A BETTER APPROACH TO TRAINING:
Why You Should Teach EMDR in Your Home Town
Ricky Greenwald Psy.D. Level 2, Independent (EMDRIA-Approved)
Trainer
1997
Abtract: The controversy
about EMDR training previously focused on whether it was necessary. In this
paper I argue that the current model of training is not sufficient. I propose
a higher standard of training, taking advantage of locally-based trainers who
can offer more personal attention and supervised practice over an extended period.
A Better Approach to Training: Why You Should Teach
EMDR in Your Home Town
EMDR has had a unique history in many ways, including a long-standing controversy
about how practitioner training has been conducted. Two years ago I explored the
issue in detail (Greenwald, 1995), and concluded that Shapiro's efforts to maintain
control of the EMDR training had been highly beneficial to EMDR's early development.
In essence, I called her an appropriately protective mother. By now there can
be little doubt that Shapiro's representation and guidance has been critical to
EMDR's growth and credibility.
More recently, however, in exploring the status of EMDR, I pointed out that even
the Level 2 training is often insufficient for EMDR proficiency (Greenwald, 1996).
Although it was nice to be able to blame poor outcomes on lack of treatment fidelity,
this begs a new question: why should clinicians with Level 2 training sometimes
fail to conduct EMDR appropriately? Of course, many do learn EMDR well, but some
don't, with perhaps a greater deviance rate from the standard protocol with increasing
case complexity (Greenwald, 1996).
In the past year, I have had the opportunity to teach EMDR, and to serve as a
fidelity rater for a study. I have become increasingly convinced that EMDR is
fairly tricky, indeed quite difficult to master. Although the basic protocol is
reasonably straightforward, even that requires a therapeutic stance which may
feel foreign to many. And to use EMDR in more challenging situations requires
a high level of EMDR proficiency as well as good clinical skills. To put it bluntly,
many good therapists have trouble "getting it;" and bad therapists will
almost certainly do bad EMDR.
In light of the challenges inherent in learning EMDR, it is time to reconsider
our approach to EMDR training. Whereas the EMDR Institute's dominance was formerly
beneficial, times have changed. EMDR now enjoys strong empirical support and rapidly
increasing recognition and acclaim. There are skilled and experienced EMDR practitioners
in many locations around the world. Shapiro (1995) has published an excellent
textbook and turned control of the training over to an independent professional
association (EMDRIA). Although these developments attest to the successes of the
EMDR Institute, the limitations inherent in the Institute's approach are now harder
to justify. How many Level 2 graduates are not fully proficient in EMDR? We don't
know, but the proportion may be substantial. How many Level 1 graduates fail to
even complete their training?
I propose that the current EMDR Institute, or weekend workshop, model of training
be replaced with a locally based model. Of course, the weekend workshop model
will still be needed for some time, to introduce EMDR in regions where there are
no qualified trainers. I am arguing here that the locally based model can be more
effective, and should become the model of choice.
Here is the basis of this model. First of all, if EMDR is really so complex and
difficult to master, then we should be teaching it the way we teach other complex
clinical skills: with supervised practice over an extended period of time - not
in a weekend workshop. I would further suggest that there is no good reason to
offer less than the complete training. I don't refer patients to those with only
Level 1 training, so I don't offer it. EMDR is now proven and clearly worthy of
the time and financial commitment; also, there is less overhead in a local training,
so costs can be kept down. Finally, I believe that the standard of training should
be raised, to include more individual attention and supervision, over more time.
Trainees should not "fall through the cracks" so easily. This need has
been partially met on an informal basis in some areas through regular study group
meetings as well as private consultations. I suggest that it be expanded and incorporated
as part of the formal training.
As an example, here is the outline of my next course, the content of which is
standard and EMDRIA-approved. The teaching methodology is often similar to that
of the Institute, but additional methods, appropriate to smaller groups and to
a variety of training contexts, are being developed and discussed informally,
via the EMDR list on the Internet, and at the EMDRIA conferences. Here, I wish
to emphasise the sequencing and timing, as well as the additional activities which
I have incorporated.
Maximum of 12 people in the class;
Cost: $500 (£312) plus $50 (£31) materials (for the textbook, a pointer,
copies of articles, etc.)
Location: a meeting room in a centrally located food co-op. I pay no rent, and
there is easy access to snacks and meals.
Schedule:
September 4 Thur 6:30PM-9PM - Introduction, literature review, status
of EMDR, AIP theory (pulling this out makes the rest of the Level 1 less of an
information overload).
September 12 Fri 9AM-5:30PM - Day 1 of Level 1
September 13 Sat 9AM-5:30PM - Day 2 of Level 1
(Telephone consultation as needed - minimum 2 contacts)
October 18 Sat 9AM-5:30PM - Day 1 of Level 2
(Telephone consultation as needed - minimum 2 contacts)
November 15 Sat 9AM-5:30PM - Day 2 of Level 2
(Telephone consultation as needed)
December 11 Thur 6:30PM-9PM - Study Group: Facilitated peer supervision; advanced
instruction by request.
January 15 Thur 6:30PM-9PM - Study Group: Facilitated peer supervision; advanced
instruction by request.
This course allows for the integration of reading, classroom learning and practice
over a 4-month period. As an instructor, I get to know each participant and can
address any issues which may interfere with their mastery of EMDR. I provide about
an hour of individual telephone consultation for each participant, as well as
the personal attention inherent in working with a small group over time.
Based on my limited experience of having taught a similarly structured course,
people who go through this type of training should have a high success rate for
mastering EMDR. Of course, this is only my personal impression - but an impression
based on the close contact for which I am advocating. The model should ultimately
be judged by dropout rates and by the proficiency of the graduates. Certainly
we can expect the dropout rate to be consistently low when participants commit,
in advance, to the entire training. When proficiency testing becomes available,
it will be interesting to see how graduates of small, independent, locally based
programs such as mine match up against graduates of the weekend workshops. The
weekend workshop model has the advantage of more experienced teachers, and the
Level 2 graduates will be self-selected for their positive response to EMDR. On
the other hand, those who only complete Level 1 may also be using EMDR, and must
be counted. I predict that the local model will outperform the weekend model on
retention of participants as well as proficiency of graduates.
Of course, my program is only one of many possible ways of conducting a locally
based training, and is presented here merely as an example, a basis for discussion*.
However, I believe that other locally based trainings should also include the
small class size, individual attention, and the opportunity for integrating learning
and practice over an extended period. This should increase our success rate with
therapist training, and increase the frequency with which EMDR is conducted appropriately
and effectively. The successful history of the EMDR Institute should not blind
us to the possibility that we can do better.
* Please send your comments to the editor of this journal.
Correspondence
Ricky Greenwald Psy.D. Level 2, Independent (EMDRIA-Approved) Trainer rickygr@childtrauma.com
References
Greenwald,
R. (1995). Evaluating Shapiro's stance on EMDR training. On Line Journal
of Psychology, 1, 130-134. Modem 2092719025.
Greenwald, R. (1996). The information gap in the EMDR controversy. Professional
Psychology: Research and Practice, 27, 67-72.
Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles,
protocols and procedures. New York: Guilford Press.
©1997 The EMDR Practitioner - All Rights Reserved Worldwide