Eye movement desensitization and reprocessing therapy (EMDR) is a unique modality founded in the 1980s to support individuals living with post-traumatic stress disorder (PTSD), primarily veterans. Since its founding, EMDR has been extensively studied as one of the most effective therapeutic techniques for managing and treating PTSD and many other mental health conditions. Keep reading to learn more about how offering EMDR can help you provide evidence-based, trauma-informed care to your clients.
What Is The EMDR Modality?
Eye movement desensitization and reprocessing therapy is a modality focused on the technique of bilateral brain stimulation. When both sides of the brain are stimulated by movement, touch, or visualization, they can work together, combining the emotional and rational centers of the brain. This process can help individuals process challenging emotions and memories, especially traumatic ones, in a way that takes some of their emotional power away.
The discovery that EMDR works to reduce flashbacks in people with PTSD was found in initial trials of EMDR for veterans with PTSD. Currently, the US Department of Veterans Affairs (VA) recommends EMDR as a treatment for those living with this condition. However, EMDR has since been proven to support many people living with PTSD, including those who are not veterans or whose PTSD occurred for different causes. In some cases, EMDR may also treat conditions like anxiety and depression.
A History Of EMDR
According to the EMDR Institute, EMDR was developed in 1987 by Francine Shapiro when she noticed that “eye movements appeared to decrease the negative emotion associated with her own distressing memories.” As a psychologist, Shapiro tested her theory, trying out different cognitive techniques and procedures until she settled on a final format for practicing EMDR with clients. The first case study on EMDR was then carried out by studying 22 people living with traumatic memories. Of these 22 individuals, 50% of them received EMDR, and the other 50% received a less complex treatment not involving imagery.
In 1989, Shapiro’s study of this new treatment was published in the Journal of Behavior Therapy and Experimental Psychiatry. The study took off in popularity, and more clinical trials and randomized controlled studies were done on the potential effectiveness of EMDR. The modality was initially considered controversial, as some did not believe eye movements were enough to cause significant reductions in PTSD symptoms. In 1995, EMDR was officially considered a therapeutic modality, no longer considered “experimental,” and clients started receiving support for PTSD. Currently, EMDR is regarded as one of the top evidence-based modalities, if not the best, for PTSD and some other conditions.
The Stages Of EMDR
EMDR is practiced in eight stages, which include the following:
- History taking
- Client preparation
- Assessment
- Desensitization
- Installation
- Body scan
- Closure
- Reevaluation of treatment effect
In the first session, the therapist can take the history of the client’s traumatic past and build a roadmap of memories. Treatment planning occurs in this phase and may take more than one session. The client can then be briefed about the EMDR process and how it may help them. In the assessment phase, the EMDR therapist ensures the client is ready to integrate EMDR therapy practices like bilateral stimulation.
The therapist and client can target one specific memory during the session, which involves the client picturing the images and ideas associated with this memory. At the same time, bilateral stimulation is achieved through eye movement, harmless hand buzzers, or another way that activates both sides of the brain. This process starts the desensitization process.
In the installation phase, the therapist helps the client replace the traumatic memory with positive cognitions or ideas, potentially using visualization and imagery exercises. The client may use a body scan meditation to clue the therapist into any uncomfortable sensations and to let them know whether dissociation is occurring or if they need to slow down the session.
Afterward, the therapist helps the client reach the closure stage by using a mindfulness exercise or visualization to calm themselves. After the session, reevaluation is done by interviewing the client about their experience and what they may want to change in future sessions. The therapist may also ask how the client feels about the memory after the session and if anything has changed for them, such as whether they feel more or less distressed when they recall these memories.
EMDR And REM Sleep
The reason EMDR works may have a lot to do with how memories are processed during REM sleep. People process typical, healthy memories during sleep, especially in the REM phase, which involves the eyes rapidly moving back and forth. After the processing takes place, the memories are transferred from the amygdala and hippocampus to the rest of the brain. However, traumatic memories can remain stuck in the brain, and many people with PTSD have interrupted REM sleep or unhealthy sleep cycles.
EMDR mimics the REM sleep cycle during the day in a safe environment, allowing individuals to reprocess memories without experiencing nightmares. For this reason, EMDR may also improve sleep in people with PTSD.
What Does It Mean To Offer Trauma-Informed EMDR?
Trauma-informed therapy considers how trauma can be a unique process for every individual. No two people experience trauma in the same way, and everyone copes with it differently. Even two or more people who have gone through the same situation can have different reactions to it.
Offering trauma-informed care can mean understanding PTSD, C-PTSD, and other trauma and stressor-related disorders. However, it can also mean taking intersectionality, culture, identity, stigma, and co-occurring conditions into consideration and recognizing how these factors may change the outcomes of a particular approach for a client. Try to remain patient and empathetic when working with clients with severe trauma, and ensure you focus on building a safe and comforting environment to create a strong therapeutic relationship.
EMDR Training For Therapists
Below are a few options for EMDR training for therapists to learn how to integrate this modality into their clinical practice. Each program offers a different structured approach, allowing you to achieve your certification in EMDR therapy in whichever way you choose.
EMDRIA Approved EMDR Basic Training
The EMDR International Association (EMDRIA) offers EMDR Basic Training to therapists worldwide based on the official guidelines of the EMDR Institute. EMDRIA-Approved Basic Training involves taking classes, often in a university setting, over a 12-week semester. Post-graduate training can be done in two weekends, over several weeks, or tailored to a therapist’s schedule.
The minimum requirements to become certified through this course are 20 hours of instructional material, 20 hours of supervised practice, and 10 hours of consultation. You can use another EMDR course that fits these requirements to receive certification from the EMDR International Association. However, you must apply online or send an application and pay the applicable fees to get certified.
The EMDR Institute Basic Training
The EMDR Institute offers its own form of basic training with a similar curriculum. This course involves two weekends of training for already licensed mental health professionals treating adults or children. The training occurs on Friday and Saturday from 8 a.m. to 5 p.m. and Sunday from 8 a.m. to 4 p.m. for two weeks. Online training is offered but must be completed within 12 months of first starting the program.
The basic EMDR training by the EMDR Institute is only a beginner’s level course and does not necessarily guarantee certification in the modality. You may be required to take continuing education units (CEUs) or extra schooling to get certification.
In the EMDR basic training program, you may learn:
- How to take client history and build a trauma roadmap
- How to take a trauma-informed approach to care
- How to support clients with anxiety, depression, grief, and addiction
- How to apply EMDR in couples or family therapy
- How to stabilize clients who are in crisis
After the course, you can receive a certificate of completion and a continued education certificate (CE certificate) for 20 credits. To complete training, you must also have ten hours of case consultation.
The Center For Excellence In EMDR Therapy Training
The Center for Excellence in EMDR Therapy offers an integrative approach for therapists who want to learn how to practice EMDR therapy. This organization provides basic, intermediate, and Masterclass level courses and retreats, as well as specialized classes on applying EMDR for children, families, addictions, or attachment difficulties. You can learn more about basic, intermediate, advanced, and master training through their website and apply for courses online. Some of their courses are also eligible for CE credits.
Offering Remote EMDR Support
EMDR is a complex modality, so some therapists who work remotely may wonder how they can offer EMDR to their clients. If you’re interested in offering remote EMDR or other forms of trauma therapy, you may consider working through a platform like BetterHelp, which allows providers to take on as many or as few clients as they’d like. You may be able to apply for free or low-cost CEUs by working with an online platform, allowing you to learn more about offering online or remote EMDR.
Online therapy may also be more accessible, affordable, and flexible than other options. Therapists can choose their own schedule and allow clients to pick between phone, video, or live chat sessions, giving each of them more control over the therapeutic experience.
Online EMDR has been found effective in many settings, including those that are virtual. In one study, researchers discovered that web-based EMDR led to a 55% reduction in trauma symptoms in clients attending remote therapy during the COVID-19 pandemic.
Takeaway
EMDR is a more modern therapeutic modality that can be used to treat PTSD, anxiety, depression, obsessive-compulsive disorder, eating disorders, and many other mental health conditions. This evidence-based modality can be valuable in supporting clients with a traumatic past or history of adverse experiences. To learn more about EMDR, consider taking a course through the official EMDR Institute or finding another course that suits your needs and schedule. Once you’re certified in EMDR, you may consider signing up to be an online counselor through a platform like BetterHelp to offer your services and skills.
