activating your healing resources through bilateral stimulation. Boulder, CO: Sounds True Books.
Payne, P., Levine, P., & Crane-Godreau, M. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 4 February 2015, DOI: https://doi.org/10.3389/fpsyg.2015.00093
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing: Basic principles, protocols, and procedures, 3rd ed.New York: The Guilford Press.
Ancient philosophers talked about the good life.
The good life is a sort of craft – the Greeks used the word techne. A call from and response to the world around us, requiring adaptation and contextual awareness. The blacksmith, for example, carefully integrates understanding of his material’s malleability, the temperature of his fire, and the resistance of his anvil in hammering out metal goods. Crafts, nay arts, are doings. These aren’t things that are thought about in the abstract. They require the thoughtful and active integration of material conditions in one’s world in order to produce an put forth or express a product. Likewise, the good life, is an active process in which one’s life is carefully crafted like a work of art.
But somewhere along the way philosophers began talking about what it means to live morally - searching for the correct set of rules or principles to which ones’ behavior or internal compass must conform. Kant is most famous for this with his categorical imperative: “Act only according to that maxim whereby you can, at the same time, will that it should become a universal law.” It’s a rather wordy command, that suggests that we ought to take no actions that give rise to logical contradictions. For example, the notion that “stealing is acceptable” is immoral, since stealing wouldn’t be possible in a world where everyone was stealing from everyone all of the time – it would result in a logical contradiction. Ergo, stealing is morally wrong. What is wrong is always wrong and what is good is always good. We can determine right and wrong, good and bad without any reference to the conditions in which a person lives.
Understanding morality this way is certainly a tidy way to look at the world. But humans are full of contradictions. For example, in one moment I might desire your approval, while in the next I could care less of what you think of me. Some might even say that the contradictory nature of our desires and thoughts are the distinguishing feature of what it means to be human. It is certainly one of the things that makes human beings such fascinating creatures. Humans grow, change, and adapt. We look back on the past in light of new experiences and rethink what those past events mean to us. We look into the future with the baggage of past experiences coloring what we see in front of us. We very often have our minds made up only to let all our old ideas go in the face of a new feeling, experience, or idea, and reform our minds again and again over the courses our lives. Very often we are confronted with experiences thrust upon us by conditions outside of our control, and we are forced to grow and adapt to accommodate these changes.
If we suppose that a “good” life can be understood in moral terms – that is right and wrong – we run the risk of losing what it means to be human at all. Because as much pain as there might exist in growth and change, there is also a great deal of beauty.
Over the course of my life I’ve had the privilege of mentoring and coaching a number of women through life challenges. Of watching them crawl through suffering, wash out their wounds, and trudge along. Inevitably, I find a moment in which we are sitting across the table from one another laughing about something completely inconsequential. And there she is. A fully realized human being, flourishing in her own right. It’s like a dance, an artform, to watch another person begin to integrate the pieces of their lives and reorganize their own narrative moving from tragic victim to laughing friend. It’s a dance that invites us to participate ourselves, reconsidering our own stories and rewriting our own endings.
Living morally is living abstractly – divorced from the world in ivory towers determining what is right and wrong for everyone. Living beautifully, crafting a good life, is done in concert with the world in which we live and each another, taking the time to integrate life lessons, and opening our hearts to grow. To rewrite our own unique stories and invite others to do the same.
In the summer of 2000, I set out on my first proper backpacking tour of Central and Eastern Europe. For six weeks I would be visiting all of these historical places that I studied about for years, and I was ill-prepared! The cheap $20 rolling duffle bag with pieces of things pretending to be straps just would not do, especially on the trains. During my first stop—Prague—I saw how much easier it was for other young travelers to navigate the trains having proper backpacks. So at my next stop—Krakow—I found an outdoor shop and paid $80 for my first real backpack. She was amazing! Blue with black trimming, she was so easy to pack, and so wonderful to carry on the trains. I feel like she opened up the world for me and the possibilities in it even wider. For the next nineteen years, she would literally help me carry the baggage of my life and my transformation.
The word “baggage” has taken on an interesting emotional connotation in modern times. My mother always warned me not to date a guy with “baggage.” By the time I got to my mid-thirties, I was brave enough to respond, “Um…mother, I got quite a bit of my own baggage by now.” There’s even a Game Show Network series called Baggage hosted by none other than Jerry Springer where dating show contestants evaluate each other by whether or not they can live with each other’s baggage. And as a trauma therapist I’ve long helped people come to terms with their baggage, a word they often use for the burdens they carry. Sometimes I help them to shed the load that’s weighing them down and other times I help them to make peace with their past and how they carry it. Using the backpacker’s metaphor, sometimes we just need to get a more efficient piece of luggage.
Recent events prompted me into some deep introspection about baggage and all of its metaphors and meanings. I am currently on a one-month tour of the U.K., teaching and writing. When I got to the airport, I noticed that one of the last two functional buckles holding my old girl together had cracked and broken. Over the years everything that once made the old girl an ideal backpack went bad—the waist buckle, the chest strap, some chords and zippers. The two back straps were still intact which made her still okay to use. And suddenly that was no longer the case. I checked in at Cleveland for my flight to London. Yet trying to haul a month’s worth of gear into London city from the airport with a broken backpack was exhausting. I gave her one more go as I proceeded up to Scotland last week and the strain wreaked havoc on my shoulder and back. Knowing that there was no way to fix or to replace the buckle, it was time to lay her to rest and get a new pack.
I was surprised at how difficult that was for me. I’m not really the type to get attached to material things, yet there I was, attachment sick over literal baggage.
“Wow, Buddha would have a field day with this,” I snickered.
The old girl was different. She carried me through the healing journey of the second nineteen years that sought to unravel the confusion and pain that tangled me up in the first twenty. Setting out to travel the world was a major component in my recovery for it showed me new perspectives and different energies. When I ended up moving to Europe for three years in November 2000, I carried everything I needed in the old girl. She came with me on every international trip that followed as I connected with these lost pieces of myself.
When I walked into the outdoor shop in Inverness, Scotland, I reflected on just how far that 20-year-old girl who walked into a similar shop in Krakow had traveled. Two marriages come and gone, sobriety, a doctorate, seven books written, a successful business established, major mental health relapses healed and still healing, coming out in various ways, a story of transformation still in process… Most importantly, we’ve achieved liberation by connecting to the certainly of who we really are and what we stand for—we are total and yet continually evolving towards wholeness. Traveling, embracing the journey—both literal and metaphorical—brought me these gifts.
And now the time had come to get a more functional, efficient pack for the next nineteen years and beyond. When Mark, the lovely salesman in Inverness, explained all of the features on the state-of-the-art red Osprey pack I was privileged enough to buy, my first response was, “But the pouches on the new pack aren’t like the old one—I liked that feature better!” I chuckled at myself—realizing how it’s so easy for all of us to do that during the change process. Without a doubt my new pack is better for my body, contoured for a larger woman’s back and hips and full of efficient features. This new pack is 15 gallons smaller than the old girl, which will force me to pack more efficiently. That’s probably a good thing! I knew in that moment that as attached as I can get to the things I’ve gotten used to, they may no longer be what serves me the best presently.
I’ve learned to travel lighter in the last nineteen years, both literally and metaphorically, and this adjustment certainly helps. I am also a human being struggling to make sense of attachment and heal or release the storylines I carry. In trauma focused therapy, working with attachment is a topic du jour. As an EMDR therapy trainer, I often entertain questions on how well our curriculum can help trainees to work with attachment trauma. While it’s clear that many people with complex trauma were severely wounded in early childhood by the caretakers with whom they should have formed healthy attachment, I’ve never felt that repairing attachment is the entire answer. As a mindfulness-focused EMDR program committed to East-West integration, detachment is just as important. I heartily believe the Buddha’s teaching that attachment or clinging is one of the three main causes of suffering. Yet we are human and healthy attachment is a legitimate need—so how do I reconcile this one, Buddha? Contemplating this question in meditation has taught me that acceptance and letting go are vital to the change process. We can do this at the same time as we grieve the childhood we needed and never received. We can also bring healing to the younger, wounded parts that may still live inside of us, modeling healthy attachment for them. Letting go of the storylines and the attachments that no longer serve us in the present is paramount. Letting go clears the path for healing at all levels.
I ended up letting go of the old girl in my hotel room in Scotland with a note for hotel staff to do what they saw fit. It felt appropriate laying her to rest on the international road, especially in a place as magical as Scotland. I was also blessed to stumble upon a teaching from de-cluttering guru Marie Kondo during the days I wrote in Scotland. She advises, “Have gratitude for the things you're discarding. By giving gratitude, you're giving closure to the relationship with that object, and by doing so, it becomes a lot easier to let go.”
I don’t think I’ve ever read anything so wise and so applicable for people on any path of recovery. Gratitude is a quality of recovery that directly helps us to let go of unhealthy or unserving attachments, yet in modern times gratitude can become so difficult to practice. We are socialized, especially in the West, to focus on what we don’t have instead of celebrating what we do. Further, practicing gratitude can feel impossible especially when you’ve been so hurt and so wronged by life and the people in it. Hopefully this will not block you from at least giving the practice of gratitude a try in your process of letting go and lightening the load.
I thanked the old girl vocally before I left the room that day, and writing this article is a way of publicly offering my thanks. Yes, it’s to an object, yet think of how much this wisdom can also help us let go of the so-called “baggage” from our past that weighs us down—memories, shame-based scripts, unhealthy coping skills, and the impact of wounding relationships. We can thank those things and those people for the role that they played for us at the time. Even the horrible stuff—if you are willing, thank it for its role in bringing you to where you are today, hopefully on the precipice of a major shift in your continued healing and recovery.
Institute for creative mindfulness
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