If Therapy is Slowly Killing You, Maybe You Should Do it Differently

Traditional talk therapy is a mess.  Everyone pretty much knows it, especially therapists.  We sit in small rooms all day with people who need to make deep and lasting changes.  They rarely do.  We hope that our attentive listening and empathy will promote that change (there is good reason to believe this… many of our clients have never been validated).  We hope our suggestions about behavioral changes will spur internal changes (and it is entirely possible that this could happen).  We believe that if we can help change the way clients think, they can eventually change the way they feel (in theory, this can happen).  Some “really good” therapists aspire to deliver the right interventions in the right way and at the right time in hopes that things will finally “click” for clients (one part principal, one part shaman).  Seeing real change occur so rarely, many therapists shutter the possibility of change and therapy naturally devolves into a kind of scripted listening and reflection (the therapist dies a little bit each day on the inside and the client usually doesn’t notice enough to take it personally).  Regardless of the approach, real change in talk therapy is often glacially slow if it occurs at all.  This is particularly true for the most severely “stuck” clients.  More often than not, all of this wanting, listening, scrutinizing, supporting, reflecting, empathizing, coaxing, and motivating amounts to astonishing little.  Helpers find that they can help remarkably little.  Clients find that they change remarkably little.  Our clients do not change because they do not heal.

In many ways, the system is designed for this very disappointment.  It is optimized for pharmacology–which when it works, it works as long as the prescription.  Billable issues are categorized and pathologized across nearly 1,000 pages, the vast majority of which we rarely see.  In community mental health, we go long periods without seeing a client that falls outside one of the six or seven issues that we diagnose over and over.  We see a lot of anxiety issues.  Next depression problems.  Maladaptive coping mechanisms that have become problems.  Then, mood cycling of some type.  We see a few angry men.  A sprinkling of clients with thought disorders.  Finally, a few clients with clear personality disorders.  But, the thing that we encounter the most is almost completely invisible.  It sits like a huge nearly invisible elephant thumping and thumping in every tiny therapist office and in every session.  It sits inside virtually all of the anxiety and depression that we see.  It sits inside a surprising number of other DSM pathologies.  Our clients do not get better because we conspire with them not to see it.  It’s remarkably difficult to heal anything when the core injury isn’t recognized as a legitimate core focus of treatment.

The EMDR worldview makes trauma visible.  It centers it at the root of most of our distress.  It dramatically simplifies how we understand most anxiety and most depressive disorders.  It explains why in ways that are deeply rooted in the client’s experience.  It provides a clear treatment path and any warm and well trained EMDR therapist can pick up where another EMDR therapist left off should a therapist change occur.  Therapists whose primary approach is EMDR see most of their clients get objectively “better” in the short term and astonishingly better in the longer term.

EMDR is built on the radical belief that trauma–even the most severe forms–is resolvable using internal processes that are already present inside all of us.  Everything needed is already there.  Our role is primarily navigational.   Initial sessions are spent helping clients prepare to make the journey.  Once prepared, we assist the client in finding the road and heading in the right direction.  Reprocessing traumatic memories requires that clients hold a traumatic memory and notice what comes up when holding the memory.  The bright yellow center of the EMDR road is noticing.  The left-right stimulation that is central to EMDR helps propel the client down the road.  Once the client is on the road, we get out of the way and simply follow.  We use our navigational expertise when needed to help the client deal with obstacles.  In the vast majority of EMDR reprocessing sessions, we simply follow and witness clients make real progress toward their goals.  Other than short check-ins every 20-40 seconds while the client is noticing, we do remarkably little talking in session.

In an average session, we see incredible change.  After successful reprocessing a specific memory or chain of memories, clients are able to recall them with very little or no distress.  The memory feels like it happened when it did (instead of happening again in the present).  Those experiences are unlikely to appear again as flashbacks or other core PTSD symptoms.   Additionally, clients regain instantly and seamlessly much of the self-esteem that those original traumatic experiences took from them.  Positive and adaptive thoughts–the elusive golden unicorns of cognitive-behavioral therapy–are present in abundance and are fully embodied by the end of most EMDR reprocessing sessions.  Likewise, clients report that they feel lighter, more relaxed than they have been all week, and feel much more centered.  When was the last time you explored intense traumatic experiences with a client in session and they reported that the memory was completely resolved with 0/10 distress, that they were relaxed, that felt more secure and safe, and that had far more self-esteem by the end of the session?  This happens consistently in EMRD.  Every single day I get to see this happen in my primary roles as an assistant navigator and a witness.

You should do this.  It’s an incredibly rewarding way to work.  Seeing the reality of deep healing makes the awfulness of trauma feel less awful.  However, if you are a therapist and doing therapy has been killing you, please get your own EMDR therapy before putting your EMDR training to use with your clients.  EMDR requires that you learn to see trauma in others and in yourself.   It’s not a type of work that just anyone can do.  There are some EMDR therapists with poor trauma navigational skills, deep problems with empathy, and with their own unprocessed issues that can become obstacles to clients.  Becoming an effective EMDR therapist requires that you develop a deep understanding of how this type of healing occurs, which getting your own therapy can help provide.

You may find that EMDR often requires you to work in ways that are very different than what you and your clients are accustomed to–which should be the best news of all.

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