Extending EMDR Therapy to Personal Growth

Guest Blog Post by Bradford Stucki, PhD, LMFT

Therapy for Lasting Change

Many people come to therapy after their distress has reached a tipping point—their work has started to suffer, they realize they are not themselves, or they find it difficult to concentrate on what matters most to them. Their symptoms may range from depression and anxiety to post-traumatic stress disorder or relational conflict. While some of these people may only want symptom relief, others seek lasting change – by treating the root cause.

In marriage and family therapy, this differentiation between symptom reduction and lasting change is known as “first-order and second-order change” (Davey et al., 2012). When people request symptom relief, they are requesting first-order change, or a short-term change, such as the person’s experience with their distress. When providers treat the “root cause”—or second order change—they can create not only a lasting change, but also a significant one as well, as it commonly changes a person’s perspectives about themselves, their interactions, and their worldview.

EMDR therapy’s role

One therapeutic approach that aligns with both first- and second-order change is Eye Movement Desensitization Reprocessing (EMDR) therapy. EMDR is most known for its efficacy as the best treatment approach by trained providers for treating PTSD (Schrader & Ross, 2021). As time has passed, EMDR has also been utilized in treating a variety of mental health conditions other than PTSD, including depression, anxiety, eating disorders, and panic disorder, and continuing evidence for these treatments continues to grow (Carletto et al., 2017; Maxfield, 2019).

EMDR therapy is comprised of eight phases, starting with assessment of someone’s situation, resourcing or building coping strategies when distress arises (first-order change), and assisting an individual in reprocessing experiences of the past that cause current triggers. Reprocessing in EMDR therapy can also be explained as working to change the distress level and internalization of an experience. Following this is installation, body scan, closure, and reevaluation, a debriefing of the experience that is being targeted (Shapiro, 2013). The length of EMDR treatment can vary depending on the severity and duration of the situation someone has previously experienced, the client’s internal and external resources, as well as how consistent both clinician and client are in continuing EMDR treatment (Shapiro, 2013).

A personal growth lens

Using EMDR to help people who are seeking personal growth follows a similar approach to treatment, whether you are working with someone who has anxiety, depression, or another set of challenges. Let’s look at the progression of assessment, conceptualization, and intervention through an EMDR lens.

Assessment of the client’s needs and wants. When meeting with a client, determining which type of change (first- or second-order change) they are looking for is paramount for clinical success. This commonly happens during phase 1 of EMDR; however, assessment needs to be an ongoing process throughout therapy, as evidenced by the questions that clinicians ask clients prior to beginning phases 4-6 of desensitization, installation and body scan. Anytime a clinician asks about the image that captures the worst part of the target memory, Subjective Units of Distress (SUD), a Validity of Cognition (VoC), or where a client feels sensations of the target incident in their body, assessment occurs.

Failing to clarify what type of change a client wants may create a mismatch, which can lead to not only frustration but potentially termination from therapy. Does the client want assistance navigating a particular situation or realigning their self-beliefs from deficit to strength? What about the client who asks for help becoming a better parent or employee? Or even the client who wants to accomplish something they have not done before, or done before and failed? Navigating any of these opportunities can be accomplished through assessment of a client’s symptoms and their goals for therapy.

Example questions that providers can ask themselves through this process may include:

What is the client coming in for?

Too often, clinicians can get stuck in the metaphorical weeds of the details of a client’s experience. When clinicians use this question as an anchor, they can more readily focus on the purpose of therapy.

What keeps happening that the client is distressed by? What are the client’s triggers and situations that amplify those triggers?

Looking for patterns is an excellent way to identify sources of distress, but also to identify contexts, interactions, and activating events that can inform treatment.

What are the client’s secondary gains for keeping this problem around?

People have underlying motivations, needs, or intentions that drive their behavior, whether conscious or unconscious. Assessment of what benefits the client is experiencing can inform further assessment and clarification.

How would the client identify the problem?

Just as identifying what type of change a client is looking for, understanding how the client perceives the problem is yet another way to reduce the potential of mismatches. Successful treatment can commonly occur when both clinician and client are on the same page as to what is happening in the client’s life. If the therapist’s assessment of the problem differs from the client’s, it is important to provide psychoeducation and discuss those differences. This discussion can help to both strengthen the therapeutic alliance and provide support for the client to adopt a stance of curiosity toward their own problems and ways to overcome them.

What does the client want to achieve in therapy?

Just as aligning a client’s core belief with their symptoms, assessing whether a client’s therapeutic goals align with both their behavior and symptoms creates congruency in treatment.

These questions offer an ability to refine not just the therapist’s understanding of the problem, but also allow a more nuanced understanding of how the client perceives their situation and symptoms (K. Quinlan, personal communication, October 28, 2024).

Conceptualization. Contrary to the predominant and generally linear mindset in healthcare, where the person is the symptom and the symptom is the problem, Shapiro’s (2007) focus on the adaptive information processing (AIP) model homes in on the wholeness of the person and their experience. This type of therapist conceptualization typically happens in phase 1 of EMDR. As clinicians intentionally use the AIP model to determine a client’s common behavioral, cognitive, or emotional denominators between their past and present connection, clinicians can more effectively navigate the conceptualization in phase 1 (Hensley, 2021). This connection between past and present not only helps clinicians to later narrow and identify a negative cognition with their clients, but also provides clients with a reasonable hypothesis on why they do what they do.

Intervention. Once a conceptualization is developed and reviewed with the client and you have their buy-in about what the problem is, intervention follows in phases 3-8 of EMDR therapy. During this time, situations may arise where a client needs to utilize a more adaptive sense of self. This is called the “Positive Future Template.” Shapiro (2001) describes this process as:

“I ask my patients in session to develop an image, as clearly as possible, by visualizing themselves in situations that they would like to master. When a clear image is created, they are then asked to become aware of their body sensations, i.e., what it feels like to be successful in the situation. This is then elaborated upon in further detail as I continue to use words and phrases previously created by the patients for self-enhancement. When the image becomes more powerful, I begin the work of integrating therapeutic techniques for self-enhancement and ego-strengthening by using bilateral stimulation” (p. 535).

According to Shapiro (2001), “this model of treatment allows for rapid change from previously maladaptive thoughts and behaviors to adaptive resolution” (p. 533). As resolution occurs (phases 4 and 5), clinicians can link the client’s changing behaviors, emotions, and mindset back to the original conceptualization, as identified in phase 1. This practice is effective in further highlighting the shift clients are making, but also seeing how their small changes are part of a larger pattern of change. Clinicians can further leverage these changes by inviting clients to “tap in” their positive accomplishments, which can strengthen the client’s adaptive neural network, thus illustrating another instance where clinicians can promote second-order change, rather than focusing on first-order change, such as resourcing.

Additional considerations

Countertransference and biases. Personal growth can look very different to people from different cultural backgrounds or identities. Issues of transference can arise when clinicians have different philosophies or ideas around what personal growth means or looks like. To mitigate this, clinicians can be mindful of their own biases, assumptions, or interpretations of what personal growth looks like. For example, when a client first begins therapy, they may describe their goals for therapy as the resolution of their problem; however, as therapy and EMDR treatment progress, clients may adjust their expectations of being okay with a SUD score of 4. In this situation, clinicians may experience a difference in what personal growth looks like, as the EMDR protocol indicates that the goal is to work towards a SUD score of 0. Yet, in many codes of ethics, respecting client autonomy and choice is paramount over maintaining fidelity to the EMDR protocol. In these cases, clinicians will need to adjust their own definition of personal growth to fit the client’s experience to minimize transference.

Using EMDR as a mechanism for personal growth

EMDR therapy is an excellent treatment approach for resolving past challenges and can be applied to multiple mental health conditions. In addition to treating past difficulties, EMDR can also be used as a mechanism in promoting personal growth and adaptation, thereby promoting a strengths-based approach to treatment and meaningful second-order change.

Dr. Bradford Stucki is a Licensed Marriage and Family Therapist who works with adults in Utah, Virginia, and Texas who have experienced trauma in their childhoods or trauma as an adult. Dr. Stucki has expertise in treating anxiety, and relationship problems, and specialized training in working with PTSD as well as couples issues. His private practice, BridgeHope Family Therapy is in Provo, Utah.

References

Carletto, S., Ostacoli, L., Colombi, N., Calorio, L., Oliva, F., Fernandez, I., & Hofmann, A. (2017). EMDR for depression: A systemic review of controlled studies. Clinical Neuropsychiatry, 14(5), 306-312. Open access: https://www.clinicalneuropsychiatry.org/download/emdr-for-depression-a-systematic-review-of-controlled-studies/

Davey, M. P., Davey, A., Tubbs, C., Savla, J., & Anderson, S. (2012). Second order change and evidence-based practice. Journal of Family Therapy, 34, 72-90. http://dx.doi.org/10.1111/j.1467-6427.2010.00499.x

Hensley, B. J. (2024). An EMDR therapy primer: From practicum to practice (4th ed). Springer Publishing Company.

Maxfield, L. (2019). A clinician’s guide to the efficacy of EMDR therapy. Journal of EMDR Practice & Research, 13(4), 239-344. http://dx.doi.org/10.1891/1933-3196.13.4.239

Shapiro, F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice & Research, 1(2), 68-87. https://doi.org/10.1891/1933-3196.1.2.68

Shapiro, F. (2013). Getting past your past: Take control of your life with self-help techniques from EMDR therapy. Rodale Books.

Shapiro, S. (2001). Enhancing self-belief with EMDR: Developing a sense of mastery in the early phase of treatment. American Journal of Psychotherapy, 55(4), 531-542. https://doi.org/10.1176/appi.psychotherapy.2001.55.4.531

Schrader, C., & Ross, A. (2021). A review of PTSD and current treatment strategies. Missouri Medicine, 118(6), 546-551. https://pmc.ncbi.nlm.nih.gov/articles/PMC8672952/

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Extending EMDR Therapy to Personal Growth