Adapting EMDR to keep you safe

What does it mean to “process” traumatic memory?

When you bring a sense of calm from the present moment, and then you remember the traumatic memory while staying anchored in a current sense of safety, you can show yourself that despite that bad thing happening in the past, you are now actually safe, and okay, and lovable, and worthy. The goal is to allow your brain to do in a calm state now what it couldn't do in its overwhelmed state then—to bring in adaptive information.

For example, when you were in a car accident years ago, you may have been afraid you were going to die—so when we bring up that memory now to process it, it's helpful to notice that, in actual fact, you are safe here in the therapy office. When you were being bullied as a child (then) you may have felt helpless and hated, and it's helpful to notice that you are now a grownup and to notice any close friends or loving connections with family. The actual process of getting to that adaptive information varies—sometimes your brain brings it up by itself, sometimes your therapist will do what's called an “interweave” to help nudge you along. So if I have someone stuck on “I feel so helpless, I feel so helpless,” I may ask, “Would it be possible to show your younger self the time that you stood up for a friend at work?” Or if someone is stuck in “I just keep seeing the image of the collision,” I may say, “The movie doesn't stop there, what happened next?” to get you unstuck. Occasionally I do a parts work interweave: “is there something that younger you needs to know from present you?” or “would it be okay to give permission to younger you to feel exactly how she feels?”

[This is a good place to take a tiny pause. It's a long blog post, I know it. If it's feeling weird or overwhelming at any point, I'll tell you that sometimes it's easier to talk about this stuff in person, whether with me or another therapist. I just prefer to have it online so people who aren't ready to come into the office yet can still access this information.]

Now we break it down

Traditional EMDR is basically setting you up for success by ensuring you feel safe and grounded now, letting you “visit” the memory while you're sitting in a safe place now, and then trusting your brain will pull the information it needs. Your brain pulling that information is called “free association.” We let you visit the memory of the car accident (negative), and then maybe your brain goes back to when you were learning to drive and almost missed a stop sign (negative), and then maybe your brain goes back to getting a driver's license (positive), and then recent memories of safety (positive), or remembering your mom being proud of you passing your test (positive), and on and on. Part of my job as your therapist is to make sure this free association isn't sending you too far off track—so for instance if you go straight to a different trauma memory (“I remember being bullied about my weight in gym class”) I will gently nudge you back to the target memory. My goal there is to make sure we focus on one thing at a time.

For some people, particularly those with repeated developmental or complex traumas (think childhood abuse or intimate partner violence), one memory will trigger another will trigger another will trigger another. So while we may have started with a recent “dining room argument” memory, we also end up lighting up the “driving yelling” memory from two years ago and the “financial control” memory and the “hiding a bruise” memory and then also any similar memories from past relationships—you get the idea. The problem with lighting all those memories up is that each of those memories contains a massive amount of emotion. Processing all of that at once is like trying to absorb water from a fire hose with a towel. If we don't limit the processing, people end up feeling very overwhelmed by their emotion, outside their window of tolerance, and they have a bad experience with EMDR. That's valid and makes sense, because it is ineffective and overwhelming to try to process the first 0.5% of 200 different memories instead of the full 100%, first to last, top to bottom, of a single memory.

So we adapt EMDR. One way therapists do that is by limiting that free association. So instead of doing bilaterals and then saying “what are you noticing?” we might instead say, “Okay go back to the target memory. What do you notice now?” This way we make sure that even if your brain said “Hey remember this time that other thing happened?!” we go back to the original memory. Returning again and again to the original memory allows us to ensure that we process this one as much as we can without hopping to another memory and leaving this memory only partway done. When you limit free association but you allow reprocessing, this is called EMDr, or said aloud, “E M D little r.”

An even more limited type of processing is just EMD. Desensitization without any reprocessing at all. So essentially this is, “what's the worst image of the memory? Just notice that.” Then go back to the image and rate how distressing it is now. Then, “what's the worst part of the memory now as you look at it? Notice that.” The key difference here is we're not opening the door to “what are you noticing?” like with EMDR and EMDr. It's, “what's the worst part of the memory?” This narrows processing even further and ensures your mind is not taking you to other memories AT all.

Sometimes we have to break it down even beyond “go to the target memory” to just, go to an image. Take an image of the abusive person's face and desensitize that. Take an image of the car coming at you and desensitize that. Sometimes it's too much to look at the full image—can we look at the image on a TV screen, or in black and white, or from 100 feet away? There's all kinds of little visualization tricks we can use to help increase a sense of safety while interacting with this overwhelming material. And, once we're able to desensitize some of the elements of the memory, then we can potentially move forward to do EMDR (with free association) or EMDr (with limited association) with the full memory.

There is also a technique I use (CIPOS, or constant installation and present orientation of safety, Jim Knipe) where we install your ability to ground in the present moment as a resource. If my felt sense of safety with my therapist is a resource, my dog loves me unconditionally and that’s a resource, my competence at work is a resource—my ability to get out of the memory quickly to the safety of the present can also be a resource. [I'm not sure that is clear—so an analogy would be, no one wants to hold a hot potato if they don't think they'll be able to drop it. We can install your ability to get out of the memory to the here and now, just like we would want you to know you can drop a hot potato.] When you can dip your toe into a trauma memory and then come back to the present pretty quickly, that increases your sense of safety while reprocessing the memory.

There are other resources and techniques therapists can use to help with processing trauma memory, and I'm aware of the judgement that this post is already pretty long. I feel it's a start, and it may be that a part 2 of this post comes along at some point. If you'd like more information on what EMDR might look like for you, I offer in-person therapy in Huntersville, NC, and online therapy in NC and SC. Thank you for the time you invested reading this.