Who shouldn’t do EMDR?
In our EMDR series of blog posts we’ve discussed what EMDR Therapy is, how it works, who it’s for, and even the uncomfortable pieces you are going to want to know about. You’ve even started casually asking around and you come across the friend who says it was life transforming buuuuuttt... you also run into the acquaintance that says EMDR just didn’t work for them.
So who shouldn’t do EMDR? Or who should it be used with caution with?
Because stability must come first, you don’t use EMDR to process trauma when a client is actively abusing alcohol, drugs, or something to help them feel less. This may include psychotropic medications; definitely tell your therapist!
Successful EMDR treatment is built on stability in the client. So if you find yourself feeling suicidal or experiencing psychosis, wait to do EMDR until you again stabilize. Do tell your therapists about your feelings and experience!
One important way to determine if you’re ready for EMDR therapy is knowing if you can tolerate your emotions. If your emotions feel overwhelming or if you tend to shut down when you feel an emotion, you may not be ready for EMDR therapy. If you are not motivated or willing to do the work to feel the feelings, you may not be ready. EMDR therapy relies on your body and mind’s ability to process through your thoughts and feelings. If you’re unable to process in that way, EMDR therapy may not be effective. This doesn’t mean you can’t do EMDR; it simply means you have some more preparation work before you’ll experience the full benefits of EMDR.
Know that this therapy can briefly intensify emotion during the session. You may want to talk to your doctor first if you have a condition like seizures or another neurological disorders. As with other health treatments, it’s a good idea to check it out first with your doctor if you’re pregnant. (Note: pregnancy isn't a deal breaker for doing EMDR as it once was!)
If you suspect that you dissociate more than just daydreaming, make sure the EMDR therapist you select has received training in treating people with dissociative disorders.
Also, if you have an eye condition or wear contacts, tell the therapist. You may be more appropriate for a type of dual stimulation that doesn’t involve eye movements.
Finally, if your trauma generated a legal case, tell your therapist and process what doing EMDR therapy could change before the case resolves. It could impair your testimony or influence the perception of a judge or jury concerning the trauma’s impact on you. Because EMDR generally resolves symptoms, your attorney may need to be informed in order to obtain a deposition/statement prior to treatment. Note: being involved in a legal case IS NOT a reason to not seek support and treatment from a therapist!
And what does it likely mean if EMDR “just didn’t work for you”?
When I hear this, my first question is: What do you mean it didn’t work for you?
Typically clients who say this are reporting:
no trauma symptom reduction
no reduction in painful emotional memories
an increase in uncomfortable emotions or symptoms
Unfortunately, the “EMDR doesn’t work” story is one that is told to me every few months and that I see in facebook groups and message boards more regularly than I’d like to admit. When I gather more details about what they mean, there are usually a few things that I hear.
1. They were in “regular talk therapy” and their therapist suggested they “give EMDR a try” to see if it would help. In these instances, the client often didn’t seem to have an understanding of what they were doing and why. There was little education about EMDR and it’s rationale as part of a comprehensive treatment. In these cases, we see EMDR was attempted haphazardly in only a few sessions, and it was not employed as the full treatment modality that it is. In full treatment, plenty of time should be spent setting therapeutic expectations and ensuring informed consent is provided.
2. The client faced symptoms that had deep and complicated roots. Their symptoms stemmed from a more complex trauma presentation than was acknowledged. The client had a significant comorbidity which was not overtly discussed as part of the treatment plan. The reality for many patients is that most of the women and men who find their way to our practice have a long term history that complicates their treatment. Many got their start in very high stress families. These families struggled with emotional problems, substance abuse, divorce, depression, anxiety, mental illness and a host of other problems. Many times, these clients don’t recognize the impact this stress has had on them. Like fish in water, they view intense stress as unremarkable. Good therapy helps your brain and your nervous system to learn. EMDR changes your brain and can speed along in this learning process. But a brain that is dealing with a multitude of stressors often takes longer to learn.
3. Someone started EMDR therapy and began bilateral stimulation sessions and then stopped going to therapy - leaving a target open and incomplete. It is crucial to follow through with your therapy sessions (or find a new therapist) to completion of the current issue you’re working on. Leaving this incomplete will allow the brain’s continuing processing of memories targeted in the session, which means experiences such as more vivid dreams, disturbing thoughts or feelings, insights, the emergence of related memories, etc. can continue until all eight phases have been completed.
Many people seem to believe that EMDR can treat trauma in a few short sessions. Is this true? Well, sometimes. But it totally depends on the patient, their situation and their history.
One of the myths surrounding EMDR is that it’s just a tool to process trauma. Actually, it is a complete therapy model that includes eight phases of treatment (discussed in our earlier post).
If you are finding that EMDR hasn’t worked for you in the past or are trying to figure out if you should dive right in, it might be helpful to reflect on the following questions;
Am I using drugs and alcohol with any regularity?
Is my life unsafe, very stressful and/or unstable?
Do I have symptoms that predate the trauma?
Do I suffer from chronic anxiety or depression that pre-dates the traumatic incident?
Am I secretly, or openly, seeking a quick fix?
Do I dissociate?
Am I uncommitted to therapy, kinda committed, or “just checking it out”?
Am I impatient with therapy?
Do I avoid giving my therapist feedback, being actively engaged in therapy, or avoid asking questions of my therapist?
If the answer to any of the above is yes, it’s probably a good idea to discuss this with your EMDR therapist. Remember, good therapy is teamwork. That’s true of any psychotherapy, but it’s especially true of trauma treatment
If you find EMDR interesting and want to learn more, the internet can offer a lot of information. Finding the most accurate and helpful information about EMDR therapy might be challenging.
As a therapist, I believe in EMDR therapy because of the positive impact it’s had on my own life and the amazing progress and impact I’ve seen my own clients have.
We recommend reaching out for a consultation with an EMDR therapist, perusing the EMDR Institute Website, and finding more info in our EMDR section HERE as well!