Alright ... How did EMDR really become a thing?

[The Cinnabon]

Post-Bacc here who is pretty research oriented and into trauma treatment.

I know that EMDR "works" because it's essentially "PE Lite", but I really need to know how this took off? I won't lie in saying the first time I read the eye movement stuff I honestly was taken back because there are medical interventions in StarTrek that have less outlandish evidence behind it. At this point it's led me to wonder how I haven't heard any big lawsuits regarding EMDR practice just because of its deceptive marketing and most of it being snake oil? I mean it can't be that far out there to think that a patient has sued a provider over false justification and claims regarding what EMDR is and is not? There has to be some ethical concerns there right?

I need seasoned people's perspective on this issue.

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[Sanman]

Lawsuits? If the PE part works, what harm is being caused? If none, what would damages be? No lawyer would take that case.

I agree it is woowoo, but if aduhelm can get passed by the FDA there are bigger fish to fry.

 

[The Cinnabon]

Lawsuits? If the PE part works, what harm is being caused? If none, what would damages be? No lawyer would take that case.

If agree it is woowoo, but if aduhelm can get passed by the FDA there are bigger fish to fry.

I can agree with the FDA having bigger concerns and I do find the "if the job gets done regardless" easy to follow.

But I can't get passed that you're taking a clients money, and selling them something which has a lot of junk science behind it. I guess I don't have any issues with providers using the treatment. So long as they properly inform a client what it is vs. isn't.

 

[WisNeuro]

I can agree with the FDA having bigger concerns and I do find the "if the job gets done regardless" easy to follow.

But I can't get passed that you're taking a clients, and money selling them something which has a lot of junk science behind it. I guess I don't have any issues with providers using the treatment. So long as they properly inform a client what it is vs. isn't.

Are you independently practicing yet? If not, I have some bad news for you, EMDR is only the tip of teh junk science iceberg in terms of snakeoil out there in the MH world.

 

[The Cinnabon]

Are you independently practicing yet? If not, I have some bad news for you, EMDR is only the tip of teh junk science iceberg in terms of snakeoil out there in the MH world.

Oh ... I supposed I'm going to have to buckle up.

 

[Fan_of_Meehl]

Post-Bacc here who is pretty research oriented and into trauma treatment.

I know that EMDR "works" because it's essentially "PE Lite", but I really need to know how this took off? I won't lie in saying the first time I read the eye movement stuff I honestly was taken back because there are medical interventions in StarTrek that have less outlandish evidence behind it. At this point it's led me to wonder how I haven't heard any big lawsuits regarding EMDR practice just because of its deceptive marketing and most of it being snake oil? I mean it can't be that far out there to think that a patient has sued a provider over false justification and claims regarding what EMDR is and is not? There has to be some ethical concerns there right?

I need seasoned people's perspective on this issue.

It goes waaaaay back...

Franz Mesmer - Wikipedia

en.wikipedia.org

 

[R. Matey]

It goes waaaaay back...

Yep. "Cures" by mysterious processes are not at all new nor are they restricted to psychotherapy. People love mystery and novelty much more than than they love the drudgery and difficulty that often accompanies true behavioral change. EMDR works just well enough because it co-opts PE and adds mystique, which contributes to buy in for a certain subgroup of the population. Like PE with a hefty dash of con. It could be worse though: go look up Milton Erickson or Jacques Lacan. Shapiro is tame by comparison.

 

[counselor2b]

I recently completed a training with Kathleen Chard and she and her team are in the midst of directly testing EMDR against CPT and PE for PTSD. I am not sure when the results will be published, as they are still in the middle of the study. Hopefully this will at least establish the hierarchy of EBP’s for PTSD once and for all.

I’m sure there will always be some that will drink whatever Kool Aid they are served since it “works”, but at least there will be definitive data to support or reject the claims for what is most effective for the treatment of PTSD. Unfortunately I see EMDR being used for everything under the sun, so even if it does not hold up against rigorous testing against CPT and PE, I imagine it will continue to be deployed elsewhere.

 

[Sanman]

I can agree with the FDA having bigger concerns and I do find the "if the job gets done regardless" easy to follow.

But I can't get passed that you're taking a clients money, and selling them something which has a lot of junk science behind it. I guess I don't have any issues with providers using the treatment. So long as they properly inform a client what it is vs. isn't.

This is a good stance to have. The problem becomes once you graduate and need to put food on your table. It is easy to access EMDR training if you are a midlevel and clients often want the treatment. Will you turn them away or take their money when the rent is due? Some if us can and some of us cannot.

Really, this is no different than the cash pay client that wants to come in and complain but has no goals for therapy. Turn them away because you are not offering concrete treatment or continue take their money and listen to them until they get tired and leave?

I worked in the psychiatry dept at a med school as a grad student. During my time there, the dept banner all pharmaceutical sales reps from coming so that there was no undue influence on prescribing of medications. That ban lasted 6 months. The dept could not afford to pay for all the free lunches for residents and students that the pharma companies offered every week during meetings (along with the pens, coffee mugs, staplers, etc.).

Professional ethics are hard in the real world when no one is looking that closely.

 

[WisNeuro]

This is a good stance to have. The problem becomes once you graduate and need to put food on your table. It is easy to access EMDR training if you are a midlevel and clients often want the treatment. Will you turn them away or take their money when the rent is due? Some if us can and some of us cannot.

Really, this is no different than the cash pay client that wants to come in and complain but has no goals for therapy. Turn them away because you are not offering concrete treatment or continue take their money and listen to them until they get tired and leave?

I worked in the psychiatry dept at a med school as a grad student. During my time there, the dept banner all pharmaceutical sales reps from coming so that there was no undue influence on prescribing of medications. That ban lasted 6 months. The dept could not afford to pay for all the free lunches for residents and students that the pharma companies offered every week during meetings (along with the pens, coffee mugs, staplers, etc.).

Professional ethics are hard in the real world when no one is looking that closely.

I get the point from an intellectual point of view, but I don't think that in any way excuses both these unscrupulous practitioners, nor their incompetent programs for teaching ethics and other important issues that concern healthcare delivery. Any one of us can make more money than we do now by engaging in shady practices that we know are wrong. Thankfully, most of us don't. I don't think the ones that do deserve any kind of pass simply because "adulting is hard."

 

[cara susanna]

Basically, EMDR has awesome marketing. Resick (CPT) and Foa (PE) thought that the science would speak for itself, but they were wrong. Resick especially admits that she wished she'd focused more on marketing. I also think the neuroscience-y explanation is easier to buy into than CPT and, especially, PE. Not to mention the EMDR people now blatantly attack exposure, which is hilarious given that EMDR likely works because of exposure. You can find a lot of videos on TikTok from "trauma experts" that talk about how exposure doesn't work and is bad for patients.

The ethical issue with EMDR isn't so much that it doesn't work, but that EMDR costs bucketloads to train people in when it's essentially PE with bells and whistles, and PE is MUCH cheaper to get trained in. Apparently some people actually brought up that issue when EMDR was first developed, but it sounds like nothing came of it.

Also, as WisNeuro said, unfortunately the trauma field is chock full of floofy stuff that can even be worse than EMDR. I think it's because clinicians have a tendency to fragilize trauma patients. They'd rather try anything than make them feel distress. Also this trauma centrality concept where people think trauma is a part of them and how can we fix that over only 12 sessions?

 

[PsyDr]

1) On a societal level, people have been instructed, since kindergarten, that they are special. "Brain" explanations make common problems sound complex, and special.

2) "Brain" based explanation remove a component of responsibility. You can see this in the phrase, "My brain made me do it.". If you take away a component of responsibility, it eases discussions in clinical and social settings.

3) Since history repeats itself, society has incorporated psychiatric terms into common parlance. We are no longer "sad". We are "depressed". This creates some confusion when discussing the need for treatment. If society thinks that "depressed" means "sad", then most "depressed" people would be ridiculous to seek treatment. A "special" treatment demonstrates that the person is not dealing with common emotions.

4) In marketing, you need VISUAL cues to show differences. This is illustrated in the perfume industry. It's an olfactory product that is invisible when you use it. Why would the container be of any importance? But perfume companies spend a lot of money on bottle shape, to show it is "different" than Axe Body Spay.

5) So you take a treatment, throw in some visual cues to ensure people see it as "different" and "special", offer a "brain" based explanation that takes away some of your responsibility, and sell it.

 

[Sanman]

I get the point from an intellectual point of view, but I don't think that in any way excuses both these unscrupulous practitioners, nor their incompetent programs for teaching ethics and other important issues that concern healthcare delivery. Any one of us can make more money than we do now by engaging in shady practices that we know are wrong. Thankfully, most of us don't. I don't think the ones that do deserve any kind of pass simply because "adulting is hard."

Not trying to excuse it, just trying to explain why it happens. That said, when entities like the APA or the VA do little to nothing to differentiate between these treatments and have endorsed EMDR at times, I will not hold every individual practitioner to a higher standard than them. I also will not practice EMDR when better treatments are available and I have been trained in them.

 

[Fan_of_Meehl]

Basically, EMDR has awesome marketing. Resick (CPT) and Foa (PE) thought that the science would speak for itself, but they were wrong. Resick especially admits that she wished she'd focused more on marketing. I also think the neuroscience-y explanation is easier to buy into than CPT and, especially, PE. Not to mention the EMDR people now blatantly attack exposure, which is hilarious given that EMDR likely works because of exposure. You can find a lot of videos on TikTok from "trauma experts" that talk about how exposure doesn't work and is bad for patients.

The ethical issue with EMDR isn't so much that it doesn't work, but that EMDR costs bucketloads to train people in when it's essentially PE with bells and whistles, and PE is MUCH cheaper to get trained in. Apparently some people actually brought up that issue when EMDR was first developed, but it sounds like nothing came of it.

Also, as WisNeuro said, unfortunately the trauma field is chock full of floofy stuff that can even be worse than EMDR. I think it's because clinicians have a tendency to fragilize trauma patients. They'd rather try anything than make them feel distress. Also this trauma centrality concept where people think trauma is a part of them and how can we fix that over only 12 sessions?

On the other hand, purple wizard hats (to wear in therapy) are quite inexpensive.

Herbert, JD (2003). The science and practice of empirically supported treatments. Behavior Modification, 27(3) 412-430.

 

[R. Matey]

1) On a societal level, people have been instructed, since kindergarten, that they are special. "Brain" explanations make common problems sound complex, and special.

I think this has been in a thread before, but Sally Satel's book with Lilienfeld is a fascinating look at this phenomenon:

Amazon product

 

[ClinicalABA]

You might find some answers here:

http://www.appstate.edu/~bromanfulksj/Pratkanis%20-%20How%20to%20sell%20a%20pseudoscience.pdf

 

[cara susanna]

I've actually been really curious about the VA and EMDR, and it sounds like one of the biggest barriers to the VA implementing training for it is the cost and process to get clinicians trained. It's funny because, although that's how EMDR makes its money, those same barriers are making it harder for the VA to implement, which means that EMDR won't catch on as well in this setting (which as you know is a MAJOR trauma setting) until those are solved. I guess every pro has its con.

 

[ClinicalABA]

Not trying to excuse it, just trying to explain why it happens. That said, when entities like the APA or the VA do little to nothing to differentiate between these treatments and have endorsed EMDR at times, I will not hold every individual practitioner to a higher standard than them. I also will not practice EMDR when better treatments are available and I have been trained in them.

I don't know about this sentiment. I'd hope you'd hold me to a higher standard than "some authority says say so." I can take it!

 

[ClinicalABA]

Basically, EMDR has awesome marketing. Resick (CPT) and Foa (PE) thought that the science would speak for itself, but they were wrong. Resick especially admits that she wished she'd focused more on marketing. I also think the neuroscience-y explanation is easier to buy into than CPT and, especially, PE. Not to mention the EMDR people now blatantly attack exposure, which is hilarious given that EMDR likely works because of exposure. You can find a lot of videos on TikTok from "trauma experts" that talk about how exposure doesn't work and is bad for patients.

The ethical issue with EMDR isn't so much that it doesn't work, but that EMDR costs bucketloads to train people in when it's essentially PE with bells and whistles, and PE is MUCH cheaper to get trained in. Apparently some people actually brought up that issue when EMDR was first developed, but it sounds like nothing came of it.

Also, as WisNeuro said, unfortunately the trauma field is chock full of floofy stuff that can even be worse than EMDR. I think it's because clinicians have a tendency to fragilize trauma patients. They'd rather try anything than make them feel distress. Also this trauma centrality concept where people think trauma is a part of them and how can we fix that over only 12 sessions?

Exactly. I think ACT is a good example of this on the other end of the spectrum. The experimental basis for ACT comes largely from contextualist and their applications of relational frame theory, which traditionally falls more under the umbrella of ABA. Labelling it "Acceptance and Commitment Therapy" rather than something like "Relation Frame Based Intervention" or "Stimulus Equivalence Foundation Behavior Change" has resulted in a bunch of relatively "woo-supporting" clinicians doing what is, in essence, ABA. Masterful marketing!

 

[R. Matey]

Exactly. I think ACT is a good example of this on the other end of the spectrum. The experimental basis for ACT comes largely from contextualist and their applications of relational frame theory, which traditionally falls more under the umbrella of ABA. Labelling it "Acceptance and Commitment Therapy" rather than something like "Relation Frame Based Intervention" or "Stimulus Equivalence Foundation Behavior Change" has resulted in a bunch of relatively "woo-supporting" clinicians doing what is, in essence, ABA. Masterful marketing!

In my psychotherapy seminar, I remember we watched a video of Hayes trying to differentiate ACT from other behavioral therapies. IIRC, the reasons were quite tenuous so I left with the general impression that ACT is behaviorism + woo.

 

[counselor2b]

In my psychotherapy seminar, I remember we watched a video of Hayes trying to differentiate ACT from other behavioral therapies. IIRC, the reasons were quite tenuous so I left with the general impression that ACT is behaviorism + woo.

I feel like this is true of many different types of psychotherapy. It seems like many theories use similar approaches and just change it enough and rebadge it with a new shiny name.

 

[Sanman]

I don't know about this sentiment. I'd hope you'd hold me to a higher standard than "some authority says say so." I can take it!

Sure, but just you and @WisNeuro!

Seriously though, I hold folks to the standard of care. I recommend CPT and PE to anyone suffering with PTSD as gold standard care. However, if the APA is listing it as a standard treatment, I am not going to get as up in arms about it as someone who is thumbing through Dianetics as a tx for their PTSD. A lot of those mid-levels were just doing non-directive supportive hand holding before they learned EMDR anyway.

In other news, I am pioneering some studies on spin therapy. It is the same as PE, but you spin around in circles for 3 min at the beginning of the session. The spinning around resets your brain circuits. Early data looks promising for tx of ptsd.

 

[clausewitz2]

Sure, but just you and @WisNeuro!

Seriously though, I hold folks to the standard of care. I recommend CPT and PE to anyone suffering with PTSD as gold standard care. However, if the APA is listing it as a standard treatment, I am not going to get as up in arms about it as someone who is thumbing through Dianetics as a tx for their PTSD. A lot of those mid-levels were just doing non-directive supportive hand holding before they learned EMDR anyway.

In other news, I am pioneering some studies on spin therapy. It is the same as PE, but you spin around in circles for 3 min at the beginning of the session. The spinning around resets your brain circuits. Early data looks promising for tx of ptsd.

Gotta break the cycle of trauma, after all.

...I'll show myself out.

 

[ClinicalABA]

Sure, but just you and @WisNeuro!

Seriously though, I hold folks to the standard of care. I recommend CPT and PE to anyone suffering with PTSD as gold standard care. However, if the APA is listing it as a standard treatment, I am not going to get as up in arms about it as someone who is thumbing through Dianetics as a tx for their PTSD. A lot of those mid-levels were just doing non-directive supportive hand holding before they learned EMDR anyway.

In other news, I am pioneering some studies on spin therapy. It is the same as PE, but you spin around in circles for 3 min at the beginning of the session. The spinning around resets your brain circuits. Early data looks promising for tx of ptsd.

For many of my clients, excessive spinning is one of the presenting complaints!

 

[Sanman]

For many of my clients, excessive spinning is one of the presenting complaints!

Have you tried having them spin in the opposite direction?

 

[ClinicalABA]

I feel like this is true of many different types of psychotherapy. It seems like many theories use similar approaches and just change it enough and rebadge it with a new shiny name.

It's almost as if there were a few fundamental processes underlying the most common mental illnesses and that most therapeutic approaches eventually touch on those processes and lead to positive change. If only there were good methods for determining which components of those approaches were the most effective and most efficient, as well as professional and ethical guidelines that encouraged the use of those most effective and efficient components (winking face to denote sarcasm)! Instead, we must rely on marketing strategies.

 

[ClinicalABA]

Have you tried having them spin in the opposite direction?

A topic for another thread, but recent research/social validity work suggests that we really don't need to do anything about the spinning. Letting the kids spin (unless it's physically hurting them) is easier and just as effective in the long term as trying to get them to stop doing it. Good things, 'cause trying to stop kids from spinning is really hard to do!

 

[Sanman]

A topic for another thread, but recent research/social validity work suggests that we really don't need to do anything about the spinning. Letting the kids spin (unless it's physically hurting them) is easier and just as effective in the long term as trying to get them to stop doing it. Good things, 'cause trying to stop kids from spinning is really hard to do!

This is the answer with a lot of dementia behaviors as well.

 

[Justanothergrad]

Oh ... I supposed I'm going to have to buckle up.

Like, and wear a helmet. It's about to get down right absurd. I know local psychologists who, on the same page they describe therapy, offer Soul stones for sale. I wish EMDR was the biggest issue, but I do agree with your point of EST drift we should be wary of

 

[PsyDr]

Like, and wear a helmet. It's about to get down right absurd. I know local psychologists who, on the same page they describe therapy, offer Soul stones for sale. I wish EMDR was the biggest issue, but I do agree with your point of EST drift we should be wary of

What, in the Harry Potter, are “Soul stones”?!

 

[szymk1sm]

Like, and wear a helmet. It's about to get down right absurd. I know local psychologists who, on the same page they describe therapy, offer Soul stones for sale. I wish EMDR was the biggest issue, but I do agree with your point of EST drift we should be wary of

Haaa --- this makes we wonder if we know the same person 🤦🏻‍♀️

 

[WisNeuro]

What, in the Harry Potter, are “Soul stones”?!

Probably some Paltrow type absurdity where you have to put the stones in places they really shouldn't go.

 

[Sanman]

What, in the Harry Potter, are “Soul stones”?!

Probably some Paltrow type absurdity where you have to put the stones in places they really shouldn't go.

My immediate thought was that this must be on the west coast.

 

[psychma]

EMDR has been well-marketed as a cure all at this point. I have people with severe social anxiety who come to me demanding EMDR and somatic therapy. I do neither. They are offended by the suggestion of CBT which is seen as an evil therapy. I send them on their way. Hope somatic therapy works for you.

Or brain spotting. Yikes.

 

[Fan_of_Meehl]

What, in the Harry Potter, are “Soul stones”?!

They're useful items in both Diablo 2 and Grim Dawn.

 

[smalltownpsych]

EMDR has been well-marketed as a cure all at this point. I have people with severe social anxiety who come to me demanding EMDR and somatic therapy. I do neither. They are offended by the suggestion of CBT which is seen as an evil therapy. I send them on their way. Hope somatic therapy works for you.

Or brain spotting. Yikes.

Good job sending them on their way. As I alluded to in the thread on somatic experiencing, you probably don’t want these types of people in your practice anyway.