In this episode of Thanks for Sharing, Jackie talks about treating trauma with EMDR. She explains what EMDR therapy looks and feels like and what the goal of EMDR should be. Jackie also talks about hesitancies therapists may experience in treating trauma.
TRANSCRIPT: Resolving Complex Trauma with EMDR Therapy
Hi everyone, welcome to Thanks for Sharing. I’m your host, Jackie Pack. In today’s episode I wanted to talk about EMDR. Now EMDR, this won’t be the first episode where I’ve talked about EMDR or even had guests, I think we’ve had a couple of guests on in the past three years of doing this podcast, we’ve had guests on who talked about EMDR. In the state where I live, which is Utah, EMDR is becoming a really popular training for therapists to take, and the training actually comes here to Utah, which is always convenient and it’ll reduce the cost of training for therapists because they don’t have to pay… local therapists don’t have to pay for travel and stay while they’re away for the training, and I think it’s a good thing overall for more therapists to get trained in EMDR because we live in a world where so many have experienced trauma, and we also know more about trauma than ever before. We also know and understand more about treating trauma than we’ve ever understood before, and so for therapists, what this means is that we have to be offering treatment for trauma. Maybe this wasn’t always the case even when therapists were treating trauma, maybe they didn’t always have an informed approach from which they were treating that trauma.
Now I will say just as kind of a disclaimer, EMDR is not the only treatment that there is for treating trauma. Neurofeedback or biofeedback is another form of treating trauma. We also offer that at Healing Paths, and then there’s also like lifespan integration and a couple of other treatment modalities, somatic experiencing is another treatment modality for working with trauma, so EMDR isn’t the only way to treat trauma, and I think that’s important to remember as maybe a therapist, you’re looking at kind of creating a well-rounded approach for clients to be treating their trauma, and also just if you are a consumer of therapy to understand if maybe you want to work on your own therapy to understand that EMDR isn’t the only way to treat trauma. The other thing is therapists become more aware of trauma and how to treat it, and it starts to rise in its popularity, I think it gets to this point in which the general population become more informed about it, and so they learn to start asking specifically for it, and I don’t think that’s a bad thing to start to look for EMDR in a therapist’s bio or if you’re talking to a therapist about receiving trauma treatment, it can be a helpful thing for consumers of therapy to know to start to ask. That’s one of the buzz words, and I think that’s also contributed to therapists going and getting the training.
I recently took a master class on EMDR with Deany Laliotis I think was her name, I could be pronouncing the last name incorrectly, but her first name was Deany, and Deany had trained in EMDR really since the beginning. It was kind of fascinating to hear her talk about it, and this particular training that I took focused on using EMDR in a relational way, which is not how all therapists who have been trained in EMDR will approach the treatment in EMDR. Now I have to admit that I have a bias about taking this relational approach into therapy, not just because it makes me feel like my role as a therapist is important and that my training and my skills and my awareness and knowledge make a difference, but that does make me feel better, but also because I’ve seen for years the benefit of working with therapists who are relational with their clients, so it wasn’t surprising to me when Deany was saying that they are learning this relational approach to EMDR often helps clients who may have gotten stuck or reached an impasse. Maybe there are people who EMDR does not work for, and that this may be kind of a key piece to EMDR being one modality that helps move towards healing.
So first I want to talk about in this episode the history of trauma and treatment related to EMDR. So in the field of psychology, we have identified trauma treatment as a condition that we’ve been focusing on only since 1980 when it became part of the DSM, and DSM stands for the diagnostic statistical manual. It’s currently as of 2020, it’s in its fifth revision. We were dealing with it, though… we were dealing with trauma throughout the entire history of psychotherapy, but it was only in 1980 that PTSD was identified as a specific psychological condition that was part of the therapist’s toolbox or arsenal, and that began a whole period of exploration, of confusion, of discovery, and I think it’s fair to say that the area of trauma treatment has been the source of some of the most important innovations in the field over these last 35-40 years, and EMDR has been a big part of that evolution. When I read about how Francine Shapiro, who is the founder of EMDR, when I read about how she came up with it, I’m amazed because first of all, my brain does not work the way hers does in that, but it’s almost… I won’t say this, this is my view, but I’m sure for Francine, there was a little bit more into it, but it was almost like happenstance that she kind of… these dots started to connect for her and she was able to put together this modality of EMDR. Now even though early practitioners weren’t trained to treat trauma, like I said they were treating trauma. Now Deany told the story of working at the VA hospital in an inpatient / outpatient unit treating combat veterans from World War II, Korea, Vietnam, some of whom were even POWs, and these were really traumatized folks who had been suffering with symptoms for the better part of 25 years or more. She said it was really a welcome opportunity to see if there was something more that they could do to relieve their symptoms. Now before she was introduced to EMDR, she said they were just trying to help these clients cope, to help them manage their symptoms and to be in relationship with their family, their friends, and in their communities, but at the same time, these clients were having intrusive thoughts and nightmares and flashbacks, and they were hypervigilant about their safety, so it was really hard trying to get them to stay in the mainstream of their lives. In fact, they would try to talk about some of the experiences in combat that they had, and invariably it would trigger them and they would become more symptomatic, so it was a real challenge to help them quiet down and quiet their system down and be more in the present and not be hijacked into the past, where they never knew what was going to happen from one moment to the next.
Now these early trauma therapists reported it was good. They saw some benefit to the vets coming in and meeting with therapists. They had groups for them where they could have coffee and donuts with one another, and try to create a community of people who had like experiences, kind of have a connection maybe come together experiencing some common ground, and all of that was useful, but it was not transformative. It didn’t change what they were dealing with on a day-to-day basis, so Francine Shapiro published her first paper on EMD in 1989. It was an article that described a simple desensitization procedure that had the client focus on an image, so this would be like a distressing image. They’d identify the negative thought and the negative feeling that went with that image, and they would then rate their level of distress, and then using eye movements, at that time, which was a form of bilateral stimulation, so it’s stimulating left-hemisphere, right-brain hemisphere, back and forth, so it’s that form of bilateral stimulation, and they would continue to have them focus on it until they achieved a desensitization affect, and that was pretty remarkable at the time back in ‘89. It was magical in a different way. It wasn’t just intellectual, it wasn’t just talk therapy, it was emotional and it was sematic, and it shifted the entire experience of what happened, and it shifts the person’s orientation to it. It shifts the meaning of the experience, and that’s remarkable, too. So how has EMDR evolved over time, since 1989? So it was a treatment for PTSD where they would take a single memory, whether it was a recent traumatic event, or it could be a past experience like a childhood experience or an earlier experience that was informing the current PTSD symptom, so they could get complete if not total remission, and they would get a substantial shift in the client’s symptoms in 3 to 5 sessions is what they were reporting for a single event that caused PTSD symptoms, so that’s like a one-time event, like I had a car accident and I do EMDR just around the car accident, and in 3 to 5 sessions, the symptoms that I experience go down, so that’s kind of a single event. Now what they realized overtime is with more complicated experiences that took place over time, so it wasn’t a single event, it happened over time or had earlier roots in childhood experiences, they would take 10 to 12 sessions, but it was still a very discreet, very systematic, we’re going to focus in a very systemic way on what’s coming up now. We’re going to apply bilateral stimulation in the systematic way to get a reduction in the distress. So what was good about that is that you don’t have to target with EMDR processing every single time, like say for example we’re targeting abuse memories. We don’t have to target every single memory associated with abuse because similar experiences cluster together in the brain, and that’s the good news, so over time, as we’re applying EMDR and started keeping notes, these were early therapists, I’m saying we, I was like graduating high school at this time period, so as early therapists were applying EMDR, they started keeping notes, they would share their clinical experiences with each other and about this time, early ‘90s, this is about the time when they all started using the internet, so they had this online community where they could share and compare notes, and the community was relatively small, especially compared to today in 2020, when we have so many therapists who have gone through the training.
Now also, when a trauma perspective started coming into treatment and into the therapy field, initially it was looked at in extreme incidents, so when PTSD started being recognized int eh DSM as a psychological condition, it only looked at much more extreme situations like, for example a veteran who had gone to war and experienced the trauma of war, or it started to include like rape victims or rape survivors, but we weren’t seeing the scope and the width of trauma or the depth of trauma, so the net that we were catching for early approaches to trauma were not going to catch everything. They were limited to what we understood as being trauma, but as the field of psychology has continued to study trauma and to learn and understand more, the approach was different in the sense that it was more complicated. We’re now seeing trauma as a much more complex, complicated thing, and the net we are catching to include trauma is much bigger, so there isn’t just like here’s one event that has now generated symptoms. These symptoms are generated over time and are usually from a constellation of experiences, not just one or two or three experiences, so it tends to be a longer treatment period in EMDR. That’s one of the things that has evolved is the length of time required to reduce the symptoms and reach desensitization. It takes a longer period of time because we’re working with issues of self-esteem. We’re working more with issues of relationships. We’re working more with issues of affect dysregulation, and those are rooted in childhood developmental trauma more often than not, and so it’s a broader emotional landscape that we’re currently seeing with EMDR than it was in the beginning.
So let’s talk for a minute about this idea that comes out of the EMDR literature that talks about this concept of memory networks, and this idea of memory networks is what began to evolve over time in EMDR. So what is a memory network and how is that central in EMDR treatment? Well, let’s bring that into the larger context, which is the precept of the model is what we call the adaptive information processing model, and that model posits that the present difficulties are informed by past experiences that are inadequately processed and maladaptively stored, so that’s a whole lot of long words and long syllables to say at one time, so for example I’m going to use the example Deany used in her training. She used the case of a young child who spilled their milk at the dinner table and the father is yelling at them. He’s yelling thing like “How could you do that?” with a loud voice and a stern tone and a stern look, and the child is shocked and there’s usually fear or anxiety or shame accompanying that shock, and without any other mitigating information or intervention, the child is going to walk away from the dinner table with that image, thought, feeling, sensation, and a belief because we have to make sense of what we are experiencing, we start to formulate beliefs, and those beliefs can become secondary traumas, so that belief may be “What I did caused my dad’s anger, and so therefore it’s my fault. I’m the bad one.” So that’s an example of how memory is maladaptively stored because in that example, the child didn’t have adequate access to information to help him or her with a more adaptive conclusion. If we go back to that example but this time let’s say the mother comes over to the child and says, “It’s ok, it’s ok, your father’s just having a bad day. He’s under a lot of stress. It’s not your fault.” Now there’s a beginning, there’s a middle, and we have an adaptive end to that experience for that child. There was an arousal, and then there was a de-arousal when the mother came in and calmed the child and reassured the child, so the information that initially that experience offered saying this is about you and you must be the bad one, all of a sudden this intervention offers the information that says this is not about you, and so that memory, even though it’s not a happy memory, it gets stored differently than it would have without the intervention. It gets stored as an adaptive memory because there’s a conclusion to it. There’s an emotional sematic conclusion to it.
Now memory networks are memories that are clustered along similar components or similar things, so let’s just pretend, let’s take the example to make the point that this father loses his job. The father in the milk story, let’s say that this father loses his job, and he’s now more and more agitated, he’s more irritable, he’s more angry, and he’s starting to blame his kid for his deregulation, and this is happening on a regular basis, so now this kid is starting to collect a number of these experiences. It wasn’t a one-time experience at the dinner table. This kid is now collecting a number of these experiences, and so it becomes more the rule rather than the exception, and the kid over time begins to identify with these experiences. “Oh my gosh, maybe I really am a bad person. Maybe there is something wrong with me.” And so part of what we’re looking for in EMDR is how the client’s memory networks look. What’s the extent that these networks adaptively stored information and memories, where the information is congruent with the experience, so in the first example when the mom intervened, “Oh my dad’s just having a hard time. I’m ok. I’m a good person.” That was a memory adaptively stored. Or “I’m safe now.” Those would be adaptive memories where there’s a memory of the bad event that happened or the bad situation that occurred, but I’ve got an ending to that that is adaptive and that doesn’t have me as being what’s wrong or that I’m not safe or something along those lines. We’ll talk about kind of those memory networks and the things or topics that they circle around.
Now any good, well-trained EMDR therapist is going to have an idea of what kind of experiences they’re going to get into before we start the actual reprocessing, so as an EMDR trained therapist, I’m going to be mapping out the general emotional landscape with the help of the client. I kind of want to know what are the active belief networks or the active beliefs that were maladaptively stored that we’re going to want to change in order to cause the transformation for this client to do things different and to be different. Now that said, on the other hand, we often don’t know how the brain connects what’s informing the current difficulty, so part of what’s always fascinating, and I continue to this day to be completely fascinated if not surprised by how the brain links memories together in a way that may not be logical to the client or to me as a therapist who’s been doing this for years, but certainly it informs the client’s difficulties in a way that is beyond what we could think to interpret or think to identify or think to put together, so I’m a big believer that all behavior makes sense, and that if something doesn’t make sense, we simply haven’t uncovered enough of the story for it to make sense. Now EMDR is a way for us to uncover and see how these memories and experiences were stored, and it starts to make sense. At first sometimes as clients are doing EMDR, they may say things like “Wow, I’m all over the board today.” or “I hope you’re following me. This doesn’t make sense to me with what comes up in the course of an EMDR session.” Maybe at one point they’re reprocessing and they’re kindergarten age and something happened in kindergarten, the next memory they’re in adulthood, and then they’re in junior high or high school and different things are coming up, so of course they feel scattered but when we start to tie it together in the way that memory networks work in terms of like well how did it feel in your body? What were the sensations that you were feeling? Well maybe there’s a tenseness in my shoulders and kind of a pain in the back of my head, or all of these seemingly scattered and all over the board memories actually have that piece in common, the way that t felt in the body or the belief that they have about it. I’m not enough or I’m not good enough or something like that. That’s actually how it was stored. It starts to make sense and it starts to tie all of these memories and experiences together and connect them, so in that regard, there’s this inherent wisdom using the client’s neurobiology to access how all of this is connected, rather than the therapist having to figure it all out in advance, which by the way, we can’t do anyway because this is not our biology, and even when I’ve gone and done EMDR myself, and as a therapist and as the person whose neurobiology it was, I was still surprised at what came up and how my brain connected and tied things together that I would not have guessed, so that means that the client’s brain already has this stuff organized, which is what we’re referring to as the memory networks, so we don’t have to decide, okay we’re going to go after this memory and this memory and this memory because every time we target a memory, the memory is means to an end, as well as an end in itself, so what that means if we take a representative experience, we take one memory, and it’s representative of a host of memories, so let’s say someone’s really feeling incompetent at work, and one of the representative experiences is coming home in high school or junior high with five As and a B. Not a particularly uncommon or even a remarkable experience, but this was representative of a daily dose of being criticized by one or both of their parents, so in that moment, this was a daily diet of “I’m not good enough, no matter what I do.” So this kid’s performing fairly well in school. Most parents would be happy with the way this kid is performing, and yet this kid on a daily basis is being told it’s not good enough or you need to do better. Why is it 90% instead of 100%? That kind of thing, and so we bring that memory to mind for the client. We bring that up and we ask them, “How does that memory make you feel about yourself?” So let’s say the client says that “I’m not good enough” because that’s the belief that’s getting triggered with this memory, and so then we’re going to ask the client, “How does this memory make you feel about yourself?” and let’s say the client says, “I’m not good enough” because that’s the belief that this memory is pushing on and what’s getting triggered. Now I want to say another thing also because this experience of getting five As and a B and being hounded by their parents or being told that they could do better may not seem to even this client that it was trauma, and let’s say when I’m meeting with this client and we start talking about trauma, they’re not seeing the trauma, but when we started to understand more about how trauma works and an important factor of how trauma is stored and then how it shows up in our present, then we start to see this situation of getting five As and a B and being hounded by the parents to do better. We actually start to see this incident differently and we start to understand the impact that that experience had and we would call that trauma. So when we go down that memory lane if you will, we start to access memories that we may not have discussed. We may not have even put them on the original map that we were creating in the beginning, but emotionally and somatically, they’re connecting because that’s the way the brain has linked these associations together, so needless to say, it’s an interesting journey when we start going down the EMDR path.
Now Francine described EMDR as a 3-pronged protocol of past, present, and future. So again, we’ve already discussed this but I think it bears repeating, the present difficulties that the client is coming to us for help with are informed by past experiences that are inadequately processed, so our job as a therapist is to map out that emotional territory, those memories, bring them into awareness and target them using EMDR procedures that are laid out in a very straightforward, systematic way to give the client the opportunity to reprocess those experiences now so then in the present, they’re not longer triggered. So let’s take for an example an adult survivor of childhood sexual abuse, and let’s say currently this survivor is in a relationship with someone with whom they feel safe with, and with whom they want to be sexually intimate with, but they’re having difficulties because of their history. So we’re going to target those earlier abusive experiences, but then we’re also going to need to swing back to see what if any difficulties remain in the present because that person could have been in a relationship with their partner for months or years having these difficulties, which means now they also have a separate memory network of their own, separate from the abuse they experienced as a child, so we have to target those memories around this relationship and the difficulty they’ve had with this person all on its own in addition to what happened as a child. So there’s a saying that I use when I’m working with clients, and even when I’m supervising new therapists, and the saying is “The absence of negative doesn’t automatically translate into something positive.” And if we talking about EMDR, I would add “and adaptive”, positive or adaptive. So just because maybe we’ve desensitized them to this previous trigger and they no longer react as though the past is happening, that doesn’t mean that they automatically just move into this positive framework and positive things start… they start to experience positive things. We have to kind of help them and stay with them to move them into positive and adaptive, so the three-pronged protocol is a very robust way to systematically treat clients who have had these problems throughout their lives because then we have a chance not only to reprocess them, but we have the opportunity to facilitate developmental repair and help them develop the needed skills going forward so they can be more fully in the present with all the capacities that they can develop and bring to their situations now.
So now I want to talk about some of what Deany was talking about in this master class about EMDR from this relational approach. Now if we’re treating as therapists, as professionals, if we’re treating interpersonal trauma, which is largely what we’re talking about here in this episode, I believe we also need to treat it interpersonally, so this is a personal thing that happened to this person and we have to treat it as such in the therapy room, so while we’re reprocessing experiences, there’s a parallel process that’s going on at the same time where while the client is revisiting these experiences in their past, they’re also in their present in the room with us, the therapist, and their bodies are talking to our bodies, and our bodies are talking back to their bodies, so that’s one thing that’s going on. The other thing that’s going on is that we are being with them in a relational way, or I hope we are, and sometimes that means that we’re just mindful and present and we are keeping our hearts open to what’s happening right now in the room. Now for many clients, it’s not just about a resolution of the negative. It’s also about giving them the opportunity to have a full range of emotional response to what actually occurred then. For example, let’s say I’m working with someone who was severely abused as a child, where they were so terrified of their primary caregivers that they never said a word. They were compliant and they just tried to keep themselves safe and off the radar. Now in EMDR processing, they’re getting into not just what happened and the facts of what happened and how the memories were encoded, but now what’s starting to happen because they’re here with us in the present and I as a therapist am being a witness to this experience, I’m inviting them sometimes actively, sometimes very directly, I’m inviting them sometimes just by being there and feeling the emotions myself as a therapist, but I’m inviting them to have all of the emotions now that any reasonable person would have given what actually occurred, and yet when these things were happening to them, they couldn’t feel it. That would have made things worse. That would have put them on the radar. That might have meant a dangerous situation and so they were just compliant and they just pushed it down, but we’ve got to process those, and part of the way we process that is to feel it and in EMDR, they’re given this opportunity to feel what they couldn’t feel before, so in this example, they get to be mad, they get to be sad, they get to be hurt, they get to relate to the betrayal that they experienced where someone who loved them was also someone that hurt them, and that’s something that happens for the first time, and that’s something that doesn’t happen automatically because not all clients even as adults are emotionally prepared to face that kind of truth, and yet we know as therapists that when we help them approach what actually happened to them so that they can have a more adult understanding of what happened to them as children, then they can get to the other side of it. It’s the relationship in that moment-to-moment unfolding of experience where as a therapist I’m either coregulating their reflective experience, helping them tolerate pain that they couldn’t tolerate left to their own devices, or I’m helping them get to the feelings of anger that, left to their own devices, they could avoid if not shut down altogether because that’s what they’ve been doing all along, so in addition to saying that the absence of the negative not only doesn’t translate into the positive, I would say as a therapist, and I do say this to therapists that I’m supervising and training, we have to be with them every step of the way to translate what they’re experiencing and what they’re feeling into positive or at least into processed and adaptive experiences, and I think that’s where hope can start. They can hope that it will be different. They can hope that they will be different, and when clients start to hope again, that’s where some really beautiful things start to take place in therapy.
So with trauma, there is confusion. There’s confusion between the self and the other. There’s frequently an overidentification with the perpetrator that would say something like “You’re treating me bad; therefore, it must be because of me.” So the clinical challenge in EMDR therapy is to externalize the responsibility and to place it where it belongs. We’ve got to let go of what this client has been carrying. We’ve got to place it where it belonged all along, so the child who grew up to be an adult, this adult might know it’s not my fault that I was abused, but that’s not how it feels in their body. So there can be a confusion between what I may know or understand and have knowledge about as an adult and how it feels inside me. So this fundamental confusion of responsibility or what is referred to as defectiveness, I’m the defective one, I’m the bad one, it’s my fault, it’s a very pervasive confusion for most clients, and for clients with complex trauma, they’re confused about all of these plateaus, so when we talk about kind of these plateaus, these topics or these narratives that trauma is encoded and stored as if it’s not processed properly, so one of them may be this confusion of responsibility. A second one is about safety, so if your sense of safety as a child was compromised, if not completely ruptured, then you never knew when you were going to get hit, you never knew when you were going to get yelled at, you never knew if somebody was going to be home or not, those are all safety issues for children, so there’s a chronic sense of uncertainty, of unpredictability. Now fast forward and you’re an adult and you continue to be vigilant about that same kind of uncertainty and unpredictability long after those conditions have passed, so in adulthood, safety issues should change from what they were as a child. As a child, I am somewhat helpless, and I am for sure dependent on those adults in my life, but as an adult, I’m no longer or I don’t need to any longer be dependent upon other people for my needs or for my safety to be created, but I may not have grown up that way. I may not have grown up and been allowed to shift to some more healthy responsibility for myself and my safety because it wasn’t provided for me when I was younger and needed it. So that gets to be confusing where how I should be as an adult is not where I need to be because a part of my development got stuck or sometimes we use it in the term it got arrested back here, and so the way I would have developed under healthy circumstances didn’t happen and my development has some holes in it. So while there might be some past confusions about safety, there should be a difference as an adult about my safety.
Now you may kind of get a view of this if you’ve ever been in a car accident, you may have had the experience after the car accident, let’s say it’s even a week or two weeks after the car accident, and for the most part, you’re healthy so you can be driving again, you may have had the experience of bracing for impact, responding to other cars as you did when you experienced the car accident because our brain is still scanning for and even perceiving a threat when that car accident, and so when that threat has long passed, and that can happen with us too, except it can lengthen out the time, so the threat or the danger when I was a child, I may not have shifted and seen that it is no longer a threat or a danger to me as an adult, so that’s a problem for obvious reasons, and then the final area of confusion is around power or control or the ability to make choices, good choices on our own behalf. So if we go back and we think about developmental trauma and being a kid, we have very little control on a good day about the choices that are made for us, the things that we can and we can’t do. So in part, we are rendered powerless just by the virtue of the fact that we’re children and that there are adults in charge of us who are in control most of the time, or worse, if you’re being abused as a child, you’re powerless, you’re helpless, you can’t do anything about what’s happening to you, and if you’ve had too many victimization experiences, what you come into adulthood with is you continue to feel and act as if you’re powerless and that bad things keep happening to you and you have no control over them. So these are common confusions for clients who have had pervasive developmental trauma, and part of what we’re doing in EMDR therapy from the very beginning is we’re listening for those things so that we can understand where the client lives emotionally most of the time and we begin to think about how to prioritize what we want to work on to help them feel more safe in their world so that they can feel like they have more agency, more control, they feel better about themselves and so forth, then they can move through their world not being bogged down, not carrying the weight of past experiences, and they can make choices through a clear lens instead of one that has gotten foggy from the past.
Now I believe that what we’re asking our clients is to be brave, to venture into unchartered emotional territory that they have spent the better part of a lifetime avoiding it, and often avoiding it for some valid reasons, and they have no reason to approach except for the fact that what they’re doing isn’t working so well anymore, and if we’re asking them to do that, we have to meet them there by being courageous ourselves as therapists, so I’m looking for, if I’m treating trauma, I’m looking for the answer to this question: What is it that is going to make it possible for them to do this different? Where’s the opening for us to do a piece of work together that makes it possible for something to happen for the first time that couldn’t have happened before now? What’s the reason to do this, and what is it that they want, and how do we get there? Now one of the things that gets in the way for therapists, and what I often talk about with therapists that I coach or supervise or consult with, therapists frequently struggle with not wanting to make things worse, and I get it, and we all got that message loud and clear from the moment we stepped into graduate school. We were told first do no harm, and I understand that, I agree with that. Now in EMDR training, one of the things that the trainers tell therapists, and by the way, you have to be a licensed therapist or a student in a graduate program to become a therapist in order to take EMDR training, so one of the things they tell therapists is you can’t mess this up. The protocol is systematic, it’s scripted. If you just follow that, you’re not going to mess it up, and maybe that’s reassuring to therapists who are going to be working with highly traumatized clients. They also will tell us in EMDR training not to go off script, that our clinical skills aren’t needed, that we have to kind of get those out of the way so that this client can have the experience they need to experience without us kind of projecting or overlaying some things to that process, and I can see that because there are times, lots of times when I’m working EMDR with a client, and like I said, I don’t know exactly where this journey is going, or I’m surprised by where we ended or what happened or what came up, and not surprised in a bad way, but I think for therapists, they have to get comfortable with the fact that they don’t know where we’re headed. We’re going on a journey with our clients, and we don’t know what we’re going to find along the way, and we don’t know exactly how we’re going to get to our destination, and so it could be reassuring to therapists who feel unsure about the trauma work because there’s just uncertainty involved in doing the trauma work, but therapists can also worry about it so much that we play it so safe that we miss opportunities to offer healing, where healing is in fact possible, and I think the other aspect of it is because we work with clients that have been severely traumatized and damaged by the lack of care, lack of attunement, lack of appreciation, lack of love that they believe that they’re actually far more damaged than they might be. They focus too much on the trauma and not enough on their capacity for change. They and we focus too much on the trauma and miss their capacity for change. We miss the person who survived the trauma and is sitting in our office saying “Help me with this,” saying “I want things to be different. I don’t want to keep going on the way I’ve been going on.” It requires us as therapists to see beyond the story of where they got and learn about the story that got them there. This is the all behavior makes sense, and we have to see the process that actually brought them to our office and brought them to the point where they’re willing to ask for help because part of their trauma and part of the trauma story that I’ve seen with every trauma client I’ve ever worked with is getting help or asking for help was not an easy process, and so the fact that they come into therapy and they want it to be different and they’re asking for help is such a huge strength if we will see it as this and trust ourselves and trust them to take us on the journey that will bring about the change that they’re hoping for.