EMDR Therapy Quarterly

How did you become an EMDR therapist? 

A good question! I am relatively late to the therapy field, having previously served in the military, worked as an engineer and management consultant specialising in improving operations. I trained as a psychodynamic/person-centred/integrative counsellor and was always fascinated about how we could bring about the ‘corrective emotional experience’ (Alexander & French, 1946). I could see the shortcomings in the approaches I was being trained in, so jumped on EMDR as soon as I could, recognising that this provided an elegant, embodied and transformative solution to effecting change in our clients. And the rest is history, as they say! 

Although it is perhaps worth noting that as I saw EMDR therapy as a broad approach for many (most/all?) mental health conditions, I also saw the need to maintain a strongly relational focus and comprehensive application of the EMDR standard protocol across a wide variety of presentations. 

What is the Flash technique? 

The Flash technique is a brief, safe, and effective intervention for partially (or fully) desensitising traumatic memories without clients having to talk, think, or feel those memories. The important question is why is it relevant to EMDR and why was it originally developed by a US EMDR trainer (Dr Philip Manfield)? Since my initial training in EMDR, much of my CPD was around working with complex trauma and how to keep clients in the window of tolerance to avoid either abreaction or dissociation. Fractionating trauma, CIPOS, and pendulation were all techniques I learnt about, which all feed into the question of ‘how much phase 2 prep and stabilisation is required before I can start processing’? The answer to this question is not immediately obvious, and I still see many supervisees battling this question. The tendency is to err towards perhaps spending too long on stabilisation. 

One of my favourite sayings with these supervisees is that ‘the best form of stabilisation is processing!’ Now, of course, we cannot start phase 4 EMDR processing in the first session, for many reasons which we are all familiar with – we don’t know how their system will react to target activation and bilateral stimulation, so we need to understand their system and their history in a fair amount of detail. This is where Flash comes in. Although it is not a name I use to either describe the approach or indeed use the name in the Flash process (I just teach the word ‘blink’ instead), Flash has solved this ‘problem’ – it is brief, safe, and effective, and can be used completely blind to therapist very early on in therapy. In fact, I have used it within the first five minutes of the first session with a client who was getting visibly upset as they shared why they had come to therapy. It took less than 10 minutes, and it allowed the client to resume talking in a much less distressed way, with the ‘target’ memory feeling further away and less distressing. For the most part (as with EMDR), the change in the Subjective Units of Distress (SUDs) is a permanent shift, but it is important to note that unlike EMDR, which is a comprehensive therapy approach, Flash is just an intervention to take SUDs down. The flexibility that it offers is very useful with EMDR but it doesn’t replace EMDR in any way but, rather, enhances it. 

The analogy I sometimes use is that Flash is like a top-down desensitisation, whereas EMDR processing is bottom up and more associative in terms of connections, AIP, and opening up new channels of association. I have found over the years that there is quite a lot of confusion about what Flash is and isn’t, and even fear that proponents of Flash are trying to replace or usurp EMDR – nothing could be further from the truth! Flash simply addresses the problem that EMDR requires high levels of activation, which can sometimes make it difficult for clients and therapists alike. 

How did you learn about the Flash technique? 

I originally hear about Flash on a forum and then attended one of Philip Manfield’s early webinars, who taught Flash v1.0, which was described in the early paper (Manfield et al., 2017). Although this was not the streamlined approach used today, I could see much clinical utility in this approach and invited Philip to the UK to teach it to UK EMDR therapists. It is also worth noting that the name ‘Flash’ comes from this early version, where the process would involve clients ‘flashing’ to the trauma memory and back again (to a resourced state) so quickly that they wouldn’t feel the pain – a bit like passing a hand through a flame very quickly. The major innovation at this time was realising that you didn’t need to ‘go to the trauma memory’ at all, and that the process of blinking would allow this to happen naturally. Further enhancements, such as a more flexible approach to a conversation engaging focus rather than a positive engaging focus, have also made Flash easier to use with all types of clients. 

How do you explain the Flash technique to a client? 

After a brief introduction and invitation to use the technique, a target memory needs to be chosen. This step might only take a fraction of a second if the target is highly distressing (i.e. SUD = 10+) before switching to an engaging focus, such as talking about a favourite TV programme. It is during this time that the therapist says the word ‘blink’, which the client then responds to by blinking three times in rapid succession. After five or so of these triple blinks, the therapist invites the client to take a break and notice if there is any change (yes or no, not a general invitation to ‘what are you getting now?’) in the target memory. Further sets or additional troubleshooting (which might include a tapping and swaying) take place as the distress comes down. Flash can be used to take the distress to a zero, but very often three or four sets will suffice during preparation, and in later stages I would switch to EMDR processing, which I have already described as being more associative. 

The interesting thing is that clients are generally very surprised that rapid change has happened, but not that interested in how it has happened, whereas therapists want to know ‘how’ and the mechanism of action. As with EMDR, there are no definitive answers, but I describe it as a form of memory reconsolidation that is facilitated by targets being put into working memory (which only requires an infinitesimally small amount of activation), and then the pendulation to an engaged focus with the blinks, which somehow engenders consolidation of the memory into a new (less distressing) permanent state. 

When do you use the Flash technique? 

I use Flash in three ways as part of the Standard Protocol. The first is as part of preparation phase, where I want to reduce the trauma load, especially someone with complex trauma. I am not looking to get SUDs to zero but to see some reduction in the most significant traumas that have come up during history taking (sometimes as part of history taking). If there are events that cannot even be mentioned in history taking without causing distress, these would be ideal targets for Flash, which is very flexible; it can be used ‘blind to therapist’ and, moreover, can target time periods; for example, ‘all the abuse that happened between ages of 8 and 12’. Once the SUDs are reduced, this ‘folder of targets’ can then be unpacked and more targets worked on with Flash. Multiple incidents can also be targeted simultaneously with Flash, although I tend not to do this for the most intense memories (i.e. SUD = 10). Being able to tell clients that they won’t have to talk, think, or feel the trauma memories puts them rapidly at ease and I find that once they experience change, it really does enhance the therapeutic relationship. 

Not only do they not need to talk about trauma, they also don’t need to feel associated distress either. For some client groups, such as military veterans and those who have experienced childhood sexual abuse, these are the very reasons they are fearful of engaging with therapy, so Flash really does help with client engagement. 

The second way I use Flash is when working on a specific target during the main part of the work where I ask the client, ‘If you were to think about the target, would you find it overly distressing?’ If they say ‘yes’, I start with Flash. Once SUDs have fallen, perhaps to less than 5, I switch to the Standard Protocol. I find that the associative benefits of EMDR come to the fore at this point. Sometimes Flash takes the SUDs down to a zero, in which case I would return to target and see if there are any other channels of association to be processed (probably with EMDR) before progressing to positive cognition and body scan in the usual way. 

The final way in which Flash can be used is if I have started with the EMDR phase 4 processing and it starts getting too intense. I can then ‘back out’ of the target and, pointing to one side, say ‘let’s put that over there’ and start the Flash process. Once the intensity is down, we can return to the Standard Protocol. I find this approach more effective than trying to engage a client’s calm or safe place at this point. 

What evidence is there to support the effectiveness of the Flash technique 

There are now 27 (12 in 2023) published papers about Flash including randomised controlled trials, use of Flash with EMDR, and as a stand-alone intervention. All these papers can be downloaded from Phil Manfield’s Flash website (https://flashtechnique.com/wp). So even though we do not know exactly how memory reconsolidation is occurring during Flash, the evidence base for its effectiveness is building. 

What is your anecdotal experience of using this technique with patients? 

Flash works – and even a two- or three-point reduction in SUDs that can demonstrate real change to a client is valuable for a 10-minute intervention, and it is often more than that. I have been running three-hour Flash webinars for four years now. I do two live demonstrations with participants in each one and have always had a demonstrable reduction in distress. If I thought results would be more ‘hit and miss’, I wouldn’t subject myself to the stress of that during a webinar! 

I have also been involved with an NHS trust for several years, teaching Flash to many clinicians (not just EMDR) and they are 18 months into a pilot of a cut-down version of Flash (we are calling it flashlite) in their crisis teams, which is showing positive results. 

What further reading would you recommend to clinicians? 

The Flash Technique website has all the latest research papers, so I would keep an eye on that! Philip Manfield has also run an annual Flash research conference over the past two years in July, which has produced some very interesting talks. 

Finally, although the steps involved in using Flash are very simple, and there is really only one variable (the target), I am still surprised about how Flash is not used appropriately, or precisely, especially with intense traumatic memories. The transfer of information about how to do Flash by word of mouth can lead to the meaning and emphasis being changed, even for something as simple as the Flash technique. 

Dr Justin Havens is an EMDR accredited consultant and a Board member of EMDR UK. He provides 3hr webinars on the Flash technique (as well as other topics) and more information can be found at www.justinhavens.com.