Healing What We Can, Accepting What We Cannot: Using EMDR Therapy With Chronic Illness

Guest Blog Post by Maraeca Butler, LPC-S

At its core, EMDR therapy is a therapy of change. As EMDR therapists, we help our clients reprocess distressing past experiences that are causing difficulties in their lives today. This gives adaptive information new tracks that can be carried into a successful future, one beyond the remission of their symptoms. This is especially true when working with clients with chronic illness, where the remission of their symptoms is often unrealistic and outside what our roles as therapists can offer. 

Individuals with chronic illness often present with complexities influenced by their health status, traumatic medical experiences, cumulative and enduring exposure to stress, complicated grief and loss, exacerbated by the common early childhood wounds most of us have experienced. Many EMDR clinicians feel overwhelmed and unsure of where to begin with these complexities. Even asking, “Can EMDR therapy help my client even if it can’t take away their illness?”  

Working with clients who experience chronic illness invites us to expand how we conceptualize trauma and treatment goals within the EMDR framework. The illness itself may not be curable, but the psychological, physiological, and relational impacts of living with it are highly treatable with EMDR therapy.  

Chronic illness, trauma, and allostatic load 

The mind-body connection between trauma and chronic stress is well documented, with consistent links to a broad list of physical health disorders. The allostatic load is a well-researched theory that refers to the physiological toll of repeated or chronic sympathetic nervous system activation (McEwen & Stellar, 1993). When the nervous system remains chronically organized around threat, regulatory systems, such as immune, endocrine, and cardiovascular functions, are greatly affected.  

Chronic illness often emerges within a context of cumulative stress and, in turn, adds to the daily stress the body and mind endure. Many clients report trauma histories that predate their medical diagnosis. The illness itself, often a traumatic event, further adds to this history, escalating symptoms and increasing the overall burden of managing both mental and physical health needs. The shock of diagnosis, invasive or frightening medical procedures, ongoing uncertainty about prognosis, and experiences of invalidation within healthcare systems can reinforce maladaptive memory networks and cause repeated trauma. 

As EMDR clinicians, we use the Adaptive Information Processing (AIP) model to view these experiences as maladaptively encoded and inadequately processed, thus contributing to persistent somatic distress, affective dysregulation, and negative cognitions about themselves and their bodies. EMDR therapy addresses not only how the body holds past memories but also how the client responds to present triggers and anticipatory worries about the future. This gives us a powerful ability to assist our clients in making adaptive meaning out of their experience of chronic illness while also finding ways to bolster their health going forward. 

Nervous system regulation and health-related outcomes 

Regulation of the nervous system, particularly for people with chronic illness, is critical for long-term management and for reducing complications associated with chronic illness. Persistent sympathetic activation has been associated with heightened pain, fatigue, gastrointestinal illness, and immune impairment (Carlson et al., 2018). Our goals as EMDR clinicians should emphasize healthy stress management and increased affect regulation, which, in turn, have been shown to support a more favorable immune and inflammatory profile (McEwen, 2007), thereby improving our clients’ health status. 

Grief, loss, and ongoing trauma

 I have firsthand experience with chronic illness: I have Type 1 Diabetes and other autoimmune diseases. While each person’s experience is unique, a common thread is the experience of grief and loss. For many, chronic illness can be an invisible loss that others do not see or understand. Others may minimize, invalidate, or misunderstand their experiences. Processing what is different, what has been lost, and how their lives have been changed by the illness is imperative.  

Clients may mourn the loss of, or changes in, their physical functioning, career trajectories, relational roles, fertility, independence, and even the life paths they had anticipated. These grief experiences differ from acute losses in that they are often recurrent and nonlinear, resurfacing with symptom changes, medical setbacks, or disease progression. 

Treating these experiences through the 3-pronged approach of EMDR allows clients to integrate the reality of their illness without remaining organized around helplessness, despair, or self-blame. Importantly, EMDR therapy does not eliminate grief; rather, it supports adaptive integration so that grief does not dominate the client’s internal experience. 

Creating realistic treatment goals

As EMDR therapists, we work collaboratively with our clients to set realistic treatment goals. When working with those affected by chronic illness, many clients, understandably, wish for a pain or illness-free life. While we can all understand and may even relate to these hopes and wishes, our role as the therapist is to provide kind and honest feedback on what can be changed and what cannot.   

In my work with clients living with chronic illness, validating their fears, losses, and somatic symptoms is essential. When I begin a conversation with a client about what they hope to feel, think, and do differently as a result of our work together, I first listen. I hold space for these often unrealistic hopes and honor the grief of living with a chronic illness. We recognize and label together the innate powerlessness we all feel over our lives, bodies, and health.   

A case example

In one particular case with a client living with Multiple Sclerosis and degenerative hearing loss, our preparation work included gaining a deeper understanding of her disease and medical symptoms. Doing my own research on her condition and having her share her experiences helped me guide our conversations about how much of a “pain-free” life would be realistic or attainable for her.  

In the same way, her hearing loss now required her to wear hearing aids, a change she was grieving and resisting. We eventually focused on moving toward acceptance of her illness, pain, and hearing loss, while celebrating the health she still had and the good days that remained. Alongside this, she felt increasingly empowered to advocate for her treatment options with her providers and to use natural pain-relief skills such as diaphragmatic breathing, mindfulness practices, and acupuncture. With her hearing loss, our work included gradually increasing her use of her hearing aids, speaking up when she did not hear someone clearly rather than pretending she had, and deepening her observation and gratitude for her other senses throughout her day.   

As you can imagine, this was long-term work. There were many everyday triggers, such as putting in her hearing aids, taking her medication, experiencing pain flare-ups, and attending her regular medical appointments, that were first desensitized using EMD. This allowed the client to see progress and feel a sense of relief from these symptoms and triggers. From there, we explored her experiences of powerlessness and defectiveness that were fueling her inability to manage her illness today.   

Addressing a common clinical question 

When providing EMDR consultation, I often hear EMDR clinicians ask: “Can EMDR therapy help my client even if it can’t take away their illness?” This question highlights both our ethical limitations due to the scope of practice, as well as being grounded in what is within our locus of control to change.  

The answer lies in broadening the definition of healing. While EMDR therapy does not alter the underlying medical condition, it can significantly reduce trauma-related distress that exacerbates symptoms and limits quality of life. We can give our clients reduced mental and physical stress reactivity while managing the long-term nature of their illness. We can improve their ability to care for their bodies and meet their unique needs, given their health status. We can assist them in implementing daily coping skills to manage triggers, physical symptoms, and ongoing grief. We can also help them recognize and appreciate the body’s many functioning systems, fostering a healthy perspective and relationship with their body.   

When clinicians explicitly frame treatment goals around nervous system and affective regulation, integration of healthy coping strategies, and adaptation to the body’s needs rather than a cure, therapy becomes a space of validation and empowerment rather than a source of implicit pressure to “get better.” 

Clinical considerations for EMDR therapy with chronic illness 

  • Staying flexible: Some clients may experience limitations to their physical or emotional capacity due to their chronic health conditions. Get curious with your client about how their illness may impact EMDR sessions and what is most important to begin reprocessing work. Inquire about scheduling needs, pacing of the session, pain levels, and daily symptom fluctuations, and adjust accordingly. Keep in mind that what works for one client might not work for another. Client-centered care requires collaboration and flexibility. 
  • Target what’s needed: Use EMD and other specialty protocols to desensitize present-day distress when a client needs rapid relief. This can also be important when they lack the tolerance to revisit foundational memories adequately. We can utilize the Float-Back Technique, Affect Scan, and Direct Questioning to gain awareness of past-present connections for treatment planning, guided by the client’s system and unique experiences. Important targets to assess may include symptom onset and diagnosis, invalidating healthcare encounters, medical procedures or hospitalizations, functional limitations and impairments, experiences of medical trauma, as well as changes in relational roles due to the chronic illness. 
  • Focus on the future: Clearing the past does not always resolve the issue in the present and the future. The use of the Future Template through the 3-pronged approach can reduce anticipatory anxiety and support adaptive coping with ongoing medical care, symptom management, and necessary lifestyle accommodations. 
  • Provide a holistic approach: Working with those who experience chronic illness requires a holistic approach. Using integrative methods such as yoga, breathwork, sound baths, meditation, and acupuncture supports the body’s progression toward nervous system regulation. When appropriate, it may also be helpful to collaborate with nutrition and medical providers to assist the client in making changes that will benefit their medical and physical health needs. 

 

 

Maraeca Butler is a Licensed Professional Counselor and Board Approved Supervisor in Tempe, Arizona, where she owns and operates her group practice, Hope Rebuilt. She is an EMDRIA Approved Consultant™ and Certified Therapist™. Butler is passionate about the transformational power of EMDR therapy and integrates somatic and relational approaches into her work. She specializes in attachment trauma, eating disorders, and chronic illness. 

 

References 

Carlson, L. E., Zelinski, E. L., Toivonen, K. I., Flynn, M., Qureshi, M., Piedalue, K. A., & Speca, M. (2018). Mind–body therapies in cancer: What is the latest evidence? Current Oncology Reports, 19(10), 67. https://doi.org/10.1007/s11912-017-0626-1 

McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Reviews, 87(3), 873–904. https://doi.org/10.1152/physrev.00041.2006 

McEwen, B. S., & Stellar, E. (1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153(18), 2093–2101. doi:10.1001/archinte.1993.00410180039004 

 

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Basic Info Collapse

Date
March 13, 2026

Contributor(s)
Maraeca Butler

Topics
Medical/Somatic, Pain/Chronic Pain

More Info Collapse

Audience
EMDR Therapists, General/Public

Language
English

Content Type
Blog/Blog Post

Access Type
Open Access

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