Shapiro’s Challenges to Clinicians Implementing Effective EMDR Therapy
Although Dr. Francine Shapiro is no longer with us, her research, writings and insights continue to inspire and educate. Memories of her impactful EMDRIA conference presentations such as this one (2011) continue to resonate strongly as we navigate the ethical delivery of evidence-based EMDR therapy.
Therapist Drift
Dr. Shapiro highlighted a common phenomenon known as “therapist drift,” where therapists, regardless of their specialty, may stray from the methodologies they were originally trained in. She cited studies showing that even CBT therapists often deviate from standard procedures post-training. This raises a critical question for EMDR practitioners: “Are we conducting the clinical work that research supports?” The integration of other protocols and innovations, while enriching, must not dilute the efficacy and clarity of the standard EMDR protocol. Regular updates and training refreshers are crucial to remind us of the foundational practices proven to work.
Research Outcomes vs. Clinical Outcomes
Dr. Shapiro referenced a meta-analysis from 2002 and a study by Kaiser Permanente in 2012, which underscored the positive treatment effects linked to adherence to the standard EMDR protocol. These findings prompt two vital questions for practitioners: “Are we achieving comparable results?” and “On what basis are we deviating from the standard protocol?” Shapiro stressed the importance of informed consent if deviations occur, advocating for the standard protocol unless justified modifications are based on solid research.
Do We Trust the EMDR Process?
A significant concern Dr. Shapiro expressed was the premature use of resourcing by therapists during client abreactions in reprocessing sessions. She argued that this approach shifts EMDR from a client-centered to a therapist-controlled therapy. She emphasized the importance of allowing unimpeded processing, trusting the client’s brain to facilitate healing without unnecessary intervention.
“Good Enough” Preparation
Dr. Shapiro also addressed the tendency for over-preparation in therapy, suggesting that extensive preliminary sessions might not always be necessary. Drawing on Bessel van der Kolk’s research, she recommended assessing each client’s unique needs based on both their trauma history and existing adaptive neural networks, thus tailoring the preparatory phase accordingly.
More recently, Ad de Jonge’s research for EMDR 2.0 provides evidence for processing with less resourcing with clinical results remaining the same as for the standard protocol. See de Jongh, Ad, de Roos, Carlijn and El-Leithy, Sharif (2024) State of the science: Eye movement desensitization and reprocessing (EMDR) therapy. Journal of Traumatic Stress, International Society for the Study of Traumatic Stress, 28 January 2024 https://doi.org/10.1002/jts.23012
EMDR Heals—and Fosters Growth
Dr. Shapiro highlighted that EMDR not only alleviates symptoms but also promotes significant personal growth and trait changes in clients. She cited studies demonstrating EMDR’s effect on maternal bonding and post-traumatic growth, reinforcing the therapy’s profound impact beyond symptom relief.
Final Thoughts
Reflecting on Dr. Shapiro’s address reminds us of the ongoing relevance of these challenges in the practice of EMDR. Her insights continue to guide and inspire EMDR clinicians towards more effective and ethical applications of the therapy. As we miss her leadership, let’s carry forward her legacy by adhering closely to the foundational principles of EMDR, ensuring our practices align with the best outcomes for our clients.
Bonnie Mikelson, LISW
