Now that we have looked at the standard protocol for EMDR and how it can be adapted for DID, we want to discuss the technique based on our own experience with it. As always, we are focusing on the treatment of complex trauma with structural dissociation.
Some people don’t trust EMDR because it is not entirely clear why it works. There are guesses that include bilateral stimulation, dual focus, effects on the working memory, bridging that overcomes dissociation and titration but it is hard to say what the active elements are. Studies can show contradicting results (like one saying that eye movement works better than other kinds of bilateral stimulation while another proves that the bilateral stimulation is not needed at all). What all the studies have in common though, is that they agree that EMDR works. I have no idea how my phone works and I use it anyway. Maybe understanding the Why is more important for scientists than it is for patients who just need it to work somehow.
Even though the bilateral stimulation might not make a big difference for people with a single trauma, it often has an effect on structural dissociation. For some it makes inner communication easier and provides access to part that are usually locked behind amnesia walls. For some this effect is too big and they get overwhelmed. There is no way of knowing what will happen before we try it. It needs careful Ts who know about this side effect to explore it. Then it highly depends on our own reactions if EMDR is going to work for us or not. I am among the ‘lucky’ ones, where the effect is moderate, so I can use bilateral stimulation on my own without causing bigger problems. But it has to be clear that it won’t work for everyone. Especially if bilateral stimulation was part of programming, systems might struggle. Organized abuser groups are picking up these techniques to pervert them and it can become a major trigger.
Generally speaking, using eye movement for bilateral stimulation is still the most helpful way to go, even if it doesn’t influence processing that much, simply because it makes it very easy for the T to see when we start dissociating. They can stop when they see that we start staring straight ahead or can’t follow the movement anymore. It is a lot harder to dissociate during unusual eye movements than eg while sitting on a stationary bike.
Titration is proving to be a technique that makes processing more manageable for people with complex trauma. It means taking the smallest possible steps and then giving the body time to regulate and ‘digest’ it. The way EMDR implements intervals of exposure and re-orientation is pretty similar to that. The steps are still bigger than they would be in a body work approach. The processing of fragments instead of whole scenes adds to the effect though. There is a big difference here to other exposure techniques that keep the tension up for a long period of time to move through the beginning, middle and end of the memory. The titration-like processing is more gentle and less likely to overwhelm the patient. Therefore it is much better suited to severe trauma.
During the breaks between the intervals there is close contact and an exchange with the T, which offers a sense of not being left alone with the trauma and receiving help with regulation and difficult thoughts and feelings. That way, EMDR treats the interpersonal part of the trauma, offering a corrective experience, without adding another step to the therapy process. In complex trauma having a regulating other is incredibly important to counter old trauma patterns. EMDR is pretty good at that.
Generally speaking, EMDR is more gentle for the therapist and the patient. There is no need to speak about all the details of the trauma. It is enough when the patient knows where they are at and shares the pieces that are relevant during the processing. The processing is quick and doesn’t need to be repeated over and over again like classic desensitization. There can be instant relief, even with extremely fractionated processing. Noticing that short periods of working with EMDR can already make a difference keeps up the motivation to stick to therapy work and come back for more. When it feels like we are looking at a lifetime of trauma, simply too much to ever work through it all, these small but powerful victories are important and keep hope alive. EMDR is known for processing clusters of similar experiences at the same time, so that it won’t be necessary to process every trauma memory separately.
Therapists can use different frameworks for their EMDR treatment of people with structural dissociation. It is increasingly popular to work through the ‘Adult Self’ and let the fronting part manage all that is going on inside. Switching is discouraged. It is less messy and it is easier to work with for the therapist . It is also harder for the patient. I’ve had all my EMDR treatment done this way and the burden that was placed on the host got to the point where it was almost crushing. To make the processing work the host got flooded with memories, basically getting traumatized with things she didn’t know before, so they could be processed with someone in the back. That’s not ideal. Ts who insist that working through the Adult Self is always the best way to go are missing the reality of how that works for the fronting parts. With all my experience today, I would be careful when working with a T who insists on an adult to be front for processing.
EMDR is actually simple enough that younger parts can front for it as well, they do just fine. Often it can be more effective to process things directly instead of going through the filter of the host.
It would be important for Ts to see that there are different reasons for switches during processing. Sometimes things get too intense and we withdraw, pushing someone to the front to manage it somehow and that is hindering further processing. It absolutely happens for a good reason and if this happens the T did not stop in time. But sometimes a switch happens because a certain part who carries that specific fragment of information comes to the front, because it is theirs to process, and then EMDR can be continued without demanding that an adult is front. The system actually knows it better than the theory here. I see the value of working with the Adult Self. But it is crucial to see the limits as well. Sometimes hosts need to be protected from breaking under that burden. Rigid Ts will traumatize their patients. A T who is unwilling to work with parts directly should never start working with a DID system in the first place! People with DID have the sad habit to comply, even if it almost kills them. The Adult Self is one of those things that, if it is communicated as a rule, can bring great harm.
Even with EMDR tools that can be used during stabilization it is essential for successful processing that the stabilization phase is not skipped. The phases of EMDR have to be implemented into the 3-phase model for treating trauma. Sometimes EMDR therapists are so convinced that EMDR can bring quick and easy solutions that they move towards processing too fast. Working with structural dissociation takes time, no matter what technique is used. We might get tempted by all the promises of easy healing and try to use short cuts. It won’t work. We need to do it right, with all the foundations in place. EMDR is not a miracle healing.
The fact that processing with EMDR is possible, even for DID, doesn’t mean that it is entirely safe. We cannot predict how we will respond to bilateral stimulation. We cannot know what kinds of memories might come up, where amnesia walls will be reduced, which parts might be more connected and how much of the dissociated memory might come into our awareness. It is delicate business that needs a gentle, careful and very skilled EMDR therapist. They need experience and thorough training. They need to keep up to date with their training too, because it is evolving, new tools are found and taught, mistakes get corrected etc so having done EMDR training once 20 years ago will not do.
The most dangerous thing in therapy are therapists who firmly believe in their technique. EMDR has proven to be useful in so many areas of mental health that some Ts are obsessed with it. They use it like a cure-it-all, sometimes introducing patients to it in the very first session so we will know how wonderful their favorite tool is. Whenever you run into a Believer, you need to be extremely cautious. No technique works for everyone. Structural dissociation makes things less predictable and it needs much, much more gentle handling. If your initial interview with an EMDR T already shows you that they are obsessed with EMDR I would advise you not to go there again. There is so much that can go wrong, even with a good tool. It is still severe trauma we are dealing with.
I think that EMDR is a valuable technique for the processing of complex trauma. I consider it superior to other exposure techniques because it can easily be adapted to include structural dissociation and processing can be fractionated to accommodate personal needs and the risk of dissociating is reduced. For some the effects of bilateral stimulation make it less useful. In any case, a well-trained and careful therapist is needed.
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