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Is EMDR Overrated?

Updated: Sep 13, 2023

by Adrienne Loker, LCSW, EMDR, SE

To quote an admired colleague, “EMDR is the Pumpkin Spice Latte of therapy.” Don’t get me wrong, being a client of EMDR was a life changing experience. And as an EMDR practitioner, I’ve witnessed drastic improvements in very short periods of time for my clients. But my clients and I didn’t receive EMDR in a vacuum – it was integrated with other modalities that prepare the nervous system for and/or amplify the results of EMDR.

What even is EMDR?

Basically, EMDR, or Eye Movement Desensitization and Reprocessing, is a watered-down combination of Exposure Therapy and Cognitive Behavioral Therapy, with a sprinkle of somatic input. In a standard protocol

EMDR uses eye movements to reprocess trauma

session of EMDR, the client is asked to think of a distressing memory. From there, they’re asked to identify the image of the worst part, followed by the corresponding negative belief, emotion, and physical sensation. The body is bilaterally stimulated (right/left, right/left) through eye movements, auditory input, or physical touch.

The theoretical framework that grounds this modality asserts that the bilateral stimulation in EMDR simulates REM sleep – wherein our brain prunes unnecessary information, consolidates memories, and processes emotions. As a result of this hard work, our brains are able to store information from our life experience adaptively so that we can live in a way that is functional.

EMDR Trauma Therapy simulates REM sleep

When the brain is overwhelmed by stress, it creates a meal too big to digest by sleep alone. Our life experiences become stored in a maladaptive way, which serves as the root to all our mental health diagnoses.

More recent research highlights the chief mechanism of bilateral stimulation is dual attention – where we simultaneously hold an awareness of our current surroundings as well as our sense of distress. In so doing, we gently move our nervous system out of the dominated state of fight/flight or freeze and rest with more permanence in a relaxed state.

Why does everyone love EMDR so much?

It’s powerful and it’s quick. In one 60-minute session, we can achieve a year’s worth of CBT. But this is for singular events and for nervous systems that are already primed to contain distress without being flooded by complete dysregulation.

What can go wrong?

When a nervous system is flooded, it can go one of two ways:

In one way, we have a rapid release of endorphins caused by heightened sympathetic arousal (the gas pedal in our brain). Endorphins are feel-good hormones that serve to medicate us. We can experience euphoria when they’re released in our system. Think of how you feel after a workout, a good cry, or even a primal scream.

Trauma therapy and somatic therapy tools in Richmond, VA

But without the proper containment, this energy is released into the ether to float around in nothingness. It becomes an isolated event that has no impact on the changes we wish to see in our lives. It allows us to check the self-care box while all we really did was get high on the experience.

Another thing that can happen when our nervous system gets flooded is re-traumatization. Our system believes whatever we’re reprocessing is happening again in real time – it’s unable to tell the difference between then and now.

How to keep it from going wrong…

Whatever the response is, a proper neurological container is necessary to see sustained results. Containment refers to the simultaneous capacity of both the therapist and the client. The therapist is responsible for holding space – meaning that in real time, we know what energy (anxiety, apathy, joy, etc) belongs to us, and what belongs to the client. We know how to expand and contract the container in a way that serves the client. If emotions become too high, we work to widen the container that holds it. If the emotional landscape is all dried up like a desert, we compress the container so that it doesn’t feel too big.

The client’s responsibility of containment still primarily falls on the therapist to attune to what tension their nervous system can handle. We look at their ability to shift from a dysregulated to a regulated state, how they hold two polarized beliefs or emotions, and how they navigate between their internal environment and the external environment.

When clients are primed for EMDR, we can get straight to work with reprocessing. But if the nervous system’s ability to contain still needs attention, we can cause harm.

If not EMDR, then what?

Somatic therapy is the most successful way to prime a nervous system for EMDR. Not only this, but somatic therapy can replace the need for any EMDR reprocessing.

Somatic therapy is an umbrella term for various healing methods that intentionally use the body to heal trauma wounds, such as Somatic Experiencing, Somatic Movement Therapy, and Somatic Inquiry. There is a heavy emphasis on learning how to listen to what the body says – much like how we listen when we’re hungry or need to relieve ourselves. This level of awareness alone is deeply transformative.

Clinically, the word “trauma” doesn’t reflect the severity of harm caused by an external force, rather, it reflects the state of our internal force. When we experience traumatization, our nervous system is stuck in a fight, flight, or freeze response. Whether it’s being quick tempered, high anxiety, or prone to depression, we release this energy by letting the body tell us what it needs to have happen.

Any skilled practitioner will integrate other modalities into their EMDR practice. You have a right to vet your EMDR practitioner to make sure that you’re getting the highest quality treatment. And whether or not you pursue EMDR, seeking Somatic Therapy as a foundation to the trauma work you do is paramount.

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