07.22EMDR and Fad Therapies
by Stuart Losen, PhD
It was only a few years ago that the public heard a lot about psychotherapists dredging up the previously repressed memories of their clients to ward off the development of multiple personalities.
There were also many reports of special therapeutic procedures specifically devised to help individuals cope with those multiple personalities, particularly the anti-social “Eve Black” types that were the most troublesome. Now it appears that most of the breed of MPD therapists who specialized in those ‘uncovering’ techniques have shifted gears in line with the more sophisticated view that classic multiple personality disorders, like those depicted in the film “All About Eve,” are actually quite rare. The current view is that most of the multiple personality problems brought to therapists’ attention are better understood as displaying a kind of Dissociative Identity Disorder (see DSM IV 300.14). Therefore, the temptation to search intensely for hidden, previously denied recollections of sexual and/or physical abuse, in one’s early childhood or developmental years, has somewhat abated in favor of a more thorough assessment of a client’s earlier history — consistent with traditional therapeutic practice.
For quite awhile, however, large numbers of variably trained and marginally credentialed ‘psychotherapists’ went the route of much public advertising and many workshops to highlight and promote exploring significant early, suppressed or repressed memories. They also promoted the beneficial cathartic value of such explorations — at an appropriate fee, of course. On the other hand, many licensed practitioners in the mental health disciplines viewed such developments with alarm, and it wasn’t long before our concerns were borne out when therapy-aided and, in some cases, therapy-suggested, early memories created havoc in families. In fact, it soon followed that many young adults began making claims and in some cases brought legal suits against often confused, bewildered, and sometimes totally surprised parents regarding past events which they, the parents, said they doubted had ever happened. Fortunately, the reconstructed early-memories trend has abated. Too many false or unsubstantiated claims hurt too many people, even though society’s eyes were opened to the reality that sexual abuses inflicted upon easily quieted or controlled children were not uncommon. Unfortunately, such therapeutic trends are especially troublesome to an often bilked public, and to the stature of creditable therapists. Probably they keep cropping up due to the public’s general lack of real knowledge about matters pertaining to mental health, and the mysticism perpetuated by all who profit from things that go bump in the night.
So even as old fads fade away, there are usually plenty of new fads to take their place. A current technique known as EMDR (Eye Movement Desensitization and Reprocessing), which entails therapists directing their clients to engage in a series of eye pursuit or tracking movements, is now claimed to provide important breakthroughs in the resolution of previously “blocked” traumatic experiences by “reprocessing diverse types of trauma.” Dr. Francine Shapiro, Director of the International EMDR Network, trains clinicians to aid their clients in unlocking “all those memories of early childhood experiences” including rape and sexual molestation. Adult combat-related traumatic experiences have also reportedly been reprocessed by EMDR, and proponents of the method claim sound research support for their successes.
Dr. Shapiro claims that EMDR provides a way of being able to access those memories and then catalyze an “inherent information processing system that we believe we all have.” This information processing system is “hard-wired in all of us” to be adaptive, but “early childhood experiences basically block the system and cause psychological disorders and distress.” Dr. Shapiro has been further quoted to claim what “With EMDR we’re able to go in, access those memories and catalyze that information-processing system, which then allows the information to move to an adaptive resolution.” As a result, the client “is able to take what is useful, self-enhancing or instructive from the experience and discard the rest.”
Dr. Shapiro, when interviewed about the theoretical foundation regarding why EMDR works, responded by reflecting on the hypothesis that eye movement might be linked to what occurs in REM (rapid eye movement) sleep. “The unconscious information comes up to be processed and the eye movements catalyze the information, allowing it to go to a less distressing form,” there “capitalizing on an inherent mechanism the body has within it in a direction toward self-healing.” As to what actually occurs in the brain, Dr. Shapiro indicated that “there are a lot of hypotheses at this point and no studies to really inform us one way or the other.” She adds that “a number of folks have come up with ideas that it might be the bilateral movement, or activation across the corpus-collosum, or that saccadic eye movements are linked with hippocampal involvement which is connected with the consolidation of memory.”
The speculative theorizing about EMDR’s success need not detract from the reportedly current accumulation of research data, i.e. that the method often works with clients who have difficulty retrieving memories of early traumatic experiences suggested by their present unhappiness and other symptoms.
The relationship between therapeutic eye-movement techniques, REM sleep, and other brain functions may well be forthcoming from appropriate future research, much as other medical studies by brain researchers have, in recent years, begun to disclose the neurophysiological underpinnings of attention deficit disorder, Tourettes Syndrome, obsessive-compulsive disorders, manic-depression and other DSM IV identifiable clinical disorders. However, there are other problems regarding the wide-spread use of eye-movement therapeutic procedures and the claims made about their benefits that prompt the old, sage advice “let the buyer beware.”
Many more traditionally trained and experienced psychotherapists, representing different licensing disciplines, question whether it is the eye-movement technique which works, when supposedly it works, or is it the introduction of an extraordinary or unexpected technique which is the important variable? Is it an intervention, in other words, which surprises the client, suggests some authoritative wonder-cure potential and thereby feeds the client’s belief that such a procedure may prove helpful while other procedures have been disappointing? Furthermore, Dr. Shapiro’s hypotheses include some questionable assumptions such as her reference to “unconscious information” coming up from somewhere “to be processed.” Those assumptions have not yet been fully supported by clinical research. Similarly, her allusions to “inherent” body mechanisms, among other debatable constructs, may also never be adequately substantiated. But the critical point here is that the unsophisticated public, the needy, vulnerable clients out there seeking the easing of their stresses, anxieties, and conflicts, can easily be persuaded that EMDR is a viable, proven technique that will cleanse their unconscious of terrible, forgotten or only vaguely recalled traumatic experiences.
There have been many roto-rooting techniques, foist upon the public in the past, like L. Ron Hubbard’s Dianetics and the use of his “going down the time-track” ENGRAM dissolution techniques, to eliminate the brain traces of developmental incidents still distressingly residing somewhere in one’s neurons. And going back further still, there were those laboratory perception experiments, popular in the 1940s and 1950s, which alluded to some sort of pre-perceptual brain mechanism that actually operates to distort what we perceive (before we actually see something clearly) so as to satisfy specific physical cravings or personal desires. The constructs developed to explain such phenomena were never proven but were later employed to influence people’s market behavior and, in the case of Dianetic Counseling, to dramatically cure many illnesses or symptoms of distress. The appeal of such ideas often resided in how quickly such techniques might work, given client disappointment with traditional methods of influencing behavior. That’s the real problem beclouding any consideration of the effectiveness of EMDR or any other dramatic procedures. Nevertheless, if EMDR works, as its proponents claim, we really need to thoroughly and comprehensively investigate why it works, so that its utility as a therapeutic measure can be extended to help more people.
As noted earlier, one of the alternative hypotheses to be explored is the possibility that merely introducing something different into a therapy approach, which has previously produced limited results, could be the main reason for its subsequent therapeutic success, as a kind of attention-getting, refraining factor. If so, that factor deserves fuller exploration for its therapeutic value per se. Similarly, postulations about the neurophysiological sub-stratum, which explain why eye-movement therapy is effective, need to be examined closely so as to avoid what possibly also could be harmful about the procedures employed.
Finally, the control methodology difficulties inherent in so much study of comparative therapeutic techniques needs to be underscored. It may be that EMDR could turn out to be a valid and worthwhile new approach in and of itself, or that it could be a valuable option used to change a stale therapeutic relationship into something more meaningful and informative.
It should be noted that the historic long-ago abuses of electro-shock therapy (ECT) and psycho-surgery were also based upon no really sound formulations about brain functioning or brain chemistry. They were perpetuated based upon evidence that sometimes those techniques worked to quiet disruptive or destructive patients. ECT is now still sometimes employed, but generally in more humane fashion, against the backdrop of increased knowledge (about the effects upon chemical neuro-transmission in the brain) to account for its successes.
We need similar evidence about the neurophysiological constructs employed to support EMDR, or lacking such evidence, about how its use changes therapeutic relationships for the better.
Stuart M. Losen, Ph.D is a licensed psychologist practicing in Connecticut.