Dr Marianne Trent (00:00):

When it comes to trauma, what if the reason you can't just move on isn't because you're weak? What if it's because part of your brain is still responding as though the danger is happening right now? In this episode, clinical psychologist EMDR trainer, Dr. Alex Button and I explore EMDR therapy, PTSD, trauma, grief, and how the brain can finally begin to learn. That was then This Is Now. Hi, welcome along to psychology actually. I'm Dr. Marianne Trent, a qualified clinical psychologist, and I'm joined here today by a fellow qualified clinical psychologist, one that I do know rather well. It's Dr. Alexandra Batten. Hi, Alex.

Dr Alexandra Button (00:45):

Hi, Marianne. Good to see you.

Dr Marianne Trent (00:47):

Lovely to see you too. Let's level people right at the start. You are my EMDR supervisor and you have been there for many years. That's right. And that's because you are just amazing, Alex.

Dr Alexandra Button (00:59):

Thank you.

Dr Marianne Trent (01:01):

But if people are watching this because they might be thinking, "Well, maybe I would want EMDR therapy for myself, or maybe I would want to train in it if I'm a clinician already." Could you give us a bit of an overview about what EMDR is?

Dr Alexandra Button (01:15):

Yeah, sure. So EMDR stands for Eye Movement Desensitisation and Reprocessing. And it was developed in the 80s by a lady called Francine Shapiro who had her own cancer diagnosis and was trying to work through that and process that and noticed that when she was going on a walk one day through the park, her eyes had been moving back and forth rapidly in a diagonal motion, and she felt less distressed about her diagnosis and what was happening for her. And then she consciously was thinking about what had been happening when she was walking, and that's how she noticed that her eyes had been moving back and forth really fast. And then she started thinking about using that technique, I guess, for other difficulties that she was having, not big traumas, just everyday kind of niggly things that were bothering her and realised it was having the same effect.

(02:06):

It was reducing her distress about events. And she then went on to do proper research with initially Vietnam veterans, survivors of sexual assault, and had the same results. But because she was then doing the eye movements with other people, she was using her hand to direct their eyes. And so that's where eye movement came from. It was originally a therapy treatment for PTSD and still is. It's in the NICE guidelines for PTSD. But actually what we know now is EMDR works for lots and lots of different presenting issues because so many different presenting issues have an underpinning of trauma around them. So what EMDR does, I mean, there's lots of different neurobiology and explanations for it, but in a nutshell, for lay people, it's a way of like, if you think of a computer that's got lots of fragments, I guess, of information in there that hasn't been made sense of properly, it's kind of the same with traumatic experiences that the brain can't make sense of those experiences necessarily in the same way that it would with everyday events like having your breakfast, going to the shops, et cetera.

(03:17):

When something happens to you that overwhelms your brain's natural healing capacity and an inherent capacity to make sense of something, we get a backlog, if you like, of information. And that might be smells, sounds, thoughts, feelings, body sensations, like fragments of the experience from the time. And those don't get made sense of in the same way as they normally would. So what happens is people end up with a bit of a backlog, if you like. Like I say to my clients, it's like, if you imagine a cupboard in your mind that we've just stuffed everything in, in order to get on with life, and then things in the everyday life will trigger that door of that cupboard to sort of fling open and bits will spill out and then people re-experience those fragments of information as if they're happening again. So a lot of my clients will say, "I know it was a year ago, a month ago, 10 years ago, but when I get triggered back into it, it feels like it's happening again." And that's because those fragments of information haven't been date stamped and filed in the other part of the brain like they would for everyday events.

(04:21):

So EMDR, like I said, there's different explanations of it, but it's kind of like rapid eye movement sleep. People think it's sort of like rapid eye movement sleep where your brain is sort of defragging, if you like, backlogs of information through the night with the rapid movement of the eyes back and forth. And there are other theories like taxing the working memory. So you can't, when you bring up a distressing event and you are then part of your attention is taken up attending to something else like the presence of the here and now or the eye movements, or some people have headphones on that bleep or click alternately, or they might have buzzers or they might tap themselves. We see videos of this online. That bilateral stimulation not only kind of activates and jumpstarts this inherent natural healing capacity, but it's also somewhat of another thing your brain is having to give up some bandwidth to attend to.

(05:15):

So then you've got a competing demand on your working memory, which can take the heat out of the distressing information. But having said that, all of that is happening within the context of hopefully for people, a sound therapeutic relationship. So they are bringing to mind the difficult event in the safety of sitting with somebody who's able to support them through it, which is very different to having a flashback and the stuff coming out the cupboard in the mind and trying to manage it themselves. So that's the layperson's version of what EMDR is. That's how I would, but obviously when I'm training, I go into a lot more detail than that.

Dr Marianne Trent (05:51):

Of course. Thanks, Alex. That was really, really helpful. I think I might saying that Shapiro said if she was renaming it again now, and she's no longer with us, she's passed away I think, hasn't she? But if she was going to be naming it again, she perhaps wouldn't call it eye movement because could you tell us then why we've got all these different ways that we can kind of use it, not just with eyes? What's the theory behind that?

Dr Alexandra Button (06:18):

Well, so it started with eye movements because that's what she noticed in herself was her eyes were moving rapidly back and forth. And certainly the initial pilot studies in the MDR in the '80s, it was all, and for a long time into the '90s, it was all sort of eye movements. So the gold standard, the research is around eye movements. However, what we now know is that tapping ourselves left and right, any form of bilateral stimulation, anything that is stimulating the brain, left and right, then left then right, whilst someone is holding in mind the difficult event that happened for them and in the safety of the therapeutic relationship also will have the same kind of effect. And this is why she said she wishes she hadn't called it eye movements because what people went on to find out that is the tapping alternately or people holding buzzers alternately or the auditory.

(07:10):

But also there are research studies. There was a lot of stuff happening in Cardiff University over the last few years with veterans who were on running machines. That was their bilateral stimulation. And certainly clinicians that work with children and adolescents are very creative in how they're doing the BLS. They've got children hopping from one foot to another or doing all kinds of things and it will have the same, it will be stimulating the brain left, right, left, right in the same way. But the research literature is obviously much more around very clinically in a room with the eye movements or with the tappers or the buzzers.

Dr Marianne Trent (07:46):

Yeah. It's so interesting, isn't it? Because I think lots of people who perhaps don't work in this space don't necessarily realise that in order for me to wave my broken right hand at you, that's actually the left side of my brain that's doing that. And then for me to point to the left side of my brain with my left hand, that's the right side of my brain that's doing that. So what we're looking to do and what we do manage to do with EMDR is we're activating both hemispheres of the brain. That's

Dr Alexandra Button (08:14):

Right. Yeah. And there's actually, the brain is so complex. We will never know. We will never know exactly what EMDR is doing despite all the MRI studies and brain imaging scanning studies that happen. We will never know for sure what the exact mechanisms of EMDR are, but there is plenty of literature out there describing different mechanisms of action. But I think therapists and clients get very hung up on what is it because of the eye movements. And then that makes them curious, well, how is that having an effect? And absolutely right to be curious about that. But we also don't ask all those questions of compassion-focused therapy or CBT or act. We don't ask those same questions about talking. We don't think about what's happening in the brain. But I think it would be safe to say the brain is so complex that we will never know 100% what is happening exactly in EMDR and what the mechanisms of action are.

(09:12):

But there are so many different theories and so many imaging studies that will show differences in parts of the brain that are lit up, if you like. If you were to scan the brain lit up pre and post EMDR therapy for things like PTSD. Yeah. So it's impossible to say for sure, but definitely it's not necessarily as clear cut as left and right because there will be multiple areas of the brain involved in those processes during the EMDR therapy.

Dr Marianne Trent (09:43):

So helpful. Thank you, Alex. And so if someone's thinking, well, what kind of things could this be used for and what symptoms might someone be experiencing? I guess for example, if we spoke about someone that'd been involved in a multi-car traffic accident, what kind of things might they be experiencing and how might EMDR be helpful? So I've just given you a random thing so that you're not accidentally giving us client. I know you're very good at client protection, but no one client would ever want to think that they were being identified. So I've just picked something random.

Dr Alexandra Button (10:16):

Typical scenario that we might - Yeah, exactly.

(10:18):

Yeah, yeah, yeah. So yeah, very common that we will, especially through insurance companies and stuff, that therapists will have people referred to them who've been in some kind of accident, usually a traffic accident, but it might be a work related thing. But to use your example, I think what you were alluding to there is kind of the typical PTSD type presentation. So we have three different sets of symptoms typically we're looking out for as clinicians in what we call simple PTSD, which are the re-experiencing symptoms. So somebody might be having flashbacks, which is like literal reliving of the event. So it feels as if it's happening again. They might be having intrusive memories, which are slightly different in that person will still have a sense of it being 2026, but there's the hyperarousal that comes with that is feeling like. So they're kind of experiencing both if you like there.

(11:12):

They know they're in there now, but they are literally experiencing some of the smells, sounds, et cetera, from the time. That's slight difference. And then the other typical kind of re-experiencing symptom is nightmares. So people will report having bad dreams and that might be like a literal reliving of the event or it will be on a theme. So it might be a trapped and can't get out kind of dream, which might be what happened in the car crash, but the dream might not be a car or it might be that they're literally having a nightmare of having been trapped in the car. So those are the re-experiencing symptoms. And then people will often have what we call hyperarousal symptoms as well, which is where the threat system is very on. So they're looking out for stuff. They're very vigilant. They don't want to get back in a car.

(12:01):

They're very triggered by the sound of braking or sirens. Everything's very on is one way I would describe it, whether that's all the senses or the person's emotions are very heightened. So they might be very afraid, big startle response, easily jumpy, panicky, or angry. Some people are very angry. Or it might be a big old mix of those everything being on stuff. And then we have our hypo-arousal or numbing or avoidance set of symptoms that we call it, which is kind of the other end of the spectrum where the threat system can't stay on all of the time. So then people might find that their system goes the other way and almost detaches from stuff. So some people will describe having no feelings about anything, including good feelings, like they've lost all feeling for everything. They just don't care anymore about stuff. They feel very disconnected from people that they used to be really close to.

(13:02):

They will sometimes have stopped doing activities that they used to like to do. It's kind of a real shutting down and loss of interest in life, which can look like depression. And also the hyperarousal in PTSD can look like anxiety. So sometimes people who should have been diagnosed with PTSD will come away from a GP surgery with diagnoses of anxiety and depression often. And it's only when you meet them and you start asking them, "Well, when did you become depressed or when did you become anxious?" And they essentially tell a trauma story. So PTSD is the common thing that people would think of EMDR as being used for. And it's certainly in the PTSD NICE guidelines for treatment for adults and children. But what I've noticed is, and I said this earlier, so many different presenting conditions often have trauma in the background, whether that's big trauma like something like a baby loss or a sexual assault or an accident or an injury of some kind.

(14:03):

But lots of other people have the less obvious traumas and they might sit in front of me and say, "Well, but I haven't had trauma, Alex." And then they tell me about long histories of being bullied at school, for example, or parents that were super busy, or they might have had a sibling with a lot of medical conditions. And actually the parents were so occupied necessarily dealing with the sibling that actually they didn't particularly get very seen and heard. And it's not the parents' fault, it just is what it is. And so what I'm looking for in the therapy I do with people and certainly masses, as you know, of what I supervise isn't the big obvious trauma where people go, "Well, I haven't been a soldier and I haven't been in a tsunami or I haven't been in a plane crash or I haven't got trauma." But actually we're looking at what we call the small T traumas for people, which is like the drip, drip, drip of the not so obvious stuff, but it takes its toll.

(14:56):

And that can show up as really low self-esteem, feeling really rubbish about themselves, feeling depressed, lacking confidence, or might show up as body dysmorphia. There's something wrong with me. People that have been bullied for their looks, for example, or it might show up as an eating disorder or OCD is a common presentation that I see, not just in my own therapy service, but in all the supervisees that have. Yeah, it takes many different forms, but there's often trauma underpinning these conditions.

Dr Marianne Trent (15:28):

Yeah, there really is. And I was just thinking as you were speaking, I obviously do a lot of work for grief and people obviously can be completely destroyed by grief, understandably so. And I often think with people about when it comes to grief, it's whether we can help you separate the grief from the trauma. If we can get the trauma bits to lay flat, and they were like, "Well, I'm never going to feel any different to this." And I'm like, I often will think about when I lost my dad in 2017, it all felt like grief. But actually over time, I began to think about key painful bits. So for example, there was a bit where he was trying to walk to the toilet with the help of a nurse who thought that he was stronger than he was, and then he kind of faulted and went to fall over.

(16:19):

That really wasn't lying flat with me, Alex. And it's because with hindsight, that's not grief, that's a trauma aspect. So when I'm working with people, we'll be like, "Let's deal with the trauma." And often they will say, "I'm actually happy to keep the grief because that feels important to me."

Dr Alexandra Button (16:42):

Absolutely. Absolutely. Like you, I work with a lot of grief. Sadly, life is difficult for people, isn't it? People lose people in, like for you and I, very drawn out experiences of losing a loved one. But for other people, it's literally sudden. And both have different trauma aspects to them, don't they? But like you say, I think some people worry, clinicians particularly will say, "Well, I can't do EMDR with this person because they've only just lost this person and they need to wait several months to see." And actually that's a myth. Like you've said, EMDR will be treating the trauma of what's happened to them. EMDR will not remove a normal grieving process. So I certainly have a number of supervisees say, "Well, I can't start yet because I don't want to disrupt their grieving process." And I'm like, EMDR won't. EMDR will only remove the bit that shouldn't be there.

(17:38):

EMDR will not remove something normal, rational, valid. So whilst we will process with people to take away the trauma, like you say, let's iron out the hills, if you like, or the mountains in the story, then actually they will still have the bumps and the ups and downs of the grief. Of course they will because that's normal. But what I've seen happen with people is, especially with traumatic grief, they will come really traumatised by what's happened. They are either completely flooded all of the time or they've shut down and they aren't talking to anyone about it. They won't think about it. They're massively avoidant to the point where it's causing a problem in their lives, obviously. And what I've always, always seen with grief is when we process the trauma, what will happen is your connection to that loved one that is around as a traumatic event, that will get removed.

(18:31):

And then what people get, what comes in its place is the good memories come back. They don't lose a connection. I think a lot of clinicians and clients worry, "Well, if I process this, then I've lost them. They're gone completely." And that has never happened. In all the people I've worked with, actually, they get the good stuff about the person back. They get a reconnection with the person that isn't about trauma. But absolutely, as you've said, Marianne, I haven't had anyone leave therapy that's had a loss that is going, "Well, I feel nothing about that now." But what they do get is a different relationship to the lost one back.

Dr Marianne Trent (19:05):

Absolutely. And you begin to be able to assimilate it better into your life rather than it just jutting out like this sudden stone wall. And yeah, it's sometimes with grief, like you said, it can be so sudden. And there can also be bits where caregivers and loved ones are having to be involved in that. So perhaps they're having to do CPR, perhaps they're having to manage the situation over the phone with. And all of that can be an added trauma that is just not lying flat.

Dr Alexandra Button (19:36):

No, sure.

Dr Marianne Trent (19:37):

So when you were talking to us about how trauma can mean that you disengage from your life and stop doing all the things that you love, I just felt so proud to do what we do, Alex, because I just thought, God, we get to be in a position where we see people just come back to themselves and they suddenly are like, God, I really missed myself. Or other people start to notice that with them like, oh, you smile or you did this, or you just seemed very different. And it's so powerful, isn't it? Tell us about how EMDR can help us to help people to reconnect with their lives again.

Dr Alexandra Button (20:21):

Yeah. Well, I think, like I was saying, sometimes people are, they haven't meant to cut off. The hair just had to carry on life doing life, but the feelings aren't allowed to be around because they're too overwhelming. And so what EMDR will do is if we can bring up, like you just gave me an example of what we would call a target in EMDR when that moment where your dad had a stumble and for you, that just wasn't settling. We would call that a target in EMDR. I call them hotspots with people typically because within often it's a chapter in someone's life, isn't it? It's not a one off event that happened in a split second and was done. Often we're working with people on things that have gone on for hours, weeks, months, years sometimes. And so we look in the story for what these particular hot moments, if you like.

(21:14):

And in EMDR, we would prime that moment. So we'd get those fragments out the cupboard. We would've created the safe relationship and the safe space. And then we would be allowing the brain time to decompress, I guess, defrag that difficult moment until it's not as overwhelming anymore. And then the person will. Well, let me say it another way. I had one client many years, many years ago who summed up, I think, what EMDR does really, really nicely. And I use this example on my trainings. So she had actually had a car crash and she had gone to see a therapist for CBT. That was what she was. And rightly so, trauma-focused CBT was completely appropriate according to the NICE guidelines, but it hadn't worked. It hadn't taken the edge off. And then she came to see me for EMDR. And when we'd done the EMDR and it had been really successful, I asked her what was different.

(22:10):

You've had both. And she said, "Do you know I feel like CBT was going, if you can think differently about this, you will feel differently about it." She said, "But I couldn't do that because when the feelings showed up, they were so strong that I couldn't think rationally." And what we did in EMDR is we made space for the feelings and we processed the feelings about what had happened. They dialled down. And then naturally I thought differently about stuff. And I think that's some way of answering your question. How do people reconnect with life? Because when people have got, often with traumatic events, people will have a number of negative beliefs either about themselves, other people, the world that might be, I'm a failure, I get things wrong, I mess up, or I'm in danger, or I'm not in control. Other people are not trustworthy, the world isn't safe.

(23:01):

And so people learn to shut down and cut off because that is self-preservation. But actually when these beliefs shift in therapy, which they do, when the high distress comes down, the thinking brain will come back online more naturally. And then people can reengage with life because not only are they not disconnected from it anymore because their feelings about stuff do start to come back, but in a healthy way, like we said with the grief, when their beliefs shift into much healthier sets of beliefs like, "I'm okay, it's over, I'm good enough. Some people are trustworthy, the world is safe enough," then they can venture into life again, feeling more robust. And that's what helps people reconnect with people, places, activities that they used to enjoy. It

Dr Marianne Trent (23:51):

Really does. And it can be such a visceral experience to carry trauma. I'm reminded of a case I worked with, and whilst EMDR breakthroughs don't all happen at the same time in session one, we often will get what John Burnham in systemic therapy refers to as magic moments where you can literally just have this real transformational moment. And I had this experience in EMDR with a client where at the end of the session, they said, "Well, it feels like I've put down these heavy shopping bags that I've been carrying for almost 10 years that I didn't realise I was carrying. And then today in this room is the first time I've realised what a weight that has been and what a relief it is to not have to carry that anymore." And then was able to really clearly say, "Well, now when I look back at that, that does feel like it's been getting on for 10 years ago." Whereas when I walked in here this morning, that felt like it was now.

(24:55):

I couldn't get that time distinction, that filing cabinet label that we often think about. I just couldn't get it. It was so loose and fluid.

Dr Alexandra Button (25:07):

Yeah. So people will say, "It feels like now when it shows up, when the cupboard flings open, it's literally happening again." And because of that, send off the person's threat system, their alarm system in their body will go again. So it makes them feel like it's literally happening again. And people feel like they're going mad because they'll say, "Well, I know it's over, but I don't feel like that." And that's the difference I think with EMDR is we call it this head-heart lag, if you like, or this head-heart distinction where people might have done a lot of talking therapy and go, "Well, yeah, logically I know it wasn't my fault or I know I'm safe," but it doesn't feel like that. And what we see in EMDR is when the high distress is dialled down, when the shopping bags get put down and the thinking brain can come online, the head can come online, we get a marrying up of the two.

(25:55):

So the cupboard is no longer flinging open. Actually, the cupboard's now been, I say to clients, it's like we're going to empty the cupboard safely, carefully, bit by bit. We're going to sort out this stuff and put it somewhere else so the door isn't stuffing a load of stuff away anymore. They're not vulnerable to the cupboard door flingging open anymore. And as you say, Marianne, it's not always a real quick win in EMDR. For some clients, it really is. For other clients, it's much more of an up and down process in therapy, especially the longer term, more chronically traumatised someone is, the harder it is. But it can get there for sure. But yeah, you talked about how visceral, and that's the head body distinction, right? Because people literally feel stuff in EMDR, don't they? And sometimes people don't like that because the feelings are horrible and they've done a really good job of cutting off from them.

(26:47):

But if we can bring the feelings into the space safely and process them and they can get filed away differently in the brain with that date stamp of it's over, that was then, it's now. People really, really benefit from that. Had a veteran come to see me a few years back who had a very bad stammer when I met him to the point where I couldn't really understand a lot of what he was saying, which EMDR was great for because you don't need to talk a lot in EMDR. But I really, that was one of these moments where he was a little bit stuck on something. And I said something like, "Do you need to keep doing that now? You are safe in the UK." And he went, "No." And I said, "Okay, go with that." And we added some more BLS. And he went, "Oh, something left my body." And his stammer had gone.

(27:36):

I mean, it's just weird and amazing all in one go, but that talks to that how visceral stuff is. And it's implicit. A lot of stuff is implicit for people. The brain hasn't had a chance to put the story on and make really good sense of it. If you think back to for some clients we're working with when they were really little and they won't have a coherent narrative of that event, but the body is holding the shopping bags.

Dr Marianne Trent (28:02):

Yeah, what a really powerful moment and what a privilege to be there for these really authentic, vulnerable, human moments. And obviously this can be incredibly difficult. You and I have both been in sessions with people. You and I have both probably been clients where we've just been like a snotty mess when we're having EMDR. It can be really, really evocative. But what I would say, and what I know you would want to make clear is this is not uncontainable. This is not unmanageable. We would always make sure that a client was safe and could be well-resourced to be able to be stable so that they weren't left managing this after a session.

Dr Alexandra Button (28:46):

EMDR, I'm always really sad and disappointed when I get people coming to me saying, "I had EMDR. It was absolutely awful. It was really re-traumatizing. I never want that again." And often when I say, "Could you tell me a bit about that? How quickly did you get in processing it?" And often I hear it straight away. We were processing straight away. And I know there are definitely therapists that do that. And certainly there's a big group of people in the Netherlands who work in an inpatient service who do process with people really quickly, but it's within the containment and safety of an inpatient service. But I think what some EMDR therapists who have trained in it or not trained in it, which is the bigger issue, because anyone can go and do a training that isn't regulated, and this is where the problems can stem from.

(29:37):

But yeah, some people think it's a technique. If I just do this to somebody, that's going to magically make their trauma process. But actually I'm a big, big advocate. And I'm sure this is what Franceine Shapiro was teaching is you don't just sit in front of somebody and say, "Well, think of that," and then start let the cupboard in the mind fling open. You and I know, and all my supervisees work too, actually you spend a good amount of time building a strong relationship with that person, looking at their risk history, checking what they can and can't manage processing. And I always say to my clients, "You didn't have control at the time of the trauma. I want you to have control in the room with me. You need to have a sense of being in the driving seat. I'm alongside you. I'm helping you navigate, but only you can decide how much you do or don't do and what you process." So I have some clients say, "I'm coming for the car crash.

(30:34):

I absolutely am not touching my childhood trauma." And I'm like, "Fine." We have to be respectful, but sometimes clients don't get that message. It's like, just get on with it and we're going right back here to this stuff that happened to you when you were seven or eight. And clients don't know that actually they should have more of a voice than that. So no, EMDR should never be. It's not reliving. There's very much a mindfulness component with EMDR that should absolutely be present in every session where we call it dual awareness. So whilst you are noticing this difficult thing here, we've got some stuff out the cupboard, you're not reliving it. Actually, we need you to have very much a sense of safety in the here and now in the therapy space, whether that's online or whether that's physically in a room with somebody, we are saying to them from the safety of the now, I want you to just observe, just notice that thing that happened back then.

(31:28):

They're not meant to be reliving it. Obviously people can get a bit flooded, but that's the therapist's role is to co-regulate that person in the space where we're not meant to sit silently and just say nothing and be completely neutral. We're not interfering with the processing, but we absolutely are holding the space nonverbally, verbally. We're not talking to them the whole time, but they should be very aware of our presence.

Dr Marianne Trent (31:53):

Yeah, I really agree with you that this is safer in inexperienced kind of hands. And I didn't learn this until I was already a qualified psychologist. And it felt like it was an additional tool in my toolkit, but I'm very glad it's not my only tool in my toolkit because like you, I believe that all the other things I've learned along the way and had experience of with clients are so important.

Dr Alexandra Button (32:16):

Absolutely. And I was going to say for accredited trainers, EMDR trainers in the UK, we've all gone through pretty rigorous things in order to demonstrate our competencies. And that's why there's an eligibility criteria to get on accredited trainings. You already need to be a pretty well-established therapist because you need the foundational skills. If you don't have the skills to sit with someone in their distress and manage risk and co-regulate someone and know who to ring and what to do, if someone is quite distressed or you don't know how to bring someone back into their window of tolerance, you shouldn't be doing EMDR. That's why there's an eligibility criteria. And that's why I get frustrated when people set themselves up as trainers who have none of those skills and actively advertise. We don't have an eligibility criteria. And I think what a shame for the public who won't know the difference because they don't know.

(33:17):

Someone advertises that they're an EMDR therapist, go and have EMDR, have sometimes really bad experience and they're more traumatised and never want to do it again.

Dr Marianne Trent (33:28):

Absolutely. So there are different levels of qualification and experience with EMDR. Can you take us through what they might look like,

Dr Alexandra Button (33:35):

Alex? Sure. Yeah. So to get on accredited training in the UK, as I said, you already have to meet an eligibility criteria. And I'm not going to tell you about all of them right here because they're on the EMDR Association UK's website and they're on my training website and all the other trainers' websites. So your first different trainers do it slightly differently. Some like me will have three parts, some have what we call four parts, and that's essentially because they've split the supervision day into two halves to give people a little bit longer to get things under their belt. And also a whole day of supervision is quite long for people. So you can probably imagine.

(34:15):

But the material covered is to all intents and purposes the same. So all trainers will have to do 24 hours of teaching, 18 hours of practicals, and 10 hours of supervision. So some people might do level one or part one, we call it part one, part two, part three and/or part four, depending on which trainer they're going with. That's called standard training. And at that stage, you can call yourself a part one trained EMDR therapist or a part three trained EMDR therapist. Then that's not accredited. There's no assessment process for that. Obviously you have to join in, in all the activities on the trainings and you have to demonstrate a level of competency, but we're not assessing you on that because you're just literally learning it. It's like the learning to drive, but then the getting good at it comes with the supervision and the hours of having a go.

(35:06):

And like you said, we're learning through our mistakes sometimes, aren't we? And some of the most important learning experiences come through that. So the next level up from that, which is called accredited is practitioner, which you can apply for just roundabout one year after you finish your part three. So you have to be fully standard trained in order to then go towards practitioner. And that is very much more of a rigorous assessment process where you need to see a minimum of 25 clients that you've processed with. You need to have had another 10 hours minimum of supervision on top of what you had on your training. It's a very competency-based. So it's not even a numbers game. Some people will say, "Well, I must be nearly there now because I've done..." They might contact me via my website and say, "Oh, could you see me through to practitioner?

(35:55):

Because I've done 23 clients, I'm nearly there." And I'm like, "Well, I actually need to be confident that you know what you're doing. So that's going to probably be another year, if I'm honest with me, before I feel like that we're there," because they have to see video footage and everything. So you can hear it's quite an extra bit of work compared to your standard training, but it does demonstrate good clinical competency. If you get there, you can go on the EMDR association map and be searchable. And then that's kind of your seal of approval. If you've made it to the map, you've demonstrated your competency at practitioner level. And then from there, if people want to, they can then go on to become a consultant. So you're in essentially what we call consultant in training period for a minimum of three years after practitioner level.

(36:43):

Some people take longer, some people really get through it really quickly and really adapted it, but it's another three years minimum from practitioner level. And for that, it's much more about your supervision of other people. So really understanding that standard protocol and many other treatment plans inside out back to front and being able to support someone else to learn how to do EMDR, but they're not teaching people EMDR, that's a trainer that would do that. And then the next level up from there is facilitator where people might work towards facilitating trainings. And again, that's several years on from there. And then someone might become a trainer and then they might become a senior trainer. So there's multiple sort of gateways, if you like. But practitioner's your first level where it's like, right, you've demonstrated this competency and you're on the map.

Dr Marianne Trent (37:36):

Amazing. Thank you so much, Alex. And I know that having been your supervisee for quite a few years now, I know that you were doing your facilitating and then you are now a trainer as well and you've got your own training company. Could you tell us a little bit about what you offer, Alex?

Dr Alexandra Button (37:56):

Yeah. So I've got two businesses essentially. The business that I see you in is what I call my therapy and supervision business. So that's where I see my own clinical caseload because no matter how high up you are in EMDR, you obviously still need to keep your feet on the ground and do the work yourself. So we as trainers, facilitators, we always still have a therapy caseload. So my one side of the business is therapy where I see clients, they often come through my website and then I do a lot of supervision online for clinicians like you in private practise, or I do a huge amount of NHS supervision. Again, mostly online. So that's the one strand of the business. And then more recently, we set up a training business. So I qualified late 2024, but in the time it took us to get everything up and running, we ran our first training in April 2025 and we've run a few now.

(38:52):

So we're based in South Devon. We only currently offer in-person training because it's very experiential. And actually I feel like for me, where I'm at with training at the minute, I want to have eyes on people in the room and be able to read the room and see how people are understanding what I'm saying. But also for the practical side of things, I feel like you genuinely learn it much better when you are actually physically sat with someone having a go and you've got someone overseeing that and supporting you and noticing. And I just think whilst learning EMDR online is great, and I'm not saying I wouldn't move towards that at some point, there's something about being in breakout rooms and not being visible all the time that stuff can get missed and lost a little bit. And certainly when I've supervised people who trained purely online, when it comes to doing it in person with somebody, they're like, "Oh, I don't know.

(39:44):

I'm not really sure about sitting with someone and doing that." So we offer the training. Like I said, we're in the Southwest, so we physically have venues in Bristol and Torkey, but we do run in-house trainings. We've run some for Cormal, we've run some for Avon and Wiltshire, and we're open to going around the country and doing stuff. But yeah, that's what we do really. We're moving more towards being fifty fifty therapy supervision and then the other side of the business being training. Oh, don't work with children. That's probably worth saying. So I'm a standards trainer, so I don't have. Even in my clinical psychology career, I think I did one child placement. It wasn't my thing. And so I've never. I did a little bit of child work because I did child training in EMDR and I dipped my toe in. But actually, I think honestly, from my perspective, I think you need to have the core skills, like we were saying, in working with children and families if you're going to offer EMDR to children.

(40:48):

But what we have done is collaborate with a lady called Alice Bine, who is a child and adolescent trainer, but she's based up in Lincoln, but she's collaborating with us to bring EMDR child training to the Southwest because there aren't any currently down here.

Dr Marianne Trent (41:01):

Great. And I was just going to say, I'm aware that someone that we both met at one of my in-person psychology events, she is not based down in the Southwest, but treated it as an opportunity to have a few days on holiday in a hotel and so joined you from the Midlands. So if you are willing to travel.

Dr Alexandra Button (41:19):

Yeah. And the Bristol one's actually in a spa hotel.

Dr Marianne Trent (41:24):

Lovely.

Dr Alexandra Button (41:25):

That's

Dr Marianne Trent (41:25):

Not to like.

Dr Alexandra Button (41:26):

Absolutely. Yeah. So people do use it as a getaway. They'll come down, have. The training is three days, but people might stay four or five and we have discounted rates at the hotels. And especially if you come in the summer season and from April onwards down here, it's really quite buzzing and talking and there's been lots of regeneration in the area. So yeah, it's quite being by the sea, people often come from places that, like you said, in the Midlands that haven't got any senior than for miles and they'll come down here and it's quite a refreshing break.

Dr Marianne Trent (42:00):

How nice. I could talk to you all day, Alex. Where can people learn more about you and your work? What's your website?

Dr Alexandra Button (42:07):

Yeah, so my website is www.drbutton-emdrtraining.co.uk. But if you Googled Alex Button EMDR training, it would show up in the searches as well. And within that, we have a membership area that we've just generated in the last few months for our training delegates, but we open it up to EMDR therapists who've trained with another accredited trainer because lots of people were saying to us it's a lot of information to take in seven days and I'd really would love to be able to watch it back or be able to come into a joint kind of space to ask questions. So we generated the Refresh and Master membership area, which is also available via the website. So our training delegates get that for free for a year. But then people who've trained with other people can also, as long as they can prove that they've trained properly, they can apply and have a monthly subscription to that.

(43:03):

So that's got all the training videos, downloadable resources, links to lots of things to a WhatsApp group that's private and only questions are only answered by consultants that I know. And two hours worth of drop-in sessions a month where people can drop in. It's not clinical supervision, but it's like a place to say, "I got a bit stuck with this," or, "Can you tell me a bit more about EMDR for that?" So we offer that in the membership area as well, and that's available via the website.

Dr Marianne Trent (43:31):

Perfect. Amazing. Thank you so much for your time, Alex. You really are lovely at this and really good at what you do. So thank you for being a lovely guest.

Dr Alexandra Button (43:42):

Oh no, thank you for inviting me.

Dr Marianne Trent (43:44):

So lovely to have you. Thanks, Alex. Wow, what a lovely chance to chat with Alex on camera. I just feel so lucky to get to spend time with Alex. She's so wise and being able to do so on camera, sharing it with you feels like a real treat as well. She just has a way of breaking things down that make everything seem to make sense. I hope that you've got someone like that for you in your life. She's also really funny and I love having her in my world for that reason too. We got together in person for the first time last summer at an in-person psychology networking event, and it was really special. I love working with clinicians that are human and excellent at what they do, and that's what I aim to bring you in psychology actually. If you're not already following Dr.

(44:45):

Alex Button on Instagram or LinkedIn, please do so. Her details are in the show notes or on screen. I certainly learn a lot from being in her world on LinkedIn where she's Dr. Alex Button. If you are an aspiring psychologist and you are striving to be a clinical psychologist, much like myself and Dr. Alex, then I think you'll really find the aspiring psychologist membership helpful. You can join from just 30 pounds a month with no minimum term. There are details on screen or you can head to www.aspiring-psychologist.co.uk. If this episode has wept your appetite for learning a little bit about trauma and how it shows up in practise, then why not head along to the episode I did about Nobody's Child, which is the book by Virginia Roberts Dufrey. Don't forget that we've got an extra brand new episode of Psychology actually, which is coming out midweek, coming out Wednesday evenings, both on YouTube and wherever you get your podcast on MP3.

(45:53):

It's called Inner Work. And I think if you like the main episodes, I think you might just like the new inner work ones, which are now completely free. I love any feedback you've got. And in the meantime, the next episode of Psychology actually will be available from 10:00 AM on Saturday on YouTube and then wherever you get your podcast from 6:00 AM on Monday. Thanks very much. Take care.