How We Do What We Do: The Therapist, EMDR, and Treatment of Complex Trauma

Abstract

This article discusses strategies for working with patients who present with the specific psychological deficits associated with complex trauma. In order to maintain the patient's stability, safety, and capacity for adaptive information processing (AIP) during sessions, these treatments require an extremely active therapist who is able to help regulate the pace of therapy and the patient's participation in it. Attunement to both patient's and therapist's experience is a core therapeutic process that enables the treatment. Eye movement desensitization and reprocessing (EMDR) therapists must set the frame of the therapy, help to build and then utilize the capacity for AIP, and establish a relationship capable of coregulating the patient's state during both resource development and trauma processing. All of these functions can be enhanced using bilateral stimulation (BLS). They are accomplished via specific therapist actions during sessions: assessing and supporting the capacity for AIP, looking for opportunities to strengthen resources and competencies, and staying attuned to empathic resonances and countertransference. Decisions that shape the treatment process and affect its pacing evolve from an integration of multiple factors: the therapist's attunement to self, patient, and the therapy relationship; and an understanding of complex trauma, dissociation, therapeutic process, and EMDR. Examples of patient–therapist interaction during two EMDR sessions are provided to illustrate therapy process and the use of the treatment relationship in clinical decision-making and coregulation.