I grew up tortured by the tenets of fundamentalist Evangelical Christianity, and in my young adulthood, navigated to conservative communities within Catholicism. While some use my background against me, saying that I’m unnecessarily guarded, I believe that proactively healing from the wounds of spiritual abuse these last two decades gives me an uncanny ability to call out rigidity when I see it. Even as a kid being volleyed back and forth between two devout parents in their own right (one Evangelical, one Catholic), I learned to see the merits of both. AND I couldn’t understand why we all seemed to resist seeing the common ground. That included Jews, and Muslims, and Hindus, and Jains, and Buddhists, and all the great wisdom traditions of the planet! To me, our beliefs have a common thread, yet I grew up in contexts where I was told differently. The first time I ever saw the now legendary CoExist symbol was on a billboard when I first visited Sarajevo in 2000. I turned 21 that summer and Bosnia-Hercegovnia, where I would remain to live and teach for the next three years, was still in the throes of recovering from a brutal civil war. Personally, I was struggling to identify my own spiritual path as I sought recovery from addiction. When I saw that billboard, I knew with every fiber in my being that the CoExist symbol was my path. I came to learn it had a name--sanatan dharma—the threads that unite us are the essence of truth and worthy of embracing. The rest is just details.
Resting into this spiritual path serves me well in my personal life, and it’s largely shaped my professional outlook. Which brings this all to eye movement desensitization and reprocessing (EMDR) therapy… An experience with a phenomenally integrative EMDR therapist in 2004 saved my emotional life (when I was two years sober and still struggling with maladaptive dissociation). I received my training in 2005-2006, and jumped in with both feet, regularly offering the therapy to my clients. While working on my doctoral studies, I first attended the EMDR International Association (EMDRIA) annual meeting in 2007. Brazenly, I introduced myself to EMDR founder Dr. Francine Shapiro to thank her for what she created, yet it was at the conference where I would also meet other wonderful people in the EMDR community who would made even more of a difference for me. One of those people was Dr. Sara Gilman from Encinitas, CA, who became my primary consultant throughout the certification process. She also helped me wade through my frustrations around the politics and personalities in the EMDR community that bothered me immensely. Sara was (and still is) a radiant, real human being who truly understood how my mind worked, and she never once tried to change it. She worked with it and helped me fall in love with EMDR even more! A line that she consistently used in our work together, when I struggled with some of the rigidity in the protocols was, “Jamie, this is what the textbook tells you to do. This is what I actually do.”
That guidance from Sara represents a balance that I hope I have also been able to impart as an EMDR clinician, consultant, educator, and training provider. This guidance was the inspiration for my first book that Premiere Education and Media published in 2011, EMDR Made Simple: 4 Approaches to Using EMDR with Every Client. I knew that the book would likely make me a pariah in the EMDR establishment, and at that time I didn’t care. I believe I had something useful to say from my lived experience about how fundamentalism and rigidity benefits no one, especially people like me with complex trauma and dissociation. Even at that point, I would sit in conference presentations and feel like the powers that be who got the microphone on these topics were talking in such intellectual terms about people who need to be treated in a very human way—the way that Sara treated me. As I learned that EMDR therapy can play well with other therapies and approaches in a spirit of integration and modification, I started bristling when people said things like, “Well, that’s not really EMDR,” generally in putting down a savvy modification or adaptation. It reminded me of hearing people at church say things like, “Well, then you’re not really a Christian if you believe, say, or do that (insert any violation of the "rules" here).”
Ouch—why were people connected to a therapeutic modality that I loved, a therapy that helped me to heal from much of that trauma, spouting the same kind of aggression?
I dug in to investigate my reactions that were being elicited, and in 2010 I ended up writing an explanatory model that would become the basis for EMDR Made Simple—something I dubbed “the Four Faces of EMDR.” The idea is based on a teaching of St. Augustine called The Four Voices of God, presented for a modern audience by Fr. Benedict Groschel in the book Spiritual Passages: The Psychology of Spiritual Development. We studied this Augustine teaching in my Catholic graduate program and it was honestly the most important take away for me. People relate to God in one of four primary ways—as truth, as fire/oneness, as beauty, and a goodness. Of course we can have secondary paths of relating (I am fire/oneness first, and beauty second), and we tend to get along the least with the people whose style of relating to God most differs from our own (e.g., for me that’s the “truth” people… the theologians, dogmatic types, and to offer a clinical parallel, the strictly quantitative researchers). Augustine taught that all are different, and all have their place, for God shows up in a variety of ways and forms.
Call me crazy (I truly don’t care, it’s a compliment these days), this idea seemed to fit as it relates to all psychotherapies and the controversies that ensue about model fidelity versus tendencies to innovate and to modify. And from there I proposed “the Four Faces of EMDR:”
I’ve long embraced that all of these faces of EMDR are valuable, and we need all of them in the clinical arena. Since I attempt to be as non-dogmatic as possible, I also agree it’s possible to identify with more than one face. For instance, although primarily Face 2, I have a great deal of Face 4 in me. I consider the Dancing Mindfulness approach to expressive arts therapy that I developed in 2012 to be an extension of my EMDR work and thus Face 4 in many ways. Additionally, a person may see themselves as somewhere between Face 1-2 or between Face 2-3. Although I am Face 2, I can pull out my "Face 1" language and savvy when I need it, especially in offering foundational (basic) trainings or in communicating my ideas to other Face 1 people.
I published this model in an attempt to promote some semblance of unity and cohesion among people who love and are intrigued by the wonders of EMDR therapy. Of course many resented me for it, and many considered me a genius for it… I’ll let you be your own judge of that. I’ve been thinking a great deal about “The Four Faces of EMDR” since the COVID-19 pandemic thrust an entire community of therapists, not just EMDR therapists, into working in telehealth…an area where so few of us are trained and where few research studies exist on best practices. As battles ensued around me over propriety and appropriateness in shifting EMDR therapy to telehealth (e.g., do you let people self-tap or not?, is it ethical to do trauma work online with people who dissociate?, is it prudent to venture into an area where there is so little research?, should we be taking advice on online therapy from people who are in different ideological camps?), the Jamie who wrote EMDR Made Simple ten years ago re-emerged.
I admit, especially since I am now an EMDRIA-approved trainer who has more Face 1 qualities than she used to, I’ve sometime wondered if EMDR Made Simple did more harm than good in helping therapists hone their EMDR craft. I am much less rebellious and a lot more party line as it relates to proper EMDR technique than I was back then. I’ve learned that the technique isn’t the enemy; it’s the attitude and approach that people take to the technique that causes problems. You can use it rigidly, or you can use it artfully. I even wrote two pieces lauding proper technique and explaining how I reconciled with the standard protocol here on this blog. I’ve come to appreciate that much of what I initially interpreted as rigidity in Dr. Shapiro was truly her push to get EMDR therapy validated as evidence-based by the metrics of empirical research. Even though thinking in those terms does not serve me either personally or clinically, I see how it serves our larger community. And in 2018, Springer Publishing—one of the largest publishers of mainstream EMDR material and the publisher of The Journal of EMDR Practice and Research—put out my second EMDR book (EMDR Therapy and Mindfulness for Trauma Focused Care, co-authored with Dr. Stephen Dansiger). Rebel Jamie from 2010-2011 was a bit shocked by that one!
Yet in the week when we switched over to telehealth and I struggled to find resources for my trainees and community—I listened to the different voices and the old Jamie who wrote EMDR Made Simple paid me a visit. I realized that rebel Jamie is who I need to be for myself right now, and how I need to show up for my students and my community. As I declared on a public webinar I did with my friend Mark Brayne on March 22, however you do EMDR in your office and in whatever face you work—transfer that to telehealth. Your confidence in your approach will inevitably translate and we can continue to ease or even end some suffering during this difficult time. There’s plenty of time to debate and even to research when all of this is over. For now, show up for your clients with whatever EMDR face you wear and do your best to honor other EMDR and EMDR-related clinicians who are doing the same.
When I first met the person who would become one of my spiritual teachers, he told me that I wasn’t ready. I asked him a series of challenging questions from the crossroads at which I found myself in life. I struggled to make sense of deeper yoga teachings that would help me move from a place of doing to being. Ever the good student programmed to challenge what I was told at face value, I persisted with my questioning.
“You’re not ready,” he said.
On one hand, he had a point. I hadn’t been ready for quite some time—but I was there. Present. Doing the work. Asking the questions. Preparing myself in a manner that would allow me to become ready. Yet on the other hand, I felt incredibly insulted to be told I wasn’t ready when I was clearly willing and making preparations. It made me think of every time I’d told a client, “You’re not ready yet,” and I suddenly chided myself, realizing how demeaning and degrading that could have felt for them. Since that incident in the Fall of 2015, I stopped using the word ready in clinical settings with my clients or in teaching with my students.
A visceral reaction overcomes me every time that I hear the word ready. Maybe because I realized how ugly it sounded when pelted at me. I also became attuned to how often people say, “I’m not ready.” And I recognized how frequently my clinical consultees, primarily learning EMDR and other trauma therapies, worry that their clients weren’t ready to go further with their work. When they express this worry, the subtext is usually that they do not feel ready to take a client further. Folks that I mentor can doubt their ability to teach a class or accept a professional opportunity I present, claiming they are not ready. Why did I suddenly hate the word so much? In addition to it feeling like an insult towards me, it felt like others were using I’m not ready as an excuse or an easy word to express distrust in their own abilities within the natural flow of process.
For years I taught the importance of client readiness in moving forward with deeper phases of 12-step work or trauma therapy. Yet my experience caused me to reevaluate the word and everything I believed about it. Like I do at any crossroads in inquiry, I turned to word origin for some answers. The word ready traces to the 13th-14th century Middle English where it is largely conflated with the word prepared or preparedness. Although there is an element of the original word usage that also implies promptness; i.e., not dragging out the process. Ready and prepared may seem like synonyms, yet there are subtle differences that may offer some solutions.
I’ve been posing the question quite a bit lately—to my friends and to the hivemind that is my social media following—about the difference between ready and prepared. Most seem to associate readiness as a state of mind or a mental quality whereas preparedness or being prepared is more logistical. There are plenty examples out there of people believing they are ready for something (e.g., marriage, a hike on the Appalachian Trial), only to find out that they are ill-prepared. For me, embracing the full meaning of prepare and all of its forms (preparedness, preparation) is where we find our freedom to grow and to realize our intentions. The Latin root from which we draw the English word prepare draws from the same root as to parent. To bring something to life! Taking the action to get ourselves prepared inevitably impacts our attitude of readiness. If we declare that we’re not ready and do nothing to get ready (i.e., prepare), we can find ourselves in an excuse-making loop for years. Moreover, consider that such a thing as perfect readiness may not even exist.
Amber Coulter, an artist I follow on Instagram, recently published one of her visual journaling pages that declared, “If we wait until we’re ready, we’ll be waiting for the rest of our lives.” My body rejoiced with an enthusiastic YES when I read those words. The answer to the question of why I held so much disdain for the word “ready” began to take shape. A few weeks later I taught a workshop on my Trauma and the Twelve Steps book. A participant posed a question about readiness to do the steps, especially the fourth and fifth step (the inventory and sharing the inventory with another human being steps).
“Who is ever really ready to do a fourth step?” I replied.
I offered that letting people off the hook from doing a fourth and eventually a fifth step is not the answer. Rather, how can we better prepare them for the challenges of these steps and guide them through the difficulty? I’ve heard too many sponsors tell people to “just do Step 4 and don’t come back until you’re ready to do the fifth.” With that lack of guidance, no wonder that people don’t feel ready and keep putting it off! To be clear, forcing people to do the steps is not the answer. I still believe there is value to not rushing any process. Yet playing the “I’m not ready” card, even if it is out of legitimate fear, can keep us stuck in the rut of life behaviors and emotional states that cause us problems. I have found that doing these steps are a lot less scary with proper preparation and guidance. Preparation and guidance can assuage the fear.
What if we could learn to replace the declaration of “I’m not ready” with the question “What can I do to get myself prepared?” There are other helpful questions too: “What kind of support will I need to grow into readiness?” or “How will taking action and making necessary preparations help me to get ready?”
The founder of EMDR therapy, the late Dr. Francine Shapiro, made a brilliant move when she named Phase 2 of the therapy Preparation instead of Stabilization. While many other trauma modalities use terms like stabilization, I find that this word can frustrate clinicians and clients alike. Clinicians can believe that a client has to be totally stable before they can handle deeper phases of trauma healing. Yet it may be impossible to achieve stability in a total sense until the person whose life is ruled by unhealed trauma engages in some deeper healing that allows them to process the impact of their trauma. When new trainees pose the very common question, “Are they stable enough?” or “Are they ready?” to handle deeper level EMDR, I generally respond with, “What are you doing to help them prepare? Remember, the phase is called Preparation. The objective is for the client to acquire enough mental resources and skills so that they can reasonable handle or tolerate what may come up when the work gets harder.”
I assure my clients, and pass this along to my trainees, that if they begin the deeper journey and realize they are not adequately prepared, we can always take refuge back in the Preparation phase and work on more skills and strategies. To simply say “I’m not ready,” especially when you have a goal of getting better, is generally not helpful. True, some people just need some time. Yet I encourage people to productively use that time by taking proactive steps, no matter how small, towards their own healing.
Perhaps my overachieving, good student tendencies that I’ve carried throughout childhood have simply carried over to how I approach the healing process. I recognize that my tone in this piece may come with an air of “no excuses” and I am aware of my privilege. Since I decided to get sober and well 18 years ago, I’ve had the ability to access healing resources in the form of counseling, psychiatry, 12-step meetings and other holistic practices. I also had seasons of my life where unhealed trauma rendered me paralyzed and unable to fully take advantage of them. Yet realizing what I do have and mustering enough willingness to prepare myself has long been the key that’s opened the door to readiness. I’ve seen people without the resources I have access to make up for it the willingness to prepare themselves in whatever way is possible. Which leads to a final question: When we say, “I’m not ready,” are we really declaring that we’re not willing?
Maybe. Maybe not.
I’ve seen the answer to that question go both ways for people. And in both contexts, the lynchpin seems to be preparation. Taking action steps. Change will come as it is meant to when we put one foot in front of the other with a minimum of stalling. There’s a recovery saying that it’s easier to act your way into better thinking than to think your way into better acting. This approach is generally more trauma-informed than change the thinking, change the behavior mantra that can dominate cognitive-behavioral discourse. Acting your way into better thinking recognizes that our thoughts keep us stuck. Our thoughts tell us things like “I’m not ready.” Our actions move us towards a different reality and eventually a different attitude and outlook on life.
As a certified therapist in both Eye Movement Desensitization and Reprocessing (EMDR) therapy and Dialectical Behavior Therapy (DBT), many times therapists give me the “huh” look when I say that I use them both – together. You know that look, head cocked to one side and brow furrowed. “I don’t see how that could work”, “my clients don’t like DBT”, “I don’t like DBT” and/or “it’s too structured”. “HOMEWORK?!?!” However, over my thirteen years of working in the field I have found EMDR and DBT to be a beautiful fusion. Just like fusions with food, two things that might seem counterintuitive to put together can turn out being even better than their standalone ingredients. Think about it: chocolate and chili, sea salt and caramel, brown sugar and ketchup (BBQ sauce). Dialectics hard at work!
Like my colleague Dr. Mary Riley, the culinary arts and metaphors have been a large part of my life. Many times, the metaphor of baking has helped me to make sense of new ideas, learn new concepts, or put my thoughts together more seamlessly. Before we dive any further into the kitchen with EMDR and DBT, let’s explore some introductory information first. For those in need of an orientation, the proceeding paragraphs will give a short explanation of EMDR and DBT. Note, trauma in this context is considered to be a “wound” not necessarily just the big traumas many of us usually identify such as war, a lethal accident/occurrence, or sexual assault/rape.
EMDR therapy is defined by World Health Organization in this manner:
“[EMDR] therapy is based on the idea that negative thoughts, feelings, and behaviors are the result of unprocessed memories. The treatment involves standardized procedures that include focusing on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements. Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.” (Marich, 2019).
Regarding DBT, Marsha Linehan the developer of the therapy states:
“Dialectical Behavior Therapy is a broad-based cognitive-behavioral treatment originally developed for chronically suicidal individuals diagnosed with Borderline Personality Disorder (BPD). Consisting of a combination of individual psychotherapy, group skills training, telephone coaching, and a therapist consultation team, DBT was the first psychotherapy shown through controlled studies to be effective with BPD. Since then, multiple clinical trials have been conducted demonstrating the effectiveness of DBT not only for BPD, but also for a wide range of other disorders and problems, including both undercontrol and overcontrol of emotions and associated cognitive and behavioral patterns Furthermore, an increasing number of studies suggest that skills training alone is a promising intervention for a variety of populations…” (Linehan, 2015).
Merging these together, just like chocolate and chili, if we look at the theoretical frameworks alone (cue the eye rolls from us more expressive arts types), EMDR’s AIP model is closely related to DBT’s Biosocial Theory. They both assert:
Now that we have our foundational principles in place, let’s bake a cake, shall we? The use of metaphors is frequently implemented in DBT and can help clients understand weightier concepts; just as the baking metaphor has helped me in my life. Let’s put on our aprons and get to work! The 8 Phases of EMDR can be considered the recipe while the application of EMDR is putting the ingredients together to bake. DBT’s role is that of fusion, again, the chili to the chocolate. With this idea of baking, DBT’s modules and skills (ingredients) can easily align with EMDR’s phases (recipe with ingredients). The recipe is as follows:
Voila! A perfectly baked therapy cake with all its yummy fusion goodness! To finish off our baking masterpiece, let’s talk about icing. Icing is what usually draws us to the dessert. Seeing those lovely frothed peaks of icing begging to be eaten, how can we say no? Icing, in this case, can be identified as the “sell” to the client; the explanation of why EMDR and DBT work so great together. In Phase 3 of EMDR, when we are getting the client activated, we can compare this to a raging fire or the extreme temperatures of an oven. When making the “sell” Arbeitman, Goodwin-Brown, and Loomis (2016) give the example that “DBT manages the fires. EMDR Therapy extinguishes the fires.” By educating clients that the fires of life will always be there in one form or another, we give them a choice. They can choose to use those fires and temperatures to bake a cake or choose to have those same fires burn them alive. I’m guessing your clients might want cake instead of ongoing emotional 3rd degree burns. So why not invite them into the kitchen and have them sample how the combination of chocolate and chili might sound odd?
Odd, and yet oh so tasty!
Arbeitman, D., Goodwin-Brown, R., & Loomis, G. (2016, April). Integrating dialectical behavioral therapy (DBT) and EMDR with suicidal and self-injuring clients. Presentation at the 12th Western Mass Regional Network Spring Conference, Amherst, MA
Koerner, K. (2012). Doing Dialectical Behavior Therapy: A Practical Guide (Guides to Individualized Evidence-Based Treatment). The Guilford Press. New York, NY.
Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder.
Linehan, M. (2015). Skills Training Manual for Treating Borderline Personality Disorder. Second Edition.
Marich, J. (2014). Trauma made simple: Competencies in assessment, treatment, and working with survivors. Eau Claire, WI: PESI Publications & Media.
Marich, J. (2019). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Training Course Part 1 and Training Course Part 2 Manuals. The Institute for Creative Mindfulness 2015. 8th Edition.
Institute for creative mindfulness
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