Eye Movement Desensitization and Reprocessing

By: Lauren Goldbach, LCSW, CCTP

Many people come to me frustrated by their symptoms, tired of feeling terrible, and wanting immediate relief and help. They often express a hopefulness that if they begin EMDR right away, “get in there” and look at all the terrible things that they’ve experienced, and talk about it, they will feel better quickly and can move forward in their lives.

This is rarely the case, as trauma can cause so much disruption to a person’s life. Most of the time, stabilization has to take place before trauma work can begin. Imagine walking up to a homeless person on the street and trying to talk to them about their childhood or other events that led up to their situation. Will they be able to benefit from this? Would they even be able to participate in the discussion? Doubtful, as they are more concerned with safety and survival: their hierarchy of needs. You would probably spend a lot of time getting them stable and cared for before diving into the past.

This is true of any type of trauma work. We can’t “jump right in” and expect results if the hierarchy of needs is not addressed. We also won’t benefit from talk therapy if the nervous system has ‘alarms’ that are constantly sounding off telling us we are under threat.The trauma narrative (the story itself) is only a tiny piece of the puzzle when it comes to rebuilding a life and reorganizing the mind. The bulk of trauma therapy is rewiring the brain to feel safe. This is done with preparation.

The phases of treatment can take time: months, or sometimes longer, depending on how much ‘homework’ a client does on his or her own to calm the nervous system and how much is accomplished in therapy to bring safety and stabilization to their lives. The more a person prepares, the more likely they will experience success in treatment.

It can feel like progress is not being made, or that therapy is not on task when we don’t “jump right in” to the trauma story itself in sessions.

However, there is a reason for this approach. In order for reprocessing of memories to be successful, a person must be able to feel relatively safe in his or her body.

Two things have to happen in trauma work before reprocessing of traumatic material can successfully take place:

We need to re-wire the nervous system to stop sounding alarms for fires that aren’t actually happening. For more on this, please refer to my post on “Polyvagal Theory” and “Exercises to Engage Rest and Digest” on this page.

We need to ensure that safety and stabilization are in place so that the mind does not continue to focus on survival while it’s being asked to revisit the past.

Imagine going to a doctor’s office for an infection and wanting only to talk about how you got sick. Imagine being given antibiotics, but never taking them and returning every week. Would you get better? Perhaps with time. Perhaps not. Focusing on the body’s response to illness and following your doctor’s instructions to take your medications is a vital part of getting better. Trauma therapy is the same.

The prescriptions in trauma therapy are the exercises I give my patients to do daily. Compliance with treatment is a must for improvement.

The following guidelines are useful in determining if you need more stabilization and preparation, or if you are ready to begin EMDR

I have resources: a stable, safe place to live and my basic needs are met, the ability to come to sessions regularly, a source of income or support.

I am able to regulate my emotions: I can use skills to calm myself down when I am very upset or when I am triggered by traumatic memories. I can switch from being very distraught to finding a “safe” space in my head and body. I am not severely depressed.
I have support systems in place: I have at least one person in my life I can rely on or talk to when I am in need.

I am stable enough to feel worse after or in between sessions: recalling traumatic events does not make me so upset that I need to come in for extra or emergency sessions. It does not cause me to relapse into unhealthy coping skills. I attend to my daily basic needs.

I am not actively engaged in substance use or abuse, self-harm, or other unsafe behaviors. I have been sober from these behaviors long enough to minimize the risk of relapse when triggered. I have strong support for avoiding relapse and have adaptive coping skills in place to deal with urges.

I am aware of my body: I can feel and notice my body most of the time. I am not reliant on pain pills or anti-anxiety medications, so I can come to sessions without having taken these recently.

I don’t ‘space out’ or dissociate a lot: I can keep track of time, can focus on what others are saying, and don’t check out for long periods of time.

I’m not a danger to myself or others: I have no recent suicide attempts, no recent history of assaulting others, and have no active plan or intent to hurt myself or anyone else

I am firmly planted in reality: I don’t see or hear things other people don’t. I do not feel paranoid or have symptoms of mania.
If you do not meet these guidelines, that does not mean there is no hope! It only means that we have to work for as long as it takes to prepare you for the final stage of trauma work: EMDR.

Remember: processing the actual event or events is only a small piece of the puzzle of getting better!