EMDR and Attachment-Informed EMDR – what exactly are they?

What is EMDR?

EMDR is a way to change unhelpful core beliefs which we develop in our early family environment, such as ‘I’m not good enough, ‘I’m unworthy’ or ‘I’m powerless.’ These unhelpful core beliefs affect our thinking patterns, feelings, behaviour and physiology. 

 EMDR was invented by psychologist Dr Francine Shapiro. In 1987 as she walked in the woods thinking about a difficult memory, she realised her eyes were moving quickly from left to right. She later noticed that the memory didn’t bother her as much. Fast forward 50 years and hundreds of meta-analyses, randomised clinical trials and non-randomised studies have been conducted. EMDR is recognised as a trauma treatment by the World Health Organisation (WHO) and the National Institute for Health and Care Excellence (NICE).

 How does EMDR work?

Simply put through rewiring maladaptive neural networks As we know, the brain is divided into two hemispheres divided by a corpus collosum. The left hemisphere is more involved with rationalising, planning and organising. The right hemisphere is where the fight and flight responses are located and is more involved in creative and emotional processes. Unhelpful core beliefs are located in the neural networks of the right hemisphere. They cause maladaptive information processing. This is when we perceive the world around us through biased filters due to our core beliefs. For example, we expect all women to be controlling because our mother was, or we anticipate a life of financial hardship because we believe deep down that we are not enough. To clarify, that doesn’t mean we walk around actively thinking about our unhelpful core beliefs. They operate out of awareness for the most part. They are the bottom of the iceberg.  It is the creative adjustments to our negative beliefs, which are evident at the top of the iceberg. These show up as addictions, relationship and sexual issues, anxiety, depression, obsessive compulsive behaviours and eating disorders to name a few.

How do we develop negative core beliefs? 

 On reading this we might say, “but my childhood was good, I wasn’t traumatised, so this doesn’t apply to me”. Indeed, even if we can relate, we might feel guilty or fiercely protective of our parents for implying they had traumatised us. Well the truth is, pretty much all of us have picked up some kind of trauma from childhood. Trauma is defined as anything unhelpful from the past that lingers on in the present. A fear of spiders as a result of a childhood incident with a spider is a trauma. A fear of commitment due to our parents’ divorce is a trauma. 

EMDR works for both single incident and attachment focussed traumas. The former is a one-off event that is not connected to our parents although they may have been at the scene. A car crash, being held hostage or a robbery are examples. Attachment trauma refers to psychological wounding received at the hands of our caregivers. This does not need to be explicit physical or sexual abuse. We can have had the best parents in the world and still have attachment trauma. Indeed, we probably do because there is no such thing as a perfect parent. Just as there is no such thing as a perfect human. 

Some of us will immediately identify attachment traumas such as a critical father, an emotionally absent mother, or some other form of physical, emotional or verbal abuse. 

For others, it takes a bit more exploring. It might turn out we had parents who expressed their care very pragmatically. Rather than acknowledging their child’s hurt feelings when he is not invited to a party, they attempt to make him feel better by telling him to just ignore the issue. They have inadvertently sent their child the message that his feelings are not valid. Rather than acknowledge them by saying, ‘yes you must feel really upset about that’, they override them. As a result, a young child develops a belief that ‘my feelings/needs don’t matter’. This is often at the heart of people-pleasing, submissive behaviours or individuals who are not connected with their emotions but have a host of ‘symptoms’. 

Another less obvious source of attachment trauma is an anxious parent. An anxious parent is a scary parent. How so? A child’s most important need is to feel safe and settled with their caregiver. If they are anxious and unsettled, the child cannot settle either. And as they develop into adulthood such an individual wants to protect their anxious caregiver from upset. They learn to withhold their own fears and anxieties and are thus unable to get the emotional support they need.

But don’t all parents lose their temper from time to time? Yes of course and that doesn’t mean that there will be any lasting trauma. There is no such thing as a perfect parent, just a good enough parent. One who is able to mend ruptures. However, we can only mend the ruptures we are aware of. If we as parents have our own emotional/mental issues, had inadequate parenting, or are simply very different characterologically to our child, an attachment trauma can ensue. The purpose of EMDR therapy is not to criticise parents but to provide what was missing even when our parents were doing the best they could. What happens in an EMDR session?

EMDR therapy is more structured than traditional talk therapy. There is a set process which includes the eight phases of EMDR. The first phases ensure sufficient background information has been gathered and that there is enough safety and trust in the therapeutic relationship to contain the future work. The length of this stage varies from individual. For some it may take one session, for others the preparation phase can take six months or more. It’s important that an individual can master ways to calm themselves down or pick themselves up after an intense challenging emotion. This is because we are working with trauma material where there may suppressed fear, anxiety, anger, pain or sadness.

To do so we may use body interventions from Sensorimotor therapy, visualisations or Gestalt Therapy to build up a more solid sense of inner safety. We also use relational Gestalt therapy, to increase trust in the therapy relationship. Once an individual is able to calm and soothe themselves sufficiently, we can move on to stage two.

In stage two we identify specific and concrete examples of the issues you want to work on. From these we elicit the unhelpful core belief, feelings, body sensations and other factors. We rate the distress so that we have a concrete way to measure the success of the processing. We then process using bi-lateral stimulation which can take the form of tapping on alternate knees, sounds in alternate ears, following a light or the therapists’ fingers as they move from left to right.

When doing attachment focussed EMDR we may ‘float back’ from the present-day symptom to an earlier experience of the same symptom. Individuals sometimes say, “I remember nothing from my childhood, so it probably won’t work on me”. To which I reply, ‘it really doesn’t matter if you don’t have a clear memory of your childhood”. We can just as easily stay processing the present issue however it’s surprising what the mind brings forth when we experiment with going back to the past. It might feel ‘silly’ or entirely unrelated but experience shows the mind knows exactly what it is doing and what seems un-relevant is somehow related. 

Once the traumatic material is processed, we ‘tap in’ the adaptive positive beliefs. These might be, ‘I’m in control’, ‘I’m safe’, or I’m good enough’.

In the last stage, once we have dealt with the past we focus on the present and future triggers to ensure the new adaptive beliefs are embedded. We may do this by imagining present triggers and seeing if they feel less difficult now that the past has been processed. They always do. We then foray into the future, imagining potential situations that could set us off. We imagine handling them differently with the positive beliefs we had tapped in.

Case Study – this is an amalgamation of several client’s experiences. All identifying information has been changed.

Amy came to see me due to feelings of low self-worth, anxiety and intrusive thoughts. In the first session I asked her to share how these issues affected her day-to-day life. I also enquired about her past and childhood experiences. It was apparent to me that Amy may have experienced some attachment insecurity as the youngest child in a large family. Her brother closest in age was very academically advanced and received a lot of parental attention.  The other siblings were much older. Amy often felt less important than her siblings. She managed this feeling by becoming a very ‘good’ child, keeping out of trouble and going along with what other family members wanted. She experienced anxiety around being away from home for very long as a child. The intrusive thoughts started at university. 

We decided to ‘target’ some recent moments of anxiety and used the ‘bridge back’ technique to arrive at some childhood memories of feeling overlooked. The negative beliefs we worked on were, “I don’t belong’ and ‘I’m not safe”. We continued processing these memories for around twenty sessions. By the end, Amy felt a lot more confident about her ability to speak up for herself at work and in her relationships. She felt a lot calmer on a day-to-day, and the intrusive thoughts were much more fleeting.

Common issues

Clients sometimes wonder if they are ‘getting it right’ during EMDR. There is no right or wrong way to process. Some people get very emotional, others connect with very little emotion but process anyway. It’s common to worry that our experience doesn’t’ make sense. It’s not supposed to make sense! We are working with the emotional part of the brain that hangs on to irrational beliefs. Wherever our mind takes us during processing, we trust that it makes sense on some level, even if not on a rational level. We also trust that the therapist has enough training and experience to tailor the EMDR to whatever is coming up.

We may feel more emotional after EMDR as with any therapy. The brain continues to process after the session and we might experience the feelings we were processing as more intense. We can also have more vivid dreams. This usually settles after a few days.

Who is EMDR for?

It can be used for any symptom from anxiety to schizophrenia. In the early days, practitioners were wary of using EMDR with those who had a personality disorder. However, developments in the EMDR process such as Attachment-Focussed EMDR mean it can be used even for those with complex trauma, which is often at the root of a ‘personality disorder’. The most important factor before processing can start is that an individual can regulate their emotions, that they can soothe themselves. This means that the preparatory phase can take anything from one to two sessions to two years.

How long does EMDR take?

EMDR is not a miracle therapy. It cannot eliminate an issue that has been around for many years in a matter of sessions. If on the other hand the issue is due to a single incident trauma then a lot can be done in twelve or twenty-four sessions. However whereas a childhood attachment trauma could take five years of therapy to resolve, with the addition of EMDR, it could take two years.

Many symptoms are creative adjustments to attachment trauma. A child who feels unsettled with a depressed parent experiences this as a regular ongoing event for possibly many years. Eventually they develop obsessive compulsive traits in an attempt to soothe themselves.  By the time we come for therapy our ‘symptoms’ have been around for a long time. EMDR work can be likened to a jigsaw puzzle. Gradually we work through different childhood memories, linking up pieces of the jigsaw puzzle. Gradually we notice that the depression, anxious thoughts, anger or urge to self-harm is less frequent until is no longer there at all. The symptom rarely leaves with a big fanfare, it tends to leave via the backdoor. In between EMDR processing we may also use Gestalt talk therapy to get more awareness and clarity on what we are working on. We might also incorporate Gestalt therapy to practice new ways of relating for example being more assertive. Since an attachment wound occurs in relationship, a therapy relationship is also a good way to heal attachment wounds. It’s for this reason that where there has been early childhood wounding, both EMDR and relational Gestalt therapy in combination work best.