First, do no harmHippocrates
THE DANGERS OF EMDR THERAPY
EMDR therapy is a powerful treatment that can make your symptoms go away. It has been shown to be effective with multiple mental health and physical conditions. But in order to work effectively, EMDR has to be practiced by a skilled therapist, with a lot of attention to safety. When done incorrectly – without attention to your safety – it can lead to deterioration and have the opposite effect.
Let me say that again: if done incorrectly, EMDR can lead to serious side effects. It can make you feel worse. If not done with a lot of attention to safety, EMDR can be harmful.
A BRIEF HISTORY OF EMDR
In 1990, A few years after EMDR was invented, Francine Shapiro, the founder of EMDR therapy, received reports of people who were treated with EMDR therapy and had gotten worse. It wasn’t just that clients didn’t improve as a result of their EMDR treatment. EMDR made some people experience symptoms they hadn’t had before they started treatment.
What Shapiro quickly realized was that therapists who took her training started teaching EMDR. They showed other clinicians what they learned immediately after they completed their basic EMDR training. These unfortunate events led to the foundation of the EMDR International Association (EMDRIA).
EMDRIA has a very structured way of training EMDR therapists. Clients’ safety is being emphasized throughout the training and clinicians are trained on how to deal with safety issues, including stabilization and assessment for dissociation.
For your safety, It is crucial to choose a therapist who was trained by the EMDR International Association (EMDRIA)!
WHY EMDR THERAPISTS HAVE TO PUT SO MUCH EMPHASIS ON SAFETY?
Since EMDR therapy goes back to the source of your symptoms, it usually triggers a lot of emotional disturbance. This mostly happens at the beginning of the EMDR work. EMDR can lead to flooding of memories, thoughts, emotions, and physical sensations.
POTENTIAL DANGERS OF EMDR THERAPY
When doing EMDR, your symptoms can temporarily feel worse in or between EMDR sessions. Your therapist will have to use her clinical judgment before starting your EMDR reprocessing. Even after starting the reprocessing, your EMDR therapist should always look at the balance between helping you keep one foot in the past (what is being processed) and one foot in the present (feeling safe in the present).
In other words, your EMDR therapist will teach you how to use dual attention.
Since EMDR will activate your nervous system, your therapist will first teach you how to regulate. If you are about to start your EMDR therapy – you know that distressing memories will come up. These memories can bring disturbance in the form of negative emotions, nightmares, disturbing thoughts, and some physical sensations.
You should also know that information processing usually continues between sessions. Memories from the past may arise after your session is over, and these memories are often accompanied by some level of discomfort.
For your treatment to be successful, you must be able to cope with the memories, emotions, and physical sensations that may come up in and between sessions.
SAFETY FACTORS IN EMDR THERAPY
- RAPPORT – Good rapport with your therapist has a major role in getting successful results in EMDR treatment. You should be able to feel vulnerable with your therapist. Your vulnerability will allow you to feel open and transparent about what you’re experiencing while you’re reprocessing.
- STABILITY – EMDRIA-trained therapists are trained to assess your stability. If there are any concerns about your safety – they should be addressed. In many situations, the therapist will do a lot of preparation work before starting the reprocessing. Safety should include assessment of suicidality, dissociation and coping abilities. Always mention to your therapist if you feel suicidal or experience dissociation.
- ABILITY TO HANDLE EMOTIONAL DISTURBANCE – This ability is directly related to your stability. Your EMDR therapist should test your ability to handle emotional disturbance before exposing you to intense emotional disturbance.
- Environmental stability – Your therapist should not start processing trauma if you are experiencing a major life stressor or a crisis (divorce, homelessness, recent loss of a loved one).
- SUPPORT – You should have natural supports, such as friends and family members who can be there for you between sessions. If you are isolated and have no friends or family to support you between sessions – mention it to your therapist. Level of support is very individual and should be assessed by your therapist.
- GENERAL PHYSICAL HEALTH – You should have some basic level of physical health to start processing. If you suffer from a cardiovascular, a neurological condition or epilepsy – talk with your specialist before you start your EMDR work.
- LEGAL ISSUES – If you were a victim of a crime, or need to testify in court for a crime that you witnessed, consult with an attorney. EMDR processing can change your memory of some events. It’s not that you will forget what happened, but some aspects of your memory may fade or slightly change.
- PSYCHOSIS – According to Paul Miller, MD, EMDR can be successfully used to treat schizophrenia and other psychotic disorders. However, EMDR therapy for psychosis should be done with caution, by an EMDRIA-trained therapist who has experience treating psychosis.
SAFETY FIRST! TREATING CHILDHOOD TRAUMA WITH EMDR
EMDR therapy is very effective in the treatment of early childhood trauma. If you have complex PTSD or a dissociative disorder, your therapist should take additional safety measures.
Processing early childhood trauma can be extremely distressing. If you were a victim of physical, sexual or emotional abuse, you may become very vulnerable when you start your EMDR work.
Make sure you do anything in your power to create a stable environment outside of your therapy sessions. Take a mindfulness class, start working out or do anything else you can to bring balance into your life. Trust me, it’s important.
CULTURAL CONSIDERATIONS IN EMDR THERAPY
If you already have trauma or anxiety, EMDR processing can lead to a temporary increase in your symptoms. While for most Americans, symptoms of trauma and anxiety are perceived as what they are – symptoms, in other cultures an episode of a panic attack can be interpreted as being possessed or crazy. For people who come from other cultures, these symptoms may have different consequences for the client, and sometimes for the client’s family.
In my work with refugees from all over the world, I’ve learned that in some cultures, experiencing mental health symptoms is considered shameful for the whole family.
For example, in some African countries, once one member of the family has experienced symptoms that are related to mental health, members of the family may have trouble finding a partner. In other words, once one member of the family is suffering from mental health issues, the whole family may be labeled as mentally ill.
OTHER PRACTICAL CONSIDERATIONS
EMDR can be mentally and physically exhausting. If you have a big presentation on a Monday morning, it is probably better to avoid scheduling your EMDR session on Monday at 8am. This is very individual and, from my experience, some clients may not feel drained by EMDR processing, while others feel exhausted.
If possible, schedule your first EMDR processing session when you don’t have anything scheduled right after. This will allow you time to take time to reflect on the work you did.
Rotem Brayer is a certified EMDR therapist and an EMDR consultant in training, practicing in Denver, Colorado. He divides his time between helping refugees to improve their mental health and maintaining a private practice.
Resources contain some affiliate links. To learn more, please read the affiliate disclaimer.
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