To commemorate Endometriosis Awareness Month, we turned to EMDRIA member Peter Pruyn, LMHC, therapist and writer on EMDR therapy and endometriosis.
EMDR Therapy and Endometriosis
Guest Blog Post by Peter Pruyn, LMHC
“To see the world through the lens of EMDR is to see pain as an invitation to healing.” – Peter Pruyn
Tell us a little bit about you, your experience becoming an EMDR therapist, and what drew you to the topic of endometriosis and menstrual pain.
The first thing to say is that I didn’t really enter the mental health field with a particular interest in mind. I think what ended up happening is that I just followed “the trail of breadcrumbs” of need over time.
My first internship was at a homeless shelter for veterans. The big picture lesson from that experience was the pervasive role that trauma played in those individual’s lives. I then interned at a student counseling center at a predominantly female university, so that was my introduction to women’s health issues, generally. I next worked as a substance abuse counselor in a methadone clinic and in community mental health. That also reinforced the pervasive role of trauma in people’s lives, but it also highlighted how women typically have higher rates of sexual trauma. I then went into private practice, and on average, women were far more likely to come to psychotherapy than men. Over time, my clients disclosed to me their issues with sexual health and menstrual health. Finally, I became aware of how women have far higher rates of chronic pain on average, than men.
It is important that I acknowledge two significant limitations I have in coming to this work. The first is that I am not a medical professional. And second, I do not have a uterus. This means that pretty much everything I’m going to share with you today I’ve learned from other people: my clients, generous colleagues, and, in particular, I want to express my gratitude to Heather Guidone, BCPA, Surgical Program Director at the Center for Endometriosis Care in Atlanta, Georgia, who really has become my endometriosis medical mentor. If it wasn’t for Heather, I wouldn’t be talking to you today.
How can EMDR therapy help with endometriosis? What successes have you seen when using EMDR therapy with clients who have endometriosis?
My endometriosis learning journey began three and a half years ago with a client I will call Shauna, who initially came to me to treat anxiety. About six months into treatment, we had just begun a session online, and she announced that she was in so much menstrual pain that she wasn’t sure if she could continue the session. It was only then that she described her lifelong history of endometriosis, often having to come home from work in extreme pain. I explained to her that I wasn’t a medical professional, and I couldn’t promise that EMDR would make a difference with physical pain. But based on what she was telling me, I had a hunch that it might be able to help.
Over six sessions, we targeted EMDR on the psychological component of her pain. Before coming to me, Shauna reported that her average peak period pain was an 8 out of 10. After these six sessions, Shauna reported that her average peak period pain halved to a 4 out of 10. And that has sustained over an 18-month follow-up.
Ever since then, I’ve tried to be a good student of endometriosis and related issues. At this point, I’d like to quote Heather Guidone on how she defines endometriosis. Guidone likes to describe endometriosis as a systemic inflammatory condition that is both chronic and progressive. It’s extremely important to emphasize that every presentation of endometriosis is unique, but the most common symptom is pain, and it is a leading cause of infertility. What surprised me was its prevalence. An astounding 10 percent of women and transgender individuals who menstruate have endometriosis, and yet, it’s rarely talked about. That’s the exact prevalence of diabetes, which pretty much everyone has heard of. Meanwhile, because every presentation is unique, something that’s extremely common for sufferers of endometriosis is that it can take an astounding seven to 12 excruciating years to achieve an accurate diagnosis, often leaving a sense of feeling gaslighted and causing medical trauma in the process.
There isn’t a clear understanding of what causes the condition or an outright cure. But what is known is that there’s a solid correlation between childhood physical and sexual abuse and individuals developing the condition. It turns out that individuals who have had severe to chronic abuse have a 79 percent higher risk of developing endometriosis. So, from a trauma and EMDR professional’s point of view, endometriosis is a perfect storm of trauma: starting with a foundation of societal stigma around menstrual issues, the trauma of the experience of the illness itself, and then the typical gaslighting and medical trauma that endometriosis sufferers often experience.
Are there any cautionary measures you would like to mention regarding the use of EMDR therapy with clients who have endometriosis?
I think the central characteristic that EMDR therapists need to have in treating all clients is humility. Just because you’ve treated some people with a particular condition, you haven’t yet treated the next person who has come into your office. And because endometriosis has unique presentations for every individual, this sense of humility and treating everyone as an individual is doubly important.
Something else that I think is very important to keep in mind is that during their journey, endometriosis sufferers are so often told, “It’s all in your head!” This victim-blaming and gaslighting creates one of the wounds of trauma that needs to be addressed in treatment. So it’s crucial when medical providers and therapists suggest psychotherapy and EMDR that this suggestion of psychotherapy does not reinforce that insult. As a result, it’s important to position psychotherapy and EMDR as specifically treating the psychological component of pain and empowering clients with tools and techniques to manage their pain better.
Because endometriosis is a systemic condition that can affect different parts of the body, it’s also extremely important to treat it with an integrative approach. Therapists should coordinate with other healthcare professionals—such as pelvic floor therapists and nutritionists—whom their clients may also see.
Lastly, as with any chronic illness or condition, clients are not always well enough to make their sessions. Meanwhile, therapists do have cancellation policies. So, I think you need candid conversations with clients about how you’ll navigate that together. Every individual will be unique, so the best way forward is to be as relational as possible.
Are there any myths you’d like to bust about using EMDR therapy with this type of condition?
The main one is not positioning EMDR as a quick fix or cure-all. We need to frame EMDR, again, with humility, that it may not work for everyone. And if it does work, it’s impossible to predict how long it will take. Having said that, my EMDR mentor, Dr. Deborah Korn, likes to offer that for most individuals doing EMDR, there is incremental relief. It’s also my experience that those who do EMDR therapy often benefit by gaining a set of tools and techniques that they can apply to other areas of their lives well after treatment.
What multicultural considerations might EMDR therapists need to keep in mind regarding using EMDR therapy with clients who experience endometriosis?
I’m so glad you asked this question! Once again, as with all psychotherapy, I think the key is humility, in this case, cultural humility. I also asked Heather this question, and she gave a wonderful list of characteristics to remember for all medical professionals.
First, the importance of acknowledging the broad spectrum across different cultures of beliefs and attitudes towards illness, pain, and trauma, in particular. These attitudes will shape individuals’ comfort level with self-disclosure and boundaries around these topics. Multiple identity factors come from different cultural experiences: gender, sexuality, faith/religion/spirituality, and so many others. How those combinations of identity markers intersect creates dynamics of either more or less privilege that the person will have had in their lives. A wide variety of family structures and social supports will also be available to different individuals. Finally, it’s essential to acknowledge the wide disparities in access to care, depending on the different cultural backgrounds clients may come from.
It seems to come down to a stance of humility. On the flip side, one of the gifts of this work is the opportunity to really get to know people as individuals. I think that’s one of the joys of doing this work.
Do you have any favorite free EMDR-related resource you would suggest to therapists working with this population?
Free Resources: I was very disappointed about how much I could find about EMDR and menstrual health or endometriosis. So, the first thing I did was ask Heather if she would agree to have me interview her.
- Pruyn, P. (2023, April 26). Peter Pruyn in conversation with Heather Guidone, Part 1: An introduction to endometriosis. YouTube. www.youtube.com/watch?v=fht87NEKzMY (53 min)
- Pruyn, P. (2023, September 1). Peter Pruyn in conversation with Heather Guidone, Part 2: Endometriosis, trauma, and EMDR. YouTube. www.youtube.com/watch?v=ZP5LumIo29s (52 min)
I also wrote up the case study about Shauna. Since then, I have written up three other case stories that focus on using EMDR:
- Treating Endometriosis Pain with EMDR: https://tinyurl.com/yyys4sw6
- Treating Menstrual Pain with EMDR: Can releasing emotional pain lessen physical pain?: https://tinyurl.com/yn4xyrmp
- PMDD and EMDR: A story of chronic pain, motherhood, and healing: https://tinyurl.com/386h4wyn
- Treating Medical Trauma with EMDR: A case story of a mammogram, a biopsy, and reconnecting with the body’s wisdom: http://tinyurl.com/2s4vcna7
- How Psychotherapy Can Reduce Chronic Pain: Exploring the relationship between memory, pain, and the brain: https://tinyurl.com/8aujby6t
Finally, I’m delighted to share a link to a current exhibit on endometriosis at a museum in London called the Vagina Museum. You don’t have to go in person, because they’ve also created a beautiful website that allows you to visit the exhibit online:
- The Vagina Museum, London, an online exhibit on endometriosis: www.vaginamuseum.co.uk/endometriosis
Books: I think everyone who treats endometriosis with EMDR should familiarize themselves with the following books. The first is one of Heather’s favorite books, which gives a beautiful medical perspective on the integrative treatment that should be standard practice for treating endometriosis:
- Orbuch, I. K., & Stein, A. (2019). Beating Endo: How to reclaim your life from endometriosis. HarperCollins Publishers
From a more personal perspective, I would recommend an endometriosis memoir:
- Parker, L. (2020). Vagina problems: Endometriosis, painful sex, and other taboo topics. Macmillan
And then, finally, even though it’s not specifically about endometriosis, I highly recommend the single most accessible book on women’s health I’ve ever seen. It presents an entirely down-to-earth, practical, and stigma-free review of topics like menstrual health, sexual health, and many other aspects of women’s health. It also includes ample resources for further exploration. I believe everyone of all genders should read this book:
- Thinx, Conti, J., & Cho, M. (2020). The vagina book: An owner’s manual for taking care of your down there. Chronicle Books
What would you like people outside the EMDR community to know about EMDR therapy and endometriosis?
The big picture that comes to mind is that our world needs more bridges and fewer walls. I hope that the endometriosis community—both individuals who have it as well as medical providers—can learn more about EMDR, and the EMDR community can learn more about endometriosis and what EMDR can offer those who suffer from menstrual pain and related issues. Whether that means writing articles accessible to a general audience, as I try to do, or EMDR professionals being speakers at gynecological conferences, or medical professionals being speakers at EMDR conferences, I think all that would benefit everyone.
Is there anything else you’d like to add?
For potential clients and people who are curious about EMDR, the main piece of advice I would give you in choosing a therapist is: trust your gut. While credentials and technique have their place, the most important thing in a psychotherapeutic relationship is that you feel comfortable with your therapist, that you believe they are the best fit for you. It comes down to the relationship; only you can decide that for yourself.
For EMDR therapists and medical professionals, I would share my disappointment and confusion that after 30 years of proving, empirically, that EMDR can be of help with so many different kinds of chronic pain, I don’t understand why there isn’t more research on using EMDR with menstrual pain and related issues. I will risk using a very colloquial word to describe this situation: I think it’s stupid. I think it’s stupid that a technique that has shown so much promise has not been documented as being used on undoubtedly one of the most frequent kinds of chronic pain for our species. So, if nothing else, I hope this will serve as an exhortation to both the EMDR community and the medical community to do more research and prove that EMDR can work on these issues.
In wrapping up, the other thing that comes to mind is that when you’ve done EMDR for many years, it changes how you see the world. For one thing, you understand how silence makes pain worse, whether that pain is emotional or physical. So, one of the beliefs I’ve come to in doing this work is that seeing the world through the lens of EMDR is to see pain as an invitation to healing.
Peter Pruyn (“prine”), LMHC, is an EMDR Consultant and Facilitator in private practice in Western Massachusetts who works with female survivors. He has a research interest in using EMDR for women’s health and is the author of Peter’s Psycho-Ed Handouts for Trauma, EMDR, and General Psychotherapy, 3rd Edition. He writes about trauma recovery, women’s health, and gender equality at peterpruyn.medium.com. He would enjoy hearing from colleagues who are doing related work at pwp04 [at] icloud [dot] com.
Resources:
Center for Endometriosis Care. (2024). https://centerforendo.com
EMDRIA. Find an EMDR therapist directory. https://www.emdria.org/find-an-emdr-therapist/
Harris, H. R., Wieser, F., Vitonis, A. F., Rich-Edwards, J., Bynton-Jarrett, R., Bertone-Johnson, E. R., & Missmer, S. A. (2018). Early life abuse and risk of endometriosis. Human Reproduction, 33(9), 1657-1668. Open access: https://doi.org/10.1093/humrep/dey248
Madrigal, J. (2018). EMDR seems to help me cope with endometriosis trauma. Endometriosis News. https://endometriosisnews.com/2018/10/26/emdr-helped-cope-endometriosis-procedures-trauma-ptsd/
Mapes, D. (2018, July 17). New Fred Hutch collaboration highlights yet another poor health outcome associated with adverse childhood experiences. Hutch News. https://www.fredhutch.org/en/news/center-news/2018/07/endometriosis-linked-to-childhood-abuse.html
Orbuch, I. K., & Stein, A. (2019). Beating Endo: How to reclaim your life from endometriosis. HarperCollins Publishers
Parker, L. (2020). Vagina problems: Endometriosis, painful sex, and other taboo topics. Macmillan
Pruyn, P. (2020, May 22). How to Find a Good EMDR Therapist Medium. https://tinyurl.com/y7qtc4rn
Pruyn, P. (2020, May 22). What is EMDR? Medium. https://tinyurl.com/y6jkmpwc
Pruyn, P. (2021, January 4). Treating Endometriosis Pain with EMDR Medium. https://tinyurl.com/yyys4sw6
Pruyn, P. (2023, April 26). Peter Pruyn in conversation with Heather Guidone, Part 1: An introduction to endometriosis. YouTube. www.youtube.com/watch?v=fht87NEKzMY
Pruyn, P. (2023, September 1). Peter Pruyn in conversation with Heather Guidone, Part 2: Endometriosis, trauma, and EMDR. YouTube. www.youtube.com/watch?v=ZP5LumIo29s
Pruyn, P. (2023, October 23). Treating Menstrual Pain with EMDR: Can releasing emotional pain lessen physical pain? Medium. https://tinyurl.com/yn4xyrmp
Pruyn, P. (2023, November 30). PMDD and EMDR: A story of chronic pain, motherhood, and healing. Medium. https://tinyurl.com/386h4wyn
Pruyn, P. (2024, February 3). Treating Medical Trauma with EMDR: A case story of a mammogram, a biopsy, and reconnecting with the body’s wisdom. Medium. http://tinyurl.com/2s4vcna7
Pruyn, P. (2024, March 6). How Psychotherapy Can Reduce Chronic Pain: Exploring the relationship between memory, pain, and the brain. Medium. https://tinyurl.com/8aujby6t
Thinx, Conti, J., & Cho, M. (2020). The vagina book: An owner’s manual for taking care of your down there. Chronicle Books
Vagina Museum. (2024). Endometriosis: Into the unknown. Online exhibit November 4, 2023 – March 31, 2024. www.vaginamuseum.co.uk/endometriosis
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Date
March 25, 2024
Contributor(s)
Peter Pruyn
Topics
Pain/Chronic Pain
Practice & Methods
DEI/IDEA