Kyle: There are eight phases to EMDR, and in this session we’re just focused on phase one, which is client history and treatment planning. How does this work?
Dr. Judy: So client history and treatment planning is the first phase of EMDR.
It usually lasts one to two sessions, although it may take a little bit longer if the person has a really extensive trauma history, or it just takes them a little while to establish trust and rapport with a new therapist. And this part is not as unique as any other type of treatment where you’re just getting to know the client.
You’re just making sure that you understand exactly why it is they came to therapy. But it does involve three very specific targets of information. So the first one is the past history, the past memories, the past traumas that have perhaps provoked their problems in this current time.
And the second component is the triggers of your current distress – what things are triggering you, what’s preventing you from doing well? And then the third part is future goals. What goals do you have for yourself in relationships, in work, in how you function on a daily basis? And you go through this systematically because EMDR does focus on all three of those components.
I always say that EMDR is a therapy that’s really designed on the past, present, and future. They really focus on this. So the past traumas are holding you up, the current distress that’s causing, and the future that is preventing you from having, right? And so you have to address all three of those components, and that’s why the client history taking is so important to make sure that you get ample information in all three of these areas.
Kyle: So I’m trying to apply this to me who has a very microtrauma and it doesn’t affect my relationships with people. It does not affect my work. It only affects this very specific part of my life. So in the goal part, would my goals then just to be that it doesn’t affect this very specific part of my life?
Dr. Judy: Exactly. And it may be that you would not be a candidate for EMDR if it’s really not impacting you to this level.
Kyle: Got it. Good point.
Dr. Judy: Good point. But I do think that for a lot of people it’s very global. Once the trauma occurs, it really does seep into all the areas of their life, right?
So let’s say they had a sexual trauma and that sexual trauma was perpetrated on them by a male family member. But they realize that now it’s not just about not having good relationships with other males and it’s certainly not just the family, it’s everybody in their life. It’s impacting their ability to work, it’s impacting their mood.
They may even be diagnosed additionally with a major depressive disorder or generalized anxiety disorder on top of the PTSD. I feel like those are the individuals where EMDR will be the most effective because they realize that trauma has generalized. That it’s not just this one specific area.
I know what you’re talking about. I actually got stuck in three elevators in the span of two weeks when I was in my twenties. And actually for a month, I just didn’t wanna go in any elevators because I’m like, I don’t wanna get stuck again.
And I realized that I needed to fix this problem when I was living in the fifth floor of an apartment building, and I was throwing my groceries in the elevator and then running up to catch the elevator and then grab all my groceries. And then one time my groceries got stolen. Because I don’t run as fast as the elevator.
Kyle: Who stole Dr. Judy’s groceries? Come on now.
Dr. Judy: I know, I know. And that was a lot because I was just freshly outta college and that money is like hard to get.
That was like a lot of stuff that I just bought from Target.
So anyway I realized that I had to resolve that problem and so I spent a day doing exposure therapy on myself. I just went in probably a hundred elevators all around the city. I was living in the Bay Area at the time.
So I actually did a whole progressive thing with it too. I started with the most expensive, fancy elevator in a big nice building in San Francisco where you obviously can’t get stuck. And I finished with one of the elevators that I got stuck in for two hours. And then I got better.
That I don’t think is an EMDR thing, like you were saying, it’s so specific to your life. But once I realized that my groceries were getting stolen, I needed to get back into elevators again. I just went and tried to solve my own problem and it worked.
That’s very different. EMDR is more like it generalized so much that you literally can’t function very well. For any long period of time. So it’s really causing so much disturbance in your life that you really need to resolve.
Kyle: I’m glad you made that distinction. And if I go to therapy for real trauma and the therapist takes my history and then starts to discuss the treatment planning and they indicate that EMDR might be for me, but I don’t believe in it…I don’t believe in binaural anything. Can EMDR still work?
Dr. Judy: I think it can. And I think that it doesn’t really necessarily involve the active belief of the individual about the model.
And in fact, sometimes therapists won’t even go into the details of the model with that patient.
And I think it just depends on the person. Some people are really curious, how does this develop? What’s the scientific basis behind it? What is a theory? And other people are just like, do something that will fix me.
Give me something that’ll work. And I think therapists might as well just jump sort of the overall education and kind of move into the techniques so that they can actually start to experience how it works.
And I also think that for some individuals it’s really helpful for them just to understand that all of us, if you are struggling with some kind of traumatic memory, you’re not gonna wanna think about it very much. That’s just the normal thing. That’s a symptom of PTSD. And so it’s really about you saying you don’t wanna think about it very much and that’s an avoidance coping strategy. It just precludes you from being able to function better.
So this is just a treatment that helps you to work on the avoidance strategy and changing it into something else that’s more adaptive.
Kyle: Yes. So when we talk about the treatment planning, what information does the therapist provide to the client at this point?
Dr. Judy: So at this point, it’s usually just a general education of how trauma works.
And of course, if you’re an EMDR therapist, you have a belief about the model that trauma is stored in a place in your memory that sometimes makes it hard to access. And you can talk a little bit about the science behind this. There’s research that shows that, again, the brain is trying to protect you by not remembering certain parts of the trauma that are just too much for you to bear.
And you don’t have the current coping strategies to deal with it. And you educate the patient by letting them know that you’re going to be teaching them coping skills so that now that they’re accessing certain parts of the trauma, even though that sounds scary to them as individuals in this therapeutic environment, they will be able to do it in a safe way where they can access a trauma while still having ways to cope with it when a lot of negative beliefs and thoughts and physical sensations come up.
And letting them also know that this is really a type of program that gives the power back to the individual. Because people who have PTSD feel very powerless.
And so at the end of the day, it’s about giving you the skillsets to function better now and in your future. And so eventually you’re not gonna be working in EMDR anymore. It’s a short term therapy. You impart the skillsets. And then you move on. So in that way, it’s very similar to CBT.
It’s a skills-based approach and I think that’s also really helpful to focus on for people who might be skeptics.
Kyle: Absolutely. Final words on phase one?
Dr. Judy: I think phase one is just really, again, a phase where you learn about the client, you tell your therapist what you want them to know, but I think it’s also important to know that it doesn’t require you to recount the trauma in specific detail.
Sometimes people don’t even wanna try EMDR because they’re thinking, “Oh, I have to process this negative memory. I don’t wanna talk about my trauma in detail. It’s just going to trigger me.” And the cool thing about EMDR is it doesn’t require you to go into detail.
You can. If you would like to, the therapist is happy to take that history, but you can just say, “This thing happened to me in the past and it’s causing me these types of problems now”.
And that’s actually plenty to get started. So for anybody who’s scared about that phase, don’t be scared because basically you bring whatever you want to the table and the therapist just needs a general outline to get started. Kyle: This is so good.
