EMDR: Weird Name, Useful Technique
Don't let the confusing acronym hold you back.
Hello Voyagers,
If you’re new to this newsletter, welcome. I’m Meredith Arthur, I work in tech, and for the past decade I’ve been exploring new ways for overthinkers, people pleasers, and perfectionists to navigate anxiety. These days I am particularly focused on making sure my body and mind understand each other via my tripod of healing.1 Today I’m digging into a topic I’ve been curious about for years: EMDR therapy.
What is EMDR?
It’s a type of therapy that was first invented in 1987 by psychology student Francine Shapiro, the Brooklyn-born daughter of a car mechanic and homemaker. Strolling through a park in Los Gatos, California,2 trying to distract herself from negative news she had just received, Francine zoned out while watching squirrels jump from one branch to branch, from side to side. The earliest seed of what would become EMDR was planted when she observed that her negative thoughts and fears seemed to be diminishing.
The acronym stands for this mouthful: Eye Movement Desensitization and Reprocessing. The technique is pretty simple — you move your eyes while revisiting memories with a strong emotional charge.3 You may have heard of EMDR’s popularity in treating veterans with another acronym — PTSD, or post-traumatic stress disorder. The World Health Organization Guidance on mental health care after trauma includes EMDR as a recommended approach, saying it helps people reduce “vivid, unwanted, repeated recollections of traumatic events.”
My experience with EMDR
You wouldn’t describe me as someone who has experienced the kind of trauma referenced in most online EMDR writeups.4 When I was diagnosed with an anxiety disorder nearly ten years ago, I never thought of EMDR, assuming it didn’t apply to me. And yet, in the past couple months, a handful of virtual EMDR sessions alleviated my stress in a way that years of talk therapy alone could not. Here’s how I figured out which episodes to focus on in those sessions:
I looked for the challenging themes coming up most frequently in my daily life. Example: “I feel different than other people” or “I just can’t relate to others.”
I sat with and wrote about those themes, exploring moments in my life when those themes felt strongest. Example: “My move in the middle of 4th grade from a small town to a bigger city” or “The time I got fired the same week my boyfriend dumped me.”
I knew I had found the right past episode when thinking about it brought a tear to my eye since the emotions still felt present and relevant today.
After identifying the past episodes that retained a strong charge but still felt timely, I was ready to get started. This preparation came in handy: it allowed me to hit the ground running and save money.
Did I mention the bad news about EMDR?
It’s expensive, and it’s not usually covered by insurance unless you’re being treated at the VA. [EDIT UPDATE DEC 10: This may not be exactly accurate, as I have learned thanks to one of my astute readers who happens to be a practicing therapist. See more info in comments!] That may change in the future, however, as more peer-reviewed studies like this one from 2022 argue for the success rates of independent chatbot-based EMDR assistants.
A chatbot can’t fully replace the human experience. I have been grateful for the guidance of my wonderful EMDR therapist5 whose gentle wisdom has pushed me in exactly the right way, propelling me forward in a way that impossible to imagine with the current version of AI we know today. But for people who may not be able to afford this bespoke experience, the research into autonomous online support is promising.
Other people’s experience with EMDR
In a small collection of first-person essays written by community members of The Small Bow6 called What Is It Like to Do EMDR?, one therapist described EMDR as a “weird, nonlinear process where we are prompting the client's adaptive processing system to kick in and do the work that it had stalled out on.” I like the “stalled out” description, as I think this is often what’s happening with nervous system dysregulation (and why I think it’s been working for me.)
I also like this description from another community member: “EMDR has been central to my ability to hold certain facts: I almost died when I was in my thirties; my father left when I was very young; the first year of my daughter's life was inordinately challenging — with a neutrality.” That neutrality is another way to describe the removal of the emotional charge I’ve experienced after my sessions. I’m always good-tired for a couple of days after my sessions as my nervous system gets used to the adjustment that EMDR seems to bring.
I know this is all a bit hard to believe! How can moving your eyes around while re-experiencing challenging memories actually change your nervous system? Again, from the Small Bow: “I have come to believe, and I think EMDR researchers would agree, that it is not the bilateral stimulation that works in EMDR but dual attention accompanied by physical stimulation.”
There is no agreed-upon understanding of why EMDR works, and that can be confusing for everyone involved. Dr Francine Shapiro’s NYTimes obituary tries to tackle this confusion, describing research led by Iris Engelhard of Utrecht University in the Netherlands, describing how our imagination routinely intensifies the image of upsetting memories. “The reds are harsher, the faces more contorted, than they were when the memory was originally stored.” It goes on to conclude that “eye movements tax working memory to such an extent that that same disquieting memory is in fact deflated and dimmed.” But this is just one theory of many.
In the past, the lack of concrete evidence for why EMDR works would have bothered me. These days, I accept that there are limits to what we can know about how the human mind works. I’m just grateful for those squirrels that ran back in forth in Francine’s path, and the curiosity that led her down a new path of invention. Thank you, Dr Shapiro!
The tripod is currently Clinical Somatics, Polyvagal Theory, and Mindbody Syndrome, but I may need to expand it to include Parts Work, Attachment Theory, and EMDR. A better metaphor might be a communal dining table?
I’m imagining the good people of 1987 walking by, listening to their Walkmen playing Whitney Houston’s "I Wanna Dance with Somebody,” Kangol bucket hats resting on their heads, Benetton green striped rugbys tied around their shoulders.
I know that sounds like therapy-speak, but what it means is that there are certain memories that our nervous systems have coded as threatening. Discrete or specific past experiences are what you’re looking for when engaging with EMDR.
I was lucky to grow up in a supportive, financially stable family. My mother thoughtfully reads and responds to every newsletter and I send out. Thank you, Mom.
DM me if you want the rec!
The Small Bow describes itself as “A Recovery Newsletter For Everyone.”
Hey everyone,
I added an update my EMDR post and wanted to elaborate on it. After sending out my newsletter I heard back from one of my readers who is also a practicing therapist in Ohio who said, "I wanted to let you know that EMDR is covered by insurance. Practitioners can bill it the same way they do other psychotherapy and add the "interactive complexity" code to distinguish the service. It can be affordable (Relatively speaking. I know insurance isn't affordable to everyone.) and accessible to all!"
In response I asked, " I wonder if out-of-network therapists like mine could provide paperwork I could submit for reimbursement?" And she said, "We usually ask for a single case agreement. Sometimes insurance companies will grant this which allows the provider to be reimbursed at the in-network rate and services covered as such. Usually, they grant a sca if there is a long standing clinical relationship and a change in provider would be detrimental to the client’s health/safety (use those words when requesting). Also, if there is a shortage of providers in the area for a specific service insurance will Sometimes grant a sca. It never hurts to ask! Providers can give clients billing sheets or HCFAs to submit to their insurance companies on their own."
I love this extra information and am grateful to this reader for taking the time to share it! Thank you!