EMDR: an Integrative Approach by Serge Ginger 1

 

 

EMDR: an Integrative Approach

by Serge Ginger 1

Second EMDR University Research Seminar

Metz, France, November 25- 26, 2010

Introduction

I’ve been extensively trained in Psychoanalysis, Psychodrama, Gestalt Therapy

and EMDR, among others, and have also been initiated to several other therapeutic

modalities. I’ve been practicing Gestalt Therapy for more than thirty-five years now,

giving individual sessions, doing couples’ therapy and leading ongoing therapy groups.

My work integrates both physical and emotional dimensions and I am quite interested in

bringing into it psycho-biological phenomena, analyzed by contemporary neuro-

scientific research.

I have in fact discussed these aspects (which are not adequately treated in

traditional Gestalt literature), in two of my books, which were translated into a dozen

different languages. In 1985, I gave a lecture in the United States entitled: “Is Gestalt

Therapy an Involuntary Form of Chemotherapy?”2 I discussed how Gestalt Therapy

brings about rapid biochemical transformations in the way our brain operates

(producing new synaptic connections and neurotransmitter modifications), which partly

explains its effectiveness.

This is how, during one of my frequent trips to the US, I came across a book by

Francine Shapiro (Eye Movement Desensitization and Reprocessing, Basic Principles,

Protocols and Procedures, The Guilford Press, New York, 1995), which had just been

published: I purchased it immediately and read it from cover to cover in one single

1 S. Ginger, Clinical Psychologist, Psychotherapist, trained in Psychoanalysis, Psychodrama, Gestalt Therapy and
EMDR. Founder of the EPG (École Parisienne de Gestalt) or Paris School of Gestalt; Founding Chairman of FORGE
(Fédération Internationale des Organismes de Formation à la Gestalt) or International Federation of Gestalt Training
Organizations; member of the Board of EMDR-France; Secretary General of the FF2P (Fédération Française de
Psychothérapie et Psychanalyse); member of the Executive Council of the EAP (European Association for
Psychotherapy); Registrar in charge of the ECP (European Certificate of Psychotherapy) and Chairman of TAC
(Training Accreditation Committee), in charge of approving psychotherapy training organizations among the EAP’s
41 member countries. He is the Author or co-Author of 24 books about special education, psychotherapy and Gestalt
Therapy – some of which were translated into 15 different languages.
2 Subsequently published in Gestalt Review, Vol. 6, Number 32 (2002).

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evening.

Later, when an intensive EMDR seminar was set up in France by Professor

David Servan-Schreiber, I quite naturally signed up, eager to find out more about this

new approach, which deliberately took into consideration the activity of the brain (even

though it has not yet successfully explained it scientifically).

Today, I often include a series of EMDR sessions in my work with a client –

especially when major psychological traumas emerge in their case history: a death, a

suicide or a serious accident affecting someone close to them (or the client himself),

violence, murder, rape, diagnosis of a serious illness, etc. Sometimes I also take on

clients in emergency situations through EMDR, and then to go on to expand their

treatment through Gestalt Therapy.

these two methods.

I would like to share some ideas about how I combine these various practices, using

I won’t spend too much time describing Gestalt Therapy, since it is now widely

known – and even though a variety of different styles exist. I would simply like to

mention that it has now become one of the most widely used forms of psychotherapy; in

France, for instance, it has moved up to 2nd position, right behind psychoanalysis, and

far ahead of Cognitive Behavioral Therapies (CBT), or of other Humanistic and Family

therapies.

EMDR… or ABS?

EMDR stands for Eye Movement Desensitization and Reprocessing, but

in reality the technique has evolved over a number of years, and it would be more

accurate today to talk about Alternating Bilateral Stimulation (ABS), since we can

replace (or accompany) eye movements with auditory stimuli (alternating from one ear

to the other) or kinesthetic (tapping on one’s hands, knees and shoulders…) or by

spontaneous stimulation of the soles of one’s feet… a similar effect to what is produced

by jogging (which may be a partial explanation for its soothing and harmonious effects,

including the production of endorphins!) – as some of our political leaders seem to have

intuitively understood!

Eye Pursuit

Nevertheless, several studies have shown that eye movements (EM) give clearly

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more efficient results than tapping (Lee & Drummond, Australia, 2007). This is also

what I found out through my own personal clinical experience. One can therefore

wonder about the EM’s specificity.

We know that during each phase of “paradoxical sleep” (dreaming

phases), the eyes go through rapid movements (Rapid Eye Movement or REM) under

the eyelids, which are shut. The precise scientific explanation for REM’s, and for the

effects produced by different ABS’s, is still a controversial issue, and laboratories are

pursuing their research into this area. This kind of superficial sensory stimulation

undoubtedly stimulates different areas in the brain (especially the deeper emotional

limbic brain) and leads to an increase of its activity – the details of which are still

unclear.

We also know that eye pursuit has been considered by several researchers to be a

genetic indicator of schizophrenia, since this reflex is permanently disrupted among 52

to 86 % of schizophrenics (and among 32 to 50 % of related cases), as opposed to 6 to

8 % of normal people (Campion, Thibaut et al., 1992; Peretti, 2003; Ross, 2004), and

even among 96 % (sic!) of schizophrenics (Laplante et al., Quebec, Canada, 1992).

I was thus most particularly interested by Zoi Kapoula’s current work (2010) on

the connections between disorders of eye pursuit and schizophrenia, autism, and even

dyslexia, and by the reduction of remedial jerks, replaced by a greater smoothness of

eye movements. Remember that for Perls, the Founder of Gestalt, smoothness and

fluidity is the main characteristic of good mental health.

Would it be possible to formulate the hypothesis of a direct regulatory action on

cortico-frontal functioning by EMs? Could difficulties in following an object moving

through space be linked to a lack of focus of the patient’s attention, between his inner

world and the events occurring in his environment, implying a breaking off of his

contact with outer reality?

EMDR: hypotheses and metaphors

We may assume that these stimulating impulses bring on synaptic associations

between the two hemispheres and between the profound structures of the emotional

limbic brain – where the emotions are recorded and treated: amygdala, orbitofrontal

cortex (OFC), where interpretation and decisions take place, etc.

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Between each sequence of alternating “sweeping” movements, each lasting no

more than a minute, the client is invited to express spontaneously “whatever” comes to

the forefront of his conscience: images, sounds, words, movements, physical

sensations, etc.

I sometimes use “horizontal figure eight” sweeping motions, based on the

hypothesis that they facilitate “vertical” connections between the various cortical and

limbic layers of the brain, and not only horizontal connections between the two right

and left hemispheres. Moreover, movements then have a tendency to “flow” more

smoothly, instead of being jerky.

This “cerebral sweeping” triggers and accelerates, often spectacularly, often

unexpected mental and emotional associations, between certain dramatic events and

other, apparently insignificant events, having occurred at various different times in the

life of the subject. For instance, a pervading sense of powerlessness after a physical or

sexual attack or threat of death, and other feelings of powerlessness — more discreet and

less conscious, but often repeated – which they tolerate in their everyday lives with

regards to their parents, partner, teenage children, or colleagues at work…

In this way, we witness a kind of “defragmentation3 of the hard disk” of our

emotional memory, reassembling and reclassifying the saved sequences into a new

organization. It’s as if we completely reorganized our library of memories (conscious

and unconscious), which provides a certain sensation of tranquility: everything that I

may need is now at my fingertips, with no effort. I have “organized my personal files,”

assembling and classifying similar elements, separated out unnecessary information,

discarded useless or outdated documents, and written on the front of the file the

essential information contained within. I have not thrown out important memories, but I

have reorganized them in a useful way. I have put some order into my stock of

information, thus modifying my cognitive perception and my place in the world.

We may go on to metaphorically associate the sideways rapid eye

movements, in one sense, to “underlining” important passages of my interior novel,

with felt tip pens of different colors, and in another sense, to “erasing” the emotional

component of traumatic passages, now obsolete, useless, and even burdensome. The

3 Defragmentation: In the context of administering computer systems, defragmentation is a process that reduces the
amount of fragmentation in file systems. It does this by physically reorganizing the contents of the disk to store the
pieces of each file close together and contiguously.

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text thus becomes more clear, more accessible and easier to use. The fact – that might

seem paradoxical at first sight – that the same movement produces opposite effects, is in

no way exceptional: the acceleration of the heart beat can give rise to a state of panic or,

on the contrary, mobilize one’s biological resources; the same punishment can cause

rebellion or a healthy adaptation; love can induce excessive dependency or foster

maturation and autonomy…

EMDR: an integrative approach

EMDR – of which I will not give any more details here regarding its techniques and

procedures – is related to several aspects found in the varying approaches of traditional

psychotherapy:

A nationwide survey, in October 2009, with 379 EMDR practicioners, members

of the Association EMDR France, showed that, among the 101 respondants:

• 50 % of EMDR practitioners were initially trained as psychoanalysts

(Freudian, Jungian or Lacanian);

• 36 % had followed body-centered trainings; 10 % had been trained in Gestalt

Therapy and 7 % in psychodrama – in other words a total of 53 % of body

psychotherapies.

• 35 % had been trained in hypnotherapy, (mainly Ericksonian);

• 26 % came from family or systemic therapy;

• 25 % practiced the CBT;

• 25 % had followed a person-centered approach training (C. Rogers) ;

• 18 % NLP;

• 15 % Transactional Analysis;

• 11 % sexotherapy;

(the total is far above 100 %, since several choices were possible for each practitioner).

We are now going to try and quickly point out a few of the common aspects

between EMDR and these various methods:

1 • As in Psychoanalysis, EMDR uses free association and awakens many

memories buried in the unconscious. The patient is invited to mention these

associations in whatever order they appear in his mind. On the other hand, they are

never interpreted or used in reference to any pre-established theory. It is surprising to

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see that the association process is thus considerably amplified (boosted).

The significance of sexual traumas – in childhood or more recently – is obvious.

Transference mechanisms are at work in the therapeutic alliance.

2 • Just as in body psychotherapies, emotions are involved right from the start,

but also focusing on breathing, « scanning » the body, to focus on sensations of

oppression, of feeling stifled, and various types of somatizations. The therapist also

mobilizes his body and does not stop at merely verbal exchanges, punctuated by

silences. The physical closeness of the two partners (in accordance with the

recommended « setting ») causes an unconscious exchange of pheromones, via the

VNO (vomeronasal organ, directly connected to the unconscious limbic areas),

encouraging feelings of empathy.

Just as in Gestalt Therapy, EMDR encourages the expression of our emotions

and re-experiencing traumas (including their bodily connotations), but in the reassuring

framework of a wholehearted therapeutic alliance, induced by the therapist’s

empathy. It often tends to conclude the « unfinished Gestalts » in the client’s past. It

takes full advantage of the « polarities » of his – deliberate or unconscious – choices,

opposite or rather complementary polarities, such as the concomitant needs for security

and independence, tenderness and assertivity, negative self-images (« negative

cognition ») and idealized images which the subject wishes to achieve (« positive

cognition »). It combines interest for inner phenomena (intra-psychical imaginary

representations) and one’s relations with the outer world (inter-psychical

communication), through the « contact-boundary » between the organism and its

environment, in the « here and now ». It carries out regular assessments of one’s bodily

sensations and feelings (« bodyscans »).

Just as in Psychodrama, certain sequences can be played back, staged again

during the session, along with possible emotional catharsis, and not only simply

mentioned verbally.

3 • Just as in hypnotherapy, EMDR induces states of altered consciousness, and

uses the mental « dissociation » between various levels of perception of reality. These

two methods help the patient to get in touch with still unknown parts of his inner world.

Just as in Ericksonian hypnosis, we consider that each individual possesses within

himself the resources necessary for his own evolution, his own transformation, that the

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spontaneous « healing » of his wounds is a natural phenomenon.

4 • Just as in Systemic Family Therapy, we are interested in the overall

situation, in the communication and information system, in the inter-psychical

relationships and not just in individual intra-psychical phenomena.

5 • Just as in Cognitive Behavioral Therapies (CBT), it implies precise

procedures and a regular measured evaluation of the internal subjective experience, such

as: personal estimation of the intensity of disturbance (SUD, or Subjective Units of

Disturbance, developed by J. Wolpe) and validity of positive convictions of the subject

(VOC, or Validity of Cognition). EMDR proposes an alteration between an

“exposition” or mental immersion in the problematic situation, and a progressive

desensitization (Joseph Wolpe, 1915-1997).

6 • Just as in Carl Roger’s client-centered approach, the psychotherapist

abstains from any kind of interpretation or directive as far as contents are concerned,

always letting the client take the initiative, in an « unconditional acceptance » for

anything « that might come up in the client’s mind », and this in a climate of explicit

empathy.

7 • Just as in therapeutic NLP (tNLPt), the therapist focuses on processing

information; when the memory is an image, you try to change it by « zooming in or

out », and by sharpening it more or less; you focus on body sensations; on his resources

and positive beliefs; you watch the eye movements; you use « reframing » and

« anchoring »…

8 • Just as in Transactional Analysis, EMDR works on various « states of the

self » (Parent, Adult, Child), thus making « life scenario » changes possible, recorded

from early childhood on, and making « redecisions ».

9 • Just as in Sexotherapy, patterns of sexual abuse,both recent or archaic, real

or feared, acted out or merely verbalized (humiliations and insults) regularly emerge.

Thus, the EMDR protocol and its specific techniques of information

reorganization fits well into a variety of other approaches – to which is added a

neurophysiological dimension, not yet completely formulated. Please remember that

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EMDR is only taught to professionals who are already psychotherapists, and it is

therefore not surprising that most of the practitioners combine their usual method of

preference with the original techniques of EMDR – which creates a sometimes

spectacular synergy.

Some Clinical examples

Stéphanie is 30 years old; her life had been greatly impoverished since she was

the victim of a hold-up at a bank window where she worked. Threatened by a gun to

her forehead, she saw herself already dead, with the abrupt feeling that the world would

go on as usual: in fact, she realized all at once that “she was useless, her life was of no

use whatsoever!” Since this traumatic experience, already five years ago, she no longer

left her home: she couldn’t stand going outside, nor crowds, stores or restaurants: she

had developed a severe case of agoraphobia. She distrusted everything and everyone.

No distractions. She lost all her friends. She became bulimic and gained 30 kilos. In

fact, she was like the “living dead.” Besides her disturbing agoraphobia and daily

bulimia, she now suffered from repeated nightmares; and all that, in spite of

psychoanalysis sessions twice a week and several drugs to treat her depression and

anxiety…

I then worked with her during two sessions of EMDR of one hour and a half

each, separated by a week: the first was centered around the hold-up itself and the

differing dramatic sequences; the second focussed on the confrontation with her young

assailant at the Court proceedings – whom she hesitated, again and again, to “condemn

to death”… or else to forgive! In front of her family and the whole audience of the trial,

the expert psychiatrists presented her various problems and difficulties. She was filled

with shame and couldn’t stand having everyone stare at her.

At the beginning of the first EMDR session, her great suffering was obvious: she

sweated profusely and had trouble breathing. On a subjective scale of discomfort from

0 to 10, her estimation of her situation was … 18!

At the third session, Stéphanie arrived completely upset: “I’m really upset! I

feel lost! I don’t recognize myself anymore! No one else recognizes me, either: my

parents are asking themselves what has happened to me; my boyfriend doesn’t know

who I am anymore: I am no longer the same person!”

As I listened to her, I was myself a bit worried, but I didn’t let it show. And here

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