Can you move your eyes from side to side? Try it now!
Did you know that doing that is a form of psychotherapy? I expect you’re feeling better already!
Eye Movement Desensitization and Reprocessing (EMDR) is a curious technique used to help victims of trauma — for example, a road accident or rape. It has also been used to treat other mental illnesses.
In common with other curious techniques, EMDR is supported by a lot of soft science that proves it works. For an explanation of what I mean by ‘soft science’ and ‘proves’, see last week’s post here: Shopping
How does it work?
How does moving your eyes from side to side help you to recover from trauma? If you are a believer in soft science (and who isn’t?), how it works is neither here nor there. Don’t ask questions like that!
There are several theories about how it might work, and none of them makes much sense. If you are a believer in soft science, making sense is neither here nor there either. Don’t theorise like that!
Me, I’m a grumpy old hard-science person. You might say that I’m only like that because of childhood trauma that I could overcome by moving my eyes from side to side for a while, but I’m not only grumpy, I’m stubborn…I want to know how it works. I want it to make sense.
If you think how EMDR works is a mystery, there’s an even greater mystery, which is that EMDR is popular with CBT therapists.
The register of CBT therapists in the UK even lists EMDR as one of the ‘treatment options’ for CBT. (That’s true at the time of writing. Its presence in the listing is controversial within the BABCP, and it might be removed soon depending on who wins the argument.)
This is mysterious because CBT is meant to be about making sense of the causes of mental illness. Whatever EMDR may do, it doesn’t help anyone to make sense of anything. So, whether or not it works, it’s certainly unrelated to CBT.
There’s a clue that may solve both mysteries.
If you go on a course for CBT therapists about conventional CBT treatment for trauma victims, much of the work focuses on helping patients to explore memories and interpretations of the traumatic event. But chat to other therapists in the tea break, and you’ll find that many of them avoid doing this kind of work. It scares them. Other people’s past traumas scare them. They won’t go there. They don’t know how.
Now imagine there’s a technique that distracts therapists from their own fears. By using that technique, therapists would be able to remain calm while they help a patient to explore memories and interpretations of a traumatic event.
What kind of technique would work in that way? A technique like EMDR. My theory about EMDR is that it gives therapists a legitimate way to zone out when a patient is dealing with the most distressing (for the therapist) aspects of a past trauma.
By zoning out, therapists become more neutral so that their own emotions do not interfere with patients’ cognitive restructuring of the past. Of course, if these therapists were properly trained in the first place they could actually help their patients, but that’s just wishful thinking. The best that a poorly trained therapist can do in these situations is to avoid making things worse.
This would explain why EMDR is so popular with CBT therapists, many of whom are poorly trained in therapeutic alliance. With a weak therapeutic alliance, the therapist’s own feelings come to the fore inappropriately and disrupt therapy. EMDR is a way to cover up and mitigate a weak therapeutic alliance.
How it works
Returning to the first mystery, EMDR could work because it neutralises your emotional response to your patient. Your patient’s own emotional response is, presumably, maladaptive in some way. By retelling the story in the presence of someone apparently neutral, your patient can learn the neutral response that you appear to be modelling. Your neutral response is likely to be less maladaptive for the patient.
Notice that the paragraph above makes no reference to trauma. This effect would work in any situation where you fear your own emotional response to your patient. It would work for trauma, where you fear whatever happened in your patient’s past. It would work for other illnesses, where you fear the illness itself.
However, this is still not CBT. In CBT, both you and your patient participate in therapy as whole people. The aim is not to be emotionally neutral. The aim is to make emotional sense. Successful CBT allows patients and therapists to experience strong emotions when strong emotions are appropriate.
If you simply model neutrality, that is likely maladaptive in itself. It may be the case that neutrality is less severely maladaptive than the patient’s original response. So it may be the case that patients generally improve with this kind of therapy.
But it is not at all clear that patient’s actually become well with this kind of therapy. To become well for real, patients need their therapists to be real. They need to deal with emotions and memories for real, and for the outcome to make real sense.
That’s idealistic, I know, given the quality of CBT training. I can imagine you reading it and rolling your eyes…wait a minute, rolling your eyes…I think I have just invented a new form of psychotherapy!