1 00:00:00,049 --> 00:00:05,509 EMDR is a very popular treatment option for pretty much everything. 2 00:00:05,509 --> 00:00:08,689 At this point though, it began as a treatment for trauma. 3 00:00:09,289 --> 00:00:11,474 You're probably seeing it everywhere and have been, and 4 00:00:11,474 --> 00:00:15,799 there's a good chance you've worked with a therapist who uses EMDR. 5 00:00:16,790 --> 00:00:23,644 When most people think of EMDR, they picture a therapist waving a finger in 6 00:00:23,644 --> 00:00:27,185 front of someone's face, and that's it. 7 00:00:28,265 --> 00:00:30,185 That image has become shorthand. 8 00:00:31,205 --> 00:00:35,165 This shorthand image causes a lot of confusion when it 9 00:00:35,165 --> 00:00:37,114 comes to accurately assessing. 10 00:00:37,864 --> 00:00:40,565 What's actually helpful about EMDR. 11 00:00:42,364 --> 00:00:49,384 So in this episode, I'm gonna look at what EMDR is beyond the eye movements. 12 00:00:50,044 --> 00:00:56,824 Also, I'll look into whether or not EMDR is helpful based on research, and 13 00:00:57,724 --> 00:01:03,604 even more interestingly, what research says about what's helpful about EMDR. 14 00:01:03,741 --> 00:01:05,031 If you're new to the podcast. 15 00:01:05,151 --> 00:01:05,881 Hi, I am Justin Sunseri. 16 00:01:06,951 --> 00:01:11,001 I'm a therapist licensed in California, and I've been, I've been practicing 17 00:01:11,001 --> 00:01:16,971 for about 17 years with a wide range of demographics, uh, populations. 18 00:01:17,661 --> 00:01:22,701 I primarily use a blend of very present, moment focused, body-based 19 00:01:22,761 --> 00:01:25,431 and solution-oriented techniques. 20 00:01:26,091 --> 00:01:28,401 I also run the Unstucking Academy. 21 00:01:28,401 --> 00:01:33,216 It's a small, private community for those who love what I do here on the 22 00:01:33,216 --> 00:01:39,216 podcast and are ready to take their self-regulation efforts to the next level. 23 00:01:40,086 --> 00:01:44,166 I'll have links to the Unstacking Academy and everything that I discuss 24 00:01:44,676 --> 00:01:47,136 here in this episode in the description. 25 00:01:47,226 --> 00:01:51,156 Okay, so the first thing is we need to understand what EMDR actually is. 26 00:01:51,906 --> 00:01:54,726 This is gonna change how you hear everything that comes 27 00:01:54,816 --> 00:01:57,156 after this first uh, piece. 28 00:01:58,716 --> 00:02:05,436 Uh, and to do that, we will look briefly at the eight phase structure of EMDR. 29 00:02:06,726 --> 00:02:11,016 Phase one includes history taking and treatment planning. 30 00:02:11,076 --> 00:02:16,716 The therapist gathers context, identifies target memories and judges whether 31 00:02:16,716 --> 00:02:21,276 the person is ready to begin trauma processing, pro trauma processing. 32 00:02:22,806 --> 00:02:26,076 Phase two is preparation and stabilization. 33 00:02:26,766 --> 00:02:28,116 The therapist explains. 34 00:02:28,116 --> 00:02:33,726 The EMDR process builds rapport and teaches the client grounding 35 00:02:33,726 --> 00:02:38,886 skills and uh, ways to manage when things get intense, which. 36 00:02:39,771 --> 00:02:44,961 I, they very likely will just due to the nature of talking about traumas, 37 00:02:45,801 --> 00:02:47,451 phase three or traumatic incidents. 38 00:02:47,841 --> 00:02:49,851 Phase three is assessment. 39 00:02:50,451 --> 00:02:55,461 Here the therapist and the client activate a specific memory and identify 40 00:02:55,461 --> 00:03:01,611 the components, the image, the negative belief attached to it, the positive 41 00:03:01,611 --> 00:03:07,326 belief the client wants instead, the emotions, the bodily sensations. 42 00:03:08,106 --> 00:03:12,876 They measure the distress and the believability of the new belief using 43 00:03:12,996 --> 00:03:15,396 baselines before processing starts. 44 00:03:17,316 --> 00:03:20,526 Phase four is desensitization. 45 00:03:21,426 --> 00:03:25,866 This is the one almost everyone thinks of when they hear EMDR. 46 00:03:26,826 --> 00:03:32,196 In this phase, the client holds the target memory in mind while following a 47 00:03:32,931 --> 00:03:39,261 bilateral stimulation of some sort, and the therapist continues the bilateral 48 00:03:39,261 --> 00:03:42,081 stimulation until the distress reduces. 49 00:03:43,913 --> 00:03:49,341 Phase five is installation where the therapist again uses bilateral stimulation 50 00:03:49,341 --> 00:03:53,211 to strengthen a new adaptive belief. 51 00:03:54,591 --> 00:03:56,901 Phase six is the body scan. 52 00:03:57,651 --> 00:04:01,221 The client holds the memory and the new adaptive belief. 53 00:04:02,706 --> 00:04:06,216 And then scans the body for any resi- residual tension. 54 00:04:06,996 --> 00:04:12,816 If tension shows up, additional processing can follow. 55 00:04:14,376 --> 00:04:20,226 Phase seven is closure sessions end with containment strategies and the 56 00:04:20,226 --> 00:04:26,016 return to baseline, so the client leaves feeling stable whether or not, 57 00:04:26,286 --> 00:04:28,416 uh, the processing was completed. 58 00:04:30,171 --> 00:04:33,231 And finally, phase eight is reevaluation. 59 00:04:34,071 --> 00:04:37,551 At the next session, you check whether or the therapist checks whether 60 00:04:37,551 --> 00:04:42,531 the the gains are held, whether the target is still processed, and 61 00:04:43,161 --> 00:04:45,951 whether new targets need attention. 62 00:04:47,541 --> 00:04:50,991 So notice where bilateral stimulation shows up. 63 00:04:51,531 --> 00:04:55,581 It's mainly in phases four, five, and if needed six. 64 00:04:55,811 --> 00:05:01,661 That means the eye movements or taps, or sounds or whatever 65 00:05:02,021 --> 00:05:05,351 are a part of the process, but they're not the whole therapy. 66 00:05:06,641 --> 00:05:14,531 When viewed as a cohesive whole, the vast majority of EMDR is not very special. 67 00:05:15,611 --> 00:05:20,831 Once you remove the bilateral stimulation component, it involves 68 00:05:21,611 --> 00:05:28,331 assessing and treatment planning, the rapport building, managing distress, 69 00:05:28,841 --> 00:05:34,166 questioning beliefs, and thinking, thought replacement, bodily awareness, 70 00:05:35,396 --> 00:05:42,026 discussing past traumatic incidents, reevaluating and making new goals. 71 00:05:43,436 --> 00:05:47,786 All of these pieces are fairly typical therapy components. 72 00:05:48,596 --> 00:05:53,006 If you ask any therapist if they do any of these pieces, they'll probably say, yeah, 73 00:05:54,596 --> 00:05:59,966 and they'll probably say that they, uh, do many of these pieces in some combination. 74 00:06:00,716 --> 00:06:01,586 Likely all of them. 75 00:06:03,596 --> 00:06:05,636 So does EMDR work? 76 00:06:06,176 --> 00:06:10,616 The short evidence-based answer is yes. 77 00:06:12,446 --> 00:06:17,336 Multiple organizations have, uh, recognized EMDR as an effective 78 00:06:17,336 --> 00:06:23,606 treatment for PTSD, the American Psychological Association, the APA 79 00:06:24,236 --> 00:06:26,966 includes it among evidence-based options. 80 00:06:28,106 --> 00:06:28,346 Well, uh. 81 00:06:29,396 --> 00:06:30,656 Sort of, there's a caveat there. 82 00:06:31,076 --> 00:06:33,656 They list it as a second tier option. 83 00:06:34,406 --> 00:06:39,746 The APA says it's more helpful than being on a wait list and more 84 00:06:39,746 --> 00:06:45,476 helpful than treatment as usual, and that the pros of EMDR outweigh the 85 00:06:45,746 --> 00:06:50,036 cons or the cons of, I guess, not undergoing anything at all, basically. 86 00:06:50,036 --> 00:06:54,386 Well, it's better than standing around and doing nothing and probably better 87 00:06:54,386 --> 00:06:57,896 than very basic talk therapy, so. 88 00:06:58,751 --> 00:06:59,621 That's kind of something. 89 00:07:00,851 --> 00:07:06,071 The World Health Organization lists, EMDR as a standard, and the 90 00:07:06,071 --> 00:07:10,781 United States Department of Veterans Affairs and Department of Defense 91 00:07:10,991 --> 00:07:13,751 give EMDR a strong recommendation. 92 00:07:15,431 --> 00:07:21,191 In randomized trials, EMDR, consistently outperforms wait list 93 00:07:21,821 --> 00:07:25,781 controls and non-specific treatments. 94 00:07:26,486 --> 00:07:31,166 Which is important, but again, it doesn't really tell us very much beyond the fact 95 00:07:31,166 --> 00:07:36,146 that the protocol does more than the passage of time or simple attention. 96 00:07:38,232 --> 00:07:42,986 People get better and evidence shows that EMDR helps them get better. 97 00:07:43,856 --> 00:07:44,636 So that's important. 98 00:07:46,466 --> 00:07:49,016 But that's only half the question really. 99 00:07:50,156 --> 00:07:56,726 When researchers compare eMDR to other trauma-focused therapies like, 100 00:07:56,726 --> 00:08:02,456 um, cognitive processing therapy, or trauma-focused CBT or prolonged 101 00:08:02,456 --> 00:08:09,566 exposure the outcomes are, broadly speaking, similar direct comparisons 102 00:08:10,406 --> 00:08:14,366 amongst these tend to show equivalent reductions in PTSD symptoms. 103 00:08:15,596 --> 00:08:21,656 That pattern shows up across multiple trials and meta-analyses. 104 00:08:23,516 --> 00:08:24,506 So what does that tell us? 105 00:08:25,016 --> 00:08:30,356 It suggests EMDR is an effective, uh, and effective to make sure that was 106 00:08:30,356 --> 00:08:36,146 clear and effective path to healing, but not necessarily a unique one. 107 00:08:37,946 --> 00:08:40,406 Different roads can lead to the same place basically. 108 00:08:41,361 --> 00:08:45,386 So let's talk about what those shared roads look like. 109 00:08:45,686 --> 00:08:51,011 In psychotherapy research, common factors emerge- elements that 110 00:08:51,011 --> 00:08:56,981 appear across different therapies and explain much of why they work. 111 00:08:58,421 --> 00:09:03,731 For trauma therapies, these common factors are maybe especially relevant. 112 00:09:04,871 --> 00:09:06,701 So the first one, I'm gonna give you four. 113 00:09:07,241 --> 00:09:11,466 The first one is the therapeutic alliance, the relationship between 114 00:09:11,576 --> 00:09:17,306 therapist and client is a major predictor of positive outcomes 115 00:09:17,306 --> 00:09:20,696 across almost every form of therapy. 116 00:09:21,206 --> 00:09:22,676 I would say every form of therapy actually. 117 00:09:23,126 --> 00:09:28,106 That bond the therapist's empathy, the attunement, the ability to repair 118 00:09:28,106 --> 00:09:34,016 ruptures- these create predictability and a safe other to heal with. 119 00:09:35,456 --> 00:09:40,886 This co-regulation process from therapist to client, creates a platform for safety. 120 00:09:41,891 --> 00:09:46,631 It'll even activate the body's ventral vagal pathways, which are 121 00:09:46,631 --> 00:09:51,731 responsible for many cognitive, social, and health benefits when active. 122 00:09:53,021 --> 00:09:56,471 When active, the then the therapy techniques are useful. 123 00:09:57,221 --> 00:10:03,341 So when in safety, then techniques become useful, whether that's challenging false 124 00:10:03,341 --> 00:10:05,741 beliefs or telling the trauma narrative. 125 00:10:07,181 --> 00:10:08,171 So that's, that's the first one. 126 00:10:09,161 --> 00:10:10,421 Number two is exposure. 127 00:10:11,456 --> 00:10:15,956 Processing a traumatic memory by holding it in mind while 128 00:10:15,956 --> 00:10:18,296 staying present is exposure. 129 00:10:19,376 --> 00:10:25,376 In EMDR, the client activates the memory and stays with it during desensitization. 130 00:10:26,576 --> 00:10:30,446 In prolonged exposure, the person repeatedly recounts the narrative. 131 00:10:31,436 --> 00:10:35,606 Trauma-focused CBT has the client tell the narrative repeatedly as well. 132 00:10:37,106 --> 00:10:41,036 The formats differ, but all of these involve confronting the 133 00:10:41,036 --> 00:10:42,956 memory rather than avoiding it. 134 00:10:44,456 --> 00:10:49,316 Exposure allows the brain and the body to relearn that the memory is 135 00:10:49,316 --> 00:10:51,836 a memory and not a current threat. 136 00:10:53,516 --> 00:10:58,016 The recovery process of exposure is also extremely important- i- is important, 137 00:10:58,016 --> 00:10:59,006 but I would say extremely important. 138 00:11:00,056 --> 00:11:03,986 The system learns that it can access discomfort, whether through 139 00:11:03,986 --> 00:11:05,126 a memory or something else. 140 00:11:06,056 --> 00:11:08,816 It can access discomfort and then recover from it. 141 00:11:09,716 --> 00:11:12,806 Repeatedly doing so builds the body's distress tolerance. 142 00:11:14,576 --> 00:11:18,716 Third is expectancy and hope. 143 00:11:19,916 --> 00:11:23,276 Belief that the therapy will work matters. 144 00:11:24,326 --> 00:11:27,086 Positive expectations is mobilizing. 145 00:11:27,986 --> 00:11:33,326 Somebody with hope is more likely to take action and maximize their therapy time no 146 00:11:33,326 --> 00:11:35,486 matter what style the therapist is using. 147 00:11:36,746 --> 00:11:42,746 Simply having hope is big and having hope with a safe other is even bigger. 148 00:11:44,396 --> 00:11:48,116 And number four, the last one is cognitive reprocessing. 149 00:11:48,926 --> 00:11:52,916 Most therapies involve some level of questioning thoughts, 150 00:11:52,916 --> 00:11:58,076 whether through reframing them or reality testing or something else. 151 00:11:59,621 --> 00:12:05,351 Many clients of mine actually, they will explicitly tell me or ask me to, 152 00:12:06,281 --> 00:12:08,381 to call them out on their thinking. 153 00:12:08,951 --> 00:12:13,241 Like if they're avoiding things through making excuses or rationalizing 154 00:12:13,241 --> 00:12:14,831 their pain or minimizing it. 155 00:12:15,641 --> 00:12:18,041 People want to have clearer thinking. 156 00:12:18,041 --> 00:12:19,001 They wanna be called out on it. 157 00:12:20,231 --> 00:12:25,001 These elements and more show up across various therapies. 158 00:12:25,871 --> 00:12:28,151 They are not unique to EMDR. 159 00:12:29,291 --> 00:12:33,671 They account for a large share of positive outcomes regardless 160 00:12:33,671 --> 00:12:36,431 of the modality a therapist uses. 161 00:12:38,231 --> 00:12:45,611 So we have addressed whether or not EMDR is effective, but there's a much more 162 00:12:45,611 --> 00:12:47,201 interesting question we need to ask. 163 00:12:48,761 --> 00:12:54,011 Do the eye movements or other forms of bilateral stimulation matter? 164 00:12:56,096 --> 00:13:02,426 Is that the active ingredient that makes EMDR special, or is it just an accessory 165 00:13:02,546 --> 00:13:04,286 on top of the things that actually work? 166 00:13:06,176 --> 00:13:10,766 People have tried to answer this question with dismantling studies. 167 00:13:11,546 --> 00:13:17,006 These are clinical trials that compare full EMDR with versions that 168 00:13:17,006 --> 00:13:22,166 remove the bilateral stimulation or put other controls in place 169 00:13:22,166 --> 00:13:23,756 of the bilateral stimulation. 170 00:13:24,446 --> 00:13:30,656 And research trials have found that EMDR, with and without eye movements found no 171 00:13:30,656 --> 00:13:33,236 significant difference in PTSD symptoms. 172 00:13:33,516 --> 00:13:36,846 A meta analysis of several dismantling studies found no 173 00:13:36,846 --> 00:13:42,031 significant- significantly, uh, statistically significant advantage 174 00:13:42,771 --> 00:13:44,287 for bilateral stimulation. 175 00:13:45,316 --> 00:13:50,121 But there was another meta-analysis that found a moderate benefit to eye movements 176 00:13:50,121 --> 00:13:57,441 in lab-based studies, but this benefit was inconsistent in clinical PTSD trials. 177 00:13:58,461 --> 00:14:03,141 So a benefit in the lab, but not so much outside the lab. 178 00:14:04,431 --> 00:14:09,921 You're wondering, "But Justin, why would lab results be different than clinical 179 00:14:10,011 --> 00:14:13,206 trials?" Well, many potential reasons. 180 00:14:14,256 --> 00:14:17,226 Uh, in lab studies, everyone is on their best behavior. 181 00:14:18,036 --> 00:14:19,386 They're following protocols. 182 00:14:20,016 --> 00:14:25,386 They know they're being monitored, maybe evaluated, and therefore 183 00:14:25,506 --> 00:14:28,896 that provide, they provide the best possible treatment that they can. 184 00:14:30,226 --> 00:14:33,906 In controlled trials therapists are also more likely to be trained 185 00:14:33,906 --> 00:14:39,531 for the study and supervised, unlike the real clinical world. 186 00:14:41,286 --> 00:14:43,686 On top of- where therapists act more in silos. 187 00:14:44,556 --> 00:14:49,446 On top of that, the client may also be experiencing the like next level 188 00:14:49,566 --> 00:14:54,936 of placebo, where they subconsciously buy into the process even more due to 189 00:14:54,936 --> 00:14:58,626 the nature of the lab experiment and professionals and data and whatnot. 190 00:15:00,996 --> 00:15:04,626 Another reason is that lab participants often have less intense 191 00:15:04,776 --> 00:15:09,306 PTSD symptoms, or they're asked to focus on distressing memories, but 192 00:15:09,486 --> 00:15:11,676 not necessarily traumatic ones. 193 00:15:11,676 --> 00:15:16,626 And these are often voluntary students who are a part of these trials. 194 00:15:17,676 --> 00:15:21,096 There are also critiques about how the EMDR field has 195 00:15:21,096 --> 00:15:23,166 responded to these findings. 196 00:15:24,096 --> 00:15:28,746 When early dismantling studies fail to find a difference, train EMDR 197 00:15:28,746 --> 00:15:34,056 training materials and manuals were updated to emphasize different dosages 198 00:15:34,056 --> 00:15:36,156 and variants of bilateral stimulation 199 00:15:38,286 --> 00:15:44,196 when different modes of bilateral stimulation like tapping showed similar 200 00:15:44,196 --> 00:15:52,686 outcomes, tapping became framed as a legitimate variant of EMDR rather than a 201 00:15:52,686 --> 00:15:55,986 distinct control that proves otherwise. 202 00:15:57,591 --> 00:16:02,031 Obviously if the unique feature of EMDR can be expanded to include 203 00:16:02,421 --> 00:16:05,121 other things, then it's not unique. 204 00:16:06,891 --> 00:16:11,571 I actually, I once talked to a, uh, fellow therapist who had just returned 205 00:16:11,571 --> 00:16:18,531 from an EMDR conference, and they were genuinely convinced that walking was 206 00:16:18,596 --> 00:16:23,091 now an EMDR intervention, walking. 207 00:16:24,186 --> 00:16:24,486 Why? 208 00:16:24,486 --> 00:16:28,866 Well, because it involves alternating bilateral movement, right? 209 00:16:29,886 --> 00:16:32,106 And you're, you're, you're right: that sounds odd. 210 00:16:33,246 --> 00:16:37,956 At some point, if everything counts like tapping or sounds or walking, 211 00:16:38,646 --> 00:16:40,326 then really nothing is being tested. 212 00:16:42,036 --> 00:16:45,906 Critics rightfully argue that this looks like moving the 213 00:16:45,906 --> 00:16:47,406 goalpost, and I would say it's. 214 00:16:48,066 --> 00:16:49,266 That's a very serious critique. 215 00:16:50,451 --> 00:16:54,651 The field of psychology advances by testing hypotheses with a willingness 216 00:16:55,221 --> 00:16:57,681 to accept inconvenient answers. 217 00:16:59,151 --> 00:17:05,061 If the specific mechanism you name as central to your modality, if it fails 218 00:17:05,061 --> 00:17:11,241 repeated tests, the honest response is to revise the theory rather than to 219 00:17:11,841 --> 00:17:16,011 redefine the terms so your treatment still fits the original claim. 220 00:17:17,916 --> 00:17:21,426 That is fairly questionable, if not shady, in my opinion. 221 00:17:23,166 --> 00:17:28,536 If you do a deeper dive into, uh, EMDR and its founder Shapiro, there's uh, 222 00:17:28,536 --> 00:17:32,106 actually more questionable ness to it. 223 00:17:32,736 --> 00:17:37,026 Um, I highly recommend the YouTube video from Neural Transmissions. 224 00:17:37,896 --> 00:17:43,716 Uh, the video is titled "A Hard Look at EMDR and Its Unscrupulous Founder." 225 00:17:45,366 --> 00:17:48,696 Of course I'll have a link in the description along with all the 226 00:17:48,696 --> 00:17:51,246 sources that I'm pulling from, but not naming in the episode. 227 00:17:52,776 --> 00:17:59,526 As I said before, EMDR is supported by evidence, but the evidence has 228 00:18:00,156 --> 00:18:04,266 weaknesses and there's actually more weaknesses- all, all this for you. 229 00:18:05,046 --> 00:18:05,616 Um, 230 00:18:05,676 --> 00:18:08,736 One major concern is allegiance bias. 231 00:18:08,736 --> 00:18:13,316 Many EMDR studies are conducted by clinicians who train in and promote EMDR. 232 00:18:15,486 --> 00:18:19,356 Studies run by invested parties tend to produce larger effect sizes 233 00:18:19,386 --> 00:18:23,256 or more ben- benefit basically across psychotherapy research. 234 00:18:24,396 --> 00:18:27,606 And, you know, that doesn't automatically invalidate things, but 235 00:18:28,326 --> 00:18:32,046 it does mean we need to spend more time on independent replications. 236 00:18:34,056 --> 00:18:39,396 Uh, also, sample sizes in many trials have been small, which has weakened statistical 237 00:18:39,396 --> 00:18:42,156 power and increases uncertainty. 238 00:18:43,386 --> 00:18:45,636 Publication bias is always a concern. 239 00:18:46,296 --> 00:18:50,616 Negative or null trials are less likely to be, to be published, which, um, 240 00:18:50,886 --> 00:18:54,336 inflates what we think is true about EMDR. 241 00:18:55,596 --> 00:19:00,066 So these shortcomings, by the way, they're, they're not just an EMDR issue. 242 00:19:00,846 --> 00:19:06,156 Psychotherapy studies in large part have major problems such as these. 243 00:19:07,446 --> 00:19:12,306 Uh, let's do a little thought experiment to, to illustrate the, the overall point. 244 00:19:14,016 --> 00:19:20,736 Imagine you were coming to me for therapy because I have a revolutionary 245 00:19:20,736 --> 00:19:23,766 new method that has shown great results. 246 00:19:24,756 --> 00:19:31,386 I help my clients to process their trauma through telling the trauma, 247 00:19:31,386 --> 00:19:36,816 narrative the story, but while they do, so, they flex and curl their 248 00:19:36,816 --> 00:19:38,166 toes and then they release it. 249 00:19:39,246 --> 00:19:46,101 It's called Toe Curling Desensitization and Reprocessing, or TCDR. 250 00:19:48,351 --> 00:19:55,611 At first you think, Justin, you want me to tell you my traumas the most horrific 251 00:19:55,611 --> 00:19:57,621 things in my life while curling my toes? 252 00:19:58,461 --> 00:19:59,271 It seems weird to you. 253 00:20:00,396 --> 00:20:07,896 I assure you that tow curling creates a rhythmic motor pattern that occupies 254 00:20:07,896 --> 00:20:13,266 a portion of working memory and thereby reduces the vividness of the traumatic 255 00:20:13,266 --> 00:20:15,336 image while you hold it in mind. 256 00:20:17,406 --> 00:20:23,736 TCDR still sounds silly to you, but the reasoning I give you sounds fancy 257 00:20:23,736 --> 00:20:27,906 enough and you can't argue with the studies that say there's benefit. 258 00:20:29,136 --> 00:20:34,416 And everyone's talking about it and Bessel VanDerKolk raves about it and 259 00:20:34,416 --> 00:20:40,086 The Body Keeps the Score, which you, a book you love, so you cautiously agree 260 00:20:40,086 --> 00:20:42,336 to meet with me, desperate for change. 261 00:20:43,836 --> 00:20:48,426 When we meet, I don't just ask you to clench and release your toes, obviously. 262 00:20:49,236 --> 00:20:52,086 I also greet you at the door and I invite you in. 263 00:20:53,346 --> 00:20:56,466 The office is calming with natural greens and blues. 264 00:20:56,466 --> 00:21:03,246 It's, it's silent, and there's a nice view out the window, which overlooks the water. 265 00:21:04,626 --> 00:21:06,396 We smile together, we chitchat a bit. 266 00:21:07,326 --> 00:21:08,046 Talk about the weather. 267 00:21:08,736 --> 00:21:11,136 I learn more about you and assess your needs. 268 00:21:11,706 --> 00:21:13,446 We make a treatment plan together. 269 00:21:14,436 --> 00:21:16,236 You know, basic, basic therapy stuff. 270 00:21:16,236 --> 00:21:21,786 Right now, as you're ready, you tell me your traumatic life context. 271 00:21:22,896 --> 00:21:25,566 Yes, while curling and releasing your toes. 272 00:21:27,126 --> 00:21:30,096 And it's not pleasant to talk about this stuff, but you're okay. 273 00:21:30,666 --> 00:21:31,266 You recover. 274 00:21:31,836 --> 00:21:32,976 We process what happened. 275 00:21:33,456 --> 00:21:37,596 You get homework and we meet again the following week. 276 00:21:39,546 --> 00:21:44,561 I suspect that TCDR would be just as effective as EMDR. 277 00:21:46,026 --> 00:21:50,346 Not because the toe curling, which is obviously not necessary, right? 278 00:21:51,591 --> 00:21:54,411 But even though it might sound plausible, but because of the 279 00:21:54,411 --> 00:21:55,731 common factors of therapy. 280 00:21:56,836 --> 00:22:02,511 The the toe curling is, is dressing it's cosmetic and ultimately unnecessary. 281 00:22:04,311 --> 00:22:05,811 So what's the practical takeaway? 282 00:22:06,831 --> 00:22:10,551 First, EMDR is an evidence-based option. 283 00:22:11,271 --> 00:22:16,041 If you have found a clinician who uses EMDR and you feel safe 284 00:22:16,041 --> 00:22:20,256 and supported and you're making progress, that is meaningful. 285 00:22:20,256 --> 00:22:21,156 And that's positive. 286 00:22:21,366 --> 00:22:22,026 And I'm happy for you. 287 00:22:23,256 --> 00:22:32,016 Second, many of the helpful components of EMDR are not unique to EMDR. 288 00:22:32,376 --> 00:22:33,456 Actually, the majority of it. 289 00:22:34,296 --> 00:22:39,921 Safety building, co-regulation, gradual exposure, cognitive change, 290 00:22:40,776 --> 00:22:44,556 and more show up in effective therapies across the board. 291 00:22:45,516 --> 00:22:50,241 You do not need to have EMDR to get those ingredients. 292 00:22:51,711 --> 00:22:58,521 Third, the central signature of EMDR- bilateral stimulation, especially 293 00:22:58,521 --> 00:23:04,191 with eyes- is probably not essential for the bulk of its clinical effects. 294 00:23:05,301 --> 00:23:10,191 The research suggests it may add a small effect in tightly 295 00:23:10,191 --> 00:23:17,016 controlled lab conditions, but in the messy reality of therapy it is 296 00:23:17,016 --> 00:23:19,566 not the engine driving recovery. 297 00:23:21,276 --> 00:23:24,336 That conclusion should be liberating more than upsetting 298 00:23:25,656 --> 00:23:27,186 or maybe for clients, more so. 299 00:23:28,116 --> 00:23:28,866 Potential clients. 300 00:23:29,166 --> 00:23:34,026 Healing trauma is not locked behind a single ritual or a single technique. 301 00:23:35,286 --> 00:23:39,426 If you're worried that you missed something because you didn't have EMDR, 302 00:23:39,426 --> 00:23:45,561 or you're choosing between therapists and the only option is someone who 303 00:23:45,891 --> 00:23:52,401 practices prolonged exposure or cognitive reprocessing therapy, that's That's okay. 304 00:23:53,601 --> 00:23:54,201 Or something else. 305 00:23:54,201 --> 00:23:54,591 That's okay. 306 00:23:55,281 --> 00:24:00,741 Focus instead on the practical markers of good care: a therapist who 307 00:24:00,771 --> 00:24:06,111 prioritizes safety, who can help you regulate, who builds a steady alliance, 308 00:24:06,111 --> 00:24:11,151 who introduces the work slowly and who helps you make meaning of change. 309 00:24:12,786 --> 00:24:15,276 Those pieces are essential and, and more. 310 00:24:17,106 --> 00:24:21,786 As a therapist and coach, I also use gradual exposure to discomfort. 311 00:24:23,183 --> 00:24:29,076 But instead of asking clients to tell me trauma narratives, uh, we focus on 312 00:24:29,166 --> 00:24:33,786 emotions that are typically difficult to acknowledge, uh, difficult to pay 313 00:24:33,786 --> 00:24:39,381 attention to, to feel, but they're there anyway, so we gotta pay attention to 'em. 314 00:24:40,521 --> 00:24:46,881 We pay attention within or slightly past the edge of what the client 315 00:24:46,881 --> 00:24:48,831 can tolerate, and then we recover. 316 00:24:49,791 --> 00:24:53,901 Once back at a baseline, we can try again if they would like and if 317 00:24:53,901 --> 00:24:58,101 they're ready to over time, typically within a single session, these 318 00:24:58,101 --> 00:24:59,751 emotions become much more tolerable. 319 00:25:00,396 --> 00:25:03,276 Not cured, I'm not saying that, but much more tolerable. 320 00:25:04,206 --> 00:25:07,716 And we can then target more difficult ones as they are 321 00:25:07,716 --> 00:25:09,336 already, as their capacity allows. 322 00:25:10,386 --> 00:25:14,736 But I don't think, personally, I don't think that there's a need to 323 00:25:14,736 --> 00:25:19,986 add anything else to the mix, like eye movements and tapping and sounds 324 00:25:19,986 --> 00:25:22,956 and no, not even clenched toesies. 325 00:25:23,751 --> 00:25:24,471 You can if you want. 326 00:25:25,251 --> 00:25:29,571 In fact, I believe I can even step back from the equation for many 327 00:25:29,571 --> 00:25:33,891 potential clients who don't have a severe level of dysregulation. 328 00:25:33,921 --> 00:25:34,701 I'm not saying that. 329 00:25:35,751 --> 00:25:39,411 And that these potential clients with mild to moderate activation, 330 00:25:39,411 --> 00:25:42,351 that they can learn and practice their own self-regulation skills 331 00:25:42,351 --> 00:25:44,991 through the Unstuckinging Academy. 332 00:25:46,536 --> 00:25:49,086 Well, for the most part, I'll step back in the academy. 333 00:25:49,086 --> 00:25:50,346 You'll still learn from me. 334 00:25:50,346 --> 00:25:54,006 You'll meet with me during live q and As and Nervous System Capacity 335 00:25:54,006 --> 00:25:55,926 Builder live events and more. 336 00:25:56,766 --> 00:26:00,876 You'll listen to prerecorded meditations from me to help you 337 00:26:01,446 --> 00:26:05,676 build up your skills, but the practices are ultimately up to you. 338 00:26:06,696 --> 00:26:07,776 It's still up to you to show up. 339 00:26:08,826 --> 00:26:11,361 Still up to you, up to you to learn and to apply. 340 00:26:12,366 --> 00:26:16,416 The small community is incredible and has lots of wisdom within it. 341 00:26:17,106 --> 00:26:22,716 And all Unstucking Academy co-regulation to your students can join the many live 342 00:26:22,716 --> 00:26:27,756 cohorts and live events throughout their subscription, like safety, simplified 343 00:26:27,756 --> 00:26:29,226 and Self-Regulation simplified. 344 00:26:29,976 --> 00:26:33,576 You can learn more about The Unstucking Academy, by the way, at 345 00:26:33,596 --> 00:26:33,896 Stucknotbroken.com/UnstuckingAcademy. 346 00:26:38,226 --> 00:26:38,646 Again, stucknotbroken.com/UnstuckingAcademy. 347 00:26:44,721 --> 00:26:49,911 So to wrap up, EMDR gives clinicians and clients a structured 348 00:26:49,911 --> 00:26:53,031 path to change toward change. 349 00:26:54,261 --> 00:26:59,181 Bilateral stimulation is part of that path, but probably not the sole 350 00:26:59,181 --> 00:27:04,036 reason the path exists and probably not even a necessary piece of it. 351 00:27:05,466 --> 00:27:09,756 That puts power back into your hands as a potential therapy client. 352 00:27:10,476 --> 00:27:11,976 You have lots of choices. 353 00:27:12,576 --> 00:27:13,686 Healing is not a trick. 354 00:27:13,686 --> 00:27:14,586 It's not a gimmick. 355 00:27:15,336 --> 00:27:16,266 It's not a hack. 356 00:27:16,956 --> 00:27:22,296 It's a reliable set of practices built on top of safety and all those 357 00:27:22,356 --> 00:27:28,146 wonderful co-reg pieces of therapy that all styles should have in common. 358 00:27:29,346 --> 00:27:33,396 Thank you so much for spending time with me here on Stuck Not Broken.