The Unique Integrative Aspects of EMDR

There are hundreds of psychotherapies but not all of them are created equal. I believe the great therapy models integrate the best elements of all of them; EMDR therapy may fit as one of the best (especially for trauma), largely because it's an integrative approach (Shapiro, 2002; Shapiro et al., 2007). Here, I cover how EMDR interfaces and integrates many of the most prominent and well-researched psychotherapies, and how I believe this makes it effective. (Note: I personally practice EMDR and this is my own professional perspective.)

EMDR's International Recognition and Clout

The American Psychological Association has endorsed EMDR therapy as effective for treating trauma since 2004. The International Society for Traumatic Stress Studies and Departments of Veterans Affairs and Defense put EMDR in the highest category of effectiveness and research support also since 2004.

Since 2016, over 7 million people have been treated successfully by 110,000 therapists in 130 countries (Shapiro & Forest, 2016). EMDR therapy was found to be superior to Prozac in trauma treatment (Van der Kolk et al., 2007). This is likely because research shows that EMDR works not necessarily more effectively, but possibly faster than many trauma treatments to date (de Jongh et al., 2019; Hoogsteder et al., 2002; Matthijssen et al., 2020; Shapiro, 2004).

Whereas other models usually try to be purist, in EMDR trainings, trainees are encouraged to integrate EMDR with other models, often as an adjunct treatment. I argue that its flexible and integrative nature may be at the root of its success.

Seeds, Roots, and Tendencies of Integration

Joseph Wolpe’s seminal publication (1968), “Psychotherapy by Reciprocal Inhibition” heavily influenced EMDR. It recommended pairing a stressful stimulus with a peaceful one until the stress attenuates.

This is core to EMDR; the EMDR therapist applies a boring and predictable, back-and-forth bilateral stimulation, usually via eye movements, audio, and/or tactile buzzing while the client is instructed to focus on a traumatic event. Through this mechanism, the trauma usually loses a lot of its sting and lowers the often intense, long-lasting, and frequent physiological arousal trauma can create.

Although how EMDR works still needs more research, the bilateral stimulation (BLS) in EMDR may mimic the rapid, automatic eye movements in REM sleep. It turns out the "just noticing" your felt experience as you receive bilateral stimulation has roots in indigenous healing practices, similar to using silence, rhythmic drumming, or dancing with music to catalyze healing (Marich, 2022). Music naturally contains the rhythmic bilateral stimulation that EMDR is known for.

In this sense, EMDR wasn’t radically new as a therapy when it was created in 1988. Instead, it could be seen as a uniquely effective package, combining elements of healing from many potent healing therapies and practices. More specifically, the intersecting therapies overlapping with EMDR are:

1. Cognitive-Behavioral Therapy (CBT)

The CBT therapist helps the client shift core negative cognitions/beliefs, which aren't rooted in fact but can feel true, to a positive, factual, adaptive belief (i.e. "I'm inadequate" to "I'm good enough"). Unlike CBT, however, in EMDR this happens on its own indirectly, not through direct thought corrections common in CBT.

The two modalities differ in that, in EMDR, the negative thought distortions are seen as symptoms of traumatically and maladaptively stored memory networks, instead of an erroneous belief. Once you "heal" the memory in EMDR, your thoughts naturally become more adaptive, and usually positive.

2. Humanistic, Rogerian

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In humanistic therapy, the therapist helps create change by listening proactively, compassionately, and non-judgmentally to the client. Similarly, while EMDR is therapist-led, it's highly client-centered; the client is always in-charge and can stop or pause whenever they'd like. Both are also strength-based, trusting that clients already have all the resources needed to heal.

EMDR differs in that the EMDR therapist is, at times, compassionately more detached than a humanistic therapist, to allow the client’s natural/adaptive healing mechanism to kick in during the trauma reprocessing phases. The actual reprocessing part of EMDR is not dialogic like it is in humanistic therapy.

3. Psychoanalytic

Freud surmised early on that traumatic, unresolved memories can fuel psychological suffering (Haynal, 2008). In both EMDR and psychoanalysis, there is free association—the client states whatever comes up for them in the moment—but in EMDR, it's during the periodic, brief pauses in bilateral stimulation, and in psychoanalysis, it's more spontaneous and conversational as the therapist listens and interprets. Both also assume that the roots of the client's distress reside in the past, often in childhood, where its foundation was formed.

4. Mindfulness

In mindfulness-based therapies such as acceptance and commitment therapy or mindfulness-based cognitive therapy, the therapist helps the client cultivate non-judgmental awareness of the traumatic material that arises. This de-personalizes the trauma's effects, just like in EMDR. Both are rooted in purposeful, nonjudgmental present orientation, but in EMDR this is often when focusing simultaneously on past traumatic memories (Shapiro & Forest, 2016; Solomon & Shapiro, 2008).

5. Somatic Experiencing (SE)

While SE focuses more on the body than EMDR does, EMDR is also very somatically-oriented. In both, the client is continually linking the trauma-related feelings and perceptions to where they reside in the body, and healing occurs when the client re-experiences the sensations in present time, generating new sensations of relief, insights, perceptions, and feelings.

6. Prolonged Exposure (PE)

In PE, the client faces and moves through traumatic material or situations instead of avoiding them. But unlike PE, EMDR doesn’t require the client to verbalize or directly face/encounter the trauma for resolution. Accordingly, EMDR can usually work faster and be less painful.

7. Narrative Therapy (NT)

Although quite different, effective NT and EMDR result in a profound shift in the client's view of self in relation to the trauma. The NT saying that "person isn't the problem; the problem is the problem..." and its signature "externalization" process where the clinician helps the client separate from the problem's or the trauma's grip intersects with the re-storying aspects of EMDR (i.e. "I'm weak" to "I'm a strong survivor"). Both are also client-centered, strength-based, and trust that inside clients are all the resources needed to heal.

8. Internal Family Systems Therapy (IFS)

EMDR stimulates the brain in ways that lead it to process “unprocessed” traumatic memories, naturally leading to an adaptive resolution, decreasing emotional charge and linking them to positive memory networks. This is akin to the "Self" in IFS, the healthy core of the client that can lead and guide their traumatized parts and is courageous, calm, clear, confident, connected, and compassionate, similar to the adaptive direction the client advances toward in EMDR (i.e "I'm not good enough" to "I'm good as I am"). Like NT above, both are also client-centered, strength-based, and trust that inside clients are all the resources needed to heal.

9. Hypnosis

Even though hypnosis works with the subconscious mind and EMDR the conscious mind, both aim to create for a "special learning state" (it's just called adaptive information processing in EMDR) that allows old, problematic ways of responding to be set aside, core experiences to be felt and listened to, and new, adaptive views, feelings, beliefs, and identities to naturally develop. Both aim to creatively adapt to the client rather than force them to follow a protocol.

10. Solution-Focused Therapy

Both intentionally expand and focus on affirming experiences, behaviors, perceptions, and emotions that combat the trauma's negative effects. Like NT and IFS above, both continue what's working, are also client-centered, strength-based, and trust that inside clients are all the resources needed to heal.

11. Collaborative Therapy (CT)

Both strive for an equitable, nonhierarchical position for both parties, actively soliciting client participation, agreement, and collaboration. Like a few above, both are also client-centered, strength-based, and trust that inside clients are their own resources to heal.

12. Accelerated experiential and dynamic therapy (AEDP)

Both AEDP and EMDR are in the category of experiential therapies--they're "bottom-up" (body to mind) instead of "top-down" (mind to body). Both attest that says blocked emotion can create pathology. Thus, AEDP strives to make the implicit explicit, the explicit experiential, and the experiential relational (Fosha, 2000). I am sure that many EMDR therapists would agree with this therapeutically. Both focus on in the moment, careful, slow, and compassionate attention to the client's emotional experience in order to cultivate a new felt experience of what the client struggles with. To accomplish this, a common intervention in AEDP is helping clients float back to childhood traumas like in EMDR. This is done through a "portrayal" in AEDP (bringing the client's adult self to support their traumatized child's self) and a "retrieval" (bringing the wounded child to the client's present adult self). Unsurprisingly, these AEDP interventions have striking similarities to many aspects of EMDR.

13. Marriage and Family Therapy in General

EMDR therapists often identify relational factors worsening the trauma's effects and build relational support to heal the trauma. EMDR therapists have included the couple (Linder, 2020) and family contexts (Shapiro et al., 2007) to bolster EMDR's effectiveness and potential.

Accordingly, I believe great therapies take the best of all worlds to boost their effectiveness in healing.