Written by Dr Kate Beaven-Marks
EMDR is the popular abbreviation for ‘Eye Movement Desensitisation and Reprocessing’ a therapy approach that is commonly associated with processing trauma. This blog will explore what EMDR is, how EMDR works and also what it offers to hypnotherapists in their everyday therapy practice.
EMDR includes work on behavioural, cognitive, emotional and physical aspects of a client’s experience, with elements of exposure therapy and debriefing. As a result, it works well when included within an integrative hypnotherapy approach or within more focused hypno-analysis (especially free association) or CBT-H / REBT-H (cognitive-behavioural hypnotherapy).
Although EMDR is sometimes considered a hypnotherapy technique there are notable differences. EMDR work is conducted out of formal hypnosis, with the client in an associated state, whereas, in hypnosis, dissociation is a key hypnotic phenomenon. There are many similarities as well though, including the therapy progression model of ‘stabilisation, treatment, maintenance’, whereby a client is prepared to engage in therapeutic change and then, afterwards, given the resources to maintain and develop that therapeutic change.
A key concept within EMDR is ‘Adaptive Information Processing’ (AIP), which considers how information is processed in memory networks of images, thoughts, sounds, sensations, emotions, beliefs and self-talk. Where a client experiences an event that is overwhelming (beyond their ability/resources to cope), this processing doesn’t occur fully and effectively and the memory is retained as it was experienced. When anything triggers this memory (e.g., an image or sound), it can trigger the original response as well. It is thought that the memories are stored in networks which are linked to each other, thus a smell may remind you of an emotion. EMDR is thought to help process the event’s residual material so that it may become appropriately integrated. This processing is considered to be aided by the multiple focus of attention (event, thoughts, sensations).
The bilateral (left and right hemisphere) stimulation is a key component of EMDR work. The ‘eye movement’ element within EMDR refers to the most usual application of bilateral stimulation, although there are other ways of achieving this as well. If you were to watch a demonstration of EMDR you would likely see a therapist asking the client to focus on the therapists two fingers held in front of the client’s face at eye level and then moving horizontally and rhythmically, with one pass (left to right to left) approximately per second. The aim being to get the eyes to move to the outer edges (far left and far right). Although this is the most usual way of working, there are some disadvantages. The eye movement work is tiring for the therapist (arm, neck, back) and also for the client (eyes). It is also unsuitable for some clients who have eye conditions. However, there are other methods of bilateral stimulation (BLS), both therapist-conducted and self-applied. The therapist may use a tactile method, such as alternately tapping on the client’s shoulder, knees or hands (placed on knees). Or, they might use an auditory cue, such as finger clicks (snaps), alternating either side of the client’s ears. Some therapists prefer a more technological approach, whether this is a visual approach achieved with a light bar (the client follows a series of lights along a horizontal bar), hand buzzers (the client holds two bars which alternately buzz) or tones via a headset or headphones.
In addition to manual or high-tech therapist-applied approaches, there are also methods that the client can conduct on themselves. This is particularly helpful for online work and also for ongoing self-care, although it works perfectly well in a face-to-face therapy setting as well. A visual form of BLS can be achieved by the client following their own horizontal, side-to-side finger movement. A tactile approach can be either the client alternately tapping their knees or crossing their arms to tap their opposite shoulders, or even an auditory BLS with finger clicks (snaps).
The ‘desensitisation’ element within EMDR work comes from the multiple focuses during the processing work. Clients are asked to focus on an aspect of the disturbing memory together with bilateral stimulation and focus on negative self-talk.
The ‘reprocessing’ element within EMDR work helps a client move forward with more positive self-talk.
How to use EMDR
There are four key categories of applications for EMDR:
- Protocol-oriented EMDR has a scripted protocol which is strictly followed.
- Flexible EMDR follows the protocol process and tends to be used alongside other therapies, such as counselling.
- The use of EMDR as a technique has greater flexibility as the protocol may be followed in full, part or deviated from according to the needs of the client.
- Finally, EMDR informed interventions make use of BLS within other therapeutic approaches.
The use of EMDR within hypnotherapy tends to fall within the latter two categories.
The EMDR protocol
Each of the standard eight phases within EMDR can contribute to a hypnotherapy session separately or you can incorporate some/all of the phases. During our own EMDR for Hypnotherapist’s training course, we also add in an additional phase (phase #0).
Phase 0 – Stabilisation
In this phase, the focus in on stabilisation techniques including self-care, ego strengthening and resource building. This prepares the client for the therapy process. These techniques can be helpful simply included in any hypnotherapy session.
Phase 1 – Client intake
Hypnotherapists and talking therapists are likely familiar with the client consultation or ‘intake’ process already. If a therapist is considering include some EMDR within the therapy session, then the specific EMDR-related questions could be included into their standard hypnotherapy intake. There are some specific client risk factors and contra-indications that would need to be check for, and this could also be added into a standard intake form, ready to use if needed.
Phase 2 – Preparation
Just as a hypnotherapist would gain consent for therapy and present psycho-education, so they would when using EMDR. There are some specific explanations of EMDR to be included and also, within this phase, safety aspects are considered, including establishing a stop signal and a safe place. Depending on what a hypnotherapist may be working with a client on, to set up these safety aspects in a regular hypnotherapy session can be helpful. When done purposefully, a client may feel more secure within the therapeutic relationship and engage further than they might if they were concerned about not being able to stop therapy if things got a bit much.
Phase 3 – Assessment
This phase is focused on more information gathering, seeking specific information about the client’s issue and scaling several aspects of the experience they wish to address in therapy. In addition to gaining information about the worst part of the event, the negative cognition (thoughts/self-talk) is sought and scored (0-10), together with what the potential (positive) alternative would be, and it is also scored (1-7). Body sensations relating to that event are also noted. Again, this level of detail about the client’s past experience can offer valuable insight for the hypnotherapist in any hypnotherapy session, so gaining such information could naturally be built into a standard hypnotherapy intake/consultation. Towards the end of this phase, there is a specific assessment relating to the client’s experience of BLS. Generally, a therapist will demonstrate the eye movements hand sweep, and assess a client’s preferred speed and distance. They will also commonly introduce alternatives, such as hand taps and finger clicks/snaps. This is helpful as, if they do need to change to an alternative method of BLS within the therapy session, the client’s preferences (e.g., speed/location) have already been noted. Finally, the client will be told the processing is about to commence. A reminder or recap of the essential information to this point may also be given.
Phase 4 – Desensitisation
In this phase of EMDR, the focus is on processing the past event. The client will be asked to focus on aspects of the event, and, simultaneously, also focus on the therapist’s hand sweeps (for eye movements) as well as repeating their negative thought or self-talk and any related body sensations. Within a regular hypnotherapy session, where sufficient information has been gained during the intake process, this phase could also be beneficial. For example, when working with limiting beliefs, cognitive distortions, negative associations/anchors, phobias and a vast range of anxieties. Processing continues, with regular checks of the client’s reduction in SUD score (subjective units of disturbance) until it has reduced to an appropriate level (often 0 or 1).
Phase 5 – Installation
When the SUD score has reached an appropriate level, then the next phase is commenced. Here, the new, positive cognition (thought/self-talk) and corresponding VOC (validity of cognition – how much they believe it to be true) score is checked and then processing commences (usually until achieving 6 or 7, the uppermost point). Within the installation phase, the focus is on the eye movements, the event and the positive belief. Body sensations are not focused on in this phase. This phase can be conducted, in isolation, within a regular hypnotherapy session. For example, it may be that you are working on a client developing a positive mindset or belief about their ability to follow an exercise plan or healthy eating programme. The VOC may be initially assessed as a 2 and the positive cognition could be processed until it achieves a more desirable score.
Phase 6 – Body scan
When the positive cognition has been fully processed, the next focus is on any residual body sensations relating to the event. This phase will generally start with a body scan, from feet to head, considering the event, as it seems to them now, together with the positive cognitive (thought, self-talk, belief) and becoming aware of any residual body sensations. When any negative sensations are addressed, then the next phase can be moved to. Where a hypnotherapy client has specific body sensations relating to an issue they are working on in hypnotherapy (e.g., a dog-phobic person tensing when they see a dog), this could be addressed within a hypnotherapy session by using this specific phase.
Phase 7 – Closing the session
If may be that the entire EMDR process is completed in one session, or it may be that it will be spread over two or more sessions. Where the entire process isn’t concluded within the session, it is good to allow sufficient time to prepare the client for stopping and advise them about ongoing processing outside of the session and appropriate self-care (which you taught to the client in phase 0). This is a phase where a hypnotherapist can make full use of their hypnotherapy skills and use a range of in-hypnosis approaches to wrap up the session neatly and provide appropriate ego strengthening and possibly future pacing to support the gains achieved so far.
Phase 8 – Re-evaluation
At the start of each subsequent EMDR session you will have a review of how the client has been, considering any post-session processing and re-checking SUD and VOC scores. This process is nothing new to a hypnotherapist, who will be accustomed to checking in with a client and re-evaluating the treatment plan at the start of each therapy session.
EMDR for hypnotherapists
As you will have seen, hypnotherapy and EMDR work well together, whether that is incorporating a single phase or multiple phases. Beyond the well-known applications for trauma, treatment approaches also work brilliantly for anxiety; fears, phobias (e.g., spiders), motivation (e.g., to exercise), behaviours (e.g., to stop nail biting) limiting beliefs (e.g., can’t end unhealthy relationship) and unhelpful behaviours (e.g., over-eating). There are a vast number of opportunities to incorporate EMDR into your hypnotherapy practice.
There are many different ways to learn EMDR and it can be worth shopping around for the right course for you. At HypnoTC we have developed a blended learning approach to teach hypnotherapists and talking therapists how to incorporate EMDR into their regular hypnotherapy work with our ‘EMDR for Hypnotherapists’ course. During the ‘live online’ training (over two days), you get plenty of practice using each of the EMDR phases. As many hypnotherapists work online, the best way of learning how to use EMDR approaches online is to teach it online, so you will be able to immediately use what you are taught as you study. However, it is also useful to learn how to use EMDR face-to-face, so we include a one day (optional) in-person training day, where you get to practice the whole EMDR process in-person and learn some advanced techniques as well. Rather than give you lengthy lectures, the relevant theoretical material is included in the course manual. Meaning there is lots of time for practical work, both online (using Zoom breakout rooms) and in person.
We hope you enjoyed this blog on how to use EMDR in the hypnotherapy session. If you have any questions about this topic or anything else for that matter, do please get in touch, because we’re always happy to help!
– written by Dr Kate Beaven-Marks