EMDR vs Traditional Talk Therapy
By: April Lehman, LPC
EMDRIA Consultant in Training
Back in 2011, when I started my journey as a therapist, I had in my toolbox of skills several talk therapies that I routinely used with my clients. I considered myself an eclectic therapist, but I routinely used my “go-to” therapies of cognitive behavioral therapy and motivational interviewing with my clients with co-occurring disorders. After attending a 2-day, live training in 2015 with Bessel van der Kolk on his book The Body Keeps the Score, I learned more about a therapy I was only vaguely familiar with at the time—Eye Movement Desensitization and Reprocessing (EMDR). Then in 2016, a coworker told me about a local EMDR training and I immediately signed up. It’s not an overstatement to say this training changed the way I practice as a therapist. EMDR has some similar attributes of traditional talk therapy, but how does it contrast?
Let’s start by talking about how traditional talk therapies typically work. Talk therapy typically employs the strategies of meeting clients where they are at, building on their strengths, and problem solving. In psychoanalytic therapy, therapists will be guiding their clients to uncover unconscious material and analyzing and making sense of childhood experiences. “The assumption is that this exploration of the past which is typically accomplished through the transference relationship with the therapist, is necessary for character change” (Corey, 2005, p.82). In cognitive behavioral therapy, your therapist will be looking at cognitive processes and how this affects your behavior. Clients are taught to identify, challenge, and counter maladaptive thinking to reduce problematic behaviors. In more postmodern approaches like solution-focused brief therapy, therapists focus on working with client’s strengths and applying this to help resolve their problems in the shortest amount of time possible. These are just brief snapshots of talk therapies many of us use today. The list of talk therapies is vast, but at their core they are “talk” therapies. That being said, “the wisdom of all the psychology orientations is needed to make sure no one is left behind” (Shapiro, 2018, p.6).
As mentioned above, I started out my career as a therapist working with clients with co-occurring disorders. I worked at a local mental health clinic for about 5 years and practiced traditional talk therapies with my clients. Some of those clients I saw for the duration of the time that I worked there. Over time, I started to notice that talk therapy was not enough. Though client’s gained understanding of how their past affects their present and they learned helpful skills to cope in the present, I often heard sentiments such as “I know I’m not bad from a rational standpoint, but part of me still feels that way.” or, “I know I’m safe in the present, but I still feel anxious.” What I came to learn was that traditional talk therapy was not resolving the symptoms of underlying big “t” or little “t” traumas.
So, what makes EMDR different from traditional talk therapy? Well, EMDR can actually employ the strategies of traditional talk therapies as we prepare our clients for desensitizing past traumas. However, “EMDR is a distinct form of therapy and has principles and practices that are different from these and other approaches” (Shapiro & Silk Forest, 2016 p.4). Standard EMDR is an eight-phase treatment consisting of a three-pronged protocol addressing:
- Past negative experiences
- current triggers or situations
- positive templates to address future triggers or similar situations
However, there are other specific protocols and therapeutic tools that can be used depending on the presenting problem. Shapiro developed the Adaptive Information Processing Model (AIP) to explain how the clinical results of EMDR occur. She posits that “AIP regards most pathologies as derived from earlier life experiences that set in motion a continued pattern of affect, behavior, cognitions, and consequent identity structures. The pathological structure is inherent within the static, insufficiently processed information stored at the the time of the disturbing event” (Shapiro, 2018, p.15). In other words, early negative life experiences can become stored dysfunctionally in the brain, leading clients to experience negative affect and beliefs from these memories when triggered by present day stimuli. EMDR uses Dual Attention Stimuli (DAS), through eye movements or tactical or auditory stimulation, to unlock and process these memories and access “physiological networks containing adaptive information” (Shapiro, 2018, p.16). AIP is considered to be an innate process similar to the way the body heals itself from a wound. For example, if you have a splinter, healing will be blocked until the splinter is removed. In this case, EMDR is helping to access and remove a “block” in the form of dysfunctionally stored memories to allow for adaptive processing and restoring mental health. Instead of analyzing and verbally processing past traumas as in traditional talk therapy, EMDR is following the brain.
One important difference between EMDR and traditional talk therapy is that during EMDR a client does not have to talk about the negative event or trauma to get resolution. They need only hold the image in their mind while the therapist guides them with DAS. EMDR provides a way to help clients revisit their trauma without being retraumatized and reduces the risk of flooding. In many cases, EMDR can result in symptoms being resolved in a shorter amount of time. As in the illustration I used above with clients I had seen for about 5 years, there was a lot of talk therapy and processing going on, but we were missing the root problem. Without accessing the early dysfunctionally stored memories of traumas, progress was being stalled.
Traditional talk therapies are an essential part of every therapist’s toolbox. EMDR, while also another psychotherapeutic approach, is unique in that it can utilize other talk therapies while also offering its own unique protocols and principles to address dysfunctionally stored memories contributing to pathology. When we understand this difference, it will change the way we practice with our client’s and how we conceptualize our cases.
References:
Corey, G. (2005). Theory and Practice of Counseling and Psychotherapy (7th ed.) California: Brooks/Cole.
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.) New York, NY: The Guilford Press.
Shapiro, F. & Silk Forest, M. (2016). EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma (Updated ed.) New York, NY: Basic Books.
About the Author
April Lehman, LPC completed an EMDRIA Approved EMDR Basic Training in 2016. This training completely changed the way she conceptualizes treatment with clients and started her on the path to becoming a trauma therapist. She maintains a solo private practice in Kearneysville, WV as a therapist and EMDR Consultant in Training and is currently working toward becoming an EMDR Consultant for EMDRIA.
