EMDR- Basics
Eye Movement Desensitization and Reprocessing (EMDR) is a unique type of therapy as it can be a stand-alone modality, but it can also be used in conjunction with a wide range of other psychotherapies. EMDR pulls in many aspects of other major psychotherapies to create a holistic framework for healing. For instance, EMDR pulls the attention to etiological events from psychodynamic therapy, conditioned responses explored in behavior therapy, the beliefs of cognitive therapies, the emotions of experiential therapies, the body sensations of somatic therapies, the imagery work of hypnotic therapies, the contextual understanding of system’s theory, and even a bit of exposure from exposure therapies. Due to all this, and the very nature of EMDR, it can very easily be incorporated into most treatment modalities. I want to take the time to explain why EMDR and DBT specifically work so well together and give you a general sense of what treatment could look like with these treatment modalities combined.
Choosing A Starting Point
First, which one we start with will depend on what your specific goals and “problem behaviors” (what you want to work on in therapy) are. If you are someone who experiences self-harm and/or suicide urges or behaviors, we’ll be targeting those first with a DBT framework. While decision could be made on a case-by-case basis, typically you can expect to start with the comprehensive DBT program which would involve group, individual therapy, and phone coaching. At the same time, I’d be participating in a consultation team so I can provide you the most effective treatment possible. Once those behaviors subside, we can focus on more trauma work with EMDR. I typically do this in this fashion because trauma work can be, and often is, stressful, scary, and bring up moments of heightened emotions. The way we heal the neural networks in EMDR is by activating them- which means that, at least for a short period of time, you have to be able to tolerate some levels of discomfort or distress as we bring up traumatic moments. It’s a difficult and necessary part of the process and I want to be sure you can do that safely and DBT will teach you the skills to do so. Once you’ve completed DBT and those life-threatening behaviors are managed, and you are better able to regulate your emotions, we can start EMDR. We’ll rely on so many of those DBT skills to set you up for success in EMDR. For example, we’ll use mindfulness skills of being able to stay present, noticing your emotions/thoughts/body sensations, distress tolerance skills for when you feel heightened in session or out of it, emotion regulation skills to help you check the facts and regulate emotions effectively, again, in session or out of it, and even the interpersonal skills to be able to ask for what you need from me as your therapist or those in your environment. DBT sets up a solid framework for EMDR to grow from and, with this framework, you may notice more safe and potentially rapid progress in EMDR because you’re coming from a more skillful place.
If you’re not dealing with those life-threatening behaviors, the outline might look different. Depending on what you’re coming in with, if you have some emotion regulation skills already, they don’t have to be perfect, but if you’re able to regulate well and tolerate distress safely (again, not perfectly, but safely), then we may dive into the EMDR process sooner. We’ll still assess for what you want to have differently in your life and come up with a list of goals. We’ll go through the process of building rapport, gathering information, teaching you some more regulation skills- all necessary first steps before processing. Once those are completed, we can start processing to help heal those beliefs you have due to how you were raised and/or the trauma you’ve experienced in your life. This is where DBT can come in, if needed. If you want to be more assertive, for example, we will process the beliefs that you may have that lead you to not being assertive (“I don’t deserve…,” “I’m unlovable…,” etc.). As we are working on healing those beliefs, DBT is full of skills to help with how to be assertive. So then, once the beliefs are healed, you’ll believe and know you deserve to stick up for yourself (EMDR) AND you’ll have the skills to know how to do that (DBT). I’ll also be teaching you DBT skills, such as the mindfulness skills and distress tolerance skills above, to aid in your ability to manage the emotions and regulate effectively while doing this work.
In Conclusion
All-in-all, DBT is almost like a “how to” manual for mental health, teaching people the skills needed to live life how they want for themselves. EMDR helps heal the traumas you’ve experienced (big or little) that cause the dysregulation and stop you from doing the things you want to do or feeling the way you want to feel. When they’re used together, EMDR and DBT can provide a solid framework to help you heal and give you the confidence to reach your goals and find your life worth living.
If you want more help with skills like this, join our skills training groups or schedule with a therapist at CCDBT. We’d love to go more in-depth with this skill and many more like it!
About the Author
Maria Mangione (she/her), M.A., LPCC-S is a licensed clinical counselor who specializes in dialectical behavior therapy. Maria works to help people develop the tools they need to develop trust in themselves and build their life worth living. Maria believes in having meaningful connections with her clients and believes that therapy and healing can be fun. Click Here to learn more about Maria’s experience and therapeutic style.