EMDR 2 Tal

Hello. My name is Tal Kreutero and I am the CEO of Experts Clinics for EMDR treatment method - a nationwide clinic network. I will begin with my personal story and how I got to EMDR, as to place other things that I am about to cover in the continuation of the kit, in context.

I will talk about (1) Treatment in general; (2) EMDR in general, and (3) what can help you prior to the treatment commencement or at the treatment outset, to ensure it will be as quick and focused as possible, and that you receive the assistance as soon as possible. So first let us place all this into context.

A number of years ago, I was still a private therapist, and considered myself a fairly good one. All in all clients were pleased, I received good recommendations, and people completed their treatment and felt good. I supposed then this is all there is, until things changed a few years ago.

A number of years back a young religious girl came to me for treatment, in a catastrophic state. She went on a prearranged "Match made" date and was sexually abused by the man she was set up with. She did not want to tell anybody, so as not to jeopardize her chances for dating *being set up again, and was not prepared to begin taking medication as treatment for the same reason.

I did not know what to do in such a turbulent situation, because in the past when patients came to me in a similar state, I first recommended they begin with medication in parallel to other means, and calm down a bit in order to allow conversation treatment. As I mentioned she categorically refused, so I turned to my instructor and asked how to go about such a situation. My instructor said: "If she refuses medication, there is no other way, but to "Be with her in her pain, until things settle down" as she put it. This was inconceivable to me, since if God forbid the situation was reversed I wouldn’t want to have a therapist who would settle for "Be with me in my pain", just as much as if my knee would hurt, I wouldn’t want to be treated by an Orthopedic Doctor that would settle for "Being with me in my pain". I believe a therapist's job is to do as much as possible, to help as much as he or she can, and as fast as possible, and this is my patients.

On the shelf I found a book written by a French psychiatrist and Neurologist by the name of David Servan-Schreiber, titled The Instinct to Heal: Curing Depression, Anxiety and Stress Without Drugs and Without Talk Therapy", or in short "Healing without Freud Or Prozac".

"Without Freud"- came from home; I am no big Freud fan. "Without Prozac" was what my patient asked for, so the book caught my attention and I began reading it.

The book is excellent; Most of the chapters deal with what a person can do on his/her own for himself, in order to ease any depression, stress and pressure. There were two chapters on a method I had never heard of before called EMDR. He discussed this method and quoted research showing an eighty percent recuperation rate within three to five sessions.

This is the point where my jaw simply dropped, because I worked with post-trauma casualties during my practical training, and it was not about three sessions, nor three years and not necessarily thirty years. Where I worked, the farthest we could advance with post-trauma casualties was to ease their symptoms with medication, and not much more than that.  Here he was talking about eighty percent healing rate in three sessions. This was a dramatic difference which was borderline Science fiction *near fiction.

Specifically speaking I couldn’t comprehend, why if it helped so much, hadn’t I heard about this method during my studies, not at the Psychiatric ward, not at the mental health clinic nor at any extracurricular course I attended, despite the fact that I was one of the most well rounded therapists I knew. After all, this was a book written by a Psychiatrist, so I decided to search for more information and not rule anything out. I began searching the internet and discovered dozens of papers written about research having taken place, with the same results, with such high recovery rates, in such a limited number of hours. I couldn’t believe I had never heard of this method before. I continued to look for more information, and it so happened that around the same time there was a lecture by an Israeli Psychiatrist, who was part of a humanitarian delegation to help women in Congo. I don’t know whether you know about the situation of women in Congo, but it is catastrophic – Rape, abuse, Exile – Demonic Horror.

He had been there for two to three weeks, and returned with a number of excel files and video footage documenting women before and after EMDR treatment. I was astonished, and said to myself – Lord almighty, most of the people who come to me are in a much better state than the women in Congo. If this helps them in such a short period of time, it will most certainly help my patients who are better. I rushed to study. Many therapists in this situation might think: Good Lord, I am so lucky that I don't have such patients as the Congo women. And then they wouldn’t carry on studying; actually the area of Trauma treatment in Israel is somewhat ignored, but that is another story.

I went to study, delving into this topic, I ordered dozens of books from abroad on EMDR, I joined distribution lists belonging to thousands of EMDR therapists from around the world, I attended every course and training session I could get to, locally as well as abroad, and I began seeing the results he had reported about – the same success rate in such a limited number of hours. After a while, I decided I could not remain "Small-time", remaining a therapist who can only help a limited number of people who reached me. There was an overload of requests for treatment, and I thought it would be a shame for all this information to remain with me. I began seeking a way to disseminate this information; not the topic of EMDR for Trauma care, but rather EMDR for cases less severe than Trauma. My view was that if it helps in severe cases, it would help in less severe circumstances for sure.

In 2011 I launched a chain, at first only with therapists in the Center region of the country, and today we are spread out nation-wide. Due to the fact that in Israel we are a bit behind and are mainly familiar with EMDR as treatment for Trauma almost exclusively; in a number of places treating patients suffering from anxiety from Kassam Missiles, and some Ministry of defense clinics handling Shell-Shock patients, I "Yanked" therapists from the public sector, who specialized in treating patients in those areas, and trained them to care for a larger population. Most of my therapists truly come from treating patients suffering from anxiety from Kassam Missiles, some caring for Shell-Shocked patients, or sexually abused, and I train them to use EMDR in a broader span of cases.

I little over a year ago I was approached by people from the foreign Ministry, and now I treat diplomats and staff from the diplomatic core, who come to me with post-traumatic symptoms, and usually within two to three weeks they leave my clinics without them.

Now that there is a background and you understand where I come from, I would like to begin talking about three topics that the kit will deal with, and the first topic is Therapy – in general – What causes us to suffer, and how we can relieve suffering.  There are various treatment methods that originate from different places, and when this is understood, one can comprehend why EMDR works so fast, where other treatment methods often require years.

1.     In the first treatment wave, by Freud and his disciples, there was a premise that our suffering stems from events we were unaware of, that occurred at a young age, and if only we could transfer them to the conscious level, things would work out. At first it was about treatment that took place almost every day for years, to transfer things to consciousness. This didn’t help, even if you read Freud's books, apart from the fact that he was an excellent author, you could see miserable individuals before and after treatment. Freud's treatment wasn’t effective, even for those who he wrote about himself.

For financial and other reasons they moved on to treatment once a week, in order to discuss things in therapy. I can say that from my experience as well as that of other people whom I meet and talk to – there is a big difference between being aware of things, and actually changing those things, and very often I meet people who come to me after years of ordinary conversation treatment. They are in fact very much aware of what hinders them, limits them and disturbs them, and also know where things are coming from, but they don't know how to move forward with all this awareness. One may say that we were "Had" or tricked when we were told that awareness was enough. It may be the first step, but it is really not the last.

Another premise with this kind of treatment is that the relationship with the therapist will slowly form and set an example for a beneficial relationship. I am familiar with this premise but I do not agree with it. I wish for all who are watching me, a mutual relationship and not a unilateral one; a complementary one and not one for pay;  and one for more than an hour a week. In my opinion this is not a good model for relationships we have outside of the treatment room. That was the first wave which was followed by additional waves, because this one was far from satisfactory.

2. The second wave includes the cognitive - behavioral treatment and the personal coaching. Here it is said that once there is awareness to things, the treatment will provide tools to cope with them. The premise here is that the cause for problems are thoughts – Paradigms, negative beliefs, blocking beliefs, and non-adaptive beliefs. These beliefs in turn cause feelings. Feelings in turn affect behavior, and if one wishes to change this cycle, thoughts must be changed. Treatment ought to provide tools to change thoughts and from there on, with will power and determination, the patient will be alright. Unfortunately, for some people this method does not help, and it does help for some when they practice, but when they stop practicing the problem recurs. Thoughts are not the problem, and they were not created in a vacuum, but if they are perceived as a problem and not a symptom, they will endlessly change back to restrictive thought, and we are talking about a very arduous struggle.

3. I will discuss the third wave of EMDR, and how the premise regarding both the problem and the solution, sheds light upon what happens to us. The assumption in EMDR is as follows: Just as we have a scratch on our body, it progresses towards healing because we have this ability in our body. Thus even in the event that we experience rough incidents, we possess the tools to handle them and our body will lead towards healing – The mind will process the events, for example by way of dream sleep or by way of talking to people, and is capable of moving on. Our brain can succeed in processing the memories, we can learn our lessons and all this can be kept with us in a processed way. However, sometimes there are events that are so overwhelming, that feel so "flooding", that we fail to deal with them in real-time. The brain cannot manage to complete its processing in real-time, and thus the memory is stored in a crude form and not in a processed form. What does a crude form mean? The meaning is that all the feelings, emotions, bodily sensations, smells, scenes and sounds related to the event, are stored in our memory in a crude form, as though the event is occurring right now. When the details are stored in our memory in such a crude and unprocessed form, there are two implications:

1.     Whatever is stored crudely in our memory is saved separately from our brain's general memory network. Meaning, that regardless of what follows, and what is added later on to our memory, it does not change whatever has been stored in a crude and separate form. Hence, even if we obtain new information that danger has gone away, one may still sense danger in the crude form, for example: Nobody has ever recovered from Shell shock due to our forces retreat out of Lebanon. There are many Post trauma patients from the war in Lebanon, they all are aware that we pulled out of Lebanon, but this knowledge did not help even one of them to heal. It is not at all about knowledge, we know about what we have stored in our memory, both the processed material and the crude form, but there is no emotional connection between the two. The crude material is still alive and kicking in our body in a crude form.

2. When there is a trigger in the present which sets off or is connected to a past memory, it could come back and make itself heard at a similar volume as it was during the event itself, with the thoughts, emotions and physical feelings as at that juncture. In classic Post-trauma, it is also about the sensual components of the event, such as smell, the sounds, and the sights at that point. In less severe cases it is about thoughts, emotions and physical sensations. The sound of a tune could awaken past events, a location situation or a specific interaction could all cause us to behave in a way that seems strange to us, all because it is about crude material that awakened in a way that is out of our control.

In EMDR we do two things – Identify these places, and I will explain later in the kit how to go about doing this and how one may create an accurate list of all these memories that are stored in you in the crude form; and then you complete the memory processing.

How do you complete the processing? You return to the memory by way of four channels:

1.     The sensory channel – usually sights, but sometimes some smells and sounds.

2.     Emotional channel

3.     Cognitive channel

4.     Somatic channel (Bodily sensations)

The memory is retrieved and the brain is given a chance to do what knows how to do; the mind is being allowed to return and complete the processing which it had not completed in real-time. I will discuss the process, but what I must add is that once the brain completes the processing, the memory is no longer kept in the crude form system, but rather, in its processed form, and it hooks up to the general memory network, and it is not operated by triggers any longer.

How does this process take place? We have two hemispheres in the brain- the left, which better connects to the cognitive and verbal parts; and the right, which better connects to parts associated with emotions and body sensations. When we talk about things, which is what we usually do during regular discussion therapy, we activate the left hemisphere much more, thus creating a gap. We know the memory should not disturb us, but it still does; We know the event occurred a long time ago, but the feeling is that it happened yesterday. A gap between the cognitive part and the emotional part is formed.

In EMDR, we don’t wish to open this gap and therefore we use a technique which enables us to get both hemispheres involved in the process. In remote treatment, on the internet, you can use two balls which may be pressed in both hands. When we squeeze the ball in our left hand we activate the right hemisphere and when we squeeze the ball in our right hand we activate the left hemisphere, because there is a diagonal connection between the hemispheres and our limbs. During a face-to-face session, we use an instrument which vibrates alternately; In the left hand it activates the right hemisphere, and in the right hand it activates the left hemisphere. 

In this way we ascertain that both hemispheres take an active part in the process and the alternate transition between the two hemispheres enables accelerated processing. This is a similar process to what occurs during dream sleep. We simply identify the events and give our brain a chance to do what it knows how to do.

In other words, in EMDR I don’t provide you with tools to deal with memories, but rather, I actually change the way the memory is stored in your system. Think of it: How did the past affect us?  Not because it surrounded us, but rather because of the way it was stored in us. Various methods gave us advise how to deal with and treat the past. There is one approach that tells us "to try to ignore it": That is the whole approach involving personal training claiming that "You have nothing to do with the past; you have no time machine; simply ignore it". The problem is that this simply does not work, because the past is here with us by way of our memories and those who try to ignore it, are involved either in a rigorous- grueling effort put into trying to ignore the past; or, people fail and blame themselves, which is a pity. 

So the issue of ignoring doesn’t work; Some say "simply be aware of it" and therefore there are some people, as I explained during the first treatment wave, who are very much aware of what their past was like: "Mom did this, Dad did this, and Grandma did this and this…" – It still doesn’t help them, and they still suffer.

Those were in fact the two options: Either you know and it won't help you, or ignore it and that won't help you either.

EMDR offers something new – Not to provide tools to cope with memory, but rather to change the way in which the memory is stored in our mind. When the memories are stored in the brain in the crude form, it is a live event. It is as though a piece of us is still living the event, with the same thoughts, emotions and feelings. However, if we give the brain a chance to complete the processing, the information connects to the general memory network,  it is no longer stored in our brain in the same way and doesn’t affect us in the same manner. I will tell you a parable, which in my opinion explains the difference between the various therapy methods attitudes to problems and solutions: The story is about a man near a river, saving people from drowning in the water. He saved and he saved, until one day he got up and left. So he was asked: "Where are you going? Who will save the drowning people?" And his answer was simply: "I am going to take a look who is throwing them off the bridge".

There are treatment methods which slowly inform you that it is not coincidental that people are in the water. There is someone throwing them off the bridge, or rather: The moral of the story is that there is something from the past that "throws" you some suffering into the present, and the therapy will slowly inform you of this. There are treatment methods that offer improvement by identifying as fast as possible that someone is in the water, and to quickly improve his swimming style and to get him out of there. Those methods are the ones providing tools to cope with the problem as fast as possible from the minute it appears.

The solution doesn’t treat the problem's root cause, and therefore the problem will persist. In EMDR we kick the bully off the bridge. The bully on the bridge is the crude memory which continues to affect us as though the event occurred yesterday. Many times you can hear people reporting events that took place decades before, very often hearing something like "it feels as though it happened yesterday", because that is the way the memory works when it is stored in us, in the crude form.

What we will do in EMDR, and soon I will instruct you how to do this, is we will identify the events and complete their processing. Due to the fact that this is warranted, as opposed to tools or awareness, the treatment works very rapidly. Research shows as mentioned before, anywhere between eighty to ninety percent healing rate, anywhere between five to twelve hours, for post-trauma treatment, when dealing with severe cases. In less severe cases, for each traumatic memory, the treatment time is shorter. 

I want to move on now to a number of myths related to treatment in general, or human suffering in general. Those who believe these myths suffers more than they should, and that is a pity.

1. "What doesn’t kill us forges us" – In Israel there is an addition: "What kills us forges Mom…" let's put this aside. This myth is untrue. The moment we cope with something, it does not necessarily forge us. The question is how we cope or deal with things. If we coped with something and came out strengthened because we learned new things and we feel better, that means it was a smaller challenge than our abilities to cope, and we came out forged. However, often, there are events that may leave us standing on our feet, but still wobbly.

It's something that nibbled away at our resources and our ability to deal with issues, and then we see phenomena like "The last straw that broke the camel's back"  - the event that withdrew resources from us to the extent that we can hardly stand – that that is trully not something that forges us. It is something that should prompt us to seek help and therapy, otherwise, one is in a state of dwindling resources, and even a little thing may be the straw that really will break our backs, so to speak.

2.     "Time heals all wounds" – That is a myth, because it doesn’t matter how much time passes, but rather, what happens during this time. When talking about traumatic memory, and I repeat – Traumatic memory is not something that, if occurring today, would knock us over. Traumatic memory is one, that when it did occur, was larger than our ability to cope with. Sometimes traumatic memories are events that if presented with today, we would "chew them up and spit them out", however, since they happened when we were young, or ill, or came at us by surprise, and our brain didn’t complete its processing, the memories are stored in their raw-crude form. When that happens, the time that has passed is immaterial. You can hear interviews commemorating the Yom Kippur October war and see that it doesn’t matter how much time has passed - the event still affects the present. It doesn’t matter how much time has passed since the accident, the rape, the assault or job termination – The event continues to "play" in the background, and to give it time means to give suffering more time; not change.

3. There is no difference between therapy methods – That is a myth which regrettably is entertained by therapists and is even taught in the academy despite its erroneous nature. The source for this myth is a comparative study that was held which compared a small number of psychodynamic therapy methods which found few differences between the methods apart from the connection with the therapist. Of course, this study cannot attest to methods which were not included in the study. Furthermore, today in comparative studies, one may see variances comparing different methods, in a given number of sessions; what improvement rate was shown in one method (percentage) versus another method. For example: studies show that EMDR was found to be beneficial within fewer sessions than a cognitive – behavioral method. Another study that compared EMDR to PE (A behavioral method) showed that within three sessions, there was a sixty seven percent improvement rate in post-trauma with EMDR patients, and only seventeen percent improvement rate with PE patients, so of course the method used for treatment, does make a difference.

In this context, with reference to Trauma, three methods were academically proven to be helpful in trauma treatment, and they are: EMDR, Cognitive – behavioral treatment, and PE. Studies show that only one of these methods does not require homework between sessions, and that is EMDR. The other two methods require many hours of exercises between sessions. In addition, one method was found to help faster, and that is EMDR. Therefore one shouldn’t believe that the method of treatment is of no consequence, but rather only the relationship with the therapist, because it is not true.

4.     "The most important thing is the relationship with the therapist"  - A number of years ago a guy came to me and said: "Tal, what a therapist I have- he is a pleasure. He knows me like the palm of his hand. I enjoy going to him so much, unbelievable. It's a shame there aren’t more like him". So I asked him how long he was in therapy with him and he answered: Three years. Then I asked him what brought him to that therapist in the first place and he answered: Anxiety and difficulties with intimate relations. And when I asked him how he was at present, I realized no improvement had occurred with the issues he wished to solve. A few months later he came to me for treatment, and today he no longer suffers from anxiety issues, and is in a relationship. It's wrong to judge therapy by whether the therapist is nice or not, does one like to go to him/her or not, and not by the reason that made me go to therapy and what has developed there.  I see many "fall for that", and stay in therapy for many years with a pleasant therapist that they pay handsomely. What disturbed them before still disturbs them, and that is a pity.

5.     "It's normal" – The criteria "Is it normal"  is used to ascertain if there is a problem, and then people suffer because "it is normal to be fearful of driving after an accident" or "it is normal to have anxiety after a relative died of Cancer" or "It is normal to be fearful of elevators after getting stuck in one". It is true that it is normal to have fears and anxiety after traumatic memories and events, but one doesn’t have to remain with them. The relevant criteria is not whether it is normal, but rather, "Does this hinder me" and if it does, is it reversible.

I had a patient whose mother died of cancer. This is a relevant example of someone who's loved-one died of cancer and such a thing causes anxiety. She went to therapy and was told: "It's normal, you lost your mother to cancer, which could reach you as well, so it is normal to have anxiety". 

This isn’t an inevitable decree: I can say from experience and from her specific case as well, that this kind of anxiety is treatable within a very limited number of sessions. If so the criteria of "Is this normal" isn’t relevant, because even if it is normal, it doesn’t mean one needs to tolerate it.

6.     "Which problems does it help, and which one it doesn’t" – various psychological treatment methods as well as medication treatment problems tend to be grouped together by symptoms rather than by origin. For example, depression could stem from biochemical and organic reasons, or from life events. That is why we may see contradictory research – Sometimes one can see research in which medication helps depression, and another time you may see research in which a placebo administered helps just as much as prescription drugs. The same occurs with anxiety.

Human suffering may be divided in two: Suffering due to biochemical and organic reasons, which warrant seeking western medical or alternative medicine treatment; Or, suffering from past life events that continue to accompany us. When the latter is the reason for suffering, EMDR may be engaged. I will provide an example to a mistake in classification by symptoms. For example, Flight anxiety can stem from totally different reasons.

 I will give you examples from my patients – One of them had flight anxiety, despite the fact that he had flown before with no difficulties, until he experienced one rough flight with air pockets and flight anxiety developed. In this sort of case we work on completing the processing of memory from that traumatic flight and get rid of flight anxiety. On the other hand, another patient flew without a problem until he encountered a person who abused him in his distant past as a boarding school pupil. A connection was formed between the traumatic event and the plane, and thus flight related fear was formed. For someone like this man, an explanation how safe flying is in comparison to driving would be irrelevant. What we needed to do was work on his original memory of the abuse from the boarding school and complete its processing, and then complete the flight event processing which made a connection between anxiety and flying, and from then on he continued flying without a problem. A third patient noticed that he had anxiety from the first flight. In other words, nothing happened that connected flying to anxiety, but rather there was anxiety before the first flight. That meant that there was a prior problem that became apparent here. In this case we had to search for that source of fear, complete the processing of the relevant memories, and continue from there. We can see here the same symptom, with entirely different reasons.

The same goes for stage fright – People come to me for stage fright treatment, and complete it within two to three sessions. For example, I had a patient – lawyer who suffered from stage fright which originated from a "Black-out" he had at his Bar Mitzvah. We completed the memory processing and after that he spoke in court with no problem. On the other hand, with someone else who came to me, the issue of public speaking touched upon the issue of low self-esteem, which was connected to traumatic events from his past which included banning and degradation. After working on these events, his stage fright improved.

In other words, it makes no difference what the symptom looks like on the outside; What matters is what happened before, in order to build a treatment plan. Things that look alike could originate from totally different origins. I am known for saying that if we see someone moving their legs rapidly, we still cannot know whether the person is exercising, chasing a bus or running away from someone who is chasing him. So I suggest not to judge according to symptoms, but rather dynamics.

When can EMDR treatment help?

EMDR has existed since 1987 and originally EMDR-treated populations were from the field of post-trauma. The first patients questioned were soldiers who suffered for years from post trauma from the Vietnam war, and after being treated for decades with other methods, they were helped with EMDR within a few hours. Another population treated with EMDR was sexual abuse victims, and even there the method was found beneficial. After the method was proven to be beneficial for post-trauma treatment based upon clinical evidence, research and clinical work developed in two directions: The first one was for populations in better condition, like Exam-anxiety treatment and athlete performance improvement. The second direction was for populations worse-off, like treatment for the mentally challenged, Autism, and Schizophrenics. Of course one doesn’t recover from schizophrenia through EMDR, but very often schizophrenics have a history of traumatic events, and after completing processing of their memories there is an improvement in quality of life, and less episodes and less symptoms as a result.

What is Trauma?

I wish to talk in this context about all that’s connected to Trauma. Many people, and unfortunately many therapists in many case do not see the connection to trauma. This is because the way in which trauma is defined in the DSM, the Psychiatric classification manual. In the DSM one of the criteria for trauma is a life threatening event, that in its wake bring symptoms of unrest, invasive thoughts and avoidance. Both reality and research indicate, that very often, events that do not involve a life threatening situation, create symptoms that are identical if not more severe. It is not clear to me why the criteria of a life threatening event is needed, when often events that don’t involve life threatening situations, like banishment, redundancy at work, infidelity in marriage or divorce could create traumatic-like symptoms. The definition of trauma in EMDR does not include life threatening events necessarily, but rather an events which while occurring were greater than the ability to cope with. When an event is larger than the ability to cope, the brain cannot manage the processing, it is kept in our memory in a crude form, and that is the definition of a traumatic event. Meaning, that often, our suffering as a result of prior life events, is a result of traumatic memories. Memories of humiliation, failure and things of that sort, and events that were larger than our ability to cope with. When we know that what creates a traumatic event is an event which is larger than our capability to cope with, we can learn prevention. The minute there is a severe event, what we want to do is close the gap between the size of the event and our ability to cope. How does one do this? One of the things that can help, once the danger is gone, is to calm ourselves down, as quickly as possible. This is because when in an alerted state, the brain doesn’t free valuable resources for processing, but rather for survival. We would like to convey the message, as soon as possible, internally, that the "coast is clear". Many people make the mistake of not setting sleeping and eating patterns straight after a rough event, and it essential to do so, because we want the body to have as much energy in order to focus on completing the event processing, in other words, to give the body as little signals as possible that the emergency state is still in effect. More related material about this may be found on our site www.emdrexperts.co.il   , on the things one may do to avoid making emergency situations into chronic ones. Essentially, in our treatment plan, we seek the events that were larger than our ability to cope with.

When should one opt for EMDR treatment?

If suffering originates from Biochemical or organic reasons, and I will soon explain how to ascertain that suffering is not coming from that direction, one must turn to western or alternative medical attention. If suffering originates from life events, one can seek help:

·       Negative feelings from prior events, which despite the fact that they took place long ago, their effect doesn’t diminish.

·       Internal barriers that keep us back, when past events brand these barriers into us

·       Recurring patterns that keep us back. Here as well,  each pattern has an event or events that branded it.

These are the cases in which you should seek help. As I said before, one should be careful of the myth "It is normal for me to feel bad" without examining other parameters, such as the intensity of the emotion, it's amount and what its implications are on one's functioning, while these are the reasons behind turning to treatment.

What should be done before going for treatment

If you are experiencing depression, anxiety or similar emotions, the first thing we want to ascertain is that we are dealing with a psychological reason and not anything else, or, even if there is a psychological reason – there are no other contributing factors. I suggest there are four things to be checked, three which are your responsibility:

1. Medical conditions exacerbate depression and anxiety – For instance: Lack of vitamin B12, vitamin D or folic acid, thyroid problems, PCOS, Anemia, Mononucleosis and insomnia. I suggest you go to an MD and ask for specific blood tests, as I have suggested and in addition those added if appropriate by your Doctor, to check there are no such additional conditions. I send my patients to such tests, and one out of five comes back with an indication of such a biochemical problem. This is important to me as a therapist, so I won't give a psychological response to a non-psychological problem. For example, a lady who describes that lately she is not in the mood for anything and that she is has less and less energy, may be suffering from Mononucleosis and not necessarily depression, This is worth checking.

2.     To check the side effects of all medication we are taking – There are medicines that have depression and anxiety related side effects. I will never forget how a number of years ago a women came to me in bad condition, with suicidal thoughts and it turns out she was under skin treatment taking a medicine for facial treatment called Roaccutane, of which the side effect list included "suicidal thoughts". Birth control pills as well, could increase anxiety and depression, the same with steroids, sleeping pills and more. That is why it is important to check side effects related to mood in the medication we take. If such side effects are found, one must go to a doctor for consultation.

3.      We must take notice of substances we put in our body (intake) –Caffeine, Nicotine, Marijuana and stronger drugs, and alcohol – all these are likely to increase anxiety and depression. I can speak from experience that the same patient who caught his wife cheating on him, after having seven cups of coffee, or without all that intake, will not respond the same, despite the fact that the situation remains the same. The caffeine takes its toll from the nervous system, makes us more alert and therefore more prone to anxiety and depression. It is important to note all our substance intake, and we want as little as possible intake related to irritation of the nervous system. Caffeine and Nicotine don't really calm us –they only give us brief relief for the unrest we feel because we are addicted to these substances.

4. Make sure we get good nutrition and sleep – There are people who don't get enough sleep (even "Military-regulation-six-hours" isn’t enough), and what we really need are seven or eight hours of sleep.  When we don’t get enough sleep we feel weaker, the events seem tougher to deal with, and there are more chances that a gap will develop between the event and our ability to cope with it. The same goes for food. We need various substances in our body for processes we are going through, and we are the gate keepers- If we don’t let them in they will not enter. Therefore we must mind what we eat and how we sleep, because it influences our coping capabilities and our mood. All that is not related to these last paragraphs is Psychological and can be treated with EMDR.

I will say a few words about cases that less fit EMDR, or they require very specific expertise which few EMDR therapists possess. In order to do this processing, one needs coping resources. They do not have to be in large quantity– I remember that in a clip I saw about women in Congo, there were women who drew an egg, because in their eyes, if one has an egg, it means they have the next meal, and you can be calm enough, and this helped the women process traumas related to sexual abuse. In other words, the resources need not be massive in order to perform the required processing, but one does need a minimal quantity of resources. To those who do not have that, they should first check for the reason they are missing it. Very often when there is a substantial shortage in coping resources, one may be dealing with biochemical and organic reasons that lead to this. What one does in this situation is "Resource reinforcement" till the individual reaches the level which enables processing. This is one of the cases in which the processing will be slower and may require more preparation.

For eighty to ninety percent of the population, EMDR seems exactly as I described till now, if you go to the right therapist. I will explain how one choses a therapist in a moment, because this is very important as well.

For a small group with terribly difficult disturbances, like dissociative disturbances that were caused by repetitive traumas in childhood one needs to find a therapist who knows how to treat dissociation by using EMDR. As we mentioned we are talking about a small percentage of the population. If one of the spectators watching now is in this situation, I recommend you do not complete this evaluation, stop here and seek therapy. If the situation is so severe you must not do things on your own but rather in the presence of a therapist. All those who are not in such a bad state, and that is the vast majority of the population, are more than welcome to continue watching.

How to choose an EMDR therapist wisely

A moment before I talk about what you can prepare before the first session in order to expedite the process and save as much time from the session, in order for the session to be all and only about processing, I want to say a few words about properly choosing an EMDR therapist.

I say such lovely, good and true things about EMDR, but all this is true only if the therapist knows how to work properly with EMDR. These are the criteria to be used to select a proper EMDR therapist, they are criteria I fully believe in, and by which I choose the therapists that work for me.

These criteria eventually are what differentiate between therapy and sessions that resemble the research, that last a few weeks, and the treatments that mix in some EMDR and last years.

Training –

1.     The therapist must have completed Stage 2 and above in EMDR training – the first stage qualifies the therapist to work with focused cases of post trauma, while the second stage widens the training to extra approaching reasons and also builds a suitable treatment plan. I am a certified therapist and certified trainer in EMDR, but there are not many therapists in Israel at a "Certified" level.

2.     The therapist must participate in ten training sessions per year at the very least – The number of training sessions attended attests to the number of EMDR bases treatments he or she did, and also shows the personal responsibility the therapist has for professional training.

Expertise

3.     The therapist knows how to use EMDR as a Psychotherapy method and not only as a tool within treatment – EMDR is Psychotherapy, and someone who uses it at the "Tool" level is only utilizing a few percent of what should be done with EMDR. A good EMDR therapist should know how to use EMDR as psychotherapy which stands on its own right- not only as something that he does as part of another treatment. This kind of methodical work with EMDR often creates differences between short focused treatment, and treatment which can take years, even though they integrate EMDR in them.

4.     A therapist should have a two-digit number of hours per month of EMDR treatment – Many therapists seldom  deal with EMDR and therefore their treatment-related experience is limited. The more EMDR hours a therapist has suggests a higher level of experience and control of EMDR. Till recently, I would do between ninety and one hundred EMDR hours a month, that is considered a very large amount, and I don’t know of any therapist who does so many hours.

I am very selective when it comes to people who work for me and I adhere to these criteria.

What should be done in preparation for EMDR treatment?

As I have said already, what we do in EMDR is identify the events that are still kept in memory in a crude form, and there are two types of events:

1.     A severe event that at any age could be bigger than our ability to cope with. Therefore, if you have been through one of the following: An accident, illness, physical injury, sexual injury, Loss, death of a close loved-one, you may want to write these events down and work on them. Even if other things are disturbing you at the moment, they may be related to a sense of helplessness, and the feeling of helplessness "pulls the rug from under" many things in life. It could also cause a more severe reaction to later events, when the helplessness button is pressed. These are the kind of events you would want to integrate into your work/therapy , even if you are coming from other therapy-seeking reasons. You don't have to but it is worthwhile. I suggest you ask about these events at your first session, in order to integrate them into the work plan in chronological order. There is a great advantage in working on events according to their chronological order, because very often the events are "sitting" one on top of the other, and when working on the earlier event, which is referred to as a "generating event", all the events on top of it don't get in the way as much. If you have been through very severe events that flood you entirely, the exercises that I will show are not for you, you should stop watching and seek professional help, and prepare this part with a supportive therapist.

2.     Events that were greater than our ability to deal with, but aren’t the first type of severe events. These are medium strength level events, and even so we were weaker than them. These are usually events that occurred when we were very young, or when we were sick, or took us by complete surprise when we weren’t prepared. Very often the events we will work on, which are the root of many kinds of psychological barriers, are events from very early ages. This is why I will work with a seventy year old man who comes for treatment for events from very early years, because if he didn’t experience severe events, or he did and we managed to set them in a work plan, it means that what is disturbing him originates from  early events which were branded in him.

Techniques for identifying earlier events

Let's take a symptom that disturbs us, for example stage fright, and we will attempt initially to see where it began – Did we suffer from it in college? If not, the meaning of this is that we must identify when the fear began, from then till now. Did we have it at our first job, second position and so on. If we already know that we had it in University, we should go back in time, to recall whether we had it during our military service.  If not, we will go forward, if yes we did already suffer from it, we will go back even more etc. Because I have a lot of experience in EMDR, I can suggest events that occur to many people, that can create symptoms.

I also have a series of Webinars that could be partially viewed, and parts may be purchased through our site  www.emdrexperts.co.il  on EMDR for anxiety, depression and trauma, EMDR for business owners, EMDR and relationships, EMDR and achievement improvement in sports, EMDR and students, EMDR and parenting- where I provide specific examples based on my clinical experience for events which many people experience. For example, stage fright, black-out at a Bar Mitzvah is a classic, or a teacher who summoned someone to the whiteboard, and there are more cases. One goes back to determine when it all began, and very often the case is that things started at Nursery school. This is because one of the main things characterizing little kids, is that not only are they softer and weaker, they also tend to blame themselves for what is happening. For example, if Daddy is mad, then it is not because he is a nervous man, or because someone at work make him upset. It is because I am a bad boy. Another thing that characterizes kids thinking is "Magic thinking", in other words they can connect unconnected things directly to them, for example:  If grandma died, "maybe I did something that caused it…". Therefore, events from early childhood are destined for the worse, and very often the roots are there.

The reverse way is, to begin with nursery school and go forward. There are some people who attempt to recall earlier ages by means of using albums, or by way of conversation with one's parents, and you can see that very early on, events started to evolve. So we will look for the "generating events" in this time period.

I can give an example of a twenty seven year old guy who came to me and said: " I'm twenty seven and work in physical, shitty jobs, and I'm fed up with them. The reason these are the kind of jobs I manage to find, is because I have no matriculation or final exams that I took, and the reason I haven’t completed my finals is because I couldn’t pass my English exam, even not the bare minimum "three points class". If I so much as take the slightest  glance at the English textbook, I literally kick it out of sight in disgust".

"I got recognition in the fact that I am challenged in English studies, I received more exam time, but what difference does it make, even two hundred percent times zero is still zero. I did all the other matriculation exams, I registered to extracurricular evening courses but the lowest level they teach is "four points class". If you help me get a passing grade in "four points class", I will worship you. Just help me overcome this somehow".

We went back to see where the English problems were, there were some in High school, in middle school, and in elementary school and in that way we got to Kindergarten. He of course doesn’t walk around as a twenty seven year old with living memories from his Kindergarten or Nursery school teacher, but when you go back and stick to the theme you can recall. He remembered that at that age he was taught to write his name in Hebrew and in English. He succeeded to do so in Hebrew, but not in English, and he remembered that the assistant teacher mocked him for that. We worked on this memory and later when his resistance to English subsided he was capable of taking an English book to his hands. From this generating event, we progressed to more events related to the English language. To make a long story short, within a few weeks he moved up to the "five points class" and eventually he got a 95 grade (A +)., and this year is already a college student. Before this all he wanted was to complete his high-school matriculation certification, and today he has aspirations to get a master's degree.

The reason I raised this story,  in addition to my opinion that it is inspiring, is to show how events from a tender age can keep us much smaller and more shriveled-up than we could be, how vulnerable we are at a young age, and how degradation and ridicule can stop us. The minute he his brain were given a chance to complete the processing of this event, it happened very rapidly. We are talking about a very talented young man, with a clever head on his shoulders, but when this happened to him when he was five it was too much for him, and he took it harshly. Now however, when he has been given a second chance, within a session or two he was able to complete the processing and move on.

If what is disturbing you is not the result of a harsh event, it is worthwhile to focus on the young ages. Specifically speaking, I recommend bringing to the first session ten pleasant memories and ten unpleasant ones prior to the age of eighteen. If there are more they should also be brought and if there is less than ten then no need to dig up more and so on, but that is the ball park figure. Check if what disturbs you existed in Kindergarten age, or did it begin later, etc.

Very often in the transitions, whether they are between elementary school and middle school, or while moving from one city to another, one can detect a breech line or traumatic memory. There were barely any cases in which people returned after moving or residing in a foreign country for a few years, and didn’t require my assistance. This included working with them on traumatic memories related to a child's feelings as the new kid, or someone who felt that he didn’t belong- trying to fit in. Therefore, if you experience such shifts and moves in your past, give it some thought in order to see whether it could be relevant.

We weren’t born with these barriers and feelings. A child that is born demands attention; if he falls he gets up and goes on. After all, if a child would behave like an adult, he would fall, feel embarrassed and uncomfortable, decide that he's had enough of this, and would go crawling to therapy. This is not what happens. A child repeatedly falls and gets up, and as adults we experience all sorts of events that hurt our ability to do so. We need to identify those events.

One technique is to go over events chronologically forwards and backwards. Often, there are interconnected events, so when making a list one recalls more memories. The list related to the work plan usually entails harsh events, and events from tender ages. Part of them will be on this list and another part will be those that you recall when going over the initial event list. When there is a symptom or a group of symptoms, we wish to add to our list the earliest times we encountered them, the most severe episodes we felt them and the latest. For example, if someone has fear of elevators, we would try to note the first time he or she got stuck in an elevator, the last time, and the time they found themselves climbing ten floors out of sheer fear.

You take the last time it occurred, for example, yesterday the boss said something and "I exploded" and he said to me "If that happens one more time – I will fire you". You must connect with that feeling, and together with that estimation you will get a list of negative and positive cognitions. This list contains three parts, because in general there are three types of negative cognitions that accompany traumatic events.

The first part deals with responsibility – These are things connected to a feeling of imperfection or blame; The second part deals with security or danger; And the third part deals with choice – To what extent I feel imprisoned, or do I have a choice. What I suggest you do is to go over the list and identify which negative words match with the last experience I had, yesterday or a week ago, the last time the symptom disturbed me. When you connect to the memory and negative words, see how that makes you feel.

If for example there was that event with the boss and it connects to the feeling that "I am a looser", then bring up the picture of this event and the words "I am a looser", close your eyes and go back in time to see where else this feeling is familiar from. Every time you identify another place it is familiar from, open your eyes and write it down. If it reminds you of degradation you experienced in the military, open your eyes and jot it down; if it reminds you that in high school they always selected you last for a game, open your eyes and write it down. Simply go back and forth with the feeling you connected to, and by association you will recollect more and more things, till you reach very early events. This is a list that will serve you well as you progress.

In the same context, I will give you two techniques which may assist you if this list overwhelms you a bit. As I mentioned, if you are very overwhelmed by it, do not continue the list, just stop watching and turn for help to a professional therapist as soon as possible. If it just floods you a bit, this could be beneficial to learn new tools that could change your situation instantaneously. They won't change your situation permanently – for that you need to treat things from their root cause, and complete memory processing, but they can assist instantaneously:

A.     Spiral –Close your eyes and imagine the negative feelings as a spiral in our body. See which direction they spin, clockwise or counterclockwise. When you identify the direction, consciously watch the spiral turn to the other side. Very often this technique enables us to form a separation between the automatic response and what you feel.

B.     Dubbing – Take the negative words, chose a favorite character from a cartoon, and try dubbing the words with its voice. If it is Bugs Bunny, Mickey Mouse or Donald-Duck, say it in that character's funny voice. The reason for our negative feelings that come up following the memories is that something is automatically "playing" in the background from our past, and we wish to put up a barrier or buffer.

C.     A list of pleasant places – A pleasant vacation, pleasant people, dogs, cats, and so on. Think about one of these things and enjoy it in order to distract the thoughts.

As I mentioned all these methods work temporarily, but they can ease things till issues are solved permanently.

When you’ve formed a list of these memories, that is supposed to summarize all the events that are stored in your memory in a crude form, one can come for therapy. Of course one doesn’t have to wait till then. As I often joke about this with patients, this is "Non obligatory" homework, because those who don’t prepare it, have to do them as homeroom tasks… Of course all that I have mentioned thus far could be done with a therapist, but if there is a matter of cost or time, you can make the list on your own, at home, and then just supplement it with the therapist.

There are a few more places that are a bit tricky, aside from the transitions that I mentioned before. Additional events that make me be more attentive are family jokes. Very often family jokes don't make at least one person laugh, very often that person is the patient, and you can find in that area many insults and humiliation.

Very often people from the Hi-tech industry come to me, approaching their forties, it doesn’t matter why they came to me, and I speak to them about changing from being employees to self-employed. This is one of my personal beliefs that employees will become worse off in the long run, less and less stable, and accordingly salaries will diminish. In the Hi-tech industry it is very apparent, because if they fire you as an employee, unfortunately it could be a premature "early retirement".

A patient came to me after catching his wife with another man, we treated it and then I suggested we work on and treat the issue of being self-employed.  He said: "Tal, forget it. Business and I don’t go together". I actually could hear a negative belief in this sentence, so I did not try to persuade him that "You and business do go together" , like they do in personal coaching methods, or cognitive – behavioral  therapy. What I picked-up with EMDR ears, is that previous events taught him that assumption, and I sought to approach them and complete their processing, so that this belief won't escort him.

We went back using the techniques I mentioned to see where that came from and we reached the age of six –he was at summer day camp and there was a "Barter day" that he and his parents had forgotten about. It was a day of barter between the kids, and he arrived empty handed, apart from a Bandana on his hand that he liked a lot. Inevitably, he had to trade it and he returned home with a crummy piece of black cardboard. He came home crying and his parents thought it was funny – "You and business…. What a pity, it's not for you".

He of course didn’t find it humorous and for over thirty years since, lived with the feeling that was never checked, that he and business are not good together. After we worked on his memory, this topic no longer bothered him and today he is self-employed as well. In this context I would like to point out that not only events that we have experienced ourselves could be overwhelming to us, but also events we witnessed. If for instance our friend's parent died at an early age, this could spur anxiety surrounding death. Another thing I see a lot has to do with unsuitable books and films that children are exposed to at a young age and can haunt them in the future. I have seen female patients that suffered from post-traumatic symptoms because they were exposed to rape films at an early age. I have seen mature men with fear and recoil from the dark because they watched all sorts of horror movies when they were too young. Very often I recommend adding to the treatment program frightening movies. I met a number of patients who had anxiety surrounding shows about crime like "America's Most Wanted". There was the movie called "Buzz" about the Derek Rott's murderers and such, which I hear from patients that were exposed to at a young age. That within itself could form a capsule of crude and unprocessed material which connects to fear that a trigger pressed in the present, could arouse. Therefore I recommend remembering movies you watched at a young age and may have left some negative impression related to anxiety. These are things that should be entered into treatment, along with the transitions that were mentioned, the issue of relationships with kids in class, if I was a popular child or not, if I was banned or not, if the teachers hated me, didn’t like me, etc. Early black-out events are often generating events of the next time. These are the things we would like to collect.

When we are dealing with a focused application for treatment, such as "Ever since the accident I don’t drive", "Ever since I got stuck in the elevator I have a phobia", "Ever since a dog bit me I'm afraid", "Ever since my black-out I have stage fright"- The time frame will ordinarily be between five and twelve consecutive sessions. I can say from my working experience with the diplomatic core, that one can work for consecutive hours, day after day, because in EMDR the process isn’t built upon the idea that you slowly get to know the therapist, and only after trusting him/her you tell them something.  Rather, it is built upon  the notion of identifying events stored in a crude live form, and helping the brain complete their processing. Thus if the therapist has the availability, and the patient has the resources, you can work at it for a few consecutive hours. There were patients who came to me with a narrow time frame, like a month before a birth due date, or someone coming in from abroad only for one week, and there is the "marathon" option, and there is no reason to stick to the "One hour a week" structure.

How does it work?

In the next few minutes I will explain how the treatment will be carried out. We spoke about the idea and the concepts and what we do ideally, but I want to tell you what you could expect when you come for a session. The first thing that happens is event identification, together with the list you’ve prepared. The therapist will also interview you to determine whether there are additional events and to get to know the background. There is no need to know your entire background in order to begin working. There is a need to know what we are working on, and it must be determined whether you have the resources to do the processing, but there isn’t a need to take down the entire history for lengthy hours. The therapy works without that, because it's unique components and the fact that it is not built upon an in depth relationship and acquaintance between the therapist and patient, but rather on the therapist enabling the patient to do what he/she knows. My job as a therapist is to create the environment that enables the patient's brain to complete its processing and to ascertain that it is happening. If it is not, I have various tools that I can use to make sure that the processing is possible and for the process go on.

Once we chose a certain event, what happens now? The first thing we want to do is connect to it, meaning, to make it "play" (in the background). The intention is not to stir the event anew and flood the patient - this isn’t exposure treatment. We want it to play in a way that enables the brain to complete its processing, not to relive a recurrence of the trauma, that is definitely not the goal. The objective is to connect to the event for the brain to complete its processing.   I ask: "Do you have an image  that represents the memory?" The picture is a default, but I may ask about smells and sounds. When there is an image, we already have a sensory channel, and I add another channel, until we reach the four. Then I will ask you: "Which negative words go with the memory?" That is what you may refer to as an "Open-book exam", I provide a list of words, all those negative cognitions that I suggest to choose from, and you will choose two or three that especially connect to the memory. While doing that, I will ask: "Which positive words would you wish to take with the memory when we are done?", this is in order to know where we wish to aspire to (aim for). Along with the negative cognitions we have the positive ones that you can choose from. For instance, if right now the negative cognition is "I am not good enough", we can choose a positive cognition such as: "I am worthy and valuable". In other words, not how I feel right now, but rather, how I would like to feel. The negative words as well are currently connected with the memory.

After all, we have a couple of tenses – what I felt then, and what I feel now. I ask about the boundary line between these two tenses – what I feel now while looking at "then", because that is the manner in which our memory influences us and that is the exact interface that we will endeavor to change in EMDR. When there are negative words like "I'm a loser" we already have two channels: A sensory channel (image) and cognitive one (words). The next question is "How does that make you feel now?" and that is the way one connects to emotion, which is the third channel. I ask: To what extent does it bother you from a scale from one to ten, which is the SUD scale, "Subjective scale of disturbance", to what extent does the memory disturb, where zero represents the most relaxed, and ten is the most disturbing. Please note – at zero, the meaning is not a feeling of "That was great – I want a re-run". There are many events we would never want to recur – ever. The meaning in zero is that the memory is just a memory, it does not prompt my actions, and I don’t feel it is happening now.  Then I will ask: "Is there a place in your body in which you feel the memory?". It isn’t a must for there to be such a place, however, sometimes there is a sensation of a lump in ones throat, or stomach churning, and so on. When I work with people on a specific injury, one can feel the pain of the injury.

In this context, there are a number of researches on EMDR and phantom pain. This is fake pain that people feel after losing a limb, for example, a pain in a person's arm after losing it in an accident. In the past, use of pain killers and other treatment had partial success. Today there is research about EMDR treatment that relates to pain as part of the traumatic event of losing that limb. It has been found that EMDR treatment suspends these pains suffered by a large part of the patients. This is because part of the traumatic memory stored in crude form, originates from the physical channel and what we felt from that event. So we actually connected to four channels.

As we progress I will request from you - "Bring up the image in your head, together with the negative words 'I am a loser, notice your body, and lets begin'. At this point you are already holding the two vibrating balls we discussed (or in internet treatment – two squeezable balls) and we can begin.

Very often I am asked "What is appropriate, medication or a discussion treatment" and the truth is that both medication and discussion treatment were not found effective enough with traumatic memory treatment **. If the problem is biochemical or organic, medication is liable to be ineffective altogether or just conceal the difficulty while taking them.

In discussion treatment, talking alone doesn’t help. What helps is designated trauma treatment, as I mentioned previously there are three methods that have been found proven by research as helpful for trauma treatment – EMDR, CBT and PE and out of these three it has been found that EMDR helps within the shortest time, and without home work.

What will happen in treatment, are sequences of processing and short reporting. Processing usually lasts between thirty and sixty seconds and following it a short report. What occurs during processing? We put the brain at the starting point, and we hold the two vibrating balls which move from hand to hand, and we let the brain go wherever it wishes to go.  We do not try to focus and we try not to make any effort, because once a person makes an effort, they activate the conscience part of the brain and that is not what we want – we want the non-conscience part to work. By the way, the process is non-hypnotic and performed in full consciousness. We let the brain wonder wherever it wishes, and I tell patients "If your mind wants to think about an avocado, think about an avocado, it knows where it has to go".  Don’t decide whether the thought is related to the subject or not. Very often during the next sequence the connection becomes apparent (clear). For example, I worked with a patient on the sense of self-value and he said during the report that an unrelated thought came up "I suddenly saw a bicycle". I asked him not to criticize and only pay attention to what will happen, etc. In the following sequence suddenly a memory came up from an early age, when he was four and his brother was three, they both received bicycles and his brother learned how to ride them without training wheels quicker than him, even though he was a year younger. Of course this story became a family joke and that was one of the earliest memories related to worthlessness. Freud also spoke of free associations, but in his method they occurred slowly and here the transfer between both hemispheres accelerates the process, like "Psychoanalysis on Speed", and the associations transfer quickly.

The process seems different from one to another, in accordance with the natural way the brain processes things. There are some whose process seems like a dream, even though it is done in full awareness in the sense that suddenly things grow, diminish, connect, suddenly he is flying or jumping, many things occur as if in a dream.  There are some who get a different perspective from later events and enable a different perspective on events. Each time the processing looks different, even with the same person working on different memories. We let what's happening happen, and take care not to control the thoughts forcibly.

The mind recalls, integrates a later perspective, and enters alternative scenarios to what truly happened. For example, a woman who experienced an attempted sexual assault recollected that she actually managed to escape. These are things the mind knows how to do, these are not things that the therapist gives as a suggestion from the side, but rather the therapist enables the conditions.

In summary, what we do after making a list is to go over memories one at a time, we retrieve a memory, bring it up and let the brain do its processing. I will repeat the details by eight phases, of the basic protocol:

1.     Taking the relevant event history – as mentioned most of this step can be done at home before arriving for treatment.

2.     Preparation –To make sure one has enough resources, to give you an explanation about EMDR and the process, which is essentially what I do in this kit.

3.     Connection to the event through various channels, as described.

4.     Processing- Completion of the process till the memory disturbs at a "0" level or close to it. The event severity doesn’t diminish the possibility of obtaining "0" level. People have reported "0" level even when talking about memories such as sexual assault, loss of a family member, and so on. That is what a processed memory looks like, we remember it, we don't attempt to get rid of it completely, but it doesn’t activate us.

5.     Here we wish to see to what extent the memory goes together with the positive cognition from one to ten. One represents a total mismatch and seven represents a perfect match. If the number is below seven, something in the memory still requires processing and we return to point 4. We will continue processing until the memory will fully fit in with the positive words.

6.     Checking that the body is relaxed. We not only arouse the memory by using four channels, we also ascertain that processing has been completed using four channels. After seeing that emotionally the event is relaxed and from a cognitive point of view the event fit in with the positive words, we'll check that the body is relaxed. At this stage I will ask you to bring up a memory together with the positive words, for example: 'I am adequate and valuable' and I will ask if you still have any sensation in your body. If there is, fine, but if so then we will return to point 4.

7. Conclusion – I inform you that following the work we have done there may be thoughts, insights or new dreams, to pay attention to, you may write them down and bring them to the next session, because very often the processing continues up till thirty six hours after the treatment. Therefore, if we haven’t finished working on a certain memory, in the next meeting I will measure the indexes again and there might have been processing that continued between sessions that affected the indexes.

8.     In the next meeting, we'll check how the memory is. Usually it takes anywhere between one and three sessions to complete a memory processing, if there are enough resources for processing, which is what eighty five percent of the population have. After completing working on the memory, the numbers will remain low forever. Why? Because you weren’t given a tool to deal with the memory, and we have changed the form in which the memory is stored in the brain. There are however two cases that the number could rise:

A.     If we have completed the processing of one layer of memory, but there is another layer. For instance: We took away the shame layer, but a anger layer still exists, or blame. In this case one returns to the memory, takes the appropriate parameters and completes the processing of the remaining layer. Then it is reduced to "0" and it will remain there forever.

B.     Cases in which there are 'Feeders' - These are memories that are earlier than the memory we worked on. This means that we missed something in the work plan, and there is an earlier event that wasn’t identified, and due to the fact that it is alive, it reconstructed the connection. When this happens, we must return to the earliest memory that we identified, complete it's processing, and then complete the processing of the other memory and both will remain down for good.

In most cases, beginning with the first time, the numbers go down and remain down. During the processing three side effects could appear:

A.     For some people, processing can be very tiring, and as a result after the treatment the brain will want to sleep and complete the processing. So, if you yawn during a session, the therapist isn’t offended, it could happen. If you can sleep after a session-great. If not, doesn’t matter.

B.     Sometimes when working on early memories, distress indexes may go up before going down.

C.     This is a rare occurrence, but still happens- Sometimes while working on memory, the crude distress is so severe that it may cause confusion and a feeling that it is happening in the present. For example, I worked with a patient who was informed fifteen years ago that his two year old daughter was diagnosed as terminally ill with cancer. When we were working on this memory he got up and left the room, and needed to complete the treatment the next day. Then, it was a case of doctors who misdiagnosed what they saw in an x-ray, and the girl is alive and well. When we analyzed what had happened, he said that he felt the same distress that day, as he did when the event occurred and simply wanted to get up and run away and operated by impulse. This is a rare occurrence, but when working on memories of this sort I make an agreement with the patient, that if he/she feels a need to run, or that he feels the event is happening that moment, he should pay attention to it but not act. Later on as the processing progresses, the differentiation between then and now will be clearer and the distress will subside.

In the past there were various limitations to EMDR treatment, that with time and clinical experience were gradually removed. At a certain time they said the treatment was unsuitable for pregnant women, but today it is known that there is no reason not to use EMDR while pregnant. The prohibition was not out of negative experience, but rather as a precaution. Since then the method has been thoroughly studied. In cases of epilepsy they also recommended against treatment with EMDR, but today no need to prohibit such treatment when dealing with a stabilized situation.

The letter D in the name EMDR stands for Desensitization, the blunting of the event's affect. The letter R represents the Reprocessing, the event's reprocessing that is experienced and processed anew. The letters EM represent the words 'Eye Movement' which I haven’t mentioned yet. The connection to eye movements was relevant when the method was developed in the eighties. Then they thought that the way to bilateral stimulation (Activating both the hemispheres), is by eye movement. That is when different means were developed for eye movement during processing, by moving the patient's hand from side to side, or lights that were turned on in front of the patient's eyes. Since then it has been discovered that the same effect can be achieved in various ways, not necessarily involving eye movements. One of the ways is use of earphones playing sounds alternatingly from side to side. In Holland for example most treatments are performed with earphones. There is another device for EMDR therapists that vibrate alternatingly on the patient's hands and I use this method. Dr. Francine Shapiro, who developed the EMDR method, is a Jewish Psychologist. A while back she did her Doctorate in Literature and then she got breast Cancer. When she recovered she decided that she wanted to make a groundbreaking change in her life and retrained and studied psychology. One of the topics that preoccupied her was the effect of the mental state over the medical situation. She attempted to find ways to ease pain and turned to use known as well as unknown methods, learned various new methods and finally developed her own. When she did, she thought that one important element for processing is eye movements, and today it is known that it is about any sort of bilateral stimulation. The first study, which was her doctorate, was published in 1989, and the rest is history. I can tell you from my personal correspondence with her that she regrets the name that was given to the method, because there is no need necessarily for eye movements and today she would have given the method a different name, maybe 'Reprocessing therapy", because that is the main mechanism – the issue of reprocessing. There are people who think the method is odd because of the eye movements, but once one understands that there is no need for it and the rationale behind it is to make sure the two hemispheres take part in the processing, and when one understands the limitations of talk-based therapy methods where only the cognitive method is activated in the process, this method seems very logical.

 In connection to this I would like to answer a question I am asked quite often and each time it breaks my heart that this is still the situation: "How, for God's sake, haven’t I heard about this method before?". I heard this from my twenty seven year old patient, who was in psychodynamic and cognitive treatment for fifteen years before we met and was still suffering - my heart broke when I heard about her. Some people reach EMDR from friend's recommendations or acquaintances, others reach EMDR from Psychiatrist's recommendations, however, there are people who reach EMDR after trying other therapy methods and giving up on it and who cannot comprehend why they suffered so many years with other methods that didn’t help. The reality is that it takes a lot of time from the moment there is a new treatment method, till it reaches the public. In Israel the Cognitive – Behavioral treatment method is considered relatively new, while in reality it has been around for about forty years. The NLP method which also became popular, has been around for 40 years. EMDR has be around since 1987, and this kit, my network, the book I wrote and other things that I do are here to close the gap, so we won't have to wait an additional few years till the knowledge reaches the public. 

An additional reason that is especially relevant for Israel is that the method was originally developed to treat trauma and the trauma treatment is funded by governments and insurance companies that require research proof. On the one hand a great advantage that makes the method one of the most researched that exist, and the most upheld that there is. However, the disadvantage is that in Israel we are in delay compared to other countries, and the treatment in Israel is mainly limited to post-trauma, and is not in all the clinics treating post-trauma, but rather, only part of them. The method is principally taught in public frameworks that treat post-trauma and due to this fact, for the most part the method's potential isn’t identified, for help to the general public. Thus you have an absurd situation, in which an anxiety casualty of missiles from the Negev ( frontier) is likely to be familiar with EMDR, much more than an accident survivor or a stage-fright patient that lives in the center of the country. My chain of EMDR specialist clinics made it its goal to make the method accessible to the public.

Problems choosing a method, and how EMDR solves them

 In summary, I would like to discuss a number of problems that people have choosing treatment and how EMDR can solve them:

1.     Reliability – How may I rely upon a therapist that can truly help me? It is important for me to say that to be an EMDR therapist, one must first be a professional with a license to treat patients, meaning Social Workers (mainly clinical), Psychologists, Psychiatrists, and Clinical Criminologists. In other words, firstly one must have a therapist license and only then may they study EMDR. That is how you may ascertain that you are turning to a professional that has been through a certification and licensing program, and a person who has experience and a background in treating more severe cases, because EMDR actually comes from trauma treatment.

2. How can I tell it is working/helping – Unfortunately, I hear from people whom I ask whether the treatment they are involved in is helping them, and their answer is "I am only being treated for the past two years, how can you tell". I emphatically don't believe in this sort of treatment, but rather in proven researched measurable treatment, so that you will be able to know whether your treatment is helping or not, yourself. EMDR is based upon empirical findings, and is recognized by APA – the America Psychiatric association, by APA – the American Psychological association as well as a long list of additional international treatment institutions. In addition, EMDR is, as I mentioned previously, a quantifiable method, and therefore there are scales from zero to ten used to measure, to what extent the event disturbs the patient, and from one to seven, to measure the adaptability between the event and the positive cognition; You may check that the body is relaxed; even after some time, you may come back and recheck that the memory is processed and not active. You can always see improvement parameters, at first in the treatment room, and later on - outside it. Our memory is like a hunk of ice, we do not aim the flame directly at it because it won't have any effect. What we do in EMDR is melt one piece at a time. Within a number of sessions, like the room lighting using a dimmer dial, the situation improves gradually.
3. Speed - I believe that treatment should help us as fast as possible. At times people see that as a negative, or as a shortcut. I do not see EMDR as a shortcut, after performing thousands of EMDR hours I think that this is the way, and all the other methods are "Long cuts"… prolonging the way. That is an interesting point to think about; what is the measuring scale by which we measure. From my experience, when you do the right thing and approach what is required, and don’t work around it by attempting to ignore or provide coping tools, but rather, complete the problem's processing, the treatment takes substantially less time. In my opinion the treatment speed is a very important issue and I wish to talk about it in the context of price. I can speak about the prices in my chain of clinics, I am not responsible for other therapist's pricing, but sometimes people ask me why EMDR treatment costs more, and that already shows a misunderstanding as to what I said before in the context of  treatment duration. It is a common mistake to look at the cost per session instead of the cost per treatment. I know people who paid tens of thousands of Shekels; two hundred Shekel per session, for a long period of time. When we wish to examine the treatment cost, we must not only look at the cost per session, but rather the cost per session times the number of sessions. An EMDR treatment by us costs anywhere between thousands of Shekels and tens of thousands of Shekels less than the alternative treatment methods. Each session may cost a bit more, but when reviewing the total cost, you can see that EMDR costs substantially less that other methods. I treated a young lady who suffered from postnatal depression for months, while at the same time an article was published in "Hebrew Psychology" (A professional mental health community publication) about a treatment that lasted four and a half years, meaning, roughly 50 times the duration of our treatment. Therefore, don’t look at the cost per session, but rather the cost of the entire treatment.

I hope this kit helped you understand a bit more about what causes us to suffer; When to turn for treatment; Which myths help us preserve the suffering; What things should be done before treatment to make sure our suffering is psychological and doesn’t originate from, or is not amplified by, biochemical or organic reasons; which things should be prepared for the treatment itself, to assist and bring forward the process commencement; and to further understand what happens in the process itself from a technical aspect.

So, what now?

If you still have questions following the kit, please do not hesitate. You can contact us through the internet site www.endrexperts.co.il

As well as the phone number 1-700-70-90-76. By phone, you also have the option to get an initial consultation call for free, from an EMDR therapist.

So, no need to suffer. It would be a real pity to live a partial life, as opposed to what you could live, all because of psychological barriers.  Whether you are suffering or whether you feel psychological barriers, if they are not due to biochemical or organic reasons, but rather an outcome of previous life events – We would be glad to help you.

Waiting to hear from you. 

A list of negative and positive cognitions

Positive cognitions PC  (Security, control)

Negative cognitions NC  (Inferiority, guilt)

I am good enough as I am I am smart enough I am worthy, valuable I am a winner I am loveable I can improve I am intelligent I count/am important I am healthy, comfortable with myself, coping, worthy I am handsome, attractive, alright as I am, worthy, I deserve it I am innocent/can forgive myself I did my best I can be trusted I am a good human being I have dignity, I am worthy of respect I deserve good things I can trust my judgment I am OK as I am I deserve to live I deserve happiness I can learn from what has happened/to improve I can choose who to trust The world is fundamentally a good place/neutral I have good things in me and bad I am destined for a good future/I can influence my future It's over, I am safe and protected now I am sturdy, strong I have survived I can find for whom to be I can deal with it I am in control/coping I have a choice I am strong I can take care of myself I can achieve whatever I wish I can be myself

I am not good enough I am not smart enough I am not worthy, I am a zero I am a looser I am not loveable I am hopeless / a screw up I am a fool I don’t count / insignificant I have a defect/ damage /illness I am ugly/repulsive I don’t deserve I am guilty I should have done something different I cannot be trusted I am a bad person I am ashamed of what I am I deserve bad things One cannot trust my judgment I am not right, I am disappointing I deserve to die I deserve to be miserable I will never change Nobody can be trusted The world is fundamentally a bad place I am fundamentally bad I am destined for a bad future I am in danger/ feel insecure I'm fragile/vulnerable/ could be crushed I am about to die There is nothing to live for I cannot suffer/stand it I am not in control I am helpless I am weak I cannot care (guard) for myself I cannot achieve what I want I have to be perfect/to satisfy everyone