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A proposal to add a trauma training
component to the standard EMDR training
September 2002 Note: This paper reflects the personal views of the author only. I’m writing this as a contribution to the recent discussion regarding the possibility of modifying the standards for EMDRIA-approved EMDR training. The Training and Standards Committee’s proposals generated a lot of discussion that was long overdue. I believe that there needs to be more public discussion of these issues. I have published papers on innovative approaches to training in 1997 (Greenwald, 1997; also Greenwald, 2002b), and I wish that more people would write about issues and approaches to EMDR training. I have been providing EMDRIA-approved consultation since such a thing existed, and have talked with a lot of other consultants as well. One of the problems we encounter with great frequency is that people with (what we have called appropriate) EMDR training are just not using EMDR. There is the extreme of over-use; some people try EMDR as soon as they sniff a trauma, and they get in trouble for trying to do trauma resolution work before the client is ready. More common, though, is someone who has been trained an EMDR, can even do it well, but doesn’t use it very often. They say things like, “I just don’t have many EMDR clients.” The over-use and under-use phenomena are both examples of what consultants variously describe as a lack of case formulation skills, poor case conceptualization, or lack of understanding about how to systematically conduct trauma informed treatment. In other words, people don’t how to look at a case in a way that allows them to set it up so that EMDR fits in. In my own experience as a trainer and a consultant, this is the main impediment to EMDR being used appropriately in therapy. Even though EMDR is a complex treatment, we are now pretty good at teaching people how to wave their fingers, how to do the standard protocol. We’re still pretty bad, though, at teaching them when to wave their fingers. Right now, EMDR is the only serious (i.e., empirically supported) trauma treatment that does not include training in trauma treatment. In fact, trauma treatment involves multiple steps, trauma resolution being one of the later steps, and EMDR being primarily a trauma resolution method. Yes, the eight phase treatment model does encompass a systematic trauma treatment approach; but in the standard EMDR training, we only mention these phases, we don’t really teach them (with minor exceptions such as Safe Place). On the other hand, if you attend a five-day training in Prolonged Exposure, only a couple of the days will be spent doing exposure. The rest of the training will be spent systematically teaching participants about an overall trauma treatment approach and about exactly what to do and how to do it at each phase of treatment. This is what’s missing in EMDR training. I propose to add this (for an example of the proposed additional curriculum, see Greenwald, 2002a). Remember, very few therapists have received in-depth specialized trauma training prior to learning EMDR. Sure, everyone’s been to a conference or two where theories about trauma were presented. But most therapists are not trauma specialists. How does a trauma therapist say hello to a new client? How soon in treatment do you ask for a trauma history, and what words do you use when you ask? How do you explain to someone who’s not psychologically-minded that their presenting problem might be directly related to their trauma history? How do you get a new client, who has learned from experience to be discouraged and apathetic, to invest in positive goals and commit to treatment activities? How do you teach self-management skills? How do you know how many sessions to spend focusing on stabilization and self-management skills before moving ahead to trauma resolution? These are things that a trauma therapist knows. We offer EMDR training to family therapists, psychoanalysts, humanistic therapists, cognitive-behavioral therapists, and anyone else who can get a license for independent practice. By virtue of offering EMDR training, we have a responsibility to teach whatever material is necessary to use EMDR appropriately. I think this means that we have to teach participants how to do trauma therapy, not merely refer in passing to this set of concepts and skills as if everybody has it already (unfortunately, there is no widely used credential to document such expertise). In practical terms, I propose adding one to two days to teach this material. This will make the training more cumbersome and expensive. Since one of the goals of the EMDR community is to get EMDR to everyone who need it, this proposal will surely be controversial. I argue that the benefits of providing more adequate training far outweigh the possible negative impact caused by the perception of EMDR training being too long or expensive. With the addition of trauma treatment training to the standard EMDR training package, I believe that those who complete EMDR training will be more likely to use EMDR more appropriately, more frequently, and more effectively. This proposal also has implications for other aspects of the EMDRIA credentialing structure, regarding certification and consultants. For example, there is a lot of discussion lately about standardizing consultation to focus on the therapists’s competency with the standard protocol. However, as a consultant, I have argued that the standard protocol isn’t even relevant unless the therapist knows how to structure treatment to get a chance to do EMDR. In practice, much of my time as a consultant is indeed focused on trauma-informed case conceptualization and specific trauma treatment skills. Should this proposal be accepted, and trauma treatment is taught as part of standard EMDR training, then in theory at least, consultants will be able to focus more on the standard protocol. The history of EMDR is that over time we have gained a progressively more sophisticated appreciation of the complexity of the treatment. EMDR was first introduced as a single-session treatment that could be learned from a brief article (Shapiro, 1989). Then it was expanded to a weekend workshop with a single instructor; then as a longer workshop with multiple supervised small-group practice sessions (Shapiro, 1991). More recently we have acknowledged that competency in EMDR requires supervised practice over time, beyond the initial training sessions (Greenwald, 1996, 1997; EMDRIA, 1999). The specialized field of trauma treatment has been rapidly developing, and EMDR has claimed a special place in that field. This gives us unique responsibility and opportunity. It is incumbent upon us to continue to learn from our experience, acknowledge our errors and limitations, and improve ourselves accordingly, to continue to offer the best possible training, and by extension, treatment. Correspondence
Correspondence may be addressed to rg@childtrauma.com.
References
EMDR International Association. (1999). Requirements
for certification in EMDR. Available Internet: http://www.emdria.org.
Greenwald, R. (1996). The information gap in the EMDR controversy. Professional Psychology: Research and Practice, 27, 67-72. Greenwald, R. (1997). A better approach to training: Why you should teach EMDR in your home town. EMDR Practitioner. Greenwald, R. (2002a, June). Getting to EMDR: Structuring treatment so that EMDR fits in. Invited full-day pre-conference institute presented at the annual meeting of the EMDR International Association, San Diego. Greenwald, R. (2002b). Spreading the wealth: More and better EMDR training. EMDR Practitioner. Shapiro, F. (1989). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 20, 211-217. Shapiro, F. (1991). Eye movement desensitization and reprocessing: A cautionary note. The Behavior Therapist, 14, 188.
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