Expanding EMDR Therapy To A Group Setting | Regina Morrow Robinson of The Book, EMDR Group Therapy

Think of substance abuse, for an example. Loads of need there. And I can't think of a human struggle, whether it's organic in nature or related to overwhelming experiences, our brain can struggle to process it and digest it. And it's that struggle to digest that the group EMDR protocols really work effectively for. And the earlier we get those overwhelming incidence is treated, the less likely it's to move into acute stress disorder or PTSD disorder, strain relationships. You know, when you're overwhelmed, you're less available to your loved ones. You don't sleep well, you don't eat well. So the sooner you treat those, just like in a medical situation, if you have a medical injury, you don't think to wait until infection sets in. You go right away. If we had accessible groups that allow people to jump in right away, they're going to utilize less medical care, less mental health care. They're going to be back to work more quickly physically. Their body will be less taxed.

Welcome to the Mental Health Entrepreneur Podcast. We are here to inspire creative ideas and connections for entrepreneurs and advocates working to address our mental health crisis. As you listen, I hope you will experience new ideas and motivation to innovate in your business, your community, and in your life. Welcome, everyone, back to the Mental Health Entrepreneur Podcast. We are here today to continue to talk about innovative ideas for mental wellness. And I am so excited to introduce to you our guest, Reg Morrow Robinson. She is a therapist, consultant, and trainer in EMDR therapy, as well as an innovator and author. Her book, group EMDR Therapy, opens up a great conversation about making EMDR accessible in a group format. Reg, welcome.

Oh, it's a pleasure to be here. Thank you for having me, Rachel.

Of course. So I wanted to start by talking a little bit about EMDR for maybe people who are listening who aren't so familiar. How would you describe EMDR as a therapy?

Oh, well, it's a whole psychotherapy model. But when somebody is struggling with an issue in the present day, sometimes it's directly due to past experiences they've had in their current life that haven't yet digested all the way. What's undigested keeps kind of joining today's struggle and exacerbating it, making it feel bigger. A lot of people kind of recognize the need for EMDR when they think one thing, but their gut tells them something else when there is an incongruence. So it's a wonderful model, whether you're dealing with depression or anxiety or trauma. I use it with athletes and performance enhancement and couples and families. It's a broad application.

It does. I agree. And so we want to talk. I think specifically, we know that EMDR is a great treatment for trauma, but you have focused this book that you edited on all the different ways that we could make this applicable to bigger groups of people. And so I'd love to know, how did you get inspired to dig into that, to publish this book?

Well, it goes way back to when I became a therapist and learned emdr. I had way more work. So I created a community of EMDR therapists, and that community couldn't keep up. And then I was introduced to group emdr, and it was originally developed for disaster response. Big events where there's a surge of need and very few therapists available. But as we started utilizing it, where we recognized it can be used in so many different settings, like a high school athletic team that has a poor performance and they're annoyed with each other and they are lacking confidence because of, you know, they're in a learning curve, they're making mistakes. The team could go through group emdr. It works great with a family who's just suffered something unexpected and overwhelming. So I recognized as I began studying more about EMDR, group therapy, and the different protocols, it's got great application all around the world. In fact, other countries seem to be adopting it way more quickly than we are in the United States. And it works in a stepped care model, meaning each level of care, you begin with a simplest, what's the easiest, less intensive, and you work your way up to the most intensive. And group EMDR fits with the early stages and the middle levels of intensity. It allows us to serve more people with fewer resources. And the best part is you're in connection with other people, so it reduces stigma. You're not sharing out loud what your struggles and pain are, but you are sharing out loud the good stuff. So there's a feeling of we're healing together, we're in connection. And you can just kind of watch the people, their face light up and they start connecting with each other more. They don't feel like there's something wrong with them, like they're broken. They feel a lot more normal and a part of just their community. It's really a beautiful thing to watch.

Yeah, that's really interesting. From that perspective of mental wellness, this idea of being able to be in a group, can you give a story or an example of something? Obviously, without sharing any inappropriate details?

I can give a couple different extreme examples.

That'd be awesome.

Working with a family that had A medical crisis over a holiday. The father did and the rest of the family was highly anxious. I met with a couple and we did a group model with them and brought their disturbance down. But part of their anxiety was how it impacted their five children and how they were still reactive. So I went to the house and we did some group EMDR with the whole family, the kids and the parents involved together. It also gave me a sense to see which of the family members needed more tailored individual therapy. The most common examples is being utilized right after a community disaster, whether it's natural disaster or man made incident. We began utilizing G Rep, GTEP Assist and IGTP in Ukraine while the bombs were in the early stages of going off. When we were delivering it through telehealth using Elon Musk's Starlink.

Wow.

I know it was quite interesting that it all happened, but agencies are adopting it and using it for wait list reduction. We're using it in schools for kids who struggle with one form of learning issue or bullying. They can experience a group with other kids going through the process.

I'm wondering in your process because you have so many different authors in this book that have written different chapters and that was inspiring to me seeing that there are so many people working on different applications of this. I'm wondering what that collaboration process was like, if you can speak to that at all or anything that stands out for you from working with that many people on this.

I think it was my favorite part of the book. I didn't realize how much I valued it till we were done and I missed it. I grieved it. Brilliant gifted giving clinicians from nine different countries using it in very tough situations. They all had their different ideas about how to work with first responders, for instance, and working with the forestry service out in the field even. And they were willing to meet on zoom and share ideas and acquiesce to kind of the shape of the model of the book, how we wanted it organized and they respected each other, inspired each other. It was really. The EMDR community is quite giving and supportive of one another and that was so evident in this journey to prepare the book. Awesome.

Yeah. And then that just broadens the perspectives and the applications for all of this. So what is your vision for group work and EMDR like? If you could just say this is what I would love for it to look like. What do you see?

I would like to see anybody anywhere who's trying to support and help people. Teachers, nurses, clergy, peer support and the emergency response community to be able to learn some of the protocols that can be taught to non mental health therapists to be able to deliver it to each other. For therapists who work in a group setting to be able to as a team, give this and reduce their buildup, their secondary exposure. You know, we used it a lot in Covid, so nurses and doctors were reducing their overwhelm and distress. That was happening. The group protocols can be built on each other into a more expansive program. So if a program is created and some of the providers are not mental health professionals, they learn, they deliver those lower intensity protocols, those still needing care move up to a group that is more engaged with the trauma and that's then licensed mental health professionals. And the more intense are EMDR trained mental health professionals. And as the person gets relief, they can step down into the lower care of group or individual work. In this journey, the providers support each other. They know that there is this connection and they're a team effort. And as they keep repeating the program, their capacity to give more and more of the programs expand. Think of substance abuse for an example. You know, there's loads of need there, and I can't think of a human struggle, whether it's organic in nature or related to overwhelming experiences. Our brain can struggle to process it and digest it. And it's that struggle to digest that the group EMDR protocols really work effectively for. And the earlier we get those overwhelming incidences treated, the less likely it's to move into acute stress disorder or PTSD disorder, strain relationships. You know, when you're overwhelmed, you're less available to your loved ones. You don't sleep well, you don't eat well. So the sooner you treat those, just like in a medical situation, if you have a medical injury, you don't think to wait until infection sets in. You go right away. If we had accessible groups that allow people to jump in right away, they're going to utilize less medical care, less mental health care. They're going to be back to work more quickly physically, their body will be less taxed. Boy, I could keep talking about this. So feel free to pause me and read.

No, I'm, I'm just soaking it in because I think this, I mean, to me you're describing almost a triage approach where we can do effective mental health care right away. There's no try to call and get on somebody's waiting list, or you go to the hospital, but there's no bed. All these things that happen in our field all the time, which was a lot of the inspiration for this podcast. Is there's just not enough to go around. No matter how many people I hire in my group practice or how many locations we have, we have a huge waiting list.

It just is, you know, everywhere around the world.

Yeah, exactly. So. So we do need something different. And as I'm listening to you talk about this, I'm really fascinated with that piece about you don't have to be an EMDR trained clinician, you don't even have to be a licensed clinician to apply some of these things. I think that broadens the opportunity. So can you talk a little bit about that piece and what that looks like?

Well, it's like in medical care, we all have our own first aid kit at home and other basic courses that we can utilize ourselves as individuals not being a medical professionals. We have walk in, dock in a boxes. You know, we can go into a clinic pretty quickly or outpatient medical care. Mental health needs to borrow from what medicine does and give more tools that allow us to remain in connection. And so when a family together has been in a car wreck or had a house fire, for instance, or they've had an unexpected loss or a loss due to a protracted illness, rather than let that pain kind of each of them individually isolate and fester with it, they come together and utilize one of the lower intensity or no trauma intensity and allow their bodies and mental well being to downregulate and soothe. And they're in connection. And it's the connection with each other that is so important to help us get through stress. And we could do that in school settings and many different kind of settings where we have ongoing stress.

Yeah, I'm just thinking about this. So if we had, say in an urgent care. Right. Kind of a setting, if there was a medical professional, somebody trained in just a regulating group protocol that you're talking about, then not only the physical injuries, but also the mental wellness could be supported just right away, right there.

Right. One of the protocols was developed by a psychiatrist who worked in emergency rooms.

Mm.

And it has been so difficult to get people to listen to him because they feel like you've gotta wait till you have a quiet office, one to one, one therapist to one client. Wait till the dust settles before you intervene.

Yeah, I know. I hear that a lot.

You know, we don't do that with medicine. We don't wait. We treat ourselves or we get to this lowest level of care that we can as quickly as we can. And then we don't need the more intensive care. We avoid a lot of complications from treating early and often.

So what kind of training would that take to have that available? Like you're saying in schools, in hospitals, maybe in doctor's offices to maybe in mental health clinics? Like what kind of training is required for offering that?

Well, a couple of the most basics like the four elements protocol or the butterfly protocol, those you can go right online, you can google them and you can learn them. They calm the body, they connect us with ourselves in the present moment utilizing the bilateral stimulation that EMDR is so known for. But assist, any licensed mental health can go online and take a webinar. G REP Group Resource Enhancement Protocol also has a webinar that people can go online for G rep and assist. You just need to be a mental health therapist. So you can be in grad school, you can be working towards licensure or not yet licensed and take these courses. The protocols that are more directly engaged with the trauma, they bring it up, they intentionally try to help people digest it. That requires EMDR training. So that's a licensed degree or license eligible. Plus the additional EMDR training, which is, you know, a chunk of time and a chunk of work, it's intensive. Plus the additional training of the advanced course and the group protocols. I'm hoping that as we continue to get the word out, we can begin to change that perspective. Because group protocols do not work as intensely or deeply as traditional EMDR standard protocol. There's a lot more containment and safety built in and power of being in a group is also an element that one to one doesn't bring to the table. So there's a lot of containment and group and safety and kind of like if you're driving a car, you're dropping the gear down instead of flooring it like we do, put our pedal to the metal. And one to one, EMDR group protocols are, are slower, safer, we do smaller bites of work.

Yeah. So realistically, there really are the regulating pieces that can be broadly applied and then we have some of the group pieces that require less training but can be supportive. And then we have that higher level of training. So when you were talking about the step and just for people that maybe are not familiar with the EMDR lingo, the butterfly hug is crossing your hands in front of your chest and kind of alternate tapping in a nice calm, slow pace. Then you also mentioned the four elements, which is also like a calming regulating strategy, Earth, wind, water, fire, that you take your body through just that regulating process. I just wanted to define those for people that don't know we use that lingo so often.

One of the benefits of the four elements is you take a measure of your level of distress before you do it and one after. So let's say a teacher was delivering four elements to her classroom. She could tell from the kids who weren't able to soothe enough that they might need some more attention. So it has a screening component built into it. GREP Group Resource Enhancement Protocol also has the same four elements as in G REP and gtep Group Traumatic Episode Protocol. Four elements can be done by anybody. I mean, you can go Google it in YouTube right now and find a lot of different options.

So is this being used in this way in a school or anywhere that you're aware of? I just. You mentioned the teacher, and I think about. I know that locally we have had some traumatic experiences for classrooms and schools, and I just think, wow, if we could triage in this way in a school setting, we would then find maybe the students that needed that more intensive level of care, but we would also help everyone in the process.

That is right. I mean, a teacher delivering the four elements is also benefiting from it. Yes, we are using it in university settings. University students who go to therapy or just need a break, they can do the four elements in a group setting. It's being used in elementary schools, middle schools, high schools. So it is. It's being used in children's hospitals.

Hmm, I love that. Are you aware of anyone that uses like the full scope in. In this vision you're talking about, about stepping it up and having these different levels anywhere of where that's happening?

It is. There was a beautiful program that occurred with Syrian refugees, parents who receive all virtual seven meeting session on being a parent through trauma and recognizing it in their kids. So they're learning. And then when they finished that, they all the parents received a GTEP to kind of process their disturbance. They felt as they thought about the moments they couldn't be there for their kids the way they want to be there for their kids. Their group experience was focused on improving their sense of confidence as a parent. And this particular situation, first responders are receiving it right after an event, a critical incident. There's one group that for a year, a full year, they receive something called a checkup from the neckup, meaning they would get a group experience where they could review the difficult experiences over the last year in that same meeting process, one of them, without sharing out loud what that experience was. Now, that was led by licensed EMDR clinician, the one I'm thinking of right now. We're still in the early Stages of getting. The fact that group EMDR exists is still new to EMDR therapists, much less the general public. So what you're doing right now, Rachel, helping many more people outside of the world of EMDR know this is available is so critical and so important.

Well, and I think part of what you mentioned there that is really important for EMDR and for group EMDR is this idea that you don't have to share. It's not like we're sitting around in a group and sharing our traumas. That's not what we're doing or talking about how we feel. I know some people say, I don't want to just sit around and listen to a bunch of people cry about something that's already making me upset. So this is not what we're talking about at all. Just to clarify, it is very contained and the only sharing is really about anything positive that somebody wants to share, and it's voluntary. So someone can sit in a group EMDR session and never share anything if that's their choice?

That is exactly accurate, yes.

Yeah. I just think that that helps people have a sense of safety about it just from the get go. So understanding that is a. Is really important.

Think about how that shows up, like bringing a group of people that work together. They don't want to share their vulnerabilities with each other, but yet they want to be in connection. They want to know that they're all working through this event that's happened in their workplace or that's happened in their community. So they're hearing the growth, but they're not hearing about how each person is seeing, smelling, feeling about the experiences that's not shared, but they're watching the smiles and the shifts that come afterwards.

Yeah, I'm just really stuck on this question of how do we. How do we roll this out more? I don't know if you have any ideas on that, but how. Certainly awareness is a piece of that, as you already mentioned, and maybe in this podcast there will be people that become more aware of it, but are there any other plans or ideas that you have had in terms of growing this? Your book is a great way of getting the word out too, by the way.

Thank you. Thank you. Well, you're also helping with that, doing webinars and podcasts, going to associations of different professions, you know, meeting with community leaders, meeting with administrators and a team in schools. I have colleagues that work with first responders, and they do ride alongs and build a relationship and then start to share. You showed me yours. Let Me show you mine and they start shifting ideas. I don't want us to wait until our community is met with a disaster and group EMDR is deployed for people to learn about it. I'd rather everybody be aware and know that it's available and using it for the smaller things. So when the big things come around, that's like, of course I'm going to do this. You know, it's like of course you the wound out. Of course you close up a wound. And group emdr, I'm waiting for it to be. Of course I'm going to.

I love that as an idea and I think there's lots of ways for communities to use these resources to start to normalize that.

Yeah.

But I'm also wondering about clinicians. So maybe EMDR clinicians that are already trained and doing individual what have you noticed is helpful for them to be able to transition to offering group protocols?

One, basic trainers need to begin talking about it and two, those of us who are using it, talking in our professional opportunities, whether it's Facebook groups or LinkedIn or present conferences, which is happening more and more. Some of the best ones have been in Europe. I also think it's inviting EMDR clinicians to come co lead or co facilitate or support the groups that we're doing. In my community in Orlando, Florida, our Trauma Response Network regularly offers GTEP to therapists so they can process some of their difficult cases or the experience of responding to incidences. Because it's not shared out loud, there is no breach of privacy that happens in the group, which is very, very nice.

Yeah.

And going to other professional associations and talking there about the group experience. Going to the Marriage and Family Group or American Counseling Association, American Psychological Association, Clinical Social Work, letting those associations know so much more.

That's good. I know you mentioned some of this in the book, but I'm wondering if you can talk a little bit to the research because of course we all love research and EMDR is based on research. So I know that group is newer in this vein, but I wonder if you can talk a little bit to what is it looking like for group EMDR in terms of research?

Well, there are three protocols that have really reached the gold standard of randomized controlled trials consistently and that is Integrative Group Trauma, igtp, OTS Assist. Those are both accessible through Scaling up the Trainings to Learn More and GTEP Group Traumatic Episode Protocol, which is really a wonderful thing. The other protocols are newer. In fact, many of them really came to life in 2020 when Covid happened and then improved even further with the Ukraine war because those are two clear instances where we were way under responding and needed to be creative and come up with more. Since the Israeli Hamas war has begun, we have two new ones that have evolved out of that situation. Oh yes. So in critical incidences when we're quickly responding, it's difficult to do research because getting an informed consent, having them do pre post assessments when the world around them is kind of up in the air, it's hard to do follow ups. So we're now waiting till we can do other settings and applications. So in response to cancer for instance, or a sudden death, and the research is now coming in, I mean there are multiple articles published on group emdr. I don't even have a count off the top of my head.

That's a good sign that there's quite a bit.

I know Francine had three versions of her text to train therapists and the latest One was in 2018 and it was the first time she gave a nod to group EMDR protocols to Nacho Herrero's IGTP and Alain Shapiro's gtep. But she mentioned we need more research and since then that's exactly what these two protocols have been going through and assist came along also with good research.

Yes. That's awesome. So we are about out of time about at that point of wrapping up. I'm wondering if there's anything else that you want to leave people with. Any last important information that you want listeners to know.

Well, be curious. Be innovative. Consider integrating group EMDR protocols so that you can feel the connection and witness that felt sense of group work and watching the shifts happen. They're not hard to learn and they're well worth the energy and time.

Amazing. I love that. Well, congratulations on your book. It is awesome and thank you so much for being here and sharing your vision for group work in treating mental wellness in our communities.

Thank you for hosting this podcast series. It's so innovative. It's wonderful.

Thanks Rich.