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Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures
About the Author
Francine Shapiro, PhD, the originator and developer of EMDR, is a senior research fellow at the Mental Research Institute in Palo Alto, California. She is the founder and President Emeritus of the EMDR Humanitarian Assistance Programs, a nonprofit organization that coordinates disaster response and pro bono trainings worldwide. She has served as advisor to a wide variety of trauma treatment and outreach organizations and journals. Dr. Shapiro has been an invited speaker on EMDR at many major psychology conferences, including two divisions of the American Psychological Association and the American Psychological Society Presidential Symposium on PTSD. The author or coauthor of numerous articles, chapters, and books about EMDR, she is a recipient of the Distinguished Scientific Achievement in Psychology Award presented by the California Psychological Association
Francine Shapiro, PhD, the originator and developer of EMDR, is a senior research fellow at the Mental Research Institute in Palo Alto, California. She is the founder and President Emeritus of the EMDR Humanitarian Assistance Programs, a nonprofit organization that coordinates disaster response and pro bono trainings worldwide. She has served as advisor to a wide variety of trauma treatment and outreach organizations and journals. Dr. Shapiro has been an invited speaker on EMDR at many major psychology conferences, including two divisions of the American Psychological Association and the American Psychological Society Presidential Symposium on PTSD. The author or coauthor of numerous articles, chapters, and books about EMDR, she is a recipient of the Distinguished Scientific Achievement in Psychology Award presented by the California Psychological Association
472 pages, Hardcover
Published August 6, 2001
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Displaying 1 - 30 of 52 reviews
November 3, 2019
Just finished this monster manual.
I’m about to take a Mindfulness Based EMDR training in a few weeks.
I have been somewhat skeptical regarding the model, but I work with a couple of very effective EMDR therapists, and based on their work, I became convinced enough to take the plunge.
This is the required reading for the training.
I am actually really impressed.
As far as treatment manuals go, it’s among the best I have read.
The model is well developed conceptually, with ample outcome data to support efficacy claims.
The model is speculative regarding the causal action of the the bi-lateral stimulation component.
But the author is transparent about the speculation.
Again, there’s tons of supportive outcome data.
And the theoretical aspects of the model have reasonable predictive power.
In other words, they know ‘that� the treatment works, they just don’t 100% know ‘how� it works. But their willing to make an educated guess, and it’s plausible and predictive enough to operate with sufficient clarity and confidence.
So, while there are still a lot of interesting unanswered questions, there’s definitely enough evidence and theory to support clinical work.
I’m going in!
I’m about to take a Mindfulness Based EMDR training in a few weeks.
I have been somewhat skeptical regarding the model, but I work with a couple of very effective EMDR therapists, and based on their work, I became convinced enough to take the plunge.
This is the required reading for the training.
I am actually really impressed.
As far as treatment manuals go, it’s among the best I have read.
The model is well developed conceptually, with ample outcome data to support efficacy claims.
The model is speculative regarding the causal action of the the bi-lateral stimulation component.
But the author is transparent about the speculation.
Again, there’s tons of supportive outcome data.
And the theoretical aspects of the model have reasonable predictive power.
In other words, they know ‘that� the treatment works, they just don’t 100% know ‘how� it works. But their willing to make an educated guess, and it’s plausible and predictive enough to operate with sufficient clarity and confidence.
So, while there are still a lot of interesting unanswered questions, there’s definitely enough evidence and theory to support clinical work.
I’m going in!
August 2, 2009
This is the textbook for Eye Movement Desensitization and Reprocessing—as opposed to the popular book titled EMDR. The popular book is much more readable, citing numerous case examples and transcripts of actual therapy sessions, while the textbook is much more thorough, presenting the nitty-gritty, step-by-step details on how to perform the therapy.
EMDR is a technique for treating psychological problems caused by trauma. Initially, it was applied primarily to combat veterans and rape victims suffering from post-traumatic stress syndrome (PTSD). Later, it was extended to other ills such as panic attacks, phobias, somatic disorders and multiple personality disorder. Francine Shapiro, the mother of EMDR, claims an 80-90% success rate when the technique is properly applied by experienced clinicians. She ardently advocates rigorous research and clinical evaluation of this and other psychotherapy techniques to see how well they really work. (The book contains an appendix that lists all studies that have evaluated the effectiveness of EMDR.)
EMDR is based on the assumptions that: 1) people’s brains are normally self-healing just like their bodies, so the therapist’s role is to facilitate this natural process; 2) severe psychological trauma somehow “freezes� or “locks up� painful memories by isolating the neural networks that contain them—this keeps the information from being normally assimilated by the brain (another analogue: the isolated network is like a sore that fails to heal properly and festers, poisoning the whole body); and 3) somehow systematic eye movements help “thaw� or “open up� the traumatic memory so that the material can be normally processed (“allowed to heal�) and thus integrated with other memories and cognitions (the sore lanced and its contents dissolved and assimilated by the body).
No one knows why the eye movements work. Among the more interesting hypotheses: they induce a relaxation response, which allows the patient to more easily handle the traumatizing material (there is a possible parallel with REM sleep: one of the leading hypotheses about REM, supported by studies, is that it helps the brain assimilate the day’s events—and the more emotional the events, the more rapid the eye movements). Another interesting hypothesis—my favorite—is that the eye movements synchronize the activities of the two cerebral hemispheres (the idea is that networks in the two hemispheres are isolated from each other because they have different voltage thresholds—and that the eye movements somehow converge the thresholds).
EMDR is a lot more than simply eye movements. It is a detailed, comprehensive therapeutic procedure that borrows many techniques from other therapies. The basic steps are:
*Image—Identify and target, one at a time, the images involved in traumatic (“stuck�) memories. This gets them moving again (reinitiates information-processing and assimilation by the brain).
*Abreact Emotions—While targeting the traumatic memory and performing the eye movements, release the “locked in� emotions in the safe environment of the therapist’s office, thus permanently diminishing their (now-inappropriate) intensity.
*Negative Cognition—Identify negative cognitions growing out of the traumatic experience and its aftermath—negative generalizations like “I’m a bad person,� or “I’m unlovable� or “I always screw things up.� Such generalized self-images are very common among the severely traumatized (e.g., rape victims, combat veterans).
*Positive Cognition—Identify and “install� credible positive cognitions to replace the negative ones. For example: “I’m a good person,� “I did the best I could,� “I’m very capable.�
*Physical Sensations—Scan for physical sensations related to the traumatic memory, and target and process any that remain.
Shapiro developed a detailed 8-phase procedure for therapy, and insists that it be rigorously followed. The phases:
1—Client History and Treatment Planning. Evaluate the client’s suitability for EMDR (for example, is she medically capable of handling the intense emotion of abreaction?). If suitable, evaluate the total clinical picture and jointly devise a treatment plan, identifying specific memories to be targeted.
2—Preparation. Develop rapport with client; explain how EMDR works; discuss any client concerns; discuss safety issues; teach the client relaxation techniques that will permit him to neutralize abreactive stress.
3—Assessment. Identify specific image(s) involved with the target memory; identify negative cognitions; identify acceptable (realistic) positive cognitions and evaluate for believability (using VOC—Validity of Cognition—scale); identify the disturbing emotion engendered by the traumatic memory, and rate its intensity (using SUD—Subjective Units of Disturbance—scale); and identify the location of any physical sensations associated with the traumatic memory. Based on these evaluations, establish a response baseline (something to measure progress against as therapy proceeds).
4—Desensitization. Run a series of “sets� in which the client focuses on aspects of the traumatic memory while making eye movements, with the intent of abreacting the disturbing emotion. After each set, evaluate progress using the SUD scale (client rates on a scale of 1 to 11 the intensity of the emotion elicited by the target image). Proceed until SUD scale reduces to 0 or 1.
5—Installation. Run a series of sets to install the positive cognition. In each set, while making eye movements focus simultaneously on (now emotionally drained) target memory and positive cognition. After each set, evaluate believability of positive cognition using VOC scale (rate credibilty—“do I really believe it?”—of positive cognition on a scale of 1 to 7). Continue sets until positive cognition rates 6 or 7.
6—Body Scan. Client slowly scans own body from top to bottom for physical sensations (e.g., areas of tension) while focusing simultaneously on the target memory and the positive cognition. Perform desensitization sets on any residual (negative) physical sensations.
7—Closure. Return client to state of emotional equilibrium before terminating a session (this is especially important if the traumatic memory has not yet been completely processed). Instruct client what to expect between sessions; remind her of relaxation exercises; instruct her to keep a log of experiences between sessions, for use in defining further target images; instruct the client to “take a snapshot� of any disturbances that occur between sessions.
8—Reevaluation. Evaluate progress at the beginning of each new session, after going over client log and discussing between-session experience. Reevaluate the treatment plan, if necessary adding new targets. Treatment does not terminate until all targets have been "cleaned out� (reduced to 0 or 1 on the SUD scale).
What about the eye movements themselves? The typical set includes about 24; guided by the therapist’s fingers (two), the movements consist of quick passes from wide left to wide right and back again; they start horizontal but can be switched to diagonal or vertical as experience dictates. (Different clients respond differently.) For people with eye problems: rhythmic tapping of the upturned palms sometimes works just as well as eye movements, as does alternating finger-snaps beside the left and right ears.
EMDR is client-centered. This means that the therapist provides a structure and facilitates the natural propensity of the client to self-heal, but does not dictate or over-steer the client. This approach works well in about half the cases. Shapiro devotes a chapter of the book to dealing with more difficult cases. With these she uses what she calls the “cognitive interweave,� in which the therapist takes a more active role in getting the client “unstuck.� Many of the more directed methods are drawn from other therapies, such as behavior mod and gestalt.
Shapiro also devotes a chapter to special client populations—and how to tailor EMDR to accommodate them. She especially emphasizes the necessity, before applying EMDR to the dissociative disorders (and especially multiple personality disorder—now called “dissociative identity disorder�), the therapist should be thoroughly grounded in the clinical characteristics of the dissociative disorders themselves (it’s easy for a therapist unlocking the trauma of one MPD alter or subpersonality to find herself suddenly confronted by a completely different—and possibly hostile—one).
In the final chapter Shapiro calls—begs—pleads—for more and higher quality research by psychologists on the effectiveness not only of EMDR but also of competing psychotherapies.
This textbook is probably too nitty-gritty for any but those with a keen interest in EMDR—but for the keenly interested, it’s indispensable.
EMDR is a technique for treating psychological problems caused by trauma. Initially, it was applied primarily to combat veterans and rape victims suffering from post-traumatic stress syndrome (PTSD). Later, it was extended to other ills such as panic attacks, phobias, somatic disorders and multiple personality disorder. Francine Shapiro, the mother of EMDR, claims an 80-90% success rate when the technique is properly applied by experienced clinicians. She ardently advocates rigorous research and clinical evaluation of this and other psychotherapy techniques to see how well they really work. (The book contains an appendix that lists all studies that have evaluated the effectiveness of EMDR.)
EMDR is based on the assumptions that: 1) people’s brains are normally self-healing just like their bodies, so the therapist’s role is to facilitate this natural process; 2) severe psychological trauma somehow “freezes� or “locks up� painful memories by isolating the neural networks that contain them—this keeps the information from being normally assimilated by the brain (another analogue: the isolated network is like a sore that fails to heal properly and festers, poisoning the whole body); and 3) somehow systematic eye movements help “thaw� or “open up� the traumatic memory so that the material can be normally processed (“allowed to heal�) and thus integrated with other memories and cognitions (the sore lanced and its contents dissolved and assimilated by the body).
No one knows why the eye movements work. Among the more interesting hypotheses: they induce a relaxation response, which allows the patient to more easily handle the traumatizing material (there is a possible parallel with REM sleep: one of the leading hypotheses about REM, supported by studies, is that it helps the brain assimilate the day’s events—and the more emotional the events, the more rapid the eye movements). Another interesting hypothesis—my favorite—is that the eye movements synchronize the activities of the two cerebral hemispheres (the idea is that networks in the two hemispheres are isolated from each other because they have different voltage thresholds—and that the eye movements somehow converge the thresholds).
EMDR is a lot more than simply eye movements. It is a detailed, comprehensive therapeutic procedure that borrows many techniques from other therapies. The basic steps are:
*Image—Identify and target, one at a time, the images involved in traumatic (“stuck�) memories. This gets them moving again (reinitiates information-processing and assimilation by the brain).
*Abreact Emotions—While targeting the traumatic memory and performing the eye movements, release the “locked in� emotions in the safe environment of the therapist’s office, thus permanently diminishing their (now-inappropriate) intensity.
*Negative Cognition—Identify negative cognitions growing out of the traumatic experience and its aftermath—negative generalizations like “I’m a bad person,� or “I’m unlovable� or “I always screw things up.� Such generalized self-images are very common among the severely traumatized (e.g., rape victims, combat veterans).
*Positive Cognition—Identify and “install� credible positive cognitions to replace the negative ones. For example: “I’m a good person,� “I did the best I could,� “I’m very capable.�
*Physical Sensations—Scan for physical sensations related to the traumatic memory, and target and process any that remain.
Shapiro developed a detailed 8-phase procedure for therapy, and insists that it be rigorously followed. The phases:
1—Client History and Treatment Planning. Evaluate the client’s suitability for EMDR (for example, is she medically capable of handling the intense emotion of abreaction?). If suitable, evaluate the total clinical picture and jointly devise a treatment plan, identifying specific memories to be targeted.
2—Preparation. Develop rapport with client; explain how EMDR works; discuss any client concerns; discuss safety issues; teach the client relaxation techniques that will permit him to neutralize abreactive stress.
3—Assessment. Identify specific image(s) involved with the target memory; identify negative cognitions; identify acceptable (realistic) positive cognitions and evaluate for believability (using VOC—Validity of Cognition—scale); identify the disturbing emotion engendered by the traumatic memory, and rate its intensity (using SUD—Subjective Units of Disturbance—scale); and identify the location of any physical sensations associated with the traumatic memory. Based on these evaluations, establish a response baseline (something to measure progress against as therapy proceeds).
4—Desensitization. Run a series of “sets� in which the client focuses on aspects of the traumatic memory while making eye movements, with the intent of abreacting the disturbing emotion. After each set, evaluate progress using the SUD scale (client rates on a scale of 1 to 11 the intensity of the emotion elicited by the target image). Proceed until SUD scale reduces to 0 or 1.
5—Installation. Run a series of sets to install the positive cognition. In each set, while making eye movements focus simultaneously on (now emotionally drained) target memory and positive cognition. After each set, evaluate believability of positive cognition using VOC scale (rate credibilty—“do I really believe it?”—of positive cognition on a scale of 1 to 7). Continue sets until positive cognition rates 6 or 7.
6—Body Scan. Client slowly scans own body from top to bottom for physical sensations (e.g., areas of tension) while focusing simultaneously on the target memory and the positive cognition. Perform desensitization sets on any residual (negative) physical sensations.
7—Closure. Return client to state of emotional equilibrium before terminating a session (this is especially important if the traumatic memory has not yet been completely processed). Instruct client what to expect between sessions; remind her of relaxation exercises; instruct her to keep a log of experiences between sessions, for use in defining further target images; instruct the client to “take a snapshot� of any disturbances that occur between sessions.
8—Reevaluation. Evaluate progress at the beginning of each new session, after going over client log and discussing between-session experience. Reevaluate the treatment plan, if necessary adding new targets. Treatment does not terminate until all targets have been "cleaned out� (reduced to 0 or 1 on the SUD scale).
What about the eye movements themselves? The typical set includes about 24; guided by the therapist’s fingers (two), the movements consist of quick passes from wide left to wide right and back again; they start horizontal but can be switched to diagonal or vertical as experience dictates. (Different clients respond differently.) For people with eye problems: rhythmic tapping of the upturned palms sometimes works just as well as eye movements, as does alternating finger-snaps beside the left and right ears.
EMDR is client-centered. This means that the therapist provides a structure and facilitates the natural propensity of the client to self-heal, but does not dictate or over-steer the client. This approach works well in about half the cases. Shapiro devotes a chapter of the book to dealing with more difficult cases. With these she uses what she calls the “cognitive interweave,� in which the therapist takes a more active role in getting the client “unstuck.� Many of the more directed methods are drawn from other therapies, such as behavior mod and gestalt.
Shapiro also devotes a chapter to special client populations—and how to tailor EMDR to accommodate them. She especially emphasizes the necessity, before applying EMDR to the dissociative disorders (and especially multiple personality disorder—now called “dissociative identity disorder�), the therapist should be thoroughly grounded in the clinical characteristics of the dissociative disorders themselves (it’s easy for a therapist unlocking the trauma of one MPD alter or subpersonality to find herself suddenly confronted by a completely different—and possibly hostile—one).
In the final chapter Shapiro calls—begs—pleads—for more and higher quality research by psychologists on the effectiveness not only of EMDR but also of competing psychotherapies.
This textbook is probably too nitty-gritty for any but those with a keen interest in EMDR—but for the keenly interested, it’s indispensable.
August 14, 2017
I read this book concurrently with the EMDR Basic Training. . . I highly recommend it. It is a fascinating therapy and I was amazed by the success rate of EMDR. I am planning on rereading it and getting additional training. I have seen first hand with myself, my colleagues, my clients, and my family members (a lot of practice is needed to complete the course). . . the amazing qualities of EMDR therapy.
I am so excited to further incorporate EMDR therapy with my client population (and may get some additional EMDR done on myself!)
I am so excited to further incorporate EMDR therapy with my client population (and may get some additional EMDR done on myself!)
August 11, 2022
This is "the book" of course, for clinicians doing EMDR, written by the person who actually invented the technique. Lots here to study and re-read, lots here to skip too. Probably the most important sections for those who have had basic training are those on the cognitive interweaves and the basic process. Personally, I found the theoretical section on research really cool, since there is so much speculation on just why EMDR is so damn effective and I enjoyed the exploration.
February 15, 2024
I feel like i should get extra credit for reading books over 5000 pages
December 26, 2016
Good manual, but raises many questions
I discovered EMDR because it was well mentioned and reviewed in another book I read about depression. I did my research and watched some sessions on YouTube and albeit convincing, they seemed like circus' mentalist tricks. And yet, I was curious, bought this book and tried it in some of my more stable patients who agreed.
I can't argue with results. After some sessions my patients and I were mesmerized. I got in few sessions results I tried to achieve for months.
And yet, it is weird. EMDR hasn't any solid science explaining why it works. Ok; many health sciences are like that, especially everything dealing with the mind. What bothers me is that every hypothesis presented in the manual feels like mumble jumble sci-fi.
I'm pleased with EMDR, but I need more answers than Shapiro gave me.
I discovered EMDR because it was well mentioned and reviewed in another book I read about depression. I did my research and watched some sessions on YouTube and albeit convincing, they seemed like circus' mentalist tricks. And yet, I was curious, bought this book and tried it in some of my more stable patients who agreed.
I can't argue with results. After some sessions my patients and I were mesmerized. I got in few sessions results I tried to achieve for months.
And yet, it is weird. EMDR hasn't any solid science explaining why it works. Ok; many health sciences are like that, especially everything dealing with the mind. What bothers me is that every hypothesis presented in the manual feels like mumble jumble sci-fi.
I'm pleased with EMDR, but I need more answers than Shapiro gave me.
May 4, 2008
I've been reading this since January for a certification program in EMDR and I finally finished today. As far as textbooks go this one is pretty readable but I'm still really glad to be done!
The book does a great job of explaining the whole protocol but it definitely needs to be used in conjunction with coursework and clinical supervision-the book alone is not enough by any means.
The book does a great job of explaining the whole protocol but it definitely needs to be used in conjunction with coursework and clinical supervision-the book alone is not enough by any means.
September 2, 2024
I am elated to finally mark this as read. Full of valuable information & well-organized but very dense & at times dry. My rate of reading this book was between 10-20 pages per hour, usually on the slower side of that range (especially so before I began basic training). It is not an exaggeration to say I spent over 30 hours reading this book. Finishing it feels like a triumph of the human spirit (okay okay, that part’s an exaggeration). I am really loving EMDR and getting to implement it into my practice with clients, and I’m thankful to have this as a resource to refer back to!
July 25, 2022
Read for a six day EMDR training for work
June 24, 2023
dense as hell but i had to read it because she’s a responsible queen
January 12, 2022
What can I say� this book is THE manual for EMDR therapy. I’ll probably reference it for the duration of my career. At times, the reading can be opaque and clarification is needed. However, with having the interpreter of a good supervisor and class teacher, this book is thorough and helpful! As for the therapy� INCREDIBLE!! EMDR is a complete game changer for treating trauma. I now approach the most heinous traumas with confidence.
February 19, 2019
This book is geared toward professionals receiving emdria approved trainings in EMDR. For that reason, the language in this book is clinical in nature. However, if you are a client interested in understanding more in depth how the EMDR process works, I could see how this book could benefit that understanding. Shapiro makes it clear that no professional should practice EMDR without approved training.
September 24, 2020
Тяжеловатая книга, написана непростым языком. Но на практике - очень простая вещь (когда ты пациент) и результаты просто удивительные. Прочитал из любопытства, захотелось понять насколько все это серьезно и почему оно так происходит.
С первым вопросом разобрался: вроде бы все весьма серьезно. А вот как это работает, даже сам автор в конце написал, что мозг штука темная и пока что ниче непонятно )
С первым вопросом разобрался: вроде бы все весьма серьезно. А вот как это работает, даже сам автор в конце написал, что мозг штука темная и пока что ниче непонятно )
January 10, 2022
I’m somewhat conflicted. One the one-hand it is a hood reference-point for the start and context of, what we now know to be an eclectically constructed, therapy. On the other hand it feels hugely outdated on the neuropsychophysiology, repetitive and heavily risk-averse.
Yes, it does give a good and thorough overview of what was the start and foundation of EMDR, and for that I’ll give it 3 stars�(otherwise I would’ve given it 2)
Yes, it does give a good and thorough overview of what was the start and foundation of EMDR, and for that I’ll give it 3 stars�(otherwise I would’ve given it 2)
June 6, 2019
I read this book slowly as part of a training requirement.
It is very much a manual, textbook type book so be prepared for dense material. At times it feels repetitive or that fewer words could have made the point just as strongly.
Recommend as a precursor to training because it allows you to become familiar with the information so you are not as overwhelmed with the information.
It is very much a manual, textbook type book so be prepared for dense material. At times it feels repetitive or that fewer words could have made the point just as strongly.
Recommend as a precursor to training because it allows you to become familiar with the information so you are not as overwhelmed with the information.
September 13, 2018
Very scientific and a lot to read. I needed to break it up in sections. Well written and a how to to perform this type of therapy. Gives the basic information, history, process, groups to work with. A wealth of information, and a great starting point.
August 18, 2019
I was trained in EMDR in its infancy.. this book reveals hiw refined the technique has become and its helpful to see the advances snd uts succesful use for far more than trauma. i found it highly successful in my practice.
September 20, 2019
My therapist lent me a copy of this to learn about EMDR. Though this isn't written for the layperson, i was able to get enough insight and understanding about this modality to enhance the work i was doing in sessions.
December 21, 2020
Excellent book for EMDR therapists. It goes over everything I learned in my EMDR trainings to become certified. Francine Shapiro goes even further into the techniques adding more information to my toolbox for using the different ways to use EMDR.
September 3, 2017
Excellent content, clunky academic writing.
October 31, 2017
educational for sure. helpful for therapists. used as reference often in therapy
July 31, 2018
Read most of it. Very clear and helpful guide - would still need consultation and training to practice, though.
December 23, 2019
Great book. Easy read for a text book. Very helpful and detail oriented.
September 20, 2021
What an exceptional book by the founder of EMDR. Although she is no longer with us, her therapy will live on for years and years to come.
December 23, 2021
5⭐️…as a new EMDR trained therapist this one had to get high praise. But man it sure read like a textbook.
Read
January 1, 2022Not an easy read, but an important one (this book is non-fiction).
May 11, 2022
Fantastic overview of EMDR.
Read
December 10, 2022Excellent information. Very informative
January 26, 2023
Lots of great info but, whew, really dense.
January 17, 2018
High ranking because it’s a seminal work.
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