Our meeting this month addressed the topic of Eye Movement Desensitisation and Reprocessing (EMDR), presented to us by counselling psychologist Angela Loulopoulou. Having heard a great deal about EMDR as a treatment method for trauma and PTSD, this seemed like a useful and important tool art therapists might be able to incorporate into their work.
As usual, we started with art-making on the theme Angela suggested: “difficult memories and safe places”. This led to some poignant feelings and ideas being shared in the group, with the group discussion touching on the fact that safety – and being in a safe place – are necessary to allow difficult memories to be addressed.
Angela briefly explained the history of EMDR, which is based on F. Shapiro’s research into the way eye movement can help us integrate difficult memories. Shapiro looked at the way trauma can upset the balance in our brain and found that bilateral stimulation is helpful in restoring this balance. EMDR stimulates eye movement while alternating between left and right, and enabling the client to process ‘stuck’ memories in the room with the therapist in the ‘here and now’. The therapist might ask clients to follow his/her finger with their gaze in order to stimulate eye movement, but many also use tapping or even equipment which plays a sound in alternate ears or sends sensations to clients’ hands, causing the client’s eyes to move involuntarily from side to side. Angela first trained in EMDR when working with refugees who had experienced persecution, violence and assault in their home countries. When asked about the effectiveness of EMDR, she said “I’ve never known it not to work”.
EMDR, Angela explained, is not a therapeutic approach or an orientation; rather, it is a tool, an intervention. EMDR training is open to qualified and registered therapists only (this includes art therapists who have relevant experience and are registered with HCPC). A typical course of treatment lasts 6-10 sessions and can be offered as a brief intervention, although therapists often use it within the context of an existing trusting therapeutic relationship to help a long-term client who needs to address a specific trauma or a phobia. It might be especially useful in a scenario where the client’s difficulties, phobias or negative self-belief stem from specific events. The intervention should not be offered in the first session because the client has to be comfortable in the therapist’s presence, and the therapist needs to have a good enough understanding of the client and the extent of the trauma. EMDR has a very specific protocol: for example, the therapist and the client sit in a way which places the therapist physically close to the client and in his/her peripheral vision, but avoids direct eye contact. Unlike most forms of psychotherapy, certain aspects of EMDR (for example, tapping) can involve touch; additionally, it is not considered a problem to offer EMDR to friends or family, because it is a tool rather than a form of psychotherapy.
Sometimes, Angela said, when we have a traumatic memory, “it is tangled up with other memories like a ball of wool. Other events can pull on it and activate this memory, or initiate strong feelings associated with this memory. EMDR does not help the client forget what had happened, but it will help the client process memories from the past in the here-and-now, as an adult.” It helps the client realise that “this happened then, it is not happening now and it is not happening all the time”. The idea is to untangle the ball of wool, to “tidy up the memories”. Obviously, once memories begin to become untangled the work can be emotionally intense and it is not clear where it might lead. For this reason, it is vitally important to help the client feel relaxed and safe in the room and to explain to clients that there is no “right or wrong” way of talking about their experience.
Before the EMDR process of recalling and talking about the event starts, the therapist has to establish a ‘safe place’ with the client. The client is asked to think about a place where they feel calm and secure, a place they would like to be; ideally this is a real place they remember well. The therapist should ask for many tangible details to help the client feel grounded. Relaxation can also be part of the session, and clients start and end each EMDR session in their ‘safe place’.
The client is then asked to recall the traumatic event, each time for short bursts of time while having bilateral stimulation. Each time they are invited to tell the therapist about the experience, and in every session their beliefs about the traumatic event (for example, “I’m in danger, I am going to die”) will be monitored against what they would like it to become (“I’m safe, I am not in danger”). At times, clients may become distressed during recollection and require reassurance. They are also asked to be aware of their bodily sensations and discuss them afterwards. Often, clients find that they think about the process during the week and that the experience of re-framing their memory means that they remember more details about the event. EMDR treatment usually ends when clients identify the new belief (such as “I’m safe”) as stronger than their previous, post-traumatic beliefs. Alternatively, when working with multiple traumas, therapy ends when no new material is generated.
Talking about counter-indications for treatment, Angela pointed out that some clients, who may have built their identity around traumatic experiences might be reluctant to let go of their trauma and they might not engage fully. We discussed the ways EMDR might be similar to SE (Somatic Experiencing) and CATT (Children’s Accelerated Trauma Treatment), both of which involve going in and out of traumatic memories while employing different methods to enable clients to feel grounded. Images are often used in EMDR when working with children, who might find telling their story verbally more difficult; this led us to consider the ways images and image-making could be used as part of the EMDR process. EMDR takes place as a 3-part intensive training over two or three days’ blocks. For more information, please see: http://www.emdrassociation.org.uk/home/index.htm
Posted by Nili Sigal, art therapist &
clinical meetings coordinator