Shapiro: History and Overview
A chance discovery by Francine Shapiro in 1987, forever changed the recovery of trauma processing. When Shapiro was taking a casual walk on campus, she noticed being triggered by negative cognitions and memories. The thoughts were quickly desensitized with spontaneous and continuous eye movements. Continued research and practice evolved the process of EMDR into what it is today, not only desensitizing the trauma, but reprocessing the memories to encourage them to “fire and wire” together in a more functional way.
Shapiro concluded that when she shifted her eyes back and forth and tried to re-access the memory it seemed to feel less intense in emotional responses. Implications of the continued research may take some time to be solidified as they continually retested and restructured. The evidence of success is a challenging objective, but one with continued persistence that has been making large strides in the field of counseling and trauma processing. The implications of EMDR being based on a chance discovery allow for some misconceptions and skepticism of this more recently developed trauma resolution model. Some research showing the differences between EMDR and hypnosis help to alleviate some disbelief. Also a few legal cases seem to have begun to be more open to EMDR as an effective treatment model, but this process may take some time to become even more of a conventional trauma method.
The change in designation from EMD to EMDR in 1990, is one of the shifts that occurred with continued developments. Shapiro describes the initial focus of desensitized memories shifting to a more adaptive reprocessing paradigm. Along with desensitization came spontaneous insight and cognitive restructuring which allows for an association to positive affect and neurophysiological shifts. Therefore, not only were the memories desensitized as initially discussed, they were now being reformatted, to align in a healthier thought pattern.
The Adaptive Information Processing Model encourages the cognitive, emotional and somatic elements to interact for processing. Continued evaluation of this process is being conducted to show evidence in its success and explain the rapidity of results with the patterns of responses. By accessing the different areas simultaneously and bringing together additional theoretical models and procedures, reprocessing can occur at a rapid speed.
The AIP model channels the different parts of our awareness simultaneously to get memories unstuck in our mind. While accessing our cognitive, emotional and somatic parts we shift the memory that in a previous talk therapy session might not have seemed possible. Clinically this process will rapidly reduce symptoms of distress regarding a particular trauma, negative cognition and level of functioning.
By targeting the stored dysfunctional memories during EMDR clinical pathologies are amenable to change. By taking a thorough client history and preparation prior to EMDR, clinicians can avoid substituting their own ideas and allow the client to identify memories that have created negative self-concepts over time. This shifts the role of the therapist who previously probed for clarity surrounding meaning and now an active, but also hands-off approach allows the client to be guided, but not lead to healing.
By adequately preparing for EMDR sessions with the client, forming trust, and utilizing phrases such as “good” and “go with that”, the client continues to process the memory to more functional thought patterns while the therapist avoids substituting their own thoughts into the process. Substituting the therapist’s thoughts can prevent adequate and successful processing in most situations, however when a client is stuck, cognitive interweaves can allow clients to continue reformatting on their own.
This shift for therapists to avoid traditional talk therapy can be challenging, however the research is proving interrupted processing is detrimental to progress. The ability to access the memory with cognitions, emotions and somatic while attending to all channels will help speed up recovery from traditional talk therapy. To allow for natural processing is the most effective for clients, but when stuck cognitive interweaves can be helpful for suggestions and processing. When we interrupt this natural flow of alignment of the memories it can be more difficult to see the success of the treatment.
As a client it can also be challenging to trust in the experience of processing. Especially if a client does not have coping skills, it can become triggering for them or cause an abreaction. As a client, I also found it difficult not to share the experience at the next session, however this might shift with time as the process becomes more natural.
The behavioral approach of prolonged exposure can be challenging for clients to tolerate. While managing their anxiety and continuously exposing clients to triggering stimuli can be effective, it takes longer to complete which can seem unfavorable to clients. EMDR may seem similar to this initially due to initially maintaining the traumatic event in memory, however the amount of exposure is much less and there is no effort to exacerbate the level of anxiety. There is also a failure to address the irrational cognitions or to provide alternative coping strategies which leads to a high dropout rate in therapy.
With cognitive behavioral approaches, it can be more effective, but a full determination will continue to need more research. Although a cognitive behavioral approach has many diverse techniques, one important factor that EMDR addresses is the integration of new desirable self-statements and an alleviation of inappropriate self-blame.
Highly compatible with psychodynamic approaches, the “completion tendency” is similar to EMDR’s blocked processing paradigm, in that it continues to rework schemas by accessing the numbing and avoidance behaviors until integration occurs. EMDR seems to enhance the free associative process of “working through” the memory in insight and integration.
AIP case conceptualization and set up is thorough prior to trauma processing which helps with the formation of positive memories and “adaptive resolution.” The case conceptualization takes into account developmental origins, memories and schemas. This helps with making connections to appropriate associations and is adapted into a positive emotional and cognitive schema.
History taking, case conceptualizations and treatment planning (phase one)
Assessments during the history taking phase in treatment can help with identification of target list for processing. A few assessments which identify true traumatic events, or things that happened that shouldn’t have, include the impact of event scale, life events checklist and the life stressor checklist.
These assessments can be done with the client in session to help identify events for the target list. It also can help with a client who may not identify the events as traumatic or be avoidant in the discussion. It can continue to help build rapport and can help with identification of trauma.
The assessments that can help identify neglect trauma, or things that should have happened that didn’t, include the YSQ-S2, to identify schemas and the Young Parenting Inventory (YPI). The adverse childhood experiences scale (ACE) can also identify both things that should and shouldn’t have happened that are considered targets for trauma reprocessing.
Case Scenario:
“Peter”
A 35 y/o Caucasian male presents for therapy. He is currently single and reports struggling with relationships on and off for most of his life. He has a distant relationship with his parent and feels close to his one sister from time to time. He presents for therapy with symptoms of anxiety and depression and feeling a lack of connection with others. He describes at times suicidal thoughts and a history of drinking.
Peter reports this problem has gone on as long as he can remember and he gives an example of being yelled at in the elementary school cafeteria and a cognition of “I don’t belong” and feeling “embarrassed”. Treatment goals include decreasing symptoms of anxiety, depression including suicidal ideation. Along with improving social interactions, maintaining healthy relationships and communicating effectively with others while building healthy coping skills.
In history taking, Peter identifies targets of dad yelling, being mistreated by kids at school, a break up in college, dad’s meltdown, janitor yelling at him, grandpa’s death, parent’s divorce and the death of his cat. In using the three pronged protocol this list lays the ground work for dysfunction and these traumas are processed which allows for new associative links and adaptive information.
The current circumstances targeted next include the difficulty with relationships which he more clearly identifies as feeling lonely after trying to talk to someone and being shut down. This processing will allow for the internal and external triggers to be desensitized. This would also include any recent break ups and losses in his life. He may process, the changing of jobs, not having someone to talk to at a recent party, and running over a rat with his car.
The third prong would include future orientation and planning by using imaginal templates to assist in adding new skills for continued adaptive functioning. Using the future template Peter could imagine himself coping with anxiety and maintaining a healthy conversation with someone. With the positive belief of “I fit in as much as anybody” and a new sense of confidence. Any new blocks or anxieties about this future scene would processed.
Often when ordering memories, starting with the earliest memory and working through the past first can be beneficial. At times this may clear out current events that may not need the same processing they would have. The list of memories is ordered below. I would start with the earlier memories first. However also keeping in mind that the hardest part of the memory might be the reaction of others, which is why it may be helpful to process mom and dad’s reaction first due to the higher SUDS rating. Then identifying other schemas or themes I would work on next set of past memories prior to working on the more current situations.
Order Age Memory SUDS
1 3 Me screaming in my crib and no one came for me 6
9 25 Bad breakup with Jimmy 5
6 8 Grandpa swore at me 3
8 12 My first date went badly 4
7 16 My teacher called me a loser and said I’d never make it in college 5
2 5 Christmas got delayed due to a blizzard 5
10 19 I got expelled from college 9
3 5 Mom and Dad screaming at each other 8
11 40 Broke my leg skiing 5
5 6 Chris’s friend touched me sexually 7
4 7 Mom and dad wouldn’t believe me when I told them about Chris’ friend. 9