EMDR Therapy Quarterly

Introduction 

Violent extremism is a topic that has at various points occupied a significant presence within the media and social landscape, as extremist events have touched many lives in many countries, often leaving lasting scars (Horgan, 2008). Yet globally there is no agreed definition of what violent extremism is, with countries defining it in different ways and legal processes responding in varied ways: some focusing on punishment, others on prevention, others on rehabilitation and reintegration. Psychological, sociological, and political models have attempted to explain the phenomenon (Borum, 2011) and, while research exploring links between mental health and extremism is growing (Marsden & Lewis, 2021) those links remain poorly understood (Gill et al., 2021). In the UK, extremism is addressed through the Prevent programme (HM Government, 2024), which aims to prevent people from entering extremism and to support those who wish to leave. For those thought to pose a greater risk, the Channel panel (HM Government, 2025), a multidisciplinary group that includes police, healthcare, housing, and social services, works to devise a needs-based approach. Interventions vary in focus: some address ideology as the root cause, using ideological and religious mentors to challenge it; others target social deprivation and seek to meet basic needs such as housing, healthcare, education, and employment. To address mental health difficulties, there are referrals to NHS mental health services, alongside the development of specialist services such as Vulnerability Support Hubs, which co-locate police and mental health professionals to enable earlier identification and intervention. 

This article draws on learning I have gained over 4.5 years of working with former violent extremists formerly associated with the far right, Islamist movements, and involuntarily celibate (incel) communities. The participants were living in the community and no longer involved with statutory services. The work combines EMDR therapy and narrative approaches to explore how this population disengages from extremism and works towards reintegration. While this might sound like a niche area, much of what I have learnt is relevant to clinicians working with those who present with a range of internalising and externalising difficulties, including suicide and self-harm, addiction, forensic histories, antisocial behaviour, and other presentations that render people hard to reach. As I slowly untangled these lives, I realised that despite the demonisation and othering so prevalent in media narratives, these people are so much like everyone else. I could see echoes of their experiences in the lives of other clients who had nothing to do with extremism. This gave me hope. 

Violent extremism is best understood as a multi-final process: a single starting point that can lead to a range of outcomes (Corner et al., 2019). It begins with trauma or adversity, followed by exposure to possible solutions, the social reinforcement of those solutions, and the presence or absence of alternatives. The Adaptive Information Processing (AIP) model of EMDR offers a natural and powerful lens: unprocessed early experience, shaped and compounded by environment, driving increasingly entrenched and ultimately harmful responses (Shapiro & Maxfield, 2002). While through one lens the behaviour might seem incomprehensible, the lens of the AIP framework allows for a much more nuanced understanding. 

It is important to state clearly that I do not seek to minimise or excuse the harm that violent extremism causes to individuals, communities, and society. That harm is real and serious. What I do argue is that effective clinical work requires the capacity to hold two things simultaneously: an unflinching awareness of the harm a person has caused, and an equally clear-eyed understanding of the harm that has been done to them. This is not a moral equivalence. It is a clinical necessity. It is also worth noting that given the lack of a shared definition, ‘violent extremist’ encompasses a wide spectrum: from those who hold radical views privately to those who enable, recruit, radicalise, or fundraise to the smaller minority who directly commit or plan acts of violence. The public image tends to collapse this entire spectrum into a single figure. Clinically, that flattening is not useful. The individuals described in this article were, in the main, people trying to leave and trying to understand how they had arrived at this point. 

Getting through the door 

Before any EMDR can take place, the first challenge is engagement. Unlike private practice or NHS services where clients choose to attend, with this population, the obstacle is not a lack of need or even, at some level, a lack of desire for help. The obstacle is the gulf, often felt as insurmountable, of fear and mistrust that lies between where they are and where therapy begins. 

The very idea of therapy can elicit responses such as ‘What do I need therapy for? I am fine’, ‘Talking doesn’t do anything anyway’, and ‘What’s in it for you?’ Much of this resistance is rooted in prior experiences of seeking support from professionals that proved fruitless, and in a normalisation of distress so profound that panic attacks, nightmares, and flashbacks no longer seem to warrant comment or intervention. Psychoeducation, offered before any therapeutic contract is in place, can therefore be an important first step. 

Further challenges typically follow: inappropriate peer referrals (‘Can you help my mate?’), difficulties with literacy, and a deep institutional distrust that makes informed consent and therapy agreements genuinely difficult to navigate. Responses such as ‘I don’t do paperwork’ and ‘I trust you, why do I need to sign stuff?’ are common. Practical barriers to attendance are also significant: financial instability and lack of employment make in-person attendance costly and complicated. For those working online, securing a private, safe space can be difficult, and limited access to suitable devices or digital skills sometimes led to requests to conduct sessions via WhatsApp or Facebook. 

Each of these challenges requires careful negotiation and a recognition that ideal conditions are rarely available to this group. The task is to find an ethical, collaborative, and safe way forward that may require creativity and compromise on both sides. The overarching lesson is straightforward: flexibility is not an optional feature of this work. It is the work itself. Clinicians working with people who misuse substances, those with forensic histories, or young people involved in gangs will recognise much of this terrain. 

History-taking, stabilisation and phases 1 and 2 

The structure of the work is summarised in Table 1, which maps the correspondence between Herman’s three-phase model, the EMDR protocol and the ACT-informed consolidation phase. 

Phase	Judith Herman (1992)	EMDR	ACT (Acceptance and commitment therapy) (Hayes et al., 2013)
1	Safety and stabilisation	Phases 1 and 2: history-taking, assessment, preparation and resourcing
2	Trauma processing	Phases 3 to 8: assessment, desensitisation, installation, body scan, closure, and re-evaluation addressing past and present targets
3	Reconnection and reintegration	Future template addressing the future concerns	Values clarification and committed action: building an identity and life beyond extremism

The starting point in every case was narrative: tell me your story from birth to the present, in the context of your extremist involvement. Tell me who, what, where, when, how. Tell me what affected you, influenced you, changed you, hurt you, helped you. Tell me whatever you want. Time and again, clients described this as the first occasion on which they had been listened to without interruption and without an agenda. Previous therapeutic encounters had typically been symptom focused or offence focused: tell me about your crime, your drinking, your risk. Constructing a timeline together helped people begin to understand how they had come to be where and who they were. 

The experience of having one’s full story witnessed, even when this took three or four sessions, was consistently reported as profound. Identifying the key themes running through a life, recognising both the accumulation of smaller injuries and the pivotal crossroad moments, had a transformative quality extending beyond information-gathering. This experience of being heard without agenda is not unique to this population: it is frequently described by clients who have had repeated contact with services focused on the number of clinical contacts or risk management rather than understanding. 

This process was accompanied by psychoeducation drawing on several frameworks: compassion-focused therapy to address shame and self-criticism (Gilbert, 2009); polyvagal theory to help clients understand their bodily reactions, dissociation, and emotional numbing (Porges, 2011); attachment theory to illuminate interpersonal patterns (Bion, 1962; Bowlby, 1988; Schore, 2021; Winnicott, 1960); internal family systems to support a more compassionate relationship with conflicting internal states (Schwartz, 2013); and the AIP model to frame the whole. Each framework was introduced in response to clinical need rather than as a sequence and, together, they produced not just intellectual understanding but a meaningful reduction in self-blame and shame. 

Skill-building in this phase was broad and individually tailored (mindfulness, breathing and grounding, connecting with parts, safe or calm place, calm state, resource team, pendulation and the light stream) alongside tools drawn from other approaches as needed. The goal was to ensure sufficient internal resourcing before any trauma processing began. With this population, that resourcing phase consistently required more time and space than standard protocol might suggest. 

A second narrative interview followed the completion of this phase, capturing shifts in self-understanding that psychometric measures alone would not easily have revealed and giving clients an opportunity to tell their story anew. The practice of structured narrative-telling at multiple points across the therapeutic journey has been one of the most significant learnings from this work, and one I now incorporate into my broader practice. 

Phases 3 to 8: client-led targeting and processing 

While standard EMDR practice involves a formulation-based approach to identifying past events, present triggers, and future concerns, the targeting process here was intentionally and explicitly client led. The completed timeline enabled the clients to identify the events they believed had most shaped their story: the crossroads moments. This was a deliberate clinical choice, designed to offer a degree of control and agency that had frequently been absent from their prior therapeutic encounters and, indeed, from much of their earlier lives. 

Notably, identified targets rarely related directly to extremism. They were more likely to be a friend’s suicide, the loss of a parent without the chance to repair a relationship, or sustained childhood bullying. Just as in the narrative interviews, one enters expecting extremism to be the central preoccupation only to discover that clients define themselves, and locate their pain, quite differently. The extremism was rarely the whole story, and rarely even the most painful part of it. This finding echoes what many clinicians observe when working with offending populations or those with complex presentations: the presenting problem rarely reflects the depth or origin of the distress. 

Phases 3 to 7 followed standard EMDR protocol, with one meaningful addition to Phase 7. Alongside standard closure, clients were actively supported to bring wounded aspects of their earlier selves safely into the present and to begin constructing a future template: a concrete image of themselves navigating life differently. This left people with a sense of agency and forward momentum at the close of each session, rather than simply contained. 

Phase 8 focused not only on residual disturbance in relation to the processed target but also on observable behavioural change. The explicit question was: how is this making your life better? This is always implicit in EMDR but, here, it was made more visible and deliberate. In part, this reflected the clinical reality that these clients often needed support in recognising and naming their own progress; in part, it reflected the fact that behavioural change in this population also functions as a meaningful indicator of ongoing deradicalisation and reintegration. 

Across the entire process, four narrative interviews were woven through the work: before therapy began, after Phases 1 and 2, after the trauma processing block, and after the final ACT-informed phase. In this last phase, clients identified core values and constructed a concrete image of what a life guided by those values might look like (Hayes et al., 2013). The progression across all four narratives was consistently one of the most moving aspects of the whole project: a record of change that belonged entirely to the person narrating it. 

Identity after extremism: The work of becoming someone new 

EMDR can change how people understand themselves. When the person in question carries a publicly known and socially reinforced identity as a violent extremist, that process carries particular weight. The establishment of a new, grounded identity needs to be actively supported, both through the internal work of therapy and through external anchors: relationships, activities, and meaningful social roles. 

Early relational trauma frequently produces not only impaired emotion regulation but also a fragmented, unstable sense of self, one shaped by the responses of inconsistent caregivers rather than by any secure internal foundation. In this context, it is important for therapy to address not only what the person is no longer but also who they are now and what that means going forward. Failing to do so risks leaving a psychological void that others offering containment, belonging, and purpose may rush to fill. This is why the ACT-informed consolidation work at the end of therapy matters as much as the trauma processing that precedes it: it works alongside the future template to consolidate identity and support confidence in a viable path forward. 

The question that recurred most often in this phase was: what else is there? Once someone is no longer an extremist and no longer only a former extremist, who are they? What are they allowed to become? Rebuilding a sense of self that is neither defined by extremism nor entirely by its renunciation requires active clinical attention and honesty about the limits of what therapy can achieve when society itself remains unforgiving. For many, rebuilding relationships, employment, and community belonging is complicated by a past that is, to varying degrees, known and stigmatised. Drawing on Janoff-Bulman’s (1992) work on shattered assumptions and Neimeyer et al.’s (2010) work on meaning reconstruction after loss, what many clients were navigating was the loss of the world they had known inside extremism, alongside the loss of the person they might have become. Helping people grieve both and bridge the gap between the life they find themselves in and the life they had imagined is some of the most delicate work in the entire process. Similar processes of identity reconstruction are encountered when working with those leaving cults or coercive relationships, those in recovery from addiction, and those released from long custodial sentences – anyone for whom a former identity, however harmful, provided structure and belonging. Beneath it all lies the same fundamental human need: to matter, to be seen, to be valued, to be believed in as someone who has something to contribute (Billingham & Irwin-Rogers, 2021). 

Epistemic trust, psychosocial reality, and the limits of therapy 

Trauma, and particularly attachment and interpersonal trauma, erodes epistemic trust (Fonagy & Allison, 2014). It leaves a lasting mark, making it difficult for people to identify reliable sources of support, to feel genuinely understood, or to believe that another person’s intentions are benevolent and worth engaging with. For this population, whose histories are typically saturated with relational rupture, betrayal, and exploitation, rebuilding epistemic trust is not a by-product of effective therapy. It is one of its central tasks. 

Working with former violent extremists therefore involves more than symptom reduction and trauma reprocessing. It involves helping people understand how they came to be where they were, rebuilding the capacity to trust, and supporting them to move towards having their fundamental unmet needs finally, tentatively, met. 

It is equally important to be clear about what therapy cannot do. When symptoms reduce and stability increases, the psychosocial reality of these clients’ lives does not disappear. Barriers to employment and housing persist, alongside ongoing financial insecurity, often compounded by a criminal record or degree of public notoriety and the stigma that goes with it. The process of building new relationships while carrying the fear of being seen only as who one used to be is slow and frequently painful. Stability, it turns out, comes with its own demands, and these are often felt most acutely once the immediate crisis has passed. The combination of psychological fragility and practical instability is familiar to anyone working with homeless populations, those leaving the care system, or survivors of domestic abuse, groups for whom the gap between clinical recovery and functional stability is wide and rarely acknowledged in standard outcome measures. 

Evidence suggests that alongside psychological support, people need practical assistance with housing, employment, education, and finances to scaffold their everyday lives (Marsden, 2017), as well as social relationships with people willing to take a chance on them (Clubb et al., 2024). Therapy can be a crucial part of the reintegration process but it cannot be the whole of it. Holding awareness of the wider context and collaborating where possible with other services and supporters is a necessary part of clinical practice with this group. 

The therapeutic relationship: Endings, inconsistency and the danger of opening up 

When someone has never experienced relational safety, has never been listened to without judgement, or given space to think without an agenda, the first time this happens in therapy can be deeply destabilising. Attachment can be intense and ambivalent: clients may push and pull, disappear without explanation, or oscillate between engagement and withdrawal. It is important to be alert to this from the outset: to name it, normalise it, and work through it as a live clinical issue. Unaddressed, it can make endings harmful and, for a population already marked by profound relational rupture, that is a risk that must be taken seriously. 

Inconsistency in attendance was a recurring feature: forgotten appointments, ghosting, the pattern of someone declining further sessions and then returning six months later. Managing inconsistency required genuine flexibility and a conscious effort not to interpret it as personal failure or a breach of the therapeutic frame. Therapists working with adolescents, with people who misuse substances, or with those who have experienced repeated placement breakdown in care will be well acquainted with this pattern of approach and withdrawal. Simultaneously holding warmth and structure, flexibility and self-compassion, was an ongoing clinical and personal discipline. 

A consistent challenge was what might be called the danger of opening up. When someone begins to feel things, often for the first time, the experience can be overwhelming. The fear that powerful feelings will not stop, that they will take over and render functioning impossible, is especially acute for clients with an absence of adequate support networks and for whom destabilisation could be costly. It is important to prepare clients for this possibility and to agree explicitly that they will let you know when it happens, so that pace and depth can be adjusted. I now raise this possibility early, and frame it not as a sign that something has gone wrong, but as a sign that something is working. 

Fear of change also deserves direct clinical attention. Some clients had built an organising narrative around victimhood that functioned to justify, or at least explain, what they had done. Others had constructed an equally fixed narrative around intrinsic badness or unworthiness. When therapy begins to complicate either story, the question of how to go on, and who one will become, can feel genuinely threatening. The possibility of becoming a different person, one who no longer fits easily into existing relationships and communities, is not abstract for people who already know what it is to be isolated. These fears are best brought into the room explicitly and early, and the question of how therapy might affect existing relationships should be thought through in advance wherever possible. 

Neurodivergence: An emerging dimension 

An additional complexity that emerged across the work was neurodivergence. A growing body of research suggests a prevalence of neurodivergent traits within extremist populations (Moskalenko et al., 2022; Walter et al., 2021) and this was reflected in clinical experience. In my experience, many of my participants identified as possibly neurodivergent. Of significance was how they made sense of this possibility: did it explain the lifelong sense of not belonging, of never being quite enough? Did it account for their pathway into extremism? And, crucially, did it mean that what happened was not entirely their fault? And what implications did this have for their path forward?  

This is clinically rich and ethically complex territory. A neurodivergent framework can offer genuine relief and a more compassionate self-understanding. It can also, when not held carefully, become a means of avoiding accountability. The clinical task is to hold both possibilities without collapsing into either: neither dismissing the significance of a neurodivergent framework nor allowing it to foreclose the important work of taking responsibility for harm caused. 

Therapist support, supervision and self-care 

The level of support I had during this work is worth describing, not as a standard that others must meet but as an illustration of what this work can require. Alongside clinical supervision with my EMDR consultant, I had research supervision, peer-process work to identify and work through the personal and ethical challenges the work raised, narrative supervision with colleagues working with similar material, and access to personal therapy. Each of these served a distinct function and, together, they made the work sustainable. 

The point is not that all EMDR therapists require this exact structure. It is that working with this population will, in ways that are difficult to predict in advance, press on your own values, ethics, moral frameworks, and political beliefs. It will affect relationships with people in your personal life, not all of whom will be supportive of work that involves sitting with compassion alongside people whose actions many find unforgivable. It may also challenge the therapist’s own sense of professional identity. These pressures do not arrive solely from the clinical material: life does not stop, and events in the public domain reverberate directly into the therapy room. In the course of this work, further extremist attacks occurred in the UK and elsewhere. The impact landed immediately in sessions, triggering memories, shame, guilt, and fear in clients, and requiring the adaptation of treatment plans and a return to safety and stabilisation work. This is not an exceptional circumstance. It is the ordinary reality of working with this population and it requires the therapist to be prepared (Geelhoed et al., 2024). 

Countertransference is intense and multifaceted. I noticed fear and, at times, moral discomfort, which required active management to prevent it from contaminating the therapeutic space. I also noticed, more unexpectedly, moments of genuine admiration: for the courage required to leave, for the grief of losing an identity, and for the determination to rebuild. Vicarious traumatisation is a real risk. Access to skilled supervision, ideally with someone who understands both the clinical and contextual dimensions of this work, is essential rather than desirable, and therapists undertaking this work should feel able to advocate for adequate support within their organisations. 

A wider clinical relevance: Extremism closer to home 

Violent extremism can seem like something that belongs out there in the world, associated with dramatic events and identifiable perpetrators. In reality, the gradual normalisation of extremist ideas means that more people are engaging with them than the headline figures suggest. These individuals do not present to therapy as extremists. They present as people struggling with anger, depression, low self-esteem, self-harm, suicidality, and shame. They are people whose legitimate frustrations about their lives have found expression in frameworks that offer simple explanations and clear enemies: the far-right narrative that one is entitled to more, the incel narrative that inadequacy is women’s fault, and the broader radicalising narrative that violence is the only meaningful response to injustice. 

There is nothing pathological about feeling frustrated, powerless, or unseen. These are normal human experiences and the impulse to connect with others and seek solutions is healthy. The problem arises when those connections involve polarisation, the construction of a rigid ‘us and them’, and radicalisation, understood here as the endorsement or use of violence to protect ‘us’ from ‘them’. This is not about changing people’s political beliefs. Radical or unconventional thinking does not, of itself, lead to violence. That pathway is neither inevitable nor well-established (McCauley & Moskalenko, 2017). For a small minority, however, engaging in violence can come to seem like the only available means of changing an intolerable situation. 

We are living through a period of significant socioeconomic disruption, geopolitical instability, and widespread fear. These conditions narrow the psychological window for nuanced thinking, particularly for those already struggling to find solid ground, those who feel profoundly inadequate and powerless to change their circumstances. In such a climate, ideologies that offer purpose, belonging, and an identified enemy are more, not less, appealing. EMDR therapists are likely to encounter clients who are somewhere on this continuum, whether or not they present that way. Recognising the clinical features, understanding the psychological conditions in which these ideas take root, and approaching these presentations with the same non-judgemental curiosity that characterises good trauma practice, is both a clinical necessity and an ethical one. 

Conclusions and summary 

Working with former violent extremists has been the most demanding, and in many ways the most rewarding, clinical work of my career. It has tested skills, ethics, resilience, and conceptual frameworks in ways that were not fully anticipated. It has also confirmed, more deeply than any other work I have undertaken, the capacity of EMDR to reach those who have been considered unreachable: to offer, even to those who have done or been part of terrible things, the possibility of integration, meaning, and genuine change. 

The key messages for EMDR therapists are these. First, this population is treatable. The complexity is real but not prohibitive and the potential for meaningful therapeutic change is significant. Second, supervision and self-care are clinical necessities, not optional additions. Third, the line between perpetrator and victim is rarely clean, and the ability to hold both simultaneously, without premature resolution, is central to effective practice. Fourth, the skills this work requires are largely those that experienced EMDR therapists already possess, particularly those working with other hard-to-reach populations. The framework is sound. What is needed is the willingness, and the flexibility, to apply it. 

Therapy alone is not enough. Alongside psychological support, people need practical assistance and genuine social connection with others willing to take a chance on them. Epistemic trust, eroded by years of relational harm, must be painstakingly rebuilt. A new identity, grounded and sustainable, must be actively constructed rather than assumed to follow naturally from symptom reduction. And beneath all of it, the same fundamental human need: to matter, to be seen, to be believed in as someone of value. 

What I return to here at the end: these people are so much like everyone else. The echoes of their experience in the lives of other clients, struggling with shame, with belonging, with the distance between who they are and who they had hoped to be, were constant. That recognition did not minimise what had happened. But it made the work feel possible. And it made it feel, without question, worth doing. 

I write as a British Asian psychotherapist and EMDR Europe Accredited Consultant, currently awaiting my viva for a doctoral thesis in psychology at The Open University. My perspective is shaped by 4.5 years of clinical and research work with former violent extremists in community settings, and by training across trauma-informed, cognitive behavioural, and systemic approaches. My broader clinical background spans NHS, third sector, and humanitarian contexts, including work with child and adolescent mental health services, veterans, survivors of torture, refugees, people in the prison system, and those with eating disorders. As an Asian practitioner working with a population whose experiences intersect with racialised narratives in public discourse, I have sought to maintain ongoing reflexive attention to how my own positioning shapes this work. This article is offered as a practice-based reflection grounded in clinical experience and doctoral research. I am currently working with clients and supervisees in private practice and would welcome contact from practitioners working in trauma and complexity at deeramaswamy@gmail.com.