Does virtual EMDR work?
Back in March of this year when the sh** storm, COVID, first hit, I decided that it was time to start working remotely. A lot of time and consideration went into this decision but ultimately, it made the most sense for my business because I could not regulate my own nervous system when I was seeing clients in-person at the office. My mind was racing and exhausted by all the new things my body and brain needed to orient to when working with clients. Since moving my practice completely virtual, I have been able to feel myself again in sessions. I am present, grounded and able to focus on my clients in their sessions.
While some aspects of therapy have seamlessly transitioned to video therapy, there still remain a great deal of unknown and negative aspects. One of the unknown aspects that many new and potential clients have concerns about is around EMDR. EMDR processing traditionally utilizes tappers, following the therapist's hand/fingers side to side, a lightbar or auditory head set for the bilateral stimulation phase. Not exactly ideal for virtual therapy where even just sitting still can cause many individuals to experience exhaustion, nausea, headaches, and a long list of other physical and emotional side effects. So could virtual EMDR actually work? The answer is, yes.
If you're considering starting virtual EMDR therapy, here are some things to take note of:
1. EMDR is an entire theory and process with many steps along the way. There are many steps in EMDR prior to the more active phase of EMDR, the desensitization and reprocessing phase, that most are familiar with. In my sessions with clients who use EMDR, we sometimes never even get to this phase. Many clients begin to look at the event(s) that brought them in with a new, trauma-informed lense and feel better before we get there. There is so much amazing work you can do in EMDR therapy without actually reprocessing the event.
2. You can get creative with bilateral stimulation. In 1:1 therapy, therapists will be in charge of this part of therapy, monitoring the number of times the light/buzzer will go side to side. Therapists will still monitor this part of therapy in virtual sessions but if you're a client who gets dizzy or nauseous just at the idea of watching your therapist move her fingers from left to right for several minutes while you reprocess trauma or a stressful event over the computer, you can take on this part.
Bilateral stimulation done by the client is actually not very difficult at all and really just requires a little bit of creativity from the therapist and client. If you're a client and you have the money, purchasing a theratapper machine for therapy might be worth the investment. The therapist will monitor and let the client know when to start and when to end. Some EMDR therapists even use programs like RemotEMDR or Active EMDR that can display bilateral movements through the screen.
In my training on using EMDR with children, I learned lots of different creative ways to do this. One of my favorite, more affordable options is for the client to take something like a toy car and move it back and forth on your desk quickly while the client watches and the therapist monitors sets. The free-est option would be for the client to simply tap on themselves in a butterfly hug as they engage in this part of EMDR. Many of my clients report positive results from scanning the top of their laptop or computer, or any two fixed objects in their view from side to side. In other words, there are lots of different creative ways to play with virtual bilateral stimulation.
3. Your therapist might use attachment-based or a more holistic style of EMDR which might or might not even need the use of bilateral stimulation. As a more holistic, somatic-based therapist, I have a love/hate relationship with EMDR. Some aspects of EMDR, such as reading off the protocol scripts, are just too rigid for my personal therapy approach and for many of the clients I work with. I love talking with my clients and I find that the secure attachment created through talk therapy can be invaluable for many clients who have experienced trauma or who have been in abusive relationships or families. Many other EMDR therapists are with me here and utilize a more "organic" or attachment-based version of EMDR. This version of EMDR will sometimes utilize bilateral stimulation when needed, but for the most part, the therapist will interweave attachment-based EMDR tools throughout the session. This means, you might not even need the bilateral stimulation piece very much at all if you prefer this approach.
4. The environment the client is in while doing virtual EMDR therapy is important. One big piece of EMDR, is ensuring environmental safety. Without a private office for clients to go to, many clients are forced to do therapy in less than ideal environments such as vehicles, at their work office, or in a closet at home. Although many clients are able to find a safe environment to have therapy sessions, many other clients live in close quarters with family members/roommates who can't or won't leave or who are/have been abusive or manipulative in the past. Before starting EMDR therapy virtually, the client will want to spend some time making sure they can find a private, safe space to really be able to stay fully present and engaged in the session.
EMDR therapy experts are currently studying the efficacy of virtual EMDR to give us all the final results but so far, everything coming out sounds promising. If you've been considering EMDR therapy and live in Austin, I'm happy to share feedback on whether EMDR might be an option for you in a free phone consultation session. In the session, we can discuss a plan of action and approach that works for you.
In the last blog, I brought up how to tell if your therapist isn’t a good match. This week it’s all about how to break up with your therapist while making sure that you're getting closure. Many clients ghost therapists or leave without a closing session. Termination or goodbye sessions are an amazing way of finding closure, working through what it means to say goodbye (if you’ve ever ghosted someone, you might struggle with saying goodbye), and to move forward with clean energy and honest feedback.
Here are some thoughts on how to break up with your therapist:
1. Talk to your therapist about how your needs aren't being met (we can handle it).
You'd be surprised how much therapists really truly want to know what went wrong in a session. We are trained to hear all feedback with open ears and to not let our own defenses show up. Bringing up difficult things to your therapist might even be a teaching tool for you especially if you struggle with conflict avoidance.
2. Ask your therapist what styles of therapy they have been using and if they would recommend a different style of therapy for you moving forward.
It could be that your therapist is just only trained in and using certain modalities that aren't necessarily a good fit for your needs. This is always hard to come to terms with but talking it through with your therapist can help you find a therapist who has training in modalities that might make therapy less challenging and a better fit for you.
3. If your needs still haven't been met, ask to schedule a termination or goodbye session at least one day (ideally one or more weeks) in advance so that they can prepare.
I know it can be hard to come to terms with breaking up with a therapist and feel very uncomfortable. I can't tell you just how important scheduling a break up or termination session is for you and finding a sense of closure and peace. While you might not consciously realize it, our bodies collect all energy from past relationships and have the tendency to feel unsettled until we say goodbye or find closure. If you struggle with saying goodbye, this can be even more difficult and if you feel safe to do so, this could be a good time to process what and why goodbyes are hard.
Therapists need plenty of time to be able to give your goodbye session the closure and consideration it deserves. We simply can't prepare a termination that comes out meaningful without advance warning. Let us know and we can help navigate this important session with and for you in a way that feels meaningful.
4. Therapists are humans who worry about you and your physical safety- please don't ghost us!
Just.. don't. I know, I know... If you've read my blogs you'll see that I've ghosted my therapist in the past. But hear me out. I still hold onto that energy. Several years and huge life changes ago and it still comes up from time to time. Your therapist worries about you even if they aren't a good match. At the very least, you can send them an email stating that you won't be making sessions anymore and that you're physically safe. Then go schedule yourself a new therapy appointment and work through it. Ghosting isn't just rude (therapists can handle rude btw), but it's a window into some clinical information about you. Ghosting is a fear and a way of holding power or control over someone when no harm has been done from the other party. Don't not ghost for us. Do it for yourself and grow from what you learn.
5. Give your therapist feedback.
What was helpful? What was unhelpful? What will you take with you? Are there any negative memories or bad energy that happened in your sessions? Now is the time to air it out so you don't take it with you when you're done.
6. Engage in a goodbye ritual either in the termination session with your therapist or afterwards on your own.
Here's an example of a closure ritual you can practice on your own: Find a safe, quiet spot in your house and light a candle. Scan your body and observe all of the positive energy, space, and growth you made while in therapy. Fully embody these positive sensations in your body. Next, scan for any negative energy, bad memories or emotions that you don't want to take with you moving forward. Imagine yourself funneling these things into the flame and watching them burn away. When you are done, honor yourself and the investment you made to yourself and your mental health and blow out the candle.
Your body is your most important teacher. Sometimes we struggle with knowing cognitively if our therapist is a good match so here’s a list of ways to check in with your body. This list is for clients who have been going to therapy for at least 2-3 sessions but there are ALWAYS grey areas. If you’re feeling some or all of these and have trauma, see if you can bring to mind a safe person and imagine how their presence feels in your body. Ideally, this person should bring a sense of openness, expansion (like you want to lean in), or groundedness. Consider using your awareness of your safe person as a way to compare to your therapist somatically.
Sometimes it can take a while to feel safe with a person. If you know this is you and you need time, keep that in mind here. But if you’ve been going to a few sessions and still feel this way, it might mean you aren’t a good match. Your body might be telling you something important. Somatic expressions of safety and comfort are just as, if not more, important as cognitive measures.
Here's a list of ways you can check in with your body when evaluating whether or not your therapist is a good fit for you:
1. You frequently feel like you dissociate or leave your body in sessions.
If you're giving your therapist feedback about this and it's still happening, you might want to pay attention to what your body is trying to tell you. We escape our bodies when we don't feel safe. If we don't feel safety with someone while also sharing major parts of our lives, we could retraumatize ourselves.
2. You feel disconnected from your whole self for most or all of the session.
Similar to what was mentioned above. Give feedback to your therapist. It could be that you are picking up on something your therapist is projecting onto you or maybe an old defense or protective part of you is showing up. If you've tried working through this with your therapist to no avail, trust your gut. Therapy is most effective when we feel like we can be ourselves and not hide.
3. Your body feels pulled inward or constricted when you imagine your therapist in front of you.
Again, listen to your body. If your body is constricting most or all of your sessions together, it probably isn't a coincidence.
4. It takes several days after most or all sessions to get back to feeling grounded or whole.
It's normal to have a therapy "hangover" for about a day, sometimes two when we first start therapy or when we've had a big session. What's not normal is when we feel this way after all of our sessions or if the hangover lasts for multiple days, causing other parts of our life to become disrupted. It could be that your therapist needs to give you some time at the end of each session to ground before leaving. Bring this up at your next session but if things don't improve, you might want to search for someone who can move at a slower pace.
5. You don't feel a sense of relaxation, expansion or forward movement either in your sessions or afterwards.
Therapy is hard work but we do it because of the reward at the end. If you're not noticing any positive sensations in your body or never feel a sense of relaxation or expansion either in or after your sessions, pay attention and give feedback to your therapist. You should feel some sense of relief or expansion in your body when you're working with a therapist who is a good fit.
6. Imagining your therapist in front of you doesn't bring a sense of warmth or openness in your body.
This one is self-explanatory but goes without saying. If you try this out, notice what your body wants to do without judgment. Pay attention to the wisdom your body has to offer.