Through 25 years of providing EMDR therapy, consultation, Basic and specialty training, I have responded to many questions and concerns about what presenting issues and client populations can be treated with EMDR therapy. There is not a diagnosis or issue of which I am aware that cannot be effectively addressed by EMDR therapy, including those with psychosis, limited intellectual functioning and many more. 

After 35 years of EMDR therapy research and clinical application, you can now search online to find information about nearly all issues and client populations. Below is a list of the ones I have been asked about to provide guidance and reassurance for the application of EMDR in powerfully healing so much suffering in this world. 

Understanding Adverse Childhood Experiences (ACEs)

Negative experiences in childhood and teenage years, such as neglect, experiencing or witnessing violence, and having a family member attempt or die by suicide, are known as adverse childhood experiences (ACEs). These potentially traumatic events can put children at risk for chronic health problems, mental illness, and substance use in adulthood. Fortunately, it is possible to prevent ACEs and educate parents, communities, and policymakers on creating safe and stable environments for children.

Healing Developmental Trauma

When a young person experiences a traumatizing event, it can stunt their emotional development due to the brain’s focus on survival threats over other functions like emotional and intellectual growth. The areas of the brain that receive the most use are those that develop the most. Research by Bruce Perry highlights the developmental deficits in children who lacked adequate protection and nurturing, showing how trauma impacts brain development.

EMDR for Childhood Neglect

EMDR is effective for addressing childhood neglect, which often includes preverbal trauma. Clients with childhood neglect may not know they suffer from trauma. In contrast to the important trauma question “What happened to you?” Survivors of neglect is about what did not happen to them when assessing past history. 

EMDR therapy works by accessing the body, negative beliefs, and emotions, assessing both adaptive and dysfunctional neural networks. These networks reflect past experiences that affect a person’s present and future functioning. In cases of neglect, where the absence of adequate nurturing and protection is the issue, therapy aims to evaluate and address these deficits. Building up the adaptive neural network is crucial to develop the skills and healthy coping mechanisms that were missed due to neglect. 

This is an important part of the work in EMDR, as what is missing in the adaptive memory network cannot be accessed to update the negative beliefs, emotions, and body sensations stemming from childhood neglect. EMDR therapy includes significant preparatory work to stabilize emotions and behaviors, which is a crucial part of the therapeutic process. 

EMDR with Clients in Unsafe Environments

EMDR therapy processes traumatic memories from the past, present, and future, strengthening the adaptive information network within an individual’s memory system and enhancing their overall functioning. Adults living in abusive environments can effectively process past traumatic events, including adverse childhood experiences. This processing helps to clear past distressing experiences and the resulting dysfunctional beliefs, emotions, and body sensations when experiencing adult abuse.

For example, an adult who experienced poor treatment from parents or authority figures—such as being unjustly punished for normal mistakes or subjected to excessive control—can process these past events to achieve less reactivity and greater internal stability in the present. Past memories of adult abuse can also be processed to increase resilience and lessen self-blame for others’ behavior. 

However, the generalization of this process to present and future events that continue to reinforce past adverse experiences is limited. Therapists must recognize that the time spent in therapy building a more adaptive network, including resourcing around strengths and coping skills, cannot fully counteract the extensive hours spent in abusive environments that reinforce negative experiences. 

The process is most worthwhile for adults, while requiring patience for the therapist when the client chooses not to leave the unsafe environment. Recognition of the power of hurtful words is also essential, reported by survivors as more painful and long-lasting than physical injury. 

Children, however, require the support of at least one caregiver or another caring, safe individual in their lives to engage in this work effectively. For very young children lacking such support, this approach may not be feasible. It is advisable to seek child EMDR clinicians who specialize in working with such age groups.

EMDR with BPD and Other Personality Disorders 

EMDR is increasingly recognized as an effective treatment for personality disorders, and several clinicians and authors advocate its use for conditions including borderline, antisocial, and obsessive-compulsive disorders. This therapy accesses memories stored in both the brain and body, making it suitable for addressing preverbal trauma, which is believed to underlie the etiology of many personality disorders typically forming within the first three years of life.

Effective treatment of personality disorders with EMDR often requires an integrated approach. It is essential to combine EMDR with skill-building sessions, which may be conducted in groups or individually by therapists, to provide a foundational framework for behavior and interaction management.

While it’s a misconception that trauma-induced personality disorders cannot be treated with trauma-focused therapies like EMDR, it should not be seen as a standalone treatment for these complex presentations. Skills training in managing behaviors and interactions is also crucial, enhancing the effectiveness of EMDR.

Somatic experiencing is another promising approach for these conditions, given its focus on body memories. This method aligns with the understanding that the body holds onto past traumas, as articulated by Bessel Van der Kolk in his work that emphasizes how the body retains the impact of traumatic experiences. Thus, somatic therapies are well-suited to complement the treatment of personality disorders by accessing and processing these deeply ingrained bodily memories.

 It’s not uncommon for individuals diagnosed with BPD to actually be experiencing effects stemming from trauma and there are experts currently arguing that BPD is misdiagnosed and mistreated PTSD. An additional consideration is what they are missing in their coping skills and affect management abilities. Education in affect management and relationship skills training such as STEPPS (Systems Training for Emotional Predictability and Problem Solving), developed by University of Iowa social worker Nancy Blum, are an essential foundation prior and even during EMDR treatment.

If the client suffering from BPD or other pre-verbal based traumas never had the necessary adaptive experiences, they must be learned and incorporated into the client’s adaptive memory network. Then this new information can be accessed when processing trauma in order to have effective memory integration. 

EMDR for Survivors of Accidents 

EMDR therapy has proven effective in treating symptoms of post-traumatic stress disorder (PTSD) following car accidents. Symptoms can range from mild, such as avoiding the location of the accident, to severe, including a complete inability to drive.

The severity of PTSD symptoms often correlates with several factors: the severity of the accident, especially if physical injuries were sustained or if there was permanent damage; perceived fault in the accident; and the individual’s previous trauma history and coping mechanisms. EMDR therapy addresses these symptoms by helping individuals process and integrate traumatic memories, thereby reducing their ongoing psychological impact.

Treating Resistance to EMDR work

EMDR therapy has been recommended by many therapists trained in the method but it’s common for individuals to feel self-conscious or skeptical about starting EMDR therapy. Feeling awkward or silly while trying something new is a natural reaction, and many therapists have reported similar feelings when they first started learning the technique. It’s important to communicate any concerns with your therapist, who can provide support and assist you throughout the process.

EMDR therapy operates on the principle that “the past is present.” This means that our current reactions and behaviors are often rooted in past experiences, including adverse ones. The feelings of self-consciousness you’re experiencing may be linked to similar past situations. EMDR therapy specifically aims to address and clear out these negative beliefs about oneself, which are exactly the types of issues the therapy can help resolve.

Consider what a client states about their reluctance to do EMDR as being one of their negative beliefs stemming from past adverse experiences. Clients who say “EMDR won’t work for me,” often have a history of things not working for them as they do for others, including this prediction from caregivers and others such as teachers and coaches from their childhood experiences. Clients who say, “I don’t want to because I will cry,” typically had caregivers who did not allow them to cry, shaming or punishing them when they became understandably emotional as children.

A key question when this occurs is “When did you first believe…or think…or fear…?”, an excellent way to access the past dysfunctional memory network impacting their reluctance to proceed with EMDR. You can use Robin Shapiro’s two handed interweave to reduce or resolve their ambivalence while respecting that all resistance to EMDR therapy has meaning to the client beyond what the therapist is attempting to provide for them. 

Finally, some newly trained EMDR clinicians signal their own lack of confidence in the method by how they present EMDR as their recommended treatment to clients. It is understandable to lack such confidence as beginners but as therapists, we need to mediate our own anxiety about trying something new when presenting it to others. Overexplaining EMDR or excessive seeking of permission in contrast to other routinely used therapies, signals this to clients. 

EMDR with Phobias

EMDR is actually very effective with phobias. Just google EMDR & phobias and you will see significant research about this. It can be challenging for clients to figure out how present symptoms may be connected to past events particularly when there is no recall of how a phobia began. Some clients had no traumatic experience related to their phobias, but had a parent or caregiver who modeled such a phobia, such as a fear of pesticides or of snakes. 

Some develop more acute phobias during times of stress as well. These events may not qualify as significantly traumatizing resulting in PTSD, but any adverse experiences that happened in the past that are impacting present functioning, are appropriate for EMDR therapy. We also treat past/present/future issues, so your phobias do not have to have roots in the past.

Dr. Ad de Jongh, a psychiatrist, dentist, EMDR therapist and researcher, has contributed greatly to the EMDR treatment of phobias. See his seminal 2007 work of EMDR with phobias in Jongh, Ad & Broeke, Erik & Renssen, Monique. (2007). Treatment of Specific Phobias with Eye Movement Desensitization and Reprocessing (EMDR). Journal of anxiety disorders. 13. 69-85. 10.1016/S0887-6185(98)00040-1

Healing of Mass Trauma Such as the Pandemic 

Processing memories from this horrific world experience is best done in connection with others. High numbers of people are seeking therapy following the pandemic years that caused so much grief and loss. Former clients also return to therapy because such events take people beyond their own abilities to cope.

Not everyone needs or would choose to access therapy in order to recover, but trauma impacts our world views, our sense of safety, the strength and will to persevere. EMDR will effectively clear out past memories of this most difficult global time that continue to impact present functioning for many. 

While it’s natural to wish for a return to the person they were, some events irrevocably change us, such that our future healed self is not the same as who we were before the traumatic event. But the resilience of the human brain is remarkable, and EMDR taps into this resilience, allowing clients to integrate traumatic events as part of your history, no longer overshadowing your present life.

EMDR for Shame 

Most experiences of trauma hold some aspect of the feeling of shame, a sense that the client is bad because of the bad things that happened to them, or even being told by caregivers that they are bad. Recovery is influenced by the presence or absence of support from compassionate individuals as well as the depth and nature of one’s trauma history.  Just assessing the origins and implications of shame, such a common reaction to many events, does not typically facilitate healing; shame must be addressed directly. 

Spiritual resources might aid in the healing process, though they can also complicate matters if concepts like forgiveness aren’t properly understood or applied. It’s important to differentiate between forgiveness and the natural consequences of one’s actions.

We have an innate drive towards health and recovery, upon which EMDR therapy relies. It is a cornerstone of EMDR, which posits that just as the body naturally moves towards healing physical wounds, the brain too seeks to find an adaptive way to process traumatic events. EMDR can be a vital part of navigating the path to healing, supporting the individual’s ability to change and recover, regardless of the circumstances.

EMDR for Shut-down Emotions 

EMDR therapy offers a promising pathway to restoring the ability to fully experience emotions, both the energizing ones like joy and the challenging ones like anger. This therapy aims to reawaken the range of emotions that were numbed as a survival mechanism against prolonged anxiety, dissociation, depression, and trauma.

The therapeutic relationship plays a crucial role in helping clients safely access and process these suppressed emotions gradually. When individuals numb painful emotions, this also unfortunately dulls the positive ones. Someone grieving might fear processing their sorrow fully because it feels like losing their last connection to a loved one. Yet, when they do engage with these deep-seated feelings, they often rediscover positive memories and emotions that were suppressed.

Some traumas are profoundly severe, and the idea of deriving any ‘good’ from these experiences can seem impossible. In such cases, the goal of EMDR is to help the client internalize a deep-seated recognition—felt throughout the head, heart, and body—that the client survived as best they could under the circumstances. This realization, validated and supported by the clinician therapist, can be incredibly healing, putting the adverse experience in the past.

EMDR  therapy respects the brain’s natural healing ability and ensures that anything essential for well-being remains with the client. Thus, while the person does not return to who they were before, EMDR helps in moving forward with a richer, more integrated sense of self.

Therapists need to remain sensitive about clients’ potential distress when long-numbed emotions and body sensations are accessed and released. As one client put it, “This getting in touch with emotions is not all it’s cracked up to be!” Feeling distress that has been blocked surely feels like getting worse rather than better. 

Processing long-held grief about an abusive childhood, for example, may result in a period of depression as the client faces what all they missed with inadequate or damaged caregivers. Many clients also feel deep grief and need to mourn the loss when finally recognizing that their lifelong desire to be loved by a parent will never be fulfilled by that parent. Learning to love one’s self seems like a poor substitute for what many others seemed to freely receive from their parents. 

With these tips, EMDR is a powerful tool to address difficult emotional responses that are a part of shame from trauma.

EMDR with Seizure Disorders and Traumatic Brain Injury 

Despite some debate and limited research, EMDR therapy is generally considered safe when conducted by trained professionals. By recognizing potential risk factors and implementing appropriate safety measures, therapists can ensure the safe and beneficial delivery of EMDR therapy, aiding in the healing and recovery from trauma-related seizure disorders and those with a traumatic brain injury (TMI) 

The client’s history and present treatment is an important part of evaluating risk factors in doing so because the bilateral stimulation as well as levels of disturbance can trigger an episode. Accessing current medical treatment that is managing the frequency and intensity of episodes is a key factor. The client’s attending physician should be consulted as part of history and preparation for such clients. Obtaining the client’s informed consent as to the potential for an episode as well as reassurance as to how these will be managed are important. 

The intensity and duration of the bilateral stimulation in EMDR sessions can influence seizure risk. Excessive or rapid stimulation might overload sensory processing mechanisms, potentially triggering seizures. The activation of traumatic memories can induce physiological arousal and stress responses, which may lead to seizures in susceptible individuals.

Therapists should thoroughly screen clients for any history of seizures or epileptic disorders before initiating EMDR therapy. The pace and intensity of bilateral stimulation should match each client’s tolerance, minimizing the risk of seizures.  Avoiding eye movements in favor of auditory or tactile BLS is recommended. During sessions, therapists should manage emotional arousal and implement grounding techniques to help mitigate potential seizure risks.

Although the risk of seizures during EMDR therapy is relatively low, therapists must stay alert and responsive to any signs of distress or adverse reactions. With proper precautions and adherence to established protocols, EMDR therapy can be administered safely and effectively to those seeking relief from trauma-related symptoms.

EMDR Group Therapy 

EMDR therapy has many practical applications in group therapy in various settings, including inpatient and outpatient environments, and for diverse groups such as families, refugees, and emergency responders. There are EMDR group protocols for a broad spectrum of issues, including disaster response, addictions, medical challenges, and grief.

Group therapy leaders should be experienced in both group treatment methods, crisis management and EMDR therapy. Managing a client experiencing a PTSD flashback mid-session poses a challenge involving a balance of the needs of the group and the individual in crisis. 

The preferred approach is not to manage the flashback in front of the group, to avoid drawing attention away from the group’s collective focus and possibly exacerbating the situation. Instead, having a co-facilitator discreetly remove the individual to provide stabilization is advisable. This method is particularly beneficial if the symptoms of the flashback require immediate intervention, such as the risk of self-harm or harm to others.

It’s essential to maintain the group session’s integrity as a group treatment rather than shifting to cater to one individual’s crisis. This approach helps prevent the escalation of anxiety among other group members, particularly if they share similar traumatic backgrounds. Techniques like breathwork may be used within the group setting to manage any arising collective anxiety.

Determining the affected individual’s level of presence is crucial; they should be at least partially grounded in the present (“one foot in the present”). If the individual is deeply lost in “trauma time,” immediate removal by a skilled practitioner is necessary. If somewhat present, simple reassurances of safety and differentiation between past and present can be comforting. Handling such situations requires both protection and support to ensure the individual is safely removed from the group and/or receives appropriate intervention.

Upon reintegration into the group, employing a grounding technique can help reestablish a sense of normalcy. This might involve visual exercises like having members visualize placing their distress into a container before returning to a mental state of security and calm.

See the recently published handbook for EMDR in group settings for a comprehensive overview and details on utilizing EMDR in group settings. 

EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond, Editors 

Regina Morrow Robinson, EdS Safa Kemal Kaptan, PhD (2023) is a comprehensive handbook introducing an innovative model of EMDR group therapy, providing practitioners detailed guidance on applying EMDR in group settings.

Key elements of the book include:

  • Foundational Theory: The book outlines the theoretical underpinnings of EMDR group therapy, integrating it within the traditional eight phases of EMDR therapy and early intervention principles.
  • Practical Applications: Step-by-step protocols for implementing EMDR in group settings are detailed, supported by real-life case examples from various scenarios.
  • Task Sharing: The text emphasizes the role of nonspecialist facilitators in delivering EMDR, showcasing how task sharing can effectively address the shortage of mental health professionals.
  • Educational Tools: Each chapter includes Learning Objectives, “Learned Through Experience” boxes, and Discussion Questions to enhance comprehension and practical application.
  • Cultural Competence: A detailed checklist is provided to help practitioners deliver culturally competent care.
  • Additional Resources: The book includes Pocket Guides for quick reference, a full Glossary of terms, and access to supplementary online content.

This handbook is an essential tool for those looking to implement EMDR group therapy in their practice, providing them with the knowledge and skills necessary to address complex trauma and promote recovery on a larger scale.

Bonnie Mikelson LISW