One of the most common questions I receive from consultees is how to make EMDR therapy their main modality and transition into being an EMDR therapist. They see the ease and comfort I have in my own practice as an EMDR therapist as well as in the group practice I co-founded. They want to emulate this and are stuck, not knowing the steps to take. However, what they don’t see are the years of work, education, training, consultation, client sessions, blood, sweat, and tears that went into building my clinical practice into what it is today. Cultivating a culture of EMDR therapy in your individual work with clients as well as your clinical setting is possible by being mindful of the following considerations.
Jump right in. A challenge I hear from new EMDR therapists is how to get themselves on board with EMDR therapy. Especially after part 1 of the basic training, many clinicians are completely overwhelmed by all of the new information presented and have a difficult time shifting their clinical framework from the old way of doing things to this new, seemingly mystical clinical framework. My best advice is to not wait. Jump right into to it as soon as you leave the training. Come Monday morning, start phase 1 with your clients and look for targets you can process. Also, schedule consultation soon after part 1 to further discuss and consult on how to implement the 8 phase protocol with your current clients. Schedule part 2 within a few months of completing part 1 even if you haven’t completed many consultation hours or started really using EMDR therapy much within your practice. If you wait, you will lose momentum as well as get lost in the new information. Months may pass before you tiptoe into using any bilateral stimulation, even just for resourcing. It’s okay if you have to read from a script during the first 100 sessions or ask the steps out of order periodically. Your EMDR sessions will be messier than what was demonstrated in the trainings; just keep jumping into it over and over again. Practice makes perfect and your clients will forgive you or not even know the difference if you asked for the VOC before the SUDs.
Shift your focus from clinical tool to clinical modality. Since its conception, the view on EMDR therapy shifted from a tool to use within therapy to an all-encompassing treatment modality. By viewing it as such, the approach is altered from having specific EMDR sessions in which you wave your fingers in front of your clients to engaging in EMDR therapy from day one with a client even without bilateral stimulation. Working through the 8 phases of EMDR therapy and understanding the effects of traumas/adverse experiences, further integrates EMDR therapy as a clinical modality. There are many insights and breakthroughs that occur in identifying the origins of negative beliefs and their associated traumas/adverse experiences. Knowing the power of these insights takes the pressure off of rushing into phase 3-6 when a client is not fully prepared and resourced and further highlights the benefits that occur even outside of reprocessing sessions emphasizing a culture of EMDR therapy within your practice.
Have the motto “we can process that!” I constantly have my ears open to potential targets and am known to say, to a bit of chagrin of my clients, “we can process that!”. Not all traumas/adverse experiences are disclosed at the beginning of treatment. Sometimes they are slow to reveal themselves because a client isn’t ready or is just ignorant that these potential targets are affecting their current functioning. With all the advanced EMDR topic trainings targeting specific symptoms and issues, there is potential for an endless number of special protocols. However, you do not have to be specially trained if you have a strong understanding of the basic EMDR therapy protocol and are competent in working with the specific population. Though there may be special considerations with different populations, you can target and process anything that proves to be a trauma/adverse experience. Attend consultation sessions and EMDR networking groups to listen to other clinicians’ experiences in identifying shrouded targets. The more you practice your EMDR skills, the more you will hone your intuition about what constitutes a good target.
Identify yourself as an EMDR Therapist. It is a self-fulfilling prophecy; if you identify as one, you are one. Introduce yourself as an EMDR therapist, which will give you ample opportunity to discuss your treatment approach with potential clients and referral sources. As you become more established, clients will seek you out specifically for EMDR therapy further cultivating the culture of EMDR therapy within your practice. I regularly receive requests from potential clients looking specifically for EMDR therapy indicating a familiarity with this modality. Initially after being trained in EMDR therapy, however, I had to convince all my clients to try this new-fangled therapy. It was a shift from their conceptualization of traditional talk therapy to a culture of EMDR therapy in which we identified potential trauma targets and used bilateral stimulation to desensitize and reprocess these targets. Despite my immediate enthusiasm for EMDR therapy, not all of my clients were as convinced, and it took some time, effort, educating, and demonstrating to create a culture of EMDR therapy within my own practice.
Get the word out. The more publicity and discussions about EMDR therapy, the more mainstream it becomes as a treatment modality. We can cultivate a culture of EMDR therapy in our clinical settings by addressing the effects of traumas/adverse experiences on the brain and explaining the Adaptive Information Processing model. Share the EMDR love with your friends and family. Post information and articles about the effects of trauma/adverse experiences and EMDR therapy on your social media. Host informational sessions at your practice or place of employment and work EMDR therapy into any presentations you are giving as a mental health provider. Network with other EMDR therapists by joining EMDRIA and regional network groups. If you are at an agency, hosting an informational session as a brown bag lunch can help education your colleagues in EMDR therapy. Also, ask your clients to provide testimonials about their experiences with EMDR therapy to their other healthcare providers..
Cultivating a culture of EMDR therapy can be an arduous process. You will constantly have to explain, reinforce, and reframe people’s beliefs about EMDR as a whole therapy framework. By jumping right into the 8 phases and identifying yourself as an EMDR therapist though, you will quickly begin to shift your practice to an EMDR therapy framework. Looking for potential targets within the therapeutic setting and getting the word out about EMDR therapy whether it is within your personal circle or at your practice or agency further cultivates a culture of EMDR therapy within your individual clinical practice as well as within your practice or agency. It will be well worth the effort as you process your clients’ traumas/adverse experiences helping them to achieve a higher level of healing.
I woke up this morning to the news that a mass shooting occurred in Dayton, Ohio, about 90 miles west of my home. This was the second mass shooting in 24 hours from which I am still reeling. Though these events did not affect me directly, it is still impactful because of the way it alters my thoughts, feelings, beliefs, and actions. I feel heavier, weighed down with worry, and just an overall sadness. Today, I was planning on taking my kids back-to-school shopping and can’t help but think “What if this happens there and should we even go?”
I hate this thought process and don’t want to live in fear of a tragedy happening to my family, but it’s something I can’t shake. These feelings reveal themselves in the conversations I have with my kids about what to do if a shooting occurs in a public setting. Not to terrify them, but to prepare them in a time of crisis. Unfortunately, this is a common dialogue I have with them to teach them how to keep themselves safe, and they have already gone through this narrative in their schools where they practice lockdown drills and have even been exposed to shootings within our own community. Again, though we weren’t personally affected by these tragedies by being there or having a friend or family member involved, these traumas do affect me personally as I move through the world and teach my kids how to move through the world. I have a heightened sense of worry and anxiety for my family and friends because you never know when it is going to happen.
As an EMDR therapist, I am acutely aware of how trauma can impact individuals in a variety of ways. It is important to understand how mass shootings and community traumas impact not just the direct victims but also impact the community as a whole. The obvious application of EMDR therapy is with any person who was directly involved in a shooting as a victim. There may be images, sounds, smells, somatic sensations, and other stimuli that are triggering and bring the experience flooding back into the present creating a fight, flight, or freeze response. All of these can be processed with EMDR therapy, releasing the emotional charge associated with these triggers and distancing the past from the present.
Survivor guilt is often talked about in conjunction with shootings. My friend was killed, and I survived. A stranger died saving me; if I was at that event that day, it would have been me that was killed. Our brain tricks us into believing that if I was there I could have stopped it, it’s my fault she died, it should have been me, or any number of negative beliefs that our brain uses to try to make sense of what happened. The problem is that these beliefs are just not true and most of the time our rational brain knows this (the neocortex). Our trauma brain (limbic and reptilian) just hasn’t caught up and is in fight, flight, or freeze mode. When you process the traumatic memories, the trauma brain links up with the rational brain, bringing an adaptability to these negative beliefs.
Hearing about these events on the news or through stories told by survivors can be traumatizing in and of themselves. This can instill the same trauma response as directly experiencing a traumatic event. These vicarious traumas can be reprocessed in the same manner using EMDR therapy by targeting the corresponding images you have about these events. Reprocessing these events with EMDR therapy can help desensitize the horrific pictures that go along with a mass tragedy. It allows you to bring these images and memories to an adaptable place letting go of the associated negative beliefs, putting the past in the past and building resiliency. By doing so, you can engage in everyday life and feel empowered.
As I take my kids shopping this afternoon for their first day of school outfits, I will still talk to them about what to do if some crisis occurs to prepare them to keep themselves safe. However, I will do this from a place of preparedness and not fear. I will also talk to them about the different tragedies in our community and how they can affect change just by treating others with kindness and respect and putting more positivity out into the world. I hope to instill in them a sense of safety, empowerment, hope, and love. I hope and pray nothing like this directly affects us, but with the frequency of these occurrences, I fear it is inevitable. My hope is that as we help people to heal and show loving kindness to others, the occurrences of these tragedies will diminish.
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 association 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.
I was sitting in front of a client one afternoon as she talked to me about the rape she had experienced a few months ago. As the tears streamed down her face, I began to feel my hands shake, not that she could see, but enough that I definitely noticed. She continued in details of what happened and I remember floating to the top of the room. As she cried, I could only observe her and watch without feeling as I had left my body and floated above myself. I could see my clipboard, writing nothing, see the steaming coffee beside me, hear her sobs and comments; what I could not do was feel anything…until I came back inside myself. The session was concluding and I was able to offer some superficial comfort as I escorted her to the door. When I closed the door behind her, I could see the bathroom door as I opened it. I saw my best friend standing there with another male friend of ours as they had this coy look on their faces. I recall thinking I was in trouble but did not seem able to react until they began to pull me along, down the hall, and into the bedroom. Once I was thrown to the bed and my clothes were being torn off, I could feel the tears on my cheeks, just like my clients. I slowly started to float above this scene and watched in horror. When I noticed I was still in my office and I was staring at the door, I came back to the present awareness, went to my desk chair and wept. I knew it was time to reach out for help. I could not control these memories, these feelings any longer.
I reached out to a colleague who was an EMDR therapist. She agreed to see me to help with anxiety issues I was having from work. My agenda was to be able to trust her enough to share this secret and work through it, but I remember being terrified to talk about it. The longer I met with her, however, the more comfortable I became and it did not take too long before I was able to tell her about the experience. That was hard enough, but as I sat in her office, I wondered how I would ever be able to release all the pain of the rape. How do you even begin to talk about this? How do you let go of this? How can you possibly ever trust again? Be whole again? She was very patient with me and, as I could, I began to share what happened with her. I was able to ask some of the questions I had been thinking and she began to tell me what she thought would help.
She introduced to me a procedure known as EMDR therapy. She explained that EMDR works to help resolve traumas and she talked about what we would actually “do” while in sessions. She said I would watch a light bar, following the light with my eyes, and this would begin to let these emotions process in my brain. I thought it was weird and probably would not work, but desperate for healing, I agreed to try. We talked about some of the negative beliefs I had about myself as a result of the sexual assault and how it had altered the way I see myself. I would have flashbacks and nightmares often and we talked about these as well. We took things slowly, as I could not handle too much at a time. She knew that and while pushing me somewhat, she also respected the boundaries, the lines I could not yet cross.
During the sessions, I watched the light bar and also wore headphones, which sounded a rotating “beep” back and forth in unison with the light. With both these forms of bilateral stimulation being conducted, I would picture things in my mind, feel what was going on in my body, and notice what memories or thoughts would come. Often a lot of emotion came out, sometimes I was not sure about what. This was all part of the process. We would target in on a belief due to a situation and then would let me “process” that, meaning I would watch the light, listen to the beeps and notice what happened in my body and mind. It only took a few times to realize something was happening with this process. I was beginning to deal with my past.
We continued to use this therapy to help process other areas of my life as well. Some of the other situations involved other sexual traumas I had not recalled with this great a detail. Although I was having these memories surface, I felt safe knowing we were working through this together.
I cannot say I enjoyed the therapy and remember many times leaving her office emotionally drained; yet I knew I was healing slowly. I recall one of the scariest times of the processing was when she had me hold the picture I was seeing of the rape in my mind and watch the light to begin to process this. Immediately I began to feel anxious as I pictured the scene. Although there was fear, what I realized was I was having these feelings anyway, but it was different this time. I could begin to feel myself releasing some of the pain through this process. I could feel some of the anxiety go from inside my soul. I was tearful as I followed this light and at times would sob. What was important to me, however, was that these images were beginning to change. I was able to see the incidents and not float away; I could stay inside myself and feel what I had pushed down for the first time in years. I was allowing myself to heal. Through the pain of the trauma, I was being led down a safe avenue to process this with the care and safety of my therapist right there, guiding me. I did not have to be alone in these memories anymore.
Sharing the story of the rape was one of the hardest things I ever had to do. To let someone else in to see my pain, shame, embarrassment, anger, and vulnerability was like an ache I had never before felt. But as my therapist always said, in order for true healing to happen, someone has to witness your grief. Until we can share that pain with another person, we will never truly be free of it. This made all the sense in the world to me as I had carried that grief around for years. Being free of it used to just be an unobtainable thought, but now through EMDR therapy, I could see real hope.
As I mentioned previously, I also began to recall with more memories and details a few other incidents that occurred in my childhood. Had I not been doing the bilateral stimulation that EMDR utilizes, I do not think I would have been able to recall some of the specifics that made all the pieces come together. I was able to remember what happened to me in that day care, in that school office and in that neighbor’s home. I was also able to share these experiences with my therapist and we worked through these as well. When I say working through it, it does not mean just forgetting and moving on. With EMDR, I was able to feel the emotions I had pushed down in regards to these events and begin to let the emotions go. It was as if all the years of pain came up and passed through me again. However, in order to be able to truly integrate this as part of me, this had to occur. I never knew what “processing it” meant until I discovered the EMDR journey. It was like a life saver to me. I was able to be free of the pain, not just pushing it away. I could recall the memories, but allow them to stay in the past where they belonged. I did not have to let them hurt me anymore in my present life. I could be free.
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.
“Jamie, when we first met, you brought up all of my popular girl issues and I didn’t know how to act around you.”
My mouth was agape when Ramona, a member of the Dancing Mindfulness community and now a senior affiliate trainer in our program, revealed this to me several years ago. While I didn’t wish to negate her experience, there was a part of me that wanted to rage back, “But you don’t understand! I’m anything but a popular girl. After all, the popular girls in school gave me a complex that’s taken years of therapy to repair!”
The images of that chubby girl with a bad perm being teased and set up on the Catholic school playground in elementary school came flooding back. The panic I experienced in junior high that I would never be “liked” in that way by a boy or a girl rose up in my chest. The despair in which I found myself as a competitor in high school speech because I never felt pretty enough, talented enough, or likable enough to win the top prizes came into the clearest view. Then I realized—even as an accomplished professional with a public image, I still let the kids I perceive as more popular affect me. And it turns out that many of us still do, long into adulthood.
There’s a great deal of talk about impostor syndrome in pop psychology literature and on social media—the fear that one day people are going to expose us as the frauds that we are and realize that we’re full of shit and have no business to be working in our fields. What I am putting out there for consideration is related and yet essentially different—the popular kid complex. This is the fear that no matter how hard we try, how great we look or how talented we are, we’ll never be invited to sit with the popular kids at their lunch table. While we can argue that in an ideal, spiritually enlightened world there ought to be no such thing as lunch tables and that external metrics of this nature shouldn’t matter, we do live in that world. And no matter how hard we work on ourselves or how deeply we invest in our spiritual practices, things like this can still matter even to the steadiest among us.
This idea may feel like just another variation on the keeping up with the Joneses concept, always wanting more out of a sense of competition. To explain how I see the popular kid complex as fundamentally different and even bigger problem, I’m going to call myself out on my own shit. Many years ago, I set out on the path of my teaching career as an extension of service and continuing to live in the eleventh step as described in a 12-step program—to pray for knowledge of my Higher Power’s will and the power to carry it out. At first I was simply over the moon that people wanted to book me for trainings and read some of my articles. The more I kept putting myself out there, I gratefully received more teaching invitations and my first book contract in 2011, primarily to write for other therapists.
Then at some point, I found myself getting intimated and maybe even a little jealous by the likes of Brené Brown, Gabrielle Bernstein, and Anne Lamott. They are popular! They are on the New York Times best seller list! They have a reach beyond just their niche market. Oprah invites them onto Super Soul Sunday, the ultimate cool kids lunch table for modern times. Here’s the kicker—I like their stuff, I adore their teachings. They put themselves out there the way that I would like to, and what still stops me short is this fear that I will never be as pretty, whimsical, charming, likable, talented, relatable, or popular as they are. I am even prone to thinking thoughts like, “Why does the world need teachers like me when they have teachers like them?”
Fortunately those thoughts come and go, as I know at my core that what I do in my work is a direct fruit of me asking my Higher Power and the universe to make me a vessel, in whatever form that may take. But as much as that spiritual perspective keeps me grounded, I am still human. My meat suit and all its programming can get the best of me. In the language of recovery, I can still get in my own way.
Sometime last year I looked at jealousy—is it that I’m just jealous of people who are better than me and can get things done where I can’t? The teachings of the Kripalu-Amrit lineage in which I study yoga helped me through that one. I accepted that jealousy is a fear that, at my core, I am not enough. Jealousy is about being cut off from the reality of my true Self and my true nature where none of us are separate. Spiritual me gets that. Human me still struggles.
I was recently doing some of my own EMDR therapy on this matter and the Brené Brown brings up my popular girl issues and I’ll never be likable enough to get a Netflix special was tripped-wired. The therapist working on me said “go with that” and I immediately blurted out, “Brené Brown is my Marla Carano.”
Marla Carano was the best speaker in the Ohio region where I competed my senior year of high school. Tall, articulate and charming, she looked about ten years older than the rest of us, wearing a stylish olive green suit for major competitions. She went to one of the powerhouse suburban high schools where her father was the legendary head coach. As a kid from a city school with a small team, I believed I could never be as cool as her. To be clear, she won on her talent. Also to be clear, Marla was always a gracious competitor and genuinely nice to me. I never felt anything like a “mean girl” vibe coming from her. Yet I could never shake the fact that I would perpetually be second or third next to the likes of her because I wasn’t as pretty, whimsical, charming, likable, talented, relatable, or popular as she.
And the reality is, in what has since become the classic Dr. Jamie Marich move that has defined my adult career, I wrote a pretty avant-garde original oratory for high school speech tournaments. My speech created conversations with other students and even other judges even if I didn’t necessarily win top prizes. The move I made that year to put my voice out there is the gutsiness that I celebrate and applaud in my own students. That move, I believe, made me the speaker I am today whose primarily livelihood is literally forged on my ability to go up there and speak truth without fear.
So why isn’t that enough? At seventeen, one could say I was still in high school and having a place in the spotlight matters. But I’m nearly forty. Why can I feel, especially within myself, that life is still a damn speech and debate competition? Maybe it is. After all, I’m still vying with others to win teaching contracts, spots as a keynote, deals with publishers. The cynical and yes, human, side of me knows that there will always be an element of competitiveness to life. As I continued to “go with it” in my own EMDR session that day the larger, spiritual truth filled my heart—teaching and being public in my field must never be a competition.
Our purpose as healers is to alleviate human suffering, bringing one of Buddha’s noble truths into beautiful fruition in this world. This task takes all kinds of people—those who have mass appeal and those who have niche appeal—and all types of talent. Working the front lines of community care in places like correctional facilities, treatment centers, and poorly funded public mental health facilities requires talent and commitment. People who will never give a training or write a book have a different yet wholly essential talents that I do not. This is where the heart of our work is happening and when I get into crazy places with my own ego, I must remember this truth.
In preparing to write this piece, I reached out to Marla Carano Honen, as we’ve been in touch on Facebook through the years. I wanted to make sure she was okay with me putting an article out there in which she is my nemesis of sorts. Marla is anything but a villain; she has helped me to see a higher truth. And in speaking with her about the premise of the popular kid complex—guess what? It affects her too! I firmly believe we are all that “popular kid” to someone who brings up their issues, and all of us have popular kids who bring up stuff that as adults we must learn to heal and to manage.
I also had the chance to spend some time on a retreat (Ram Das: Spring on Maui) with one of my legendary popular kids, Anne Lamott. And guess what? Anne has struggled with the perils of comparison and can still face her own share of dark thoughts. What I learned from her so robustly on retreat is that she continues to put one foot in front of another by working a 12-step program and reaching out to safe people with whom she can be honest. And in a story I ended up sharing with her, Anne helped me to sink into much of the solution.
After sitting through another beautifully folksy talk by Anne in her awkward loveliness, I walked to the back of the pavilion to get some tea. I thought to myself, “Jamie, even though you are getting more public with your work you will never be as likable as that.” And literally in the next breath a lovely young yogi comes up to me and says, “I like watching you dance at the kirtan. It’s so inspiring!”
Okay, I’m human enough to admit that part of my thinking went to, “Wow, a perfect looking young yogini likes the way I dance, I matter... I am valid! Roll credits.” Fortunately the spiritual truths of what I’ve been learning and studying kicked in and gave me the real lesson: When I dance, I am my most authentic self. I dance absent any kind of technical prowess. Dancing and responding mindfully to the music is the purest experience of being a vessel for Divine energy to flow. That doesn’t make me popular, and yet it does something much more magical. It attracts the people who need to feel it too so that hopefully they will be inspired to open up and be their unique expression of Divine flow.
And hmmm... doesn't this sound like something Brené Brown would teach in her groundbreaking work around vulnerability? Turns outI just had to work on my edge around her to fully open myself up to the teaching. From the bottom of my heart, I thank you Brené and all of my other popular kids for allowing me to "go there" and receive your wisdom.
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.
One of the great blessings of my life is to have a Jewish mother and a Jewish family in Squirrel Hill. When I heard the news of last week’s massacre at Tree of Life Synagogue in Squirrel Hill (the hub of Jewish life in Pittsburgh, Pennsylvania), I was in Montana leading a clinical training in EMDR therapy, the trauma modality that brought Sharon Saul—my Jewish mother—and I together. Although the news revealed to me that the synagogue attacked was not Sharon’s, it is in close proximity to her home in a community that is very tightly knit. Until I was able to get to Squirrel Hill myself on Tuesday morning and give Sharon a hug, something was unsettled within me. Although Sharon and I remained in touch via text and telephone after she turned hers back on following Shabbat, seeing her was the balm my soul needed. In our communications, she relayed the multiple messages defining the vigils and prayers she attended: The answer to combating all of this hatred is to fight the darkness with light, and to increase our acts of goodness and kindness.
The connection that Sharon and I share is an example of how two very different people can unite in a spirit of goodness and kindness, which is why I feel led (with Sharon’s blessing) to share our story. On Thursday night we sat in her home, a place that's become a haven to me over the years when I offer trainings in Squirrel Hill (about an hour and a half from my home base in Ohio). We were both awestruck by the workings of HaShem in bringing us together. HaShem is a Hebrew name for G-d (literally meaning "The Name") that I’ve come to use in many of my references to Divine presence. Our friendship is, of course, a beautiful Institute for Creative Mindfulness story which is why I’m posting it on our blog. I hope others may also draw some inspiration from our message and our story.
I first met Sharon in Monroeville, Pennsylvania sometime in 2013. I was still working the national circuit for PESI, an educational company, teaching general trainings on trauma-informed care. In this 2-day course, presenting a live clinical demonstration in eye movement desensitization and reprocessing (EMDR), my method of choice for treating trauma-related concerns, was part of the syllabus. As I did dozens of times before and have done hundreds of time since in my teaching, I asked for a willing volunteer for the demonstration, inviting them to come up and see me over break for screening. This lovely, traditionally dressed woman raised her hand immediately. During our screening, as we talked about her background and the issue she’d like to work on, Sharon revealed that she is an Orthodox Jew. Although she seemed to be connecting to what I taught in the course, I experienced a bit of an internal struggle, wondering if someone so traditional would respond to what I had to offer. I’d long identified as rainbow flag-waving tattooed rebel dismissive of most things connected to organized religion or anything traditional. Yet something inside told me immediately that I loved this woman and her willingness, and I was delighted when Sharon responded so well to her work in the demonstration.
Afterwards, in amazement, Sharon declared, “I have to learn this!”
She went on to explain her frustration that every EMDR training she ever found took place over the weekend which would not work for her as an Orthodox Jew. Specifically, Sharon is a Hassidic Jew in the Chabad-Lubavitch movement with a strict adherence to Shabbat observance. Training over a weekend just wasn’t an option for her, even though other folks from religious traditions have missed weekend services before to come to trainings. Sharon began traveling to Ohio to learn from me as I developed my initial training models and ideas around teaching EMDR therapy, expressing only gratitude that she was able to engage in this study during the week and in a mindfully delivered, intuitive way that matched up with her almost forty years of experience as a hypnotherapist. The more she studied and consulted with me, the more I began to trust her as a clinician and to truly love her as a person. The questions she asked helped me to grow as a clinician, and I developed an even deeper sense of wonder about Jewish faith and traditions.
In 2015 when I became officially approved by the EMDR International Association to offer basic trainings in EMDR therapy, Sharon immediately courted me to come to Squirrel Hill where she practiced and lived. She said something like, “I can get you every Orthodox therapist in Pittsburgh to come to the training if you can offer it during the week.”
When one of Sharon’s colleagues first met me, I got the once over, punctuated with the commentary of, “You’re the Jamie, Sharon’s teacher? You’re so young!”
Although I’ve gotten my fair share of the “you’re so young,” comments throughout my career, this one did not impact me with any insult. Rather, it helped me to understand why I respect Sharon so much. She is constantly willing to learn something new, especially from those of us in the younger generations. I watch how her grandchildren teach her new ways of seeing the world, and I hope that I can emulate this spirit of hers to constantly be a learner as I grow up into the example she is setting. And although I started as her teacher, it’s safe to say that we have both been each others’ teachers as our friendship has grown.
Coming to Squirrel Hill to train was a good fit for all of us—for Sharon’s community of clinicians in the neighborhood and for the growing Institute for Creative Mindfulness wanting to establish a base in Pittsburgh. When I visited Squirrel Hill for the first time, some tears filled my eyes. There are moments here when I feel like I’m in Eastern Europe, where I spent a great deal of late teens and early twenties studying and working, primarily in my ancestral homelands of Croatia and Bosnia. There’s just something about the vibe of Squirrel Hill and its Jewish soul, beautifully blended with other cultural influences in the container of Pittsburgh, its own cultural wonder, the visceral epicenter of our region’s heartiness. Something magical happens here at this area around the intersection of Forbes and Murray Avenues. In the past three years I’ve adored working with the people of Squirrel Hill and I enjoy spending time here with both friends and Sharon’s family. Sharon has always taken great care to assure that a guest bedroom in her home that is set up to accommodate her large family for holidays is always ready for me when I come to town. I typically stay in one of the basement guest rooms and sleeping down there feels like I’m in a warm cave being blanketed by an entire house that’s full of tradition and love. I’ve said for several years now that Squirrel Hill is truly my second home.
Sharon has seven children and a slew of grandchildren (I can never keep count). I’ve had the privilege to get to know many of them and their spouses, including one of her sons who is now a budding therapist and has trained with me. I attended the wedding of her youngest son and considered it the greatest honor ever when Sharon began caring for me in a way that led her to declare, “I’m sorry, I can’t turn off the Jewish mother in me.” The first time is when we were leaving her house in Squirrel Hill—it was a rainy morning and we were crossing the street to my parked car, on our way to the training site. A car came unexpectedly whizzing down her street and she brought out the infamous “mom arm” to protect me. Later that year, Sharon and I roomed together at the EMDR International Association conference in Minneapolis. While I’ve enjoyed a wide array of roommate experiences as I’ve traveled for work over the years, Sharon’s attention to detail in making sure I didn’t forget things and that I had a sounding board for things going on at the conference warmed my heart. She once again said something like, “I can’t turn off the Jewish mother,” and I thought to myself, “Nor do I want you to.”
My entire life I’ve struggled with feeling accepted by the people closest to me, especially in my family of origin, because my beliefs and way of being in the world is so different from their traditional (Christian) views. Sharon’s acceptance of me, even as a religious woman, includes a full embrace of my soul and my questions, even when we disagree on certain approaches to life, faith, and identity. While I wish that more devout people from all faith traditions would learn from Sharon’s example of acceptance, knowing her gives me hope that the healing power of what St. Benedict called radical hospitality is possible. Sharon’s willingness to bring me around her family and feel the warmth of their friendliness and the candidness of their interactions with me—even though they are all religious and I am more of a liberal hippie, “spiritual but not religious” type makes me know in my bones that we all have more in common than not. Knowing Sharon Saul and having her as my Jewish Ima (mother) is nothing less than a corrective experience in attachment. And it’s restored my faith that getting to spend substantial time with people from faiths and cultures other than our own is a big part of the answer to bringing about the healing of the world.
So, it’s little wonder that I wanted Sharon to join our Institute for Creative Mindfulness team as both a consultant and a facilitator as soon as she was eligible. In the midst of this Squirrel Hill tragedy she referred to EMDR therapy as “God’s tool for healing,” and I cannot disagree! She is a fabulous educator and mentor and serves our EMDR trainees well. Sharon is responsible for building enthusiasm about EMDR therapy in Squirrel Hill, working very hard to find us good spaces to train during the week. So many of the therapists we have trained here are now on the front lines of working with the community this week and will be in the coming weeks as the people of this neighborhood seek answers and healing.
But even if Sharon didn’t work with me in this professional capacity, I would still want her to me my friend… and of course, my Jewish mother. Even in the midst of debriefing her own experience of this week’s tragedy with me, Sharon still offered me spiritually on point advice about my own love life and my career path, as any attuned mother would. As we sat together the other night in our moment of awe at the Divine dance that brought our lives together, it dawned on me that a friendship like ours and everything it represents is the answer to the madness in which we find ourselves in this modern world. This isn’t something, even as a writer, that I can put elegant syllables together to explain. I simply challenge you to experience it if HaShem ever gives you the chance, because HaShem will.
In her infinite, faith-filled, maternal wisdom Sharon declared, “HaShem, you have a view of the bigger picture. I trust you when I can only see the parts of that bigger tapestry.”
Sharon and I both had the opportunity to do trauma response work this week in Squirrel Hill and were amazed at how this tragedy is bringing other things to the surface for people that have long needed healed. This poses, once more, the age old question: Is tragedy’s hidden gift the sparking potential it holds to stir us into action, first within ourselves and then in our communities? The idea of changing the world can feel overwhelming and impossible, especially with the hopelessness and hatred that seemingly paralyzes our existence. Perhaps the real answer is to heal ourselves and then make a difference on a one-on-one relational level, as Sharon and I have done with each other. When the small pearls of these healings and interactions string together, we create a valuable and beautiful force that will transform the world.
After working together today at the Jewish Community Center here in Squirrel Hill Sharon continued with her teaching for me that began the night before on the importance of the bigger picture: “It just feels like the redemption really is at hand and all of us good people doing all the good we can and all the healing we can it’s our job to just tip it. It feels like we’re almost, almost, almost there.”
“I have to do what?!?”
My gut squelched as I voiced my protest in the form of this question. For years I yearned to take a full 200-hour yoga teacher training. Because of my hectic schedule with my own training work, arranging one never seemed possible. In the interim, I committed to taking many weekend modules in trauma-informed and recovery yoga, in addition to deepening my own practice. In 2015, I formally discovered the Amrit Yoga system developed by Yogi Amrit Desai, carrier of the Kripalu lineage to the United States. Having been invited to Amrit Yoga Institute (AYI) as a guest teacher in a recovery program, I immediately fell in love with the Integrated Amrit Method and knew that when the time came to take a full teacher training, it would be at AYI. Several amazing things fell into alignment and I was able to take the full 200-hour program in the Summer of 2018, split into two, ten-day modules. When I presented for the first module, my teachers informed me that when returning for the second module, I would be tested on the Amrit method script… and 70% compliance was required to pass!
After my initial question, more protestation flowed: “They can’t box me into a script!,” “I am anything but a scripted person, what the hell did I get myself into?!,” “I haven’t had to do this kind of rote learning since graduate school…what do they expect me to learn from this!?!” Then it dawned on me: the teaching methods employed by the AYI team are not too dissimilar from what I ask my eye movement desensitization and reprocessing (EMDR) trainees to do. In EMDR therapy training, even in a system as mindfulness-infused as my own Institute for Creative Mindfulness curriculum, trainees are asked to stick to a script. In the heart of EMDR therapy, often referred to as the trauma reprocessing stages, the script is very precise as required by the EMDR International Association. While there is room to adapt in some of the other phases, we still ask our trainees to follow a prepared script as we have found this to be the most solid method for educating the majority of our adult trainees who pass through the program. A key difference is that I was being asked to memorize the Amrit Method script and we don’t expect memorization from our trainees, simply that they read from the prescribed script until it becomes second nature to them.
While my challenge felt slightly more difficult, I knew the process would allow me to step into the shoes of what I’ve been asking my trainees to do over the years. A key factor in what helped me to stay optimistic about learning the script is that I as the teacher was allowed to use my own words to teach what is called the second part of the pose in Amrit Yoga. The second part of the pose is the artistry—giving students the time to bask in the stillness of the pose after taking deliberate movement in the first part of the pose (what I had to memorize). A similar process occurs in learning EMDR therapy. There is room for bringing your own clinical judgment and artistry into the practice of EMDR; yet this ought to only come in the context of first assuring a solid technique in one’s set up.
In my several month process of studying on my own and then returning for the second module of intense practice before being tested, I threw every tantrum possible. In addition to the standard issue “I can’t do this” and “I’m incapable,” I found myself beginning to resent the yoga method that I really loved very much and credited with changing my life. I did not feel the same allegiance to Yogi Desai that many of my fellow students and teachers felt and the challenge to “respect his words and his language” didn’t particularly resonate. I did, however, resonate with an explanation given by a teacher that the scripted portion of the pose is designed for us to know how to get people into and out of poses safely. By learning time-tested language for this, the burden of having to grasp for optimal language was removed. As Kalindi, my small group mentor whom I resented many times during the process, taught: “When you don’t have to worry about the language you’re using, something Higher will come through.”
I fought the notion that using someone else’s words—granted words and concepts that I liked very much—would allow my Higher Self to come through in my teaching. By the end of the training process I realized that my dear Kalindi was right. The moment of realization didn’t even come when I took my exam. Although I got through it well and was even able to correct an error that I made with a reasonable degree of elegance, it was in our final class for the whole community that the magic happened. Each of us in our group got to teach a pose and at the relative last minute, I was assigned what I perceived to be one of the more difficult poses in the Amrit sequence: Warrior I. There are a lot of moving parts in the script for Warrior I even though this is a yoga pose I’ve practiced for almost a decade. Getting up in front of my entire cohort and other members of the community, I breathed into it and didn’t experience a shred of nerves. The pose just flowed through me and the experience in my body was one of the most powerful I ever felt as a teacher. And I teach for a living! By time the second part of the pose rolled around and I shared from the organic learning of my own practice, it clicked why Yogi Desai and the entire AYI team put me through this process. I felt a freedom within the structure, and it was glorious!
Throughout the process, and especially in that final class, I realized the power of why we have EMDR trainees learn from a script. For many years I bristled against this teaching methodology. Sure, I learned from the script when I did my own EMDR training in 2005-2006 because I had to. From that initial learning, I found myself resisting the technique of it and improvising a great deal. Much of this adaptation was clinically justified, artistic, and especially needed in serving the most complex clients whose processing work in EMDR therapy will not be very likely to follow a textbook flow. I had a fabulous early consultant who helped me to navigate the finesse around adaptation and modification. After I finished my consultation period, however, I was drawn to other approaches to EMDR therapy that were even more modified and less structured. There was a period of a few years where I taught and even advocated for many of these less structured approaches to EMDR therapy. In becoming an official EMDR trainer, a role that I resisted accepting for years out of fear that I wasn’t “technical” enough, I learned to fall in love with the scripts and the protocols of EMDR in a new way. I discovered that in working with the majority of adult learners that we serve, having the scripted core protocol as the base is the foundation from which a successful EMDR practice in built. As I discuss with my co-author Stephen Dansiger in my latest book EMDR Therapy and Mindfulness for Trauma-Focused Care (2018), the standard protocol is rich with mindful language and concepts, evidence of Dr. Shapiro’s own foundation as a mindfulness practitioner. Granted it took years to work through my initial tantrums about not being a person who exists well in a box to see the beauty in the technical aspects of EMDR. I learned to appreciate that the principles, techniques, and protocols were not the boxes I once feared them to be. Rather, they are tools like paintbrushes, paints, and canvases that allow my clients, with my guidance, to create works of art.
The words of Nirali, my lead teacher throughout the yoga teacher training experience at AYI, sum up what I’ve come to learn as both a yoga teacher and an EMDR therapist/trainer. In one of our closing classes she said, “Learn the rules so that you know how to break them elegantly when you need to. But if you don’t learn the rules you just come off as amateur.” For anyone currently struggling to learn any system that makes you feel boxed into a script, I encourage you to consider this wisdom. If years down the road you are still feeling boxed in and stifled there may be a larger issue to consider here about whether the approach in which you’ve been trained is right for you. My hope is that after an initial period of practice in any scripted or protocol-driven approach you will feel more liberated to be yourself instead of less liberation. This is the art of allowing your Higher Self to shine through in your work, in your life, and in all that you do!
Institute for creative mindfulness
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