If you are already working on healing from a history of trauma, dissociation is likely a familiar concept. You are likely aware it is a system of coping that, in times of distress, offers protection from the full realization of trauma and its associated emotions, sensations, images, thoughts, and patterns of thinking.

The lack of realization and integration of these components creates the symptoms that bring people to therapy. The greater the extent and intensity of the traumas, the greater the complexity of the typical dissociative process and, of course, the treatment approach.

The “window of tolerance,” a concept introduced by Daniel J. Siegel, describes the equilibrium our systems need in order to heal from trauma. When we have unhealed traumas, our systems may not be fully present. They might not fully know or feel that the danger has passed and can become fixed in states of hypoarousal and hyperarousal or fluctuate between the two states.

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Hypo- or hyperarousal can result from the dissociative symptoms linked to the trauma, which may be positive (adding to the experience) or negative (taking away from the experience). Positive dissociative symptoms might include intrusive images, emotions, sensations, and thoughts. Negative dissociative symptoms may include amnesia, derealization, and depersonalization.

When we are stuck in these upper and lower zones of hyper- or hypoarousal, the full integration and healing of trauma cannot occur. But in the middle, within the window of tolerance, healing and integration can occur.

The shift outside the window of tolerance into hypo- or hyperarousal is the dissociative process, and it may be subtle or extreme. In those moments we experience what I call the “quantum leap effect,” where aspects of our former self, still stuck in the original trauma, do not have access to what the present self knows. That keeps us stuck in the reliving of the traumatic material, even though a part of us—an inaccessible part, so long as we are dissociating—knows it is in the past.

Anchoring Yourself in the Present

After noticing a dissociative shift into hypo- or hyperarousal, it may be helpful to utilize a skill that anchors you mindfully to the present. The anchor is not just about noticing you are “in the now.” It is imperative you notice and acknowledge the present is different from whatever you think you are stuck in. “I know I may be seeing old stuff,” you might tell yourself, “but that old stuff can’t be happening because I am in this room now, and these are the ways it looks different.”

The shift outside the window of tolerance into hypo- or hyperarousal is the dissociative process, and it may be subtle or extreme.

A more specific example might look like this: “The wall is brown, there is carpet, and I am 22 years old. I can’t be in that old circumstance. I am in the same room as this brown carpet. It must be over, because I am in a different room and I am older. I wasn’t wearing these shoes. In fact, I couldn’t fit in these shoes if I was in that time.”

If you are trying to heal from trauma, think of this anchoring skill as a way to get aspects of your former self more current and stay within your window of tolerance. To really take root, it must be practiced over and over. But it is an essential coping skill for any trauma survivor, even before processing any traumatic material in therapy.

Reference:

Siegel, D. (1999). The Developing Mind. New York: Guilford.

Fourteen years ago, when I was first trained in EMDR therapy, there was less of an understanding of its benefits, as well as a lot of confusion about what eye movement desensitization and reprocessing actually was. One thing it’s never been is a quick fix. And while I make it a point to educate people about this reality, I have found there is another layer to that common misunderstanding: lack of awareness that the existence of complex trauma, as opposed to single-incident trauma, can make EMDR an even longer-term treatment.

When working with those with single-incident trauma—a survivor of a car accident, for example—the standard eight-phased, three-pronged EMDR protocol has the potential to guide the treatment process in a relatively straightforward manner. Treatment can also be more clear-cut and focused when there are multiple traumas that can be grouped into the same category. Someone who reports being raped at various times in their life would be an example of this. Neurologically, the traumas can travel down a similar “track” when processed.

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However, it is usually the cumulative effect of multiple traumas, of multiple kinds and categories, that brings folks to my office. The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences—developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

Complex trauma is identified by Judith Herman and other leaders in the field of traumatology as “the existence of a complex form of posttraumatic disorder in survivors of prolonged, repeated trauma” (Herman, 1992). An example of a history of complex trauma would be a woman who was adopted at birth, experienced sexual abuse by her brother, experienced ongoing physical abuse by her mother, and perhaps had a series of abusive relationships throughout her teenage and early adult years. She has an extensive history of interpersonal traumas at various ages and developmental stages, and spanning multiple categories.

The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences, developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.

As part of our healing journeys, we must pay attention to traumas of both omission and commission; both matter and can impact a person’s mental health. Neglect and abandonment, among others, are traumas of omission. Sexual abuse, physical abuse, and violence are clearly acts of commission. Perhaps a person experienced ongoing parental misattunements, significant attachment losses, a parent’s hospitalization or depression, or witnessed a mother grieving the loss of a sibling. These and myriad other experiences are examples of traumas that, at the time, impacted the person’s sense of emotional and physical safety and, more often than not, included caregivers. If they happened in childhood, they may greatly impact the person’s perceptions of the world today. All of this adds up to complex trauma.

Many leaders in the field of trauma treatment believe the newest diagnostic criteria for posttraumatic stress (PTSD), as outlined in the DSM-5, are not comprehensive enough. Although an improvement over the DSM-IV, the latest guide for mental health practitioners does not account for the full clinical picture when it comes to developmental trauma.

The term “complex trauma” didn’t even make it into the DSM-IV; instead, “DES NOS” (disorders of extreme stress not otherwise specified) was often used in clinical application. In the DSM-5, some of the symptoms of DES NOS, such as re-experiencing, avoidance, negative cognitions and mood, and arousal, were included in the PTSD criteria.

Which brings us back around to EMDR therapy. Yes, it is possible to heal from a history of complex trauma. Doing so just takes a conscious, methodical, and phased approach to treatment. If you are considering EMDR and have a history of complex trauma, I highly recommend ensuring that your therapist has experience in working with both. Make sure, also, that your therapist talks to you about extensive preparation and stabilization; these aspects will be a necessary part of your healing journey.

Reference:

Herman, J. (1992). Trauma and Recovery. New York: HarperCollins.

Editor’s note: This is the first article in a two-part series that explores how the Pixar movie Inside Out offers a compelling and accessible way to look the impact of trauma and dissociation. Part II appears here.

It’s rare that I give homework to people in therapy. In fact, as a trauma therapist specializing in complex trauma, I find that more often than not some homework assignments can be triggering. So it is a very conscious choice when I ask people to do homework in between sessions.

When I do suggest homework, it is often with the emphasis on increasing their calming and relaxation skills, or to provide additional psycho-education surrounding trauma recovery. Structural dissociation theory, eye movement desensitization and reprocessing (EMDR) therapy, and the neurological aspects of trauma’s impact on the brain—these topics can present as “heady” or “too academic.” I always look for a more accessible way to describe such topics. Pixar Animation Studios has provided such an opportunity.

To me, the most effective, powerful, inspiring homework and psycho-education opportunities are more organic and experiential in nature.

With this in mind, I recently began asking some people to watch Pixar’s recent movie release, Inside Out. While this article is neither a review nor a place for spoilers, it is a testament to the power of Inside Out to teach people about trauma and dissociation in an inspiring and open-hearted way.

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The ‘Inside Out’ Story

In Inside Out, a girl named Riley, the 11-year-old main character, is faced with the challenges of moving from her family’s hometown. Her primary emotions, joy, anger, fear, disgust, and sadness, are represented as characters by the same names, each with influence over the “control console” of her mind, also known as “headquarters.”

Often, we “reject” our emotions, or other aspects of the traumas, because it feels too risky or too dangerous to fully realize them at the time of the experiences.

As Riley navigates the events surrounding her family’s move and the associated traumatic stressors, the primary emotion of “Joy” is no longer at the helm. “Sadness” becomes more prevalent, creating more core memories surrounding her distress at the move. By a variety of methods, “Joy” attempts to bring headquarters back to “normal,” meaning “Joy” at the controls, but as “Anger,” “Fear,” and “Disgust” take over, Riley’s internal world, and the personality islands associated with things she enjoyed—family life, friends, and her love of hockey—disintegrate. She shuts down.

It is not until all of the emotional states accept and integrate “Sadness,” solidifying that each emotion has its place, that new core memories can be built and her healing occurs.

So what does Inside Out have to do with trauma recovery? More than perhaps is clear at the onset.

Core Memories

As I have written in previous articles, it is our unprocessed and fragmented memories, the traumas that are “locked” in their state-dependent form, that cause distressing symptoms in our now. Our emotions, as well as what we saw, believed, and somatically experienced, are “frozen in time” and contribute to our distressing symptoms in the present.

Inside Out does an exceptional job of showing how our fully integrated, realized, and healed “core memories” can be stored in our headquarters in ways that are adaptive. Our system does have fully processed memories—that is, all aspects are acknowledged and healed. Pixar describes them as core memories symbolized by translucent spheres mindfully placed in a conveyor-like storage system. That said, when traumas are not fully healed, we have memories that are fragmented and displaced, even rejected.

Rejecting or Banishing an Aspect of Trauma

Often, we “reject” our emotions, or other aspects of the traumas, because it feels too risky or too dangerous to fully realize them at the time of the experiences. This is illustrated in Inside Out, where “Joy” cannot accept “Sadness.” “Joy” rejects her. Similarly, as we move forward in time, we, too, can become phobic toward some aspects of our trauma(s). In Riley’s case, “Sadness” had a very important job and was an important part of her moving from Minnesota. In fact, as Riley moved through her process of daily living, “Sadness” kept trying to push through—to touch the other memories in order to be acknowledged and processed.

It is not until the characters, the other emotions, become more accepting of “Sadness” that the full healing can occur. As Riley’s internal system, headquarters, becomes able to fully accept ALL aspects of the trauma, including what was once rejected or deemed dangerous to fully realize, “Sadness” is able to take its rightful place.

In the context of structural dissociation theory, no longer did Riley’s system have to feel phobic of that part of the experience. Riley could not fully realize and heal the trauma of her move until “Sadness” was acknowledged by her whole system. “Sadness” did have a place, and was key to healing the whole memory.

We may have experienced various traumatic experiences in childhood, whether it be abuse, neglect, abandonment, or ongoing misattunements from caregivers that impact our ability to feel safe to attach. Even though the events themselves may be behind us, those internal responses to the traumatic experiences—images, sensations, meanings we create, and emotions—can become “stuck” in the nervous system. They continue to have a “charge.” That charge stays in our system, is stored maladapatively, and is part of our inner world.

At the most unexpected times, this material can push through what we would consider our “normal” day-to-day activities—such as parenting, working, relationship building, and self-care—in the “outside world.” As a result, we may find ourselves in a constant balancing act of pushing back at that charge. Our normal everyday selves, if you will, try to show the world that we are fine on the outside, even though there may be a lot of material that pushes through.

For example, perhaps we are in a discussion with a loved one when, all of the sudden, we interpret that we are being abandoned, even while there is no actual evidence of this. Or perhaps while attempting to set a boundary with a child, we feel feelings of guilt because we don’t feel that we “deserve” to set those boundaries. All of these can be intrusions on day-to-day life, all from past hurts.

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Those feelings and interpretations can actually be the experiences of the past clouding the now, stopping us from truly being in the moment. The nervous system is activated and defending itself from a past injustice. Unfortunately, that charge from the past compels your nervous system to act as if the traumatic experience is still happening.

There can then develop a kind of tug-of-war between who we are on the outside and the charges that remain from the past. If the tug-of-war with the traumatic material becomes too much and we become flooded, we may need to go numb in order to be able to still “do” life on the outside. We may shut down. Even if we do, it doesn’t mean that the material on the inside is gone; it just means that we have had to become more unaware of it in order to function on the outside.

One of the most challenging aspects of complex trauma, whether or not pursuing EMDR therapy, is that we must be able to identify and “own” our feelings and experiences. This allows us to then process traumatic experiences from the perspective of being “here and now” and visiting them versus feeling as if one is flooded and still in those experiences. In EMDR language, we look for one’s ability to maintain dual attention. It expands into making sure we stay within a window of tolerance as we visit those memories.

Often, those starting their healing work find themselves in one of two extremes: flooded by feelings all of the time or feeling completely numb.

For some, this may not seem like such a large step, but for the majority of those who are healing from complex trauma, it is in fact very difficult. Often, those starting their healing work find themselves in one of two extremes: flooded by feelings all of the time or feeling completely numb. The numbness often comes because the material in our inside world becomes unmanageable and we become more fearful of that material. We shut down from the outside world because the inside world is so invasive.

We typically learn to dance this dance of “daily life” vs. “inner stuff” at an early age. In infancy, we learn that our attachment to our caregivers is required; we cannot survive without a caregiver or we will die. Period. We also learn that our attachment relationship is dependent upon us being in tune with our caregiver’s reactions—to know what to do, how to act, and how OK it is (or not OK) to have our emotions be expressed and seen in the outside world.

We also determine whether it is dangerous to really identify, own, and be with the feelings of shame, anger, or sadness, even happiness or calm. We then create certain strategies that seem helpful at the time but show up later as distressing symptoms. As outlined in my previous article on blocking beliefs, it is often those cognitive errors that hold us back from fully realizing and being in tune with our past hurts because it was, at the time, too much to fully realize.

In future articles, I will share more about what it means to fully realize and own what was once unrealized, back when we were experiencing past injustices. Similarly, I will share more regarding what it means to own and process feelings we may have deemed unacceptable in order to survive the past.

If you are a therapist and are interested in expanding your knowledge on this topic, especially as it relates to structural dissociation theory, you are encouraged to read The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (2006) by Onno van der Hart, Ellert R.S. Nijenhuis, and Kathy Steele.

I find myself looking at this person; I feel for him, knowing that he is tormented by his anxiety and sense of isolation. While he has made amazing strides in therapy, especially through eye movement desensitization and reprocessing (EMDR), there is something that keeps “blocking” him from reaching the point of accepting that the past is truly “over.” There is something that pulls at him, drags him down into the murky depths of his sadness, telling him that he can’t reach that positive belief that he is “good enough.”

His story is not unique. He is like many of the people I work with in therapy who struggle to loosen themselves from the hold of trauma. He is like many who walk into my office wanting to feel free of the past, to fully integrate what they know “logically”—that they are “OK, lovable, worthy, safe, here now”—with their emotional selves, who are just not buying it.

As you are reading this, perhaps there is some aspect of your healing work that you feel “stuck” in. It’s a common theme; folks do amazing trauma healing work and perhaps might find that they have hit a wall. They want to feel healed, but on some level it just won’t budge. “I don’t know why” is a common statement. What we often find is that there is some next layer of the person’s experience that is revealing itself. In EMDR therapy, we call it a “blocking belief.”

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Why does this happen? Why is it that, on the one hand, we can know that the past is behind us, and yet there is also a sense that it is not? We can begin to explore this question not only through the perspective of trauma therapy, but specifically EMDR therapy.

A blocking belief essentially blocks us from shifting our core beliefs about ourselves. For example, in processing deep-rooted trauma through EMDR therapy, the person I described was working through a core belief (EMDR therapists call it a “negative cognition”) of “I’m not good enough” and then, right when it was getting to a decreased intensity, found another layer—a blocking belief that “I shouldn’t get over this.” That same blocking belief kept the trauma from decreasing in intensity from a 10 (most disturbance) to a zero (neutral/no disturbance). It wasn’t until we shifted that blocking belief—“I shouldn’t get over this”—that the core belief of “I’m not good enough” could release its hold as the trauma was processed.

Blocking beliefs can come up often in EMDR therapy when we ask about the SUDs (subjective units of disturbance scale). It’s a scale we use to find out how the person’s distress about the event has shifted. Keep in mind that it doesn’t mean that the event is not disturbing. That it’s disturbing doesn’t change. It will be a disturbing event as a trauma, by its nature of being a trauma. But the person doesn’t have to continue to feel disturbed by it.

When we start to explore our core beliefs about ourselves, and the traumas that have driven them, be sure to explore any blocking beliefs that may show up. It may just mean that you are that much closer to healing those traumas than you may have thought. It may just be that deepest layer waiting for you to discover it.

Believe it or not, it is possible to get to a neutral or zero about traumatic events and the disturbance we feel about them, even for the most upsetting and distressing experiences. But there may be some reason we hold on. Unconsciously, perhaps we think we need to keep some fear, just enough, to help us feel safe and prepared for next time. Perhaps we think it’s “impossible” to heal from those experiences. Perhaps there’s a mistaken, unconscious belief that it’s not “something we should get over,” that it’s not OK that we heal this event: “It’s just too painful; if I feel neutral or no disturbance, then I am not honoring the experience(s) and the impact on my life.”

The fact is, and this comes up a lot for folks when they do EMDR, it is possible to heal trauma.

It is possible to feel differently about our lives, whether it be to feel safe, calm, or even feel and know that the past is over. Yes, it can change; I’ve seen it. I’ve also experienced it. That said, it can take time, even with EMDR therapy, especially with multiple of types of traumas, and when traumas span across the developmental stages of our lives.

My work with people often drives me to explore themes that are currently showing up in my counseling practice. If you are a counselor, you know what I mean. You may have many clients or therapist consultees presenting with the same needs, perhaps some who are saying similar things of late. That’s not to say that these issues are the “same,” for they are not. Nevertheless, there are topics that may repeat themselves. I pay attention to these because I believe that there is much to explore and learn by being aware of patterns.

A pattern I have seen of late is related to eye movement desensitization and reprocessing (EMDR) work, specifically about the process of being “ready” to do EMDR. I have had a lot of therapists inquiring about their clients’ readiness to do EMDR. Keep in mind that if you are doing EMDR, you are always doing EMDR; it just depends on the phase you are in. If you are one of my EMDR clients or therapist consultees, you know how much I emphasize this as key to understanding the EMDR therapy model. Keep this in mind: EMDR is a process, a model, and not a technique.

EMDR’s preparation phase is phase two of the eight phases of EMDR. EMDR therapists look for people to have a minimum of two state-change skills as part of this phase. In phase two we are making sure that the client has the ability to not only tolerate emotion, but also to shift into a relaxed state, a para-sympathetic response. In other words, can the person bring up a disturbing event, be “in it,” but then also utilize a relaxation skill or calming technique to then change states if needed?

Keep in mind that the concept of changing states may be something that sounds easy, but for many it is not. Some folks seeking to utilize EMDR therapy as part of their trauma recovery may need more extensive preparation-phase support. This is especially true in the case of those struggling with dissociation and addictions.

In its simplest form, a state change means being able to utilize a relaxation skill to settle down one’s system. State-change skills can help the EMDR client to become calmer and more settled while still maintaining “dual attention”—i.e., being present while bringing up traumatic disturbance(s). In contrast, and though it may appear like it, the ability to utilize state-change skills does not mean changing states via dissociation. Certainly, one’s ability to dissociate may appear similar to a state-change skill, and is a survival skill, but dissociation keeps us “away from” traumatic material and from integrating the somatic, visual, emotional, and cognitive aspects of it to then heal.

For example, dissociation takes one away from the present moment because the past feels as if it is happening now and it feels safer to leave the present. But to be able to heal and integrate the traumatic material requires that state of being present. We just have to learn the dance between feeling the disturbing material and being able to shift into a contrasting, calmer state.

In exploring the concept of EMDR and state-change skills, addictions can also be explored as an attempt to chemically or behaviorally illicit a state change. I often explain to people that substance abuse is often driven by an ill-fated attempt to chemically dissociate. One can easily become entrenched in the vicious cycle of using addictive substances and behaviors to shift “out” of traumatic material in order to feel something, anything, and everything different from the pain of a traumatic history. And, for many people, addictions have become a way to change states, to feel away from and out of traumatic material.

The bottom line is that to heal, trauma histories beg to be accessed, stimulated, and reprocessed. The challenge can be in our making sure that EMDR clients are fully supported in having the state-change skills in place to be able to come back, to ground, and to stay present first. Therefore, creating and implementing these state-change skills can be the key to supporting EMDR clients in their recovery and throughout EMDR’s eight phases.

As you may know, eye movement desensitization and reprocessing (EMDR) is a research- and evidence-based therapy created by Francine Shapiro, Ph.D., over 20 years ago. An integrative model, EMDR is comprehensive, including aspects of multiple psychotherapeutic approaches. With this in mind, equine experiential activities, such as those found in equine-assisted psychotherapy (EAP), support and help to facilitate EMDR’s eight-phased model, while also maintaining fidelity to standard protocol.

The EquiLateral™ protocol is brought with a deep respect and understanding of EMDR but also the power of equine-assisted therapy. I am constantly reminded that EMDR and equine-assisted therapy both have the ability to support and often deepen a client’s ability to access where those traumas are stored. In my 10 years of experience as an EMDR therapist, I am still constantly amazed and inspired by the depth of healing that can be reached through EMDR, let alone through horses, who are often our most powerful and forgiving teachers.

Current research emphasizes the importance of maintaining fidelity to EMDR’s eight-phased approach. Nevertheless, in doing so, EMDR “may be implemented in more than one way as long as the broad goals of each phase are achieved” (www.emdria.org).

EquiLateral™ is the first equine-assisted EMDR protocol. We are still doing EMDR but are incorporating equine-assisted experiences within the eight-phased, three-prong, standard EMDR protocol. For more information on this approach to healing trauma, please visit my website: www.dragonflyinternationaltherapy.com

Horses, Comfort, and PTSD
Horses are prey animals. What this means is that they are highly in tune with their environment, readily noticing changes in the world around them and being able to respond to what they notice and actively seek what horseman Buck Brannaman describes as their wanting to return to “peace.” When in this energetic state, their nervous systems are settled and calm. They can readily focus on just being in the world, in the moment, which for them means grazing, moving 20+ miles a day, and relating with herd members. In contrast, when sensing danger, their peace is threatened, and their nervous system becomes activated enabling them to react, primarily through flight, although sometimes through fight or freeze, for self-preservation.

If you are a trauma survivor or know someone who struggles with posttraumatic stress, perhaps you can relate. Our bodies have the capacity to do as horses do, react, respond, then calm down and return to “peace.” But, we humans often learned to “stuff,” “repress,” “deny” what happened when all the body really wants to do is release and move through those feelings and body sensations. Doing so actually helps the trauma memory settle in, to release the “charge” that the body stores about what happened. By nature, horses, like all animals, know how to do this.

But, when trauma is still locked in the body and blocked, our nervous systems don’t return to a baseline of calm and peace. Instead, the fight, flight, or freeze that was experienced at the time of the event continues to remain activated, leading one to feel on alert, hypersensitive, anxious, easily agitated, or constantly “on,” making it challenging and often nearly impossible to relax.

That said, horses know how to relax. But, they also instinctively know to be alert and flee when threatened. They are preyed upon in the wild and are really in tune to danger, of any kind, including that which threatens their physical and even emotional safety, and that sense of comfort and peace that is their baseline state of being. And if you are a trauma survivor, all you want is peace and comfort as well. And this is just the beginning of why the horse and the trauma survivor may just “get” each other.

In light of the powerful connection between horses and trauma survivors, I am consistently shown the power of horses to help heal humans, especially through the integration of EMDR and equine-assisted therapy via this protocol.

Keep an eye out for the Part 2 of this post coming soon!

Related articles:
EMDR: Symptoms and Phases
Common Therapy Approaches to Help You Heal from Trauma
How Trauma Impacts My Sense of “Me-Ness” – Part II

The alphabet soup of degrees, licenses, and various organizations related to all things EMDR (Eye Movement Desensitization and Reprocessing) is confusing to be sure, but it is imperative that you review your therapist’s level of training.

As I have addressed before, contrary to popular belief, EMDR is not an intervention, but rather a full and comprehensive modality, one that includes eight phases, each phase with its distinct functionality, process, and methods. An EMDR therapist will approach your case, treatment goals, and your progress through the eyes of that model as it were. EMDR is a way of conceptualizing what you are working on, how your arrived at the symptoms you want to change, and what you want the future to look like.

Knowing your EMDR therapist’s training level will also enable you to determine their experience and knowledge base regarding this modality. While this information may be a little dry, it will give you the tools to ask what you need to of a potential EMDR therapist. You will know what your therapist means when he or she tells you what their level of training is. Remember, most of all, look for someone who has attended an EMDRIA Approved Training.

The Basics

Prior to 2007, the EMDRIA standards for EMDR Basic Training came in the form of an independent two-part training model. EMDR therapists who are trained prior to 2007 would, therefore, identify having been trained at Level One or Level Two. Each workshop took a weekend to complete and in contrast to the current training standard, did not include any consultation hours in between trainings. The EMDR therapist was trained in EMDR and able to identify him or herself as being EMDR trained with just the Level One training, as the Level Two training was not required. Nevertheless, please keep in mind that being Level Two EMDR trained was strongly recommended. From a client’s perspective, Level Two heightened the EMDR therapist’s understanding, provided him or her with additional tools within the EMDR model, and provided skills for processing more complex trauma cases. If your EMDR therapist chose to complete both trainings, he or she would have completed 34 training hours in EMDR.

After 2007, as I previously mentioned in last week’s article, the EMDRIA training standards for EMDR practitioners evolved. What was once Level One and Two EMDR training became a Basic Training model, one that required the completion of both independent trainings in order to identify oneself as having completed the Basic Training that now constitutes 50 total training hours. The lecture and supervised practice portions are conducted over two weekends at 20 hours each weekend. What this also means for you is that your therapist can start using EMDR after Part I, and is encouraged to, while their Basic Training is still in process.

Furthermore, as part of this 50-hour Basic Training, and to receive a formal Certificate of Completion the therapist must also complete a total of 10 documented consultation hours. Five hours must be conducted after the first weekend, and the final five after the second weekend.

Considering Certification

For those seeking to refine their knowledge and utilization of EMDR, there is an option of becoming an EMDRIA Certified In EMDR. Essentially, the goal of the certification process is for the EMDR therapist to demonstrate fidelity to the EMDR protocol and increase his or her knowledge, expertise, and experience with the modality.

To become certified EMDRIA requires that a clinician who is EMDRIA Certified in EMDR has been licensed or certified in their profession for independent practice and has had a minimum of two years experience in their field. They have completed an EMDRIA approved training program in EMDR, have conducted a minimum of fifty clinical sessions in which EMDR was utilized, and have received twenty hours of consultation in EMDR by an Approved Consultant. In addition they must complete twelve hours of continuing education in EMDR every two years.

Working with a Consultant

The EMDR therapist seeking certification completes those 20 consultation hours with someone called an EMDRIA Approved Consultant in EMDR. Or, an EMDRIA Approved Consultant In Training can provide 15 consultation hours, and an EMDRIA Approved Consultant completes the remaining 5.

As an individual seeking EMDR therapy, think of an EMDR Consultant as one who helps EMDR therapists further enhance and assure their understanding of EMDR. To be classified as such, an EMDRIA Approved Consultant must already be EMDRIA Certified, have a minimum of three years experience with EMDR after completion of Basic Training, and have conducted at least 300 EMDR sessions. In addition, the Consultant must continue to obtain at least 12 CEUs, specific to EMDR, every two years.

Whew! Now, keep in mind, you may also run across someone who, on top of being an EMDRIA Approved Consultant in EMDR, is also EMDRIA Institute Facilitator, EMDRIA Approved Training Provider or EMDR HAP Trainer. EMDRIA Facilitators or HAP Trainers conduct and facilitate the actual Basic Training that therapists must complete to begin their EMDR journey. In addition to actually conducting the training, they also provide the consultation hours that are required in between the Part I and Part II of the Basic Training. For those completing the Basic Training through HAP an EMDRIA Approved Consultant or Consultant In Training can conduct those consultation hours in between Part I and Part II.

So, that all being said, I know it can be very confusing. But, I hope that this article has given you an idea of what those EMDR training levels mean! Best of luck to you as you travel your healing journey.

He called me, as most new clients do, to inquire about me, my practice, and my approach to helping. What made this call unusual was that I had to educate him about Eye Movement Desensitization and Reprocessing (EMDR), not because he was unaware of the treatment, but because what he had heard about it from his current therapist was inaccurate. Unfortunately this happens a lot with all kinds of therapy.

As I tell many folks, finding a therapist is like finding the right pair shoes. Some shoes look good, but they don’t fit. Some don’t appear to be a good fit or style, but they are. Just as many of the choices you make as a consumer are aided by research and experience, becoming an educated therapy consumer is a necessary part of your healing journey. When you contact a new therapist, the therapist, too, will wonder whether he or she is the right therapist for you, whether the type of therapy used will be in your best interest, and whether the therapist can offer the expertise that you seek.

With the potential new client on the phone, I found myself in a bind. On the one hand, I wanted to be respectful of the relationship he had with his therapist, but on the other hand, what he had been told about EMDR was not accurate and could possibly hurt him. I elected to educate him and tell him the truth about it, even though it was different what he had heard from his provider. With this information, he was able to better identify what he needed from a counselor and to determine when or whether to pursue EMDR.

EMDR Is Not a Quick Fix

We often look for a quick fix in this culture. Certainly, EMDR’s way of processing traumatic material can be rapid, intense, and highly effective, but it is no guaranteed quick fix, as the client on the phone had been told. Generally, when I first meet with a client to talk about EMDR, this is one of the first misunderstandings that comes up. EMDR is like a specialized surgery procedure, a laser beam of sorts that hones in on the material that is stuck in the nervous system causing distressing symptoms. I wouldn’t ask my surgeon to rush, nor would you. In fact, rushing may mean missing out on completing the eight phases.

More than Just Eye Movements

The name Eye Movement Desensitization and Reprocessing suggested to the client that the treatment involved little more than eye movements. This is a common misconception. If your EMDR therapist is talking only about eye movements and nothing else, it’s not EMDR. EMDR consists of eight distinct phases, which I will illustrate for you. If you are currently using EMDR therapy, you may already know where you are in the process. If not, I hope to reveal some of the mystery behind the treatment. Though the phases are intended to be completed in a particular order, transitioning between them, in a circular fashion, is not uncommon. We can go back to a phase at any time.

The Eight Phases of EMDR 

1. History Taking
   In this stage, your therapist will learn about you and your history and might conduct the standard assessments that he or she uses. This is the time when you share your story, get to know your therapist’s style, and set up initial treatment goals. The therapist should also be creating a target sequence plan, an overview of what affects you from your past and a template for your future. In this phase you are likely to discuss touchstone events, previous experiences that contribute to your current symptoms. You may be surprised to know that how you think and feel in this moment is linked directly to your past. As you review these events with your therapist, you may be asked to rate how disturbing things are to you on a scale of 0-10.
2. Preparation
   The next three phases are like a traffic light, and phase two is like the red light. At this point, you are learning more about EMDR, as well as identifying and ensuring your readiness to move further through the phases. You may be learning additional grounding skills, stress reduction skills, or state change skills, and your therapist will help create a safe-place image for you. You will also be asked to complete a brief assessment to identify if you experience dissociation. You will learn about bilateral stimulation (BLS), the back-and-forth eye movements, sounds, or tactile sensations that help the right and left hemispheres to process the traumatic material and activate the brain’s Adaptive Information Processing (AIP) system. In this phase, you may also hear your therapist talk about resourcing and using the BLS to help you access more positive experiences, thoughts, and images before moving on through the remaining EMDR phases.
3. Assessment
   This phase is like the yellow light on a traffic signal. In the assessment phase, you and your therapist will look at what you want to target when you move into the processing phase. Your therapist will ask you for an image, a negative cognition, and a positive cognition, and to rate how true your positive cognition feels on a scale of 1-7 and how disturbing the target is on a scale of 0-10, and to describe what you experience in your body.
4. Desensitization
   This phase is the green in our traffic light analogy. This is where the BLS really comes into play. Those who have used EMDR know that this is where what you are working on comes up. All of your senses become involved as you process the disturbance you are targeting. You won’t talk to your therapist during this process; you’ll have a brief check in, and then go back to moving your eyes back and forth, hearing the tones, or feeling the taps. This is where AIP comes into play, and your brain will recycle the material for your nervous system to release it as it did not get to at the time. In between sets of BLS, your therapist may also throw some things in for you to think about; these are called cognitive interweaves. The same 0-10 scale from the assessment phase will be used here to assess your level of disturbance. When the level of disturbance is rated at zero and the target truly feels neutral and not distressing, we move on to phase five.
5. Installation
   Next, we will install the positive cognition that you chose with the BLS, but before we do, we recheck to see if the positive cognition has changed at all. It often does because you have moved further on in your healing. We will also check to see how true that positive cognition feels to you, using the same 1-7 scale from phase three. We then keep using the BLS to see if anything is getting in the way. When you get to a 7, completely true, we move to phase six.
6. Body Scan
   Just as the name suggests, you will be asked to mentally scan your body to find any sensations or tensions that signal that something is still stuck regarding the target. If there are any lingering sensations, your therapist will continue with the BLS.
7. Closure
   This will look and sound different depending on if your session was complete or incomplete. You will close down the material and do a final check. You will also use various methods, including imagery, to contain the material that is still not processed. This may include returning to your safe place or creating a container to hold anything that may become to distressing in between sessions.
8. Reevaluation
   Though it looks like the last step, the reevaluation phase spirals back as if it were the beginning. Your EMDR therapist will do a check in at the beginning of your next session that will include reevaluating your disturbance level regarding the target from the last session. This helps to determine if your disturbance is still neutral and if your positive cognition still rings true. If the previous EMDR session was incomplete, the cycle begins again at phase four.

Ten years into being trained in eye movement desensitization and reprocessing (EMDR), I am still amazed by its ability to transform a life filled with trauma, anxiety, and hypervigilance into one of presence, mindfulness, and relief. Clients and clinicians often find themselves confused about EMDR, and I would like to address what is meant by symptom-based and eight-phased trauma treatment.

Symptom-Based Protocol
EMDR is a treatment modality that is research driven and well known for its ability to reduce symptoms associated with posttraumatic stress (PTSD), and your therapist may recommend it to relieve your symptoms associated with PTSD. EMDR clinicians around the world are finding, in clinical practice, that it is also effective for addressing an even wider range of symptoms, especially those rooted in the events of the past.

With this in mind, EMDR is what you could call a symptom-based protocol. This means that EMDR therapists focus on how your present experience is rooted in old stuff, even things that you think that you are over. We look at how the symptoms you have in the present mimic, or cluster, around those events in that past.

Trauma is tricky and can disguise itself as many things. An EMDR therapist will review your symptoms and review how your current thoughts, emotions, beliefs about yourself, and physical sensations may be related to disturbing life events and traumas from the past. Depending on when your EMDR therapist was trained, he or she may have different ways of asking you to prioritize and list what events are still contributing to your symptoms.

Even though you may not believe that those events from the past are really a big deal, they are still locked in your nervous system in what is termed a state-dependent form. Often, they are not completely processed and healed, like a record stuck in a groove. As time progresses, the record turns; it still plays, but the disturbance repeats itself over an over again, until the scratch is healed.

An Eight-Phased Treatment Model
Often mistakenly viewed as an intervention, EMDR is an inclusive treatment modality, one that includes eight comprehensive treatment phases. Each phase is a unique and necessary part of the approach. It is imperative that your EMDR therapist walk you through each of the eight phases. While they can be circular, and you may go back and forth between them, each phase will help you as you complete the therapy. The eight phases include history taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation. Unfortunately, EMDR has become known primarily for its desensitization phase, which is what people often confuse as the sole part of the therapy.

With this knowledge, those of you who are seeing an EMDR therapist can inquire where you are in the process, what phase you are in, or how you will prioritize the events from the past to work on them. You can also find out what symptoms you are focusing on and how the past relates to them. I often find that the more my clients know about each phase, the safer they feel and the more they feel they are part of the process.

If you have general questions about EMDR, please post them. Keep in mind that I can’t speak about your clinical work or therapy or provide clinical advice. I will try to cover your questions about the treatment in future blog posts.