EMDR and the Therapeutic Relationship

Embracing the EMDR Therapy worldview may transform how you do therapy.  It may transform or adjust nearly everything that you thought you knew about how people change.  However, the structure of the EMDR protocol doesn’t cover your deficits as a therapist or as a person.  It won’t clear your blind spots.  It won’t help you grow empathy–nor does it decrease the therapeutic need for it.  If you’re already burned out, simply learning to do EMDR Therapy with your clients may not save you or your career.  If you are already an excellent and empathetic therapist, every core asset that you have is directly transferable to the EMDR Therapy worldview.

Everything I can think to write on this subject also applies to almost any other form of therapy or trauma treatment.  Almost everything I can think to write on this subject is also directly relevant to being a sensitive, aware, and decent human in any relationship.  We may lose sight of some of these in the pursuit of our own survival in professional contexts that may not consistently value, support, or nurture us.

EMDR Therapy is a journey and each session is leg of that journey (see A Workable Metaphor for the Therapist Role in EMDR).  It is structured in ways that promote efficacy and safety.  However, it’s important to not lose track of whose journey this is.  Sometimes what a client may really need in a given session is to speak and be heard.  If you create an environment that is not agenda-loaded, clients may feel more open to communicate what they need.  I can think of instances where I was in such a rush toward an ambition that I had for the client that I’m not sure I was listening carefully to what the client needed from me.  Allowing clients to communicate, be heard, and get what they feel that they need is an excellent trauma-informed intervention for someone who has had very little precedent of it.  It may help create the space and trust for excellent reprocessing later.  It may help the client develop more “good stuff” that the maladaptive stuff can metabolize into.  Therapy is a journey.  The content of that journey should be open to negotiation.

We all struggle to see ourselves.  Even in the healthiest childhoods, we had very few sources of outside information about ourselves.  For clients with extensive trauma, most of the people in the child’s world reflected distorted images similar to fun house mirrors.  Severely warped information about the self and about the realities of the world warp the self and perception.  Trauma informed therapists are careful to align on the side of the client and to reflect accurate information with the most conducive light (see Baker’s Dozen of Things Not to Do with Traumatized Clients).  As the therapeutic relationship grows, the therapist can start to assist the client in developing accurate information about the self and the world.  At best, the therapeutic relationship itself can be a flat and accurate mirror for the client.

Even at first contact, therapists aren’t the only ones on the room with useful information.  It is helpful to value deeply the experience and knowledge that clients bring.  These things have helped them survive.  Learn about them.  Think about ways to strengthen and support existing coping skills.  Be careful not to judge explicitly or implicitly strategies that they have used to survive or behaviors they engaged in when survival seemed improbable.

Trauma causes a thousand ills and some of those are difficult to sit with session after session.  Your presence is one of the active ingredients in this therapy.  Your struggle to be genuine, present, and attentive is your problem to resolve and not the client’s.  Likewise, many of your clients will have a different worldview or political orientation than you do.  Avoid side battles.  Always be the adult in the room.

Many clients with extensive and life-long trauma have been exposed to severe boundary violations in most of their relationships.  They may anticipate this from you also.  Clients need you to maintain your professional boundaries.  Doing otherwise reinforces damaging processes.  It’s an art to explain why your professional boundaries allow you to function in this type of relationship.  For each client, assess and avoid (where possible) what went wrong in the client’s past therapeutic relationships.  I continue to be shocked by the stories that my clients tell me related to the behaviors of their past therapists.  This is incredibly important and sensitive work.  You didn’t become a trauma therapist to cause trauma, but this is where therapist impairment leads.

When I sit with a client, I am present inside a nest of contexts and roles (employee, coworker, state licensed therapist, biller of insurance, EMDR practitioner, male, middle-class, teacher, navigational assistant, risk assessor, heterosexual, trauma survivor, etc).   Each of these contexts influences every other context and every other role.  I strive to be the most genuine version of myself inside these contexts.  Being genuine inside such a nest of contexts is complicated sometimes.  Finding a way to be acutely present helps.  Fortunately, EMDR promotes this for both the client and the therapist.  The days that I feel the least conflicted in my various roles are often the days when I’m most deeply attuned to the real-time work and healing that my clients are doing in session.  On these days, I’m more a supportive witness than anything else.

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