EMDR: History, EMDR: History, Controversies & Controversies &

Future Template?Future Template?Tim DunneTim Dunne

Chartered Clinical Psychologist/Chartered Clinical Psychologist/Accredited EMDR PractitionerAccredited EMDR Practitioner

Birmingham EMDR Midlands Regional GroupBirmingham EMDR Midlands Regional Group55thth November 2008 © November 2008 ©

Introduction & OutlineIntroduction & Outline

Background to todayBackground to today Beginnings of EMDRBeginnings of EMDR Precursors of EMDRPrecursors of EMDR Three phasesThree phases Issues & Controversies in the Issues & Controversies in the

literatureliterature Future Template: Whither EMDR?Future Template: Whither EMDR? Appreciative Inquiry (AI) Appreciative Inquiry (AI)

Introduction to workshopIntroduction to workshop

Doctoral Research Doctoral Research ProjectProject

Therapists’ Beliefs about EMDRTherapists’ Beliefs about EMDR What explanations do EMDR Therapists What explanations do EMDR Therapists

use to understand how EMDR works in use to understand how EMDR works in practice?practice?

How do Therapists from different How do Therapists from different backgrounds integrate EMDR into their backgrounds integrate EMDR into their clinical practice?clinical practice?

Do therapists from different backgrounds Do therapists from different backgrounds have more/less difficulty in integrating have more/less difficulty in integrating EMDR into their clinical practice?EMDR into their clinical practice?

Literature ReviewLiterature Review Only 3 surveys to date of Therapists using EMDROnly 3 surveys to date of Therapists using EMDR Lipke (1995) surveyed the first 1200 Therapists Lipke (1995) surveyed the first 1200 Therapists

trained by Shapirotrained by Shapiro Lyhus (2003) surveyed how Therapists Lyhus (2003) surveyed how Therapists

integrated EMDR (N=532). Web based surveyintegrated EMDR (N=532). Web based survey DiGiorgio et al (2004) conducted qualitative DiGiorgio et al (2004) conducted qualitative

study of integration issues (N=3)study of integration issues (N=3) All 3 surveys were done in USA and used either All 3 surveys were done in USA and used either

Qual or Quan methodsQual or Quan methods My survey is cross-cultural and uses both Qual My survey is cross-cultural and uses both Qual

and Quan methodologyand Quan methodology Focus group today is part of the Qualitative Focus group today is part of the Qualitative

approach (Appreciative Inquiry)approach (Appreciative Inquiry)

BeginningsBeginnings ““Walk in the park”Walk in the park” Shapiro published first paper in 1989 (a) quickly Shapiro published first paper in 1989 (a) quickly

followed by a case study 1989 (b)followed by a case study 1989 (b) Initially called EMDInitially called EMD Considered to be a type of desensitisation approachConsidered to be a type of desensitisation approach EMD morphed into EMDR as Shapiro (1991) came EMD morphed into EMDR as Shapiro (1991) came

to understand that fear reduction and anxiety were to understand that fear reduction and anxiety were part of a comprehensive reprocessing of the T part of a comprehensive reprocessing of the T experienceexperience

She discovered that negative emotions were She discovered that negative emotions were replaced with positive feelings, insights occurred replaced with positive feelings, insights occurred and body sensations changedand body sensations changed

Often a new self of the self emerged during Often a new self of the self emerged during treatment sessionstreatment sessions

BeginningsBeginnings Transformation of the T experience thru rapid Transformation of the T experience thru rapid

learning process led Shapiro to adopt the learning process led Shapiro to adopt the Information Processing Model as the theoretical Information Processing Model as the theoretical underpinning of EMDRunderpinning of EMDR

This was adopted from the IP model of Lang This was adopted from the IP model of Lang (1977;1985) who described 3 systems of information (1977;1985) who described 3 systems of information related to emotional experiences that are organized related to emotional experiences that are organized and stored as semantic memoryand stored as semantic memory

Foa & Kozak’s (1986) “Emotional Processing” model Foa & Kozak’s (1986) “Emotional Processing” model and Chemtob et al (1988) suggested that a fear and Chemtob et al (1988) suggested that a fear structure is stored in long term memorystructure is stored in long term memory

Network = information about stimuli, their meanings Network = information about stimuli, their meanings and responses to these stimuli (autonomic arousal, and responses to these stimuli (autonomic arousal, escape & avoidance). Can be evoked by a wide range escape & avoidance). Can be evoked by a wide range of stimuli such as sounds, odours and body of stimuli such as sounds, odours and body sensationssensations

Lang’s IP modelLang’s IP model 11stst network = stimuli/cues that elicit the emotion network = stimuli/cues that elicit the emotion 22ndnd network = contains information re the cognitive, motor, network = contains information re the cognitive, motor,

and psychophysiologic responses to emotionsand psychophysiologic responses to emotions 33rdrd network = incorporates meaning attributed to the cues network = incorporates meaning attributed to the cues

and responsesand responses All components of the T are activated when one element is All components of the T are activated when one element is

stimulatedstimulated Powerful emotions can be triggered by a wide variety of Powerful emotions can be triggered by a wide variety of

stimulistimuli Once the emotions are evoked they can feel as real as they Once the emotions are evoked they can feel as real as they

did during the actual T experiencedid during the actual T experience These networks are not static but in constant state of These networks are not static but in constant state of

evolution & refinementevolution & refinement Emotions = “bottom - up” rather than “top-down”Emotions = “bottom - up” rather than “top-down” Three networks linked by Associative processesThree networks linked by Associative processes

Three Phases in Three Phases in Development of EMDRDevelopment of EMDR

Phase 1 : A Star is bornPhase 1 : A Star is born

Phase 2 : Intergalactic Star WarsPhase 2 : Intergalactic Star Wars

Phase 3 : 3G EMDR: The Next Phase 3 : 3G EMDR: The Next GenerationGeneration

A new star in the skyA new star in the sky Before Shapiro’s first paper in 1989 there Before Shapiro’s first paper in 1989 there

had only been 6 controlled studies of all had only been 6 controlled studies of all psychological therapies for PTSDpsychological therapies for PTSD

Since 1989, there have been 26 controlled Since 1989, there have been 26 controlled studies on EMDR & PTSD alonestudies on EMDR & PTSD alone

EMDR Spurred rapid increase & interest EMDR Spurred rapid increase & interest in the treatment of PTSDin the treatment of PTSD

Early EMDR papers were somewhat Early EMDR papers were somewhat “evangelical” in tone (Gallo, 1996) “evangelical” in tone (Gallo, 1996) admittedly not Shapiro herselfadmittedly not Shapiro herself

A new star in the skyA new star in the sky

Shapiro rapidly moved from the Shapiro rapidly moved from the Pavlovian type explanation to the Pavlovian type explanation to the Accelerated IP model and from there to Accelerated IP model and from there to Adaptive IP model to explain the Adaptive IP model to explain the phenomena she observed in treatment phenomena she observed in treatment of PTSDof PTSD

She has always maintained that EMDR She has always maintained that EMDR is an evolving therapeutic procedure is an evolving therapeutic procedure which is still in its evolutionary first which is still in its evolutionary first stagesstages

Intergalactic Star Wars Intergalactic Star Wars Break Out Break Out

Literature become polarized quite quicklyLiterature become polarized quite quickly Critics of EMDR (Herbert & Meuser, Critics of EMDR (Herbert & Meuser,

1992; Lohr et al, 1998; Lilienfield & 1992; Lohr et al, 1998; Lilienfield & Arkowitz, 2007; Rosen et al, 1998; Herbert Arkowitz, 2007; Rosen et al, 1998; Herbert et al, 2000; McNally, 1999 etc) reacted et al, 2000; McNally, 1999 etc) reacted strongly to the claims made for EMDRstrongly to the claims made for EMDR

Accusations of faking results, ethical Accusations of faking results, ethical violations, “mesmerism”, “pseudoscience”, violations, “mesmerism”, “pseudoscience”, “neurobabble”, slurs of personal “neurobabble”, slurs of personal aggrandisement, ad hominem attacks and aggrandisement, ad hominem attacks and innuendo of personal financial gain were innuendo of personal financial gain were all made by different writers against all made by different writers against Shapiro Shapiro

Colourful QuotationsColourful Quotations ““The novel component of EMDR (EMs) adds nothing to the The novel component of EMDR (EMs) adds nothing to the

traditional imaginal exposure component” (Lohr, Tolin & traditional imaginal exposure component” (Lohr, Tolin & Lilienfield, 1998)Lilienfield, 1998)

““What is effective in EMDR is not new and what is new is not What is effective in EMDR is not new and what is new is not effective” (McNally, 1999)effective” (McNally, 1999)

APA Task Force (Chambless et al, 1998) were “EMDR APA Task Force (Chambless et al, 1998) were “EMDR puppets” (Herbert et al, 2000)puppets” (Herbert et al, 2000)

““The research results were faked or unduly influenced by The research results were faked or unduly influenced by Francine Shapiro” (McNally, 1999)Francine Shapiro” (McNally, 1999)

““Pseudoscience” (Herbert et al, 2000)Pseudoscience” (Herbert et al, 2000) ““EMDR has been promoted to a range of professionals EMDR has been promoted to a range of professionals

including massage therapists and chiropractors” (Herbert et including massage therapists and chiropractors” (Herbert et al, 2000)al, 2000)

““Shapiro’s 1989 study was a marketing tactic touting a single Shapiro’s 1989 study was a marketing tactic touting a single session cure” (Herbert et al, 2000)session cure” (Herbert et al, 2000)

All of these charges have been explored and rebutted by All of these charges have been explored and rebutted by Greenwald (1999 a & b), Perkins & Rouanzoin (2002) and Greenwald (1999 a & b), Perkins & Rouanzoin (2002) and Smith & Poole (2007)Smith & Poole (2007)

Intergalactic Star Wars Intergalactic Star Wars Break OutBreak Out

Serious methodological criticisms of the early Serious methodological criticisms of the early Shapiro papers included failure to Shapiro papers included failure to independently confirm PTSD diagnosis, independently confirm PTSD diagnosis, reliance on subjective measures (SUDS) & the reliance on subjective measures (SUDS) & the fact that Shapiro herself conducted all fact that Shapiro herself conducted all treatments and assessments which introduces treatments and assessments which introduces possibility of experimenter biaspossibility of experimenter bias

Confusion also around role of EMs, misreading Confusion also around role of EMs, misreading of her claims in the early papers, selective of her claims in the early papers, selective reporting of her data, omission of key research reporting of her data, omission of key research findings and ignorance of basic EMDR findings and ignorance of basic EMDR protocols (Perkins & Rouanzoin, 2002; protocols (Perkins & Rouanzoin, 2002; Greenwald 1996)Greenwald 1996)

3G EMDR: The Next 3G EMDR: The Next GenerationGeneration

Consensus has emerged in the literature that Consensus has emerged in the literature that EMDR is as effective as (TF)CBT in treatment of EMDR is as effective as (TF)CBT in treatment of PTSDPTSD

7 meta-analytic reviews have reached similar 7 meta-analytic reviews have reached similar conclusions (conclusions (Van Etten & Taylor, 1998; Chambless et al, 1998; Van Etten & Taylor, 1998; Chambless et al, 1998; Davidson & Parker, 2001; Bradley et al, 2005; NICE, 2005; Seidler Davidson & Parker, 2001; Bradley et al, 2005; NICE, 2005; Seidler & Wagner, 2006; Cochrane Review, 2008& Wagner, 2006; Cochrane Review, 2008))

EMDR is more effective than relaxation therapy, EMDR is more effective than relaxation therapy, non-directive therapy, medication or waiting-list non-directive therapy, medication or waiting-list controls in treatment of PTSDcontrols in treatment of PTSD

Professional & Govt bodies such as APA (1998), Professional & Govt bodies such as APA (1998), ISTSS (2000), Dutch National Steering Committee ISTSS (2000), Dutch National Steering Committee on MH (2003), Dept of Veterans Affairs USA on MH (2003), Dept of Veterans Affairs USA (2004), NICE UK (2005) have all accepted that (2004), NICE UK (2005) have all accepted that EMDR is an effective treatment for PTSDEMDR is an effective treatment for PTSD

3G EMDR: The Next 3G EMDR: The Next GenerationGeneration

Seidler & Wagner (2006) – “The efficacy Seidler & Wagner (2006) – “The efficacy of EMDR is no longer in doubt”of EMDR is no longer in doubt”

Van der Kolk (2007) demonstrated that Van der Kolk (2007) demonstrated that EMDR is more effective than SSRIs in the EMDR is more effective than SSRIs in the treatment of PTSDtreatment of PTSD

EMDR research on anxiety disorders, EMDR research on anxiety disorders, phobias, test anxiety, gambling, phantom phobias, test anxiety, gambling, phantom limb pain & bereavement in recent years limb pain & bereavement in recent years have all shown positive effectshave all shown positive effects

In 20 years EMDR has moved from a In 20 years EMDR has moved from a simple technique to a psychotherapy in simple technique to a psychotherapy in itselfitself

New Directions: Whither New Directions: Whither EMDR?EMDR?

Integration continues – multi-modal and with other therapiesIntegration continues – multi-modal and with other therapies Multi-modal = use of EMDR with specific populations such as Multi-modal = use of EMDR with specific populations such as

substance misusers & sex offenderssubstance misusers & sex offenders Shapiro’s later writings (2007) and Dworkin (2005) demonstrate Shapiro’s later writings (2007) and Dworkin (2005) demonstrate

EMDR’s integration with Family TherapyEMDR’s integration with Family Therapy Question of the issue of EMs is still unresolved – more research Question of the issue of EMs is still unresolved – more research

neededneeded Parker & Dignall (2007) demonstrated the superiority of EMs over Parker & Dignall (2007) demonstrated the superiority of EMs over

no EMs in a verbal learning memory task, including the ability to no EMs in a verbal learning memory task, including the ability to distinguish distracter wordsdistinguish distracter words

““If I had to do it over again, I might name it Reprocessing If I had to do it over again, I might name it Reprocessing Therapy” – Shapiro (2001)Therapy” – Shapiro (2001)

Shapiro emphasizes that the goal of treatment is to help the Shapiro emphasizes that the goal of treatment is to help the individual client grow and develop within a “stable social system” individual client grow and develop within a “stable social system” (2001)(2001)

EMDR = “synclectic” approach (ie) one that synthesizes and EMDR = “synclectic” approach (ie) one that synthesizes and synergizes with other approaches but that ultimately goes beyond synergizes with other approaches but that ultimately goes beyond all other approaches in its uniqueness where the whole is greater all other approaches in its uniqueness where the whole is greater than the sums of its partsthan the sums of its parts

Appreciative InquiryAppreciative Inquiry AI is an Orgl Development research AI is an Orgl Development research

approach developed by Cooperrider & approach developed by Cooperrider & Srivastva (1987 & 1990)Srivastva (1987 & 1990)

AI aims to help Orgs to change, renew AI aims to help Orgs to change, renew and develop staff performanceand develop staff performance

AI asks questions in a particular way by AI asks questions in a particular way by asking people to envision the future asking people to envision the future (Future Template?) and fostering positive (Future Template?) and fostering positive relationships between staff/teamsrelationships between staff/teams

In this way AI claims to enhance a In this way AI claims to enhance a system’s capacity for collaboration and system’s capacity for collaboration and changechange

Appreciative InquiryAppreciative Inquiry The basic idea is to build Orgs around what The basic idea is to build Orgs around what

works rather than trying to fix what doesn’tworks rather than trying to fix what doesn’t AI acknowledges the contribution of AI acknowledges the contribution of

individuals/small teams in order to increase individuals/small teams in order to increase trust and Orgl Devtrust and Orgl Dev

AI aims to create meaning by drawing from AI aims to create meaning by drawing from stories of concrete successesstories of concrete successes

AI has been used successfully across many AI has been used successfully across many sectors including health & social care, local sectors including health & social care, local govt, religious institutions and the private govt, religious institutions and the private sectorsector

Appreciative InquiryAppreciative Inquiry

AI uses a 4 stage process of :AI uses a 4 stage process of : DiscoveringDiscovering

DreamingDreaming

DesigningDesigning

DeliveringDelivering

Appreciative InquiryAppreciative Inquiry

For our purposes we shall focus on For our purposes we shall focus on the first stage (ie) Discoveringthe first stage (ie) Discovering

Working in 3s initiallyWorking in 3s initially

Small groupsSmall groups

Large group plenary sessionLarge group plenary session

Appreciative InquiryAppreciative Inquiry The aim in this workshop to give each The aim in this workshop to give each

individual a chance to reflect on their own individual a chance to reflect on their own “peak experience” of using EMDR in twos “peak experience” of using EMDR in twos (30 mins)(30 mins)

Share these reflections with another pair in Share these reflections with another pair in order to pull out common elements of this order to pull out common elements of this ideal experience (30 mins)ideal experience (30 mins)

Finally, to bring all the sub-groups together Finally, to bring all the sub-groups together in one large group to identify common in one large group to identify common elements from the pairs work and the small elements from the pairs work and the small groups (groups (1 Hour)1 Hour)

Reflection on the outcomes and findings Reflection on the outcomes and findings from this experience from this experience

Contact DetailsContact Details

Website : Website : www.carlowpsychology.iewww.carlowpsychology.ie

Email : tpdunne@gmail.comEmail : tpdunne@gmail.com