What is ai-EMDR?
If you’ve come to this page on our website, you very probably already have some interest, and maybe some personal experience, of EMDR therapy, and are perhaps curious how this way of working differs from mainstream EMDR, or indeed from other forms of talking therapy.
It’s important to set out up front that what we call attachment-informed, or ai-EDMR (not the Artificial Intelligence variety…) builds on what’s known in our therapist jargon as EMDR’s Standard Protocol, laid out by EMDR’s founder Francine Shapiro way back at the end of the 1980s.
EMDR builds on an eight-phase approach to whatever it is that the client wants and needs to change
In Phase 1 we’ll want to get a good sense of their story, in EMDR’s not always helpful language a “Trauma History”.
Phase 2 is is about building together a safe relational and imaginal space, explaining how EMDR works, and establishing the imaginal principles of safety, support, nurturing and protection.
Phase 3 is called Assessment (feel free to ignore the terminology) where we work out what to “target”, in other words the key experiences in the past whose resolution holds the key to a different future.
EMDR Therapy’s Phase 4 is the “D” in the title, Desensitisation, the piece which you will probably have heard of, namely the “finger-wagging” which, again with EMDR jargon, we call bilateral stimulation (BLS), or increasingly also Dual Attention Stimulus (DAS).
The key thing here – and what makes EMDR truly distinctive – is the generation of an alternating left-brain-right-brain sensory focus, where, once the target trauma is activated, the therapist gets the client in classic EMDR to follow their hand (or a light) backwards and forwards in the field of vision for “sets” of around 30 seconds each.
That’s the “EM” or Eye Movement bit of EMDR, where therapist and client both stand back, as it were, and let the brain and the nervous system do their thing (again in yet more EMDR jargon, summarised in the term Adaptive Information Processing, or AIP.)
Before going on to Phases 5-8, let’s look in more detail at this Phase 4, the meat, if you like, in the therapy sandwich.
Does EMDR Have To Be Always Eye Movements?
Francine Shapiro was long insistent that EMs were in every way superior to other forms of BLS.
In her later years (she died in 2019) she helpfully and thankfully acknowledged what many of us had already long found to be true, namely that bilateral tones using headphones are just as effective, on their own or sometimes paired with eye movements.
Maybe, especially if meeting in-person, the therapist might tap the outside of your knees or get you to hold buzzers in each hand which vibrate alternately left and right.
They might – and especially if working online (which is how it’s mostly done these post-pandemic days) – use alternate tones in your headphones, or ask you to cross your forearms and do what we call the “butterfly hug”, tapping your fingers alternately left and right each side on your collarbone (or thereabouts).
As with most interventions in the field of mental health, including more mainstream treatments such as CBT or medications/anti-depressants, the neurological mechanisms behind EMDR’s effectiveness aren’t entirely understood, but probably have to do with a mixture of three processes.
There’s research that confirms how EMDR taxes the working memory, allowing the deeper nervous system spaces to activate and reprocess maladaptive emotional and somatic memories that might be still stuck in the past.
EMDR also seems to activate our mammalian survival-informed orienting response, paying immediate and urgent attention to stimulus coming in from whatever angle, as it might be dangerous.
What we tell our own clients (see below for more) and teach on our workshops is that EMDR above all seems to encourage left and right brain to work together as they do when we dream in REM sleep.
Whatever the explanation, EMDR is probably best understood as a kind of distillation of what we human beings have been doing since the beginning of our time on this planet when emotionally activated (for example after a battle or a hunt), not as formal therapy but as dancing, drumming, and just walking or running.
At Root, We’re All, Always, In Survival Mode
Remember that, at heart, we are no different physiologically to the first homo sapiens that evolved on the plains of Africa (probably in what’s now around northern Botswana), to co-exist and survive in a hostile environment full of hyenas, lions, wolves and predators of various kinds (not sure whether Southern Africa at that time had sabre-tooth tigers) which would take out anything edible that’s vulnerable, wounded or young and separated, or separate-able, from safety of the group or family.
EMDR’s Phase 4 Desensitisation, as the tones or the tappers go or the eyes go left and right, can sometimes be extremely intense as the emotional and physiological distress stored in the past comes back to the conscious surface, whether it’s a big one like rape, personal violence, war or road accident, or existential neglect, abuse and the more subtle developmental disappointments of childhood.
The aim of this Reprocessing phase is to fire up old stories in the survival-related form in which they were first experienced, and which continue to drive dysfunctional behaviours and responses in the here and now – and then, as the thinking left brain (simplifying things here) and the feeling right brain partner up, to process the past from the safety of the present.
Francine Shapiro coined the term Adaptive Information Processing, or AIP, to capture how the adult brain has the capacity and the perspective it didn’t have when much younger (the pre-frontal cortex comes online after all only around the age of seven) to put experience both present and past into an appropriate context.
Shapiro had another good phrase for this, Getting Past your Past, which reflects also that central third theory for why EMDR works, namely how it seems to activate the same left-right brain processing systems that fire up when we dream, with our eyes doing that rapid left-right eye movement of REM sleep.
In fact, it’s not to rest that our bodies need to sleep, but to dream (not just perchance as Shakespeare would say), but definitely, necessarily and every night, whether we know it or not, for up to two hours, as the brain doing its evolutionary thing makes meaning of past and current experience, integrating experiential learning in a way that will help us survive the coming day.
And that’s whether the environment is an office job or a village on the ancient plains of Africa where we all come from.
The Back End of EMDR Therapy
Phases 5-7 of EMDR’s Standard Protocol are again somewhat jargony, involving confirmation and “Installation” of a Positive Cognition (PC) – a better and more helpful thought about ourself in the present which should in Phase Four have subtly and deeply shifted from, say, I’m Not Good Enough or I’m Not Safe to I’m OK as I am or I’m Safe Now.
Then in Phase 6 we check how the body is feeling, reflecting the way in which, in the immortal title of Bessel van der Kolk’s excellent eponymous book, The Body Keeps The Score.
Having rewired the past, as it were, EMDR Therapy’s Phase 7 closes the session with a shared wrapping-up and taking-stock of what the client can use from the work in their life out there now in the real world.
Next time, in what we call the Re-Evaluation of Phase 8, we check in with the client how things are consolidating. And once that particular target is done and dusted, we move on to the next one.
The astonishing, indeed reassuring thing about EMDR is that, in our general experience, once a target memory is sorted and cleared, it’s sorted, and the distress coded into that experience at the time it actually happened ceases, permanently, to burn in the present.
For all the drama that can happen in Phase Four, the often rather undramatic new sense of safety and wellbeing almost always generalises out, as we put it, into the myriad similar trauma-generating experiences and encodings of our earlier years.
While obviously we can’t change what actually happened in the past, we do change, often fundamentally, how a client’s story continues to fire in the present – which after all is the only reality, given that the past is merely a set of memories and survival-informed assumptions about life encoded in neurological networks triggered and activated in the now.
Yes, It’s All About Attachment
So, what’s different about attachment-informed EMDR therapy as opposed to the Standard EMDR protocol?
If there’s one thing that we’ve learned and teach after 20 years in the EMDR business, it’s that a client’s presentation is very rarely actually, at root, about the more obvious story they tell.
Yes, folk have had bad things happen to them – bullying, accidents, abuse, neglect, violence and the rest.
Underneath that, however, for every single human being on the planet, what really determines how someone experiences themselves in the world NOW, in relationship with others and with themselves, is how their nervous system first learned, from the moment of conception, to manage, make survival-informed meaning of and respond to the sensory signals coming into the brain in the form of both intero- and exteroception.
Stuff in other words. Good and bad. Life with both CAPITAL L and small l. Trauma with both capital and lower case T.
Effective EMDR needs therefore to bring a targeting focus and curiosity not just to the Trauma (or trauma) but above all to the impact of what we prefer to call Formative Experiences, embedded less than consciously in a client’s experience of the here and now, but running always in the background.
Every single piece of therapeutic work that we do runs on two tracks.
One, the trauma track if you like, the external events, is constituted in the obvious, and often obviously grim, stories that people tell.
The other track – and actually the more important one – is the root programming of the nervous system, which is so often beyond trauma. This one, in our ai-EMDR trainings, we call the attachment track, in other words what happens on the inside.
Gabor Mate puts it very well in his recent book The Myth of Normal: Trauma, Illness & Healing in a Toxic Culture.
Trauma is primarily what happens within someone as a result of the difficult or hurtful events that befall them; it is not the events themselves. Trauma is not what happens to you, but what happens inside you.
That’s where what we call proactive bridging comes in, using the pain of the present (which is holding stories that want to be known) as an entry point into the rich and deep narratives of actual experience way, way back. Not pathologising them, but bringing radical curiosity to how it all joins up.
When it’s clear that there’s a now maladaptive “old friend” managing someone’s experience today, bridging done with tight and intuitive focus almost always takes therapist and client straight past the obvious (and important, of course) clutter of personal, external experience into the internal subtleties of how the nervous system got to be the way it is.
How a nervous system is “set” unfolds and is laid down in the millisecond-by-millisecond marinade of, first, maternal attachment (from the moment of conception through up-to-9 months in the womb, to the quality of the birth and how a baby’s “fourth trimester” is experienced) and then of course immediate family including father, siblings, etc etc as the neonate becomes a toddler becomes a small child becomes a schoolboy/girl becomes a teenager becomes a young and then full(-ish) adult.
Whether we like it or not, this is fundamental evolutionary neurobiology. Therapy or government policies that don’t put this centre stage, allowing for an awed wonder at the challenges of motherhood, will only ever get so far.
That’s the story the pain wants you to know – not to put mother on trial (every single human being and mammal on the planet after all had one) but to go deep into the formative stories and contexts that determined how the nervous system got to be the way it is.
Without getting in there, honouring both tracks (one external, if you like, the other internal) with subtlety, kindness and courage, therapy has one hand tied behind its back.
Protocols, Protocols, Protocols
For clients and therapists new to EMDR, and indeed for those more familiar with how this therapy can work, it’s not hard to feel confused to the point of overwhelm about what protocol to use with what client presentation.
Depression, Anxiety, Grief, OCD, ADHD, Pain, Couples, Infertility, Dissociative Identity Disorder, Childhood Trauma, In-Growing Toenails – all (except perhaps the last one) seem to have their own scripted protocol.
The difference with an attachment-informed approach to EMDR is that this isn’t a whole new protocol but an understanding of pretty much every client presentation, even the most complex kind, as rooted in early-life experiences of attachment in childhood, secure and insecure, and the presence of – or usually absence of repair to – emotional ruptures big and small.
This helps both client and therapist understand and work with, to use computer terminology, the programming that determines how that individual got to be the way they are now.
Whether the story is of war, abuse, assault, bullying, illness, injury or the full range of potentially traumatic experiences, what matters in doing this work therefore is less the detail of what happened, but, drawing on all its previous personal and shared evolutionary experience, the individual meaning which that person’s nervous system made of these stories.
Attachment-Focused or attachment-informed
In developing the term attachment-informed EMDR we’re indebted to Dr Laurel Parnell in the USA for having set out more than two decades ago the importance of focusing on clients’ early developmental stories, as later set out in her seminal works on creative and transpersonal EMDR, first in 2007 with A Therapist’s Guide to EMDR and then in 2013 with Attachment-Focused EMDR.
Dr Parnell is rightly proud of her term Attachment-Focused EMDR, suggested to her by the legendary Dan Siegel.
In developing her ideas and adding in a number of our own, and after rich discussions in the UK-based ai-EMDR Google Group community, we settled on attachment-informed as the best and least provocative and politically difficult description of what we do, differentiating it also from the AI of Artificial Intelligence.
Ai-EMDR therapy builds on both Francine Shapiro’s core EMDR model and on Dr Parnell’s development of that, adding a number of our own distinctive takes on best-practice EMDR therapy while staying both faithful to the basics of the Standard Protocol and aligned with the global EMDR community.
Attachment-informed EMDR was well described by the EMDR Association UK’s Scientific and Research Committee (SRC) in July 2021 in essence as EMDR’s standard eight-phase and three-pronged protocol “with nuances”, placing at the heart of our work from the very beginning of therapy the identification and proactive repair of the unrepaired stories of early attachment.
ai-EMDR: The Nitty Gritty
In approaching client distress with this understanding, we place strong emphasis in Phase One on case conceptualisation, with intense curiosity from the moment the client gets in touch about what their presentation is really about and, again, how they got to be the way they are.
Only rarely, in our experience, is the presenting issue the whole and complete problem (though this can happen), much more often reflecting the triggering of early-embedded childhood survival patterns that can go way into a client’s pre-verbal first 1001 days after conception, up to their second birthday and beyond into a family’s and group’s collective and shared trauma experience.
In Phase Two, and as is widely practised now in the global EMDR community, attachment-informed EMDR therapy draws generously on the work of Dr Parnell, routinely “installing”, or using Parnell’s more client-friendly terminology, “tapping in” a rich imaginal support or resource “team” of nurturing, protective and wise figures.
This emphasis on much richer resourcing than just the Special or Safe Place of basic EMDR accommodates how the human brain ultimately rewires old trauma, by stripping stories of their continued emotional and physiological distress and turning them into narratives that are safely and firmly stored in and understood by the whole nervous system as belonging to the past.
Then, in Francine Shapiro’s essential and unifying eight-phase structure for EMDR, in Phase Three we allow for much clearer use of proactive Bridging to identify a client’s key developmental targets which, once resolved, will make the necessary difference to how they experience themselves in life now. This is, after all, is why they come into therapy in the first place – to change the future, not the past, even though the past is the portal into healing the wounded spaces they need to explore.
In standard EMDR jargon, this process is known as Floatback, which isn’t a term we in EMDR Focus don’t very much like. In our experience, the very word risks inviting the client in effect to dissociate from an experience and examine/remember it intellectually/from the left brain, rather than using the right brain and associative intuition to take us into the stories that are at the actual root of present dysfunctions.
In EMDR’s Phase Three sequencing, we also allow for significant simplification of what’s termed in the standard approach Assessment, focusing on emotion and body sensation before cognitions, and largely keeping numbers out of the discussion at the point where clients can be finding themselves usefully and often surprisingly activated as they access core developmental trauma stories.
While the EMDR Standard Protocol’s Phase Three sequence of NC, PC, VoC, Emotions, SUDs and Body (jargon again!) can and does work brilliantly for single incident adult trauma, remaining the fundamental skeleton on which most EMDR research is based, getting hung up at this point on cognitions, domains and numbers, especially when working with childhood ego states, can seriously derail things.
So, after simplifying and focusing Phase Three, in ai-EMDR’s Phase Four (note by the way how closely we stick to the Standard Protocol’s sequencing of work), we allow for more creative and intuitive interweaving, and focused returning-to-target rather than letting stories flood too wide.
While doing so, we balance more explicitly than can be the case with standard EMDR the need to be proactively engaged with the client’s experience with EMDR’s instruction to the therapist to stay out of the way, allowing and encouraging space for Adaptive Information Processing (AIP) to kick in and do the work of healing.
The aim is to clear specific, subtle and impactful experiences from a client’s developmental story often through moments which would never appear on a timeline of worst memories.
Now, Where Does Magic Come Into This?
Bridging from emotion and body sensation can sometimes feel like magic, bypassing everything a client or their therapist might have thought lay at the root of the presenting distress. Bridging bypasses the left brain’s analytic assumptions about the past, into what the deeper nervous system intuitively knows to be the real issue.
Phase Four is wher ai-EMDR therapy in the hands of someone practiced and experienced can become very transpersonal, exploring symbolism, dreams, parts, and collective and intergenerational trauma. This can surprise and confuse colleagues trained perhaps in, or clients used to, more cognitive, talk-based or medical models of trauma.
So it’s important to understand that ai-EMDR isn’t a simple, protocol-based or manualised treatment, but a confirmation of EMDR therapy as a comprehensive psychotherapeutic model in its own right.
In Phases Five (Installation/Tapping In), Six (Body Scan), Seven (Closure) and Eight (Re-evaluation), ai-EMDR comes back on track with EMDR Therapy’s Standard Protocol, including confirmation of Subjective Units of Distress (SUDs – there’s that jargon again) at now zero out of 10, and the VoC (*sigh* – Validity of Cognition!) on the appropriate emerging PC up at the maximum of 7 on Shapiro’s idiosyncratic scale of scoring an emerging Positive Cognition.
Ai-EMDR in total therefore provides a relational structure and tight focus on what needs to happen to help a client heal their sense of being in the now. It is, we believe and advocate, the next and necessary step change, indeed a paradigm shift, in the development of this extraordinarily powerful therapy.
Especially to those who might still be unsettled by the inevitable debates of any psychotherapeutic or ideas-based community (think Freud and Jung, or Rome and Luther, or Stalin and Trotsky…) about who and what works best, we hope this outline of ai-EMDR is helpful.