EMDR therapy’s adaptive information processing (AIP) model views that we all have the innate ability to heal. This goes hand in hand with the emerging research on brain neuroplasticity; the understanding that our brains can learn, grow, and change throughout our lifespan. We recently learned that April is Second Chance Month, which recognizes the importance of supporting individuals to reentry communities after incarceration. This recognition allowed us to talk with member Paula Harry, LCSW, to learn more about using EMDR therapy in correctional settings.
EMDR Therapy in Correctional Settings
Guest Blog Post by Paula Harry, LCSW
I have a private practice for the last 10 years in Oshkosh, Wisconsin. I became EMDR trained in 1998 under William Zangwill in Chicago. I reached EMDRIA Certification in 2006 under Roy Kiessling and earned EMDRIA Approved Consultant status in 2016 under Andrew Leeds. From 2003 to 2018, I worked in a medium-security psychiatric hospital serving the Wisconsin Department of Corrections population. In 2016, at the EMDRIA Conference in Minneapolis, I entered a poster presentation titled, From Skepticism to Expectation: 10 years of EMDR in a Correctional Setting. I continue to see clients in my office. I present EMDR basic trainings and provide consultation.
Tell us a little bit about you, your experience becoming an EMDR therapist, and what drew you to the topic of correctional settings.
During my Master’s degree program, I worked for a prosecuting attorney in Mississippi. That’s when I became interested in all things forensic. The DA, my boss, presented with me at the MS Psychological Association Conference in 1990–that was an awesome experience. After graduating, I worked as a case manager in a halfway house in Madison, WI, and then in the county jail, doing screenings. I found it very frustrating when my trauma clients’ progress hit a wall. Out of frustration, I found an EMDR training in the area. I had no idea what it was. I was hoping to learn something. When I arrived at the facility, I had been doing EMDR for five years already. I was shocked at the wall-to-wall trauma. I shared my concerns with my Clinical Director, who said I should make a proposal for the administration to consider. We did four EMDR trainings in my first five years. My mission was to educate the facility about trauma and train as many clinicians as possible. By the time I retired in 2018, there had been nearly a dozen EMDR and trauma-related trainings that involved clinical staff from all over the state.
How can EMDR therapy help in correctional settings? What successes have you seen when using EMDR therapy in correctional settings?
EMDR can, has, and does reduce the experience of pain and suffering. When I first started in corrections, I worked with clients on just getting better sleep and having fewer nightmares and fewer panic episodes. That was a big enough success early on. Then, accomplishing activities of daily living is a success. Leaving and returning to the housing unit is a success. It can be monumental to recognize and accept an idea or belief of “I can …do better … be better … feel better.
We collected pre- and post-treatment data on trauma treatment clients. The assessment items were the Trauma Symptom Inventory (TSI-2), PTSD Check List (PCL-5), the Multiscale Dissociation Inventory (MDI) to assess dissociation, and the Beck Depression and Anxiety Inventories. The most frequent ACE scores were 7 and 8 for both men and women. The data reported in our utilization reviews consistently showed positive treatment outcomes. Symptoms remitted when we began using EMDR therapy. PTSD, depression, and anxiety remitted. Expressions of dissociation decreased. Clients could attend activities away from the housing units and complete programs. They could better tolerate the stresses of living in an institution. When residents can be managed without restraints or restrictive housing, everyone in the institution experiences less stress. Living in a correctional setting can be intensely triggering. Environmental triggers can be a barrier to treatment. Emotional vulnerability is a risk factor. Helping clients cope and use grounding and container skills is hugely important.
We enjoyed hearing about successes after residents were released from custody – employment, reconnecting with family, furthering education and careers without re-offending. My two biggest success stories are about a highly troubled male serving a life sentence and a dissociative female serving roughly 10 years. I worked with the male for roughly 12 months. When we ended services, he and others described him as “a totally different person.” He discontinued medications and his sleep/wake dysregulation finally stabilized. He was less combative and no longer suicidal. He held a stressful job in the kitchens, completed educational classes, was thoughtful and assisted less functional peers. I worked with the female for about eight months. After discharging from custody, she completed college and now leads a department in a major company.
Are there any cautionary measures you would like to mention regarding the use of EMDR therapy with clients in correctional settings?
First, the usual things are to take a thorough history-taking, conceptualize the case carefully, proceed slowly, be thorough with resourcing, be thoughtful about distress tolerance, and maintain present orientation. It is essential to be mindful of the client’s housing situation. I mentioned before that emotional vulnerability is a risk factor. Some of the clients have little or no tolerance for emotions. Predators in the environment can be dangerous to those clients. Those clients can be dangerous to staff. The environmental expectations for compliance are an area of challenge. Resourcing is critical. Grounding, soothing, and containing are enhanced by coaching in DBT modules. I especially focused on normalizing, radical acceptance, nonjudgmental stance, objective observing, interpersonal effective skills, and boundaries. Some institutions have specialized housing units, which is helpful.
Educate security and the treatment team about how to encourage success. Security and housing staff must have knowledge of how and when residents are participating in difficult treatment so there can be support for accommodations similar to medical or physical interventions. I remember explaining to a Captain that the resident wasn’t resisting; she was panicking. The interaction changed after he thought differently about the situation.
Support, consultation, and debriefing are crucial for the providing clinician because correctional institutions are places of suspicion out of necessity. It is undeniable that people engage in problematic behavior while living and working in prison. Having to justify and defend clinical decisions to others who are ostensibly on the same side/team can be very taxing when cases are complex and difficult. Security directors, clinical and medical directors, supervisors of every kind, and wardens all know a lot about many things. And so do social workers, counselors, and psychologists. Competing job goals sometimes get in the way of treatment goals. It used to be a hugely difficult task navigating perceived competition and suspicion before EMDR therapy was accepted as a legitimate treatment.
Are there any myths you’d like to bust about using EMDR therapy in this type of setting?
I found the biggest myth about using EMDR in a correctional setting is that EMDR therapy is too dangerous. In my experience, the risk is not much different from working with complex cases in the community. Hard cases are hard–we had to proceed accordingly.
A myth among some staff was that there is no treatment for trauma or PTSD. Another myth was that a particular diagnosis or condition couldn’t participate in EMDR therapy. Neither of those was true in my experience. We approached cases thoughtfully and methodically. We found workable goals even in restricted housing.
Another myth was that incarcerated residents ought not to be allowed to participate in trauma treatment (Malik et al., 2023). The sentiment was that convicted felons deserve to suffer or they are incapable of positive resolutions. There were many meetings and discussions with supervisors about trauma, symptoms, symptom-related behaviors and emotions, meeting needs, etc. One particular supervisor equated trauma treatment with forgiving and contended that ‘corrections isn’t in the business of forgiving;’ that was a long discussion. Eventually, we were able to agree on security goals for the institution.
Which brings me to another myth. EMDR therapy, like forgiving, doesn’t excuse, tolerate, or otherwise let people off the hook for past behaviors. For several of my clients, the targeted trauma was the commission of an offense. EMDR therapy, like forgiveness therapy, according to Robert Enright, Ph.D. (2001) of the University of Wisconsin-Madison, resolves irrational, negative, life-diminishing thoughts, feelings, and perspectives. The model on which EMDR therapy is built, Adaptive Information Processing, like forgiving, allows for real, accurate conclusions that are true in the current reality.
What multicultural considerations might EMDR therapists need to keep in mind regarding using EMDR therapy with clients in correctional settings?
Most residents in the institution were either African American or Caucasian. I recall working with clients from Mexico, Cuba, Southeast Asia, Africa, the Pacific Islands, Germany, Romania, Native American tribes, and South America. Cultures included Jewish people, Muslims, Christians, Pagans, and non-religious belief systems. I worked several times with language interpreters, including ASL, which didn’t hinder reprocessing.
I recall colleagues discussing highlighting and strengthening culturally-based resources to foster resilience and facilitate treatment. The institution accommodated belief systems as it could. Clients were allowed to bring faith items that we used for grounding or soothing. Targets and resources came from historical information as well as current issues.
In addition to those considerations, we also had to remember that correctional institutions have a climate and culture. Resident groups, staff groups, government groups, institutional leadership groups, and staff department groups differentiate themselves. At the intersection of residents and staff is the public. Staff and residents come from and return to the public every day. We had to consider the needs and expectations of all three spheres.
In one energetic discussion I had with a supervisor, they said it looked bad for clinical staff to give permission for a client to not attend meals in the chow hall like everyone else — “We run a tight ship here.” In general, security means no deviation from standard operating procedure. I was advocating for accommodation so the client could do more than take in a gulp of milk and run back to the housing unit because her cafeteria is a loud, crowded environment.
Do you have any favorite free EMDR-related resource you would suggest to EMDR therapists working with this population?
There are two things I started using long ago and continue to use. First, to introduce EMDR therapy, I still use a YouTube video from 2004 to give an overview of an actual case and the treatment process. I like it because it includes images of a brain scan. The video is 20 years old but still mostly accurate: https://www.youtube.com/watch?v=zBtqWrs2-K0.
The second thing I still use is a 5-item pre-treatment assignment we created to get cases rolling. It’s based on information from several different trainings. The clients respond to the questions during sessions or on their own to be discussed later. We called it “The Initial Homework.” We asked for headlines – 5 words or less – for 10 worst things (potential targets), 10 best things (potential resources), current and anticipated triggers (possible blocks or defenses and future template considerations), and current strategies they use to take care of themselves (for skills building). This was useful for narrowing down and organizing information for the client and staff. I know staff still use it, too.
What would you like people outside the EMDR community to know about EMDR therapy in correctional settings?
I want everyone to know that EMDR therapy is the best intervention available to the corrections population. Literacy is not an issue in EMDR therapy, but it is necessary for Cognitive Processing Therapy (CPT). EMDR therapy was tolerated better than Prolonged Exposure (PE) in the institution by staff and residents. Unlike PE, EMDR therapy doesn’t require recording devices.
When residents recover from trauma-related symptoms, they can make different, pro-social decisions. When trauma symptoms remit, addiction recovery is more likely. When people have a safe attachment to themselves and value themselves, they are more likely to find and cultivate safer relationships with boundaries and emotional resilience.
Is there anything else you’d like to add?
People come out of prison every day. It benefits everyone when correctional residents re-enter communities with minimal disturbance and optimal resilience. I worked in a tiny, 450-bed institution. Imagine how many people could re-integrate into families and employment if the treatment capacity were increased everywhere it could be increased. I’ve spoken to providers in correctional settings who are just beginning to entertain the idea of introducing EMDR as a treatment option. I’ve had consultees who are forging ahead with EMDR therapy as their preferred mode of treatment.
I believe any eligible clinician in a correctional setting MUST have trauma-focused training. The path into a correctional placement as a resident goes through trauma and suffering of some kind. In 2003, I was the only EMDR provider. I made it my goal to educate all the departments and demonstrate that EMDR therapy is a real thing. When I left in 2018, 22 of the 25 psychology staff and several social work staff members were EMDR trained. Nearly all of them became EMDRIA Certified, and one became an EMDRIA Consultant. The institution continues to train new staff and find ways to maximize EMDR treatment capacity. There was EMDR-trained staff in 8 other institutions around Wisconsin. I was living a quote attributed to Mahatma Ghandi – “First they ignore you, then they laugh at you, then they fight you, then you win.” It was mostly arduous and painful, but in the end we won. I’m proud to have been part of the evolution.
Resources
Cherry, K. (2022). What is neuroplasticity? Verywell Mind. https://www.verywellmind.com/what-is-brain-plasticity-2794886
EMDRIA. Find an EMDR therapist directory. https://www.emdria.org/find-an-emdr-therapist/
Enright, R. D. (2001). Forgiveness is a choice: A step-by-step process for resolving anger and restoring hope. APA LifeTools.
Hase, M., Balmaceda, U.M., Ostacoli, L., Libermann., P., & Hofmann, A. (2017). The AIP model of EMDR therapy and pathogenic memories. Frontiers in Psychology 8: 1578. Open access: https://doi.org/10.3389/fpsyg.2017.01578
KCERTE. (2008, April, 21). EMDR and PTSD. YouTube. https://www.youtube.com/watch?v=zBtqWrs2-K0
Malik, N., Facer-Irwin, E., Dickson, H., Bird, A., & MacManus, D. (2021). The effectiveness of trauma-focused interventions in prison settings: A systematic review and meta-analysis. Trauma Violence, & Abuse, Online early. https://doi.org/10.1177%2F15248380211043890
Miller, P. (2023). What is AIP? The Adaptive Information Processing model and how to use it in a therapy setting [Video]. Mirabilis Health Institute. https://www.youtube.com/watch?v=h1GEtmPGbsw
National Reentry Resource Center. Second Chance Month. https://nationalreentryresourcecenter.org/events/second-chance-month-2023
Office of Juvenile Justice and Delinquency Preventions (OCCDP). April is Second Chance Month. https://ojjdp.ojp.gov/events/second-chance-month#:~:text=Second%20Chance%20Month%20helps%20individuals,first%20real%20opportunity%20to%20flourish.
Additional References for EMDR in Forensic Settings and Offender Populations
Bashir, H. A., Wilson, J. F., Ford, J. A., & Hira, N. (2023). Treatment of PTSD and SUD for the incarcerated population with EMDR: A pilot study. Journal of Addictions & Offender Counseling, 44(2), 132-144. Open access: https://doi.org/10.1002/jaoc.12123
Brown, S. H., Gilman, S. G., Goodman, E. G., Adler-Tapia, R., & Freng, S. (2015). Integrated trauma treatment in drug court: Combining EMDR and seeking safety in drug court. Journal of EMDR Practice and Research, 9(3), 123-136. Open access: https://doi.org/10.1891/1933-3196.9.3.123
Clark, L., Tyler, N., Gannon, T. A., & Kingham, M. (2014). Eye movement desensitization and reprocessing for offence-related trauma in a mentally disordered sexual offender. Journal of Sexual Aggression, 20(2), 240-249. https://doi.org/10.1080/13552600.2013.822937
Every-Palmer, S., Flewett, T., Dean, S., Hansby, O., Colman, A., Weatherall, M., & Bell, E. (2019). Eye movement desensitization and reprocessing (EMDR) therapy for posttraumatic stress disorder in adults with serious mental illness within forensic and rehabilitation services: A study protocol for a randomized controlled trial. Trials, 20(1), 642. Open access: https://doi.org/10.1186/s13063-019-3760-2
Every-Palmer, S., Flewett, T., Dean, S., Hansby, O., Freeland, A., Weatherall, M., & Bell, E. (2024). Eye movement desensitization and reprocessing (EMDR) therapy compared to usual treatment for posttraumatic stress disorder in adults with psychosis in forensic settings: Randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy, Online. Open access: https://doi.org/10.1037/tra0001643
Every-Palmer, S., Ross, B., Flewett, T., Rutledge, E., Hansby, O., & Bell, E. (2023). Eye movement desensitization and reprocessing (EMDR) therapy in prison and forensic services: A qualitative study of lived experience. European Journal of Psychotraumatology, 2282029. Open access: https://doi.org/10.1080/20008066.2023.2282029
Fleurkens, P., Hendriks, L., & van Minnen, A. (2018). Eye movement desensitization and reprocessing (EMDR) in a forensic patient with posttraumatic stress disorder (PTSD) resulting from homicide. A case study. The Journal of Forensic Psychiatry and Psychology, 29, 901-913. https://doi.org/10.1080/14789949.2018.1459786
MacCulloch, M. (2007). Effects of EMDR on previously abused child molesters: Theoretical reviews and preliminary findings from Ricci, Clayton, and Shapiro. The Journal of Forensic Psychiatry & Psychology, 17(4), 531-537. https://doi.org/10.1080/14789940601075760
Malik, N., Facer-Irwin, E., Dickson, H., Bird, A., & MacManus, D. (2021). The effectiveness of trauma-focused interventions in prison settings: A systematic review and meta-analysis. Trauma Violence, & Abuse, Online early. https://doi.org/10.1177%2F15248380211043890
Rew, G., Clark, L., & Rogers, G. (2022). Making sense of offence related trauma: Exploring two patients lived experience. Journal of EMDR Practice and Research, 16(4), 228-238. http://dx.doi.org/10.1891/EMDR-2022-0004
Rhoden, M. A., Macgowan, M. J., & Huang, H. (2019). A systematic review of psychological trauma interventions for juvenile offenders. Research on Social Work Practice, 104973151880657. http://dx.doi.org/10.1177/1049731518806578
Ricci, R. J., & Clayton, C. A. (2016). EMDR with sex offenders: Using offense drivers to guide conceptualization and treatment. Journal of EMDR Practice and Research, 10(1), 104-118. Open access: https://doi.org/10.1891/1933-3196.10.2.104
Soberman, G. B., Greenwald, R., & Rule, D. L., (2002). A controlled study of eye movement desensitization and reprocessing (EMDR) for boys with conduct problems. Journal of Aggression, Maltreatment and Trauma, 6(1), 217-236. https://doi.org/10.1300/J146v06n01_11
ten Hoor, N. M. (2013). Treating cognitive distortions with EMDR: A case study of a sex offender. International Journal of Forensic Mental Health, 12(1), 139-148. https://doi.org/10.1080/14999013.2013.791350
Wright, L. C., Palmer, J., Kelly, R., & Derefaka, G. (2023). Eye movement desensitization and reprocessing (EMDR) therapy for childhood sexual abuse memories in men who have sexually offended against children: Changes in perceptions of abuse and offending. Journal of Forensic Psychology Research and Practice, Latest Articles. https://doi.org/10.1080/24732850.2023.2279318
Wright, L. C., & Warner, A. (2020). EMDR treatment of childhood sexual abuse for a child molester: Self-reported changes in sexual arousal. Journal of EMDR Practice and Research, 14(2), 90-103. http://dx.doi.org/10.1891/EMDR-D-19-00060
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Additional Resources
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