EMDR in a Nutshell: Healing from Trauma

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What Is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) is a guided process that supports trauma work by using “bilateral stimulation” (BLS), or stimulating each hemisphere of the brain alternately via the senses. EMDR also involves talking, deep breathing, and other ways of grounding the nervous system. (“To ground” the nervous system means to bring its level of activation back or closer to the “ground” or baseline level.)

There are many kinds of BLS that can work well, although eye movements have been shown to be the most effective. In my practice, I use a combination of eye movements (watching a light or my finger moving back and forth), as well as sounds alternating in each ear through headphones—whichever the client prefers.

When we first meet, I work together with my client to figure out what combination of sounds and colors feels best. (A person’s own report is the best indicator for what kind of stimulation works best for them.)

Rather than medicalizing distress, EMDR provides a way of healing from trauma. EMDR isn’t about trying to treat the symptoms of an illness. It’s about healing from the root cause.

What Can EMDR Treat, and What Is It Not Helpful for?

EMDR can be very useful for trauma, specific anxieties and phobias, and many forms of impact left behind by difficult experiences or relational patterns. EMDR can be effective for Complex Post Traumatic Stress Disorder (C-PTSD) and developmental traumas.

Another form of EMDR called Eye Movement Desensitization (EMD) can be helpful to reduce distress due to overwhelming or complex traumas and triggers, which can be used in place of or in preparation for additional reprocessing.

EMDR can be used to prepare for specific future actions (public speaking being one common example).

It is even possible to use EMDR for memories that may be vague, pre-verbal, or otherwise not fully available to consciousness. This is accomplished by processing the physical responses and triggers we have in the present.

EMDR is less directly useful for depression, grief, the impact of neglect, and other experiences we might characterize with the word “lack.” Many or most forms of difficult human experience involve both fear and loss, and working on the somatic or body-based reactivity to trauma with EMDR can allow grief work to become tolerable. In other words, EMDR can open the way for other therapies (such as psychodynamic, existential, and other “talk” therapies) to be more effective.

What Is the Difference Between a Traumatic Memory and Other Memories?

Each memory we have is stored in a “neural tree,” which (in theory) is a structure of cells that we could pick up and look at. Our non-traumatic or ordinary memories have many “branches” into the frontal cortex of the brain, which allows us to describe the memory with language, and into the hippocampus, which allows us to put the experience into the context of time (i.e. we know it happened in the past and therefore that it is now over).

Conversely, the neural trees of traumatic memories have fewer of these branches, and they also have a greater number of “roots” that anchor them to the amygdala, which is the fight/flight/freeze center of the brain. (“Freezing”, or dissociation, can be thought of as a protective numbing response to the “fight or flight” responses of anger, anxiety and fear. “Drifty,” “numb,” and “confused” are some words clients who experience dissociation have used to describe how it feels to them.)

This makes it much easier for a traumatic memory to activate the adrenal glands, and thereby the threat response system throughout the whole body. This is what we mean when we colloquially use the word “trigger”: the body has been activated for survival in response to a present stimulus that is meaningfully reminiscent of the past.

What Is Trauma Work?

“Trauma work,” “trauma processing,” or just “processing” are all shorthand ways we refer to helping neural trees grow more branches and untwine their roots! EMDR can make this process much easier and faster, though the process itself is ancient. We say that the brain “knows” how to heal itself, much like how the skin “knows” how to heal a cut. EMDR gives the brain support—much like how antiseptics and bandages can support healing wounds of the skin.

As we said above, unprocessed traumatic memories are less connected to the frontal cortex. This means we have less ability to use language to “look at” the memory, instead of “be in it,” and it’s much harder for our systems to believe that the memory is in the past and that the threat is over—it can feel like it’s happening all over again. “Naming it to tame it,” or putting experience into words (which, in EMDR, happens between doses or “sets” of BLS), helps grow more connections to the frontal cortex.

Another reason doing trauma work is one of the greatest challenges we face is because the brain and body don’t have a system that tells us we are in “mild distress.” We can only adjust between “life and death (fight, flight or freeze)” and “calm (rest and digest).” Recalling traumatic memories, alternating with taking breaks, helps the “roots” into the amygdala unwind and the survival system to quiet.

So even contemplating trauma work can feel like life and death! It’s important to be aware that there’s a reason for this intensity, and that after successful processing, it will fade. Working on trauma is not likely to be comfortable, but if it is not tolerable for my client, we stop (using a stop signal we agree on before we begin). If that happens, we focus on support and using grounding skills until their nervous system is closer to baseline. Trauma work is not as hard as trauma!

How Does EMDR Work?

EMDR allows us to process trauma by activating traumatic memories at the same time as it gives the nervous system cues for safety. This creates an “in and out” rhythm, which helps the brain get back in sync, and supports your brain in building connections to the neurons that store these memories.

We have data that clearly show that EMDR gets good results. Science is still exploring the reasons why EMDR works, but here are some of the most popular current theories, one or all of which could be true:

  1. The back-and-forth visual motion communicates to the amygdala that your body is in motion, which tells the brain that it is safe, active, and not trapped.
  2. The ocular nerve or other sense organs are stimulated, the activity of which facilitates rewriting (basically, it gets the area “warmed up” and ready for change).
  3. Stimulation of the sense organs takes up some of the brain’s bandwidth and resources (such as oxygen and glucose), which means less is available to fuel panic responses.
  4. The eye moments mimic what happens in REM sleep, another time when the brain is processing and storing memories. (This process is not fully understood, but it’s theorized to be similar to how EMDR and BLS work.)
  5. Trauma disrupts the natural rhythm of brainwaves, and EMDR provides a “corrective” rhythm to resonate with the brain as it processes disruptive memories.
  6. Predictable structure while talking about trauma is distracting and calming.

Any form of verbalizing trauma while in the regulating presence of a trusted other will have beneficial effects, for at least two reasons. First, “If you can name it, you can tame it”: Language activates the frontal cortex, which helps to build neural bridges, as well as causing a release of endorphins and other soothing neurotransmitters.

Second, our nervous systems are built from birth to monitor the internal state of others (including breath and pulse rates), and to resonate with them—so sharing a story with someone who is calm can help us calm ourselves while we tell it.

What Happens During an EMDR Session?

EMDR has a few different phases. In the first phase, I lay the groundwork with my client, including practicing grounding skills, setting up a stop signal, getting more familiar with BLS, and making sure they have a crisis plan and other supports in place in case they need help between sessions.

Next, we work together to come up with some “headlines” of memories to target, and explore the client’s feelings and beliefs about these memories. This doesn’t mean it’s not ok if we discover more along the way, but it can help us find some good places to start. In fact, we might say that it’s more likely than not that other memories will come up. That’s neither good nor bad, it’s just the brain going through the networks of association it has.

If relevant, we may also set goals at this point for a future action the person is working towards.

Most often, BLS is not used until session two (although this does not mean that processing cannot begin in your brain before that!). At that point, I work with the person to bring up the memory we agreed to use as a starting point, paying attention to the sense information, body feelings, and emotions that go with the memory.

Then, we do about 20 to 30 seconds of BLS. During that time, I ask my clients to “just notice,” “go with,” or “follow” what they’re noticing inside themselves. At the end of every “set,” I ask them to take a deep breath, tell me a sentence or two about what they’re noticing, and then we repeat.

It’s kind of like you’re on a train ride, and I’m on the phone with you, asking you what you see out the window.

Sometimes, what a person feels and notices from set to set will change, and sometimes it won’t. It’s even perfectly normal to have periods of feeling nothing at all. This is often the brain’s way of resting, assessing safety and connection, or otherwise taking care of you, and sometimes the best thing to do is just notice that feeling for a few minutes.

Although I keep a close eye on how my client is feeling as we go, I trust their own report most of all—as a person is their own best guide to how they’re doing. Some experiences are not always visible from the outside, such as “red lining” (panic, fury, etc.) or “blue lining” (dissociating).

I always tell my clients that if they think they’re feeling too much or too little, or are otherwise outside of their “zone of tolerance,” it’s important for the healing of their nervous system that they let me know. That way, we can take a break and use grounding skills before we continue.

Most sessions are spent doing sets for about 20 to 40 minutes. At the end of every session, we wrap up by using grounding skills to return the person’s nervous system to a tolerable state. I also ask if there’s anything they want to “leave in the container of therapy” (which doesn’t mean it won’t come to mind between sessions, but rather that they will set the intention not to continue to focus on it). Then we check in for a minute or two so we can both share thoughts and observations about the session.

Reprocessing can take several sessions. On average, it ranges from 3 to 12 weeks, though it can be significantly shorter or longer. Sometimes a person may feel different by the end of a session, and sometimes they may not.

What Do I Do Between Sessions?

In between sessions, clients may continue to process memories, meaning they may still be remembering, feeling, or even dreaming things. If that happens, their job is to notice it as much or as little as they’d like to, and then use a grounding skill. (“They don’t work if you don’t use them!”)

The client’s most important job, and their only “homework,” is to keep their nervous system and emotions within tolerable limits as much as they can. (It’s ok if they can’t do this perfectly, but it’s important to set it as a goal to strive towards.)

There are a number of questions we check in about as we prepare to engage in EMDR:

  • How will you know if you’re outside of your tolerable zone?
  • What grounding skills will you use?
  • What friends and family can you connect with, whether to ask for help using grounding skills, talk about what you’re feeling, or just to share space?
  • If you are unable to ground yourself on your own or with the assistance of loved ones,   what hotlines and/or mental health professionals will you call and how?
What Might Be Different After EMDR Is Complete?

The good and bad news is that EMDR does not make you forget what has happened. After processing, accessing memories of a traumatizing event will feel much like accessing any other memory. The most noticeable difference will likely be that the memory no longer creates an overwhelming body response.

After EMDR, it’s common for a phase of grief work to begin. This can involve feeling sadness and anger, as well as (in some cases) shifts in sense of identity or what is important to us. Sometimes we need support to explore questions like “Who am I without this fear?” or “Is it ok to get better?” Continuing in talk therapy after EMDR is over may help people continue to integrate their experiences and to heal.

To anyone contemplating EMDR, I wish you good healing, and congratulations to anyone who is willing to take the risks to talk about the hard stuff. I believe the greatest gift we can give to ourselves and to others is to make room for our feelings.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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58 COMMENTS

  1. Kerry

    This was a great summary of EMDR therapy.

    When I was doing active therapy (including EMDR) with people (until 2015) I found EMDR to be especially helpful for trauma victims. In some cases I saw remarkable positive changes take place in just a few sessions.

    People expend a great deal of energy throughout their life trying to avoid and/or “outrun” their memories of trauma experiences. These efforts are often labelled and falsely *medicalized* as “depression,” “anxiety,” or “Bi-polar” etc….

    EMDR can allow some people to finally “slow down” and look at these past events in a safe place, AND with an adult mind that’s more capable of reprocessing these events in a way that appropriately assigns “responsibility” and allows for more self empathy.

    When bad things happen to children they often “take on the badness as if it were their own.” This fills children with enormous amounts of guilt and shame at an early age that they often carry into adulthood. EMDR can sometimes finally provide the safety and necessary distance from these events to more appropriately access true responsibility and so-called “blame” for events that the trauma victim blamed on themselves.

    We now know that each time someone remembers past events they are actually recreating new memories, because there is a process of reprocessing going on that re-edits these past events with the current *adult* outlook and moral capabilities and standards.

    With EMDR people do not forget the past trauma events, but are often much more able to tolerate and “own” the memories. and especially NO LONGER have to expend so much self defeating energy running from those past memories.

    Understanding this about trauma and the positive qualities of EMDR therapy (when carried out appropriately) helps explain and expose just how harmful psychiatry’s (and their colluding partner, Big Pharma’s) Medical Model (with all their labeling and drugging) is to trauma victims in the world.

    Kerry, your work helping people who have experienced trauma is very difficult, and I salute your compassion and efforts to do this work and educate others who may wish to pursue it in their counseling career or their own personal work in therapy.

    All the best, Richard

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  2. This is cool insofar as it is a drugless therapy. But its theory is all brain-based.

    As long as we cling to this failed way of understanding the mind, we risk falling back under the influence of psychiatry and “modern” psychology. There is a whole body of work using Spirit-based theory and practices that needs to be explored.

    When am I going to hear news of someone using a Locational or similar process and what their experiences were with it?

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        • l_e_cox says: “When am I going to hear news of someone using a Locational or similar process and what their experiences were with it?”

          I sincerely hope we do not hear too much about “Locational processes.” because Scientology is a dangerous cult that has harmed many people.

          And I would warn MIA readers that while Scientology is a major critic of psychiatry, they are equally as dangerous, AND they are competing with each other for the same base of very vulnerable potential victims.

          Richard

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          • Hi Richard,

            For over a decade I have been a member of the nonprofit International Society of Ethical Psychology and Psychiatry (ISEPP, formerly ICSPP. that was originally founded by Dr. Peter Breggin and his wife Ginger. ) While many ISEPP members are mental health professionals, the organization also welcomes individuals like myself who are interested in advocacy. As an advocate, I have benefitted greatly from my membership in ISEPP.

            As I am sure you are aware, the Church of Scientology co-founded with Dr. Thomas Szasz (who was not a member of the Church and at times stated he was an ashiest) the nonprofit organization the Citizens Commission on Human Rights (CCHR)

            It was only after moving near Clearwater, FL, the “Scientology Capital of the World”, that I came across CCHR. Information on their website led me to find out about PsychRights and then ICSPP, and so on. Before that, I was only familiar with NAMI and was extremely disturbed by the information presented at the NAMI conferences I had attended.

            CCHR Florida used to be run on a shoestring budget. It was only during recent years the Church in Clearwater invested in the local CCHR and added the museum, Psychiatry: an Industry of Death. Actually, the Church has invested heavily in the entire City of Clearwater and has beautified areas of abandoned buildings that were becoming very run down.

            During my first visit to the museum I spent four hours going through every detail looking for possible inaccuracies or misleading information. I only found one item that I feel misrepresents the truth.

            I realize many individuals feel CCHR is a front for the Church but over the years I have attended many CCHR events and have never had anyone approach me on joining the Church. The events were all very informative and shared valuable information.

            I respect the accomplishments of CCHR as they are outstanding. Members of this organization work tirelessly to educate the public, investigate claims and advance legislation to protect human rights. As far as I am aware, CCHR is the only independent organization that will investigate claims of mental health patients.

            I grew up a devout Catholic and during my lifetime I have had friends who were members of many different churches/organizations, or devotees/followers of gurus/teachers and have had the opportunity to learn about/experience many different religious beliefs.

            At a health fair I even participated in a free auditing session offered by Scientology. The auditing seemed similar to biofeedback. The auditor was impressed with my results and said I didn’t need their services.

            Personally, I have no fear of the Church of Scientology, I respect my friends who are members of the Church of Scientology equal to any other friend and greatly appreciate CCHR as a “mental health watchdog”

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          • COMMENTING AS MODERATOR:

            I am getting concerned that this conversation is getting off topic and entering into one of those areas where people have strong emotions and where finding agreement is very difficult. This thread is about EMDR and should remain about EMDR. We do often allow conversations to wander off into other areas, as long as it is a productive discussion where people are learning and explaining thing to each other. When it degenerates into trading positions and making generalized statements without actual information or experience to share, that’s going too far. I know different people have had very different experiences with CCHR and the Church of Scientology, but this is really not the place to have that argument. I want to respect different people’s experiences, but I expect all of us to respect each others’ experiences as well. So I am not going to allow this to degenerate into a sparring match about the merits of a particular group or organization. I would ask you to keep to your personal experiences and respect and understand that others may have had different experiences.

            I hope I’m being clear. Comments need to be productive, or they will be moderated as “off topic.”

            Let’s get back to talking about EMDR!

            Steve

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          • Richard, you would be wise to curb your ridicule. What has my church done compared to what psychiatry has done? Do you really know anything about it, or are just parroting some enemy who has every reason to lie to protect their own secrets?

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        • After reading just this article, it looks to me as though Locational processing is a way of assisting someone in using grounding skills. In the short term, this can help someone calm down from overwhelming feelings, which is critical, but without additional elements added this intervention is unlikely to produce long term change on its own.

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  3. Thanks for your great summary of EMDR.

    You write: “Another reason doing trauma work is one of the greatest challenges we face is because the brain and body don’t have a system that tells us we are in ‘mild distress.’ We can only adjust between ‘life and death (fight, flight or freeze)’ and ‘calm (rest and digest).'”

    Are you sure we are limited to just the two, fight/flight/freeze or calm/rest/digest? How would you characterize the emotional/physiological systems (for lack of a better term) that come into play during activities such as intense cardiovascular exercise / sports, or deep cognitive work (e.g., doing advanced mathematics), or laughing a lot among an audience during a comedian’s routine?

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    • What a truly fabulous question. Here’s my take: There are only two sets of nerves that send opposing messages to different organs (one example: parasympathetic nerves slow the heartbeat, sympathetic nerves speed it up). However, there are uncountable other forms of sensory input that we can feel – hormones, rhythms of breath and heartbeat (and brainwaves!), amount of food and sleep, whether we’re being touched, energy level, and so many others – and the interaction of all of these data points produces the beautiful, rich and ever changing tapestry of what it feels like to be alive!

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    • Hi David, I’m not sure whether my reply ever made it to you due to technical reasons. (Apologies if this means it’s now making it to you twice!) Here’s what I wrote previously:

      What a truly fabulous question. Here’s my take: There are only two sets of nerves that send opposing messages to different organs (one example: parasympathetic nerves slow the heartbeat, sympathetic nerves speed it up). However, there are uncountable other forms of sensory input that we can feel – hormones, rhythms of breath and heartbeat (and brainwaves!), amount of food and sleep, whether we’re being touched, energy level, and so many others – and the interaction of all of these data points produces the beautiful, rich and ever changing tapestry of what it feels like to be alive!

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  4. The biggest problem with this article (apart from championing how treatment is a mechanistic endeavour ala the medical model) is that the science behind EMDR is speculative at best, but is sold as solid and supported fact. Many forms of exposure to trauma can be helpful (given the conditions about what constitutes a therapeutic relationship are met) and the most accurate description of EMDR I came across was: “what is effective is not new and what is new is not effective”.

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    • It’s true that we’re a long way from understanding how EMDR works, and all this article can do is sum up the current leading edges – as well as some better established thoughts on trauma (which has a bigger body of research behind it than EMDR specifically). Currently, we are sure *that* EMDR works for many people, and there is more work to be done to be sure of how.

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      • I think the difficulty understanding how EMDR works stems from assuming it works on the brain, as most researchers have done. There are many regressive processes that have focused on reprocessing past experiences, and results have varied, I think mostly because it’s not necessarily what everyone needs at a given time, or because people have other more pressing needs in the present moment that make regression less likely to be effective. The most fundamental error of the psychiatric/psychological professions is assuming that everyone having the same presenting issues has the same problem and needs the same solution. I’m more inclined to think of there being problems in the physiological, psychological, and spiritual realms, and the proper solution depends on the actual cause. Someone who is depressed because of his dead-end job isn’t going to get better with biological “treatments.” Someone with thyroid problems won’t improve with the best therapy imaginable. But people who really do have what I will refer to as ‘spiritual issues,’ by which I mean difficulties figuring out the meaning of things, their place in the world, or how to manage past events that have affected their thinking, will probably benefit from regressive processing like EMDR, whether you tap or roll your eyes or just lie their quietly while you relate what happened.

        The other critical part is that any regressive process MUST provide absolute safety from the listener, not to evaluate the meaning of things or stop or redirect the person or tell them that what they said wasn’t true or doesn’t make sense. It’s their story to tell and the processer, whatever the process may be, must be committed to letting the person tell their story without editing or invalidating or doubting anything in the story. I am guessing that’s where a lot of practitioners fall down on the job.

        Anyway, I doubt anyone looking for biological explanations for why EMDR works is going to be looking for a long time. I don’t think it’s a biological process, even if biological events are involved.

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        • Love how you expressed this Steve. I agree.

          I think we have to be careful about “modalities”. Since trauma became talked about, I think it can, like psychiatry, have detrimental searching for “something to work”.

          I think of all the thousands of people that might have real brain damage, which of course would cause adaptations (or as some say “maladaptive”)
          And who find life difficult, but no one knows why.

          This is the problem with “science”. They can’t even tell if someone has brain damage, and IF they can, they have NO clue which of the billions of neurons are affected, and how that plays out in development.

          And in the end, psych gets their greasy hands in there, STILL calling those “symptoms”, “psychiatric”.

          Well it would NOT be psychiatric, it would be PHYSICAL.
          And WHY would that be held against you?

          Many kids might have gotten hurt physically, accidently, had heat stroke, etc etc, stuff parents did not know about or can’t remember.

          Psychiatry stands in the way of anything scientific, or sensible.

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          • Of course brain injury clinics have the psychiatrist who takes over, 🙂 Since neurology has no knowledge except seeing blobs and saying, hmm this person looks to have a brain injury.
            It’s a bit like sending a guy with a broken limb to a shrink.

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        • Great thoughts, Steve – understanding each person individually must be done as well as we can manage, or we are lost. The efficiency beast of insurance systems and the “hammer meet nail” narrowing of medicalized perspectives both can make this more difficult. My best therapy is done when I remember that the client and I are both making progress on a neverending road to understand them and the way we are together. Managed care wants to pretend this road has an end.

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  5. Thank you for sharing this interesting alternative to mainstream psychiatry’s and psychology’s – primarily child abuse covering up – stigmatize and neurotoxic poisoning crimes, Kerry. Truly, trauma informed care is most definitely needed, given the fact that over 80% of the “mental health” workers’ clients, are child abuse survivors today.

    https://www.madinamerica.com/2016/04/heal-for-life/
    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

    And I totally agree, “congratulations to anyone who is willing to take the risks to talk about the hard stuff.” But, based upon my experience, that’s 100% the opposite of what my “mental health” workers did. The abuse of my child was initially covered up, based upon lies from a Lutheran pastor, by a misdiagnosing Lutheran psychologist, according to her medical records, and her DSM-IV-TR. And once the medical evidence of the abuse of my four year old child was finally handed over, a lunatic psychiatrist told me the best way to help a healing child, who’d been abused four years prior, was to neurotoxic poison him. WTF!

    Definitely, good alternatives to today’s, systemic child abuse covering up, and child abusing, “mental health” industries are needed, and EMDR sounds like an interesting alternative. However, it’s just probably best done by someone – other than those who’ve already betrayed child abuse survivors, by DSM design, on a massive societal scale – like too many of the psychologists, psychiatrists, social workers, and other DSM “bible” thumpers, have done.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

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  6. Kerry,

    Thank you for such a comprehensive explanation of EMDR.

    For over twenty years I have been involved in advocacy taking a best practice standards approach.

    Influences from psychiatry and Big Pharma are probably a large part of the reason why so many main stream advocates (NAMI) work to advance the benefits of drug therapy.

    There also seems to be a lack of awareness of alternatives among advocates and consumers. Explanations like yours are greatly needed to help expand awareness of alternatives to medication management.

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    • The fact that these approaches are called “alternatives” is in and of itself a big problem. It implies that the MAIN way to do things is psychiatry, and these other “alternatives” are for either when it doesn’t work or someone wants to “try something different.” There is condescension in the very term. Same applies to “alternative medicine.” In fact, I’d prefer these approaches not be called “treatments” at all – I’d prefer they be called “approaches” or “strategies” or “opportunities” or “processes” or anything that doesn’t imply any kind of relationship to medicine or psychiatry.

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      • Steve, I agree with your statements and in the past have engaged in many different modalities that helped facilitate healing from what was originally diagnosed as a “mental illness”. Different terms were used to describe the modalities including: orthomolecular psychiatry, complimentary therapies, nutritional/vitamin/IV therapy, functional medicine, integrative therapies and precision medicine.

        Unlike many other psych patients, I was blessed to have access to and be able to financially afford a multimodal approach.

        I am sure you are familiar with the Indian parable of the blind men and the elephant and it is one that I think has an important message to consider on different perspectives and problem solving.

        As an individual with experience as a psychiatric patient under forced treatment, a self-advocate and an advocate for others, although not always easy, I feel it is important to maintain respect for all.

        And as hard as it may be, respect must be maintainted for those who claim they or their loved one have benefitted from psychiatry, psych drugs and even ECT.

        Unfortunately, psychiatry is a very powerful and unregulated authority that can legally force whatever treatment, no matter how harmful, they want to on their patients.

        For consumers under court-ordered treatment, psychiatry is what they must purchase and they have no access or rights to any other modality.

        Psychiatric consumers under coercive treatment are at a disadvantage and are in need of strong, educated advocates who will work in their best interest. This is why educating advocates on the value of options different from psychiatric drugging/ECT is critically needed.

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  7. Thank you for the interesting article. I’d like to know more about the (im)possiblities of EMDR during the use of psychotropic medication. Lots of people have questions about this. They often get the advice to stop the medication before starting EMDR. Trying to do that they suffer from withdrawal which makes it impossible to undergo EMDR. On the other hand it sounds plausible that ‘work with trauma’ can be helpful to avoid lifelong use of harmful meds.
    What I understood so far is that there are no guidelines for EMDR-professionals what to do in this kind of situations.

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    • Pauline, thank you for this important question. I do EMDR with folks who are taking psychiatric medication regularly – perhaps more often than not! My training through EMDRIA (emdria.org) did not teach us to ask clients to taper off of medication before starting trauma work. Other non-EMDR trainings I have attended taught me “medication can be what allows the work to get done”. (Of course, it’s not right for everyone.)

      One of the central tasks of EMDR therapy is keeping anxiety and dissociation “within tolerable limits”, which can be greatly facilitated by medication – and healing will be just as possible and just as robust for that person, if not more efficient. If a person wants to taper off of medication after a course of EMDR, it can often be easier (sometimes much easier) for them to stay off of medication symptom free. I am sorry to hear that you were told otherwise. Certification programs, standardization and communication within the field continue to be challenging.

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      • Kerry

        You know I have great respect and support for what you are doing with EMDR. I hope you’re open to being challenged on a few points.

        You said: “Other non-EMDR trainings I have attended taught me “medication can be what allows the work to get done”. (Of course, it’s not right for everyone.)…One of the central tasks of EMDR therapy is keeping anxiety and dissociation “within tolerable limits”, which can be greatly facilitated by medication – and healing will be just as possible and just as robust for that person, if not more efficient.”

        I don’t deny that certain mind altering *drugs* can be useful to people in very SHORT TERM doses to manage and control excessive, or even out of control, feelings, emotions, and/or extreme psychological distress.

        That being said: when we examine the overall role of mind altering psychiatric *drugs* as it effects people with “PTSD diagnoses” and other so-called psychiatric “diagnoses,” we must acknowledge that the principle effect of these drugs is to numb emotions and interfere with (and often damage) necessary and appropriate cognitive functioning. All the things we need and depend on to navigate and better understand the world and our role within it.

        These *drugs* also create dependency and undermine a persons ability to actually develop and strengthen important coping skills to manage life in an extremely stressful world.

        The overall negative effects and role of these drugs in today’s world FAR OUTWEIGH any of the short term benefits that a small minority might obtain from their use.

        And what i have learned from my EMDR work and my readings on the subject is that when people do EMDR while on psychiatric *drugs,* they may have to actually repeat some of the same work when they come off of these mind altering *drugs,* BECAUSE they are now experiencing a FULLER INTENSITY of feelings and emotions related to past trauma events.

        And finally Kerry, notice that I never used the word “medication,” and always used the word *drugs* to describe these mind altering substances that are so prolifically prescribed in today’s world.

        I believe it is extremely important to make a clean break from all Medical Model thinking and use of language in order to promote more humane ways of helping people overcome trauma. There are no scientific medical markers to justify psychiatric diagnoses. There is no evidence of cellular anomalies that justify the word “disease” to describe extreme psychological distress. And thus: there is no scientific justification to use the word “medication” to describe what are in fact, mind altering *drugs.*

        We should NEVER concede psychiatry and their entire medical Model, the use of the word “medication” without a serious and quick challenge. Serious social and political change in the world has always necessitated the struggle over language and terminology. And the use of the word “medication” is one of those words we need to fight over and change NOW if we want genuine change if the world when it comes to overcoming all forms of psychiatric abuse.

        Richard

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  8. Hello Kerry,
    my wife is part of the early childhood trauma/extreme dissociation community, so I’ve heard about EMDR for a long time, and I’ll be honest, I’ve always been skeptical as it sounded like ‘snake oil’ and ‘magic elixir’ stuff, but I’ll grant you that I don’t always know why things I do to help my wife heal work, though attachment theory does form the foundation of much that we do.

    I am curious how you deal with dissociation. Any unprocessed trauma that isn’t dealt with, eventually becomes ‘sequestered’ or dissociated. For us, the trauma is the relatively easy part to heal using attachment concepts of ‘safe haven’, ‘proximity maintenance’ and ‘affect regulation’. It’s tearing down the dissociative walls and retraining her brain to access all those areas that had been largely unavailable for decades that has been the much bigger issue, and we’ve only found doing repetitive tasks, based on the concepts of neural plasticity, to undo that.
    However, beyond the neural plasticity issue, is the fact that the dissociative walls hide so much of the trauma, and at least in our case, the deeper the trauma, the more I’ve been the ONLY person she let into those dark places as her ‘primary attachment figure’ and so I wonder how much access you realistically have. My wife’s counselor didn’t have half the access I do, plus I’m with her every day, 24/7.
    I’m just throwing things out. I would love for EMDR to work. It’ seems so wonderful and easy…nothing like the hell we’ve gone thru the last 14 years as I’m still helping her tear down the dissociation and every time I think we have the trauma gone, another bit ‘pops’ up because we tore down more dissociation or for other reasons that are too numerous to delineate here.
    I do wish you the best.
    Sam

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    • Hi Sam,

      Thank you for reaching out. The remarkable love you have for your wife shines through!

      Family and friends, and therapists, can all be in therapeutic roles. I believe each of us offers something the others cannot.

      In my view, dissociation is a protective mechanism, and as such is not to be interfered with or targeted directly. Rather, dissociation is a sign that the client is feeling unsafe. “When in doubt, find a way to add safety.” In the moment relief can come in the form of grounding skills such as using one’s senses to interact with objects or the environment (a lot of my clients report relief by focusing on strong sensations like cold ice, peppermint oil, or very sour candies). Deeper healing comes from putting the client absolutely in charge of their pace and when they decide that the walls are ready to come down. And, as always, from connection. From welcoming in the person exactly as they are, defenses and all. It is more like holding seed and inviting a bird to come to your hand, than it is something to “do”. Even the client may most often feel like they do not have any say in when dissociation fades. So, we focus on creating the conditions in which it is ok for this to happen on its on, and do our best to accept and tolerate our own discomfort in waiting.

      EMDR can be done even on blocked memories by helping the client to focus on and process the triggers that happen in the present. I would not attempt this with someone with complex trauma without first doing plenty of preparation work, skill building, crisis planning, identifying beliefs and narratives, relationship building, and lots more.

      Often, folks with complex trauma in the getting-ready-to-process stage can benefit a lot from group therapy, which can provide relationships, community support, learning and validation, and lots more.

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      • Kerry, thank you for responding. I have appreciated reading your views on EMDR.

        I understand this article is about that, and not dissociation, and so I won’t belabor the point unless you choose to further engage with me…but unlike most people, my wife and I chose to embrace and live ‘in the dissociation’ for the last 14 years. And thus, we learned how it works and how to tear it down: it’s not something to be avoided at all costs like most people act. In fact, the deepest healing she found was as we embraced it and brought those areas back ‘online’ which takes time and hard work. And so I’d like to suggest that it’s not what you and most people think it is, at least not 40 and 50 years later after the initial trauma, and it is definitely the harder of the two (trauma/dissociation) to undo after all those decades that the neural pathways become accustomed to doing workarounds to large areas of the person’s traits and abilities.
        Sincerely,
        Sam

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        • I’m with you and your wife on this Sam.

          My earliest experiences of dissociation were interesting in the short term but became increasingly intolerable as they dragged on, often to the point where I’d self-harm to try to break out of them. But a couple of decades down the track I’d learned to accept them and even see them as a kind of refuge from more difficult mental states. In the lowest period of my life from 2003 to 2012 they acted as a kind of circuit-breaker that offered me the only waking relief I had from suicidality.

          I had a big turnaround in 2012 and have learned to accept all my mental states – though unlike you I don’t owe it to hard work. It was more like an unearned epiphany. If I was Christian I’d probably call it grace. Since then I’ve had no suicidality and no dissociation. I think coming to accept dissociation was a key part of the learning experience that led to that.

          https://neurodrooling.wordpress.com/2013/09/08/dissociation/

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    • Hi Sam,

      I’m new here, just thought I’d share my personal experience with EMDR and dissociation in case it’s any help. I don’t have ‘full-blown’ DID but do have internal ‘parts’ which have different thoughts, emotions and knowledge of the world than I do. I’m unable to engage with traditional EMDR because my dissociation is too severe, but over the last few years I’ve developed a method with my therapist which uses EMDR as a tool inside a wider process based on the Internal Family Systems model, gestalt and narrative therapy.

      I use self-guided visualisation, grounding and a technique called ‘pendulation’ to manage different dissociative parts alongside my ‘executive function’ part (aka the ‘present day me’). In a sense this allows me to become my own therapist (under the guide of my actual therapist), to negotiate with and draw on the strength of different parts to help each other. It slowly built the strength and structure which has enabled me to manage traumatic material. Personally I do find it helpful to share the content of what I’m processing with my therapist, but some people have specifically used these techniques in order to process memories which they find too triggering to speak about openly, even with a therapist.

      The EMDR itself is partly used as a way to compartmentalise the processing of extremely overwhelming memories/emotions – it’s very useful to delineate when I am ‘in’ and ‘out’ of processing mode, and as such I use it as a tool to help my ‘parts’ have a safe containing structure in which to experience excruciating material in short, manageable sections.

      It’s also useful as a grounding technique during processing (the rhythmic nature of bilateral stimulation seems to distract parts of the brain which would otherwise quickly become overwhelmed). I can’t say for sure if it does anything beyond that.. perhaps if I was using the same method but replaced EMDR with some different repetitive/ritualised movement it would work just as well, or perhaps there really is some extra neurological benefit to BLS? But I can say that EMDR has been a great tool which has helped me make more progress in the last 3 years than with any ‘talk therapy’ previously.

      The wider process I use is too complex to cover in a brief comment, but I’m happy to try to explain more if it’s of any interest you. Best wishes to you and your wife.

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      • Hi Sonus Silentio,
        thank you for taking the time to describe your experience with EMDR. I’m glad you’ve had a positive experience with it as we’ve had with attachment theory.
        I do wish you the best as you continue on your healing journey.
        Sam

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  9. Thank you for your great summary of EMDR. We need to publicize successful cases of recovery so we can elevate the trust of the larger population.

    Would you happen to know if there are any successful experiences of using EMDR for people suffering from psychosis? I would think it is almost impossible for such individuals to go through a meaningful planning process with the therapist.

    Are you familiar with the work of Paul William Miller? He has written a book about using EMDR on people diagnosed with “schizophrenia.” I have not read the book yet, but I would be interested to know your perspective based on your experience.

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    • Thank you Elahe, and I agree – the healing people gain through this modality (and other trauma treatments) can be profoundly life changing, and shifting the stigma in any and all ways we can manage is some of the most important work we can all do.

      I believe this is inherent in what you write, but to make it explicit, I would not use EMDR to target the treatment of psychosis, as psychosis is not trauma. (I use the term “psychosis” to describe an experience of reality that differs from aggregate perception, which can happen for folks with schizophrenia as well as other conditions.) Very often in our culture, psychosis can put someone at risk of trauma, and there is a significant line of thinking that trauma can induce psychosis, but they are not the same.

      Psychosis that is significant enough that it prevents meaningful communication about the structure of the treatment itself will rule out being able to participate in EMDR. Less structured trauma therapies may be more effective for this kind of client (which is out of my area of practice so I won’t comment further there). If a client is dedicated to using EMDR in particular, they will need to first utilize other therapies for psychosis before this will be an option, analogously to how someone with intolerable levels of anxiety will need treatment to bring anxiety within tolerable limits before EMDR can proceed.

      Unfortunately, I haven’t read that book, and am not familiar with Paul William Miller! If you read it, I hope you get something out of it.

      Getting ready to do trauma work is usually the longest and hardest part of trauma work! Building attachments, community support, skills to respond to emotions, discovering and addressing narratives and blocking beliefs, and many more factors that can prevent someone from tolerating trauma work can be on the scale of decades or a lifetime (hopefully not, with adequate treatment and treatment systems!) Once trauma work is begun directly, the timescale shrinks to (typically) weeks to months.

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  10. My knowledge of EMDR is a couple of decades out of date now. It stems from the research I did during an unethical and abusive trial of EMDR upon inmates of Sydney’s Mulawa Women’s Prison (scroll down about a dozen paras to see the EMDR bit).

    What I found from the literature available at the time was that PTSD trials carried out by Shapiro and her colleagues consistently made hyperbolic claims of success rates in excess of 90% while those carried out by independent researchers found no significant difference between EMDR and regular trauma exposure and desensitisation therapies (i.e. the BLS is BS). Sure enough, when the head of the Mulawa trial (one of Shapiro’s acolytes) reported his results a year or so later he too made claims that over 90% of those treated showed reductions in trauma symptoms and made no mention of the numerous adverse responses that had alerted the NGO I work with to the trial in the first place (via complaints by the trial subjects and their families).

    My conclusion at the time was that EMDR was mostly a mumbo-jumbo driven cult. It’s my understanding that its popularity among therapists has grown in leaps and bounds since then and it’s now being used in a wide range of non-trauma related applications (e.g. relationship counseling).

    Although there’s nothing in the article above that would cause me to revisit my opinion I’m always willing to adopt new conclusions in response to new data. So if any of the EMDR proponents posting here can point me to, say, some independent randomised studies carried out by researchers without skin in the game (i.e. who don’t make a living from EMDR) that have more than a dozen or so subjects and either have low dropout rates or incorporate the dropouts into their statistical analysis that demonstrate EMDR is any more effective than other exposure and desensitisation therapies for trauma or that it’s effective at all for non-trauma based treatments I’d be much obliged. Surely after more than three decades there would have to be some good quality evidence for it. If it works.

    (BTW, as is the case with a lot of D&A treatments I found the EMDR trials carried out by proponents routinely ignored the relatively large number of dropouts rather than classifying them as failures. I never got access to the raw data from the Mulawa trial, but given the number of inmates who refused to continue in the face of distressing flashbacks I can’t see how they could have reported such a high ‘success’ rate without discarding the failures.)

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    • I think mumbo jumbo seems quite apt – I trained in EMDR about a decade ago and I was initially swept up with the enthusiasm of colleagues and what seemed like people benefiting from it. However when I really began to reflect on what I was seeing and doing it made less sense.

      There can be something helpful, dare I say healing, in supportive compassionate encounters with trusted others – spaces where people can speak out what is in can help.

      I think this is all EMDR really is, especially around the ‘processing’ phase its a chance to speak it out or just have someone sit alongside – the psychobabble that goes along with it especially about the brain and the endless computer metaphors ‘installing resources’ etc is just fluff or stagecraft. However fluff in therapy does seem to help generate a little more placebo so perhaps its needed. I do wonder if we included the extraction of a white trauma dove from a seemingly empty bag might also get much the same results?

      Of course having people speak out what is in can also be very harmful, overwhelming etc . I find the resource installation and grounding ideas particularly uncomfortable because we are not computers – we cannot simply wave our fingers, follow a light or hand taps and be in possession of ‘resources’. Being able to ground self or engage in guided imagery etc if workable at all involves dedicated practice and the life resources to make such endeavours practicable and manageable. It cannot be done in brief therapy without considerable self delusion by both parties.

      We also know that nearly all ‘therapy’ is done on our terms, in the clinic devoid of context and full of people largely conformist and people pleasing, with no long term follow up or taking into account the myriad of factors that might also be helping outside of the therapy room, yet all benefit is linked to what seems the most obvious.

      After working in the industry for a long time it seems full of people I think of as ‘believers’ well meaning people often kind hearted but also very self interested and excellent and self promotion and believing in what they do and their curative powers. This would be all well and good if it really worked but we all know therapy is completely oversold yet many believers will simply refuse to engage with the critics, heads firmly in the quite lucrative and safe sand. This is a helpful book for a take down of the ‘evidence’ for therapy etc https://www.palgrave.com/gp/book/9783030327491

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      • I can see you’ve been thinking a lot about the practical and moral dilemmas that come with offering therapy, not just those posed by EMDR. I think some of the ones you raise are best addressed by approaches that connect the person seeking help to the support offered by their own community and loved ones, rather than ones that seeks to make the problem a technical, neurobabbled one for trained professionals. Whether they’re always applicable and appropriate or get the best results is another big set of questions though.

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    • What works for sure is having a system to talk about trauma deliberately and safely. In a few cases by client request, I’ve done “EMDR inspired trauma treatment” (there’s no technical name for this), which is essentially using the same procedure but without the BLS. (It’s important to understand BLS as one among many elements that make up EMDR.) Anecdotally, it’s just as effective. I’m not a researcher (and therefore I’m not the best person to point you towards the work of others), but many of my clients describe profound healing.

      Usually, to describe BLS, I’ll say out loud something like “It’s there to use if it helps you. The idea is that it will help your amygdala stay calmer as we go. You’re the best reporter of what’s helpful to you, and if it doesn’t feel good, let me know.”

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      • Yeah, I’ve gotta admit I’m not really too concerned about whether EMDR’s any better than regular exposure and desensitisation therapy. And if the mumbo-jumbo enhances rapport or the placebo effect then it’s probably gonna help people. It was the dodgy study design & reporting and cultish enthusiasm of some of its proponents 20 years ago that put me off.

        If you think there’s important differences between EMDR without BLS and regular E&D therapies – other than marketing – I’d appreciate anything you’d care to offer.

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        • The cultish enthusiasm has not waned in the last 20 years and this is due to psychology students still being taught that therapy is quite simple: you merely apply a technique/tool to a diagnosis. Armed with only a hammer, EMDR proponents have with blind enthusiasm and dodgy science been able to make every presenting problem a nail and thus affirming EMDR’s cure-all status.

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        • Actually, I’m with you – using EMDR as exposure and desensitization absolutely works. I believe BLS can help in some cases depending on client preference, and whether that’s because of placebo or because it does in fact act on the amygdala is immaterial (let’s not forget that placebos have real benefit!).

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  11. Thank you Kerry for your quick response on my former comment and questions!
    In the meantime I pointed out the article to a member of our patients-association and she replied with more questions in particular about EMDR during withdrawal.
    ‘Assuming that almost everyone has to deal with withdrawal symptoms during/after the withdrawal of psychotropic medication, one short, the other long, is it wise to undergo EMDR treatments during that time or could that that too burdensome?
    Are EMDR therapists even aware that tapering can be very taxing on the body and brain? Is this taken into account?
    Have studies been done on that? Are there EMDR patients who indicate this (experience stories, complaints, etc.)?
    Is EMDR desirable during dismantling and the time afterwards?
    How about withdrawal causing an extra trauma or even in itself? ‘

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    • I’m glad to hear this person is thinking this through so carefully!

      -I would do EMDR with someone tapering or withdrawing “as tolerated”. Basically, if the client is able to successfully use grounding skills and support to return anxiety to tolerable limits during sessions, and if they are able to keep themselves physically safe between sessions, they will then have the ability to participate in treatment fully enough to report on whether it is effective for them. Trauma work of any kind is by nature activating and/or triggering, and a person will need structure, support and skills in place before beginning. With that accounted for, EMDR is unlikely to do harm.

      -I hope that any licensed therapist is aware of the challenges of taper and withdrawal! Whether this is the case in practice, I’m not able to say. I also don’t have any knowledge of what studies may have been done on EMDR and withdrawal, or personal experience with such clients.

      -I believe EMDR and other trauma protocols stand a chance to help anyone who is able to meaningfully understand and participate in the program, stay safe while doing the work (inside and outside of the office), and is motivated to give it a try.

      -As for withdrawal causing trauma, I want to add a disclaimer that these are off the cuff thoughts – I’ve never had this question before! I welcome any other points of view here. With that said: Withdrawal is pretty freakin sucky (you can feel free to quote me on that), physically and mentally. It may cause old traumas and anxieties to surface – sometimes LOUDLY. If someone is unable to keep themselves physically safe as a result of these symptoms, this can put someone at risk of experiencing new trauma. However, in and of itself, I would not define withdrawal as trauma. Withdrawal is essentially putting us at the mercy of our own thoughts and bodies, and I would say that interaction with others or the environment is necessary for an experience to be classified as trauma (even in the case of suicidality, the environment becomes physically involved if things progress out of the realm of thought and into action). What do you think?

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  12. I got the worst headache from “EMDR” and not surprisingly, they know nothing about that.
    Funny how people know stuff about the brain, but when it comes down to the crunch, really know nothing.

    And it was not a headache or as I know headaches. It was intolerable searing/burning, which also happened to me
    when accupuncture was done to my scalp area.

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  13. Thank you for this. How can I find a therapist like you who does EMDR and can recognize disassociation and takes insurance?

    I find it so difficult to find really experienced trauma therapists that I can afford. And the fact that you are open-minded about alternate lifestyles is a huge plus too!

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