EMDR: Expectation vs Reality

EMDR is an excellent treatment for PTSD with potential for application to a range of mental health conditions. However, many clients perceive it as a “quick fix” when that is not the case. Let’s unpack the origins of this mismatch in expectations and check it with a more realistic picture of what EMDR can do.

A Brief History of Trauma Therapy

Sigmund Freud and Josef Breuer published case studies of women that today would likely be described as experiencing symptoms of trauma. At the that time, patients often spent a lot of time with their therapist—like daily sessions for years. This perception of therapy being an expensive, long, and multiple visit per week process persisted into the 1980s.

With our current wellness culture’s focus on efficiency and biohacking, traditional psychotherapy doesn’t fit well with that. Also, that much contact and cost does not appear to provide greater benefit than weekly sessions with an effective therapist.

Exposure therapy gained more popularity as the gold standard for the treatment of PTSD. I received training on it from a psychologist who previously worked with Vietnam veterans. Exposure therapy for PTSD typically involves the client repeatedly exposing themselves to their traumatic memories until they experience a level of desensitization to the material. This usually is done by the client recording a detailed account of the traumatic event and listening to the recording repeatedly. This is a vast oversimplification of the process, but it’s an important part of the treatment and many clients and therapists reported a high level of discomfort with it.

When Francine Shapiro developed EMDR, studies reported that clients experienced relief faster and with less disclosure than previous therapies. Is this true? Yes, but look at what we’re comparing it to. None of that implies that it’s an instant fix. I have seen clients with panic disorder experience symptom reduction within a few sessions, but for anything more deep-rooted, EMDR doesn’t necessarily move at a faster pace than other therapies, at least not initially.

Window of Tolerance

In order to benefit from Adaptive Information Processing (AIP), which is the core of EMDR, a client needs to be within their window of tolerance during the reprocessing and desensitization. This makes it possible for their learning system to form adaptive connections and correct for maladaptive ones. If a client is outside of their window of tolerance, the therapy is not only unpleasant, but minimally effective. A lot of clients who get turned off to EMDR have that experience because the therapist didn’t prepare them for reprocessing adequately.

Every client is different. For example, if a client is working in an environment that retraumatizes them every day, we need to work at a much slower pace than someone who is in a stable and supportive environment. Emotional regulation is key throughout the process. In order to support clients with this, EMDR clinicians need to conduct a thorough intake and employ resourcing strategies. Since an intake for trauma therapy involves discussing unpleasant material, resourcing often needs to be integrated into that process. Consequently, it could take several months before a therapist and client map out targets to reprocess. For severe trauma, targets sometimes need to be fractionated or broken down into small pieces. All of this means slowing the process down more. Clients typically begin experiencing symptom relief, but it is not 100% and sometimes disturbing material arises between sessions because we cannot protect our clients from every trigger out in the world. That’s part of the reason resourcing is so important.

Managing Expectations

Typically, clients who engage with EMDR by showing up regularly, practicing self-care, and staying focused on the treatment goals see a lot of progress in a relatively short period of time. However, weekly sessions aren’t always realistic for clients, and sometimes, life is intense and we need to pause and work on a more pressing issue.

Short version: If anyone says they can alter a pattern that has persisted for someone’s life in four sessions, don’t trust them.