How Therapists Are Adapting EMDR Trauma Therapy During COVID-19
There’s little doubt that an unprecedented number of people around the world are experiencing the COVID-19 pandemic as a collective trauma. Between fear of the virus itself, the economic impact or the uncertainty of what comes next, it’s normal if you’re feeling particularly overwhelmed right now.
“Trauma is defined often as an event that overwhelms the brain’s ability to cope,” Katie Casey, LPC-MHSP, a Tennessee-based therapist, told The Mighty. “While anxiety is an expected and normal reaction to the unknown and unpredictable, the anxiety levels most people are experiencing now is unprecedented.”
However, if you’re already a trauma survivor, COVID-19 may present a number of unique challenges. A big one is trying to continue trauma therapy in an online format — the in-person support of your therapist provides a level of safety you might not feel through a video screen while physical distancing during the COVID-19 pandemic. Arguably one of the most difficult types of therapy to bring online is the popular trauma therapy eye movement desensitization and reprocessing (EMDR).
What is EMDR?
Eye movement desensitization and reprocessing (EMDR) is a type of therapy initially designed as a treatment for those with post-traumatic stress disorder (PTSD) and trauma. It has since been shown to help with other conditions, such as anxiety, phobias, sleep difficulties and chronic pain. It’s still a bit of a mystery how and why EMDR works. One theory suggests it may mimic how the brain processes memories during REM sleep, but there’s no doubt that it does help many people.
The core of EMDR, which was developed in the late 1980s by Francine Shapiro, Ph.D., is to help your brain reprocess traumatic memories. After a traumatic event, those memories may get stuck and cause a visceral stress reaction in your current life. As explained by the EMDR International Association (EMDRIA), EMDR therapy helps your brain reprocess those memories and move them out of the fight-flight-freeze-fawn response and lessen their grip on your current-day experiences.
Doing EMDR therapy may seem a little unconventional at first. You’ll use bilateral stimulation, rhythmic left-right patterns as you focus on one traumatic memory at a time. Bilateral stimulation might be following your therapist’s finger or a light beam back and forth with your eyes, alternating tapping on your legs, or holding pulsing paddles in each of your hands. While using bilateral stimulation, you’ll focus on the difficult memory at the same time. Meanwhile, you’ll describe what you’re experiencing with your therapist in a series of reprocessing sessions until the memory’s disruption lessens.
How Are Therapists Adapting EMDR Online?
COVID-19 has moved most therapy online, and for those who were in the middle of EMDR therapy, therapists face a major challenge on how to continue delivering EMDR to clients remotely. Historically, EMDR is done in your therapist’s office. It’s a hands-on treatment method — bilateral stimulation tools usually live in the office. Therapists have solved this issue by asking clients to tap on their legs at home or use a screen-sharing program so the therapist can start and stop left-right stimulation on the screen.
Online trauma therapy poses unique safety concerns since therapists only have limited access to clients online. Trauma processing can be intense and trigger crisis-level reactions that therapists would want to help contain during an in-person session. In addition, therapists need to see your whole body to best read what’s happening so they know when you’re overwhelmed and can help keep you safe.
To work through not being in the room with a client who may be facing significant dysregulation, Sarah Stroup, LMFT, RPT-S, a therapist based in Utah, said she is relying on emergency contact information to provide a backstop for client safety.
“Perhaps the biggest challenge is ensuring our clients are safe from a distance,” Stroup told The Mighty, adding:
Because EMDR processes trauma, there’s a chance of dissociation and not being in the room with the client can present safety concerns. However, we are mitigating this through informed consent and emergency contacts on file so if a client were to dissociate or technology fails during a discussion of safety, we can call their emergency contact.
Social distancing doesn’t mean social isolation. We need to get creative with how we connect with others to maintain our mental health and relationships.
What Therapists Want You to Know
Both Casey and Stroup shared the transition to online therapy has been a major adjustment for therapists as much as their clients. The change to telehealth happened almost overnight, which included finding the correct technology, getting clients set up on new platforms and settling into a temporary new normal. Online therapy isn’t the same experience.
“As a therapist who is an introvert and has chronic pain, I feel a great difference during this time,” Casey shared.
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Regardless of the added stress, Stroup said she’s been inspired by how she and her colleagues have worked together to find best practices to bring a trauma therapy like EMDR online, which hasn’t really been done before. And therapists have gone the extra mile to make the transition because they genuinely care about supporting their clients — and each other — during this unprecedented pandemic.
“It’s a profound honor to support my people, my community and my profession during this uncertain time,” Stroup said. “We may be tired but we’re here because we care.”
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