According to the World Health Organization, 5 percent of the world’s population suffers from depression. Out of 7.88 billion people on the planet, that’s approximately 350,000,000 human beings suffering. Learn what EMDR therapist, trainer, and researcher Dr. Sarah Dominguez says about how EMDR therapy can help people with depression.
- “Every Memory Deserves Respect: EMDR, the Proven Trauma Therapy with the Power to Heal” by Michael Baldwin and Dr. Deborah Korn
- David Archer’s Let’s Talk EMDR podcast episode is Season 1 (2022), Episode 10: Antiracist EMDR Therapy.
- Go With That Magazine, EMDR Therapy and Depression, Winter 2022, Volume 27, Issue 1 (login req)
- EMDR Australia (EMDRAA)
- Understanding EMDR Podcast with Australian practionerTracy Lynch
- EMDR Fidelity Rating Scale
- EMDRIA Online EMDR Therapy Resources
- EMDRIA Client Brochures
- Focal Point Blog posts about depression
- EMDRIA Practice Resources
- EMDRIA Toolkit on Depression (login req)
- EMDRIA’s Find an EMDR Therapist Directory lists more than 15,000 EMDR therapists.
- Follow @EMDRIA on Twitter. Connect with EMDRIA on Facebook or subscribe to our YouTube Channel.
- EMDRIA Online Membership Communities for EMDR Therapists
Musical soundtrack, Acoustic Motivation 11290, supplied royalty-free by Pixabay.
Kim Howard 00:04
Welcome to the Let’s Talk EMDR podcast brought to you by the EMDR International Association or EMDRIA. I’m your host Kim Howard. In this episode we are talking with EMDR, therapist, trainer and researcher, Dr. Sarah Dominguez about EMDR therapy and depression. Sarah is located in New South Wales, Australia. Let’s get started. Today we’re speaking with EMDR, therapist, researcher, consultant and trainer, Dr. Sarah Dominguez about EMDR, therapy and depression. Sarah also serves on the board of directors for the Australian EMDR Association. Thank you, Sarah, for being here today. We are so happy that you said yes.
Sarah Dominguez 00:41
Well, my pleasure, Kim, thank you for asking.
Kim Howard 00:43
Sarah, can you tell us about your path to becoming an EMDR therapist?
Sarah Dominguez 00:48
Sure. So I became an EMDR therapist a little later in my career, I was a therapist for about eight years. And I moved to, I live in Sydney, Australia, and I moved to Western Australia to do my masters. When I moved there, my first supervisor for my master’s program was Chris Lee, who is a very well known and very well respected EMDR therapist. And so I knew about EMDR therapy, but mostly, I thought I might as well learn the things that he knows so that I can get the most from him. And things just sort of accelerated quite quickly. From there, I then started doing my research project in EMDR. And so my initial couple of years and EMDR had me doing a lot of fidelity testing of my skills, watching a lot of videos of my progress. And I learned as I sort of, had better fidelity with my EMDR that my skills just got better and better. And I think things have just kept on moving from there.
Kim Howard 01:43
Great. Sarah, what’s your favorite part of working with EMDR therapy?
Sarah Dominguez 01:48
I mean, so much. But I guess my very favorite thing is the sense of empowerment, it gives clients. I often say, particularly to new trainees, it’s really good. If a client gets better, that’s fabulous, of course. And it’s really nice when they’re like going, you know, you’re the best therapist I’ve worked with, or you really understand me, that’s really nice. But I guess what I think is even better is if they can sort of really look at the fact that my brain has done this healing, my therapist helped me but that sense of this was my in my capacity all along. And that helped to unpack some skills and stuff, excuse me that I already have. And I think that, particularly I work with a lot of people who have a lot of shame. And when they recover, and really believe that they have been the main agents of change, which I believe is true. I think that is is really special. Really wonderful.
Kim Howard 02:37
Yeah, I think that’s, I think that’s beautiful. I mean, I am not a therapist, but what you guys do is so important to the overall society and our health. And so I thank you for that, for doing all of that, that work and all of that research and impacting people’s lives in such a beautiful way. And I would suspect it’s very gratifying to be on the other side of that desk or chair or screen and hear somebody say, you know, I did this, and I healed myself with your help. And I and I am now going to be able to do XYZ fill in the blank, whatever they want to do. And so that that must be very, very gratifying.
Sarah Dominguez 03:16
Yeah, it is it is. And it means that they, you know, we can become redundant, I guess in our clients lives sometimes, which is what you want, you want them being able to live their life and recognize their skills, that adaptive information that they already have. One of the other things that I think is is really important one thing other thing that I really like in India, I am a trainer and part of the accreditation and Standards Committee in Australia. And so I really do push having a good fidelity to the standard protocol, but I love how forgiving EMDR it. So I often say particularly at level one trainings, you know, don’t let perfect be the enemy of good. If you do make a couple of mistakes, it’s likely that the person’s nervous system will be able to process through stuff. Anyway. And I think I know Derrick Farrell, who’s a very well known British trainer says, you know, EMDR is often like chess, you can learn the skills quite quickly. And it takes a long time to sort of become expert. Sure. But I think when you’re starting just using EMDR, if you’re making mistakes, do try and be stick to the fidelity. But I just I love that even if you do make a few small mistakes when you’re learning, it’s still likely going to support the client and have the same results. I think that’s wonderful.
Kim Howard 04:27
It’s wonderful. What success has ever seen using EMDR therapy for depression?
Sarah Dominguez 04:34
Lots, thank goodness. And I think this is I was really glad to be asked onto this podcast because I think, you know, we know depression is such a huge cause of disability and yeah, so I’m really heartened that people are sort of paying attention to this. I guess. The broader success story I have is a research trial we conducted in Perth, Western Australia. Two years ago, it was three years ago now it was published 2020, it was published, it was only a relatively small trial, we had just under 50 people. But for this trial, we had a group of participants who were doing a depression and anxiety management program in a private hospital. But these participants, we had three groups, or just the group program, or the group program and three additional cognitive behavioral therapy sessions, or three EMDR session. So it wasn’t a lot of EMDR therapy, only two processing sessions and one set up session during phase one and two. But for these clients, those that had the three EMDR, sessions were four times more likely to lose their depression diagnoses compared to the other two groups. So it was remarkable data, I think, really exciting data, it was only a couple of sessions. And so for clinicians working with whatever mode that they’re doing, just knowing that just a couple of EMDR sessions can substantially change the outcomes for your clients. I just think it’s, it’s wonderful.
Kim Howard 06:00
And it is wonderful. It is wonderful. And I’m sure that the people whose lives have been changed are very appreciative of that.
Sarah Dominguez 06:06
Yeah, yeah, definitely. Definitely.
Kim Howard 06:09
Are there any myths that you would like to bust about EMDR therapy for depression?
Sarah Dominguez 06:13
I hear that it’s that it’s not necessary that it can’t be used, I guess. One of the big frustrations we had after we did the study, I’ve also participated in a meta analysis with Chris Lee and Suzy Matthijssen and, and we actually had a meta analysis looking at Trauma therapies. for depression, we actually had quite a bit of difficulty getting it published. And one of the reviewers said to us, how on earth you know, he said, notwithstanding the results of the study, so the results of the science was quite sound, but how on earth you do expect us to understand why you would use a trauma intervention, when you say there’s been no identified trauma. So his mind was because it wasn’t post-traumatic stress disorder, because the person hadn’t been raped or stabbed, or had something objectively bad happened, that a trauma intervention couldn’t work, which was very, very frustrating to us, because we know you know, neglect and bullying, other low level, things that wouldn’t meet the criteria for PTSD can still lead a lasting effect. That particular reviewer made, the three of us very distressed, but it was countered by when we finally did that the paper published, one of the co authors laid out a Yelp in his office at home and his think then 10 year old son came down and said, what happened? He said, Oh, the paper Suzy and Sarah and I have been writing just got published and the child said, Oh, what, what was it about? And Chris had said, I will we wrote that if people are depressed, if you talk to someone about things, bad things that happen when you’re little, it makes you less depressed. And Adam just sort of looked at him and said, ‘well, I could tell you that.’
Kim Howard 07:55
Out of the mouths of babes, you know?
Sarah Dominguez 07:57
Kim Howard 07:58
Sometimes they are the smartest people on the planet.
Sarah Dominguez 08:00
Completely, completely. And I think, I think clinicians the stuff that I’m talking about the stuff that we’re doing with EMDR, and depression, it’s not new to clinicians. But I think for researchers, sometimes it doesn’t fit the nice, neat box. And I think Francine [Shapiro] knew this when she started talking about EMDR. She doesn’t talk she talks about Big T and little T events. And I think so the biggest myth, I guess is that EMDR isn’t just for traumas for bad things that happened to you. So we’d call that traumas of commission, things that happen. It also can be really helpful for traumas of omission. So everyday you get home from school, and there’s afternoon tea for your sibling, but not for you. Or every single night you go to bed scared and no one tells you it’s going to be okay, those things can have significant impact, and it can be addressed by EMDR therapy. So I think that would probably be the biggest myth that that I think is helpful to look at.
Kim Howard 08:55
It’s good to know, thank you. Are there any specific complexities or difficulties with using EMDR therapy for depression?
Sarah Dominguez 09:04
The way I sort of conceptualize with clients is, is quite trans diagnostically. So I don’t think it’s specific for depression. But sometimes people with more especially those traumas of omission, things that haven’t happened to happen to them, it can be a little bit more difficult. So I think having the importance of a really solid formulation. So really knowing with your client, why do they have the symptoms that they have, if they’ve got really low mood or strong self worth? When did they learn that they were worthless? I think some of the books some of the stuff that I know you’ve spoken about this on the podcast before the book that Debbie Korn and Michael Baldwin wrote [Every Memory Deserves Respect: EMDR, the Proven Power to Heal], I think is really, really good for that to really have a solid understanding of the formulation, I think is for any client. I think it’s helpful but for a client with depression, I think it’s absolutely critical to make sure that you and the client, really understand why they have Have their current symptoms. One of the other things is going for a relapse prevention, I think depression can be so pervasive and there can be a strong fear if people start feeling better that they’re going to feel worse again in the future. And once they have a slightly low mood that can then spiral. So using the future template in EMDR, can be really helpful for that. So in the future, if you do start feeling sad, or if you start feeling worthless, what can you do to around that to the future template can be really helpful. The other two last things if if I may, is one thing, working with clients with depression, I noticed with myself and also with consultations is sometimes that that hopelessness that goes with depression can be really contagious. So as a therapist, you know, if someone’s been depressed for 20 to 30 years, and things aren’t moving at the rate that you would like, and the client feels really helpless, sometimes we can feel that too. There’s a strong transference and countertransference. And so being able to recognize that as part of the process, and I think what I typically say to clients, and what I typically do myself is going back to your treatment goals, and going back to the formulation, because we can sometimes get into the trenches with our client, and we need to be able to help them to move through. The other complexity with that is EMDR works very well I’ve done there’s many studies, there’s I think now four or five meta analyses that show that there is a sub sample of depression, I find that sometimes it’s really difficult. And it’s that really nihilistic depression. So not melancholy, but really that nothing good is going to happen. So the people who are like, Oh, what have you done today? And sort of, you know, even I won a Nobel Peace Prize, but nothing’s that good. You know, that really sort of weighed down with the world.
Kim Howard 11:47
Sarah Dominguez 11:48
And I find with with clients like that, you do need to do some work, more work before you do processing. And I think got a study looking into this at the moment, but I think it’s that openness to experience. If a client is so messed with their depression, that there is absolutely no possibility that they think things are going to get better, you need to address that first. So as therapists we use things like the miracle question, if you were to get better, what would that look like? And I think for some clients, making sure that there is some openness before you start otherwise, the hopelessness is going to prevent the EMDR from being able to be as effective as it could be.
Kim Howard 12:29
Good advice. Thank you. Sarah, how do you practice cultural humility as an EMDR therapist?
Sarah Dominguez 12:35
By working out I guess the main thing, this even makes me slightly nervous to be to have a couple of minutes response to such an important question, I guess nine that it’s a work in process in progress. And that if you understand the impacts of one person’s culture, on the session and on their life, that probably means you understand the impact of that person’s culture. One of the things that I’ve put into my practice, actually, that I got from your podcast, Kim with, I meant to look it up. I think it was David Archer, that yes, so wonderful. If anyone hasn’t listened to that episode, I strongly encourage you to do. [Season 1, Episode 10: Antiracist EMDR Therapy]. Yeah, great, great. And he said, and apologies, because I’m definitely going to misquote him, then he would have said it in a much more concise way. But he said that he says to clients, and I now do the same, ‘Is there anything that happened to you before you were born, that still impacts you now still impacts what we do in the therapy environment or anything?’ And I just think that’s a beautiful, open question. And that has really helped me understand a range of cultural differences, you know, even gender differences, a range of different sort of a range of differences for the client. I think that’s a beautiful question to ask.
Kim Howard 13:12
I will link it in the description so that people have access to that and the one with Debbie Korn and Michael Baldwin [Season 1, Episode 14]. I mean, there are studies out now and you would know more about them than I would, but about how a generational trauma impacts unborn children, how they have done studies, and, you know, as a woman who has had two children, you know, I think back to my pregnancies, and I think, you know, wow, that I mean, we had some regular stress in our pregnancies, but we didn’t have anything me. Personally, I did. I didn’t have anything overly dramatic or what I would consider traumatic happen. I didn’t have anyone die that I love that there were no accidents or not those big items that you would think about, but there are women who are pregnant or in situations where they can’t control their extenuating or outside circumstances and how that impacts the baby.
Sarah Dominguez 14:38
Kim Howard 14:39
I don’t think that we think about that as a society in general that you know, if you have a positive, healthy, minimally traumatic and traumatic pregnancy, baby is better, much better off than if you were in a situation where it was high stress or high trauma and so, yeah, that’s it I’m interested in how that happens.
Sarah Dominguez 15:01
I mean, as an EMDR….I very much would see myself as an EMDR therapist, but I beg, borrow and steal things from other therapies all the time if it sort of fits and helps. And there’s a wonderful metaphor, I love explaining anything to my clients with metaphors by I heard it first from a schema therapist called Susan Simpson. And she talks about our resources and things we have, she used the metaphor of a chocolate cake recipe, and she said, we all have chocolate cake. So I have my family chocolate cake recipe. And Kim, you have your chocolate cake recipe. And I go to your house, and you give me chocolate cake. And it’s chocolatey, and sugary and delicious. But it’s all like fluffy and big. And I am bit confused by this because my chocolate cake is like a flat torch. And you then say to me, oh, but you have to put baking powder in ish. And I’ve never heard of baking powder. I’ve never missed baking powder, because I didn’t even know it existed. And my family’s recipe over the years because of maybe pandemics or wars or different traumatic incidents, baking powder wasn’t available to us. So it fell out of our recipe. So I didn’t miss it. Because I didn’t know it wasn’t there. And sometimes I think for clients, I think that I had a wonderful client, young woman who had had quite pervasive depression. And when I explained that she, she was like, oh my goodness, nurturance was my family baking powder. No one ever like no one ever talked me into bed when I was worried mom would say go and just look after yourself. And she said she managed to she was she really took the metaphor. And she said her grandmother went through the Second World War and actually lived in Germany. And she said, that’s probably when we lost the baking powder in our family, and she couldn’t nurture my mom. And it was a beautiful thing to get that client and insight into her symptoms. And then we could process it through.
Kim Howard 16:50
And then you realize how it’s all connected to you familial, you know, from a familial standpoint. I mean, from a family standpoint, you know, you, you don’t realize that until you think about your family history, about how those things happened and why those happened and how that reacts to you now as an adult or a child or whatever.
Sarah Dominguez 17:09
Yeah, yeah. And it takes a lot of the blame away, because rather than Oh, there’s something wrong with me, you’re like, Okay, this is something that I didn’t get. But we have these therapies like EMDR therapy that we can address that now. It’s, it’s a beautiful shift for clients, I think.
Kim Howard 17:24
That’s a great, that’s a great metaphor. Thank you for sharing that I’m sure that the listeners will glob on to that and use it in the future. Yes, please do. Sarah, do you have a favorite free EMDR related resource you would suggest either for the public or other therapists?
Sarah Dominguez 17:39
So I have many favorites. Well, fortunately, I mean, podcasts like, like this one, I think is fabulous. So all the technology and our capacity now to be able to access really good quality information, I think, in your podcast, knowing what what your interest is, and just going and being able to, you can listen to all of them that have just a couple of other episodes, if that’s your interest. We also have what there’s there’s many, many podcasts, but I think this would be one of my favorites. And there also is a podcast in Australia by local indigenous EMDR consultant called Tracy Lynch. And that’s really good. That’s been going for about a year I think, or maybe even a little bit less. But that’s fabulous. And she mostly interviews Australian EMDR therapists, she’s also interviewed a client. So that’s a really wonderful resource. I think Andrew Leeds is, I know Andrew has had a few shout outs on this podcast. But he’s for those who are wanting to keep an understanding of the literature, I every so often try and keep my own tabs on all of the EMDR literature but soon fall off the wagon, because there’s so much but Andrew, I don’t know how he finds time for it. But every I think every couple of months or every quarter, maybe he publishes a really in depth fantastic list of recent EMDR literature with some commentary. And I think that’s fabulous. And the last thing I think, which might not be free for everybody, depending on where you are is the national EMDR associations. So I know EMDRIA has also the Go With That magazine, which I think is fabulous. And there’s a lot of resources within EMDRIA. I know the EMDR Association of Australia, if you are a member, which is like an associate member, I think is only about 120 Australian dollars, which is about 80 US [dollars] and they’ve got dozens and dozens of podcasts that are free. Sorry, webinars that are free to members, I think joining your local EMDR association wherever you are in the world, they often have some fabulous resources there.
Kim Howard 19:37
Yeah, those are great suggestions. And I will include links in the description so that listeners can go and find that information. I’ve been in the association profession for most of my career, so about 30 years. And so I believe very strongly that associations are meant to either educate the public or educate the members or both, depending on what their mission is. And I have seen the power of what that information does, and helping the member do whatever the member needs to do run their business, be a therapist, whatever their mission happens to be, and, and how that really matters to your career path and how it makes you better at what you do. You know, and so when I go to my associations that I belong to, for people who do what I do for a living, I learned from those other people. And the only way that I can do that is to belong to that group and go either as a member or a non member, I prefer the member option, because I get more access to content that way. And it’s usually cheaper if I go as an attendee to a conference, but I learned from them. And so you can’t really operate your life professionally, at least in a vacuum, you know, and so if you don’t have those professional organizations that you belong to, that can really impact your practice, which they’re for impacts your clients and your capabilities, in terms of how you’re providing that good therapy. So I’m a firm believer in in joining those associations and belonging and getting that information. Because the other thing is, a lot of times information may be out there, and it may be in the public sector and may be free. But it may not be accurate. It may not be all the way correct. And so you got to make sure that you’re getting the right information for what you’re doing.
Sarah Dominguez 21:20
Definitely. Yeah, definitely. And I think often I’ve spoken to I have a lot of consultative find one, when they do engage with the association, not similar to going through accreditation processes, it can be really enriching. And actually, I mean, most of us are not didn’t, you know, leave high school and say, we’re going to be therapists just solely to make a truckload of money. It’s not this profession that you sort of go in, if that’s where you’re going, you go, because you want to help people. And it’s interesting, and you want to connect with like minded people. So I think engaging with institutions can sort of enrich that.
Kim Howard 21:53
Yeah, yeah, I mean, I truly believe that being a therapist is a is a vocation, because of what you guys do for a living, I think that it you have to be, you have to be called to that, I don’t think you can fake it till you make it. You know, I think if you’re gonna, if you want to be good at whatever therapy you’re offering, or be a good therapist, in general, you have to have some kind of connection to it; some reason. It’s not usually financial. It’s not, oh, I can make my own hours or whatever. It’s because you truly believe what you’re doing is helping other people. And that is, to me a vocation. So Sarah, what would you like people outside of the EMDR community to know about EMDR and depression?
Sarah Dominguez 22:31
I think that, that it’s effective, and it can be really helpful. And that there is certainly a role for medication with depression. And many people wouldn’t be able to function without medication. And it’s very important, but the biological model for depression has a lot of flaws in it. But we know from studies like you know, the adverse childhood experience study that, that when bad things happen to you, you are far, far more likely to have depression. And so you know, if you feel like you’re really stuck with your mood, talk about talk to someone, and they should be able to give you a good formulation so that it can make sense. And you can change, change some of those particularly negative thoughts, or those really stuck feelings in your body.
Kim Howard 23:15
Thank you. Good advice. If you weren’t an EMDR therapist, what would you be?
Sarah Dominguez 23:20
This question has pained me I’ve listened to. I’m always interested. I love this question when you’re in the podcast
Kim Howard 23:26
It is my favorite.
Sarah Dominguez 23:27
I’ve tried, I really did try to limit it down. But I just couldn’t. Before I was, before I was a psychologist. I was a school teacher for almost a decade. And I taught English as a second language to new arrivals in Australia. And I loved that job. So I would probably I would probably take that. But I I also love research. I’d love to be an academic. I was a travel agent many, many moons ago. And I love that job and quite like numbers. And then I sort of go down to I want to be a statistician or an accountant. But I think I think something that still leaves me I do like part of EMDR I do and mental health I guess more fully is I do like the pattern matching element of it. I do like the fact that someone will come in and say there’s just something wrong with me and we can trace it down and give a nice solid formulation. I think any if I wasn’t a therapist having something where I can look for those patterns and match them up and explain things explain really complex things by quite simple statements would be probably where I’d add.
Kim Howard 24:30
There’s no wrong answer to that question. I tell people no wrong answer at all. I just like to I just like to know what people think about doing they weren’t.
Sarah Dominguez 24:37
Their data is really interesting question.
Kim Howard 24:39
It is, is it fun?
Sarah Dominguez 24:42
Then you can find the elements that you like and make sure that you’re bringing them into your current role.
Kim Howard 24:49
That’s very true. Sarah, is there anything else you’d like to add?
Sarah Dominguez 24:53
Just really that work with depression or working with anyone just to make sure that you’ve got a really strong adaptive inflammation processing model formulation with your clients and know why the client’s difficulties are there and make sure that they have that shared formulation, make sure that clients have seen, make sure that the symptoms make sense to you and the clients. And I guess I probably should have mentioned this above, when we’re talking about free resources, I think one of the best things that we can do as therapists, at least to improve our skills is to really build on our fidelity to the standard protocol. So if there’s, you know, we’ve talked about joining the organizations, and I encourage people to do so. But I think as humans, there’s so many things that we can spend our money on right now. And so if you’ve done even if you’ve just done your training, you want to improve your skills, recording a session that you do, and looking at the fidelity rating scale, and we can put a link to one in the chat as well, is the best way to improve your skills. And we know there’s a very strong correlation between high fidelity to the standard protocol and good treatment outcomes for our clients and enjoyment as a therapist. So I think that would be the last thing is make sure you have a solid formulation for your client, change it as much as you need to as you get more information and stick to the fidelity as much as you can.
Kim Howard 26:10
It’s a good way to end the podcast. Thank you, Sarah. This has been the Let’s Talk EMDR podcast with our guest Dr. Sarah Dominguez. Visit www.emdria.org for more information about EMDR therapy or to use our Find an EMDR Therapist Directory with more than 15,000 therapists available. Like what you hear? Make sure you subscribe to this free podcast wherever you listen. Thanks for being here today.
Sarah Dominguez 26:13
EMDR International Association
Copyright © 2023 EMDR International Association
Howard, K. (Host). (2023, October 15). EMDR Therapy and Depression with Dr. Sarah Dominguez (Season 2, No. 20) [Audio podcast episode]. In Let’s Talk EMDR podcast. EMDR International Association. https://www.emdria.org/letstalkemdrpodcast/
EMDR Therapists, General/Public
Let's Talk EMDR podcast