EMDR therapy, like other forms of psychotherapy, does not guarantee success for every individual. There are several reasons why it may not always be effective. Not every therapy is suitable for every client, and the effectiveness of EMDR can vary due to multiple factors. Here are the most frequent factors that stem from EMDR therapists doing the work.
Therapist Errors, especially those less experienced with EMDR or those deeply aligned and educated with other therapeutic modalities, do impact the success of the treatment. These errors can range from improper implementation such as failure to learn and implement the standard protocol’s EMDR phases and three pronged approach. lack of a target sequence plan, not clearing out one memory network before going on to the next, and a myriad of other issues we bring into our clinical practices.
Identifying the core negative cognition (Shapiro) or belief (Kiessling) is an art as well as a skill. Failure to learn to do this well results in significant challenges in processing dysfunctional memory networks to full integration. An example is starting the process with a common negative belief such as “I am not good enough” to access the memory network, only to get blocked by a deeper core negative belief “I am abandoned,” or “I have to be in control.”
The first will not clear out the memory network until the core belief is resolved, The second will significantly block the processing that requires the client to “just let whatever comes, come.” There are numerous tools and skills that EMDR clinicians use to successfully address these issues in successful EMDR work, including asking the question, “What is the worst that will happen when..”, Sometimes, this initial step involves addressing the fear of what might happen if traumatic experiences are accessed.
Where clinicians and clients find themselves getting stuck is typically a significant aspect of the trauma for each. Some also have a deep-seated desire to please, especially for those who historically strive to meet expectations, control outcomes, or correct behaviors—common traits among many people. The desire to “do it right,” rather than letting the brain do its work, gets in the way of successful EMDR work every time. Clinicians need to trust the process themselves as they support clients to do so. Not an easy task when there’s not yet clinical outcomes the therapist can trust themselves!
Some EMDR trained clinicians are also avoidant of the strong emotions that arise so that their own fears hinder the healing of their clients. Others have a hard time trusting the client’s brain to be the instrument of changes and get in the way with more of their own therapeutic interventions than are necessary for healing.
Expert EMDR consultation is key to solidifying the application of Dr. Shapiro’s evidence-based standard protocol, the three pronged (past, present, and future) approach, and working from the Adaptive Information Processing (AIP) model. There is a lot to learn in EMDR therapy and ongoing consultation in individual or group format is vital in learning it well. Wise therapists also may start or join their own EMDR study group to learn from each other.
A few clients may not benefit from EMDR therapy because the therapist lacks the skills in their presenting diagnosis or symptoms. With more training, including consultation with Approved Consultants who do have expertise in specific client presentations, skills and knowledge to assist them through their blocks in the EMDR therapy process resolves this. A strong therapeutic relationship mediates this as well.
Inadequate Client Preparation is essential in EMDR therapy. Clients need to be ready to manage the intense emotions and memories that can emerge during EMDR sessions. The early phases of EMDR, including the preparation phase, are critical for setting the stage for effective processing of traumatic memories.
Skilled EMDR therapists learn how to assess the client’s readiness for processing, doing “good enough” preparation to support the client staying in the present while addressing the past. Those who have fears themselves, as mentioned above, may stay in the preparation phase too long, postponing the power of EMDR in the processing phases of the model.
Gaining more training and experience and addressing one’s own dysfunctional memory networks in personal EMDR therapy are the most effective ways to resolve these barriers.
Failure to Address Dissociative Disorders by not screening for and addressing dissociative disorders is a serious error that some EMDR therapists make.. Some clients have dissociative symptoms that make it difficult to maintain a connection to the present while recalling traumatic events. If these are not adequately assessed and treated, EMDR may not be effective.
This belief leads to the underutilization of diagnostic tools like the DES-II (Dissociative Experiences Scale-II), which are only employed when dissociation is already suspected. Consequently, many subtle cases of dissociation may go unrecognized and undiagnosed. There is often a gap in training and education, where EMDR clinicians are not adequately prepared to deal with dissociative disorders due to outdated or incorrect teachings that such conditions are rare. This lack of preparedness can impede the effective treatment and understanding of a significant aspect of mental health within the therapeutic setting.
Dissociation is a way of coping with the overwhelming trauma of many adverse experiences by compartmentalizing them so they are less accessible to the brain. The risk to the EMDR client with such an undiagnosed disorder is to either under-access memories such that processing goes nowhere, or over-access memories such that the client is flooded with past trauma. Both limit EMDR’s effectiveness and negatively impact the client’s as well as the clinician’s willingness to continue in EMDR work.
There are several well researched and respected tools for assessing dissociation easily accessible to most clinicians. The most frequently utilized screening tool, The Dissociative Experiences Scale for Adults (DES II) with versions for children and adolescents. These are an important beginning but it is a screening, not a diagnostic tool, as pointed out by Andrew Leeds et al in a recent article. The DES is not sufficient to diagnose the presence of moderate to severe dissociation. (Leeds, Andrew & Madere, Jennifer & Coy, D Michael. (2022). Beyond the DES-II: Screening for Dissociative Disorders in EMDR Therapy. Journal of EMDR Practice and Research. 16. 25-38. 10.1891/EMDR-D-21-2021-00019).
In contrast, the MID (Multidimensional Inventory of Dissociation) has been made freely available in the public domain Paul F. Dell, The MID offers the convenience of being self-scorable when administered via a computerized Excel spreadsheet, providing instant results that are easy to interpret. The MID serves as a practical alternative. It is a straightforward test that can be administered on paper or digitally without the need for the clinician’s direct oversight, making it an efficient choice in a busy clinical setting.
Therapists must be thoroughly trained in EMDR and continue to update their skills as new research and techniques develop. The success of EMDR therapy heavily depends on the therapist’s adherence to the established protocols and their ability to adapt the therapy to the client’s specific needs. Additionally, clients should work with their therapists to build and strengthen internal resources before diving into processing traumatic memories.
Overall, while EMDR is a powerful therapeutic tool for many, it requires careful implementation and a strong therapist-client collaboration to achieve the best outcomes. Experiencing involuntary recall of feelings and traumas when not intended, yet struggling to connect, visualize, or stay focused during EMDR sessions is a common issue. Good rapport with clients forms a strong foundation for effective therapy.
Bonnie Mikelson LISW
