I’ve just finished reading it, on Kindle, and as someone interested especially in the Attachment-Focused approach to EMDR, have a number of points it would be good to see discussed:
- First, most importantly, I wonder what status this book has in the practice, training, supervision and research of EMDR? Francine Shapiro is the originator of EMDR, and directs the EMDR Institute in the US, a commercial training operation alongside others under the accrediting umbrella of EMDRIA. But to what extent are we in Europe as accredited Consultants, Practitioners (and Trainers) bound by its recommendations, or instructions if that is what they are?
- To what extent are the revised recommendations in this important handbook based on new (or old) research? For example, Shapiro returns here to her earlier advocacy of EMD without the R for reducing activation relating to a particularly stressful memory, with the instruction when going back to target to remind the client each time of the specific NC and the original picture, something in our training and now as Consultants in supervision we have been expressly told not to do.
- (I don’t have a problem with the idea of EMD, but given that other approaches to EMDR can be and have been rejected as lacking a research basis, I’m curious how standards apply across the board.)
- And, following on from that, what were the procedures and processes, transparent or otherwise, that led to this third edition, and to what extent is it “owned” by the wider EMDR community?
Then a number of personal observations on the actual text, if I might.
- I may have missed something, but this third edition appears to soften the emphasis, stressed very strongly in trainings in the past, on ensuring a domain match in Phase Three Assessment between negative and positive cognition. Although I would see this as very much to be welcomed (since struggles with cognitions can, in my own clinical experience and that of my supervisees, badly derail EMDR with some clients), I wonder again what the research base for this change of position is.
- After Shapiro’s earlier insistence on EMs as the essential form of BLS, (stressed very strongly when she spoke at the EMDR Europe conference in Edinburgh in 2014,) it is gratifying to read her note (p.29) that all references to eye movements throughout the text should be understood refer to “sets of other effective stimuli as well.” In other words, she makes clear now that tapping and auditory stimulus can be equally effective (though I would personally take issue with her instruction that hand taps are done on the client’s palms facing upward – taps on the side of the knee or the back of the hand seem altogether more appropriate).
- There remains in my view uncertainty (and I will be presenting on this at the UK & Ireland national EMDR Conference in March) as to what precisely IS the Standard Protocol. It was good to read in this third edition Shapiro’s repeated definitions of the SP as relating primarily to the Three Prongs (past, present and future) and the eight Phases.
- However, as an enthusiast for Laurel Parnell’s Attachment-Focused approach to EMDR and in particular her Modified Protocol for Phase Three activation, I remain curious about the lack of research (though Shapiro does call now for such studies in her comprehensive concluding chapters about research) into the contribution of individual aspects of what is understood as the Standard Protocol to EMDR’s effectiveness, notably the emphasis on having to identify a PC in Phase Three and the specific ordering of NC, PC, VoC, emotion, SUDs and body sensation.
- (As colleagues will know, Parnell’s Modified Protocol for complex PTSD omits the PC and the VoC at this point and reorders Assessment into image first, then emotion, body and belief (NC). Despite being, in my and others’ experience, highly effective with most clients, particularly the more complex ones, this modification has led to Parnell’s approach being dismissed in the UK – by accredited trainersin online discussion forums and even in a short-lived refusal of the EMDR UK accreditation committee last year to grant CPD points to her trainings here – as out of compliance with EMDR as defined by Shapiro’s text, and even as “not EMDR”, a position with which I very much disagree.)
- Which brings me (admitting to a personal bias) to disappointment at the lack of credit given by Shapiro in this authoritative manual to Jim Knipe’s revolutionary contributions about CIPOS, the level of urge to avoid, Loving Eyes and targeting the positive affect, none of which are mentioned, although there is one reference (not credited to Jim) to the idea of asking “what’s good” about for example avoiding strong emotions (p 188).
- Similarly, Laurel Parnell and her, to me and many colleagues, hugely influential and valuable contributions to tailoring EMDR towards the more complex and attachment-disordered clients – who, let’s face it, represent the bulk of our work – is almost entirely overlooked, bar one passing reference to her 2009 Therapists’ Guide to EMDR. The word attachment is mentioned only 24 times throughout the entire Shapiro manual. In Parnell’s Attachment-Focused EMDR (ignored entirely in this new Shapiro book), it is referenced 273 times.
- There is also very little acknowledgement in the new edition of the value of ego state and parts work with ordinarily-complex clients as opposed to those with DID (well covered here), with only four mentions throughout the entire book. Indeed, Shapiro seems (on page 420, in relation to phantom limb pain) to suggest that ego state work is not compatible with the AIP model. As many of us know, ego state work with complex trauma is enormously powerful, and to have given it such low status in this core EMDR text seems a missed opportunity.
- Sadly, there is no reference at all to one of the most interesting EMDR developments of recent years, the Blind To Therapist protocol, which (as tested by Dr Derek Farrell in Iraq recently) suggests amongst other things that identification of cognitions in Phase Three is not in fact central to EMDR’s effectiveness – as those of us who use it at the clinical frontline already intuit and know.
While it’s greatly to be welcomed how Shapiro notes that “Each client should be treated as a unique individual with needs that vary from moment to moment,” her book is to this one EMDR Consultant – while obviously an essential text for us all and for our supervisees/trainees – a disappointment, reading more like the instruction manual for a piece of German engineering than a warm and supportive guide to complex, and as we know sometimes astonishingly effective, psychotherapy.
I hope that those who have been critical of my expressed positions on these key EMDR debates in the past will accept these thoughts as, yes of course incomplete and personal, but also useful and constructive contributions to a hugely important discussion.