Eye Movement Desensitization and Reprocessing (EMDR) Therapy: A Therapist’s Overview
Gretchen Mallios, LCSW, RYT is a therapist in private practice in San Diego and past President of Postpartum Health Alliance. In addition, she is the founder of Positively Yoga, where she and other instructors offer therapeutic yoga and mindfulness services to support emotional health
Many people compare pregnancy and parenting to a roller coaster, filled with ups and downs, highs and lows, and maybe your occasional loop-dee-loop. While that is a fun way to describe it, for some families the roller-coaster-ride analogy does not quite capture the adversity, stress and, in some cases, the outright trauma that can occur during this period of life.
It is estimated that 3 – 4 percent of women experience post-traumatic stress during pregnancy or postpartum. Yet, if you are a perinatal professional, a parent, or both, you can attest to the fact that 100 percent of parents find the journey to be extremely stressful some of the time, if not most of the time. Furthermore, an experience does not need to be outrightly life-threatening for it to feel traumatic. Having worked with pregnant and postpartum mothers and fathers for over a decade, I have concluded that emotional health issues in this period of life are their own form of trauma. Just ask any mother who felt the depths of depression or the terror of anxiety while caring for her young child and you’ll see that mental illness or emotional instability is traumatic for new parents.
“What still upsets me the most is when the nurse suddenly looked shocked. Then she just turned to me and said she needed to go get the doctor. I had no idea what was going on but it felt like something wasn’t right. I was sure I was going to lose the baby.”
“I keep replaying the moment they told my husband they were taking me into emergency surgery. I keep seeing the look on his face. He probably has PTSD from that moment too, though he never talks about it.”
“The worst part is the times when it felt like we couldn’t get her to sleep and she wouldn’t stop crying. I mean, I know we eventually slept… of course, we eventually slept! But I can still feel the panic whenever I think about it.”
There are many therapeutic modalities and interventions that are highly beneficial to new parents to help them through the adjustment of pregnancy and parenting. However, in instances when the stress does not seem to remit after an ordeal is over, or there’s a medical trauma during pregnancy, childbirth or for the newborn (e.g. NICU, hospitalization, or other medical complications), then EMDR therapy may be highly beneficial to help the parent put the event in the past, so they can resume living in the present.
What is EMDR Therapy?
EMDR therapy is an integrative approach that draws from several other therapeutic methods, including cognitive, schema, gestalt, somatic, and effective therapies. It is based on the Adaptive Information Processing theory or AIP. AIP asserts that people are innately equipped with the capacity for healing from emotional wounds without intervention, just as a small cut on your skin can heal without stitches or surgery. According to AIP theory, when an overwhelming or seemingly life-threatening event occurs, our stress response system is triggered into survival mode. This means that a cocktail of hormones floods the body to ensure a rapid response, commonly referred to as ‘fight or flightʼ. Once the event is over, and our body settles back down into ordinary living, if it was an extreme enough situation, or the person has a history of trauma that was reignited by the newest event, the mind and body don’t fully settle back into the original baseline resting state. Essentially, the nervous system takes on a new baseline of reactivity to stress, making each new exposure to stress or challenge much more intense. Furthermore, the physiological conditions of stress at the time of the trauma subsequently interfere with the mind’s ability to integrate it, thereby inhibiting the consolidation of the event into the functional memory network. Basically, the memory does not fully become something of the past and is vulnerable to being retriggered. This is what we call ‘flashbacksʼ or a ‘reliving of the eventʼ in present time.
A very common example in the perinatal population is that of reproductive loss. Consider a mother or father who endured multiple losses or who required medical interventions throughout a pregnancy. Finally, after a long and frightening 10 months, they arrive at an uneventful childbirth. Everyone feels immediate relief as if life can now begin. Shortly after the birth, however, the parents may realize they are still haunted by the unrelenting fear they faced throughout the previous year. Now they wrestle with feeling confused, asking themselves why they don’t feel pure relief and gratitude that they have a healthy baby. The answer to their question is that their nervous system is still carrying the residue of the ongoing open exposure to stress. The micro adversities and challenges inherent to the transition into parenthood are compounded by the underlying vulnerability that stems from the previous chronic stress.
Another common example would be that of medical intervention during childbirth. Whether the intervention was life-saving, or simply not a part of the anticipated birth plan, any sudden intrusive intervention during a time that is sacred and vulnerable as childbirth has the potential to feel highly distressing. This too can leave a lasting imprint on some new parents and can linger in the weeks, months, or even first years of life of their young child.
When stressful events such as these go unaddressed and if the symptoms remain acute or possibly worsen over time, they can threaten to interfere with the healthy bonding and attachment process that we would otherwise hope for during this time. Potentially preoccupied or hypervigilant about the baby’s safety or health, a new parent can become mis-attuned to their newborn as they over-respond to their baby’s cues. Conversely, in the more severe cases of post-traumatic stress disorder (PTSD), a parent may have episodes of withdrawing, as their mind replays a traumatic scene or works to tune out the mental noise of the unprocessed memory.
In these situations, EMDR Therapy would be highly appropriate, as it is recommended as an effective therapy for people who are experiencing symptoms of acute, chronic, or post-traumatic stress, in addition, to be effective in treating anxiety, depression, obsessive-compulsive disorder (OCD), and panic disorders. EMDR has a lot in common with any other good therapeutic intervention; it requires a good working relationship between client and therapist, adequate time to prepare for doing the deeper work, and opportunities to discuss and talk through the presenting issues and the desired outcomes.
Beyond those parallels, there are some distinct attributes to EMDR. Because it is an evidence-based, highly researched protocol, there are times when the process is highly structured, with specific steps being followed to help ensure the efficacy of the treatment. Beyond that, it should be identical to any other good therapeutic relationship with a mental health professional. Often times, EMDR can be so effective and powerful that people can share miracle-like stories about their experiences, which can create expectations of a one-time magic fix by new clients. I can say, most certainly, that EMDR is not magic. Nor is it a form of hypnosis. Nor does it take 1 to 2 sessions to wag the fingers in front of someone’s eyes for them to be ‘miraculously cured.ʼ These myth-busters may sound ridiculous, but they are based in actual questions many EMDR therapists receive from inquiring minds.
If you are a birth worker, perinatal professional, or mental health professional who does not currently practice EMDR, it is a very useful tool to be aware of should you have a client who experienced a trauma. Many EMDR therapists are trained to do brief, focused work with an individual solely for the trauma treatment aspect of the work, which can allow the client to resume their treatment with a pre-existing provider or to work in conjunction with an EMDR provider. Furthermore, San Diego, and Postpartum Health Alliance (PHA) in particular is fortunate to have numerous dedicated EMDR-trained therapists who have been trained to intervene quickly and briefly immediately after a trauma. Ideally, in these instances, we may be able to avoid a fuller expression of PTSD from taking hold.
If you would like to understand more about EMDR, a great source of information is EMDR International Association (EMDRIA), the international member association for EMDR providers.