The Performance Anxiety of New EMDR Therapists

Clients will often have performance anxiety related to starting any form of trauma therapy.  Many therapists also have performance anxiety about starting EMDR Therapy with their existing clients.  What happens if I offer this option to a client and she thinks I’m crazy?  What happens if the sessions don’t go the way they went in my training practicum?  What if I miss a step or don’t do it exactly right?  What happens if a client opens up something really horrible that she cannot close?  These are just a few of the completely normal, common, and expected fears.  This article attempts to normalize some of these fears by explaining what you can expect will improve as you start to do EMDR reprocessing with more of your clients.

First, You Will Make Mistakes

If your job requires that you walk around in the internal lives of others, you will make some missteps.  It’s inevitable regardless of the type of therapy that you do.  Because it’s inevitable, it must also be okay somehow.  Everything depends on what you do with your mistakes.  Owning them is a good first start.  Some therapists are open to the idea that they are allowed to make mistakes when starting something new and some are not.   If you are one of those who is not, you may want to do some of your own EMDR work around the cognition “I’m not allowed to make mistakes” or “I have to be perfect.”   Such work will likely serve you well as therapist and as a human.   Having said that, not everything that appears to go “wrong” in a session is your fault.  Many things that may feel “wrong” may be essential parts of the client’s healing process.  For instance, client who has a strong emotional reaction in a reprocessing session (or between sessions) rarely reflects a therapist mistake.  This may well be a necessary part of the healing process for that client.  We’re not responsible for what our clients feel.  However, starting reprocessing with a client who has no resources in place and no plan to deal with distress between sessions is a pretty clear example of a therapist mistake.

It’s helpful to start reprocessing with some of your healthier clients and clients that you have the closest therapeutic relationship.  If something goes “wrong” or if your execution is “clunky,” they’re more likely to have the cushion to roll with it and roll with your learning curve.  The clients who most motivated you to get your training in EMDR are likely to be the clients who most need it.  However, they may also need to have the widest array of resources in place (which may take more time).  In that time, you can learn a lot and solidify your footing by starting with your clients who are not “on fire” with trauma.

I made plenty of mistakes in my first 100 sessions.  I still make mistakes.  I try to notice them, evaluate them, consult about them, and develop a plan to do better.

Your Performance Anxiety will Decrease

Your performance anxiety is absolutely normal and will decrease the more EMDR that you do.  This is an obvious statement that requires little elaboration.  This follows the same pattern that you experience when you do anything new.  So, get started.

Clients Will Generally Roll with What Your Normalize

I have noticed lately that one of the first things that clients do when they have strong emotional responses during reprocessing is that they often look closely at me.  They want to make sure that I’m okay with the intensity of what they are feeling.  From a trauma informed perspective, this makes perfect sense.  I try to project warmth and acceptance.  I ask the client if he is okay to continue noticing.  If not, we have an agreed upon plan in place to take a break or go to a resource.  I do not project an agenda about anything.  The experience of going to a resource when a client is deeply distressed may be exactly what a client needs to tolerate and push through similar distress in future sessions.

I’m also careful to normalize that there is no right or wrong way to feel and that EMDR will often bring up things that may be uncomfortable, but to simply notice those sensations.

If strong emotions occur, that’s fine… just notice them.  If you’re going along and all the sudden you notice nothing, it’s absolutely fine to notice nothing.  In EMDR Therapy, things often come up for reasons: emotions, body sensations, thoughts, and connecting memories.  When you direct your attention to the things that come up and simply notice them, the distress often falls off and healing comes to you.  There is no right or wrong way to do this… and we have resources in place to help manage whatever may happen.

You Will Develop More Trust in the Process

As you do more and more EMDR Therapy with clients, you will see that the vast majority of your clients are getting better.  In the months after my initial EMDR training, many of my legacy clients agreed that one reprocessing session brought more healing than 20 of our prior talk therapy sessions (that was probably an understatement).  You don’t need faith in things that you see every day.  You will have dozens of data points, then hundreds, and finally thousands.  You will have clients who are astonished with the pace of their own recoveries.  If you pay close attention, you will learn many of the things that this type of healing can teach you.  It will transition from something that you “hope” may be helpful to your clients to something predictable enough for you to stand upon.

You Will Develop More Comfort with Interweaves

Shapiro’s observation that about 40% of reprocessing sessions proceed without the need for a interweave or for the therapist to assist the client resolving a block.   That percentage appears consistent with what I see with my clients across many hundreds of sessions.  Another way to state this is that some intervention will likely be needed in most sessions to help a client back into a productive reprocessing “channel.”  The more EMDR you do with clients, the faster and more comfortable you will become in intuiting what the client needs to resume reprocessing.  Reading and consultation can help a lot in the development of this essential therapist task, but there is no substitute for experience. And, experience only comes from doing it.

It May Change You

EMDR Therapy is different than most other forms of therapy.  For many, it sounds counterintuitive.  It is centered in the practice of things that are viewed skeptically by broader culture, by some trauma clients, and by some of the burned-out heads of institutions.  But, seeing deep and astonishing healing over and over may change you.  It may help transform you into the kind of person who believes deeply in possibility of change.  That’s exactly the kind of person your clients and your institutions need.  It may also be exactly the kind of person that you need to become–if you plan to survive this work.

Come on In… .The Water is Fine

You have a toolkit now.  You know how a lot of it works.  Give it a try.  You’ll  learn some things.  Your clients will heal.  You can find help when you need it.  It will all be fine.