By Mark Brayne, Director EMDR Focus, MA, Dip Psych, EMDR Europe Accredited Consultant
For therapists new to EMDR therapy, 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, Ingrowing Toenails – all (except perhaps the last one) seem to have their own scripted protocol.
So where on earth does best-practice EMDR therapy begin.
At EMDR Focus, we approach pretty much every client presentation with an understanding that psychological distress that continues unresolved, even the most complex kind, usually has its roots in early-life experiences of attachment in childhood, and the presence or absence of repair to ruptures big and small.
What matters therefore is less the detail of what happened (whether war, abuse, assault, bullying, illness, injury or the full range of potentially traumatic experiences) but the individual meaning that is made of these stories.
After all, as Gabor Mate so precisely puts it, trauma is the internal wound, not the external event.
In developing the term Attachment-Informed EMDR we’re indebted to Dr Laurel Parnell in the US 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, suggested to her by the legendary Dan Siegel.
So in building on her ideas and adding in a number of our own, acknowledging the rich work on attachment increasingly being done throughout our EMDR field (especially for example by Deany Laliotis), and after rich discussions in our global AI-EMDR Google Group community now approaching 800-strong, we settled on attachment-informed as the best and least provocative/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 – 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” – from the very beginning of therapy puts identification and proactive repair of those unrepaired stories at the heart of our work.
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 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 as 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 training reflects 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 (aka Floatback or Affect Bridge) 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 the 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, Body can and does work brilliantly for single incident adult trauma and remains the fundamental skeleton on which much 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 EMDR therapy.
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 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.
Starting out from emotion and body sensation helpfully bypasses the left brain’s analytic assumptions about the past, taking us intuitively into what the deeper nervous system knows to be the real issue.
Phase Four – so much more than just desensitising as Shapiro first named it, and closer to repairing and rewiring – is where AI-EMDR therapy in the hands of someone practiced and experienced can become really quite transpersonal, exploring symbolism, dreams, parts, and collective and intergenerational trauma as we reset the past as previously stored in the client’s brain and nervous system.
Colleagues trained perhaps in more cognitive or medical models of trauma can sometimes find this both surprising and confusing.
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 (Reevaluation), AI-EMDR comes back on track with a very clear focus on session structure within EMDR Therapy’s Standard Protocol, including confirmation of SUDs at zero and VoC on the appropriate, emerging PC up at 7/7.
AI-EMDR in total therefore provides a relational structure and tight focus on what needs to happen to help a client shift and heal their sense of being in the here-and-now, and 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.