EMDR Therapy Quarterly

Intersubjectivity as a mechanism of change in EMDR: Expanding the adaptive information processing model through a biopsychosocial lens

Abstract
EMDR therapy is anchored in the Adaptive Information Processing (AIP) model, which has given the field a powerful way of understanding how distressing experiences can be transformed into adaptive resolution (Shapiro, 2018). Yet AIP, as it is usually described, says surprisingly little about the relational mechanisms through which transformation unfolds in the room, partly because it’s simply difficult to quantify moment-to-moment relational dynamics.

This paper proposes that intersubjectivity, the co-created relational field of shared attention, presence and affect between therapist and client, is not simply a background condition that supports AIP but a central mechanism of action within it.

Drawing on Cotraccia’s (2022) biopsychosocial AIP (BPS-AIP) model, alongside contemporary ideas about attention, attachment and consciousness, I propose that the capacity to sustain attentional agency between self and other is crucial to how EMDR fosters healing. Within this view, EMDR can be understood as a relationally embedded, biopsychosocial system in which therapist and client participate mutually, rather than a primarily linear procedure applied to an isolated individual.

A clinical vignette illustrates how shifts in the intersubjective field can help reorganise a disconnected attachment system and restore the conditions needed for adaptive processing.

The paper concludes by considering the implications of a more explicitly relational AIP model for EMDR practice, supervision and research.

Introduction
EMDR’s clinical impact has always outpaced the neatness of its theory. The AIP model offers an elegant description of what needs to happen for maladaptive information to reorganise (both in and out of the context of psychotherapy) (Shapiro, 2018). Experiences that were previously stored in fragmented, state-dependent networks become linked to more adaptive information, and symptoms reduce as the system settles or recalibrates into a new configuration. For many clinicians, this way of thinking has been transformative – it gives meaning to the eight-phase protocol, organises the work across time and developmental stages, and offers a way of making sense of change that feels integrative. But as soon as we step into actual clinical encounters, AIP in its traditional formulation can begin to feel incomplete. EMDR does not occur in a vacuum. Clients do not process disturbing material alone in a scanner: they process it while sitting in a room with another human being

who is attending to them, feeling with them and being affected by them. It is a reciprocal, moment-to-moment interplay between two humans.

As therapists, we experience sessions where this interplay seems to carry the work forward almost despite us, and others where, despite a technically impeccable adherence to protocol, something in that shared space collapses and processing stalls. This paper starts from that clinical reality. It asks a simple but, I think, under-asked question: where, in our understanding of AIP, do we locate the relational field itself? We routinely acknowledge the importance of safety, alliance and attunement. We speak of “holding the space,” “staying out of the way” or “staying in the way, respectfully.” Yet we often treat these as preconditions for the real work, rather than as part of the mechanism of change. My contention is that intersubjectivity – the co-created space between client and therapist – is not only supportive of AIP but woven into its architecture.

Cotraccia’s (2022) BPS-AIP model offers a rich frame for thinking about this. By explicitly situating AIP within biological, psychological and social contexts, the model helps us understand why shifts in the relational field are not incidental but central to whether processing can proceed. In what follows, I will draw on this model to explore how attention, self-process and connection interact during EMDR sessions; how trauma can be understood as a form of absence or disconnection; and how the therapist’s own adaptive organisation becomes part of the active system. I will then illustrate these ideas through a clinical vignette before turning to some implications for practice and research.

AIP and the relational blind spot
In its original description, AIP portrays an innate information-processing system that, under the right conditions, can integrate disturbing experiences into more adaptive networks (Shapiro, 2018). The memory is activated, dual attention is maintained, and the system ‘does what it knows how to do,’ moving spontaneously toward resolution. The therapist’s job, in collaboration with the client, is to select appropriate targets, maintain the frame, apply working memory taxation in the form of BLS or other distracting tasks, and ‘get out of the way.’ There is truth and clinical wisdom in that approach, as it partially protects us from over-controlling the process or imposing meaning. Yet this framing also tends to marginalise something EMDR therapists live with every day: the work does not occur in a sealed individual mind, it unfolds in a field of shared experience, just as every psychotherapy and every attachment process does, in and out of therapy. A client’s ability to stay with their own internal process is strongly influenced by how they feel in relation to the therapist – whether they feel seen, heard and understood; whether they can sense our presence; whether they can bear being that emotionally close to another person; whether they can tolerate the unhealed parts of our nervous systems that are implicitly (sometimes, explicitly) in the room.

When clients check out in the middle of processing, when they suddenly flatten, intellectualise or insist that “nothing is happening,” we often reach for cognitive explanations: perhaps they lack sufficient adaptive information; perhaps the target is too big, too diluted or too premature to tackle; perhaps there are blocking beliefs; perhaps they’re just not in the mood today or our strategy is off, our interweave didn’t land, and on and on. While some of those may ring true, sometimes what has shifted is less about content or protocol-based processes, and more the quality of connection. The relational air has thinned. Attention has moved from a shared space of ‘we are here together with this experience’ into a place where the client is either watching the therapist for cues, protecting the therapist or himself, or altogether disappearing into internal disconnection. Traditional AIP description gives us only partial language for this. It recognises that safety and alliance are necessary (Siegel, 2012) but does not fully articulate how the relational field itself participates in the processing. This is where the notion of intersubjectivity becomes essential.

Intersubjectivity and attentional agency
By intersubjectivity, I mean the lived, reciprocal field of awareness between two people who are attending to each other. While this field includes empathy and attunement, it is not reducible to them. It is the felt sense of ‘being with’ another person, rather than simply observing or being observed. Stolorow et al. (2002) observe that the line between conscious and unconscious shifts with the patient’s sense of safety in the presence of the therapist. What can be known, felt and thought depends on the relational context in which we are trying to know, feel and think.

In EMDR terms, this intersubjective field is closely tied to what Cotraccia and others describe as attentional agency, the capacity to direct attention toward one’s own experience, toward the other and toward the relationship between the two. Trauma, particularly relational trauma, often disrupts this capacity. Some clients habitually over-attend to others and under-attend to themselves; others are locked inside their own experience with little sense of another mind being present and many oscillate between extremes. In such states, the dual attention that EMDR relies on is compromised, not only in the narrow sense of tracking imagery but also in the deeper sense of being able to hold one’s own process in mind while also feeling accompanied. From a BPS-AIP model perspective, this is not a minor complication; it is the terrain. The AIP system does not operate only at the level of neural networks; it operates within a living organism embedded in relationships and culture.

Cotraccia’s work explicitly positions AIP as a biopsychosocial system in which subpersonal (neurophysiological), personal (psychological) and interpersonal (relational) processes are constantly shaping one another. Extra-personal attunement, a habitual orientation toward meeting others’ needs or scanning their reactions at the expense of self-awareness, becomes a central pattern to understand. ‘Trauma as absence’ is a system that has organised itself around something that should have been there but was not: an attuned caregiver, a witnessing other, a sense of existing in the mind of someone else. In such a system, it is not enough to say that adaptive information exists somewhere in the network; the question is whether the person can access that information while feeling simultaneously connected to themselves and to another human being. That is an intersubjective skill as much as it is an intrapsychic one.

The BPS-AIP model as a relational expansion of AIP
The BPS-AIP model takes the original AIP insight: that the mind tends toward adaptive integration when conditions are supportive – and places it within a wider scientific and clinical landscape (Cotraccia, 2022; Shapiro, 2018). It draws on research into attention schemas and consciousness (Graziano, 2013), on attachment theory (Bowlby, 1988) and on systems approaches to self-organisation (Fogel, 1993). In this view, consciousness itself can be understood, at least in part, as the brain’s model of its own attentional processes – an internal representation of ‘what I am currently attending to,’ including the possibility of attending to another mind (Cotraccia, 2022). If trauma is understood as a disruption not only of content but of this very capacity to organise attention around self and other, then the therapeutic relationship is not just providing comfort or reassurance. Rather it offers a new pattern of biopsychosocial connectivity where the therapist lends their own organised attention to the client, who begins, through repeated interaction, to build a more coherent internal schema of being able to attend to their own experience in the presence of another.

In BPS-AIP language, the system starts to shift from a disconnected AIP configuration, dominated by absence and extra-personal attunement, toward a more connected configuration in which inter- and intra-personal attunement are possible (Cotraccia, 2022). This gives us a language for clinical phenomena EMDR therapists frequently encounter. For example, consider the client who is technically within their ‘window of tolerance’ in physiological terms (Siegel, 2012) but who nonetheless cannot stay with the target. They report boredom, numbness or a kind of existential fog. The usual interventions of ‘go with that,’ cognitive or other creative interweaves, and changing channels do little. From a BPS-AIP model perspective, what we are seeing is not only difficulty accessing adaptive information but also a collapse of the experiencing self in relation to another. The client cannot sustain a sense of themselves as a subject in the therapist’s presence; attention has slid out of the intersubjective space into familiar absences.

Clinical vignette: When connection returns, processing resumes
A brief vignette may help illustrate these ideas in practice. ‘Raya’ is a woman in her thirties working on a long-standing pattern of feeling invisible in close relationships. A target is identified involving childhood experiences of being consistently overlooked in a busy and stressed family. She can describe the memories clearly and understands intellectually that she was not at fault.

Early in processing, there is some movement: she notices a tightness in her chest, images of herself as a small child at the kitchen table, and some sadness. Then the process begins to stall, her voice flattens and she starts to offer thoughtful, detached commentary about family dynamics. When invited to notice her body, she shrugs and says, “Nothing really. It’s fine. I’m just talking.” The therapist notices feeling slightly pushed to the margins: present, but not quite in the room with Raya. There is a familiar impulse to try to ‘get things going’ by asking more questions or offering an interweave, but instead the therapist pauses the bilateral stimulation and names the shift. “Something feels different between us right now,” the therapist says gently. “A few minutes ago, it felt like you were here with that younger you, and with me. Now it feels as if you’ve had to step away a bit. I’m still here. Can we just notice together what it’s like to be in the room right now, before we go back to the memory?” Raya looks up. For a moment, there is a flicker of uncertainty, then her eyes moisten. “It’s like you’ve gone blurry,” she says quietly. “I can hear you, but I can’t really feel that you’re with me. And then I feel stupid for needing you to be.” The therapist reflects this, staying close. They help her notice the longing and the shame in her body as present-moment experiences, not just as historical concepts. The focus of attention shifts from a cognitive telling of the story to a shared noticing of how the old pattern is replaying now, in the intersubjective field. As Raya can feel the therapist’s steady presence again and to tolerate her own need for connection without immediate withdrawal, the bilateral stimulation resumes. The images return, now coloured by a different sense of accompaniment. New associations emerge – times when people have in fact been there for her; an awareness of how quickly she pulls away from that possibility; glimmers of a future in which Raya can both need and be met.

From a BPS-AIP model perspective, the key moment was not an especially clever cognitive interweave. It was the therapist’s willingness to use their own subjective experience: the felt sense of being ‘blurred out,’ as information about a shift in the relational system (Cotraccia, 2022). Naming and working within that shift in the here and now re-established a connected AIP configuration. Intersubjectivity was not simply supporting the processing of the memory; it was part of the processing, part of what made access to adaptive information possible.

Implications for EMDR practice
Viewing AIP through this relational, biopsychosocial lens has several consequences for how we approach EMDR. First, it invites us to rethink therapeutic impasses. When processing stalls, it may be more helpful to ask, “What has happened in the intersubjective field?” than “What’s going on with the client’s information processing?” This shifts our stance from assessing possible deficits to exploring relational disconnections (Cotraccia, 2022). It also legitimises spending time attending to present-moment relational patterns as part of EMDR, rather than seeing that work as separate from or secondary to ‘doing the protocol.’

Second, it reframes the window of tolerance not merely as an individual physiological capacity but as something co-created (Siegel, 2012). A client’s ability to stay within workable arousal often depends on feeling accompanied in a way that is neither intrusive nor absent. Both hyper- and hypo-arousal can be understood as symptoms of relational absence, either an internalised absence from the past or a micro-absence in the session. When we recognise this, we are less inclined to interpret dysregulation as resistance and more inclined to view it as a signal that the system has tipped into a disconnected configuration that needs reconnection rather than correction.

Third, a relational AIP perspective underscores the importance of the therapist’s own adaptive organisation. If the therapist is chronically over-stretched, defended or cut off from their own emotional life, it becomes more difficult to offer the kind of attuned presence that allows the client’s nervous system to reorganise (Cotraccia, 2022; Shapiro, 2018). Our access to our own adaptive information, including self-compassion, the extent of our own unhealed wounds, our ability to set healthy boundaries and a realistic sense of our limits in general (energetically, emotionally, etc), is not just a matter of personal wellbeing; it is part of the AIP system in which our clients are trying to heal.

Finally, this perspective clarifies the role of interweaves. Rather than viewing them primarily as cognitive/spiritual/somatic/musical, etc., corrections, we can see many of the most effective interweaves as relational interventions: ways of lending the client the therapist’s perspective, values and emotional stance at precisely the point where the client’s own self-organisation is collapsing (Cotraccia, 2022). To say, for example, “The shame belongs entirely with the perpetrator” is not just a cognitive reframe. It is a moment of joining, an explicit statement of moral position within the intersubjective space that can help the client reorganise around a different self-story.

Implications for theory and research
Making intersubjectivity explicit within AIP does not mean abandoning Shapiro’s (2018) model. My hope is that it might mean enhancing it, allowing us to articulate more clearly why EMDR was never, in practice, a simple linear procedure, as none of healing ever is, even when it was conceptualised that way. It invites research questions that include both members of the therapeutic dyad: how does shared attention fluctuate over a session? What patterns of co-regulation predict successful processing? How do therapist variables – not just training and technique, but attachment style, capacity for self-reflection and ability to tolerate their own activation – shape outcomes? There is room here to bring EMDR into richer dialogue with the broader psychotherapy literature on common factors, attachment and relational depth.

Work on client participation and motivation by Bohart and Tallman (1999), or Frank and Frank’s (1991) exploration of hope and expectation in therapy, can be integrated within a relational AIP framework rather than treated as separate domains. The BPS-AIP model offers one way of doing this by embedding EMDR within a wider understanding of human beings as hypercomplex, self-organising systems whose suffering and healing are always occurring in relation to others as well as within themselves (Cotraccia, 2022).

Conclusion

No single therapy has a monopoly on truth. Meeting people in all their fullness, their resilience and their fragility, and maintaining attentional agency, is the essence of what will allow the potential for information processing in all psychotherapies. If we take seriously the idea that human beings are wired for connection, then an information-processing model of therapy that sidelines the relational field will always feel partial.

EMDR’s success over the past decades has often left even its practitioners slightly mystified: something powerful happens in these sessions that is not fully captured by our language about memory networks and bilateral stimulation (Shapiro, 2018). Bringing intersubjectivity and attentional agency into the heart of AIP allows us to speak more honestly about what we are actually doing. In this view, EMDR is not simply a technique we administer to individuals. It is a particular way of engaging in an attachment relationship focused on processing information together. The therapist and client form a connected AIP system in which each influences the other.

The client brings their history, their patterns of absence and disconnection, their longing and fear. The therapist brings their own adaptive organisation, their capacity to stay present at the edge of their own window of tolerance and their willingness to be changed by the work. Between them, if the conditions are right, an intersubjective space forms that can hold what was previously unholdable and know what was previously unspeakable. No single model can claim a monopoly on truth about human healing. But acknowledging the relational architecture of the AIP system moves EMDR closer to the complexity of real clinical life. It honours both the mystery and the science: the measurable shifts in networks and symptoms, and the less easily measured experience of two people breathing the same air while one dares to show the other where it hurts.

While pain and suffering are often the primary motivators for seeking psychotherapy, our field can sometimes risk specializing in them without fully approaching them. As EMDR clinicians, we are invited to move closer — right up close — allowing ourselves to be touched and activated, within our own windows of tolerance. We do this within a connected AIP system, an intersubjective space that allows growth in relationship to ourselves and our clients, allowing us to notice that….to notice us.

Rachel is a Clinical Psychologist in private practice in Jerusalem, Israel, where she treats, teaches, and supervises. She is the Clinical Director of the EMDR 2.0 Intensive Treatment program at Mercaz Omakim and the author of 3 psychology books. Rachel is the creative lyricist behind the witty EMDR album “Sudrise, Sudset” that continues to elicit giggles around the world. When she’s not parenting five kids, Rachel can usually be found baking chocolate chip cookies.