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Unread July 12th, 2004, 04:37 AM
Gil Levin Gil Levin is offline
Publisher, Behavior OnLine
 
Join Date: Jun 2004
Posts: 8
Default Dialogue, continued

BOL EDITOR: You have spelled out the EMDR procedure with exquisite clarity and completeness.

I just visited the EMDR Website and was impressed with the acknowledgements there from some of the leading people in our field. It is a marvel to me that you have been able to gain wide acceptance for a method that on its face appears "too good to be true". How did you discover/invent EMDR? And how on Earth were you able to overcome the resistance it evoked.

(As I write, I am reminded of Don Nathanson's observation that you can indentify the pioneers by observing the arrows in their backs)

FRANCINE SHAPIRO: In 1987, during a walk one day, I noticed that disturbing thoughts I was having were suddenly disappearing, and when I brought them back they did not have the same charge or level of disturbance as before. Because I had been using my own mind and body as a laboratory since a bout with cancer ten years earlier, I wondered what I had been doing to cause the change, since generally that type of thought took deliberate engagement to alter or dismiss. I started paying close attention to what I was doing and noticed that when that kind of thought entered my conscious mind, my eyes started moving in a certain way: a very rapid, ballistic, flicking movement. I noticed that when the eye movement started, the thought vanished from consciousness, and when I brought it back it was less valid and disturbing. It was not a moment of great epiphany, but simply interesting and intriguing. I thought I had stumbled upon a natural physiological process that influenced thought.

Since I viewed it as a natural body/mind phenomena, I decided to see if it would work if deliberately instigated and therefore I brought disturbing thoughts to mind and then moved my eyes in the same manner. The same thing happened. The thought shifted from consciousness and when I brought it back it was less disturbing. After finding that it worked consistently for me, I then experimented with other people to see if there was a similar effect for them. I found that I had to use my hand to guide their eye movements since it was difficult for them to do it on their own. Then I discovered that the disturbance would start to decrease for everyone, but for most people it would stop prematurely and I had to develop procedures around the effects of the eye movements to get consistent effects.

Over the past ten years, as more difficult problems were accessed, the procedures have gotten more and more refined and now include aspects of all the major psychological orientations: psychodynamic, behavioral, cognitive, body-oriented, client-centered, interactional, etc. It was a process of evolution which also revealed that the eye movement is only one form of stimulation that can be used. We now know that rhythmical handtaps and tones can have the same effect as the eye movements. So the name Eye Movement Desensitization and Reprocessing is an unfortunate one. Indeed, even the term -desensitization- is limiting. The lessening of disturbance is really only a byproduct of the reprocessing of information. The client also achieves insights, connections, cognitive restructuring, enhancement of self, etc. So, if I had to do it over again, I would call it Reprocessing Therapy. However, EMDR has such world-wide recognition, that we retain the abbreviation in the same way the AT&T does, even though telegraphs are not in common use.

As to how I was --able to overcome the resistance it evoked,-- I have to say it is not completely overcome. There abounds a tremendous amount of misinformation about EMDR, as well as the inevitable attacks that come with any innovation. However, we have encouraged experimentation on EMDR since the beginning and now there are 13 completed controlled studies, which makes it the most widely researched method used in the treatment of trauma. The most recent, rigorously controlled studies all indicate that 84-90% of single-trauma victims no longer have the post-traumatic stress disorder (PTSD) diagnosis after only the equivalent of three 90-minute sessions (a review and the citations are available at the website: www. emdr. com and in my new book: EMDR -- BasicBooks).

Those who are accurately informed about EMDR, have tried it themselves, or have dispassionately reviewed the literature are certainly accepting of it. It is exciting to enter with them onto a new plateau of protocol development, investigating ways to integrate the traditional wisdom of the various modalities into a more refined, comprehensive practice. Experts in various specialty populations (such as substance abuse, sexual dysfunction, complicated bereavement, etc.) have expanded the use of EMDR to a variety of presenting complaints. However, there are still a number of individuals who refuse to accept EMDR until it can be explained by traditional theories. Unfortunately for them, however, one cannot explain three-session positive EMDR treatment effects by traditional psychodynamic or cognitive-behavioral theories. For instance, according to the exposure/extinction/habituation theory of flooding which has been advocated as the primary cognitive-behavioral treatment for PTSD, there must be 15-50 hours of exposure for positive results. Even though the controlled research on EMDR has clearly demonstrated otherwise, I have actually heard cognitive-behavioral academicians dismiss the results as placebo, even though 15-month follow-ups have demonstrated robust and lasting effects. For some, it is hard to integrate new paradigms into standard practices. Therefore, unfortunately, I have to agree with Don Nathanson. The arrows may be fewer, but they definitely exist.

BOL EDITOR: Your account of the moment of origin of EMDR sent a chill through my spine. It was reminiscent of Einstein's famous ride on the commuter train -- actually more like Gautama pausing under the Banyan tree, because of the personal significance of your moment. That would make you especially vulnerable to those arrows of skepticism and it's a great relief that none of them reached your heart.

I read your response late last night and awoke with a vivid memory from my undergraduate days. One of my most influential teachers at college was Leslie White, the distinguished (and somehat eccentric) cultural anthropoligist. White took fiendish delight in debunking myths ("What fools YOU mortals be!") and saw science as the cure for the boundless distortions that are part and parcel of the uniquely human power to make and grasp symbols. Forty years after his lecture, I can still hear White's rhetorical question/mantra uttered in a tone that would do justice to Howard Stern, "Do you REALLY suppose that an ape can believe in holy water?" This was said in a way that made it clear that the ape was on the right side of the argument. For White the essence of science was doubt and he coined a verb to describe that essence: Science is NOT-knowing.

It's clear from all you have said above that you embrace fully the scientific paradigm and the fundamental skepticism at its heart. I invite your comment (even though I know I haven't really framed a question).

FRANCINE SHAPIRO: I wholeheartedly agree that the tools of scientific investigation are crucial to eliminate error and objectively evaluate that which can be observed in order to counterbalance the possible distortion caused by subjective interpretation. However, to my way of thinking, the essence of science is investigation--not doubt. If science is used in the service of humanity, its mandate is to explore and expand the bounds of knowledge. The springboard is then curiosity and the goal is KNOWING. If doubt becomes the driving force of science then it often is subverted to the goal of debunking anything that cannot currently be measured or explained. Science then takes on the stature of religion and the dominant myth that is accepted is that one should not entertain, accept, or believe that which cannot be currently proven. Unfortunately, this eliminates from the arena all those things for which there are so far insufficient theory, measurements, and conceptual frameworks.

If one is an ape, one is reduced to that which can be understood and conceptualized in that framework. If one is a human being, there is the ability to apprehend the ineffable and the possible. The goal is to develop the tools of science to understand the governing principles of mind, body, and nature--from the subatomic to the universal. While an ape might not believe in holy water, neither would it believe in--nor have been able to conceptualize--the atom. And without the capacity for symbolic thought and conceptualization beyond the realm of what is known, all progress ceases.

BOL EDITOR: You have said that EMDR is a method that enables "reprocessing dysfunctionally stored experiences". That phrase implies that most experiences, including those that carry high affective are stored in a "functional" way and therefore do no harm to the person.

How much can you say or speculate about such functional storage? How it occurs and where? And what are the conditions that lead to "dysfunctional storage? In other words, what usually "goes right" and what goes wrong in the case of trauma?

FRANCINE SHAPIRO: The clinical observations of EMDR treatment effects seem to dovetail with conjectures by van der Kolk and others regarding memory storage. That is, when a memory of a past event is functionally stored it is in declarative or narrative memory. If it is dysfunctionally stored it is in motoric memory and retains the physical sensations and high level of affect that was there at the time of the event. With EMDR, we see clients start at a high level of affect and physical sensations and after treatment that is no longer there, and learning has taken place.

Traumatic events can cause dysfunctional storage. However, I think trauma can be defined in a number of ways. We can say the *big T* trauma that a clinician needs to designate a diagnoses of PTSD (like a rape, kidnapping, combat) , or *small t* traumas which are the ubiquitous experiences which have a negative impact upon the self and psyche. If you bring up a memory of a childhood humiliation you may find that the emotions and physical reactions are still there.

If so, I would consider them dysfunctionally stored in unprocessed form. That is the perceptions are unchanged since the time of the event and learning has not taken place. The unprocessed experience may be contributing to problems in the present that are related--such as difficulty with groups, relationships, learning, authority, etc.

I think affect and evolution theorists could contribute here regarding why certain experiences are ingrained and unchanged. It may be due to certain developomental windows. It may be due to the interaction of types of neurotransmitters and high arousal. We are biologically determined to respond in certain ways when danger and survival fears surface. It may be that experiences such as being humiliated in childhood are the evolutionary equivalent of being cut out of the herd. At any rate, if you bring those earlier experiences to mind and you get no negative physical reaction, but adaptive/adult related thoughts spontaneously emerge, then I would say the information is appropriately processed.

Why one experience is processed and not another, or why one person processes it and not another, may be due to earlier nurturance history that made the experience more tolerable, sufficient counterexamples, or biological determinants, or perhaps being comforted/calmed soon after the distress. Many maladaptive behaviors, negative beliefs, and attitudes that people carry around seem to be caused by these types of dysfunctionally stored events with affects that are easily triggered in the present. They do not have to be *big T* traumas to cause them, and the associations revealed during processing are fascinating to watch.
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