EMDR Therapy in Philadelphia
“When we recognize that we are being held back in life, the question for each of us is ‘What do I do about it?’”
- Francine Shapiro, creator of EMDR
Looking for something beyond talk therapy?
Perhaps you’re aware that what you’ve gone through in the past was bad. You are aware of the ways your past has affected you. You’ve opened up and talked about it, maybe even in depth. And you’ve learned to feel your feelings about it, too.
But your sore spots still activate you.
So you pause to regulate yourself, and then you shift from your knee-jerk reaction to your conscious, mature response.
Ultimately, you don’t want something that’s over to still take up space in your life today. Nor do you want to be defined by what happened to you. You want to come to full terms with your past, leave it there, and be informed by your experience for the better.
You’re in the right place!
What is EMDR?
At its core, Eye Movement Desensitization & Reprocessing therapy is about reprocessing unresolved, painful memories to free up space to create new memories.
Attachment trauma & racial stress, due to their chronic nature, can be made up by many memories or vague memories. There can even be amnesia (loss of memories).
If you live or have lived with chronic trauma, or if you have difficulty remembering your life — know that EMDR can be a modality that can help you.
What is EMDR?
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EMDR stands for Eye Movement Desensitization and Reprocessing. It is a memory and information reprocessing therapy.
It is named after the healing effect of side-to-side eye movements. EMDR was first practiced with visual bilateral stimulation (BLS), where clients reprocessed a traumatic memory while their eyes tracked their therapist’s fingers waving right to left. These eye movements were found to help people process disturbing experiences.
Eye movements are just one form of bilateral stimulation. There are many ways to utilize both hemispheres of the sensory cortex in reprocessing disturbance. Today, EMDR is practiced with other forms of bilateral stimulation, like auditory BLS (alternating tones through headphones) and tactile BLS (butterfly tapping or buzzers).
Francine Shapiro, the psychologist who developed EMDR, once said that if she had the chance to rename her model of therapy, it would simply be “Reprocessing Therapy”. But EMDR stuck.
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The goal of EMDR is to help people break through the effects of toxic stress with bilateral stimulation (BLS).
Stress is a normal part of life. It is not necessarily bad. We experience stress when we take a test, get married, get promoted, give birth, exercise, or learn something new.
Toxic stress, on the other hand, can wreak havoc on the mind and body. It takes many conscious and unconscious whole-body adaptations to cope and survive overwhelming or traumatic experiences.
Polyvagal theory posits that most mental health diagnosis are some form of a toxic stress response. This is concordant with the diathesis-stress model, a psychological theory and that explains how mental disorders develop under stress.
Whether your response to overwhelming looks like post-traumatic stress, anxiety, depression, addictions, obsessions and compulsions, psychosis, or eating disorders, there is a modification of EMDR that can help you.
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Bilateral stimulation (BLS) is EMDR’s mechanism of action. At one point this concept was controversial, and many still find it to be very weird. I was highly skeptical of it for a long time as well. But there has been considerable research conducted on BLS and the physiological processes underlying it. These are the three hypotheses that together produce the powerful effects of BLS.
Orienting Response/Reflex: The orienting response or reflex is an instinctual action hardwired into our autonomic nervous system for survival. It is synonymous with the concept of neuroception from Stephen Porges’ Polyvagal Theory. It may also be thought of as an investigative response.
When a new stimulus enters your environment, you instinctually orient towards it to determine if it may pose a threat to you. You orient with your eyes, ears, and head.
Research also shows that the orienting reflex produces a relaxation response when a person perceives present safety.
REM Sleep: This hypothesis asserts that BLS moves the brain into a mode of memory processing like that experienced in REM sleep.
Both EMDR and REM sleep:
promote the integration of memory (activate episodic memory and integrate them into cortical semantic memory)
have a shared physiological component of eye movements associated with information processing
help analyze, manipulate, and assimilate information between information networks
Just as many people have spontaneous insights that can come after a restful sleep, many report spontaneous insights in EMDR therapy.
Dual Attention/Awareness: Across multiple trauma therapy modalities is the central theme of dual attention or dual awareness. Keeping one foot in the past and one foot in the present is the skill needed when working on past adverse experiences. It is necessary to transition into memory reprocessing. BLS helps you keep that one foot in the present.
Having dual attention shows that someone can experiences the uncomfortable components of a memory or adverse experience but also remain connected to their window of tolerance.
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Adaptive Information Processing (AIP) is the explanatory model behind EMDR. AIP describes the linkage and storage of memory. The way we store our memories can contribute to health and wellness or disease and pathology.
When the autonomic nervous system (ANS) responds to stress, pathways for memory integration can get blocked. These experiences can remain "unresolved” in the nervous system, meaning they get activated in the present day.
This “reopening” of the incompletely stored memory explains why trauma survivors often report significant distress – their re-experiencing symptoms (ex. visual or auditory flashbacks) in the AIP model are fragments of the overwhelming or disturbing memory.
When these memories are activated in response to a reminder or trigger, the ANS is hijacked and activates fight or flight responses, freeze responses, or shut down responses.
We also have adaptive memories. When we connect to our adaptive memories, our autonomic nervous system responds in kind. We feel all the good feelings, sensations, and thoughts associated with that memory. These memories contribute to health and wellness as they shape our self-esteem, ego strength, sense of others, and attitude toward the world.
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Experiences are organized and stored as physical memories throughout the central and peripheral nervous systems, which govern the entire body.
Memories are like trees (or a whole forest) of encoded neural networks. These neural networks consist of bits of information that make up memories and memory networks.
Memories can hold different types of information. They are made up of
thoughts and beliefs (cognitive information)
feelings (affective information)
sensations (somatic information)
images, sounds, and smells (sensory information)
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History Taking: You share your history with your therapist. You share and discuss your goals for EMDR. You and your therapist work together to determine your targets for reprocessing. Your targets may be mental health symptoms related to a past experience, specific memories, negative core beliefs, or even persistent negative feelings. The therapist assesses your readiness for EMDR based upon your current levels of safety and stability and collaborates with you on a plan to enhance your readiness for smooth memory reprocessing.
Preparation: You and your therapist get to know each other. EMDR is not as beneficial or powerful without you feeling safe with your therapist. Your therapist will educate you about EMDR and how it works, and you get to bring up any concerns or questions about the process. You select a form of bilateral stimulation that your nervous system responds to the best. You will learn some resourcing techniques, where you use slow bilateral stimulation to increase your felt connection to safety, presence, hope, and other positive states. These include containment, safe calm place, or connecting with your future self. Any other foundational therapy work is done so that you can proceed with trauma reprocessing safely.
Assessment: Your EMDR targets are activated. Your therapist will ask you to focus on the disturbing images, beliefs, sensations related to the target. This is a relatively brief phase. This phase is always paired with phase 4.
Desensitization: Disturbing material is reprocessed with fast and long sets of bilateral stimulation. Desensitization is complete when your distress is as low as reasonable. It is normal for some memories to take more than one or a few hours to reprocess.
Installation of the Positive Cognition: Healing beliefs and therapeutic insights that emerged out of phase 4 get integrated into the disturbing memory with sets of fast and long BLS.
Body Scan: While holding the original experience in mind along with the positive cognition, you scan your body from head to toe, noticing any signs of remaining disturbance. The disturbance is processed with sets of fast and long BLS.
Closure: It is normal for the brain to continue processing or “continue having sessions” after an EMDR therapy session. It is important to continue to use skills while your nervous system continues to process information through these activated memory networks after a therapy session is over. For sessions with an incomplete target, your session should end with regulation or stabilizing exercises.
Reevaluation: Examine changes within yourself and notice whether outward behavior or outward circumstances have changed or contributed to the change.
EMDR therapy can help you…
stop falling into old triggers or entrenched patterns
improve your ability to digest and release stress
feel in your mind and body that the past is over now
understand how you have developed as a person since those worst times in your life
develop resilience born out of choice, not out of survival or performance
live differently — not as the person you were before, but as someone stronger and much bigger than your history
Experience real relief, now.
FAQs about EMDR
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EMDR is for survivors of overtly traumatic events, including
People suffering from war trauma - combat veterans as well as victims and refugees
Victims of crime
People with excessive grief due to the loss of loved ones or line-of-duty deaths
Survivors of sexual assault
EMDR is just as much for those who have endured the slow burn of chronic stress.
Adults who experienced harsh or physical punishment in childhood
Adult children of emotionally immature parents
Adult children of alcoholics
People who experienced verbal abuse by peers (bullying)
People with phobias, panic disorder, and other anxiety disorders
Those with chronic pain
People with obsessive-compulsive disorder
People at all stages of chemical dependency or other addictions
Finally, EMDR can be helpful for anyone who has experienced the limits of insight-based therapy.
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For people with high levels of dissociation. The standard protocol on trauma memories often proves destabilizing for dissociative systems. Somatic work, parts work, and parts-friendly modifications of EMDR are indicated.
For people with active drug use. The standard protocol on trauma memories carries the risk of overwhelm, destabilization, and the urge to use. Support should be strong between sessions. Distress tolerance, replacement behaviors, and the DeTUR protocol are indicated.
Without adequate preparation. Preparation can include identifying cognitive distortions, learning cognitive defusion, parts work, ego states work, distress tolerance skills, mindfulness skills, emotion regulation skills, nervous system education, grounding skills, dual awareness skills, trust in your therapist, and trust in the process. Attempting to process traumatic memories without dual awareness can lead to dissociation, reliving trauma memories, dysregulation, abreactions, or decompensation.
If you do not have social support between sessions. You want to have someone who empathizes with your mental health in your corner and respects that you are going through an important treatment.
If you are in regular close interaction with a dysfunctional person who may take advantage of vulnerability post-EMDR session.
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It is normal for the brain to continue processing or “continue having sessions” after an EMDR therapy session. For example, if reprocessing a memory of loss, it is normal for you to be very in touch with that sadness after processing.
Observe and note what you feel between sessions. It is not uncommon to feel heightened anxiety, nightmares, confusion, sadness, irritability, or difficulty sleeping.
Alleviating distress related to a disturbing memory reshapes neural networks of thinking, emotion, and memory. Successful reprocessing of one memory may lead to the recovery of related unprocessed beliefs, emotions, or sensations from past experiences.
Please keep your therapist aware of these difficult between-session experiences! EMDR is not a miracle fix, but it shouldn’t be torture. Telling your therapist your side effects gives her insight into what the previous work brought up and what you need next – maybe more resourcing, more talking, or extended session time. You can figure it out together.
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The traditional EMDR session length for memory reprocessing is 90 minutes.
Most health insurances cover 60-minute psychotherapy sessions.
I offer EMDR through 60-minute sessions, 90-minute sessions, as well as 2-hour, 3-hour, or 4-hour sessions. The benefit of extended sessions is that you can reprocess difficult memories without interruption.
You can choose your experience: meet me four times in 60-90 minute chunks or have a 4-hour treatment in one day. Read more here.
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This depends on your history and the type or duration of disturbing event you endured. If you experienced a single-incident traumatic event such as a car accident, EMDR may be a brief treatment of 2-4 sessions.
If you experienced multiple or chronic traumatic events, EMDR may be integrated into a longer-term therapy.
A common guesstimate of EMDR for complex trauma survivors is 6-12 hours of reprocessing. It may be more, it may be less – it truly depends on your nervous system capacity, current level of support and stability, and your unique way of processing events.