Not So Much of a Rebel: Making Peace with the Standard EMDR Protocol by Jamie Marich, Ph.D., LPCC-S, LICDC-CS, REAT, RYT-200
When EMDR clinicians learn that one of my specialties is addiction, I usually get asked, “Which protocol do you use? FSAP? DeTUR?”
I’m often met with surprised looks when I respond, “I use the standard protocol mixed with good common sense about how addiction works, which informs my preparation approach. I don’t find any of the specialty protocols particularly useful.”
I realize you may be gasping right now since, in EMDR circles, lots of buzz can be heard about the specialty protocols and methods that EMDR practitioners are developing. I participate in several Facebook EMDR groups and almost every day I read a question to the tune of, “What protocol do you use for addiction?,” “What about dissociation?,” or, “Is there a specialty protocol for condition x, y, z?”
So many times I have bluntly responded, “Um, the standard protocol mixed with clinical judgment about preparation needs and how to use appropriate interweaves.”
One of the reasons I decided to write this piece is so that I can cogently share my position as an EMDR therapy trainer, author, long-time clinician, and notorious EMDR therapy rebel. What’s funny is that when I wrote EMDR Made Simple in 2011 I called out many problems that I saw with party line EMDR. Yet as I’ve matured as a person, a clinician, and a trainer, I’ve realized that maybe I’m not so much of a rebel after all. For me, the standard protocol really is where it’s at. Learn the standard protocol well within the context of the client’s goals for treatment and know where to point the targeting sequences, and you really have all you need to do successful EMDR with a wide variety of presentations. The adaptive information processing model will guide you, as will the larger breadth and depth of what we as trauma-focused clinicians are learning about the importance of embodied, somatically-informed affect regulation skills.
In this piece I further explore my position by explaining my approach as a trainer to client context and adequate preparation. Then I explore my thematic perspective on client history, which allows me to direct the standard protocol in the direction it needs to go in order to work with a particular client presentation. Finally, I look at where interweaves and modifications may be appropriate depending on the complexity of the case involved. Since addiction and dissociation are my two main specialties in EMDR therapy (and the two main conditions for which I have been personally treated), I will draw on several case conceptualization strategies for these special populations.
One of the first pieces of wisdom I internalized from reading Dr. Shapiro’s early works is not to do EMDR with a client you wouldn’t normally feel comfortable treating anyway. In my interpretation, this means that the task falls on us as clinicians to learn more about a particular condition that may be stumping us as a general best practice. One of my biggest concerns with the rising popularity of addiction protocols is that well-intentioned EMDR clinicians who know little about addiction are simply pulling out the protocols and hoping for the best. When this happens absent the larger knowledge about the various models of addiction, the interplay between trauma and addiction, and the impact of the stages of change, inadequate care can be delivered. In one of her first books Shapiro wrote that “addiction should not be treated in a vacuum,” (Shapiro & Forrest, 1997) yet I fear this is what happens when EMDR therapists just pull out one of the specialty protocols without educating themselves more on the intricacies of addiction first. The same applies for dissociation and dissociative disorders, or any other specialty presentations that may puzzle you—start by reading up or furthering your continuing education on the generalities of that population and their needs.
Adequate preparation in EMDR therapy involves much more than just doing one Calm Safe Place exercise. Although I train the skill in my program, I discuss its limitations, and it’s one of only many strategies that I teach. While the classic skills of Calm Safe Place (which often involves changing up the descriptive adjectives to meet the client’s needs), Light Stream and Container are still very useful, they can all be very visually biased if not modified. Furthermore, to truly help a client manage affect, tolerate distress and be prepared for what may arise during trauma reprocessing (Phases 3-6), we must explore other skills.
In our program, we teach a wide variety of mindfulness strategies in a trauma-focused way (i.e., allow for modifications, emphasize not just reading the skills out of the book, rather, having a personal practice yourself as a clinician and teach from that experience). Mindfulness strategies can include traditional sitting meditation, moving meditations, mindful exploration of the expressive arts, and learning how to turn all activities of daily living into chances to practice present-moment awareness. Teaching a client breathing strategies and body scanning skills in a trauma-focused way is also imperative. Existing skills or approaches that you utilize in other modalities like dialectical behavior therapy, 12-step facilitation, or yoga can all be very helpful in teaching principles of lifestyle change and grounding. In the spirit of true trauma-focused care, the needs will vary from client-to-client depending on their existing experience with such skills and the intricacies of their presentation. I’ve learned that the more complex the client, attending to preparation in this total matter is more helpful than any specialty protocol just slapped into the treatment process. You can visit a comprehensive library of these skills and watch how I use trauma-focused language in apply them by visiting the resource site Trauma Made Simple by clicking HERE.
And no, I cannot give you a script about how many of these skills you’ll need and in what dosage. That is where clinical judgment and having done your own personal work comes in to make you as effective as possible. Personal work with these skills is important so that you know what it means to modify and adapt skills for your optimal benefit, which puts you in a better position to do this with clients. While scripts can help us build our skills, a practice that most adult learners need and that I endorse, scripts can rarely help you apply them in the absence of practice and context. To intone the wisdom of Jennifer Emch, one of my program graduates and director of Ubuntu Wellness in Chardon, OH, “Life isn’t scripted and neither are people.”
In addition to understanding the imperative of trauma-focused and enhanced preparation in EMDR therapy, we must also consider as EMDR therapists that taking a chronological history is not the best way to go. Although I agree with Shapiro’s essential position that targeting the earliest memories first is ideal for getting to the root of any given problem, due to the nature of how complex traumatic memories are stored in the limbic brain, taking a chronological client history may be impossible. Or at very least, impractical. Most clients I’ve worked with over the years cannot track a chronology, have blanked out significant pieces of time, or get very tangential when we try to take a conventional history due to the disorganization in the limbic system. When I was trained many years ago I learned the 10 best memories and 10 worst memories method for taking client history, and I’ve also found this ineffective. The most effective approach to holistic client history taking I’ve found over the years, and the approach I teach in my program, is to discover potential targets thematically. Let’s use an addiction-specific example.
For many clients new to a recovery process, there is a willingness to do EMDR therapy reprocessing and yet there may be insufficient affect tolerance to go to the earliest instances of abuse or trauma. For optimizing engagement, you may be better suited to work with their goals for recovery first, while respecting the trauma history that led to the problem in the first place. Many individuals struggling to get better, regardless of their specific goals, carry a negative belief like, “I cannot deal with my feelings without alcohol (or other drugs/behaviors). That is a negative belief that can be “floated back” using questions like, “Thinking back over the course of your whole life, when is the first time you got the message that I cannot deal with my feelings without alcohol.” You can also ask the question for the worst or most recent. What you get from the client all represent potential areas that you can target. Might these targeting sequences link in to earlier, more impacting traumatic experiences? Of course. Yet targeting them this manner is, in my experience, a kinder, gentler way to go and helps them to see the relevant connection of the EMDR work to what may be their biggest issue of concern in therapy. To see some examples of how I conduct client history in a thematic way, please visit the video demonstrations section of the Institute for Creative Mindfulness website by clicking HERE.
One of the wisest pieces of direction I received in my rather traditional basic training many years ago is that the greater the degree of complexity in the case, the more level of interweave you will need. I feel that learning the principles of cognitive interweaves (as described by Shapiro in her texts and further elucidated by other great minds in the EMDR community) is essential to doing EMDR with addiction, dissociation, and other special situations that may throw you for a loop. Yes, the classic directive in EMDR therapy is to stay out of the way as much as possible. Yet I was delighted to see Shapiro (2018) use the phrase proactive measures so much in the third edition of her text. To me, solid interweaves work as a plunger of sorts. When the flow of reprocessing is clogged, we can apply good open-ended questions, gentle pieces of encouragement or psychoeducation, and mindful or somatic techniques to get the flow going again. Although I teach a list of common interweaves in my program and Shapiro offers some solid examples of them in her text, the best interweaves are the ones that you develop through constant practice of EMDR and working with consultation to hone your craft.
Sometimes we can get nervous talking to consultants or other EMDR therapists about modifications, fearing that we’ll get “called out” on deviating from protocol. Yet consider how all of these specialty protocols that we can get so excited about in the scripted books or special trainings are really just twists and turns on the standard protocol anyway. They are proactive measures. One final modification tip that I can offer from my clinical experience on working with complex issues like addiction and dissociation related to the part of the standard protocol where we are asked to get an image (or worst part) from the client. I’ve always liked the language of worst part because it recognizes that some memories, especially pre-verbal ones, may not be stored with an image. With folks who may not have sufficient affect tolerance to handle going to the “worst part,” yet who have done all they can with preparation skills, you may be better suited to ask, “What part of this target memory are you willing to work on today?” Then proceed with the standard protocol from there. This may make reprocessing more digestible for the client in the spirit of EMDR therapy Phase 2.5. Yes, you will likely have to go back later and check to see if there is an image or worst part in a separate targeting sequence in order to achieve completion of the target in a technical sense. Yet consider how this modification may be more tolerable for individuals.
If you are the type of adult learner who needs more of a scripted protocol to learn new information, that is more than okay. I know that as a trainer I could not survive without using scripts with my students. And yet there comes a point in your development as an EMDR clinician when you must realize that the scripts are just modifications. These specialty protocols we can all get excited about are just very necessary modifications. No, modification is not a dirty word as long as you are able to clinically justify why you are making the modification or, in the case of Phase 2 preparation, enhancements. Doing this well and in the most trauma-focused manner will eventually involve you moving away from scripts and other peoples’ protocols and working to hone your own clinical common sense.
Shapiro, F., & Forrest, M. (1997). EMDR: The breakthrough “eye movement” therapy for overcoming stress, anxiety, and trauma. New York: Basic Books.
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing therapy: Basic principles, protocols, and procedures, 3rd ed. New York: The Guilford Press.
When I first started to use EMDR with my clients, particularly with more complex cases, there seemed to be more that needed to get done before trauma processing. There needed to be more resourcing but also something that is able to touch a deeper trauma that is inside of our clients. Shame is usually the culprit.
Mason (2013) stated that, “shame safeguards the spirit.” When shame is our reality, we don’t feel good about ourselves. Shame is generally learned from experiences in our most vulnerable developmental years. However, since memories can be moved/restored through the process of memory reconsolidation (Ecker, Ticic, & Hulley, 2012), our reality is subjective to the meaning we give it. This teaching may question our foundation of what composes our reality. Even more to the point, it calls into question the very essence of who we are.
In the Institute for Creative Mindfulness EMDR therapy training, we explore the client’s trauma targets using a thematic approach. Addressing traumas in a thematic way allows the client to address what they believe and how they feel about themselves in order to rewrite, renew, or own their story. Because of this, anything can be targeted with EMDR, if it holds adaptive or maladaptive value and the client can emotionally access it. However, what about the experiences that are there but not recognized consciously or that started before narrative or declarative memory developed in the brain?
Let me first acknowledge the difference between what I am presenting and Paulsen and O’Shea’s (2017) “When There Are No Words” protocol. Paulsen and O’Shea’s stance is that their protocol “reset the hardwired neuro-affect circuits” and this is done in Phase 2 Preparation. What I am presenting here is an option for clinicians who are not trained to do “When There Are No Words” (or are having difficulty following the nuances of protocol they downloaded off the web). Paulsen and O’Shea’s protocol can be helpful for clients; however, I also believe that accessing implicit memories through what I am suggesting holds additional value on two levels. One, it is a good and safer place to get “buy-in” from a client, and two, if it does not go as we would hope, it can be “diagnostic.” I want to gain access to my client’s earliest wounds. What I am proposing is more of a “Phase 2.5” intervention that links Phase 2 and the reprocessing Phases 3-6 (Marich, 2019). This intervention allows clinicians to address our client's preverbal schemas with any and all thematically shame-based core belief clusters because this is actually where the cluster begins.
Shape and Color Set-up: While taking clients trauma history (Phase 1) and assessing core beliefs (Phase 3), I am looking to put their core beliefs in two categories: shame-based (i.e., I am bad, I am worthless) and fear-based (i.e., I am in danger, I am powerless) core beliefs. Before floating back on a core belief I will ask, “Do any of these shame-based beliefs just feel like they have always been there?” (I will either ask this during Phase 1, Client History or Phase 3 Assessment.) Nine times out of ten, clients will identify a shame-based negative cognition. If the clients pick a fear-based cognition like “I am in danger,” I stay away from it because it is most likely linked directly to an event that can be directly recalled and I am not trying to have them start reprocessing a direct memory. If this happens, I will guide them towards a shame-based core belief.
After resourcing in Preparation (Phase 2), assessing targets (Phase 3), and establishing some kind of stop signal, I then have the client create a target of the core belief felt-sense by asking, “What shape and color would represent this ‘has always been there’ belief?” Once the client has the image (and negative cognition) then it is standard protocol time (i.e., Phases 4-7 and Phase 8 in the next session). Future template can be done but I feel that because I am priming the pump and that there are declarative memories still to go, I wait until I see how the client responses to the process and do future templates with memories that are able to be recalled.
Rationale: I am trying to see what is going on under the hood and also preparing their memory system for reprocessing shifts. My reference to the shape and color or image comes from Mark Grant’s work on pain management (1995). Paulsen and O’Shea also use this strategy; they do not, however, want you to activate the client. My position is that if we are addressing the client’s schema, that they are feeling all the time, they are already activated. Again, I suggest doing this on shame-based themes and not fear-based ones because I believe it is safer and the client is less likely to activate actual memories. However, activating shame-based memories does happen. In this case, I will guide them back to target or go back to resourcing. If the client has too much shame then the standard practices of creating some distance between the client and image, having the client pendulate, or taking only doing a fragment is advised. To further support my position, if the theme carries a high SUDs, which it normally does, Shapiro (2018) suggests doing a more intense early memory first because if they can do this, then they can handle whatever else is to come. Lastly, and for obvious reasons, this is actually the start of the cluster.
Buy In: Starting with a shape and a color allows the client to test-drive reprocessing. When clients open up to reprocessing they are opening themselves to their own healing. When that positive shift happens, they have experienced something that is effective and they will have more buy-in into their treatment. When, as the clinician, we express that it is a more indirect way of reprocessing EMDR, it implies that we are starting someplace safer. Clients appreciate this. Also, since their core beliefs are something that they already feel and live with on a daily basis they are familiar with it and okay talking about this more than their traumas. Once they have seen a shift in this, then now know and have direct experience that EMDR therapy works for them.
Diagnostic: Doing this is also a good test run to see if the person is able to do the deeper work and can be diagnostic in the sense that you get a feel for the clients protective/dissociative system and their level of preparedness on an unconscious level. Ideally, this is assessed in Phases 1-3 of EMDR but it is not always apparent on an unconscious level. Obviously, we need to have rapport, do assessments like the DES (at a bare minimum), and use our clinical judgment but it is not always obvious how someone’s unconscious will respond. If the client picks a shape and a color that goes from dark to something light and has freed something in them or they feel lighter, then chances are they are ready to do the deeper work that they are coming to us for. Additionally, they now have direct experience with feeling a shift in their emotional body, particularly with something that feels like it has always been there, again, we get a lot of buy-in.
As clinicians, we also get a lot of information regarding diagnostics if the client cannot remember their early childhood and/or by seeing if the client can do calm/safe place or container. If they cannot do this effectively then there is more going on in their dissociative process that is worth discussing with them (Paulsen, 2009). I started doing the Color and Shape Set-up before having the Dissociative Table (Paulsen, 2009) as a tool in my EMDR toolbox. I now will start with the dissociative table, O’Shea and Paulsen’s “When There Are No Words,” and then this Color and Shape Set-up, when appropriate.
Observations: The shame color/shape/image is usually dark. When reprocessing goes well, people get to a bright and lively color and/or translucent image. Sometimes, it just disappears. When it does not go “right” the image usually stays the same and clients will say, “it does not feel like it is going to move.” This is clinically telling and potentially diagnostic so more psycho-education and resourcing may be needed. Yes, some clients will have the wherewithal to identify that “it has always been there” or “I just feel it.” This insight may indicate where they are at in their readiness to do deeper reprocessing. This suggests to me that they are highly attuned to their body and are already primed to do EMDR or trauma reprocessing.
Generalization: Generalization is when the client starts to reprocess all of the thematic memories in a cluster (Ecker, Ticic, & Hulley, 2012). This happens because once a core belief is resolved in an earlier memory the lesson learned is applied to other similar situations. Since the brain works through making associations, any association can connect to the neuro-network that rides this theme is going to be impacted, hence has the opportunity to be reprocessed. If the client is consciously and unconsciously open to healing then they are going to do a great deal of work starting in this way.
Populations: I particularly love doing this with people are addressing their addictions because they are usually living in their right-brain processes. This also goes for people who are creative and children between the ages of 2-12 respectfully. Highly motivated adolescents respond well but other adolescents find it weird. Similarly, I like doing this with personality disorders as well because it gives them the opportunity to allow shifts to happen, and/or challenges them if it does not. It provides experiential material to work on. For more left-brained people, it can be a challenge but it gives them the opportunity to connect to their more emotional side.
Healing Light: Also, consider that this can be done in combination with healing light. I will have clients get their SUDS down to a like 2-3 and then I will perform the healing light or Light Stream on the remainder. I have witnessed some very spiritual and religious experiences by doing this.
Target Order: When I do a floatback and get the earliest memory if it is not between the ages of 2-5, I have my client’s try and float further back. Because of what I am purposing, with regard to schemas and shame-based beliefs, it is implied that the earliest recall memories are going to be represented around the chronological ages of 2 to 5. Our expertise that tells us that the schemas started before the age of 2.
Clients are coming to us for our expertise on the therapeutic process and trauma etiology, which can conflict with letting the client lead or decide what memory to do first. If I have a client who wants to address something more recent or only one specific memory then I will have them try the Color and Shape Set-up first as a test run. Similarly, if there is no discrete memory (Greenwald, 2007) or test run memory to do, I also do this. There are times when having the client lead or pick a memory that they want to work on can be effective. Allowing the client to lead the selection of targets without any guidance, however, can be what creates more work later. So, we have to have a good case conceptualization in order to maximize the outcomes of healing and our conceptualization has to be based on trauma-informed care, which means to me, safety first. What this writing ultimately comes down to is that traumas are compounded in the memory network because our neuro-networks are associative and by previous traumas so starting off at the earliest is the safest and will be more likely going to produce better outcomes (Greenwald, 2007).
Feel free to contact me for individual consultation or attend my weekly group on Friday’s 12-2pm EST.
Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.
Grant, M. (1995). From https://emdrtherapyvolusia.com/wp-content/uploads/2016/12/Mark_Grants_Pain_Protocol.pdf Retrieved on 2/8/19
Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. Binghamton, NY: Haworth Press, Inc.
Marich, J. (2019). EMDR Therapy Phase 2.5: Honoring a Wider Context for Cnhanced Preparation. [Blog Post] Retrieved from https://www.instituteforcreativemindfulness.com/icm-blog-redefine-therapy/emdr-therapy-phase-25-honoring-a-wider-context-for-enhanced-preparation-by-jamie-marich-phd-lpcc-s-licdc-cs-reat-ryt-200
Mason, M. (2013). Women and shame: Kin and Culture. In. Claudia Bepko (Ed.), Feminism and addiction (pp. 175-194). New York, NY: Routledge
Paulsen, S. (2009). Looking through the eyes of trauma and dissociation: An illustrated guide for EMDR therapists and clients. Bainbridge Island, WA: A Bainbridge Institute for Integrative Psychology Publication.
Paulsen, S., & O’Shea, K. (2017). When there are no words: Repairing early trauma and neglect from the attachment period with EMDR Therapy. Bainbridge Island, WA: A Bainbridge Institute for Integrative Psychology Publication.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures (3rd ed). New York, NY: Guilford Press.
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.
Institute for creative mindfulness
Our work and our mission is to redefine therapy and our conversations are about the art and practice of healing. Blog launched in May 2018 by Dr. Jamie Marich, affiliates, and friends.