EMDR Therapy Quarterly

Report and reflections on a presentation delivered by Matthew Wesson at the EMDR UK Annual Conference 2025

How to deliver bad news

Command HQ (aka EMDR Conference Committee): “So, Matt, your mission, should you choose to accept it, is to tell the EMDR community that they risk becoming redundant because they’re failing to deliver the evidence base to NICE research standards. Oh, and you’ll have to deliver this message at the EMDR UK Conference, at the end of a long first day – just before the boozy social.”

Matt: “Mission accepted.” (cue theme music from Mission Impossible).

So, how did it go?

Matt Wesson presented a masterclass on how to deliver bad news. He was open about his strategy from the start, which was to make his pitch funny and lively alongside the controversy. He hoped this would keep his audience awake and engaged. He would be sharing uncomfortable truths, and he did not want his audience to shoot the messenger – hence photos of his pet dog, Hilda, who he knew loved him. (cue laughs).

He also made use of a classic therapeutic tool to soften up his audience, namely, the paradoxical injunction. He warned us that what we were about to hear would make us feel uncomfortable and that this discomfort was due to our cherished basic assumptions being challenged. These were our ‘knowledge shields,’ and they were preventing us from learning. He urged us to stay open-minded because we all want to be more effective trauma therapists, don’t we?

Trauma therapists need to be able to sit with discomfort. So, as I sat there, laughing and squirming through the presentation, my ego kept reminding me, “Don’t reject this, Jessica; you want to be a better trauma therapist, don’t you?”

Very cleverly done.

Why watch this presentation?

If you have not seen this presentation, please do so. Despite the many other excellent talks at the conference, this one may have been the most important presentation of them all. This is because if we do not reverse the trend that is diluting and complicating EMDR, we will not be able to ensure it remains an evidence-based therapy. Patients who could benefit will be deprived; funding for EMDR training will dry up, and at a certain tipping point, we will lose any foothold we have worked so hard to achieve. Because of this, ambitious and talented new therapists will choose not to train in EMDR because there will be no point, as there will be no career path.

I recently discovered that there are around 30 University Clinical Psychology courses that offer CBT training. There are only two that offer EMDR training, and one of those is about to lose its funding (personal communication from Dr Johnathan Hutchins). Matt warned us that we need to adapt to the reality of NHS public health priorities and not expect them to adapt to us. As Darwin and Russell Wallace described in their theory of natural selection – what does not adapt does not survive.

There would be no more EMDR UK.

No more EMDR conferences.

No more EMDR treatments.

Extinction.

What is the problem?

In 2018, NICE downgraded EMDR as the treatment of choice for veterans and children. It limited the provision of EMDR to other adults with PTSD only. Although we know it is effective in treating other presentations, such as depression, anxiety, phobias and OCD, we have not delivered enough gold-standard research to influence NICE. Practitioners in the NHS are now caught in a catch-22 situation. They cannot collect research data on EMDR’s efficacy with different client populations because they are prevented from offering it to them.

Why is this happening?

• There is not enough research into the EMDR training model (Miller, 2024).
  It could be that our current training models are too long for teaching PTSD treatment and too short for covering all the other complex presentations. The requirement for three clients is too vague. What kind of client? Can they be colleagues? Should they have a diagnosis? Which diagnosis? The assessment criteria are not stringent enough. How do we know those clients have been seen? Should videos be submitted? – there is a need for closer governance of qualification criteria. Lastly, the eligibility for training needs to be stricter as some therapists are not really cut out for trauma work. Farrell and Keenan (2013) noted a lack of confidence in many therapists after the basic training, which brings us to the next issue…

• NICE is worried that therapists are not delivering EMDR in a consistent way. This is partly due to what has been termed “therapist drift” (Waller, 2009). Matt expressed exasperation that some of us are obsessed with changing something that works. When we drift away from the model we were trained in, patients can receive a less effective therapy that could be harmful (Speers, 2022). There followed an amusing but uncomfortable section where Matt described how therapists consistently overate their skill level – 25% rated themselves in the top 10% and no one rated themselves in the bottom half (Walfish et al., 2012). Haarhoff’s (2006) work described therapists who set themselves demanding standards, see themselves as a “special, superior person” and a bit of a maverick, so want to do their own thing. There is also an over-reliance on the therapeutic relationship and a belief in what Meehl (1973) called the “spun glass theory of the mind” – the idea that clients are too fragile to cope with the standard therapy and need special conditions. Even though for the rest of the week, their lives are pretty difficult anyway. Too many EMDR therapists are avoiding exposing clients to the trauma so they can heal, on the grounds they are dissociative. Muriel et al. (2010) found that dissociative clients benefited equally from exposure elements of trauma therapy.

What can we do about it?

After this challenging portion of Matt’s talk, accompanied by nervous laughter in the room, he offered some recommendations for the future:

• Be realistic about the context. If research into EMDR effectiveness is not delivered soon, it will inevitably be downgraded further by NICE.

• Effective research needs consistent delivery of the evidence-based model. Trainees and supervisees need to be assessed as to their fidelity to the model and strongly encouraged to remain faithful to the evidence base. Matt recommended that everyone be aware of the EMDR Fidelity Rating Scale (EFRS-Version 2.1) and that consultants and trainers use it more often to assess their supervisees.

• Conduct research into EMDR training effectiveness, e.g., comparing online training to in-person; research the criteria that make some trainees more and less suitable for trauma work and restrict training eligibility as a result: get more clarity on the definition of three training patients; increase clinical governance and oversight on those patients; require more than three to qualify.

• Supervisors need to do more live supervision and view more videos. He stated that, “Videos are not just for accreditation but can be used throughout one’s career.” Supervisors could offer more group supervision using the EFRS.

• Newly trained therapists need to restrict their CPD to those events that will help them to consolidate their model. Refresher courses are of more value at this level than advanced adaptations. This builds confidence in trainees and supervisees to address the trauma directly, using increased stimulation to stabilise dissociating clients rather than jettisoning the model too early.

• Conduct research into EMDR with veterans, other adults and children to ensure fidelity to the model. Adaptations should focus on adapting the standard protocol to different cultures/diversity to make it more accessible. We need to research whether tapping and sounds are as effective as eye movements in processing the trauma.

• Offer standard protocol to dissociative clients and increase the stimulation to help them tolerate the memory, as the evidence from Dutch studies shows that dissociation lessens after treatment.

• Keep the conceptualisation simple using the three-pronged approach of identifying past, present and future targets and focusing on the traumatic events presented by the client. There may not be a need to do as much floatback/bridgeback as is often believed. Shapiro recommended using floatbacks only if you could not find the earliest memories. Start with the worst memory (van Vliet et al., 2024), as this consistently gives the biggest treatment effect.

Response from the audience

After the laughter had died down and ruffled feathers had been self-soothed, with limited time for questions – there was only one – a very helpful question about asking clients to choose their own preferred BLS.  Matt replied that he understood why therapists were doing that but stated, “How can that be an informed choice when the evidence shows it is eye movements that are most effective?”

There was a definite buzz in the room.

I noticed more than one therapist approached Matt after his talk to defend their unique adaptations to therapy, which kind of proved his point.

The next morning, knowing I was writing this article, Matt and I talked about dissociation and Dissociative Identity Disorder (DID). I explained I was currently treating two clients diagnosed by a consultant psychiatrist with DID using microprocessing – ”and now I have guilt!” He asked me how often I get to work with DID clients, and I explained that it was a pretty rare occurrence, even when I worked in the NHS – possibly one every few years. I asked how often he came across DID in the prison population, and again, he reported it was rare. He explained that he often finds therapists claiming a “very high percentage” of their clients have DID, when it has been self-diagnosed and is a lot rarer than therapists realise.

As I met with colleagues, it was clear Matt’s talk had made an impression.

A practitioner in the NHS, asked:

“How many therapists who offer remote EMDR have access to platforms/software with BLS functionality, including eye movements? It would be interesting to know if in the NHS there are organisations who enable this, as remote sessions tend to be delivered on Attend Anywhere or possibly MS Teams.” – meaning that NHS therapists may be being prevented from offering eye movements due to the platforms being used.

I found the talk confronting yet stimulating. I decided then and there to become better acquainted with the EFRS and to apply it to my own and my supervisees’ practice. Not for the first time, I wondered how the EMDR Association, with its membership of 7,000 therapists, could, in an ethical way, tap into all their data in order to offer up more gold-standard research evidence. There must be a way of mobilising our membership as a research resource. Exposing EMDR therapists to this difficult information does not have to lead to controversy and pushback – it can also inspire and galvanise us. Posttraumatic growth, one could say.

Let’s be better!