Eye Movement Desensitization and Reprocessing,Second Edition Book

This is the textbook for Eye Movement Desensitization and Reprocessing'as opposed to the popular book titled EMDR. The popular book is much more readable, citing numerous case examples and transcripts of actual therapy sessions, while the textbook is much more thorough, presenting the nitty-gritty, step-by-step details on how to perform the therapy.
EMDR is a technique for treating psychological problems caused by trauma. Initially, it was applied primarily to combat veterans and rape victims suffering from post-traumatic stress syndrome (PTSD). Later, it was extended to other ills such as panic attacks, phobias, somatic disorders and multiple personality disorder. Francine Shapiro, the mother of EMDR, claims an 80-90% success rate when the technique is properly applied by experienced clinicians. She ardently advocates rigorous research and clinical evaluation of this and other psychotherapy techniques to see how well they really work. (The book contains an appendix that lists all studies that have evaluated the effectiveness of EMDR.)
EMDR is based on the assumptions that: 1) people's brains are normally self-healing just like their bodies, so the therapist's role is to facilitate this natural process; 2) severe psychological trauma somehow "freezes" or "locks up" painful memories by isolating the neural networks that contain them'this keeps the information from being normally assimilated by the brain (another analogue: the isolated network is like a sore that fails to heal properly and festers, poisoning the whole body); and 3) somehow systematic eye movements help "thaw" or "open up" the traumatic memory so that the material can be normally processed ("allowed to heal") and thus integrated with other memories and cognitions (the sore lanced and its contents dissolved and assimilated by the body).
No one knows why the eye movements work. Among the more interesting hypotheses: they induce a relaxation response, which allows the patient to more easily handle the traumatizing material (there is a possible parallel with REM sleep: one of the leading hypotheses about REM, supported by studies, is that it helps the brain assimilate the day's events'and the more emotional the events, the more rapid the eye movements). Another interesting hypothesis'my favorite'is that the eye movements synchronize the activities of the two cerebral hemispheres (the idea is that networks in the two hemispheres are isolated from each other because they have different voltage thresholds'and that the eye movements somehow converge the thresholds).
EMDR is a lot more than simply eye movements. It is a detailed, comprehensive therapeutic procedure that borrows many techniques from other therapies. The basic steps are:

*Image'Identify and target, one at a time, the images involved in traumatic ("stuck") memories. This gets them moving again (reinitiates information-processing and assimilation by the brain).

*Abreact Emotions'While targeting the traumatic memory and performing the eye movements, release the "locked in" emotions in the safe environment of the therapist's office, thus permanently diminishing their (now-inappropriate) intensity.

*Negative Cognition'Identify negative cognitions growing out of the traumatic experience and its aftermath'negative generalizations like "I'm a bad person," or "I'm unlovable" or "I always screw things up." Such generalized self-images are very common among the severely traumatized (e.g., rape victims, combat veterans).

*Positive Cognition'Identify and "install" credible positive cognitions to replace the negative ones. For example: "I'm a good person," "I did the best I could," "I'm very capable."

*Physical Sensations'Scan for physical sensations related to the traumatic memory, and target and process any that remain.

Shapiro developed a detailed 8-phase procedure for therapy, and insists that it be rigorously followed. The phases:

1'Client History and Treatment Planning. Evaluate the client's suitability for EMDR (for example, is she medically capable of handling the intense emotion of abreaction?). If suitable, evaluate the total clinical picture and jointly devise a treatment plan, identifying specific memories to be targeted.

2'Preparation. Develop rapport with client; explain how EMDR works; discuss any client concerns; discuss safety issues; teach the client relaxation techniques that will permit him to neutralize abreactive stress.

3'Assessment. Identify specific image(s) involved with the target memory; identify negative cognitions; identify acceptable (realistic) positive cognitions and evaluate for believability (using VOC'Validity of Cognition'scale); identify the disturbing emotion engendered by the traumatic memory, and rate its intensity (using SUD'Subjective Units of Disturbance'scale); and identify the location of any physical sensations associated with the traumatic memory. Based on these evaluations, establish a response baseline (something to measure progress against as therapy proceeds).

4'Desensitization. Run a series of "sets" in which the client focuses on aspects of the traumatic memory while making eye movements, with the intent of abreacting the disturbing emotion. After each set, evaluate progress using the SUD scale (client rates on a scale of 1 to 11 the intensity of the emotion elicited by the target image). Proceed until SUD scale reduces to 0 or 1.

5'Installation. Run a series of sets to install the positive cognition. In each set, while making eye movements focus simultaneously on (now emotionally drained) target memory and positive cognition. After each set, evaluate believability of positive cognition using VOC scale (rate credibilty'"do I really believe it?"'of positive cognition on a scale of 1 to 7). Continue sets until positive cognition rates 6 or 7.

6'Body Scan. Client slowly scans own body from top to bottom for physical sensations (e.g., areas of tension) while focusing simultaneously on the target memory and the positive cognition. Perform desensitization sets on any residual (negative) physical sensations.

7'Closure. Return client to state of emotional equilibrium before terminating a session (this is especially important if the traumatic memory has not yet been completely processed). Instruct client what to expect between sessions; remind her of relaxation exercises; instruct her to keep a log of experiences between sessions, for use in defining further target images; instruct the client to "take a snapshot" of any disturbances that occur between sessions.

8'Reevaluation. Evaluate progress at the beginning of each new session, after going over client log and discussing between-session experience. Reevaluate the treatment plan, if necessary adding new targets. Treatment does not terminate until all targets have been "cleaned out" (reduced to 0 or 1 on the SUD scale).

What about the eye movements themselves? The typical set includes about 24; guided by the therapist's fingers (two), the movements consist of quick passes from wide left to wide right and back again; they start horizontal but can be switched to diagonal or vertical as experience dictates. (Different clients respond differently.) For people with eye problems: rhythmic tapping of the upturned palms sometimes works just as well as eye movements, as does alternating finger-snaps beside the left and right ears.

EMDR is client-centered. This means that the therapist provides a structure and facilitates the natural propensity of the client to self-heal, but does not dictate or over-steer the client. This approach works well in about half the cases. Shapiro devotes a chapter of the book to dealing with more difficult cases. With these she uses what she calls the "cognitive interweave," in which the therapist takes a more active role in getting the client "unstuck." Many of the more directed methods are drawn from other therapies, such as behavior mod and gestalt.
Shapiro also devotes a chapter to special client populations'and how to tailor EMDR to accommodate them. She especially emphasizes the necessity, before applying EMDR to the dissociative disorders (and especially multiple personality disorder'now called "dissociative identity disorder"), the therapist should be thoroughly grounded in the clinical characteristics of the dissociative disorders themselves (it's easy for a therapist unlocking the trauma of one MPD alter or subpersonality to find herself suddenly confronted by a completely different'and possibly hostile'one).
In the final chapter Shapiro calls'begs'pleads'for more and higher quality research by psychologists on the effectiveness not only of EMDR but also of competing psychotherapies.

This textbook is probably too nitty-gritty for any but those with a keen interest in EMDR'but for the keenly interested, it's indispensable.