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Winter 2025

This edition had a total of 9 posts

1. A note from the Editor
2. EMDR UK Association research webinars: Developing critical analytic skills
3. Research News
4. Recording videos for supervision
5. Update from the Equality Diversity and Inclusion Committee
6. Scientific and Research Committee update
7. Encouraging a multi-perspective understanding of eating disorders
8. What can EMDR offer people living with dementia and their carers?
9. The hammock: A case report using adjunctive EMDR and art therapy

A note from the Editor

When opening the home page of this edition of ETQ, your eyes will have been drawn to the wonderful image that signposts to the lead article. Entitled 'Growth' and contributed by one of the authors Sisqui, this image captures the lightness and peace that is often experienced by clients following EMDR therapy. The article was co-created by Sisqui and her two therapists and details the use of EMDR alongside art therapy. It is a good example of how the shared ownership of the data (stories) between therapist and client serves to undermine the dominant paradigm - i.e. that professionals are the experts. Clearly, the client and the therapists educated each other. I'm sad to say that this is my last edition of ETQ. I am retiring and taking on a greater caring role for elderly parents, so the article by Jonathan Hutchins and his colleagues about using EMDR for people living with dementia and their carers particularly resonated with me. We have another column from Robin Logie, looking this time at recording videos for supervision. Robin addresses (with humour and compassion) a subject that can be highly activating for supervisees and supervisors alike. There are regular updates from the Scientific and Research Committee and the Equality Diversity and Inclusion Committee, and Anthea Sutton provides the most recent EMDR research update. Anthea and I presented an Association webinar in January on developing critical analytic skills and a summary of the webinar with resources can be found in this article. Finally for this edition, for readers interested in the treatment of eating disorders, Emma Mullins-Crocker reviews a new text book. I have enjoyed my time as Editor. I have had the pleasure of working closely with many Association members, learning about their research and practice and helping them to disseminate it to our readers.

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EMDR UK Association research webinars: Developing critical analytic skills

In line with the Association’s strategy for developing the knowledge and skills of its members, Anthea Sutton and Beverly Coghlan revealed the dark art of critical analytic skills. For some participants, it was their first foray into this arena; for others, it was a gentle reminder of the things they had learned in previous periods of study. This was a practical webinar, with participants using two real-life examples of published clinical studies to test their knowledge. It might not be immediately apparent why we need to be able to read a scientific paper critically. After all, if we find it in the Francine Shapiro Library or the EMDR UK Publications Database it must be valid, right?  Well actually, no. The EMDR Publications Database does go some way towards eliminating papers that we should be wary of, because unlike the Francine Shapiro Library, it only includes those that are peer reviewed; and it also automatically monitors for retractions, removes them and replaces them with a retraction notice. But, as the webinar participants discovered, peer review does not necessarily guarantee research quality and robustness. If Ioannidis (2014) is to be believed, only 15% of health research is useful; the remainder is reported as “wasteful” due to issues with study design, irrelevance to stakeholders and other quality issues. Critical appraisal skills increase the probability of finding the useful 15%. Critical appraisal ensures scientific rigour and reliability, helps identify biases and errors, and ultimately improves evidence-based decision-making. Figure 1 shows an accepted hierarchy of evidence generation. Figure 1. The evidence hierarchy At nearly every level, there is an appropriate appraisal checklist to assess the quality and robustness of a study, as well as its practical applicability to your work with clients. How is a critical appraisal carried out? A critical appraisal starts with a clinical or research-driven question or problem. From here, we can search for relevant articles, and the relevance can usually be discerned from the abstract. To ensure a thorough evaluation, an appropriate critical appraisal checklist, relevant to the study design of the chosen journal article, can be used. This will provide questions to guide us through the article and help us make sense of the research. These checklists are available from several different organisations, such as: Critical Appraisal Skills Programme (CASP). Centre for Evidence-based Medicine, Oxford. Cochrane Collaboration. The Queen Margaret University, Edinburgh, has curated a comprehensive library of these lists, which can be found here. While these checklists may seem daunting at first, they do make the research more meaningful. With practice, working through the list and scoring the research becomes second nature, and we become better able to sniff out research that is not robust or applicable to our client population. It is important to note that when conducting systematic reviews or meta-analyses, it is essential to score the included research on a standardised checklist. Research bias Bias in research refers to a systematic error that can occur during the design, conduct, or interpretation of a study, leading to inaccurate conclusions. Essentially, the critical appraisal checklists are designed to identify potential bias. The higher the risk of bias, the less the results can be trusted. Selection bias Selection bias can be reduced by ensuring adequate randomisation of participants to interventions and that the randomisation is adequately concealed. This should ensure that study groups are similar at baseline, and baseline demographics and disease/disorder severity should be reported. Intention to treat (ITT) analyses should also be conducted. This means that the analyses should be run on every participant, whether they completed the intervention or dropped out for whatever reason. Performance bias Performance bias can be minimised by ensuring that the care provider and the participants are blinded to the interventions they receive. This is difficult to achieve in psychotherapy investigations, and we need to remember that the widely accepted gold standard for clinical investigations (the double-blind, randomised controlled trial) was developed to test pharmacological substances and not person-to-person psychological therapies. Detection bias Detection bias can be minimised, even when the actual investigation is not double-blinded, by blinding the results assessors.  Attrition bias Attrition bias refers to the overall tolerance of an intervention and should be reported for all non-completers, whatever the reason, as well as differential attrition between the study groups. Funding bias Funding bias can be minimised by declaring the funding source and any conflicts of interest of the investigators. Figure 2 (a). Cochrane risk of bias plot for individual papers Figure 2 (b). Cochrane risk of bias plot for groups of papers (e.g. a systematic review) Statistics Of course, we must have a working knowledge of statistics to understand that the statistical tests applied are appropriate for the data and to understand what the numbers mean. p-values In a nutshell, p-values help us determine the significance of the results. p-values of 0.05 or less indicate that the result is likely to be accurate, and p-values of greater than 0.05 are considered an indicator of an unreliable result. For example, a low p-value of 0.03 indicates that if the study was repeated 100 times, on three occasions the result would be due to random sampling error or chance, and on 97 occasions it would be due to a real effect being observed. Confidence intervals Confidence intervals (CIs) are often used in randomised controlled trials (RCT) and meta-analyses. They are used to indicate the variation of results and the confidence we can have in the results. CIs show the average/overall result plus the upper and lower ranges. We would not expect to get the same result if we conducted an experiment 100 times, but a confidence interval tells us how much variation we might expect and how confident we can be in it. This is usually expressed at 90, 95 or 98% confidence. This means that for a reliable, usable result, we ideally want to see a narrow confidence interval (so just a small amount of variation between studies) with a high percentage of confidence. Power In health research, it is important to ensure studies have a high likelihood of detecting meaningful findings, so power calculations should be undertaken to determine the number of participants required to show an effect. Effect size The effect size quantifies the difference between the intervention and control groups. Calculating the effect size helps us understand whether an intervention is clinically meaningful as well as statistically significant. It allows comparison across studies with different sample sizes or methods, and as we all know, in mental health research, even small effect sizes can be hugely clinically significant. Effect sizes are typically expressed as follows: small (0.2–0.5), medium (0.5–0.8) and large (greater than 0.8). Putting critical analysis into practice As a final exercise to consolidate their learning, webinar participants were asked to critique the most cited paper in the EMDR literature – Francine Shapiro’s 1989 study, which has been cited 544 times. The question posed was, “How does this paper stack up nowadays, given that it was published 36 years ago?” We worked through the CASP RCT checklist and together concluded that because the p-value for EMD versus control was so striking (p<0.001 pre-post drop in SUD versus p>0.05 for the control group), we could take the results seriously enough to do further studies  – which is clearly what Shapiro did. But judging by our present-day standards, the risk of bias in this study is high, not least as Shapiro herself points out, because “the experimenter and author were one and the same.” Critical appraisal skills are valuable to us not only as scientist-practitioners but also in our everyday lives. We are constantly bombarded with information about products/interventions/treatments with outlandish clinical claims but couched in a pseudo-scientific way. One only has to look to the ‘wellness industry’ for examples, and often our clients present us with such information as fact. Being able to neutrally and scientifically debunk the claims can be helpful. More importantly, though, these skills can be time-saving (given the amount of information available) and lead us to better clinical judgement. Figure 3 provides additional resources to help you develop your critical analysis skills. The video is particularly helpful; it makes the whole process of reading (and analysing) a paper seem much less daunting. How to Read a Paper: Getting your bearings (deciding what the research is about) (Greenhalgh, 1997).  Anatomy of a Systematic Review (National Collaborating Centre for Methods and Tools).  How I read a paper! (4-minute video).  Figure 3. Resources A recording of the webinar can be found here.

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Research News

EMDR Publications Database The EMDR Publications Database has been developed collaboratively using the expertise of the Sheffield Centre for Health and Related Research (SCHARR) and is provided as a free resource for Association members. If you still haven’t accessed this useful resource, you can find out how to in the member’s area of the website. If you need any assistance or have any questions, please do not hesitate to get in touch at emdrdatabase@sheffield.ac.uk. The EMDR Publications Database is a collection of peer-reviewed research and dissertations/theses focusing on EMDR. It contains 1,991 references, many of which have access to the full text. The references are categorised by ‘tags’ (keywords) relating to the clinical area and study type – allowing for easy browsing. The database can also be searched by terms of interest. The most recent update to the database was in January 2025, where 38 new publications were added. The search to populate the database was conducted on the following international databases: MEDLINE, Embase, PsycINFO, ProQuest Dissertations & Theses, and PTSDpubs. Newly added publications can be easily viewed by clicking on the ‘NEW’ tag. Within the NEW tag, you can then select further tags of interest to see what has recently been added for specific topics and research types. New publications by type Research/publication type tagNumber of new publications addedSystematic reviews10Trials7Cohort studies3Qualitative research2Non-English language2(1 German, 1 Greek)Other17Table 1. New publications by research/publication type Systematic reviews Approximately a quarter of the publications added in this update are systematic reviews. Arjmand et al. (2024) conducted a review of 18 systematic reviews on the prevention and treatment of mental health conditions in first responders. Christopher Lomas (2024) (Salford University) has published a systematic review exploring the neurobiological underpinnings of addiction and examines the efficacy of psychotherapies, including EMDR, in treating substance use disorders. Also in this subject area, a team in Mexico have published a systematic review on EMDR for reducing cravings in populations with substance use disorders (Martinez-Fernández et al., 2024). There are also two new systematic reviews in psychological interventions, including EMDR, for PTSD in children and young people (Hoppen et al., 2024; Phillips et al., 2024) and two in refugee populations (Karvela & Papathanasiou, 2024; Yilmaz & Karakus, 2024). Children and adolescents Including systematic reviews, 13 publications relating to EMDR with children and adolescents have been added this month. These include a pilot study of EMDR for children with post-traumatic distress following medical procedures (Potharst et al., 2024), an RCT using EMDR as an adjunct to pain management for children during dental extraction (Rathore et al., 2024), and a pilot study of imagery reports and short EMDR intervention for adolescents with social anxiety disorder (Thunnissen et al., 2024). Physical health If you click on the ‘Physical health’ tag, you will find over 100 studies about using EMDR for a wide variety of conditions. For example, this quarter, a cohort study using EMDR for the treatment of methotrexate intolerance in juvenile idiopathic arthritis has been added (Höfel et al., 2024). Study protocols One of the ways we keep you informed of new research projects is to add study protocols to the database. This quarter, three have been added: The study protocol of a double-blind, randomised controlled trial of EMDR and multifocal transcranial current stimulation (MtCS) as augmentation strategy in patients with fibromyalgia (Gardoki-Souto et al., 2024). Secondary traumatisation in refugee care – EMDR intervention for interpreters (STEIN): a study protocol for a quasi-randomised controlled trial (Rzepka et al., 2024). Towards international collaboration of clinical research networks for EMDR: the EMDR Pain Network Germany (Vock et al., 2024). Retractions Did you know that the database automatically monitors for retracted items? Once alerted to this, we remove the retracted publication and replace it with a retraction notice. Keywords We will be reviewing the database tags shortly and making some changes, including adding new tags where required. We are keen to hear your feedback, so if there is a tag you would find useful, or if you think any of the existing tags need amending, please get in touch with Anthea Sutton, Research and Academic Liaison, at a.sutton@emdrassociation.org.uk.

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Recording videos for supervision

I learnt the trumpet as a child, and each lesson involved my teacher listening to me playing. Sometimes that went well, and sometimes it didn't. But it meant that when I started doing EMDR, it didn't feel particularly strange to me to be observed. That's not the case for everyone, however. Once a year, the UK EMDR consultants meet for a consultants’ day. At the most recent of these, I presented a workshop with Naomi Fisher titled, Is this video good enough? There is often a considerable amount of anxiety about having one’s therapy practice observed, due to a fear of being exposed, and this was something we addressed right at the start of our workshop. We asked the consultants to remember their own experience of having their work observed and how this had felt. As you read this column, perhaps you could take a moment to do the same, and if you haven’t yet submitted any videos, you might think about the fears you may have in doing so. Unfortunately, most supervisees will only produce videos of their work while working towards accreditation; therefore, it is seen solely as a way of evaluating their work. In our workshop, I reminded the attendees of the ‘three Es’ (‘Educating’, ‘Enabling’ and ‘Evaluating’, which I have described in earlier editions of this column) and that sharing videos can be as much about educating and, to a lesser extent, enabling as it is about evaluating, even though it is likely to be for evaluation that the video will usually have been submitted in the first place. To put the observation of videos into context, let’s take a step back and look at the different ways supervisees can share work with a supervisor, each with its own advantages and disadvantages. Verbal report This is what usually occurs in most supervision sessions. We just tell our supervisor about our client and where we feel stuck. We provide them with the information we think is relevant or relates to the questions they ask. Verbatim report This is a more structured form of supervision where we provide a written blow-by-blow account of everything that was said and experienced in a particular EMDR session. Written/clinical documentation review This is where the supervisor reviews all our notes and any other documentation. This would usually be used in order to ensure that the supervisee is practising safely and effectively in line with the approved procedures for their particular organisation. Simulation This is a role-play re-enactment of a therapy session. This can be particularly useful to home in on a particular technical issue regarding the EMDR protocol. Live observation The supervisor sits in on an EMDR session, physically in the room, behind a screen or online. The advantages of this are that the supervisee cannot select just the ‘best bits’ for their supervisor to see, and the supervisor can intervene if it is helpful to do so. Video recording The supervisor observes a pre-recorded video of the supervisee’s work, either together with the supervisee or separately. This is relatively easy to arrange and has the advantage that the supervisor can actually pick up on any potential mistakes the supervisee is making, as well as those that the supervisee has chosen to bring to supervision. EMDR Europe requires the last two of these ( live observation and video recording) to evaluate a therapist’s practice for accreditation. (Interestingly there is no such requirement to be accredited with EMDRIA, the accrediting organisation across the Atlantic.) Now, let’s think a little more deeply about recording an EMDR therapy session. As an introduction, I particularly like this quotation: "The word supervision is derived from the Latin super, meaning 'over’, and videre, ‘to see’. In a literal sense, audio- and video-recordings provide a direct, factually correct vision of what transpired in the therapy session. It is this direct access, unfiltered through the therapist’s recollections, that is the prime advantage of the recording. The patient and therapist can be heard in action, and seen if videoed, which is a very different matter from those events being reported. The simple exercise of comparing one’s notes on a session with a tape-recording dramatically highlights the deficiencies of memory, especially when emotionally charged and complex issues are emerging and being explored. In recollection, whole segments of interaction are not recorded in memory, the sequence of interactions become reordered, key statements by the patient are either misheard or not heard, elements are magnified or diminished, and interpretations take on a wishful perfection."Aveline, 1997, p. 82 What are the advantages of recording therapy sessions for supervision? The main reason for doing so relates to the inadequacy of alternatives. Most supervision is based on verbal reporting. “Many supervisors who rely on self-report have fallen into stagnation … at its worst, self-report is a method whereby supervisees ‘distort’ (rather than ‘report’) their work, even if they are not consciously doing so” (Bernard & Goodyear, 2019, p. 164). Muslin et al. (1981) found that 54% of the themes of videotaped interviews were not reported in supervision, and some degree of distortion was present in 54% of the interviews. Additionally, Ladany et al. (1996) reported that 97% of supervisees were conscious of keeping relevant material out of their supervision. For a therapy such as EMDR, which has a clear, structured procedure, it is particularly important that the supervisor has an opportunity to observe their supervisee’s work to make sure they are adhering to the EMDR protocol. As I mentioned at the start, the experience of having your work observed can be unnerving, and there is often the fear of shame attached to showing oneself at work in what is usually a private and confidential setting. This may be an issue in itself that needs to be addressed in supervision. Neufeldt et al. (1996) found that a willingness to experience vulnerability was a necessary quality in relation to agreeing to use recordings of therapy sessions. Scaife (2019) suggests that the supervisor should share their own willingness to show their vulnerability by letting clients see recordings of their work. Tony Rousmaniere, a big name in clinical supervision research, “starts each training year by showing his trainees a clip of a video in which he forgets the client’s name” (Bernard & Goodyear, 2019, p. 167). One reason offered by supervisees for avoiding making recordings relates to consent and their assertion that their clients would be uncomfortable about the recording of sessions. However, a study by Briggie et al. (2016) found that 52% of clients expressed no or slight concerns, and 71% were willing to consider audio or video recording. It has certainly been my own experience and that of my supervisees that, once you pluck up the courage to ask your clients about recording sessions, most clients will agree. I will share with my supervisees that it can be scary to ask and that I have found this to be so myself. But once you get into the habit of asking, you will be surprised by the positive response. One of the questions we addressed at the consultants’ day was whether the video had to be ‘perfect’ to be deemed acceptable for accreditation. To answer this question, I told a story (as I often do) about a supervisee of mine who produced a video with quite a few mistakes in it. I gave her some feedback to help improve her practice, and I asked her to produce another video. This second video proved to be much better yet still had quite a few errors; I therefore asked her for a third video. At this point, she became demoralised by the whole process and said she was wondering whether it was worth pursuing accreditation. I suggested that, for her third video, she also provided a written appraisal of the video outlining where she had a) deviated from the protocol by mistake and b) where she had deviated deliberately because it was sensible to do so with that particular client. Though not absolutely perfect, her third video was a great deal better. However, it was her written comments that indicated she fully understood the protocol. I decided that we were now in a position to put her forward for accreditation. So, to answer my question, no, it doesn’t have to be perfect, but the supervisee needs to know where they went wrong and why. To be honest, even after using EMDR for 25 years and having been an EMDR consultant for 14 of those, I still occasionally, in the heat of the moment, do something wrong. In fact, when teaching and showing videos, I often ask my trainees to spot my mistakes. This is a task which, for some reason, they particularly enjoy! Giving feedback Giving feedback can be scary for both the supervisor and supervisee. For the supervisor, who wants to be supportive and is used to being a therapist who is supportive to their clients, giving feedback can feel quite brutal and undermining. For the supervisee, it can be triggering, perhaps reminding them of some unprocessed experiences from their school days. Most of us have a fear of failure and negative cognitions regarding self-defectiveness can be easily triggered. The supervisee may be thinking: What if they tell me I’m no good at this? What if they think I’m a useless therapist? What if I’m doing this all wrong? What if this exposes me as completely incompetent? But bear in mind that your supervisor may have a parallel set of issues: What if they get really angry with me? What if I come across as undermining? What if they complain about me to other people? What if I’m not actually right about the things they are getting wrong? What if they don’t like me after I give them feedback? So, what is feedback for? For the supervisor, it is to give effective and constructive feedback to enable the supervisee to act upon it to improve their practice. For the supervisee, it is to hear the feedback without becoming defensive, and to integrate this into their practice. Once both the supervisee and supervisor feel relatively comfortable with this (and the more they do, the easier it will get), they can develop a relationship where the supervisee’s practice can grow and develop. The medium by which EMDR supervision is provided is crucial in terms of the three functions of supervision. Of particular importance is having one’s work observed, either through a video recording or in vivo. Supervisees will learn much more about their practice and how it can be enhanced if their supervisor observes them at work. They will feel supported and enabled, and most importantly of all, the supervisor will be able to accurately evaluate their supervisee’s adherence to the EMDR protocol for the purposes of accreditation.

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Update from the Equality Diversity and Inclusion Committee

A happy new year to you all. I hope the seasonal break brought some time for rest and reflection; however you chose to spend it. There are many challenges globally and nationally, with further changes still to come. These changes may impact the most vulnerable and marginalised in society, which includes our clients, peers and ourselves. There is much need to continue our work together. EDI Committee member recruitment The beginning of 2025 brings four new members to the EDI Committee following a recruitment drive at the end of last year. We welcome Karen Jane Crowe, Aisha Docrat, Azucena Guzman and Tafadzwa Tapfuma (known as Taffy). The new members bring their experience and passion to support the committee and the Association. Webinars The EDI Committee has engaged in a multimedia approach to providing EEDI-related opportunities for its members. We encourage members to engage with the committee by sharing their areas of interest via webinars, podcasts, the Forum and/or ETQ articles. A number of events, podcasts and ETQ articles have been delivered since the last update, such as working with intellectual disability and  unconscious bias. Further webinars include: Intersectionality - understanding, reflecting and applications in EMDR psychotherapy Victim blame and trauma-informed spaces Breath work. Dr Aileen Alleyne has been invited to this year’s conference to share her work on understanding generational trauma and black identity wounding. The committee continues to source and deliver a multimedia approach focusing explicitly on working with marginalised and underserved groups, to adapt and develop our EMDR practice. If this is something you could offer and are an EMDR therapist, practitioner, consultant or trainer, please get in touch. If you are a member of the Association, you are also able to deliver a webinar/event in conjunction with your consultant supervisor. This is a great opportunity for consultant supervisors to support their supervisees’ growth and assist in sharing knowledge. There are a number of CPD events that can be accessed here. Continuing professional development applications and evaluations Together we have started to integrate EEDI into CPD events and gain feedback from delegates. The CPD application form has been reviewed and updated to encourage and understand how event organisers and presenters consider accessibility and incorporate diversity in their presentations. Additionally, the evaluation form has also been updated to understand how inclusive and accessible delegates find the events. Both the CPD application and CPD evaluation form will continue to be reviewed periodically. Bursary The Association has agreed to offer some bursaries to access standard EMDR, C&A EMDR training, books and clinical supervision. This will take some time, so please bear with us. SLWG: guidance We are working on developing some tip sheets/guidance on accessibility to events for the Association. These will be shared via the forum when they are ready. Special interest groups (SIGs) and regional groups (RGs) Kamla Dadral continues to coordinate the reflective space for ethnically minoritised EMDR UK members to share their narratives and processes and to consider the group’s next steps. Please contact her at kamladadral7@gmail.com to find out more or to join the reflective group. The updated EEDI policy has been shared with SIG and RG chairs, and they have been asked to share their feedback. Awareness days SIGs and RGs have been contacted to share the awareness and heritage days they would like the Association to highlight. Katy Bell will be working with the Association to support and promote the work in this area. Forum The EMDR UK Forum is a great place to share ideas, experiences and resources. The Association aims to develop a safe space to explore issues relating to EEDI. The aim is, of course, for EEDI to be overtly integrated throughout the forum. Bea Carrington and Fiona Corbett share resources about the EDI section on the forum. Accessible answerphone We have attempted to increase accessibility to the Association, and an answerphone service has been live since May 2023. Accessible answerphone number: 0151 372 6802 This is an accessible answerphone line for those who cannot email the Association. The answerphone will not be monitored on weekends and during holiday periods. Please be mindful that queries will be responded to as soon as possible but may take a few days. Please be aware that there is a process of reasonable adjustments and mitigating circumstances that members can access. This may be relating to attending events, applications for accreditation and other support needs relating to engagement with the Association. Please email the Association at the address below to be directed to the right person in relation to your query.

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Scientific and Research Committee update

Research skills webinars The first of our planned research skills webinars took place in early January 2025. Beverly Coghlan and Anthea Sutton ran an interactive session on critically appraising research. The discussion around ‘how we can tell that a piece of research is sound’ was valuable, and we introduced formal methods of quality assessment, such as the Critical Appraisal Skills Programme. Beverly has written about the session in more detail, please see her reflections here. The Scientific and Research Committee (SRC) plans to run additional webinars in 2025 on essential research skills. These will be advertised on the Association CPD events webpage, so please look out for them there. If there are any research webinar topics you would find useful, please let us know at a.sutton@emdrassociation.org.uk Advice on funding applications As well as the webinar programme to promote research skills, the SRC aims to disseminate useful information to help members get involved in and develop research. The National Institute for Health and Care Research (NIHR) funds the Research Support Service to support researchers to develop applications for national, peer-reviewed research programmes. This covers all NIHR programmes and UK research councils, as well as national health and care charities. For further details on the type of support available, please see the NIHR Research Support Service website here. Public involvement in research Public involvement in research means actively engaging people from outside the research community, such as patients, community members or the general public, to contribute to the design, conduct and dissemination of research. Collaboration with these groups helps to ensure that research addresses real-world needs, improves relevance and can lead to more meaningful outcomes. If you have any opportunities for the public to get involved in your research, you can add these free of charge to the People in Research website. Ongoing research Researchers at the University of Sheffield have begun a ‘Target Therapies’ project evaluating digital and talking therapies using real-world data, including EMDR versus trauma-focused CBT for posttraumatic stress disorder. Further details about the project can be found here. EMDR UK annual conference We have now finalised the posters that will be displayed at the annual conference in March. We have an exciting array of topics, and the poster authors will be available to chat during the refreshment and lunch breaks, so if you are attending, please do come and see them. The posters can be viewed electronically by online delegates. Poster abstracts will be published in the conference brochure in due course. In addition, members of the SRC will be presenting an update on our work on Day One (Friday 21st March) during the lunch break, which is between 12.30 and 13.00. Please see the conference programme. We hope to see many of you there.

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Encouraging a multi-perspective understanding of eating disorders

This book delves into the relationship between trauma and eating disorders (ED). It discusses the presentations and differences between many forms of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorders such as, bulimarexia and orthorexia. Written by different contributors, the book stands out for its unique approach to reviewing the literature. I found this approach very informative, and although the information overlaps slightly in some sections (presentation, dissociation and treatment focus), I do not feel this made the material repetitive. There is no specific focus on one treatment approach, making the book accessible to a wide range of practitioners. Unlike other ED treatment books, this covers not only treatment approaches but also the medical factors and concerns that can be integral to safely supporting those with EDs. The medical explanations are clear and provide insight into the risks, such as amenorrhoea (loss of menstrual cycle), hair thinning and decline in concentration or focus. For those with minimal experience supporting clients early in their recovery, this information is invaluable. This second edition has been updated to include additional sections (the impact of COVID-19, racism, LGBTQ+IA, neurodiversity and working with children and young people). The racism section explores the systemic challenges facing those who do not align with the concept of a ‘thin white ideal’. There is a focus on racism and the body for BIPOC (Black, Indigenous and People of Colour) and understanding racial trauma. As a white woman, I connected with this section as it helped me understand the experiences of those in marginalised groups, what shapes their experiences, the impact of generational racial trauma, and how that may impact their relationship with food and their bodies. It is widely recognised that this population is underrepresented in services and often does not receive diagnoses. It is good that this section increases awareness of the various challenges these individuals can face. An area of particular interest to me is neurodiversity. I am neurodivergent, so I was pleased to see this included in the second edition. Many neurodivergent clients present with interpersonal, relationship and friendship challenges, and this section helps practitioners understand how their relationship with food and their bodies is also affected. Often, these clients begin to explore how being neurodivergent has impacted their eating behaviours. Due to their experiences not matching what is an expected presentation of an ED, they can face challenges in accessing appropriate mental health support. The section highlights the challenges that can arise when working with a client group that may have atypical feeding behaviours as part of their ASD diagnosis, such as those with sensory sensitivities and links to avoidant/restrictive food intake disorder. The book identified that a barrier to receiving support is a lack of informed practitioners. I think this section goes some way to helping understand accommodations that might benefit neurodivergent clients, but this likely depends on the modality of the therapist. I have always had an interest in working with people with EDs and disordered eating. Still, as someone who works solely in private practice, I found it challenging to find continuing professional development (CPD) that supported me in working with this client group. I found a lot of CPD lacked what felt like a human approach to healing and often focused on the medical model or NHS approach. This felt like quite a narrow focus when working with such a diverse client group. Different writers discuss their clinical experience and scientifically backed approaches, and I believe this information would have helped me when starting to treat clients with these presentations, to build confidence in my approach to working with this client group. That isn’t to say I haven’t gained valuable insights from reading the book now – I certainly have. I can, however, recognise that I could have benefitted hugely from reading it years ago. One of the things I learnt was about the differences between restrictive EDs and binge eating in terms of dissociation. The research showed that bingeing episodes were seen as dissociative, whereas restrictive eating is suggested to be less dissociative. This understanding of the literature has provided me with a useful talking point when working with clients and an understanding of how an eating disorder feels for them; many of them agreed that for them it was a way to ‘disappear’. The book explores various non-EMDR methods of working with clients, such as dance and movement therapy, neurofeedback, psychodynamic therapy, trauma focused-CBT, internal family systems and ego state work. A four-phase model of trauma-informed treatment is explained, covering assessment and treatment planning, preparation, trauma processing and relapse prevention, revaluation and integration. It is possible to identify where different modalities fit into these; for example, the eight phases of EMDR are easily incorporated into the four distinct phases of the model. The book's strength lies in the wealth of experience of its contributors, providing readers with a profound understanding of the subject matter and the breadth of content covered. I have worked with clients with EDs for several years and have read widely, and I feel this book is by far the most comprehensive because it covers the realities and practicalities of working with those with EDs. I think the combination of approaches of reviewing the research and the lived experience of working with this client group has a balanced feel, making the content more accessible. A downside to the book is its price, as it is more expensive than many other books about working with EDs. Nevertheless, the extensive research and valuable insights make it a worthwhile investment for those interested in the field. The book is not currently available as an audiobook but is available on Kindle. Another point for consideration, that perhaps wasn’t explicitly discussed in the book, is the difference in working with this client group in a multidisciplinary team versus private practice – perhaps future editions could include a section on this. In conclusion, ‘Trauma-Informed Approaches to Eating Disorders’ is an essential read for individuals working with ED clients. It offers a wealth of knowledge, practical guidance and diverse perspectives. For therapists and practitioners, this book provides valuable insights and practical applications for working with this client group.

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What can EMDR offer people living with dementia and their carers?

Introduction Dementia is an umbrella term that describes a decline over time in cognitive functions such as memory, thinking skills, understanding and speech. Dementia has enormous, personal, societal and economic effects. According to NHS England (2024), 481,783 people have been diagnosed with dementia as of April 2024, and of those diagnosed, 33,711 received their diagnosis before the age of 65. The Alzheimer's Society estimates that 900,000 people in the UK actually have dementia, which may rise to 1.6 million by 2040. Of the 900,000 people with dementia in the UK, over 78,000 are under the age of 65, and there are 25,000 from Black, Asian and minority ethnic groups. One in six people over the age of 80 has dementia. The UK charity Dementia Carers Count suggests there are 700,000 family carers of people with dementia in the UK, and this figure is projected to rise to 1.6 million by 2040 (alongside the increase in people who will develop dementia). Two-thirds of people with dementia in the UK live at home, most supported by unpaid carers. The number of people who will have left employment to care for people with dementia is set to rise from 50,000 in 2014 to 83,100 in 2030. There are different subtypes of dementia, and the distribution of disease type can be seen in Figure 1 below. Figure 1. Breakdown of dementia by disease type.https://dementiastatistics.org/about-dementia/subtypes/ Each subtype has a specific neuropsychological profile of behavioural and psychological symptoms of dementia (BPSD) that pose unique challenges to families, carers and care staff. We considered each subtype and whether EMDR can benefit people with dementia. We also considered how EMDR can support family, carers and care staff to manage these symptoms. Choosing targets for EMDR There are a range of experiences and symptoms that can lead to a traumatic event, both for the person with dementia and for those who care for them. We considered the disease progression and that it is also possible for people to experience more than one subtype of dementia simultaneously. It could be argued that there is more scope for standard protocol EMDR interventions at the early stages of dementia due to cognitive abilities being more intact. As the disease progresses, the need for adapted EMDR approaches increases, as does the increased difficulty of establishing a therapeutic alliance and/or pinpointing specific experiences to target. Studies have shown how EMDR has been used in the early stages of dementia to address previous psychological trauma, such as the trauma of being diagnosed with the disease (Ruisch et al., 2023; Amano & Toichi, 2014.). In addition, EMDR has also been used to effectively reduce the BPSD by addressing the content of ruminations as well as trauma related to hallucinations and delusions, which in turn reduces these symptoms (Adams et al., 2020). Past targets Considering the EMDR three-pronged approach of past, present and future triggers (Shapiro, 2017), the past experiences to consider targeting with the standard protocol could include: History of powerlessness or feeling out of control: These experiences may underpin the individual’s reaction to receiving their diagnosis. Prior experience of dementia or illnesses in the family: For example, witnessing a parent or loved one’s experience with dementia may contribute to present and future fears about the progression of their own disease. Early attachment history: Experience of being cared for as a child, particularly if this involved abuse or neglect, may influence their future fears as the need for care arises as the disease progresses. Additionally, re-enactment of attachment frustrations may take place between the individual and their carer, which could give scope to other possible EMDR targets. Present targets We recommend a collaborative person-centred approach to working with both the individual and their carers. Present memories/experiences to consider targeting for EMDR could include: The moment of diagnosis with the disease. Moments of self-awareness linked to specific symptoms of dementia, such as incontinence, hallucinations/nightmares or moments of challenging behaviour. For carers, present EMDR targets can include: When they first experienced their loved one experiencing symptoms such as incontinence, significant memory loss or challenging behaviour. Moments of impact when the loss of their loved one becomes clear due to how they are behaving, such as witnessing significant changes in their personality. Adjustment and loss Both the individual with dementia and their carers are likely to experience a period of adjustment and transition in relation to the dementia. This process can be considered in relation to the literature on the grief and loss cycle, described by Kübler-Ross (1969). At the early stages of diagnosis, there may be denial, shock and avoidance, leading to possible anger for both the individual and their carers/family. The moment of diagnosis can be a trauma memory in its own right. This may present a key initial target for EMDR processing to help foster increased understanding and acceptance of the diagnosis and to focus on coping both now and how to plan for the future. Additionally, as the individual moves through this cycle, they could compare themselves to what they were or could do in the past. This comparison and past focus can be a source of significant anger and sadness for the individual and their carers. EMDR may be useful to target a recent experience of a failure or the BPSD to help reduce the emotional and possible traumatic impact on individuals and their carers, and because of adaptive information processing (AIP) increased resilience and coping strategies. Another source of concern for carers can be about what would happen if they were to develop dementia themselves. A systematic review published in The Lancet by Livingston et al. (2020) explored the most effective, evidenced-based ways for both preventing dementia and providing interventions for those affected. Figure 2, which is from this article, highlights the importance of maintaining a good diet, stopping smoking, reducing alcohol, preventing and treating depression, and increasing exercise and social contact, all of which can contribute to reducing the risk of developing dementia. Figure 2. Possible brain mechanisms for enhancing or maintaining cognitive reserve and risk reduction of potential modifiable risk factors in dementia (Livingston et al.,2020) It is important to use this information sensitively and only when appropriate as people who follow a healthy lifestyle can also develop dementia and we would not want this information to be used in a shaming way. However, this diagram may be useful to share with carers to guide interventions on how to increase their social contact with others or peer support groups. One study used an EMDR Integrative Group Treatment Protocol with carers (Passoni et al., 2018) and showed that the intervention reduced stress-related symptoms, anxiety and depression in caregivers of people with dementia.   Future targets Considering the third prong of the EMDR approach (Shapiro, 2017) future targets for people with dementia and their carers can include: Identifying three qualities –to draw resources from the individual’s and carer’s life experiences to cope with the coming changes related to dementia. These qualities could include resilience, determination and control both in the past and in the current moment. These positive qualities can then aid both the person with dementia and their carer in planning for the future and the type and level of care they wish to receive. Future template – building on the three qualities, it may be possible to use a future template related to seeing themselves coping with the disease by drawing from their resilience and ability to cope with adversity. Flash forward – this technique could be used to target the feared future worst-case scenario for the later stages of the disease and/or death. This should only be considered if the individual or carer is catastrophising about the future to the point that it is interfering with their ability to cope with the present. Other targets for EMDR with carers may arise related to the attachment dynamics of the family and their relationship with the person with dementia. These targets may include potential past attachment trauma memories that may arise for carers. These memories could also be useful targets for EMDR reprocessing, as it may help to reduce the levels of carer depression, anxiety and burden associated with managing the BPSD. In addition, future planning in relation to the later stages of the disease, death and possible early grief symptoms, such as denial and anger, are also important. The role of EMDR here could be to draw on resources such as the three qualities, future templating care or funeral planning, as well as processing recent carer experiences, such as witnessing the individual forgetting who they are. Potential challenges of using EMDR with this client group Whilst different subtypes of dementia have specific symptom profiles, every person with dementia and their carers go through their own unique journey and mix of challenges. This can make it difficult to identify if the individual is at an early, mid or later stage of the disease. Another factor to consider is that, with an increasing number of people with dementia living alone, how this creates challenges in remembering appointments and attending to personal care/health needs and risk. Assistive technology is one possible source of psychosocial intervention in this situation, and the evidence base is growing. (Rai et al., 2022). Other considerations, drawing on Neuro EMDR (Hutchins & Proudlock, 2023), could include cognitive adaptations to the standard EMDR protocol, such as using external cues for safe/calm space work, shorter sets of bilateral stimulation, and offering more assistance in identifying suitable negative and positive cognitions. Severe stages of dementia As an individual’s dementia progresses, the standard protocol may need to be adjusted, as they may not be able to engage in a formal therapy session or answer specific questions in the assessment phase of EMDR. At this stage, we recommend using the on-the-spot EMDR method (Amano & Toichi, 2014). This has been adapted for use with individuals who present with behaviour that is challenging in inpatient settings. The authors used the following approach: Phase 1 – history: As this was not possible from the client, the therapists drew information from the client’s care plan as well as collateral information from family members and/or life story work. Phase 2 – stabilisation: Due to significant memory impairments, clients would often forget the therapist after seeing them, so the therapist would reintroduce themselves each time they saw the client and would draw from previous sessions and/or collateral information for safe space, etc. Phase 3 – assessment: The on-the-spot EMDR method assumes that the challenging behaviour presented by the client is the traumatic material, as they are unable to communicate the specifics of a target image, negative cognition in relation to the trauma memory and the positive cognition in relation to the trauma memory, etc. Phases 4, 5, 6 and 7: The therapists used tactile bilateral stimulation rather than eye movements to do reprocessing, due to eye difficulties in older age and the cognitive demand of eye movements. Phase 8: Re-evaluation was not possible by asking clients directly, so the therapists measured the re-evaluation through antecedent, behaviour, consequences (ABC) chart data and reports from staff on the frequency and severity of the challenging behaviour. The authors saw a reduction in both the frequency and severity of challenging behaviour (Amano & Toichi, 2014; Amano & Toichi, 2016). It may be possible to teach and support carers to use aspects of this protocol to de-escalate challenging behaviour and to help the person with dementia regulate and reduce distress. Summary and recommendations This article proposes a range of methods on how EMDR may benefit those with dementia and their carers/families. Dementia is a complex and significant condition, and the authors aim for this article to act as an initial guide to inspire practitioners to use EMDR to help improve the quality of life for this client group. Currently, there is a limited evidence base supporting the use of EMDR for individuals with dementia, and we greatly encourage further research into this area. When considering future research options, we recommend not only measures of symptom reduction or reduction of challenging behaviour but also measures of physiological responses in clients before, during and after EMDR processing. For example, studies could be carried out using wearable technology such as smart watches or socks to investigate whether EMDR has a long-term impact on the physical health and sensory integration of people with dementia. Additionally, we recommend focusing on the potential effects of EMDR on sleep quality and overall quality of life.

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The hammock: A case report using adjunctive EMDR and art therapy

Introduction The adjunctive use of EMDR with art therapy is in its infancy. Originally developed by Borstein (2009) as a brief adjunctive therapy, she described it as “a focused application of standard EMDR treatment, provided by an EMDR-trained clinician to clients already engaged in some other form of individual psychotherapy with another therapist … In this model, adjunctive EMDR does not replace or interrupt ongoing therapy. It is complementary to the primary therapy relationship, and it is provided in active collaboration with the primary therapist.” Dr Borstein’s model for brief adjunctive EMDR requires that it is used in addition to and is supportive of the primary psychotherapy treatment, and that it is focused narrowly on the referral issue. There should be active, reciprocal communication and collaboration with the referring therapist. The client should be a well-functioning individual (with no active substance abuse or safety risks) who is committed to ongoing treatment with their therapist. There should be evidence of a clear target or stuck point on which to focus the intervention. Through its psychodynamic approach, art therapy uses freedom of expression and free association to track the unique story the client brings. In EMDR, we encourage our clients to attune to their images, thoughts and feelings, and to go with whatever is there. In both therapies, the key approach is to privilege the client’s own direction. In this report, we describe the process of adjunctive EMDR and art therapy over 18 months with a client who experienced maternal abandonment trauma when she was two years old. We show that both approaches enhance the healing of trauma from infancy and any age. The trauma from early in the development of primary relationships, carried through the life of an individual, is distinctive when the lived experience of abandonment categorically informs the template for all other relationships. A key aim for us in writing this report is to give a voice to our client Sisqui by reflecting on our work together to deepen our understanding of her experiences. In order to treat her with the dignity she deserves, we include her as the central person in this report. As part of this effort, we asked her what she gained from our EMDR sessions. We wanted to reverse Sisqui’s sense of not having been heard by her family and reverse the negative ideology regarding her disability, which research shows is important for mental wellbeing. Sisqui chose her pseudonym and co-created this report. We all share concerns about protecting her anonymity so biographical details are minimal. About Sisqui “I have been paraplegic for the last 15 years following a near-fatal accident. I have use of my arms and hands after suffering major spinal cord injuries. These injuries mean I have to use a wheelchair. I experience nerve pain in my leg, as well as depression, anxiety and a sleep disorder all exacerbated by trauma. I also have suspected mild brain damage which affects my short-term memory. It is not clear to what extent this is trauma-related from childhood losses or caused by the accident. I feel that the lack of empathic involvement from my family has made my recovery more difficult. I experienced a strict religious upbringing. I chose to take part in adjunctive EMDR therapy because I wanted to take the next step in my self-help journey and heal from traumatic life events.” The art therapy process Kate Rothwell Sisqui has used art therapy to explore and discover aspects of herself that could be expressed visually but were not accessible in words because they were held emotionally at a non-verbal level. Over time Sisqui has become able to articulate these emotions in words enabling us to include them in our report. The process has been necessarily slow, cautious and gentle, leading to a gradual unveiling of gossamer-like layers. Sisqui came to therapy wanting to work on her depression, having experienced a lifetime of broken trust and abuse of mind and body. Through the psychodynamic relationship, we developed an understanding that the artwork could give Sisqui a voice for her experiences. Nurturing the development of more robust layers supported her to build a secure scaffolding whilst deepening her self-awareness. Sisqui is a highly creative, curious and courageous person who is able to use mark-making to access unconscious aspects of her psyche. She has a natural ability to let the process lead her. Using colour, form, movement and the aesthetic qualities of the media, she has developed an artist's identity that has enabled her to curate a significant body of work symbolic of a life that has meaning, resilience, emotional range and depth. At times, she uses familiar but unconventional objects in her artwork; such as unusable male catheters she had been wrongly prescribed, cast-off slow-release anaesthetic patches, prescriptions and sewing to communicate highly personal and intimate experiences. The process of art therapy, though exploratory, was also a means for Sisqui to connect to emotions she had suppressed since infancy. It revealed her sense of self, hidden behind the burden of powerful projections from family and friends since her accident which she had absorbed as if they were hers, but they did not belong to her. Art therapy for Sisqui became a lifeline and a process of self-discovery in the purest sense of using art materials to reveal an internal world where she could safely channel emotions and feelings, enabling us to make sense of her different parts. Not all these parts of Sisqui were aware of each other, yet they manifested through her artwork. This has enabled more of an integration of herself as a whole person. This was a careful process, so as not to cause Sisqui more distress than she could endure. Sisqui articulated language both verbally and visually and was determined to grow and develop from a terrified infant to a highly creative adult. After some years, Sisqui seemed to disconnect and then chose to end her therapy. Respecting her decision, I was concerned that a deeper layer (that could not be drilled through with art therapy alone)  could prevent her ongoing development – her physical pain often told us about anxieties and psychological wounds too painful to touch. Namely, fears of abandonment that surfaced when there was a therapy break. Sisqui decided she wanted to try other therapies in her healing journey. During this break, she came to accept what she could not change in others, suggesting that a more mature outlook on her family was forming. She became more independent and could make her own decisions based on her needs, not others’ wants. She also decided to restart art therapy after a significant pause of several months. Welcoming her back, we discussed the trauma she had identified that went beyond her physical injuries. I felt that after six years of working with Sisqui on complex trauma from multiple events, I had reached the limit of my skills and abilities to help her. It seemed that unprocessed trauma from her early childhood was specifically impacting her relationship with her mother. I knew that EMDR could help, and I recommended Cathy, knowing she was an experienced EMDR and art therapist, as well as a trusted colleague and friend. I had not realised EMDR could be used as an adjunctive process alongside art therapy. With Sisqui’s willingness and determination to continue with EMDR, this became probably the most defining part of her journey. Sisqui’s approach to self-help “I have used self-help psychological and body-based approaches online for some time. This is where I first found out about EMDR, and more recently polyvagal theory. I often reached out for support online but found I could be let down by this informal support. For instance, when practitioners leaked confidential information about me on Instagram. Art therapy has helped me to channel my emotions and feelings in a safe way. I was happy to explore the possibilities of the combined approach of art therapy and EMDR because I wanted to process my experience of trauma stuck in my body through EMDR.” Figure 1. Barriers Special considerations Sisqui talked about the invisibility and lack of respect she has experienced as a woman with disabilities in our society. She said she didn’t ask for a disabled label, but she got one, with all the stigma and preconceived ideas, and people getting ‘one over on her’ that comes with it. As she shared her experiences, we became ever more aware of the discrimination she faces, increased by her use of a wheelchair. Kate and I kept in mind the inescapable trauma, lack of opportunity and validation accorded to people with disabilities in our society. As we worked together, a question emerged about the similarity between Sisqui’s trauma of childhood abandonment, and the social isolation and dependency she experienced once she became disabled. The beginning of the adjunctive journey Cathy Ward When Kate contacted me to see if I could offer EMDR to her client, Sisqui, I was delighted. I looked forward to the possibility of collaborating with them as a new initiative for me. I called her as a first step, and then I met her with Kate. Sisqui explained that she hoped to explore her belief that she was holding onto trauma in her body. We arranged for all sessions to take place in Kate’s studio and for us to share the content of our sessions with each other. I knew that EMDR could be used alongside other main therapies to address specific traumatic legacies. In our discussion, it looked like there was a good fit of expectations across the three of us, which is important for adjunctive EMDR to be successful. I learned from consulting with Dr Borstein that I needed to step aside from the idea that EMDR would be the most important part of the work and understand that the main therapy would be art therapy. At the time, I was not aware that Sisqui’s decision to turn towards EMDR followed a three-month break away from therapy with Kate. Sisqui had chosen this break when Kate went on leave. Therapist breaks appeared to trigger Sisqui’s ‘rejection detector’, left over from her early childhood experiences of abandonment, which she felt had been repeated throughout her life. Had I recognised this, I might have been more prepared for her withdrawal from our EMDR sessions, when clear improvements in her confidence and quality of life were becoming apparent; for example, she planned and undertook a microlight flight, which seemed to epitomise her progress. She later captured the experience, creating a beautiful image of her flight in an art therapy session. Figure 2. Microlight flight The preparation phase In early 2023, I began using an attachment-focused approach, based on Parnell’s (2013) framework, to create a ‘place that feels safe’ and resource team. Sisqui found this helpful. Through this process, she was introduced to bilateral stimulation which we used to amplify and install positive feelings and experiences. This was particularly successful in sustainably shifting her low mood. We used McGoldrick’s (2022) repair/rescue protocol, targeting memories from Sisqui’s life at ages two, five, ten and adulthood, interweaving the repair and rescue work at each stage. Revisiting and repairing her memories in this way began to alleviate Sisqui’s anxieties about exploring her trauma memories through the standard EMDR protocol. At the outset of the work, I hypothesised that Sisqui’s accident and the consequent major adjustments would be the root causes of the trauma she wanted to free herself from. However, this proved not to be the case and these were often overtaken by her deep sense of having been abandoned by her mother. Her mother became seriously ill when she was two, and a lack of emotional support from her parents echoed throughout her life, which continued following the accident. Sisqui informed us she would prefer to continue EMDR stabilisation, resource, and resilience-building approaches. Later, we used the flash technique to explore further, resulting in her gaining more confidence in her ability to face her fears and boosting her self-esteem and self-confidence. As Sisqui processed more material with EMDR, she began to experience physical reactions of pain and swelling in her legs. Her concern about the changes in her body occurred as our first break in therapy became imminent. I noticed she had begun to voice frustration and anger at the people and services she was involved with currently and in the past. In an online session, after I had had a minor operation following my holiday break, Sisqui explained she was experiencing a lot of anger and had been ‘shedding’ people. She described ending work with the support staff around her and told me, “I only want people in my life who want me. I want to end our work together. My body is saying ‘no’ to processing things, and I need to listen to my body.” Though she did not express it explicitly, and did not seem conscious of it, this anger appeared to be about her EMDR work with me and so she decided to end the EMDR work. I recognised that this deep pattern of severing relationships was at the heart of the issues she was attempting to transform. Kate continued to do solid work with Sisqui, naming and confronting the likelihood of her abandonment history having been triggered by the breaks in therapy. Unexpectedly, meeting to plan this collaborative report provided a route back into EMDR therapy. Resuming EMDR With Sisqui’s full agreement after restarting, we were able to plan and prepare for breaks, the eventual ending of our work and to target her abandonment history and its impact on her at the centre of our EMDR work. A session that epitomised the adjunctive process In the first session following our summer break, Sisqui chose to process a poignant time a decade ago when she had met up with her family. The meeting occurred after a six-month rehabilitation period in hospital following her accident. Since she had previously described her family as being emotionally unavailable, I was expecting her to process the trauma from that vulnerable time. Instead, she described her family meeting as “feeling surrounded by love and care”. During what turned out to be an extremely moving session, memories arose of the major psychological shifts she had had to make to accommodate her injuries and disability so soon after the accident. She finished the session by processing from the negative cognition, “A big aching loss – a chasm in the ground that can’t go back together again” to the positive cognition, “I am a strong person. I can cope with many things. I’m allowed to have moments of sadness. They don’t last all the time.” When Sisqui described feeling surrounded by love and care, I realised that she might also be unconsciously referring to ‘the hammock’ of care and support Kate and I had hoped we were offering her. In my conversation with Kate about this powerful session, she suggested that a strong sense of reunion might be playing out through the memory of when Sisqui first met her family as a disabled person and that it might also be representing the current reunion with Kate and me after our breaks. This was a deep ‘aha’ moment for me, that seemed to capture the richness of the adjunctive process, in which the trauma-focused bodily memory intersected with the current reparative psychotherapeutic process – an enlightening connection between the EMDR and the psychodynamic approach. Sisqui’s experience “I have been reprocessing traumatic events using EMDR and bilateral movements, to lessen the long-lasting and rippling impact of complex post-traumatic stress disorder (CPTSD) on myself and in turn on others. Art therapy complemented the EMDR work. Whatever I thought of in EMDR, I reflected in my paintings in art therapy. The EMDR strengthened and empowered me in my self-belief, my standing in my own power, my trust in my instinct, and my trust in myself. Being open to working with EMDR was a pivotal moment. It was helpful that Kate and Cathy knew each other, and that Kate had recommended Cathy. For me, it was a meeting of three minds. The real benefit is that I can use EMDR and then have an art therapy session the next day to process through art, feelings emerging from the EMDR session.” Figure 3. Growth “My art therapy images, coming out of my EMDR sessions, were evidence and reference pieces to go back to, always linked to getting to a stronger place in myself. The EMDR allowed the feelings to be, and the art therapy became the aftercare – and both were invaluable. The art therapy was more relaxing, I could lose myself where time did not exist. Kate recognised that I shared different parts of myself with her and Cathy. It was eye-opening, as was an understanding of internal family systems, the voices I had internalised. It has led to wider perspectives for me, bringing deeper insights. Kate and Cathy were pillars of strength, able to provide me with a relational hammock or bridge, which was helpful. I felt looked after. I was encouraged to travel wherever my journey took me. Kate and Cathy were able to share diverse ideas, both understanding where I was coming from and what had happened to me." Discussion: Building trust over time The results of our adjunctive sessions were not simple or what we expected. The fact that our client had experienced parental abandonment when she was two years old shaped the whole course of our work. Through the adjunctive therapy, she played out the legacy of this experience by abruptly leaving the EMDR therapy when I took a short break. She had been triggered similarly by ending her sessions with Kate before a planned break. Sisqui restarted her art therapy the year before I began work with her. EMDR and art therapy This work shows that EMDR is compatible with art therapy. Both approaches add value to each other. Many similarities emerge which we can learn from. Art therapy is a visceral and externalising expression,

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