Patrick B. McGinnis, PhD, LMHC

Psychotherapy, Sex Therapy, Couple's Counseling, Addictions Counseling, Psychological & Psychosexual Assessment and Polygraph Testing


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Common Questions about EMDR (Eye Movement Desensitization and Reprocessing)

How was EMDR developed?
In 1987, a psychologist, Dr. Francine Shapiro made a chance observation that under certain circumstances, eye movements can reduce the discomfort of disturbing thoughts. In 1989, through the Journal of Traumatic Stress, she reported her success using EMDR in the treatment of trauma victims. Since then, EMDR has developed and been refined through contributions of therapists and researchers throughout the world.

Trauma: Small t trauma and Big T trauma
All of our experiences as human beings affect our inner lives. Of particular concern are those experiences defined as traumatic. Dr. Shapiro distinguishes two types of trauma. One, she refers to as "big T trauma," (the trauma primarily associated with Post-traumatic stress disorder or PTSD) and the other as "little t trauma."

Big T trauma often has its origin in life threatening events such as combat, crimes such as rape, kidnapping or assault, and natural disasters such as tornadoes, earthquakes or floods. Children may experience big T trauma as a result of repeated exposure to the disruptions of family dysfunction, which threaten their sense of survival or security. Children may also be affected when exposed to experiences such as sexual abuse, physical or emotional abuse or abandonment. These events may lead to intense fear, extreme feelings of helplessness, loss of control and an inability to cope with normal life expectations.

The symptoms of PTSD take forms of behavior that seem quite inconsistent such as attraction and avoidance. The individual relives experiences through flashbacks, nightmares, panic attacks or obsessive thoughts, while on the other hand avoiding the experiences through social isolation, emotional numbing or substance abuse. Frequently the symptoms involve denial to minimize the impact of the experience on day to day functioning. Those experiencing trauma frequently have physiological reactions such as insomnia, hypervigilance (fearful alert, watching, waiting) and a tendency to startle reactions resulting from reminders in the form of sound, smell, touch or some visual experience such as watching a movie.

Small t trauma occurs with the upsetting though less innocuous experiences of everyday life. Even these experiences may produce reactions similar to big T trauma, with similar consequences. Small t trauma may be an emotional shock with enduring psychological impact. These experiences will be felt as distressing, and when in conscious awareness, bring about feelings of anxiety, depression and a negative self-reference such as, "I'm so stupid!" The other extreme is to place blame and responsibility on the other for how their actions and behaviors impact those around them. Someone else is always to blame or at fault and needs to change.

How does EMDR work?
No one knows precisely how EMDR works. We do know that when a person is very upset, their brain cannot process information as it ordinarily does. This is obvious to most of us who have experienced moments of confusion. One traumatic moment becomes frozen in time and, remembering a trauma often produces feeling as disorienting as the original experience. Images, sound, smells and feeling have not changed. Such memories have a lasting affect on the way a person sees the world, and relates to people perceived to be interfering with their life.

EMDR seems to have a direct effect on the way the brain functions. Normal information processing begins to resume when the original traumatic event is brought to mind. Following a successful EMDR session, the images, sounds and feelings are no longer relived with the same negative intensity, as when the event occurred. What happened is remembered without the emotional upset. While many types of therapy have a similar goal, EMDR is unique in that sets of eye movements or alternating left-right attention, accelerates the process so that a successful resolution is attained much more rapidly. What happens during EMDR appears similar to what occurs naturally when dreaming or during REM (rapid eye movement) sleep. EMDR may be thought of as a physiologically based therapy that enables a person to re-experience disturbing material in new and less disturbing ways.

Does EMDR really work?

A number of research studies have shown EMDR to be effective. For example, the Journal of Consulting and Clinical Psychology, published an article by Wilson, Becker and Tinker in December, 1995; a study of 80 subjects with postraumatic stress, demonstrated that client improved significantly with EMDR treatment. A follow up study showed that improvement was maintained for at least fifteen months. The findings from this and other studies clearly indicate that EMDR is effective and that results are lasting. Further references pertaining to research on EMDR many be found on their internet site.

What Is an actual EMDR session like?
In EMDR treatment, the therapist works with the client to identify a specific problem to be the focus for a treatment session. The client recalls to mind a disturbing issue or event, what was seen, felt, heard or thought, and indicates what thoughts or beliefs are currently held about that event. The therapist performs sets of movements, moving a hand back and forth (a set) while the client focuses on the disturbing material and simultaneously watches as the therapist move their hand from left to right (a set). The client just notices whatever comes to mind without making any effort to control direction or content.


 Each person's information processing will be unique, based upon that persons values and experiences. It is essential to understand that there is no way for the client to do EMDR processing incorrectly. Successive sets of eye movements are continued until the memory becomes less and less disturbing and becomes more associated with positive thoughts and beliefs about oneself. For example, the client may spontaneously exclaim, "I did the best I could".


During the initial stage of an EMDR session the client may experience intense emotions; by the end of the session most people report a marked reduction in their level of disturbance. Following each session clients are asked to keep a log or journal of memories, feelings and experiences related to their experience of that session. This information may then be used in future sessions as a focus for unresolved memories or simply remain as information and be utilized as a mark of progress. The information may also serve as a reference point to where the process began and where their work has taken them.

How long does EMDR take?

One or more sessions are required for the therapist to understand the nature of the problem and to decide whether EMDR is the appropriate treatment. The therapist will often ask the new client to complete a Psychological Inventory to assist in understanding potential characteristics that might either forestall or help to foster change. The therapist will also discuss the EMDR program and provide an opportunity to ask questions about the method. Once the therapist and client have agreed that EMDR is appropriate to the specified problem, the EMDR therapy can begin.

A typical first session lasts approximately ninety minutes. Subsequent sessions range in length from forty-five to ninety minutes. The nature of the problem, life circumstances, and experience of previous trauma will determine the number of treatment sessions required. In some cases a single EMDR session is sufficient. More typically the course of treatment is three to ten sessions, scheduled weekly or for alternate weeks. While EMDR may be used as the therapy of choice, it may also be used along with other forms of therapy, such as "talk therapy." The process could involve the same therapistusing the various forms of therapy, or different therapists for each form of therapy being utilized.

Is EMDR appropriate with children?
EMDR has been used successfully with children and adolescents. With all clients the establishing of trust and rapport is essential. EMDR may be used in combination with Play Therapy or other forms of self-expression. EMDR with children can often quickly reduce trauma which typically affects other aspects of their lives, e.g. school, friends or home life. In many cases EMDR can help children with the emotional and social impact resulting from having a learning disorder. While reducing the emotional impact of the disorder, the treatment may or may not have an impact on the learning disorder itself. Children with learning disabilities have typically experienced repeated academic failure, leading to frustration and self-loathing. As an outlet, such children will often turn to a peer group with similar developmental difficulties. This, in turn, leads to conflict among families, peer group, and school. As this conflict escalates the child's self esteem is increasingly wounded. The child may begin acting out, creating even more stress for both the child and the family. Symptoms may include forms of sleep disorder, difficulty falling asleep or difficulty awakening, decrease in appetite or turning to drugs or alcohol to alleviate feelings of anger, anxiety or dispair. It is these types of trauma and symptoms that are being successfully treated with EMDR.

What kinds of problems can EMDR treat?
Research evidence has supported EMDR as an effective treatment for Post-traumatic stress. Various clinicians have reported success-utilizing EMDR in the treatment of each of the following conditions:

Post-traumatic stress
Panic attacks
Performance Anxiety
Dissociative Disorders
Stress Reduction
Sexual and/or Physical Abuse
Disturbing Memories
Complicated Grief
Anxiety Disorders
The anxiety and social impact of having a learning disability
Traumas experienced by children following a loss
Night terrors
Fear of abandonment

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