Winter 2024
By Mark Brayne
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People often ask why we need dedicated training in working with attachment in EMDR when it is of course integral to the practice of most EMDR practitioners, whether we’re taking a standard protocol phase 1 trauma history, using floatback, or identifying blocking beliefs. Whether we explicitly identify it or not, attachment is surely always a part of the therapy we deliver. In our manuals defining what EMDR actually is and how it must be practised, however, it’s striking how infrequently the word ‘attachment’ itself appears. Francine Shapiro started out, after all, as a psychologist in cognitive treatments rather than as an integrative, relational psychotherapist. That may be why, even in the definitive third edition of her book (Shapiro, 2018) which still serves as the ultimate authority on what constitutes legitimate EMDR, ‘attachment’ in the sense of a core developmental experience is referenced just nine times, and then only in passing.
Invitations to prioritise attachment awareness were earliest and perhaps most prominently raised as an explicit focus for EMDR by Laurel Parnell in her Therapist’s Guide to EMDR, Norton (2007), and explicitly brought to the attention of the wider EMDR community here in the UK only in the early 2010s. And while, as the late Queen might have observed, recollections may vary, it was my own experience at that time that Parnell’s advocacy of a new approach to EMDR came up against a good deal of individual and institutional resistance, admittedly not unusual when something new is introduced to communities and organisations that are built on ideas. Thankfully, attachment is now increasingly accepted as central to effective EMDR. Even though she is no longer formally affiliated with EMDRIA in the USA, this is reflected in the popular workshops and writings of Dr Parnell and also now in the training of two of Francine Shapiro’s closest US training associates through the years, Deany Laliotis and Roger Solomon. Laliotis has written powerfully about the importance of the therapeutic relationship in EMDR, offering trainings in what, echoing Parnell, she calls attachment-focused EMDR.
At the same time, I am not alone in hearing it reported back from mainstream basic EMDR training here in the UK that, whatever the reassurances one might hear after the event, attendees starting out on their EMDR journey can be left feeling discouraged from adding additional attachment-focused or, to give it its now more widely used descriptor in the UK and Australia, attachment-informed (or AI-)EMDR to their portfolio.
What I’m about to say may be taken by some as heresy. But based on my own practice with clients, with supervisees and developing ever-evolving workshops in AI-EMDR, I believe now is the time to openly, and I hope politely, challenge the notion that basic EMDR training, as currently understood and delivered, is sufficient on its own for a beginner to launch into their journey as an EMDR therapist.
Explicit understandings of attachment and the importance of formative experiences earlier in life need, in my view, to be factored into all training in EMDR from the very beginning, literally from day one, just as I believe that an explicit introduction to EMDR should now be encouraged, wherever possible, towards the end of all masters-level training in psychotherapy. Taking a comprehensive trauma history or listing the 10 worst events in a client’s life as a first introduction to EMDR is, after all, phase 1 of the 8-phase EMDR standard protocol and activates powerful early dynamics that can prove counterproductive to effective work. Then, moving forward into the standard protocol’s phase 3 ‘assessment’ (more appropriately understood as targeting and activation), an overly rigid emphasis on numbers and cognitions can seriously derail the kind of facilitative and kind EMDR that clients (who present with what is at root attachment-informed emotional, behavioural and cognitive wounding) need. I have argued this in the pages of EMDR Now as long ago in fact as October 2014.
As Gabor Maté powerfully argues (Maté, 2023), it is, after all, not the external events that happened to our clients that are actually the problem. Central to all presentations is the capacity of an individual’s nervous system, informed and so often compromised by early-life formative experience, to process, recover from, and make meaning of those events, big and small. The result is that the disconnects of early life – tens of thousands of them in the dance of maternal attachment – continue to resonate into the present as if they are still happening. That’s what’s sometimes called trauma time looping in the past, as Shapiro describes it, stored in “state-specific form” – emotionally, somatically and cognitively.
So, given that the nervous system’s attachment-informed survival response is, deep down, underneath everything that clients bring to us, my argument here is that the attachment-informed approach should be at the heart of all EMDR training.
In 2018, the British Psychological Society published the Power, Threat, Meaning Framework (Johnstone & Boyle, 2018). This was the culmination of a project designed to develop a “conceptual alternative to psychiatric classification and diagnosis” (p.13). The question ‘What is wrong with you?’ lies at the heart of the medicalisation of distress, and the PTM Framework proposes replacing this with four questions:
The authors of this framework argue that the co-creation of a workable formulation (case conceptualisation) should be at the centre of all psychological work, as it provides an alternative to psychiatric diagnosis and a roadmap into the spaces where a client’s problems began and how they are maintained.
The PTM Framework sums this up neatly:
From a formulation-based perspective, the work of every mental health professional should be based on the principle that however unusual, confusing, risky, destructive, chaotic, overwhelming, frightening or apparently irrational someone’s thoughts, feelings and behaviours are, there is a way of making sense of them.
(p.303).
Based on two decades of my own experience with EMDR, of observing Laurel Parnell many times in action, and of noting where my own practice and live workshop sessions are successful and less so, it is my contention that attachment-informed EMDR sits authentically within the PTM framework. I might, in passing, note here that the term attachment-informed is perhaps more embracing of rich formative experience than Laurel Parnell’s “attachment-focused”.
Very little has changed in our evolutionary and neurological make-up since we emerged as creatures of the plains of Southern Africa around 200,000 years ago. As homo sapiens evolved in an environment replete with predators, we were and are in effect prey animals, dependent for our survival on attachment, connection and relationship with the group. As Gabor Maté reminds us in his many podcasts and online interviews, if we don’t have a safe connection with our primary caregivers, with our immediate family, or with the wider village or community, we die. It’s as simple as that. Predators seek to separate the vulnerable, the sick, the wounded and especially the young from the herd, and we’re lunch. So when there is a conflict between attachment and authenticity, when it’s not safe to be ourselves with those caregivers or to share and show our true emotions, attachment wins every time.
Whatever the form of psychotherapy or treatment we use, the same key questions apply, and not just to EMDR. How did this client get to be the way they are? What is their presentation really about? If we drill down, using perhaps a kind of CBT-derived downward arrow of attachment-informed exploration, we find what might be understood as still-activating residues of a fundamental survival cascade, a succession of autonomic nervous system responses to threat. The concept of ‘fight, flight, freeze’ is now well embedded in public consciousness, if not profoundly understood. But if we pause for a moment and unpack what actually happens in the nervous system when it experiences an overwhelming threat, the sequence is perhaps more accurately described in a different and fuller order: flight, fight, freeze, flop, friend and fawn. (There are many more Fs, all of them polite, which can usefully be explored here in Sarah Schlote’s chart capturing the response hierarchy of neuroception.)
The immediate response to a threat, to life of course but also to identity and integrity, is the orienting response, the ‘oh goodness’ moment when the nervous system clocks that there might be a sabre-tooth tiger about to attack. Checking incoming sensory information – both exteroception from outside the body and interoception from within – against the evolutionary and personal database of previous, personal and collective experience, the human amygdala takes just 60 milliseconds to respond/react to whether something is ‘safe’, or ‘not safe’. To put this in perspective, that is four times faster than it takes the frontal cortex to register consciously that something dangerous might be happening.
If the amygdala’s experience-informed conclusion is ‘not safe’, then the immediate, visceral, evolutionary response is not fight but flight, since the system’s survival instinct is to move away from the threat. That is why in New York on 9/11 for example, you can see people looking up at the planes hitting the twin towers, their systems appraising the information as they realise that debris is about to fall on top of them. Their immediate response? Turn and run – an active-avoidant flight response driven by the primary emotion of fear. Decades later, that thwarted response can still resonate in a client’s adult nervous system as free-floating anxiety, as dread, as nightmares.
But what if you cannot flee from the sabre-tooth tiger, or explosion, or attacker (or angry mother or father) because they are bigger and faster than you? The next immediate nervous system response is fight – to turn towards, to approach, with the primary emotion of appropriate evolutionary anger. Both fear and anger activate the nervous system for action, for example, shutting down digestion, including saliva excretions in the mouth, and in extremis, emptying the bowels and the bladder, as the system focuses all its energy on muscles for survival-informed running or confrontation. A client presenting, for example, with chronic distress in the digestive system, with dry mouth, or of course, anger management issues is generally running an old, thwarted survival script of fight.
Now, what happens if the sabre-tooth tiger, parental figure, or abuser is bigger and stronger? In childhood, they will always be. Fighting a giant is literally life-threatening. The next responses in this survival cascade are therefore freeze and/or flop. Here, it’s the emotional midbrain, not the conscious frontal cortex, that decides. The freeze response is that of the deer in the headlights. The flop response is the lizard or the mouse playing dead. The cat, big or small, loses immediate interest and looks away, licking their paws – at which point the mouse or the gazelle is up and gone, activating the flight response again and getting back to safety in the herd.
Animals in the freeze or flop phase, of course, cannot feed, procreate, or even sleep, so what happens when that response has inevitably run its course?
Here, with an experience shared by perhaps more animals than we realise, the individual organism switches to what is usefully termed friend and/or fawn. To ‘friend’ is to appease, to smile inappropriately, to apologise all the time, to collude with the aggressor or stronger animal, perhaps even as Patti Hurst famously did when she was taken hostage by the Symbionese Liberation Army in 1974 in America, in the moment needing genuinely to believe in their cause – a response still unhelpfully known as Stockholm syndrome, where women caught in a bank robbery in 1973 were first and wrongly understood to have identified with and fallen in love with their captors.
Think also of those who have experienced coercive control and domestic violence in primary relationships. They might try to negotiate to maintain survival-informed attachment, such as to a parent or childhood attachment figure, long past the time when this was adaptive for them. Think also of how we, as members of organisations on whom our livelihood depends, might identify with dysfunctional processes, culture and goals, as happened tragically to managers and officials alike in the Post Office’s and government’s institutional response to sub-postmasters who were falsely accused of embezzling funds.
Using this evolutionary perspective in our understanding of and approach to all our client work relies less on formal history-taking and creating target lists than it does on what I like to call a radical curiosity around the implicit survival and attachment-informed sense their system has made of what has happened to them and how that’s presenting in the immediate here and now. In other words, what in their earliest life and formative experiences did they learn to do literally to survive, to manage emotions and to self-soothe, behaviourally, emotionally and cognitively?
I believe it is essential in the earliest phases of EMDR to use proactive ‘bridging’ (image, emotion, body, belief) to journey from the felt present to the formative past. The right brain, with access to emotional and narrative memory that is closed to the left brain, knows where we need to go (McGilchrist, 2019). In my experience with clients, nine times out of ten that bridge will take us into essential and not necessarily ‘traumatic’ attachment-informed formative moments in childhood, very often around the age of seven when the hippocampus and frontal cortex come online and are able to make explicit autobiographical meaning of the relationships between self, others and the outside world.
In passing, perhaps, as the intention is similar to bridging and knowing this is an ultimate heresy, just as EMDR’s phase 3 is about so much more than assessment, and phase 4 is much richer than desensitisation, I believe the term ‘floatback’ to be unhelpful. The very word invites the client to dissociate from the felt experience we are addressing and shift instead unhelpfully into their analytical and observational left brain. My proposal is that ‘bridging’ both as a term and a tool be adopted as part of standard EMDR phase 3 target identification/assessment.
Once we do find the necessary target, we can, of course, use the language and sequencing of the standard protocol (NC, PC, VoC, emotion, SUD, body). But as I already argued a decade ago, long before engaging as enthusiastically as I now do with AI-EMDR, the modified protocol of image, emotion, body, belief and optional SUD, without naming either PC or VoC in phase 3, is, in my experience, usually much more effective and client/therapy-friendly, not just with attachment-informed and early life targets. This simplified and direct approach, with much less analytical questioning, allows us to drill rapidly and efficiently down through the understandable ‘noise’ of maladaptive presenting behaviour – flashbacks, relationship difficulties, suicidality, total shutdown, or however that manifests – and, instead of prioritising immediate symptom reduction and avoidance of bad past stories, use an attachment-informed approach to travel through what might be termed fossil memories, skeletons in the cupboard, to the deeper ‘signal’ of a client’s earliest, necessary but now dysfunctional survival responses to life.
Clearly, that needs to be done with care and kindness, so as we approach the end of this article, let’s take a typical example.
Someone who has been sexually abused as a child may present with an overwhelming level of understandable ‘noise’, of symptoms and distress that are ruining their lives and their relationships. But even here, however counter-intuitive this might at first appear, the reason they remain this way today is not primarily because they were sexually molested. It is because, in the context of early life experiences and particularly of maternal attachment (every one of us is, after all, born of and to a female body after nine months of profound formative impact in the womb), our client’s nervous system has, for their lifetime so far, been compromised in its capacity to metabolise that experience. Either that child, for fear of parental response, could never tell anyone what the neighbour was doing, or when they did, they were told they were wrong, sent to their bedroom, or their own autonomous agency was overwhelmed by an over-smothering parental figure who took inappropriate responsibility and made it all about themselves. Our client has been left with the experience – the compromise of the soul, if you like – of their very identity.
In attachment-informed, as well as in standard EMDR and reflecting an old Chinese saying (Mao Zedong in 1950s and 1960s China talked about the importance to his revolution of both industry and agriculture), we “walk on two legs.” One leg is the client’s obvious and presenting history of Big T traumas, which of course need to be worked with. The other essential leg, however, is the more subtle, but in my experience, more important underlying dynamic: the quality or absence of appropriate repair to life’s ruptures, big and small. These are the stories that will ultimately provide the targets that deliver the necessary change in the client’s life now.
I propose that this understanding might serve as a paradigm shift in the treatment of mental health, and not just in EMDR. The formative experiences of childhood are, after all, the matrix, the individual database, against which all subsequent experiences are measured and responded to. I am not at all suggesting that taking a trauma history is a waste of time. But I do not advocate spending endless early sessions of EMDR therapy unpacking, for example, a client’s full chronology of bad stuff in the past, which may activate more than they can handle.
Instead, once a safe-enough relationship has been established (which might take minutes, might take months, sometimes, yes, even longer), I ask, if we could change one thing in this one session, what might it be? We then identify the freeze-frame, split-second moment where that distressing experience of self is being activated (not necessarily the worst part of this), and we bridge, almost always with astonishing accuracy, into the root rupture-and-absence-of-repair stories that need to be, as it might be formulated,‘revealed, rewired, and repaired,’ using every human being’s capacity, as in dreams (eye movement and bilateral stimulation again, after all), to reimagine the maladaptive experiences of the past and release their toxicity from the nervous system.
What I am encouraging as we listen to our clients’ stories is to prioritise an intuitive interest right from the word go about their underlying system response to life events that were laid down in their formative years, considering this, particularly in the context of maternal attachment, widening that out to siblings, father, family, grandparents, and school, society, and nation – and to just being a member of the human race with a legacy of three-and-a-half billion years of survival-informed evolution.
We could indeed call this survival-informed EMDR, but that would probably be misunderstood. So attachment-informed EMDR is where we end up.
Johnstone, L., & Boyle, M. (2018). The power threat meaning framework: An alternative nondiagnostic conceptual system. Journal of Humanistic Psychology, 0022167818793289.
McGilchrist, I. (2019). The master and his emissary: The divided brain and the making of the western world. Yale University Press.
Maté, G. (2022). The myth of normal: Trauma, illness, and healing in a toxic culture. Penguin.
Parnell, L. (2010). A therapist’s guide to EMDR: Tools and techniques for successful treatment. WW Norton & Company.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). The Guilford Press.
Research
Oleen Miranda-Stone shares the overwhelmingly positive outcomes from a pilot service that used EMDR to address the trauma arising from ACEs in a population who just did not fit in with the services that were already on offer. Not only did PTSD symptoms reduce significantly, but the lives of the clients improved dramatically too.
