EMDR Therapy Quarterly

Radical Hope: Report and reflections on a presentation delivered by Hope Payson at the EMDR UK Annual Conference 2025 

Hope Payson demonstrated her activist credentials from the very start of her presentation. The previous day, the US government had published a list of forbidden words not to be used by government-funded bodies or those seeking funding. It was too late for Hope to change her presentation, and she responded by highlighting every forbidden word in her PowerPoint in blue. She certainly knows how to convey a message.

As trauma therapists, we work with people who have been on the sharp end of oppression and the abuse of power. Those working with addiction know that such trauma plays a fundamental role in its development.

Hope divided her presentation into two parts. The first set the scene, describing her work with people with addictions, many of whom were in and out of the prison system. She told us how, on her way to her office, both she and her clients must walk past the neighbourhood heroin dealer. She asked him if he would move, but he wanted her to!

The second part was a creative demonstration of how she uses EMDR to treat addiction, using audience members to represent negative cognitions, positive cognitions, triggers and resources.

Anyone can become addicted to substances, behaviours or both, and anything can become the object of addiction because addictive behaviours create the dopamine hits that get us hooked. Hope pointed out that:

“The faster the behaviour/substance acts and the more powerful it is, the more addictive potential it has. The more underlying trauma/neglect there is, the more at risk someone is of developing an addiction”.

She described how addiction has a pulse made up of stressors interspersed with the “flatline of neglect and missed developmental stages”. Addiction leads to the wiring in of emotionally charged triggers, which lead to urges and compulsions. As a result, the individual develops maladaptive ‘positive’ feeling states associated with their addiction, and this is what leads to the constant craving, wanting and seeking. She described a phenomenon called ‘cruel optimism,’ where agencies and well-meaning people repeatedly tell people with an addiction that recovery is possible when they do not grasp the intensity of its grip.

Hope was generous in sharing what she had learned from her extensive experience. For example, how often have we, as EMDR therapists, felt overawed by the sheer amount of trauma suffered by our clients and not known where to begin? Hope’s answer is to cluster experiences under the heading of different negative cognitions, e.g., ‘I am powerless,’ ‘worthless’ or ‘I do not matter.’

Hope enlivened her presentation using video clips showing some of her clients talking about their experiences. The way in which addiction evolves as a maladaptive response was beautifully illustrated by her story of a charismatic man who was born to be a leader but never got a break in his life. The only option open to him to feel powerful and connected was to become a drug dealer. Once he got clean, he discovered a new pathway, by becoming a sponsor. He became the most popular and successful sponsor in the community. He found a more adaptive way of being powerful and connected.

EMDR treatment planning for addiction

Hope described how she planned her treatment for a particular client, a young woman who had been trafficked. She used audience members to represent each stage, asking them to hold banners. This approach certainly amused the audience and kept us all engaged.

She teased out the negative cognitions and clustered the trauma events into each of them, e.g., ‘I am worthless,’ or ‘I do not matter.’ From there, it was an easy step to identify what the positive cognitions were that were associated with the addictions. These were the maladaptive positive cognitions, e.g., ‘I am powerful,’ or ‘I am connected.’

She then found out what external and internal triggers troubled her client the most, and this was where she was able to contain her with resource figures and memories that emphasised her strengths. Hope helped her to identify her NA sponsor, her determination and her parole officer as resources and strengths.

To contain the inner triggers, such as strong emotions, and prepare for external ones, Hope used containment exercises and future templates (e.g., “What will I do when…?”). She used Jim Knipe’s Positive Affect Tolerance protocol (Knipe, 2018) or Miller’s Feeling-State protocol (Miller, 2011) to process the maladaptive positive cognitions. Gradually, the client started to see the links between these maladaptive positive cognitions and her addiction and suddenly realised why dealing helped her to feel powerful and connected.

As the maladaptive positive cognition was processed, the true traumas emerged – being trafficked, the sexual violence – and this was when the client really needed all her courage to dig deep. This was when Hope processed the most representative memories in the trauma clusters using the standard protocol.

I found Hope’s presentation to be a tour de force; she is obviously a highly skilled EMDR clinician. She managed to be witty, compassionate and politically astute. I entitled this review ‘Radical Hope,’ a term coined by Jonathan Lear (2006), who describes it as a form of hope that is needed when the outlook appears truly bleak. Hope Payson’s approach to addiction certainly brings radical hope to those of us working in treatment, or to those struggling with addiction themselves. This hope is not cruel.