EMDR FOR TRAUMA: EYE MOVEMENT DESENSITIZATION AND

REPROCESSING with Francine Shapiro, PhD

Item # 4310440
$69.95 members/affiliates
$99.95 non-members

Purpose of the Series

The American Psychological Association Psychotherapy Video Series II presents distinguished
psychotherapists of different theoretical orientations demonstrating specific treatments for specific problems
and populations. Designed for clinical training as well as for continuing education, the videotapes show
spontaneous and unscripted sessions, typically representing the third or fourth session in an ongoing course of
psychotherapy and typically lasting 40 to 50 minutes. The clients are portrayed by professional actors on the
basis of real case materials.
The session you will view attempts to capture the therapy approach and clinical style in as close to real
circumstances as possible.
Toward this end, a number of steps were taken to ensure that both the therapist and the client were anchored,
conceptually and experientially, in the clinical material, each other, and previous sessions. First, therapists
indicated the type of client and clinical problem with which they typically work or believed allowed the best
demonstration of their approach. Second, a client profile was independently developed that included
demographic data, clinical history, presenting problem, precipitating event, and other background information.
Third, the therapist reviewed this profile for its representativeness and then described what he or she typically
would do and would have hoped to accomplish in the first two or three sessions. Fourth, professional actors
adept at improvisation were immersed in this clinical history and presentation through formal role induction of
the actors by an independent practitioner, to ensure that the actor had both a cognitive understanding and an
experiential sense of what the client was struggling with, thinking, and feeling. Finally, the actor (in role) and
the therapist reviewed the content and process of their earlier sessions immediately before the videotaping so
that they were both anchored in context of the course to date of the particular therapeutic relationship.

About Dr. Shapiro

Francine Shapiro, PhD, is the originator and developer of EMDR (Eye Movement Desensitization and
Reprocessing), and is a senior research fellow at the Mental Research Institute in Palo Alto, California. She
serves as the Executive Director of the EMDR Institute in Pacific Grove, California, and of the EMDR
Humanitarian Assistance Program, a nonprofit organization that coordinates disaster response and provides
pro bono trainings worldwide.
Dr. Shapiro has written over 30 articles and book chapters and 2 books about EMDR, Eye Movement
Desensitization and Reprocessing (1995) and EMDR (1997). She has been an invited presenter at major
psychology conferences over the past 10 years and was awarded the 1993 Distinguished Scientific
Achievement in Psychology Award by the California Psychological Association.
Dr. Shapiro's primary area of interest over the course of her career has been developing a comprehensive
treatment approach that integrates the unique contributions of the major psychotherapeutic orientations. As a
clinical psychologist, she believes that the major challenge confronting the profession is to find a way to close
the gap between science and practice. Toward this end, she has long advocated for the standard incorporation
of accepted clinical standards into psychotherapy outcome research.

EMDR for Trauma Synopsis of Therapy Approach

EMDR (Eye Movement Desensitization and Reprocessing) is a complex treatment approach that combines
salient elements of the major therapeutic schools (e.g., cognitive, behavioral, psychodynamic, physiological,

and interactional). Although the eye movement stimulation (and other forms of dual stimulation used in the
approach) have garnered the most attention professionally and publicly, EMDR actually involves a much
broader spectrum of interventions, which are organized into eight phases of therapy. Currently, 13 completed
controlled studies of EMDR make it one of the most researched methods of psychotherapy used in the
treatment of trauma. Its efficacy has been supported by these studies: the four most recent studies of victims
who have suffered single traumas have demonstrated that after the equivalent of three 90-minute sessions,
84% to 90% of patients no longer have symptoms of posttraumatic stress disorder (PTSD; Rothbaum, 1997;
Wilson, Becker, & Tinker, 1995).
EMDR is based on the assumption that specific experiences from the past continue to guide the client's
responses in the present. These experiences can be the "big T" traumas that result in PTSD or the "small t"
traumas that are the ubiquitous experiences known to have a less dramatic but still negative impact on
personality and behavior.
To influence such experiences from the past, EMDR draws on an information processing model of behavior.
Conceptually, disturbing trauma-related information is believed to be held in the patient's nervous system in
state-dependent form (e.g., the perceptions and sensations experienced at the time of the trauma are encoded
in the nervous system). EMDR allows the processing of this information in an adaptive fashion so that what is
useful from the experience can be learned; stored appropriately, cognitively, and affectively; and made
available for behavioral guidance in the future. What is useless to adaptation, such as excess negative
emotions, irrational self-assessments, and disturbing physical sensations, can be discarded.
Assessment is focused not on global diagnoses but rather on specific delineations of problematic behaviors,
attitudes, and affects that need to be transmuted to allow for adaptive resolution of trauma or conflict.
Specifically, the EMDR clinician asks, what is the patient being influenced by past experiences to do in the
present that is dysfunctional and what is he or she prevented from doing that would be adaptive?
Although originally applied to PTSD, EMDR shows promise in a variety of clinical complaints that are based on
earlier life experiences that underlie the pathology and current experiences and that restimulate the
disturbance. EMDR allows clients to access and reprocess these experiences as well as to learn new skills
and behaviors for managing future life events. In all cases, the goal of EMDR is to produce the most
comprehensive and profound treatment effects in the shortest period of time, while helping the client to remain
reasonably stable.
EMDR as an eight-phase intervention approach can be considered a complete treatment in some clinical
cases, or it may be part of a more complex treatment plan that includes other more traditional approaches to
treating a specific pathology (e.g., borderline personality disorder). Within this latter integrative context, EMDR
appears to be useful for a broad range of clinical complaints and seems to provide more rapid achievement of
positive treatment effects than do these more traditional approaches alone.
Dr. Shapiro identifies her approach as "eye movement desensitization and reprocessing." What does this imply
to you? More specifically, what do you expect of her? Will Dr. Shapiro be active or passive? Will the session be
structured or unstructured? Directive or nondirective? Will it focus on the past or on the present? Will the
session focus on behaviors, on thoughts, or on feelings? What do you expect to be the relative balance
between attention to technique versus the interpersonal interaction?

Client Background and Precipitating Events

Matthew (Matt) Labokas

Age: 42
Sex: Male
Race: Caucasian
Marital Status: Married
Children: Two daughters (18 and 20 years old), both in college
Education: High school graduate
Occupation: Retired Police Officer; currently working security in a
department store
Parents: Father deceased; mother alive and living with patient's
youngest sister
Siblings: Three brothers (younger); One sister (younger)

Matt entered treatment 6 months after he had retired from the police force, when his wife insisted that he
obtain a job and seek psychological help or she was going to leave him. He told her he would get a job first
and if that didn't help, he would seek treatment. He started work as a security guard, but 2 weeks later he felt
as if his world were falling apart. He was having difficulty managing a job that under other circumstances he
would see as a "no brainer." He had difficulty sleeping, had nightmares when he did sleep, and was subject to
frequent panic attacks at work. At the end of those 2 weeks he was convinced that he needed help.
Matt's retirement from the police force's homicide division occurred after 24 years of dedicated, outstanding
service. He had worked long hours throughout his career and took great pride in the cases that he had solved;
however, he also felt relentless guilt for those cases to which he was assigned that went unsolved. Although he
had always promised his wife he would retire after 20 years, it took the line-of-duty death of his partner to
precipitate his leaving the force.
A third-generation Lithuanian, and the oldest of five children, Matt grew up with a father who was a police
officer and a mother who worked at home raising the children. According to Matt, there "was never enought
money," as his father had a penchant for drinking and gambling (e.g., playing the numbers), but he was a
happy drunk and generous whenever his number paid off. Matt's father had not wanted Matt to become a
police officer because of the danger and the relatively low pay. When Matt graduated from high school, they
struck a bargain that Matt would go to college for 2 years. If, after that, he wanted to join the police force, his
father promised to support the decision. However, his father died of a sudden heart attack the summer after
Matt graduated high school. Matt decided to join the police force immediately, at age 18.
Matt married his wife, Lucy, 2 years after joining the force, and 2 years later they had the first of their two
daughters. Matt started as a patrolman, like his father. He was nervous on entering the force and was grateful
when he was assigned a partner, John, several years his senior, who took him under his wing, taught him what
was important on the job and what was not, and socialized with him after hours. Matt idealized John for their
first 2 years as partners; John's only fault seemed to be his prejudice against Hispanics, who formed a large
proportion of the population on their beat.
One night Matt and John responded to a breaking and entering call from a house in a wealthy neighborhood.
They apprehended a young Hispanic male scaling the fence around the swimming pool, his pockets filled with
jewelry. John pinned down the suspect, then handcuffed him and led him to the fence. Matt went to radio for
help. Before Matt got to the patrol car, he heard a gunshot. He hesitated for a moment before turning back, and
when he heard a second shot he radioed quickly and ran back. The prisoner lay face down, 50 feet from the
swimminig pool, with a bullet in his back.
Matt's first feeling was relief that it was the prisoner, not his partner, who was dead. But his second thought
was a more suspicious one: His last memory was of John handcuffing the prisoner; how did the prisoner end
up dead? Matt turned to John, who looked oddly unemotional given what had just occurred. "What the hell
happened?" asked Matt.
"I was handcuffing him to the fence," John said, "and the son of a bitch broke free and ran. I shouted for him to
stop but he didn't so I shot a warning. He kept running, so I fired at him. I didn't mean to kill him, man, only to
stop him. Jesus, I'm going to catch hell for this one."

Something about the way John avoided looking at him Matt feel sick. If the man hadn't been Hispanic, Matt
thought, maybe he would still be alive. Matt continued to work with John for the next several weeks but found
he could no longer talk or joke with him. He finally asked John to request a change in partners. The fact that
John agreed to do this without question seemed to confirm Matt's worst fears about John. Matt never told
anyone about the shooting incident, and, when questioned by Internal Affairs, he did not share his suspicions
with them, although he later felt guilty for not speaking.
Soon after, Matt decided to do what was needed to become a homicide detective. He wanted "to be part of the
solution," he told his wife Lucy, "instead of part of the problem." His devotion to this new aspiration kept him
away from home even more, but Lucy was understanding, despite just having had a second child. He was
doing it in part, they both thought, so that their financial future would be brighter.
A few years later, Matt was assigned to the homicide division, where he was highly successful. His rate of
solving murders was above average, in part due to his working many hours overtime, always going the extra
mile to find the perpetrator of what would prove to be many heinous crimes. With two young daughters to care
for, Lucy was less understanding of his absences from home. she was, however, proud of his success and the
fact that, when he was home, he spent as much time as possible with their daughters. Whenever Lucy would
complain, Matt would promise that he would retire as soon as he had 20 years. When 20 years came and
went, and he was still working overtime, their marriage became extremely strained. Both daughters were in
college, and Matt used this as a reason for not retiring: now more than ever they needed the money.
Lucy suggested that she take a full-time job as manager of the retail store where she had worked part-time
since their daughters were in high school. That way, Matt could afford to retire. When Matt refused to even
consider this, Lucy told him that she would work full-time if she wanted to, since he had always done what he
wanted.
After an initial tense period, Lucy's new job actually seemed to decrease tension in the house; her self-esteem
grew as her success as manager was confirmed. She no longer complained about Matt's long hours on the
job.
In his 21st year on the force, Matt was assigned a new partner, Sam, who was younger than Matt but who had
been a successful homicide detective on the east coast; his specialty had been organized crime. Matt had
never met such a bright, effective, but friendly detective. Sam encouraged Matt to work fewer hours on the job,
suggesting that if he learned to work "smarter" he wouldn't have to work longer. Together, their success rate
was much higher than either had achieved with previous partners.
In May of Matt's last year on the force, he and Sam were working on a drug-related case, which was not
unusual. What was unusual was Sam's intensity about this particular case. Sam seemed to see it as his case
alone, and he kept Matt in the dark about certain information, about which Matt would learn a few days later.
They argued about this, which was also unusual. One night, Sam, acting alone and without telling Matt, set up
a sting operation that went bad. His bludgeoned body was found floating in the river the next day. Matt insisted
on seeing Sam's corpse in the morgue. Even after all his years of seeing dead bodies, he left the morgue
vomiting.
Thereafter, Matt became extremely depressed and contemplated suicide. Crying in bed, after he thought Lucy
had gone to sleep, Matt heard her quietly say, "Matt, don't you think you've had enough, that we've had
enough? Isn't it time for us to have a life?" These words seemed a miraculous solution to him, and he heard
the option of retirement as if for the first time. His depression lifted; he felt like a new man. Within a month, he
had retired with full benefits.
The honeymoon with retirement lasted only 2 weeks, however. Matt then became irritable and morose, and he
focused his complaints on the amount of time Lucy worked. Even though she was away only 40 hours a week,
it seemed much longer to him, and he began harassing her to quit her job. When she refused, they argued
heatedly. After these arguments, Matt would suddenly feel anxious for Lucy's safety and began insisting that he
drive her to and from work. This relieved some anxiety and gave some structure to his day. But soon he began
worrying about her safety on the job, and he would check on her multiple times during a day. At first tolerant,
Lucy became embarrassed and angry as the frequency of his visits increased. That is when she finally told him
that he needed to go to work and seek psychological help or she would move out.

He applied for a job in the K-Mart near his wife's store. She was not happy about his proximity, but at least he
was occupied during the day. Matt, however, was surprised that he felt completely inadequate on the job. He
couldn't think clearly or apply his police experience to the new situation. The store had a large Hispanic
clientele, and he felt very uncomfortable when he suspected one of the Hispanic customers of shoplifting.
Images of the long-forgotten Hispanic male his partner had shot came to him unbidden. He began to have
panic attacks, which he thought at first were heart attacks until that was ruled out. His sleep, never normal,
became even worse, and he was usually up at 3 a.m., awakening from a nightmare in which Sam, looking
physically like he did in the morgue, kept trying to say something that Matt could never make out in the dream.
Matt was left only with the sense that if he could understand what his partner was saying, Sam would be alive
today.
These dreams and day images were so vivid that Matt began to "worry that he was going crazy." His wife,
seeing this, reminded him of his promise to get professional help. This time, he admitted that he could not do it
by himself any longer. "Call any shrink you want," he said, "I'll go."
Lucy had called the Employee Assistance Program at the police force over a month earlier. They had
recommended that Matt see Dr. Francine Shapiro, and Lucy called her immediately. Matt had an appointment
within 48 hours.
Questions
What is your impression of Matt? How typical or atypical are his life experiences and his current behavior?
What do you believe are the core issues for Matt? What is the utility of these initial formulations?
Before reading the next section, what topics and issues do you think will be addressed in the initial sessions?

Process Notes on Initial Sessions

Session 1: This 11/2 hour session was devoted to getting a history of the presenting problem and Matt's
functioning to determine whether he was suitable for EMDR treatment: level of disturbance, personal stability,
and life constraints were evaluated. When suitability was ascertained, the remainder of the session was
devoted to getting a complete clinical picture of his dysfunctional behaviors, symptoms, and characteristics that
would need to be addressed in treatment.
Next, the specific targets that needed to be reprocessed were defined: the Hispanic prisoner's death involving
his original partner, the mayhem Matt had witnessed in his years as a homicide officer, and the death of his last
partner. Time was also spent defining the present triggers that stimulated the dysfunctional behaviors.
Finally, the EMDR process was explained, including its effects, and relaxation techniques for coping with high
stress were outlined.
Session 2: A week later, the second session provided an opportunity for Matt to ask questions about the
treatment and discuss any symptoms that had occurred since the first meeting. Because Matt had been having
intrusive thoughts of Sam's death through the week, and had experienced high anxiety over Lucy's safety, the
target Dr. Shapiro selected was Sam's death. Dr. Shapiro asked Matt to select the image that best represented
this trauma, which Matt reported as seeing Sam's body in the morgue. Dr. Shapiro assisted Matt in identifying
the negative self-attribution related to this image. This was, simply, that "I'm to blame." Then Dr. Shapiro
helped Matt to identify a positive cognition that was more rational, realistic, and empowering. This was, just as
simply, "I did the best that I could." To provide a baseline measurement, Dr. Shapiro asked Matt to report how
valid the positive cognition felt on a 7-point Validity of Cognition (VOC) Scale, with 1 = it feels totally false and 7
= it feels totally true. He reported a level of 3 on this Scale.
Dr. Shapiro and Matt also discussed the emotions and the physical sensations associated with the traumatic
experience. The primary feeling was guilt. Dr. Shapiro asked Matt to rate the intensity of the emotion on a 11point Subjective Units of Disturbance (SUD) Scale, with 0 = neutral and 10 = the worst it could be, to provide a
baseline from which to assess changes during the procedure. Matt rated his guilt as a 9. He also noted that he
had feelings of pain and agitation in his stomach and arms.

The actual reprocessing of the trauma began 20 minutes after this assessment. The thread of associations
Matt communicated was "I let everyone down." He reported flashes of seeing his wife, his first partner, his
father's death. Matt talked about not having given his father what he wanted his father died before he could
make him proud. Matt began crying and feeling the grief he had never let himself feel before. In successive
reprocessing sets Matt said sadly, "I tried to be a good cop I tried to be a good son I did the best I could."
Dr. Shapiro ended the session by using a stress reduction technique, debriefing Matt on the potential for more
processing, and providing instructions for keeping a log.
Session 3: To be taped.
Questions
Were the initial sessions as you expected?
As you read this summary of the preceding sessions, were there any areas or topics that you thought should
have been covered but were not? What other information would you seek to assess the patient?
Before viewing the tape, what do you think will unfold in the taped session? What issues will be discussed?
What will the relationship between Dr. Shapiro and Matt be like?
Stimulus Questions About the Videotaped Session
In the beginning of the session, Dr. Shapiro asks Matt how his previous week went and attentively follows his
lead with occasional questions related to their previous session.
What are the advantages and disadvantages of beginning a session this way? As a therapist, would you have
encouraged Matt to continue expressing his concerns about the past week? Would you have created more
structure or developed an agenda for the session by this point?
About 5 minutes into the session, Matt describes a recurring dream about his deceased police partner, Sam,
lying in the morgue trying to speak to him.
How does Dr. Shapiro respond to Matt's dream and related feelings? How might psychotherapists of other
theoretical orientations respond to the dream material?
About 6 minutes into the session, Dr. Shapiro elicits Matt's visual images, bodily sensations, and negative
cognitions associated with Sam lying in the morgue. She then proceeds with EMDR "processing" of the target
image by waving her fingers in front of Matt's visual field.
How do you anticipate most clients would initially respond to the finger waves? If you were the client, how
would you react? If you were the therapist, what alternative methods might you consider to "process" the target
image?
After each eye movement set, Matt expresses the thoughts, images, feelings, or sensations that occur to him
during the eye movements. Dr. Shapiro rarely comments directly on the content and instead briefly encourages
him to "stay with that" or "just think of that." Psychologists trained in traditional forms of psychotherapy are
accustomed to greater verbal participation in response to a client expressing feelings.
As a therapist, would you be tempted to respond to a client's feelings? As a client, would you be comfortable
with this minimal amount of therapist speech?
What are the therapeutic pros and cons of such minimal therapist speech after each set of eye movements?
About 21 minutes into the session, Matt describes a foreboding sense of something negative happening to his
wife. He expresses an "intense constriction" in his chest and an anxious feeling. Dr. Shapiro continues the
EMDR processing.

Under which circumstances, if any, would you as an EMDR therapist discontinue the desensitization process in
favor of alternative methods of reducing a patient's anxiety? What other anxiety-reduction methods might you
consider?
Following each set of eye movements, Dr. Shapiro instructs the patient to "blank it out" and to take "a deep
breath."
What therapeutic purposes do these instructions serve? How do you, personally, respond to the directive to
"blank it out." How might clients variously interpret such a directive?
Dr. Shapiro's closing words of the session are "and I'm here if you need me. Just call."
Her generous offer strikes different viewers in different ways. How did you perceive it? How did Matt seem to
perceive it? For which patients might her offer be taken as caring availability and for which patients might it be
taken as an indicator that they dependently need the therapist?
In this demonstration session, Dr. Shapiro uses EMDR to target and process Matt's trauma of Sam's death. By
the end of the session, Matt reports reduced arousal, decreased guilt, a sense of relaxation, and feeling "a lot
more comfortable." He concludes, "Yeah, I did what I could do."
How do you account for these rapid changes in one session? What causal mechanisms or change processes
seemed to operate? How might a behavior therapist, a psychoanalyst, or an existential therapist explain these
changes?

General Questions
Did the session progress as you anticipated? Was Matt as you expected? Was Dr. Shapiro?
What are your general reactions to the session? What did you feel was effective in the therapy? What do you
think were the strengths and the weaknesses of this approach?
If you were not informed that this therapy is "EMDR" what would you have called it?
Now, after reading about the patient and viewing this session, what are your diagnostic impressions or
characterizations of his problem?
How would you proceed with Matt's therapy? What goals would you set? How many sessions do you think it
would take to achieve these goals?

Suggested Readings
Carlson, J. G., Chemtob, C. M., Rusnak, K., Hedlund, N. L., & Muraoka, M. Y. (in press). Eye movement
desensitization and reprocessing for combat-related posttraumatic stress disorder. Journal of Traumatic Stress.
Fensterheim, H. (1996). Eye movement desensitization and reprocessing with complex personality pathology:
An integrative therapy. Journal of Psychotherapy Integration, 6, 27-38.
Rothbaum, B. O. (1997). A Controlled study of eye movement desensitization and reprocessing for
posttraumatic stress disordered sexual assault victimes. Bulletin of the Menninger Clinic, 61, 317-334.
Scheck, M. M., Schaeffer, J. A., & Gillette, C. S. (in press). Brief psychological intervention with traumatized
young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress.

Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols and
procedures. New York: Guilford Press.
Shapiro, F. (1996). Eye movement desensitization and reprocessing (EMDR): Evaluation of controlled PTSD
research. Journal of Behavior Therapy and Experimental Psychiatry, 27, 209-218.
Shapiro, F., & Forrest, M. (1997). EMDR. New York: Basic Books.
Shapiro, F., Vogelmann-Sine, S., & Sine, L. (1994). Eye movement desensitization and reprocessing: Treating
trauma and substance abuse. Journal of Psychoactive Drugs, 26, 379-391.
Wilson, S. A., Becker, L. A., & Tinker, R. H. (1995). Eye movement desensitization and reprocessing (EMDR)
treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology, 63, 928937.

Series I: Systems of Psychotherapy

Laura S. Brown, PhD: Feminist Therapy
Lillian Comas-Daz, PhD: Ethnocultural Psychotherapy
Donald K. Freedheim, PhD: Short-Term Dynamic Therapy
Marvin R. Goldfried, PhD: Cognitive-Affective Behavior Therapy
Leslie S. Greenberg, PhD: Process Experiential Psychotherapy
Bertram P. Karon, PhD: Effective Psychoanalytic Therapy of Schizophrenia and Other Severe Disorders
Florence W. Kaslow, PhD: Individual Therapy From a Family Systems Perspective
Arnold A. Lazarus, PhD: Multimodal Therapy
Alvin R. Mahrer, PhD: Experiential Psychotherapy
John C. Norcross, PhD: Prescriptive Eclectic Therapy
Jacqueline B. Persons, PhD: Cognitive-Behavior Therapy
Nathaniel J. Raskin, PhD: Client-Centered Therapy

Series II: Specific Problems and Populations

Jane Annunziata, PsyD: Play Therapy With a Six-Year-Old
Lorna Smith Benjamin, PhD: Interpersonal Reconstructive Therapy for Passive-Aggressive Personality
Disorder
David M. Clark, DPhil: Cognitive Therapy for Panic Disorder
Richard A. Gardner, MD: Psychotherapy of Children With Conduct Disorders Using Games and Stories
Mary Anne Layden, PhD: Cognitive Therapy for Borderline Personality Disorder
Don-David Lusterman, PhD: Couples Therapy for Extramarital Affairs
G. Alan Marlatt, PhD: Cognitive-Behavioral Relapse Prevention for Addictions
Susan H. McDaniel, PhD: Family Therapy With Patients Having Physical Health Problems
Robert J. Resnick, PhD, ABPP: Treating Adolescents with ADHD
Alice K. Rubenstein, EdD: Practical Psychotherapy With Adolescents
Francine Shapiro, PhD: EMDR for Trauma: Eye Movement Desensitization and Reprocessing
Samuel M. Turner, PhD: Behavior Therapy for Obsessive-Compulsive Disorder
Jeffrey K. Zeig, PhD: Ericksonian Hypnotherapy for an Impulse Problem