By Mark Brayne
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 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.
That’s an eight-phase approach to whatever it is that the client wants and needs to change, starting with taking what we call a Trauma History and progressing through Preparation in Phase 2 (that’s explaining how EMDR works, getting us both ready and setting the stage) to Phase Three Assessment (feel free to ignore the terminology) where we work out what to “target”, that’s the key trauma that needs processing.
EMDR Therapy’s Phase Four is the “D” in the title, Desensitisation, the piece you will almost certainly have heard of, namely the “finger-wagging” which we call bilateral stimulation (BLS) or increasingly also Dual Attention Stimulus (DAS).
The key thing here, and what makes EMDR different from any other therapy on the planet (apart from running, dancing and drumming, of course, which human beings have done since the dawn of time), is the generation of an alternating left-right 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 EMDR jargon, summarised in the term Adaptive Information Processing, or AIP.)
Francine Shapiro was long insistent that EMs were in every way superior to other forms of BLS, but in her later years she helpfully 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.
The neurological mechanism behind EMDR’s effectiveness isn’t entirely understood, but probably has to do with a mixture of taxing/overloading the working memory and of activating our mammalian survival-informed orienting response – paying immediate and urgent attention to stimulus coming in from whatever angle, as it might be dangerous.
The key is to quieten the left brain’s need to analyse and control, and therefore to allow the right brain and what’s called the limbic system to take over, activating the emotional regulation mechanisms of our survival responses configured around the amygdala as the Greeks first named the almond-shaped piece in the centre of our brain that manages our immediate survival responses to sabre-tooth-tiger attack.
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 in general (maybe the archetypal sabre-tooth tiger too) which would take out anyone vulnerable, wounded or young and separated from safety of the group or family.
Phase Four Desensitisation, as the tones or the tappers go or the eyes go left and right, can sometimes be extremely intense, as EMDR activates the emotional and physiological distress stored at the time of the trauma, 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 phase is precisely to activate those old stories in the 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 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, but only when working in that partnership with the right brain’s felt sense, coded into the system all those years ago, of NOT being safe or OK.
Shapiro had another good phrase for this, Getting Past your Past, which reflects also the 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, the brain’s evolutionary way it seems of making meaning of past and current experience and integrating experiential learning in a way that will help us survive the coming day.
Phases Five to Seven 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 Six 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 Seven 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 Eight, 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 assumptions about life encoded in neurological networks triggered and activated in the now.
So, what’s different about attachment-informed EMDR therapy as opposed to the Standard EMDR protocol?
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 key thing about the Attachment-Informed approach to EMDR therapy is that we understand pretty much every client presentation, even of the most complex kind, as rooted almost always in early-life experiences of secure and insecure attachment in childhood, and the presence 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 pervious personal and shared evolutionary experience, the individual meaning which that person’s nervous system made of these stories.
After all, as the brilliant Canada-based psychologist Gabor Mate puts it, trauma is the internal wound, not the external event.
In developing the term Attachment-InformedEMDR 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 (now approaching 700-strong), we settled on attachment-informed as the best and least provocative and politically difficult description of what we do.
AI-EMDR therapy builds on both Francine Shapiro’s core EMDR model and on Dr Parnell’s development of that, adding a number of 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 attachment trauma.
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 1000 days after conception, and beyond that 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 Laurel Parnell as set out in her Therapist’s Guide to EMDR (2007), 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 firmly belong in 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 (also known as Floatback) to identify a client’s key developmental targets which, once resolved, will make a real difference to how they experience themselves in life now.
This is, after all, is why they come into therapy in the first place – to make a difference to the future, not the past, even though the past is the portal into healing the wounded spaces they need to explore.
We also allow for simplification of Phase Three’s sequencing, 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 and remains 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.
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.
Bridging from emotion and body sensation can sometimes feel like magic, bypassing everything a client or their therapist thought lay at the root of the presenting distress – the word thought being the clue there.
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 where AI-EMDR therapy in the hands of someone practised 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 our jargon again) at zero and 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 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.