EMDR, Getting at the Trauma

[Jaunty Guitar Music]

Mike: Welcome, everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting and the Kenosha County Substance Abuse Coalition. I'm Mike McGowan.

Mike: Today, it seems like wherever I go and therapy comes up, someone mentions EMDR. EMDR stands for Eye Movement Desensitization and Reprocessing and the therapy has been described by many who have participated in it as a miracle.

Mike: Well my guest today is Dr. Wendy Freitag. Dr. Freitag is a clinical psychologist, EMDR therapy clinician, trainer and consultant as well as a professional and life coach with over 30 years of experience. She is an EMDRIA (Eye Movement Desensitization and Reprocessing International Association) Certified Therapist, Approved Consultant, and Senior Trainer for EMDR Institute of Dr. Francine Shapiro, and has been the President of the EMDR Research Foundation since 2006. I couldn't have asked for a better guest to do this.

Mike: Welcome, Dr. Freitag.

Wendy: Thank you very much for having me.

Mike: Well, you know, you hear phrases bandied about all the time and people don't often know what they're talking about.

Mike: So let's start with the basics. What is EMDR and how does it work?

Wendy: Okay. So the first question is easier to answer than the second one. So EMDR therapy is a comprehensive evidence based eight phase treatment modality that helps resolve traumatic memories or disturbing memories that have occurred in someone's life.

Wendy: And so EMDR therapy, we are looking for those earlier trauma memories or events that have happened that haven't been resolved for the client. And so we're going back and looking for those events. Because those are the events that inform and impact present day functioning, how somebody thinks about themselves or thinks about the situation or that reactivity.

Wendy: And so we go right to the source, in a sense. Now, throughout our conversation, we'll probably talk a little bit more about the process of EMDR. And so I don't want to kind of reiterate myself. But when I get to the second question about how does it work, we don't really know how it works in the brain.

Wendy: We don't really know how the brain works. And so there are a number of hypothesized mechanisms of action, maybe like some REM sleep, or maybe memory reconsolidation or one proposed mechanism is the taxing of the working memory. So as we're pulling up the memory and accessing the memory and then the doing the bilateral stim, which is the eye movement or some other modality, it's taxing the brain to hang on to that memory.

Wendy: And so that it, then it resolves and typically the distress and the emotional distress is what relieves or is what is ameliorated. And then the individual can think differently. The memory gets stored differently in the brain not like it was stored or stuck from the traumatic event.

Mike: So is the thought behind it that when trauma occurs, we automatically as humans suppress the memory and this is a way of getting it back up to deal with it?

Wendy: I don't know that it's suppressed. I would say it's more that it can become stuck or frozen in the nervous system, and it can become stuck or frozen because of perhaps it's just more than what the brain capacity to deal with it.

Wendy: And so then it gets stuck and stored with that state specific memory, you know, the thoughts, the feelings, the body sensations that are all there at that time, and that's what gets stuck or stored or frozen. And what we're doing is when we find those memories that are the root or the foundation of the distressful things that are happening in the present day, and we access that memory with the procedures, and we do the bilateral stim, it then activates the brain and activates the memory so that the brain can then do what it couldn't do at the time. It helps neutralize the memory. So the negative material gets off and more positive adaptive information comes in and moves it towards adaptive resolution.

Wendy: So it's not that we're suppressing it. I mean, some folks certainly don't want to look at those traumatic memories. And if if those traumatic memories happened longer ago, they get used to trying to push those away or not look at them.

Wendy: And what we want to do is bring that right up close and personal and reprocess those memories to neutral or to an adaptive resolution. So EMDR therapy doesn't turn a bad memory into a good memory. It really is, we resolve the gut punch of the memory. So the person may still remember the memory, they remember points of it, but they don't have that gut punch.

Wendy: That's what gets stored.

Mike: How do you know which memories and events to access?

Wendy: Okay, so that's part of our what's phase one. And we're looking for oftentimes we're going and looking for all of the memories that we can identify that the client can identify that seems to be part of what we call the memory network.

Wendy: And so when we have a specific issue in the present day, we're looking for what are those memories, maybe back to childhood way back to childhood. That seemed to be the foundational material for this disturbing material. So that's part of the phase one is looking for what are those memories.

Wendy: And we have different procedures for getting at what might be those early memories. And typically we're going looking for the earliest material, the foundational memories and reprocessing those first, because we found the other very important piece of EMDR therapy is the generalization effect.

Wendy: So it's very user friendly for the client because we don't need to reprocess every single memory. We can go to those earlier memories, foundational memories. And as we clear that. Those other memories that were built on this foundation also fall away, maybe not all the way, and we need to desensitize those, but sometimes those later memories just become not important anymore because we've worked through the foundational material.

Mike: You used the term earlier bilateral stimulation.

Wendy: Yes.

Mike: What, what is that?

Wendy: Okay. So you know, it's eye movement desensitization and reprocessing. So, oftentimes, you know, folks know it as eye movement. But it is we have the client in dual awareness where they're accessing the memory and they're present with us in, and we're doing some type of dual attention bilateral stimulation.

Wendy: It was first founded with eye movement, but in 1990, we also found that other types of modalities or methods such as auditory bilateral stimulation, or even tapping or tactile auditory. And so that's what the bilateral stimulation is. And that's really mostly what helps the memory move down to adaptive resolution.

Mike: And is that what you mean when you started this out is we know that works, but we don't know how exactly that works, but we know that it works.

Wendy: We know that it works. Yes, because, you know, part of our protocol is we're finding out how distressing is the memory when we start it.

Wendy: And sometimes those memories are 8, 9 and 10. And then through the process, they resolve down to a zero. You know, it's like it moves the material to the adaptive resolution.

Mike: I've heard people who have been through other talk therapies say that EMDR helped them resolve trauma in a short time that they hadn't accomplished in long term therapy.

Wendy: Right. And I think that's because, as I said, we go back to the foundation of the traumatic material. We're going back and reprocessing those older memories. We're not staying in the present trying to look at what's the person's negative belief and changing their beliefs. We're going to the root, and we're clearing out the root, and then any of those other memories.

Wendy: And so an EMDR therapy can move quickly, like what we get done and talk therapy could take six months. What we learn in a couple of, through a reprocessing session, the clients can learn and assimilate different kinds of information that they couldn't get to and talk therapy because part of the protocol is we're not only just doing what's their thoughts, we're doing body sensations where what are their emotions, where is it held in the body, we know traumas held in the body.

Wendy: And so, as we clear that material out, then there's resolution. EMDR is also a three pronged approach, so we're looking and resolving those past memories, and then if there are still present day triggers that are still disturbing, we would also process those present day triggers and then look at the future.

Wendy: How does the client want to respond more effectively and efficiently and flexibly in the future based on that present day trigger that we cleared?

Mike: You know, I've heard people, including therapists, I might add, say that when they first heard about this, it seemed like, for lack of a better phrase, hocus pocus.

Wendy: Right, right. So in the early days of when EMDR came out on the scenes. There was a lot of misinformation. We certainly know what misinformation is living in our current environment. And it was like, I believe EMDR therapy kind of fell victim to misinformation. A lot of the proponents of CBT (Cognitive Behavioral Therapy) or behavioral type therapies felt like EMDR was just exposure therapy repackaged or, you know, CBT repackaged.

Wendy: And there's some very different components of EMDR that are different than CBT. But that's where that got to be like it's pseudoscience because it's really just CBT or exposure repackaged. That's where that, and there was a, you know, a fair amount of negative and that negative kind of conspiracies theory about EMDR therapy. But now there is much, much more research and you might hear that every once in a while these days about the pseudoscience of EMDR therapy, but that given the amount of research, because it is an evidence based treatment protocol, you don't hear that much anymore.

Wendy: And when folks that are EMDR, therapists who are, when they come to the treatment and they, you know, as part of our training, they have to undergo EMDR therapy themselves. And so then, when they see it work and how it shifts their experience of their disturbing or traumatic events, that's what makes the shift for the therapist.

Wendy: That, like your colleague who said, it works!

Mike: Yeah.

Mike: When they say, oh, I can feel the shift, what do they describe? Like, how do they know that?

Wendy: Yeah, so it's all different kinds of things. Sometimes an individual can say I feel something shifted in my head. We don't really know what that means. You know, or sometimes a client will say I feel like there's energy running down my arms or it feels like something just clicked and the energy is running through my legs or as I said a bit ago about taking the gut punch out.

Wendy: So, it is that when a trauma is held and all those thoughts and feelings and body sensations are there and once the brain is allowed or given the opportunity to really reprocess and neutralize that material, it's like the body feels different. It's like the trauma releases. And when they bring the memory up again it's like it's held differently in the brain. Or their belief about themselves shifts from, you know, I'm a lovable to, you know, I matter. And that's just what happens with the process. We're not asking a client to feel differently or to think differently. We're just allowing the process to process and how it works.

Wendy: Everybody is different and how it works, you know, nobody's the same. And so people experience EMDR therapy differently, but typically it's just that release of the distress that they don't even know sometimes that they've been holding on to that distress.

Mike: Well, how would it be used? With, to treat like substance abuse, PTSD? I actually saw something yesterday where somebody uses it to do gambling, compulsive gambling, and other trauma.

Mike: So how, how would you get at those?

Wendy: I think a lot of it when we're looking at specific diagnoses, which in EMDR therapy, we don't think about diagnoses so much. We think about what are those memories that are stuck or frozen and causing the issues in the present day, like substance abuse or gambling or what, depression, anxiety.

Wendy: The important point is when is a client ready to do the work? So it's not if it can be used, it's when can it be used. Especially like with addictions. You know, there's often times those earlier experiences, negative experiences, that have then driven somebody to some type of addictive behavior.

Wendy: We need the client to have sufficient, a necessary affect management strategies. They need to have different coping skills. They need to be able to really reprocess all that difficult material to move on. And so again, with any kind of clinical situation, we're looking for what are those memories, those older memories, that are really informing and influencing the maladaptive behavior.

Wendy: You know, and like a car accident when we look at PTSD, so somebody has a car accident and in their brain, they might know that they're not in danger, but they drive up to that intersection and they're gripping the wheels. They're thinking I'm going to die in their stomachs doing and so then they think what's wrong with me?

Wendy: Because I know I can look around and there's no danger at the moment, but the body's responding as if they're in danger. And that's what we reprocess.

Mike: And so you can then drive up to that intersection and the trauma was still there, but you feel differently driving up to the intersection.

Wendy: And really they don't think about it.

Wendy: I look at it as there's no trauma bubble to get triggered. So that car accident is here being held and all that state specific the thoughts, the feelings, the body sensations are all here as we drive up to that intersection. All of this gets activated, and it's like, Oh, my God, you know, something bad is going to happen to me.

Wendy: Once we clear that, and that gets neutralized, those thoughts and feelings and body sensations, they're released and they're no longer driving that maladaptive behavior.

Mike: Can EMDR even help with chronic pain?

Wendy: It certainly can. There is a protocol. So there's a manualized protocol helping individuals work with chronic pain, phantom limb pain it has also been very beneficial for.

Wendy: So there's a lots of, you know, there's work that's been done with depression. So there's, like I said, over the time here, there's been a lot more research and a lot more different protocols that are specific for different kinds of you know, like chronic pain or addictions, dissociation, personality disorders, those types of things.

Mike: How is EMDR different or similar to another technique I think people have heard about, brain spotting?

Wendy: Okay, so, brain spotting is really an adaptation of EMDR therapy. So, David Grand, who was the founder of brain spotting was very much an advocate for EMDR therapy. He wrote a book for the layperson on the rapid warp speed healing of EMDR therapy.

Wendy: But then what he found that when doing the bilateral stim, that there were certain points that you know, in the clients or in the person's visual field, that when he taps into that, he finds a way to get to the unprocessed memories. Now, I will be honest with you, I've not taken a training and when I get a minute, I would like to do that.

Wendy: But I certainly have heard that, you know, brain spotting could be helpful. I also think that, you know, for different clients at perhaps at different stages of their treatment, brain spotting might be an option, just like with other types of modalities.

Mike: I can see where, you know there's a power in the trauma being released and getting it out.

Mike: But how does the healing take place? And then also how long do the effects last? Like you said, people can come into the office and say, I feel different. Does that, is that long lasting? Is it short duration and you need to repeat it or how's it go?

Wendy: Typically not. You know, if we resolve a memory and it gets cleared.

Wendy: So, what's causing the problem, Mike, for an individual is that when that memory, that traumatic memory or disturbing event is stuck in the brain, it's frozen in the brain. Every time that a person's in a situation that reminds them, it's Internal or external. When they get reminded of that on some level, it could be an unconscious level, but they're activating this traumatic material.

Wendy: They're responding in a way that's not helpful to them. And so when we clear this memory, and it's no longer being held in the way that it was that when it happened, it no longer has that state specific negative material that's there. It's just an event that's occurred. That's what it is. It's event that it's occurred.

Wendy: And so we clear that and then the person's just responding differently. They don't have to think about responding differently. There's nothing that's getting triggered because we've cleared that. So, when a good job is done, and a memory has been cleared. It doesn't come back because the memory is organic.

Wendy: It's stored in the brain. And when it gets when it gets neutralized, or it gets to adaptive resolution, the client takes with it what they need. They recognize things about that. And maybe they recognize that they were strong or they really were resilient or it wasn't their fault that that happened to them.

Wendy: Or maybe I was only 4 years old. It wasn't my fault. Those are the kind of adaptive thoughts that come in. And so that's what makes a difference for the, for the client. And therefore, when they're, faced with something that feels similar, they're not getting activated by this anymore. They're just taking what they know.

Wendy: And so it's resolution of that memory. Now, certainly, you know, if there's complex types of trauma or complex situations. I'm not, please don't hear that it's a one, you know, one session here and. Because sometimes the EMDR therapy can need months, maybe even years, depending upon how complex the place is, how many layers of trauma, and some of that is really preparing the client to be able to do that work and be able to do the reprocessing.

Wendy: So there's a readiness aspect of that. That is very important in treatment, especially with more difficult addictions, dissociation, personality disorders, severe PTSD from maybe multiple traumas. And so it's very much a process that that can take months, if not years.

Mike: I would think that some people aren't even aware of the memories that they're going to be accessing.

Mike: I'm thinking about so many people grow up in less than perfect or functional families. And if I see my parents arguing all the time and swearing at one another and being abusive and drinking and their relationship fails. You know, I can come into adulthood relationship shy, right. Not liking women or blaming them for everything. So sometimes I would think that people aren't even aware of what memory that they're releasing.

Wendy: Absolutely.

Wendy: And I mean, we're typically when we start EMDR, the reprocessing of the memory, they know what the memory is that we're reprocessing because we're having to access that memory and that's part of the procedures. But what does happen is sometimes in finding those memories, they're very surprised at what is associated with this material.

Wendy: It could be, I don't understand why that memory is coming up to my brain, but we trust what the brain says. The brain knows where it needs to go. The other pieces that when we do do the work, or maybe between sessions, there can be other memories that show up that are also connected in some way, but that weren't in conscious awareness.

Wendy: So as we clear out and there's more emotional bandwidth, sometimes other distressing memories or disturbing memories come into consciousness and then they need to be reprocessed. So, you know, some of the cautions about EMDR therapy is we don't always know what all those old memories are, but what we do know is that if there are other memories that come in.

Wendy: Other disturbing memories or traumatic memories that come into consciousness, we can then reprocess those memories with EMDR therapy and resolve those as well.

Mike: I think that's fascinating because I think when you talk to people, myself included, we all have those memories. I can go back, you know, occasionally I'll be driving or doing something and I'll have a thought will occur to me of something that seems rather insignificant that happened in grade school.

Mike: And I'm like, why in the heck would that pop up that Bobby so and so called me a this at recess in fourth grade?

Wendy: Yes. And that's actually it. And sometimes it's those little [inaudible] that seems benign that can really get stuck and they also then start once that gets stuck then other memories that are similar to that that starts to build the memory network. And that's why we're looking for those things like what happened on the playground.

Mike: It's great.

Mike: You know, I want to ask you, I think I know the answer to this, but kind of a loaded question. I've noticed that many of the who am I counselor blurbs I see in people's advertising themselves, Psychology Today, that I've run across say the counselor does EMDR. But it seems that more people say they incorporate this in their therapy than have actually been trained in it.

Mike: What do I ask as a client to make sure my, if I want this, how do I know my counselor or therapist is actually trained in it and not just says that they did it?

Wendy: Okay, a very excellent question. So part of it is, I would say you want to make sure that the therapist has been trained by an EMDRIA. An EMDRIA is EMDR International Association.

Wendy: That's the professional organization for EMDR therapists. So we want to make sure that the, that the therapist has been trained by an approved training of EMDRIAs. We also I suggest that they go to EMDRIA.Org and look, find a therapist and find somebody who is at least a member of EMDRIA. Then we also have certified therapist who have gone to a level above being trained.

Wendy: And then there's the 3rd level, which is an approved consultant. So, the different credentials just mean the more training. The more consultation they've had, and so they're more experienced for sure. So I would suggest that. Another thing with like, Psychology Today is what I tell folks that are looking for EMDR therapists is read their profile.

Wendy: So if they say they do EMDR therapy, or they've been trained, but you don't read anything in their profile or about EMDR or how they incorporate EMDR therapy. You know, we don't talk about EMDR as a technique, but for some folks, it's like, it's a technique that they put on their shelf.

Wendy: And when they see something like, okay, this person has some PTSD, I'm going to pull this off and do this. They may not be using that on a regular basis and. I would want to make sure how much experience has the, has the therapist had to have. They had a, you know, have they been trained? I think some people take the book, Dr. Shapiro's book, they read it and I think, well, I'm just going to wave my fingers in front of the client and resolve it. And it's a more complex treatment protocol. And I think the client should ask. I get that. I also oftentimes get it. You know, are you a member of EMDRIA? Are you certified?

Wendy: Are you a approved consultant? I'm all three plus I'm a trainer. So that's good. I know that that that potential client has gotten good guidance about how to find a good EMDR therapist.

Mike: Well, I've also seen people doing self EMDR on YouTube. I would assume. (laugh)

Wendy: Yeah.

Mike: Okay.

Wendy: That's a no-No, that's a no-no.

Mike: Well, I assume that, but you know, YouTube is a great thing. I learned how to change my faucet and the cartridge in it, but I wouldn't think a step by step, here's what you do to yourself would work.

Wendy: No, because clients can get stuck in that trauma material. And so if all of a sudden they start doing bilateral stim and we don't do this at cocktail parties, we never know what kinds of things could be for the person.

Wendy: And so I would, yes, that's a no, no.

Mike: Yeah. So in your office as you do this and the memories are stimulated or, you know, how do we make sure that the client leaving the office is okay to drive home?

Wendy: Yes. So we have closure procedures. That's part of when we train individuals about, you know, you might have to stop that reprocessing early enough to bring the client back, ground them, spend a little bit of time making sure that they're very present and in the office, but they also have good self soothing and coping mechanisms that if material does come up in between, they can contain it. That's all part of our closure procedures that need to happen after every EMDR reprocessing session. Even after even the 1st, when we're looking for those potential targets for reprocessing, sometimes that works people up.

Wendy: And so we need to make sure that they have containment and closure and they have good coping mechanisms to be able to manage what comes up.

Mike: I'll do my closure now. You train, you consult, you teach, you coach, as well as do the therapy. What's the most gratifying part of all of this? I mean, what do you just smile about?

Wendy: Well, I smile about when I see a client get through a horrific situation that just, you know, sometimes it's horrific what we hear and when they can get through it and see through it. But really, you know, I became a psychologist because I believe I want people to be comfortable in their own skin and my philosophy is a strength based philosophy, and I believe that all the answers are within.

Wendy: But sometimes those obstacles are hardships. We need to help the client. So I see my role as helping the client and with the EMDR therapy, it helps them move through those obstacles or those traumatic experiences so they can really live a full successful life that they want to live. And so that's what makes me smile.

Mike: That's great. You know, this has been great. So informative and so necessary. Dr. Freitag, thank you so much for being with us today.

Mike: For those of you listening, I'm going to put the contact information for Dr. Freitag's stuff, but also she mentioned the EMDRIA.org and I'll put that at the end of the podcast as well.

Wendy: Perfect. That's excellent.

Mike: Yeah. So thank you so much for being with us and listeners.

Wendy: Thank you so much.

Mike: Thank you for listening and please listen in next time until then stay safe.