BILATERAL STIMULATION CONSIDERATIONS

Bilateral Stimulation—Finger Eye Movements to Technology or Other Options

There has been discussion about the differing types of Bilateral Stimulation (BLS) with lots of variation in therapist opinion and usage. We know that eye movements following the therapist's fingers is the most often researched and the early EMDR research all used EM’s. Therapist clinical experiences would support that all types work for processing but preferences vary.  For example, several therapists expressed their dislike of the BLS technology (fsuch as, www.neurotekcorp.com) that many others, myself included, have used routinely.

    Many adult clients who prefer to close their eyes while processing may go deeper into their processing using tactile or auditory stimulation. Many also use 'tapping in' of resources, taken from Laurel Parnell's 2007 book by the same name, Tapping In. It's nice to think of 'tapping in' a positive, pleasant or peaceful state. We use a 'magic wand', a collapsible antenna or music wand, puppets, squeeze balls, drums and many other ways of bilateral stimulation or dual attention in our preparation and processing phases of EMDR work.

Roy Kiessling, Director of EMDR Consulting,  prefers not to use use technology.  He believes it interferes with or becomes a barrier to the therapeutic relationship and the therapist's attunement with the client. This is  an opinion shared by others about types of BLS. Roy had used technology in the past, but changed back to using his fingers for eye movements, hands for tapping, or snapping his fingers for auditory.  That one is impossible for those of us who can't snap that efficiently or in a sustained rhythm but it works for some. One of my consultees used the large magnetized clips for posting material on metal areas for clicking until she could purchase the technology. I've also recommended use of stress balls in alternating hands, drumming, stomping, and other adaptations to meet the needs of clients who cannot connect or get comfortable with other options.

Client Preferences

Technology such as Neurotek offers has been developed for EMDR therapy and has been used for years, still offered in many EMDR Basic Training manuals, including Roy’s EMDR Consulting Basic Training. The tactile stimulators and audio capacity are effective and my use started ongoing shoulder and neck issues. Another is that it works and clients seem to like it. I am a strong relational therapist, so I didn't feel the technology was a barrier to the therapeutic relationship.  In fact, my clients' favorite BLS form was tactile, requiring frequent replaement of the tactile attachment until they developed the Mega Pulsars. These larger paddles and thicker wire also light up, allowing for EM’s as well. These are more sturdy,and with plug in ends, can be replaced one side at a time rather than replacing the entire cord. The smaller attached tactile ‘buzzies’ are more user friendly for the little ones, however, as they easily fit into socks or small hands.

  I teach and emphasize eye movements as the first, most researched, and probably most activating form of BLS. The latest research continues to support the use of EM's (Eye Movements)  to reduce the vividness and emotionality of distressing images.  As an EMDR Basic trainer, I learned the hard way that if I don't teach eye movements first, trainees will not really learn how to use EM's, switching to tapping because it's easier. When they have to learn the EM’s, by the third day they are all confidently waving their fingers effectively in practice.

There's real benefit in learning to use EM's so that therapists can demonstrate different forms of BLS to most effectively assist the client in both resourcing and processing. We also have need of switching modalities when clients get stuck in processing. Many prefer using one form of BLS for resourcing, typically tactile or tapping, and another for processing with clients who seem to benefit from separating the BLS styles based on state or trait change work. In  Roy's EMDR Consulting’s Basic Trainings, ,we use tapping or walking through for resourcing as it makes intuitive sense to 'tap in' (Laurel Parnell) the positive to deepen and strengthen it. One concern about using EM’s for resourcing is the possibility that positive images and emotions that we are developing or enhancing become reduced rather than strengthen in Phase 2 Preparation.

Many of us use one or more of Neurotek's products and find the equipment very useful including the equipment that offers eye movements, tactile and auditory altogether, such as the Lapscan or Eye Scan. International sources offer variations on this equipment, including one that uses Bluetooth and smart phones to activate the equipment.  There are also now many apps for iPad and other electronic devices that offer the variety of BLS, with my vote going for EMDR Elite, an app developed by an EMDR therapist for IPad at $24.99.  

The 'buzzies," as kids may call them, can work well with children because you can put the paddles in their socks or under wrist bands while the little ones are playing or processing. I've had adults sit on them, which works well if you make sure the intensity is strong. Adolescents may respond to the Advanced Audio-Tactile equipment that allows for external audio to be plugged in. They can listen to their own music or play lists in a bilateral form. A few of my clients appreciated the choice in style of tones that this equipment can offer. 

Preference seems to be the tactile first, then auditory (some using both), then eye movements last. After getting the Mega Pulsars, more clients were willing to do the EM's along with their tactile.  I  had two clients who requested the use of hand tactile BLS on the knees or top of hands, sometimes on a pillow.

This is not meant, however, to be an ad fo Neurotek, though they have served me well. Instead, I would like to provoke thought as to what you use, how you decide to use it and your experiences with what works with your client population.

Client feedback as well as observation tell me that clients access internal material more easily with eyes closed, unless the eye movements are their strong initial preference. With dissociative clients avoid EM's if possible or watch their process with eyes closed to ensure they can sustain dual attention. It is also not recommended that EM's be used with anyone who has eye problems, a history of seizure disorder, brain tumer, or other eye/head injury that may impact their use or with eye/head injuries that closely associatid with their trauma history.

Asking clients to keep the eyes open is a way to anchor them or slow down flooding when processing. It also does sustain attunement and may be more important as clinicians learn to read signs that they are accessing and processing the targeted memories. 

BLS CD’s for RDI & Relaxation

   Some wrote to support the use of auditory stimulation and, in particular, commercial downloads and CD's, for resourcing to develop or enhance stabilization, affect regulation, , relaxation, and stress management. (See separate post on Bilateral Resources) Some prefer BLS sounds without music, some with music but no words, and some don't like these resources at all.  

I understand there is now research being conducted on tactile stimulation for processing (personal communication from Robbie Adler-Tapia and from Mark Grant). I look forward to learning more about these results, but am confident in the clinical results achieved through the years of utilizing tactile as well as other BLS options.

Client or Therapist Decision?

A final area of disagreement, if not controversy, is whether clients are given the choice of BLS or clinicians retain this responsibility.  I recommend introducing all forms and allowed clients to eliminate, per the excellent consultation I receive. There are EMDR therapists who feel this is part of clinician expertise to assess and decide for the client, barring any discomfort or inability (i.e., cannot track fingers with eyes without dizziness).  Best practice seems to be to demonstrate all three forms, eliminating the least acceptable by client preference. This is based on the more BLS, the better–and I do have clients who use both auditory and tactile. I. A final curiosity I have routinely noticed using BLS with clients who have or are recovering from addictions: They prefer their BLS as fast and as strong as possible, possibly due to the brain’s develped need of stronger stimulation in general.

So, what to do re BLS? Many ways of BLS can work, and it is the clinician's job to have solid reasoning, tested by experiential feedback, for what you offer, decide, or use with clients.

 Further Clarification from Roy Kiessling, Listserve Moderator

Following is further clarification from Roy Kiessling LISW in a past Listserve post, explaining his BLS preferences and how they evolved. With his permission, I’ve added his comments to my post as they are worth considering and give a clearer picture of his position.  Roy states:

" . .personally – I prefer my involvement (when culturally appropriate – previous posts).I am very, very attuned to the client when producing and pacing the self-produced [vs. machines] BLS in sync with the client's non-verbals. . .non-verbal attunement—is this not what infants attune to, and parents respond to?. . .and – with more complex clients, is that the attachment, attunement (non-verbal) that  is perhaps missing and causing the deep seeded abandonment? Perhaps the very process in the session is doing attachment repair.

Has the mutual BLS activated my own stuff – of course. a) at times – part of the client's healing ( and times needing cognitive interweaves) b) and when it did in a manner not in the best interest of the client —– – off to an EMDR clinician to 'heal myself."

Personally – I prefer using only my own activated BLS (EM's tapping on – or having the client watch and  copy my BLS ( if touching is not ok). As an aside – – at times it seems the motivation to use machines is driven by  the clinicians agenda more them the client's.  If so – please ask – "my stuff, or in the best interest of the client?" when considering the use of machines vs self-produced BLS. Just thoughts to consider…  Roy"

Summary

  More to consider as we make our own decisions about how we do BLS. 

Bonnie Mikelson, LISW

Director, EMDR & Beyond

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