EMDR Therapy Quarterly

At the Consultant’s Day, prior to the conference, I took the opportunity of joining EMDR All Ireland President Gus Murray for his presentation. With the early afternoon sun blazing down on the magnificence and beauty of historic Valencia, Gus focused his attention on the role of supervision. He noted we were at a point of opportunity and challenge since the loss of Francine Shapiro in 2019. He took time thinking about the development of EMDR and noted the recent paper exploring the past, present and future (Laliotis et.al., 2021), which tracked its evolution from a set of techniques, to standardised protocols and to the future of EMDR as a psychotherapy. Gus noted this in the wider context of the evolution of psychology and psychotherapy, with insights from neuroscience that have enabled clinicians to begin to understand the neurobiology of the processes taking place in therapy. Moving away from ‘just’ talking towards more focused work to promote changes within neural networks (working with the brain to change the mind).

Gus is an expert supervisor and spoke passionately about the role in understanding the distinction between basic techniques in EMDR and the standardised phases informed by the AIP model. Bilateral stimulation (BLS) is sometimes used alone by therapists as an addition to talking therapy. Gus pointed out that EMDR is more than just the BLS component. The standard training, he argues focuses on the teaching of new skills to enable trauma to be effectively processed when there is a straightforward identification and processing of dysfunctional material or a “clear pathway on the mountain”. However, many people present with complex trauma. These often have developmental or attachment-based origins which are implicit and inaccessible to conscious memory, and with symptoms that overlap numerous diagnostic criteria and disorders. The implications then, are for supervisors to build on the minimum seven days of teaching, practice and initial supervision in the standard training, to support supervisees to address the more complex presentations where the mountain path is far from clear and there is a risk of falling.

Supervision needs to consider the scope of experience of both supervisor and supervisee. Gus recommends a combination of formative video review, a good balance of facilitation and evaluation and the ability to provide enough support that supervisees are challenged to promote learning and growth. Gus thinks that supervision is a space for experiential learning. He often invites supervisees to step into the shoes of their clients. He helps them explore the unique balancing act therapists play with clients, enabling them to be with, but not within the memory, to retain the potential for powerful processing on the edge of the window of tolerance. Many supervisees, he argued, may need to be helped to explore this zone by encouraging them to apply and integrate phase two to resource and regulate as and when needed, avoiding the risk of too much or too little affect before the desensitisation begins.

Gus demonstrated these ideas in a series of video clips using a role play with his supervisee to explore an anonymised case.  Shane, a 47-year-old, was struggling with letting go of the past and unable to live fully in the present. When working with this sense of ‘stuckness’, Gus identified the need for congruence of the target with the client presentation.  If this is not obvious it may sometimes be necessary to follow up on the sensations and emotions identified in phase three to uncover more congruent material. Gus creatively and expertly considered where the client was stuck, connecting first with the normal functioning part, then resourcing the potentially traumatised parts, and integrating the pendulation technique (now more commonly known as Flash technique [Manfield et. al., 2017]). This was done to access the adaptive information that can promote the capacity for self-healing. Gus showed this in the role play enabling the supervisee, as the client, to step back from the emotional precipice of fear to ease the defences which were protecting, but also preventing the uncovering of a workable target.

Gus wound up by reinforcing the need for good working relationships within the client, therapist and supervisor triad. Supervision, he suggested, helps supervisees reflect on the processes in professional, personal and projective relationships. He called for this to be considered further in the continuing evolution of EMDR (and its supervision) towards its status as a psychotherapy.  

A couple of days later I was in the main auditorium for the keynote presentation of Dr Ignacio (Nacho) Jarero. With any conference there are many ideas that I walk away with. Most of these seem to dissipate over time or become integrated into my work without me really recalling where they came from. It is like slowly collecting stickers for a sticker album – who remembers the shop when you finally have Jack Grealish? This time was different, and I heard something that I will remember.

For many years I have been interested in the connection between the therapeutic relationship, transferential issues and emotional contagion, and the possibility of vicarious trauma. I even undertook my own research trying to find a biological measurement that could be used to show when therapists may be vulnerable. My doctoral research (Hurn 2015, unpublished) suggested that measuring heart rate variability (HRV) might be a useful indicator. I found also that many therapists had positive experiences of their sessions at a biological level. I never really found an answer for this until I listened to Dr Ignacio (Nacho) Jareo. He was discussing the idea of ‘vicarious resilience’ in his keynote presentation. He started with the inspiring story of the farmer who had lost everything – home, business and family in devastating floods. All he had was a chicken and his determination to rebuild his life and to be a survivor. Dr Nacho explored the internal and external factors contributing to a resilient personality, the ability to adopt an adaptive, optimistic and flexible approach to adversity. Then came the key point. As therapists we can work with survivors of trauma helping them heal but also transforming ourselves vicariously through their resilience. As a member of the SIG in EMDR and Spirituality it was lovely to hear how he linked this to spirituality as a pathway to greater resilience. This he said might be achieved through four components.

1.  Purpose – linking positive and negative events to a positive outcome
2.  Meaning – providing an explanation for the event
3. Transcendence – the sense of a constant presence
4.  Relationships and support systems to help confront challenges and reduce feelings of loneliness.

So maybe my research can now be explained. The therapists I studied although facing the possibility of vicariously experiencing their clients’ traumas could also through the skill of their work vicariously build their own resilience. Thanks for the missing sticker for my album Dr Nacho.

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References

Laliotis, D., Luber, M., Oren, U., Shapiro, E., Ichii, M., Hase, M., . . . Tortes St. Jammes, J. (2021) What is EMDR therapy? Past, present, and future directions. Journal of EMDR Practice and Research, 15 (4). doi: 

10.1891/EMDR-D-21-00029

Manfield, P., Lovett, J., Engel, L., & Manfield, D. (2017). Use of the Flash Technique in EMDR therapy: Four case examples. Journal of EMDR Practice and Research, 11(4), 195–205. doi:10.1891/1933-3196.11.4.195