I entered the training for EMDR (Eye Movement Desensitization and Reprocessing) with extreme skepticism, thinking it was the gimmickiest therapy technique ever proposed on a gullible public. Waving fingers in front of a client’s eyes as they strained to follow the back-and-forth movements and suggesting this was going to create almost immediate change seemed more in the realm of magical thinking.
I was more than impressed when I saw with my own eyes that this was all true. Using EMDR with my clients—and seeing their profound healing from trauma—convinced me of its power.
The discovery of the therapeutic effects of bilateral stimulation—using back-and-forth movements to stimulate both hemispheres of the brain—was documented in 1989 by Francine Shapiro in her EMDR paper in the Journal of Traumatic Stress. Since then, it has developed into a multi-million-dollar enterprise, and there are many thousands of EMDR therapists worldwide. So, what’s to be unhappy about?
I had two questions. I wondered how Shapiro decided—once she discovered she was stimulating alternate sides of the brain-body—to use eye movement instead of, say, sound alternating from ear to ear. And I wondered why she insisted that clients doing the therapy have to get down to a self-assessment of zero emotion when thinking about the trauma before the therapist would halt the exhausting eye-movement? To see this done on a client provoked empathy in me, since the client seemed a bit tortured by the therapist’s insistence that they needed to get to zero. I immediately felt I could do better.
One of the reasons that EMDR is so rigid is that Shapiro was determined to make the technique accurately repeatable so that subsequent research could prove it was legitimate. The name itself has been a barrier to the therapy becoming more widely known by the general public, as it is so unwieldly. “Eye Movement Desensitization and Reprocessing” is a mouthful even for therapists. It is the kind of name graduate research students give their PhD thesis.
Yet, the discovery of the healing effects of bilateral stimulation of the brain cannot be overstated. It is a miraculous experience for many people. In fact, Shapiro first noticed the healing effects it had on her own trauma before she even formulated the theory. Although slow to catch on, it is recommended as treatment for traumatic stress by the American Psychiatric Association (in 2004), the Department of Veteran’s Affairs (VA) and Department of Defense (in 2009), and the International Society of Traumatic Stress Studies (in 2009).
EMDR stimulates the brain into a rapid eye movement (REM) state. The brain is much more able to processes traumatic emotions when it is in an REM state. When dreaming or having a nightmare, the brain is attempting to heal itself, but its efforts are awkward and chaotic. While awake, a person can direct the brain and the healing effects are dramatically better.
Those that have done research on REM sleep have determined it is essential for mental health. The March 2017 issue of Time quoted sleep researcher Dr. Maiken Nedergaard: “Sleep’s primary evolutionary function is to clean out the brain quite literally of accumulating debris. It is like a dishwasher that keeps flushing through to wash the dirt away. Without that nightly wash cycle, dangerous toxins can damage healthy cells and interfere with their ability to coherently compose our thoughts and regulate our emotions.”
It is during REM brain activity that the toxic chemicals in traumatic emotions are dissolved in the brain. It is only during REM that all the various parts of the brain are in communication with each other. With EMDR, people can get a similar effect while still being awake. They can consciously direct their brain to visualize their trauma.
EMDR is an emotionally cathartic experience for most people, but the benefit of any EMDR session depends on the level of defensiveness of the client. The more the client is determined to not access the traumatic memories, or determined not to emote over these memories, the smaller the benefit they will receive from an EMDR session.
The most common coping mechanism in children is avoidance. This is healthy in children, but many continue using avoidance into adulthood. The biggest risk to anyone doing an EMDR session is largely dependent on the extent to which their emotions have been repressed. EMDR is an open invitation to these deeper emotions. If a person has repressed them, using avoidance their whole life, they can be overwhelmed by the experience.
I had been a therapist for 30 years before I was introduced to EMDR. It was only natural to incorporate the elements of other therapies I was skilled at using. I had already been practiced at creating a “safe space” for clients when doing hypnosis or relaxation exercises. EMDR clients are asked to do this themselves, but some of my clients had never had a safe space in their lives they could recall to visualize.
I knew from my experience with gestalt empty-chair work that addressing oneself is often a powerful experience. So, to use this while a client was in an REM brain state was sure to be more powerful and more therapeutic. I combined elements of six therapies to create a program that was as healing as possible. It uses hypnosis, EMDR, mindfulness, gestalt child within work, music therapy, and awe therapy (Psychology Today has identified this as profoundly connecting with nature).
I had an epiphany that this program could be recorded on separate audio channels which would alternate between the right and left ears. I used music instead of eye movement. I gradually experimented with giving clients more and more control over the experience, eventually loaning the instrument to them to have them do their own sessions at home and coming back to me to process their experience.
I chose classical music to fit the various stages of the program: Debussy to relax, Bach and Vaughan Williams to do the visualization of trauma, Vivaldi to be inspired and motivated. Music was accompanied by occasional guided imagery directing the client to do therapeutic work as well as connect with nature and with themselves and their future.
I had always assumed that all clients needed a caring, empathetic therapist to be there for them when they are emoting. I thought it was this caring aspect that was at least part of what cured. Yet client after client reported that they did better work when they did it themselves at home using this recording.
Perhaps it was because they felt no self-consciousness. When a therapist is present, a client might cry or otherwise emote for between 5 and 15 minutes, but many clients reported crying through the whole hour program when they did it at home.
The implications of this for the mental health field are enormous. The healing effects of bilateral stimulation of the brain are only beginning to be known.
Frustrated over only reaching my own clients, agonizing when I read of suicides by veterans and others, I framed this program as Se-REM (Self effective – Rapid Eye Movement) and tried to circulate it into wider use.
The very first client who did Se-REM was atypical but interesting. He was a big-city police photographer who had taken photos of crime scenes for 25 years. He reported that it had never bothered him, no matter how grisly. He focused on the technical aspects of his job.
Once he retired, he was shocked that his daily experience was almost continual flashes in his mind’s eyes of all these terrible images. He could not stop his brain from doing this processing and he was stressed and anxious. He felt his retirement was being ruined. He took Se-REM home and did the program one time. When he returned two weeks later, he reported that all of his flashbacks were gone.
His experience of delayed traumatic reaction is not unusual. I told him about Holocaust survivors who, while interred in the camps, had wonderful dreams filled with food and friends. Only once they were safe did they begin to have horrific, unrelenting nightmares. Police officers, military, and first responders often adopt a kind of superman mentality in order to face the dangers of their jobs. It is often only after the danger is long gone that they (sometimes unwillingly) feel their repressed emotions.
I knew that with traditional therapy, this retired police photographer’s flashbacks would have gradually subsided as he talked about the emotions he had never expressed. Even without therapy, his symptoms would have gradually dissipated because each time he experienced them there would be a small discharge of the traumatic emotion. But he essentially cured himself, in one session, at home.
One of the next clients to use Se-REM was an Army Ranger who had three years of night terrors that were so violent it was dangerous for his girlfriend to sleep with him. You might imagine how, after years of this, he dreaded bedtime and going to sleep. He was depressed and there was a possibility that he might have chosen to end his own life.
He did two Se-REM sessions and almost all of the troubled sleep was over. He wrote a testimonial urging other soldiers to get this help.
Over the last nine years, Se-REM has been used by therapists in nearly all 50 states and 6 foreign countries. The most common warning has come from users who feel it might be too powerful for some who have no experience with EMDR.
If you have any experience with bureaucracy, you can imagine what kind of response Se-REM has had with the VA and even with the Wounded Warrior Project… crickets. Se-REM could be used to help all returning soldiers re-acclimate to civilian life. Often their military experience has been traumatic even if they have not been in combat.
Se-REM is also a natural fit for use in psychiatric hospitals. With a pre-loaded MP3 player, patients can do their own EMDR session every day, and they will have the supportive staff there to help them process their experiences.
Many clients in outpatient therapy are being charged $80 to $200 per session. This puts in-person EMDR therapy out of reach for the majority of sufferers of PTSD. This is unfortunate, as the world is awash with untreated anxiety and trauma.
The following is my mission statement for Se-REM:
“Se-REM devotes itself to lessening the impact of Trauma in the world. It strives to provide the most effective self-help trauma treatment at as close to free as possible. Se-REM is dedicated to increased compassion and empathy and improved mental health.”
I run the Se-REM program without profit, and hope someday to bequeath it to a large health organization so that it can reach the largest number of the people who need it.
As with my initial reaction to EMDR, it seems too good to be true. But the healing really can be as simple as a self-guided daydream. Se-REM is like EMDR 2.0. This and other programs that employ bilateral stimulation are in their infancy, just being discovered as the easiest, most effective, and least expensive way to heal from trauma and experience relief from emotional distress.
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.