March/April 2010 Issue
Treating Child Abuse Trauma With EMDR
By Deborah R. Huso
Social Work Today
Vol. 10 No. 2 P. 20
EMDR has been successful in treating trauma from childhood abuse in victims and survivors young and old.
With more than 3 million instances of child abuse reported annually in the United States and probably many more cases going unreported, social workers face an often daunting client list of children and adults who are or have been victims of abuse and neglect. Left untreated, these individuals’ chances of leading lives fraught with substance abuse, incarceration, unwanted pregnancies, and future psychological conditions are multiplied by many degrees.
In the last two decades, however, researchers have made major strides in developing methods for treating victims and survivors of child abuse, including therapies that work as well (and in some cases better) with children as with adults. Among the most successful of these treatments is Eye Movement Desensitization and Reprocessing (EMDR), a therapeutic process that uses eye movements, sounds, and repetitive motions to help clients process and come to terms with traumatic memories more quickly than talk therapy alone. And since many children and some adults are unable to verbalize traumatic experiences, EMDR can often provide the breakthrough that more traditional therapies can’t.
How EMDR Works
EMDR is a therapeutic treatment that uses eye movements, sounds, or pulsations to stimulate the brain. Using these sensory experiences in conjunction with focusing on a traumatic memory can create changes in the brain that help a client overcome symptoms of depression, anger, and anxiety, among other conditions. Francine Shapiro, PhD, executive director of the EMDR Institute, developed the process 20 years ago. While researchers cannot say with certainty why EMDR works in helping patients resolve trauma, it is now the most researched psychotherapeutic treatment for posttraumatic stress disorder (PTSD).
Unlike prolonged exposure therapy (PET), EMDR does not necessarily require the client to relate his or her trauma aloud or cover it in any particular sequence. The therapist just follows the client along his or her journey through memory while periodically asking what he or she is noticing. When each new stage of the memory is reached, the therapist “installs” the memory with eye movements or tapping. Essentially, an EMDR session allows a client to mentally visit a disturbing memory in brief doses while simultaneously focusing on an external stimulus. Not only does EMDR help clients create new associations with traumatic memories, it also helps reduce sensitivity to external events that can trigger those memories while allowing them to learn to exercise control over the future.
Using EMDR With Children
Ricky Greenwald, PsyD, affiliate professor at the SUNY University at Buffalo School of Social Work and executive director of the Trauma Institute & Child Trauma Institute, has written extensively on EMDR over the course of the last two decades. Author of EMDR Within a Phase Model of Trauma-Informed Treatment, he is one of the earliest experts in the field and has employed EMDR in his counseling of more than 1,000 people.
While he admits that it’s more common for therapists to use PET when working with child trauma, he’s a strong advocate of using EMDR with children. While most EMDR research has been conducted on adults, he believes the treatment works especially well with children, as they tend to take to the process more quickly than adults. And he points out that it has consistently outperformed cognitive-behavioral therapy (CBT) in providing quicker resolution to trauma victims.
Natalie Robinson, LICSW, a consultant and trainer who has been using EMDR in her practice for 15 years, is a strong proponent of using the technique with children. Child abuse survivors are a major part of her caseload and she has found that where children are concerned, talk therapy has often not been enough to heal them. Robinson says EMDR is actually trickier with adults, especially in instances of sexual abuse, as those adults have trouble trusting anyone, so it takes time to create an alliance with the therapist before they can even consider proceeding with EMDR.
Why It Works
Greenwald believes the main reason EMDR is so effective is because it happens inside the client’s mind. “People think, on average, seven times faster than they talk,” he points out, and since EMDR doesn’t require the client to talk through everything he or she is mentally experiencing, it enables individuals to deal with traumatic memories more quickly.
Greenwald says since the trauma survivor is concentrating on the memory along with something external, it creates a dual focus that allows the individual to be both in the memory and an observer of it at the same time.
“It combines psychoanalysis, body sensations, and psychotherapy all at once,” Robinson adds. “It has a bit of hypnotherapy, too, so it really offers the best from many worlds of therapy.”
Robinson says talking alone reaches only the left side of a victim’s brain while EMDR stimulates both hemispheres. “EMDR allows us to build synapses in the brain around traumatic experiences,” she explains. “It allows the victim to combine his or her experience with wisdom.” Robinson says one way of understanding EMDR is to think of it like REM sleep. It helps people process their memories and put them in the past instead of the present.
Joanne Twombly, LICSW, who works in private practice in Waltham, MA, has been using EMDR for treating severe dissociative disorders for about 10 years. She works with clients with what she calls “huge child abuse issues” and complex PTSD. “What I find is that bilateral stimulation, mostly bilateral tapping, helps to install coping skills,” she says. Twombly points out that brain scans show the frontal lobes of the brain in trauma victims are often impaired. She says EMDR activates those frontal lobes in a way talk therapy can’t. “Trauma gets stuck in the primitive part of the brain,” Twombly adds. “EMDR gets into the part of the brain where those stuck things reside.”
Sara Biel, LCSW, doesn’t necessarily use bilateral eye movements in EMDR and says tapping on hands or knees will work just as well. “It’s about stimulating both sides of the brain,” she explains. “It’s similar to the eye movements we have during sleep. Like sleep, EMDR helps us process memory and move experiences into the past.”
Greenwald disagrees with the idea that EMDR calls on both the right and left brain to do its work, pointing out that the client can participate in EMDR by moving the eyes up and down, as opposed to right and left, and thus cancel out that supposed connection between the two hemispheres of the brain.
Regardless of the physical reason EMDR works, one thing is clear: It helps clients differentiate between what’s important in the past and what’s important now.
While CBT encompasses many different therapeutic techniques, Greenwald says it is focused mainly on management skills. On the flip side, EMDR transforms how people experience and react to their own memories. “I prefer EMDR because it’s well tolerated and it’s faster,” Greenwald explains. He says once a client has completed EMDR therapy, he or she will find an ability to revisit a traumatic memory and not be bothered by it any longer.
Robinson says in her practice she has experienced an 80% to 90% success rate with EMDR, though she adds that because she is known for offering the treatment, many of her clients are highly motivated.
Who Is Best Suited for EMDR
“Just like everything, it works better with single-episode victims,” Greenwald says. He says single-episode trauma can often be worked out in one EMDR session, especially if the client has a supportive family and has experienced a generally positive childhood.
While many researchers contend that EMDR is not appropriate for someone with seizure disorders, Greenwald says he believes just about anyone can be a candidate for the treatment. He says he would be reluctant to use it with children with autism because it can be physically distressing to them. But for most clients, he says, the real issue is, “Is the client well prepared?” EMDR needs to be part of a larger therapy. It is a phase model of treatment, and the client must be stable and in a safe place before beginning the process.
Robinson says EMDR isn’t always the best option for children, even though it tends to work faster than other treatments, because children are often still in danger when they come in for therapy. “They have to be in a safe home and they have to trust you,” she says. She says EMDR is also inappropriate when the client is hospitalized or on medication.
Twombly agrees, noting that a therapist shouldn’t attempt EMDR with someone who is not stable, and it shouldn’t be attempted with dissociative disorders unless the therapist has experience with dissociation. “Most of my clients have had over 30 years of treatment for trauma,” she adds, “and they come to me because nothing else has worked.”
She is quick to add, however, that EMDR won’t work with people who don’t have access to feelings. “People who are depressed or shut down won’t respond to it,” she says, because EMDR involves putting clients in touch with their emotions so they can overcome crippling reactions to traumatic memories.
How to Get Started
Greenwald advises EMDR practitioners to start their client off with something small and manageable as opposed to tackling an extremely traumatic experiences right away. “Sometimes it’s best to start with the earliest memories and work your way forward,” he says. “If the same thing happens over and over again in someone’s personal history, you don’t have to go through every single memory. You can group similar experiences together.”
Robinson essentially asks clients to put their traumatic memories in a container and then pull them out to look at bit by bit. Twombly says the container concept is a major reason she believes EMDR can work more quickly and effectively than PET, which reviews the same traumatic experiences repeatedly. “You don’t want to take someone who has trauma on top of trauma and open that up all at once,” she says. “This is where EMDR can help. It’s given therapists a way to work with so many people who couldn’t get through trauma in other ways.”
— Deborah R. Huso is a freelance writer based in Blue Grass, VA, who writes frequently on youth, family, and social issues.
Case Study: Working Through EMDR with Children
Natalie Robinson, LICSW, who uses Eye Movement Desensitization and Reprocessing (EMDR) in her own practice and trains others in its use, says the best way to understand how the treatment works is to see it in action. Some years ago, she assisted with the case of a 10-year-old boy who had experienced one incident of molestation by a neighbor when he was 4 years old. While the child was treated six months after the incident occurred, he came back to his therapist with recurring symptoms at the age of 10. He couldn’t sleep; yelled at noises in the house, including the television; and frequently seemed disturbed.
The boy’s therapist came to Robinson, asking her to try EMDR with the child. As with all her clients, Robinson first walked the boy and his mother through the process of EMDR, explaining how it worked, and then she asked the boy to help her find a very safe place for him to go whenever an experience became too much for him. The child came up with diorama where he was protected by some of his favorite superheroes. As a first step, Robinson asked the boy to visualize himself in that safe place. Then she installed the image by using EMDR, making his eyes follow a light back and forth.
She then asked him and his mother to tell the story of his molestation, asking the boy to give her a hand signal whenever he needed to stop or go to his safe place. With the promise of receiving Batman-related items, the boy had been persuaded to go into a neighbor’s basement. The 10-year-old’s main issue was that he felt the incident was his fault, that it wouldn’t have happened if he hadn’t wanted the Batman paraphernalia. As Robinson walked the child through his experience, she asked him to consider where in his body he felt distress. “Other than that, I don’t comment,” she explains. “I just go with him on his journey.”
Gradually, the boy worked through the pain of the episode, telling himself it wasn’t his fault. “I’m only a kid,” he said. Each time he reached a positive resolution, Robinson “installed” it with EMDR, asking him to follow the light with his eyes. She also found the boy was worried about the same thing happening to his little brother, but he decided he could tell his brother what to do in a similar instance. “I know what to do now,” he told Robinson at the end of the session.
She asked the boy to come back for a second session, after which he experienced no more symptoms, according to his mother. “It’s very rare that it goes off that well,” Robinson adds. “Most people take a little longer, but he was a kid with a single incident and a supportive family.”
For more information on EMDR and opportunities for EMDR training, visit the EMDR International Association at www.emdria.org.