As some of you may know, my motivation to specialise in trauma therapy came from my training in EMDR in the early 1990s. We don’t often cure people in psychiatry and so when I came across a therapy that improved nearly every patient’s condition and cured many completely, I decided I wanted to do a lot more of that!
EMDR has come a long way since it appeared almost a quarter of a century ago. As the underdog it had to prove itself such that there are apparently now more research papers around EMDR than any other trauma therapy. In 2013 it was the ‘star’ of the United Nations Institute for Training and Research conference on trauma therapy in Geneva (more here).
As the Australian government has noted (I elaborate on this here) the research has found that EMDR and CBT are considered to be the only two effective and recommended therapies for treating posttrauma syndromes. Finally the world is appreciating that “Talking through the trauma” is not only ineffective but can be re-traumatizing, while medications are just a chemical bandaid.
Thankfully the debate has moved onto what are the differences/benefits of each therapy. A recent study in the British Journal of Psychiatry has confirmed my clinical impression that the big difference between the two is that EMDR works more quickly and has slightly lower dropouts – largely because there is none of the homework that CBT requires.
The researchers stated the following in an interview with Medscape, “If a patient values fast symptom reduction, EMDR is the treatment of choice. If a patient feels the need to make meaning out of the traumatic experience and learn from it, a trauma-focused CBT modality is the best choice.”
A couple of comments. I used CBT before I moved to EMDR (although I still sneak in some CBT strategies) and there was a reason for the move. First, I have never had a patient who wanted the slower symptom reduction therapy! Second, in my hands, EMDR’s primary focus is all about finding the deeper meaning the traumatic experience had for the patient. As I say to my patients, we are often haunted by traumatic events until we learn from them the fullness of what they have to teach us. The lesson is not the first, prima facie one of ‘avoid that again at all costs!!’ The deeper lesson is around understanding ourselves and how resilience comes from being with, overcoming and being inspired by apparently overwhelming emotions of fear and shame.
Where to begin….These two statements knock against each other in a variety of ways. CBT has the power to help someone to re-experience their experience in the physical world and, hence, reprogram it from the conscious perspective. But, it does little to fully embed the change deep within the unconscious mind where the trouble found its original resting place. EMDR is fast and slow, it is deep and high. Its power lies in the depths of the places it can take you, while simultaneously putting you in charge of the speed and the depths to which you choose to go. Ongoing and fulfilling change that is driven and orchestrated by the patient is what EMDR offers. To create and determine your own experience is what EMDR does that many other therapies cannot.