EMDR Therapy Quarterly

Learning objectives: How does the review add to existing knowledge in this area?

This narrative review aims to synthesise literature on cultural issues and challenges in UK law enforcement affecting engagement with therapeutic interventions, specifically cultural competence in EMDR therapy.

Introduction

Eye Movement Desensitisation and Reprocessing Therapy (EMDR), originally founded and developed by Shapiro (2018), has provided strong empirical evidence in treating posttraumatic stress disorder and has also been found as an effective, transdiagnostic and integrative treatment approach for a wide range of diagnoses in a variety of contexts and treatment settings with diverse cultural populations (Laliotis et al., 2021), including working with the uniformed services. Shapiro (2018) considered culture as an essential component within the EMDR standard protocol enhancing the AIP model, which establishes the approach as a holistic therapy; an elevated level of training and clinician skill is therefore required for the delivery of EMDR treatment, especially in the face of increasingly complex trauma presentations in UK law enforcement.

The UK police force responds to millions of calls annually, and trauma rehabilitation with law enforcement frontline responders is growing worldwide (Syed et al., 2020). The latest figures state that approximately 17,000 officers across England and Wales were either on recuperative duties, long-term sickness or in adjusted posts due to mental health issues, and this has increased from 10,000 since 2017 (Phythian et al., 2022). Many of these officers, diagnosed with PTSD or CPTSD, require significant and appropriate rehabilitation. Brewin et al. (2022) also identified that police officers in the UK were more likely to develop CPTSD, described in the revised ICD-11 as the core six PTSD symptoms, clustered into avoidance, arousal and re-experience with the addition of disorder of self-organisation (Cloitre et al., 2018); the latter presentation is dependent on the volume of cumulative workplace incidents having occurred as well as any ACEs identified in assessments with officers.

Recent EMDR interventions have shown promising outcomes. An observational cohort study, conducted by Biggs et al. (2021), using clinical data from a trauma support service in the UK, found positive outcomes for personnel in the UK who received EMDR therapy from therapists in a six-to-eight-session model. Intensive treatments have also been developed rapidly over recent years, with excellent outcomes reported for police officers by Police Care UK (Rogers, 2023). The service evaluation showed promising preliminary results, with 93% of officers returning to work, as well as an 87% reduction in diagnoses of CPTSD or PTSD. They also reported a significant improvement in quality of life for those who undertook this residential programme.    

Despite these successful outcomes, changing attitudes and awareness of the effects of trauma on police officers, there still seem to be ongoing issues of stigma, which can affect officer engagement at every level of policing (Porter & Lee, 2024). The purpose of this review is to consider the recent literature on the barriers EMDR therapists face when working with this cohort, hoping that suggestions in the literature can help increase engagement moving forward.  

Police culture

Stigma is one aspect of police culture that has been covered substantially in research over the last few decades, presenting law enforcement well-being services with significant challenges. Royle et al. (2009) described stigma as a barrier to engagement in mental health services for first responders, the reason being that accessing any form of mental health intervention to assist in rehabilitation for police personnel means that there would be an admission of their inability to cope. Bullock and Garland (2017) added that stigma and social identity issues can drive difficulties in mental health presentation in police personnel, impacting the success of trauma interventions, including the quality of the interventions and the number of police personnel accessing services. 

The existing literature acknowledges that rehabilitation with police personnel involves balancing issues around police culture, such as operational stressors, organisational expectations and outside stressors (such as stigma), combined with internal individual factors such as self-stigma. These factors challenge engagement in rehabilitation, which affects therapeutic outcomes (Ben-Zeev et al., 2012; Edwards & Kotera 2020; Simmons-Beauchamp & Sharpe, 2022). Porter and Lee (2024) agree and include more specific reasons for these difficulties, such as machoism, gender differences, generational differences, work-life balance, public perception, resilience levels and the nature of the job – all of which can affect engagement.

Cultural competence in EMDR therapy

Cultural competence is essential in EMDR therapy, particularly when working with law enforcement, as it helps address challenges posed by police culture and mental health issues. Therapists must possess multicultural beliefs and skills to effectively engage with clients from diverse backgrounds, ensuring they understand the cultural impacts on the client group they are working with (Constantine & Ladany, 2001). Tervalon and Murray-Garcia (1998) present a concept of cultural humility that emphasises the importance of lifelong reflection and an awareness of cultural biases, which is crucial for building a therapeutic relationship, supporting the need for EMDR therapists to bridge the gap between themselves and law enforcement clients (Royle, 2023). McLeod (2025) also suggests focusing on the client’s cultural ‘niche’ – an individual’s unique social and cultural context – which can enhance rehabilitation efforts.

Various cultural competency models, including Relational-Cultural Theory and the ASK model, can guide therapists in designing culturally appropriate interventions (Frey, 2013; Nickerson, 2023). Additionally, the therapeutic alliance and attunement are critical factors in successful EMDR therapy, as noted by Marich et al. (2020), who emphasise the importance of flexibility, intuition and cultural awareness in addressing the client’s unique needs. This knowledge and skill set empowers therapists to embrace the officer’s current reality and historical background to overcome barriers such as stigma and self-stigma in the therapeutic setting (Levis, 2017).

Method

A narrative review was chosen, as this is a reasonably new line of enquiry in EMDR therapy. Information was synthesised from interdisciplinary sources, giving a unique insight into what may be considered a gap in EMDR therapy research (Chaney, 2021). The synthesis process reflects the hourglass model describing the inversion of the research process, where the ending of one phase provides the beginning for another. This strategy is helpful for a researcher where there is a clinical problem that may be of concern to practitioners, and some of the possible answers may be based on a theoretical framework and/or a clinical hunch as to how these issues could be addressed (Rowland & Goss, 2000). The articles selected build on each other regarding theory and findings, and clinical ideas emerge as possible thoughts for future research. 

The research databases consulted were APA PsychArticles, Academic Search Complete via the EBSCO search host, the Meta database and Google Scholar (Renner et al., 2022). Boolean search terms included: Law Enforcement AND Culture AND Mental Health; Police AND Mental Health AND Stigma AND UK; EMDR AND Police Identity; EMDR AND Cultural Competence.

The inclusion criteria comprised peer-reviewed articles, RCTs, literature reviews, other qualitative enquiries, book chapters and international and British research published between 2019 and 2024. The exclusion criteria comprised dissertations, magazine articles and conference papers. Theoretical depth was considered, whereby each article was screened using a backwards search representing the review of citations in the identified literature (Renner et al., 2022), revealing specific standard citations expected for research in this area. PsychInfo and Academic Search Complete provided more specific findings for this review. Google Scholar was considered supplementary to the principal research systems, focusing on recently published research. Systems such as Google Scholar have been reported to fail query tests, and do not support the Boolean search functionality, resulting in less specific findings when conducting a database search (Gusenbauer & Haddaway, 2020). However, some useful recent articles were sourced in this case. Below are the number of articles accessed through each search engine: 

Table 1. Number of articles accessed

Academic Search Complete N=35	PsychInfo   N=84	Google Scholar N=4010	Total N=4129
After initial screening of abstracts and duplicates removed N=3	After initial screening of abstracts and duplicates removed N=5	After initial screening and duplicates removed  N=14	N=22
Final articles included N=1	Final articles included N=2	Final articles included N=2	N=5

The Critical Appraisal Skills Programme (CASP, 2022) analytical tool was used to analyse the quality of each of the 24 articles chosen after initial screening using the qualitative checklist. CASP is the most used tool to check for quality in qualitative evidence in health sciences and has an endorsement from the Cochrane Qualitative and Implementation Methods Group (Long et al, 2020). Five articles were chosen from this list, and findings from this process are shown in Appendix 1.   

Results

Awareness and knowledge of police culture, including stigma and identity theory

The main findings of the Soomro and Yanos (2019) study concurs with much of the previous literature on stigma regarding lack of engagement and negative stereotypical attitudes to mental health in policing. Stigma and self-stigma appear to be higher among police officers compared with the general public, especially officers diagnosed with PTSD. This is an important finding, as it potentially forms a baseline of attitudes to, and engagement, with mental health services and could increase challenges to rehabilitation in the more severe cases. Ben-Zeev et al. (2012) description of stigma may explain why this happens in policing. More specifically, public stigma, where the individual is aware of the stereotypes held by the public, or in this case, the wider attitudes in the police force about those who engage with mental health interventions, therefore leading to self-stigma. The individual consequently applies these stereotypes to themselves, leading to a more internalised form of devaluing themselves, which can prevent them from trying to achieve their personal goals. Other influences, such as the ‘why try effect’ identified by Corrigan et al. (2016), are explained as a sense of futility that occurs when individuals apply mental illness stereotypes to themselves. This hampers their belief in achieving personal goals, increasing feelings of helplessness and, therefore, engagement in rehabilitation (Ben–Zeev et al., 2012).

Royle et al. (2009) also explained the concept of cognitive separation occurring within the individual into categories of ‘them and us’ regarding mental health. This manifests when an officer feels it is too risky to access or engage in help, fearing they will be perceived as weak within their group. They ultimately avoid shame by not accessing or engaging with therapy. Label avoidance, therefore manifests in avoidance or no acknowledgement of symptoms to avoid any form of stigma associated with mental health intervention (Ben-Zeev et al, 2012).

Soomro and Yanos (2019) also noted that wider police culture potentially needed investigating as a potential trigger to stigma amongst officers, aligning with findings by Turner and Jenkins (2019), who found that while officers recognised the seriousness of psychological distress, they often attributed it to bureaucratic issues, which reportedly discouraged openness about vulnerability. Higher PTSD scores correlated with greater self-stigma, affecting engagement in support services. Although the Soomro and Yanos (2019) study was carried out in the United States, there is a worldwide consensus that social support and occupational stress (including police culture and stigma) result in difficult coping strategies and contribute to mental health difficulties, and therefore findings are considered relevant to the UK (Syed et al., 2020). 

Edwards and Kotera (2020) found that the wider police culture in the UK played a much more significant role in mental health attitudes. Results from five officers concurred with previous stigma findings, highlighting self-stigma and stigma at an institutional level rather than the impact of the job itself (Bullock & Garland, 2017). This reportedly affected police officers in disclosing their mental distress due to perceived peer judgement and a fear of not being supported in the workplace, bringing a whole host of worries for their career in policing, including the consequences of taking time out.

Machoism and masculinity (as a part of broader police culture) continue to be regular descriptions of policing culture in the UK. They are often perceived as negative, which was supported by more recent findings by Porter and Lee (2024). As part of exploring gender beliefs across genders in policing, Silvestri (2017) found that displaying emotion was perceived as a weakness, and emotional detachment was valued for the most part across all genders. Bell and Eski (2016) also considered the positive effect of canteen culture, which embraced machoism, and how it helped police personnel carry out challenging duties. They described canteen culture as a form of emotional support, despite it exacerbating stigmatised beliefs about mental health. Due to the scrapping of canteens, increased workload and pressure to address stigma, access to this form of interaction was reduced, and although it is generally now regarded as more negative than positive, a void was left in support for officers.

Key findings from Demou et al. (2020) in Scotland also acknowledged that operational trauma existed, but that organisational issues were equally as problematic in perpetuating mental health issues. The stigma around mental health had reportedly lessened but still prevented some officers from seeking help. Overall, it was suggested that it was essential to acknowledge police culture moving forward and that police organisational culture constructed police identity and practice.

The results appeared more favourable regarding the effectiveness of some well-being interventions on stigma. This is supported by Porter and Lee (2024), who found improvements in engagement and attitudes towards mental health in British policing; however, added factors such as generational influences and length of service emerged as an additional concern. Younger officers were reported to have different perspectives on work-life balance, leading to tensions with older cohorts, who sometimes viewed their younger counterparts as less resilient, partly due to limited experience and time served in the job.

Edwards and Kotera (2020) continued to emphasise the need for more research on interventions to measure outcomes for preventing and managing mental health issues. They recommended involving occupational health, and recent research acknowledges that most occupational health departments in the UK now offer short-term counselling and trauma interventions. (Rogers, 2023).

The research broadly indicates that stigma surrounding mental health issues remains prevalent among UK police officers, despite initiatives like Oskar Kilo (Phythian et al., 2022) aimed at breaking down mental health taboos in forces across the country. Bell et al. (2022) further broke down wider organisational challenges, including relationships with supervisors, occupational health and policies on performance and sick leave, potentially discouraging officers from seeking help for their mental health concerns. While some progress seems to have been made in reducing stigma in UK policing, it appears there is still some distance to cover in ensuring a robust support system for officers, as there appears to be inconclusive evidence on how cultural issues are perceived across UK forces. Insight into police identity may offer some insight into assisting this process for EMDR therapists.

Identity theory

Royle (2023) discusses police culture through the lens of social identity theory, highlighting the importance of in-group/out-group dynamics and cultural norms for police officers. The key norms identified include mission focus, control focus, commitment, action, decisiveness and pragmatism, which help officers navigate chaotic situations and maintain a sense of competence. However, when officers experience PTSD and CPTSD, negative thinking can undermine these internal constructs that once kept them functioning, potentially leading to a deep existential crisis where they dramatically question their lives and existence. The tension between culture, identity and stigma, therefore, increases and poses challenges to the EMDR therapist in engaging with and facilitating recovery for affected officers.

Richards et al. (2021) challenged social identity theory as the only explanation in the context of considering help-seeking behaviour through a social cognitive theory lens, questioning the in-group/out-group notion as a stand-alone explanation. Determinants for seeking mental health support were measured through social and environmental factors, such as family support, departmental culture and societal views; behavioural outcomes, such as harm to career and stigma; and self-efficacy considerations, such as education and awareness, perception of services and personality factors.

It was considered why someone may or may not seek help and/or engage with a psychological intervention to ensure the best outcome in recovery. The findings suggested that mental health support also varied between police organisations and locations, which hampered the effectiveness of trauma interventions.

These findings concur with Drew and Martin (2021), suggesting that the relationship between help-seeking behaviour and culture/stigma may be more complex than first thought, as various studies provided contradictory results on the tolerance and perception of stigma in policing (Bell et al., 2022; Demou et al 2020). Notably, these studies were conducted in different parts of the UK, suggesting that differing cultural norms and expectations in policing groups are potentially evident, depending on the area.

This presents a challenge when applying identity theory across the board. It suggests that policing in the UK is not homogeneous and diversity within UK policing, including differences in rank, role, and exposure can affect engagement. A tailored approach to research, well-being support and rehabilitation that considers regional and individual cultural differences, may therefore be more effective (Foley et al., 2021).

Cultural competence with law enforcement and the EMDR eight-phase protocol

Royle (2023) describes how cultural theory can be integrated into the EMDR therapy protocol with law enforcement. Practical considerations during history taking and the preparation phase in working with this cohort are clearly considered, with an emphasis on framing, reframing, justification, and, importantly, collaboration in case conceptualisation in the early phases of treatment.    

The preparation and assessment phase needs to be tailored culturally in a sensitive way. Once underway, the desensitisation phase may call for culturally sensitive interweaves to move the process on, of which there are helpful suggestions. Most importantly, understanding police cultural identity can help therapists build rapport with this group and help the shift from loss of group identity to regaining their cultural identity, thereby breaking down the stigma around mental illness.

If identity theory is important in helping to navigate police culture in the rehabilitation process, viewing identity as a multilayered construct could be helpful. Hecht’s (2014) Communication Theory of Identity (CTI) views identity as a complex, dynamic and layered concept that is shaped and expressed through communication. The theory contains four identity layers: persona (self-perceptions and the internal sense of self), relational (identity through personal relationships), enacted (identity in their day-to-day communications) and communal (identity influenced by society, culture and organisational affiliations). Police identity could be explored by therapists with their clients using these layers to help the officer negotiate, express and experience their identities through communication within the various contexts they find themselves in. Identity is reported to be layered and multifaceted, evolving through communication and interaction. Essentially, communication can help the officer to express, maintain and modify their identity. This could be helpful for the EMDR therapist to consider (instead of what Hecht regards as simpler theories of identity, such as Tajfel’s social identity theory and Bandura’s social cognitive theory) and could provide a more realistic platform from which to engage with law enforcement so that culture is navigated carefully in a deeper relational way (Hecht, 2014).

Relational attunement has long been considered imperative when delivering EMDR therapy. The neurobiological aspects of relational work in therapeutic interventions like EMDR therapy focus on appraisal, arousal and attunement, which are crucial for both the clinician and the client. Effective appraisal and internal clarity enhance the therapist’s ability to attune, allowing the client to engage deeply in trauma work (Dworkin, 2006).

Unlike other therapies, EMDR therapy features a dynamic shift in the power of the therapeutic relationship throughout the protocol. In the initial and closing phases (1-2 and 5-8), the therapist’s power is greater due to directive interventions, whereas in Phase 4 (desensitisation), relational power increases, making attunement essential. If a client feels unsafe, processing may be hindered due to activating memories. Deep empathic attunement – where the therapist remains grounded yet open to the client’s feelings – is vital for successful processing (Parnell, 2013). Additionally, attentiveness to interweaves during Phase 4 is key for maintaining connection and addressing blocks. Therapists should use culturally sensitive language and responses to enhance effectiveness, particularly concerning clients’ cultural identities during Phase 4, and when it comes to police officers, paying attention to these considerations is crucial as their identities form a key part of their day-to-day lives (Royle, 2023).

Cultural competence in EMDR therapists

Findings by DiNardo and Marotta-Walters (2019) provided a helpful starting point in considering the current state of cultural competence in EMDR therapists in general. They emphasised the need for therapists to consider the universal, group and individual identities of clients as part of the Tripartite Model (Sue & Sue, 2012). Intersectionality also provides a nuanced explanation of the complexity around cultural identity constructs. Police culture could be described as an example of an occupational culture comprising its own subcultural or micro world with its own set of values and ways of relating. Utilising the concept of intersectionality, therapists may get closer to the unique combination of identities and values exhibited by individual police clients, irrespective of their group identity. The invitation to be curious about the range of cultural identities and memberships that matter to the client is said to enhance the therapeutic process and was considered valuable in relation to working with clients who experienced cumulative stigmatisation, marginalisation and oppression arising from intersecting identities (McCleod, 2025).

DiNardo and Marotta-Walters’ (2019) research also revealed that more than 50% of practitioners view EMDR as a universal therapy rooted in neurobiology, suggesting a lack of depth in acknowledging cultural aspects. The meaning of these findings challenges the conscious attitude towards the importance of cultural considerations in rehabilitation within EMDR therapy, as cultural research has explicitly suggested that correctly harnessed cultural intuition can greatly empower clients both in and out of therapy (Levis, 2017).  

The nuanced implicit findings of DiNardo and Marotta-Walterss’ (2019) research found that practitioners mostly used Germanic-origin words when describing different aspects of the protocol pre- and post-processing. These words were reported as a more authentic way to communicate, aiding the therapeutic relationship, which would help engagement in therapy during history taking and the preparation phases of EMDR therapy.

Relational-Cultural Theory supports the importance of therapist responsiveness and authenticity and using culturally sensitive language, the police officer’s social/cultural unconscious can be navigated effectively, which can guide group and individual communication and behaviour (Frey, 2013; Weinberg, 2007). 

Cultural communication is important in addressing issues such as transference and resistance in therapy. Resistance from police officers can signify a disconnection or dissociation that, when reframed, serves to protect their integrity and identity (Frey, 2013). Understanding this resistance can facilitate authentic connection and change in clients to address cultural issues more explicitly in EMDR therapy.   

Discussion

The importance of cultural competence and the focus on how to navigate relationships with police personnel is complex; however, the research clearly shows there are ways for EMDR therapists to address this.

Resistance encountered in sessions with police officers, for example, was described as a form of disconnection or dissociation (Frey, 2013) and could be viewed in strength-based terms; reframing that resistance is there to protect them from authentic connection could be explored. In the case of policing, self-revolution strategies could help the officer understand the function of their resistance as a preservation of their integrity, identity, viability and agency. Specific strategies can help individuals address connection and mutual empowerment in relationships, rather than relying solely on independence and self-sufficiency. This encourages officers to actively cultivate relationships in their private lives and at work, and to challenge limiting beliefs about themselves and others. They are also encouraged to recognise the cultural influence on current relational patterns. Working with resistance in this way enables clients to find a new way of maintaining their self-integrity and changing their person, not their problem, although the resistance naturally falls away as they become more aware of it (Frankel & Levitt, 2006).

Relational-Cultural Theory impacts at the individual and socio-cultural level, and it is these socio-cultural dynamics that inflict disconnection, silence, shame and isolation in marginalised groups. Police officers experiencing mental health disorders fall into this category; as Royle (2023) notes, they have been separated from their cultural identity. The theory and interventions considered here have significant implications for how EMDR therapists integrate cultural constructs into their work with police officers. 

Summary, limitations and future learning

Clearly stigma remains significant in policing across the UK. Additionally, cultural attitudes towards mental health have been shown to be complex and disparate across the country in the findings presented. Organisational issues have also been found to play a big part in perpetuating negative stereotypes in the mental health arena. Programmes to change these attitudes, such as Oskar Kilo (Phythian et al., 2022), have had an impact to date, but the extent is still difficult to determine. Training and research in law enforcement rehabilitation need to be more targeted so EMDR therapists understand what they face when working with law enforcement.

Alongside research into the integration of relational psychotherapy models as a benefit to facilitating increased engagement of police officers in rehabilitation in EMDR therapy, more cohesive research into police culture across the UK would be valuable. This could start with a systematic literature review followed by further broader-based qualitative research, as current findings are contradictory in this narrative review, which only addressed a few relevant articles. Targeted EMDR research into the experiences of therapists working with police officers in the UK could investigate current cultural competence, assess awareness of cultural issues, and support the development of specific culturally informed interventions within the EMDR protocol.

Acknowledgement

Professor Derek Farrell

Appendix 1

Details of research studies

Article Citation	Article Type	Methods	Main Findings
Soomro, S., & Yanos, P. T. (2019). Predictors of mental health stigma among police officers: The role of trauma and PTSD. Journal of Police and Criminal Psychology, 34(2), 175–183.	Qualitative enquiry	Online self-report using Qualtrics Research Engine:  Participants: N=296 serving police officers International/USADemographic: 75.7%  Gender: Male; 24% female; 75% of total cohort white. Age range: 18-50  Questionnaires: PCL – 5 BTQ AMIS AQ-9 RIBS MIMS-P  SSOSH Analysis: Correlation & other.   Investigator and theoretical triangulation evident in analysis.	Police officers displayed more negative stereotypes about mental health and other aspects of stigma than the public in general.    Police officers who met the criteria for PTSD showed higher levels of stigma about mental illness and had more negative attitudes about seeking treatment.
Edwards, A. M., & Kotera, Y. (2020). Mental health in the UK police force: A qualitative investigation into the stigma with mental illness. International Journal of Mental Health and Addiction, 19(4), 1116–1134.	Qualitative enquiry	Semi-structured interviews. Participants: N=5 (N=3 retired officers, N=2 serving officers). United Kingdom.Demographic: N=4 White British, N=1 British. Age range: 43-62 years old. Gender: 4 males, 1 female. Analysis: Thematic analysis. Investigator triangulation evident.	Police culture as affecting negative attitudes towards mental health issues in the police forces in the UK. Police culture and corresponding attitudes to mental health issues in the forces may contribute to the causes of psychological illness rather than be caused by the job itself.
Demou, E., Hale, H., & Hunt, K. (2020). Understanding the mental health and well-being needs of police officers and staff in Scotland. Police Practice and Research, 21(6), 702–716.	Qualitative     enquiry	Semi-structured interviews. Participants: N=38 (30 superintendents, 10 stakeholders). United Kingdom/Scotland.Demographic: N/A Age range: 46-50 years old. Gender: 22 males, 16 females.Analysis: Thematic analysis. Investigator and theoretical triangulation evident.	High levels of occupational stress and anxiety found. Underreporting of cultural issues widespread. Experiences of PTSD, anxiety and depression reported connected with organisational stress/culture.  Stigma is still an issue but not as extreme.
Royle, L. (2023). “People like me don’t get mentally ill”: Social Identity Theory, EMDR, and the Uniformed Services. In M. Nickerson (Ed), Cultural Competence and Healing Culturally Based Trauma with EMDR Therapy. Springer Publishing Company.	Case material book chapter	Book chapter.Participants: General examples of case material with police officers.Demographic: N/AAge range: N/AGender: N/A Analysis: N/A	Consideration of how social identity theory can explain uniformed services and mental health. Detailed discussion of cultural considerations within the EMDR eight-phase protocol. Loss of group identity vs regaining cultural identity. Culture clash with mental health intervention.
DiNardo J., & Marotta-Walters, S. (2019). Cultural themes and discourse in EMDR therapy. Journal of EMDR Practice and Research, 13(2), 111-123.	Qualitative enquiry	Vignette using Qualtrics Research Engine. Participants: N=54 EMDR therapistsInternational/USA, UK, Ireland and Israel.Demographic: International:  USA, UK, Ireland, Israel, no subcultures mentioned. Age range: Mean age 55.41.Gender: Mostly female.Analysis: Interpretive and discourse analysis.Theoretical triangulation evident in analysis.	Culture doesn’t influence EMDR treatment; universality is more important than specific cultural influences. Culture does influence treatment Acknowledgement of individual differences in the cultural identity of clients To a lesser extent, the acknowledgement of clinician culture as a potential issue (limited to gender differences) Use of language – Germanic vs Latin-based descriptions to describe EMDR therapy.