The word trauma has been at the forefront of many discussions surrounding mental health over the past year. Whether it’s high levels of post-traumatic stress disorder (PTSD) symptoms in NHS frontline workers, collective trauma as a widespread result of the pandemic or nuanced instances of racial trauma in the wake of George Floyd’s murder and the BLM protests. EMDR or Eye Movement Desensitisation and Reprocessing is one of the most successful therapies for trauma, but how does it work and why?
Content warning: this article contains brief mention of suicidality.
To help us get to grips with EMDR, how it works and more importantly why it works so well with trauma we spoke to Dr Justin Havens who is an accredited EMDR consultant and board member of the EMDR UK Association.
What is EMDR and what do you think people should know about EMDR before considering undertaking it as a therapy?
“It stands for, a bit of a long acronym, eye movement desensitization and reprocessing, which the founder Francine Shapiro, later down the line, wished she'd made shorter, perhaps ‘accelerated processing therapy’ for example. But the essence of it, and the thing that makes it different to all the other forms of talking therapy is that it introduces eye movements, or tapping, or bilateral stimulation tones in the ears.”
“It's a bit like in Star Trek or Star Wars when they go into hyperspace, and things move on, it really does energize and speed up the processing of memories. The genesis of many mental health problems, whether it's depression, anxiety, addictions, behaviours, is actually rooted in trauma. And what EMDR is doing is really just accelerating that natural healing process where it's got stuck.”
“I sometimes say that EMDR is like a speedboat compared to CBT, which is a rowing boat. But with the power of the speedboat, comes responsibility on the part of the therapist. Good training. Experience and supervision is essential to ensure that EMDR is used appropriately and safely”
In regards to the service user or practitioner point of view, is there anything people should specifically know about EMDR?
“It's a powerful therapy, and therefore, some of the issues that need to be understood are not so much client issues as therapist issues. You can't just start wiggling your finger around, cross your fingers and hope it will be alright. All trauma therapy is about accelerators and brakes. And, and the eye movements accelerate the process. So, you've got to know when to do it. And you've got to have an understanding of the client's history, because if they've got multiple traumatic events, it's possible to open up too many boxes.”
- See also: 'How nature has grounded me in the here and now during trauma recovery'
- See also: 'Turning Point offers innovative new service to those with personality disorders'
- See also: 'Report finds that traumatised children are being criminalised'
So, both clients and practitioners need to be really aware of these accelerators and breaks
“Yes. Certainly, if a client is finishing a session, and they're dysregulated, they're emotional… an EMDR therapist, even a relatively basically trained one should definitely not be letting them get to that state, that's a key message of the training. It’s all about safety. Obviously, when you get into more complicated service users and more complex PTSD, then it becomes may become harder and then you need that level of experience.”
We discussed the increased discourse around trauma as a result of the COVID-19 pandemic and how EMDR might play a part in responding to this, in response to this Dr Justin Havens noted the increase in EMDR trained therapists within IAPT services in the NHS saying “the NHS have just commissioned a competency framework, which is indicating that EMDR is going to be part of the future. That's quite exciting. So there'll be more accessibility of EMDR.”
Do you think you’ll see an increase in people accessing trauma therapy such as EMDR this year?
“I've not had a floodgate of new clients, and I don't think services are at this stage, I think there'll be a bit of a bow wave effect, a bit of a delayed reaction. If you think about lockdown being lifted, and people kind of getting back to normal, and then there'll be the people that haven't been able to get back to normal. It's never quite as dramatic as the media portrays in my experience. But that doesn't minimize that there is a probably going to be a major impact from COVID.”
We discussed specifically, those who have suffered during lockdowns due to underlying mental health problems or already existing and diagnosed mental health disorders, Dr Havens thought to bring up one example of a middle aged client who, at 16 was neglected and left alone to fend for herself. Dr Havens recalled this story acknowledging sympathetically, that the context of lockdowns really did retrigger those memories for that client.
Those who have been subtly affected by lockdown and the pandemic, due to traumatising memories resurfacing, or being triggered by too much time spent alone will likely be a part of this “bow wave effect” as Dr Havens puts it. As we come out of lockdown, the negative effects on mental health many of us have experienced over the past year will likely become muddied with enjoying the positives of more time with friends, loved ones, time outside, time spent enjoying our freedoms. It may only be once we have time to take stock of the past year that we realise the long-lasting impact.
While we’re all talking about trauma and the spotlight so to speak is on trauma therapies such as EMDR, what is your perspective on making mental health care more trauma informed?
“Treating the trauma and taking a trauma informed approach to assessment and diagnosis for me makes a lot more sense. You're trying to answer the question, how has person got to be this way. And when you do it from a trauma informed approach, it all makes sense, the story makes sense. And then you treat it and bringing it back to EMDR; EMDR is well researched, structured, powerful in the hands of the right therapist with the right environment, a game changer.”
For Dr Havens, understanding various diagnoses of mental illness or personality disorders even, in a trauma informed way, and thus giving patients and clients access to EMDR makes sense.
On its applicability to treat suicidality, Dr Havens said “research has been carried out using EMDR in crisis teams, working with people with suicidal ideation. Normal convention in therapy is to stabilise before treating trauma, but if the very reason for the instability is the trauma, it becomes a chicken and egg situation. Usually, if you resolve the trauma, the suicidal feelings can reduce and clients become more stable.”
Similarly on alcoholism, bipolar and even psychosis Dr Havens explained “It can be similar with alcoholism. A lot of services will say, you've got to be sober before you could access services. But, if one of the reasons why they're drinking is a major trauma, then it makes sense to treat that first. OF course these approaches do require experienced EMDR therapist, to maintain safety.”
“I've worked with a lot of people with bipolar diagnosis or psychosis and these problems can be rooted in trauma. Now, of course, there are some that are not and I'm not saying, EMDR is a panacea for all trauma and trauma is a panacea for all mental health issues. But there's something to it, there's a lot more that can be done when you take a trauma informed perspective.”
Dr Justin Havens had one last comment to make, when discussing the many complexities of the traumas that lie at the heart of many people’s mental health problems.
“For me, EMDR offers a definite route to treat the complexity of trauma, when combined with a suitably skilled therapist.”
The introduction of EMDR into more IAPT services and the increased frequency in which we are seeing discussions around trauma informed care and trauma in general, points to something very hopeful and positive in our approach to mental health as a society. With all trauma informed care, as Dr Havens said “you’re trying to answer the question ‘how has the person got to be this way?” and EMDR, it seems will be an important, if not invaluable part of that answer.
Anyone can contact Samaritans FREE any time from any phone on 116 123, even a mobile without credit. This number won’t show up on your phone bill. Or you can email firstname.lastname@example.org or visit www.samaritans.org