The APA & EDMR

[gohogwild]

I'm naive so bare with me- -

If EDMR is so atrocious, and a technique based in flawed literature, then why is it approved by the APA Practice Guidelines? I ask this in true ignorance, I would believe you if you told me that there was an EDMR lobby of sorts- but I was under the impression that the APA is the organization responsible for setting the standards of the field?

Do people pick and choose what they believe from the APA, and if so, what does that mean about what is kept and what is discarded? Or would the argument to my first point generally be that EDMR was accepted into the APA PGs because it's basically exposure with an outer shell?

On a personal note: one of my favorite profs was on the EDMR/Internal Family Systems/Psychodynamics train (clin psy phd, studied under Steven Gold who coined the term CPTSD) and now I am trying to figure out what I believe, personally.

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[WisNeuro]

RE: APA's "standards," have you seen some of the programs they accredit? Also, EMDR does actually do something with efficacy, it delivers an exposure therapy, unfortunately is also involves a debunked component. So, that's essentially what they are endorsing, for whatever good that endorsement is for.

 

[Sanman]

If I told you to sprinkle silver glitter all over yourself and spin around in circles ten times to reset your brain circuitry and then undergo a course of exposure therapy, would I be a bad therapist for telling you that glitter and spinning around resets your brain or a good therapist because I engaged you in exposure therapy for your problem? This is quandary of EMDR.

 

[JustNoticing]

Yep, EMDR's marketing and it not coming from traditional academic routes is a part of its success/brand recognition in comparison to more traditional PTSD treatments. That it is heavily marketed and hyped and rooted in questionable science does not mean it doesn't work though, as others above have noted. So I wouldn't call it atrocious, but I would question those who stake their professional identity solely on that treatment when others are available.

 

[psych.meout]

I'm naive so bare with me- -

If EDMR is so atrocious, and a technique based in flawed literature, then why is it approved by the APA Practice Guidelines? I ask this in true ignorance, I would believe you if you told me that there was an EDMR lobby of sorts- but I was under the impression that the APA is the organization responsible for setting the standards of the field?

Do people pick and choose what they believe from the APA, and if so, what does that mean about what is kept and what is discarded? Or would the argument to my first point generally be that EDMR was accepted into the APA PGs because it's basically exposure with an outer shell?

On a personal note: one of my favorite profs was on the EDMR/Internal Family Systems/Psychodynamics train (clin psy phd, studied under Steven Gold who coined the term CPTSD) and now I am trying to figure out what I believe, personally.

Not sure that's something to brag about.

 

[gohogwild]

Not sure that's something to brag about.

Fair enough- just giving context to the strength of belief from my information source.

 

[gohogwild]

Yep, EMDR's marketing and it not coming from traditional academic routes is a part of its success/brand recognition in comparison to more traditional PTSD treatments. That it is heavily marketed and hyped and rooted in questionable science does not mean it doesn't work though, as others above have noted. So I wouldn't call it atrocious, but I would question those who stake their professional identity solely on that treatment when others are available.

Although Shapiro's training program is no longer accredited, with her being a trained clinical psychologist and working in the academic sphere- how would that make the origin of EDMR nontraditional?

 

[gohogwild]

If I told you to sprinkle silver glitter all over yourself and spin around in circles ten times to reset your brain circuitry and then undergo a course of exposure therapy, would I be a bad therapist for telling you that glitter and spinning around resets your brain or a good therapist because I engaged you in exposure therapy for your problem? This is quandary of EMDR.

Quandary, indeed.

 

[gohogwild]

RE: APA's "standards," have you seen some of the programs they accredit? Also, EMDR does actually do something with efficacy, it delivers an exposure therapy, unfortunately is also involves a debunked component. So, that's essentially what they are endorsing, for whatever good that endorsement is for.

Interested to hear more about the accredited programs you find unacceptable, if you're open to sharing.

 

[psych.meout]

Although Shapiro's training program is no longer accredited, with her being a trained clinical psychologist and working in the academic sphere- how would that make the origin of EDMR nontraditional?

Francine Shapiro has been dead for years.

 

[gohogwild]

Francine Shapiro has been dead for years.

Never implied she was alive, gerund can be past tense.

 

[WisNeuro]

Interested to hear more about the accredited programs you find unacceptable, if you're open to sharing.

High cohort, minimal mentorship, terrible match rates, low EPP pass rate, high cost. Essentially, programs that manufactured an "internship crisis" due to their putrid match rates that lead to APA having to scramble to create a large number of new internship slots/programs to accommodate. Many of these programs also happened to be financial sponsors of APA. Make what you will of donating large amounts of money to the organization that accredits you and whether or not that represents a serious conflict of interest or not.

 

[cara susanna]

As you mentioned, EMDR IS effective. That's why it's recommended as a top tier therapy even by the DoD/VA PTSD guidelines. The problem isn't so much "does EMDR work?" but "how does EMDR work?" or "does EMDR work better than PE or CPT?" Regarding the latter question, supposedly Shapiro refused to do comparison studies with PE or CPT, but that research is now being done and will be forthcoming. From what I've heard, it sounds like EMDR works as well but doesn't have as lasting effects.

I do think there are some politics involved, though. Especially with the VA/DoD, because my understanding was that there is very little actual evidence of EMDR being effective at treating combat-related PTSD. APA is especially beholden to politics, because remember that they do public commentary and a lot of input from practitioners. I remember when the PTSD guidelines were open for commentary and there was a TON of controversy because practitioners were furious that their therapy of choice wasn't being recommended.

 

[smalltownpsych]

Add one more reason why I am no longer a member of APA. Endorsing a therapy that seems to be preferred by the people who don’t understand research shows that they don’t really represent psychologists very well.

 

[WisNeuro]

Add one more reason why I am no longer a member of APA. Endorsing a therapy that seems to be preferred by the people who don’t understand research shows that they don’t really represent psychologists very well.

As part of the overly broad push to promote inclusivity, APA has decided that those who believe in and practice pseudoscience also need their voices heard. They're just telling their "truth."

 

[Shiori]

It feels more like what happened to Ticketmaster when they pissed off the Swifties.

 

[WisNeuro]

It feels more like what happened to Ticketmaster when they pissed off the Swifties.

The Acolytes of the Cult of Shapiro/EMDR are not unlike Swifties in their undying devotion to their messiah and scripture. Much like the proclivity of Swifties to spend thousands of dollars on concert tickets and merch that most people would find absurd, Shapiro Cultists will spend countless thousands on workshops and "specialized equipment" to further their devotion, despite the lack, if not outright debunking evidence to the contrary.

 

[gohogwild]

The Acolytes of the Cult of Shapiro/EMDR are not unlike Swifties in their undying devotion to their messiah and scripture. Much like the proclivity of Swifties to spend thousands of dollars on concert tickets and merch that most people would find absurd, Shapiro Cultists will spend countless thousands on workshops and "specialized equipment" to further their devotion, despite the lack, if not outright debunking evidence to the contrary.

Just a thought, but I'm sure CBT therapists buy 'special equipment' (e.g. pre-made homework sheets) for their practice, too. Francine Shapiro's original methodology was with the client's eyes following the clinician's fingers. Just because there's secondary by-products or people wanna invest in unnecessary gadgetry doesn't make the whole thing an MLM. Pretty sure EDMR was created in good faith and was not the long game of the flashlight industry.

 

[gohogwild]

Add one more reason why I am no longer a member of APA. Endorsing a therapy that seems to be preferred by the people who don’t understand research shows that they don’t really represent psychologists very well.

Would you care to expand? I'm especially interested since you've expressed that you are a mostly psychodynamically oriented psychologist in the past.

 

[WisNeuro]

Just a thought, but I'm sure CBT therapists buy 'special equipment' (e.g. pre-made homework sheets) for their practice, too. Francine Shapiro's original methodology was with the client's eyes following the clinician's fingers. Just because there's secondary by-products or people wanna invest in unnecessary gadgetry doesn't make the whole thing an MLM. Pretty sure EDMR was created in good faith and was not the long game of the flashlight industry.

I'm sure things like "Neurological Chiropracty" were created in some form of good faith as well. doesn't make it any less culty, scammy, and/or ripe for taking advantage of people. Re: EMDR, there's good evidence that she actually built it from groundwork of NLP, which was debunked even when she was embracing it.

 

[PsychSupreme]

One thing that is frustrating about the APA is that it is so fragmented in many ways. On the one hand, there's what the org as a whole has to say, but on the other hand, there are a million divisions which are often seemingly at odds with other or with the org as a whole. I mean, APA endorses psychology as a science but allows for the existence of a division for psychoanalysis (Div. 39). For what it's worth, I don't think EMDR is considered a "well-supported" treatment by Div. 12, which as far as I know uses the Tolin et al. (2015) criteria for judging evidence-based practices.

My somewhat petty dream would be for APS to replace APA as the chief professional organization of the field, but APA is too old and too engrained for that to happen.

EDIT: It appears the current listing for EMDR in Div. 12's list of treatments is "pending updates," but the summary is heavy in the direction of deeming it a Purple Hat therapy:

Eye Movement Desensitization and Reprocessing for Post-Traumatic Stress Disorder | Society of Clinical Psychology

div12.org

 

[PsychSupreme]

I decided to go down the rabbit hole a bit--the division of Trauma Psychology's website has a repository of suggested syllabi for use in undergrad and graduate courses, and their syllabus for "Trauma and Dissociation" is the syllabus used by the Wisconsin School of Professional Psychology, which lists Levin's Waking the Tiger as suggested reading (i.e., it suggests reading about somatic experiencing!).

sy_trauma_and_dissociation.pdf

 

[WisNeuro]

I decided to go down the rabbit hole a bit--the division of Trauma Psychology's website has a repository of suggested syllabi for use in undergrad and graduate courses, and their syllabus for "Trauma and Dissociation" is the syllabus used by the Wisconsin School of Professional Psychology, which lists Levin's Waking the Tiger as suggested reading (i.e., it suggests reading about somatic experiencing!).

sy_trauma_and_dissociation.pdf

Having lived/worked in WI in the past, I can safely say I would not trust any class recommendation or provider out of that program.

 

[borne_before]

Could yall imagine what the EMDR therapists would be doing instead? At least a good chunk is solid. EMDR is here, at least it works, but not for the eye wiggling.

 

[WisNeuro]

Could yall imagine what the EMDR therapists would be doing instead? At least a good chunk is solid. EMDR is here, at least it works, but not for the eye wiggling.

They could just adapt PE or CPT to their patient instead.

 

[PsychSupreme]

Having lived/worked in WI in the past, I can safely say I would not trust any class recommendation or provider out of that program.

Yeah, I was hoping the reference to WSPP was enough to raise eyebrows on its own, but the further recommendation to read Levine goes beyond eyebrows and into eye rolls.

 

[cara susanna]

I decided to go down the rabbit hole a bit--the division of Trauma Psychology's website has a repository of suggested syllabi for use in undergrad and graduate courses, and their syllabus for "Trauma and Dissociation" is the syllabus used by the Wisconsin School of Professional Psychology, which lists Levin's Waking the Tiger as suggested reading (i.e., it suggests reading about somatic experiencing!).

sy_trauma_and_dissociation.pdf

I'm a member of Div 56 but it is FLOOFY. The listserv has me raising my eyebrows or rolling my eyes quite a bit.

 

[gohogwild]

I'm a member of Div 56 but it is FLOOFY. The listserv has me raising my eyebrows or rolling my eyes quite a bit.

 

[psych.meout]

Having lived/worked in WI in the past, I can safely say I would not trust any class recommendation or provider out of that program.

When I was applying to grad school, a fellow applicant at one of the program interviews eventually ended up going to WSPP and was exactly the kind of person you'd think would go there.

 

[borne_before]

Yeah, I was hoping the reference to WSPP was enough to raise eyebrows on its own, but the further recommendation to read Levine goes beyond eyebrows and into eye rolls.

Can we all follow apa rules here. Jk. I’m just a lowly autism tester. What’s is wspp?

 

[ClinicalABA]

...I’m just a lowly autism tester...

Hey! Watch yourself with that stuff!

Not certain, but maybe wspp= wisconsin school of professional psych?

 

[PsychSupreme]

Can we all follow apa rules here. Jk. I’m just a lowly autism tester. What’s is wspp?

Wisconsin School of Professional Psychology. @ClinicalABA got it

 

[smalltownpsych]

Would you care to expand? I'm especially interested since you've expressed that you are a mostly psychodynamically oriented psychologist in the past.

Just to be clear. Although I find psychodynamic concepts to be useful in conceptualizing and tailoring interventions, the interventions are based on solid research based findings. I focus more on things like the neurobiology of attachment and how some psycho dynamic constructs relate to actual neurological functions than I do on some of the outdated misconceptions of Freud for example. My training was very much guided by the cross pollination of psychodynamic thought from my program and the close relationship they had with folks like Alan Schore at UCLA so it was a little unique.

As far as APA goes, my first frustration with them was related to firstly I supporting torture and then condemning torture and appearing to get too involved in political stuff. They also don’t seem to do a very good job with promoting our profession and are too inclusive and nice in regards to encroachment from midlevels and diploma mill type operations as opposed to helping us to assert and own our leadership role in the field.

 

[Peacemaker36]

Yup. In addition to putting way too much focus on political views, APA also had that class action lawsuit because they told members that a "special assessment" fee was mandatory when in fact it was not:

https://caselaw.findlaw.com/court/us-dc-circuit/1677338.html

But I'm still a member of APA and my state chapter. They don't seem to do a great job, but they do accomplish some things, and there is no one else advocating for psychologists. We need a "seat at the table."

 

[Fan_of_Meehl]

Just a thought, but I'm sure CBT therapists buy 'special equipment' (e.g. pre-made homework sheets) for their practice, too. Francine Shapiro's original methodology was with the client's eyes following the clinician's fingers. Just because there's secondary by-products or people wanna invest in unnecessary gadgetry doesn't make the whole thing an MLM. Pretty sure EDMR was created in good faith and was not the long game of the flashlight industry.

Actually, I consider myself 'a CBT' therapist with many years experience and I think one of the selling points of the approach is that no special equipment is required (or even recommended). A simple dry erase board is the fanciest I ever got along with some blank pieces of paper and pencils/pens. The best 'worksheets' are customized and based on a firm grounding in the theory underlying effective change principles giving the specific case formulation for a specific client (and their responses so far).

 

[Fan_of_Meehl]

They could just adapt PE or CPT to their patient instead.

You'd be amazed how many blank stares from veterans I get when I respond to their requests for 'service dogs' to 'treat' their PTSD with psychoeducation on the underlying principles of change in PTSD (and improvement) involving primarily exposure (of which PE is the exemplar treatment) and/or cognitive restructuring (of which CPT is the exemplar treatment) and--according to that understanding (my understanding)--I have no reason to believe that a service dog would be helpful or effective for PTSD and, in fact, would most likely be counterproductive in the following ways:

(a) because it serves as a 'safety behavior' (maintaining avoidance of facing the Walgreens without the dog 'watching your six for attackers')
(b) because it is consistent with a 'stuck point' interfering with natural recovery ('If I don't have my service dog 'watching my six' at the local Walgreens, then I will be attacked/hurt')

 

[WisNeuro]

You'd be amazed how many blank stares from veterans I get when I respond to their requests for 'service dogs' to 'treat' their PTSD with psychoeducation on the underlying principles of change in PTSD (and improvement) involving primarily exposure (of which PE is the exemplar treatment) and/or cognitive restructuring (of which CPT is the exemplar treatment) and--according to that understanding (my understanding)--I have no reason to believe that a service dog would be helpful or effective for PTSD and, in fact, would most likely be counterproductive in the following ways:

(a) because it serves as a 'safety behavior' (maintaining avoidance of facing the Walgreens without the dog 'watching your six for attackers')
(b) because it is consistent with a 'stuck point' interfering with natural recovery ('If I don't have my service dog 'watching my six' at the local Walgreens, then I will be attacked/hurt')

Oh, I've been there. I still did therapy when I was in the VA. I've had similar conversations with Vets. I would still see them, but always informed them that the service dog most likely puts a low ceiling on their treatment progress. So, as long as they were ok only getting a fraction of improvement, we could work with that to some extent.

 

[smalltownpsych]

You'd be amazed how many blank stares from veterans I get when I respond to their requests for 'service dogs' to 'treat' their PTSD with psychoeducation on the underlying principles of change in PTSD (and improvement) involving primarily exposure (of which PE is the exemplar treatment) and/or cognitive restructuring (of which CPT is the exemplar treatment) and--according to that understanding (my understanding)--I have no reason to believe that a service dog would be helpful or effective for PTSD and, in fact, would most likely be counterproductive in the following ways:

(a) because it serves as a 'safety behavior' (maintaining avoidance of facing the Walgreens without the dog 'watching your six for attackers')
(b) because it is consistent with a 'stuck point' interfering with natural recovery ('If I don't have my service dog 'watching my six' at the local Walgreens, then I will be attacked/hurt')

I always tell patients that if they want to get a dog, then get a dog. I like animals myself, although I also tell them that I tend to prefer cats and find their purring to be soothing. Then I make it clear that they can’t come to the office and then will explain the a) and b) part of that is part of their rationale.

 

[cara susanna]

You'd be amazed how many blank stares from veterans I get when I respond to their requests for 'service dogs' to 'treat' their PTSD with psychoeducation on the underlying principles of change in PTSD (and improvement) involving primarily exposure (of which PE is the exemplar treatment) and/or cognitive restructuring (of which CPT is the exemplar treatment) and--according to that understanding (my understanding)--I have no reason to believe that a service dog would be helpful or effective for PTSD and, in fact, would most likely be counterproductive in the following ways:

(a) because it serves as a 'safety behavior' (maintaining avoidance of facing the Walgreens without the dog 'watching your six for attackers')
(b) because it is consistent with a 'stuck point' interfering with natural recovery ('If I don't have my service dog 'watching my six' at the local Walgreens, then I will be attacked/hurt')

I give the same spiel and most people are receptive, but I've also gotten fired by patients over this.

 

[Sanman]

I give the same spiel and most people are receptive, but I've also gotten fired by patients over this.

Is it wrong that when patients fire me I am usually relieved? A major headache is usually avoided this way. Never been fired by a reasonable patient.

 

[clausewitz2]

Is it wrong that when patients fire me I am usually relieved? A major headache is usually avoided this way. Never been fired by a reasonable patient.

Ohnopleasedon'twhatashame

 

[cara susanna]

Is it wrong that when patients fire me I am usually relieved? A major headache is usually avoided this way. Never been fired by a reasonable patient.

I'm relieved but it still doesn't feel great, lol

 

[smalltownpsych]

Developing the skill to get rid of toxic patients that don’t want to change is a skill they don’t teach in grad school.
Learning to set boundaries and not get sucked into manipulative patterns is mostly something I had to do for my own personal growth even before I started training. I have seen that many of our colleagues are not very good at it either and in fact they tend to be even “nicer“ aka more vulnerable than myself. A couple of tips are the broken record technique and recognizing that No is a complete sentence. I calmly tell the patient no and briefly why and then when I feel that they are just trying to get me to do something I don’t want to do then I repeat this until they leave. Sometimes I will do this without affect and sometimes in a friendly manner depending on which seems least likely to escalate. A few times I have had to be authoritative and loud and clear and sharp but that is very rare and more of a last resort.

 

[aim-agm]

Developing the skill to get rid of toxic patients that don’t want to change is a skill they don’t teach in grad school.
Learning to set boundaries and not get sucked into manipulative patterns is mostly something I had to do for my own personal growth even before I started training. I have seen that many of our colleagues are not very good at it either and in fact they tend to be even “nicer“ aka more vulnerable than myself. A couple of tips are the broken record technique and recognizing that No is a complete sentence. I calmly tell the patient no and briefly why and then when I feel that they are just trying to get me to do something I don’t want to do then I repeat this until they leave. Sometimes I will do this without affect and sometimes in a friendly manner depending on which seems least likely to escalate. A few times I have had to be authoritative and loud and clear and sharp but that is very rare and more of a last resort.

"This is my decision. I am happy to explain and discuss the decision and where we go from here, but we are not going to debate the decision nor is it going to change."

 

[Sanman]

Developing the skill to get rid of toxic patients that don’t want to change is a skill they don’t teach in grad school.
Learning to set boundaries and not get sucked into manipulative patterns is mostly something I had to do for my own personal growth even before I started training. I have seen that many of our colleagues are not very good at it either and in fact they tend to be even “nicer“ aka more vulnerable than myself. A couple of tips are the broken record technique and recognizing that No is a complete sentence. I calmly tell the patient no and briefly why and then when I feel that they are just trying to get me to do something I don’t want to do then I repeat this until they leave. Sometimes I will do this without affect and sometimes in a friendly manner depending on which seems least likely to escalate. A few times I have had to be authoritative and loud and clear and sharp but that is very rare and more of a last resort.

It is a big reason that private practice is appealing. When the institutions you work for will not enforce healthy boundaries for employees, it is harder to do so. I have taken a harder line of this as I have gotten older, but this is more a function of my level of financial stability than any external influence.

 

[texanpsychdoc]

People love the bells and whistles (and strobe lights) involved with EMDR...basically it's the fidget spinner of trauma-focused treatments. There are components of it that are helpful, but are also seen in other more well-established therapies such as CBT, CPT. For example, the exposure and cog. restructuring element is CBT in essence, so....why not just do CBT or CPT, or exposure therapy? Because strobe lights Everybody loves strobe lights. Back at the VA, I would take on clients who went through rounds of EMDR only to show up on my doorstep because it seemed like a good idea at the time, but also left them more messed up than when they came in, especially with a lot of unresolved trauma stuff that went beyond the scope of EMDR. Thus, I would run them through a course of CPT and that tended to help more.

Now that I am in private practice, I scour the Facebook referral pages for therapy and constantly see (typically from master's level providers) such as "MUST BE EMDR TRAINED" and that tends to be the more popular therapy with those level of clinicians. Makes sense when you only went through 2 years of grad school. And I basically just shake my head and then keep on scrolling to see more atrocious advertisements "MUST BE TRAINED IN BRAIN SPOTTING." Again...brought to you by the LPCs and LCSWs who all swear by EMDR.

 

[texanpsychdoc]

WEll...I thought I had seen it all, but nope, life was like "hold my beer." This morning I stumbled across one of the several Facebook groups I belong to for therapy referrals and I kid you not this is what one member posted:

"ISO a clairvoyant medium recommendation to help in processing loss and grief."

I just cant'.....

 

[smalltownpsych]

People love the bells and whistles (and strobe lights) involved with EMDR...basically it's the fidget spinner of trauma-focused treatments. There are components of it that are helpful, but are also seen in other more well-established therapies such as CBT, CPT. For example, the exposure and cog. restructuring element is CBT in essence, so....why not just do CBT or CPT, or exposure therapy? Because strobe lights Everybody loves strobe lights. Back at the VA, I would take on clients who went through rounds of EMDR only to show up on my doorstep because it seemed like a good idea at the time, but also left them more messed up than when they came in, especially with a lot of unresolved trauma stuff that went beyond the scope of EMDR. Thus, I would run them through a course of CPT and that tended to help more.

Now that I am in private practice, I scour the Facebook referral pages for therapy and constantly see (typically from master's level providers) such as "MUST BE EMDR TRAINED" and that tends to be the more popular therapy with those level of clinicians. Makes sense when you only went through 2 years of grad school. And I basically just shake my head and then keep on scrolling to see more atrocious advertisements "MUST BE TRAINED IN BRAIN SPOTTING." Again...brought to you by the LPCs and LCSWs who all swear by EMDR.

It is everywhere. It is hard not to react when I hear these clinicians talk about EMDR. I met with a local PMHNP and LMFT the other day to discuss coordinating care with some mutual patients and they touted their skills with EMDR and holistic medicine and genetic testing. All they have to do now is add in brain scans to the mix so that they can seek the pretty pictures.

 

[Fan_of_Meehl]

WEll...I thought I had seen it all, but nope, life was like "hold my beer." This morning I stumbled across one of the several Facebook groups I belong to for therapy referrals and I kid you not this is what one member posted:

"ISO a clairvoyant medium recommendation to help in processing loss and grief."

I just cant'.....

Did you post the link to Wizards of the Coast (publishers of Dungeons & Dragons)?

 

[WisNeuro]

Did you post the link to Wizards of the Coast (publishers of Dungeons & Dragons)?

We should create APA Division 57: The Division of Woo