0:02 [Music] the Dutch EMDR Association has the honor of being the organizer of the 10th EMDR Europe conference 2009 the organization is pleased that the founder of EMDR Dr Francine Shapiro accepted the invitation to come to the Netherlands for this festive occas [Music] 20 years ago Francine Shapiro wrote her now famous first article on EMDR since then EMDR has developed into a Psychotherapy recommended as treatment of choice for trauma but appli to other
0:49 areas as well an interview with Francine Shapiro about her [Music] brainchild Francine a warm warm welcome to Amsterdam thank you and thank you for the opportunity to have this interview together and I will ask you those questions that everybody always wants to know about of course the first question is how did you discover emor well it actually started um 10 years before the actual Discovery when I um got cancer yes and that
1:37 changed changed my uh concentration from the work I was doing for a PhD in English literature and put the concentration on mind and body because the whole area of psychon neuroimmunology was just beginning to arise and we were beginning to be aware of the interaction between stress and different disease process and it seemed very intriguing to me that we were able as a society to be so technologically advanced that we had put a man on the moon but we still weren't aware of how to deal with the mind and the body issues so it attracted my attention and so I started to use my mind and body as a laboratory to explore these different interventions and a different techniques
2:23 and I started a nonprofit organization that brought many people together in order to find out also what was available across different disciplines to to bring it out to the general public that sounds very Fring to me and around the time that I needed to be doing a dissertation one day I was walking along and I noticed that some disturbing thoughts that I was having were suddenly disappearing okay and when I went to bring them back they didn't have the same charge they weren't as bothersome but I hadn't done anything deliberately and I knew that these were the kind of thoughts that you usually had to engage with in a certain way in order to get them to change and I noticed that when that kind of thought came through my mind my eyes very rapidly started moving
3:11 in a certain way very rapid ptic spontaneous very rapid catic diagonal movement up and down and I didn't know didn't hadn't realized that I had ever done that before but suddenly I noticed that the thought shifted from Consciousness and when I brought back it didn't have the same disturbance so I wanted to see if it would work deliberately I brought up something that bothered me move my eyes in the same way and so the same thing happened and I started to play around with that then I went to uh see if it would work with anyone else and I would engage in a in a classroom situation and ask classroom classmates or colleagues or other people I knew what's bothering you okay
3:58 everyone had something they brought up something and then I asked them to move their eyes yeah and they weren't able to do it they didn't have the muscle control so that's when I used my hand to guide them and then found that the same thing started to happen the disturbance would begin to disappear but then for many people it would stop and I found I had to add components different procedures in order to allow it to continue to to give the the effect and those procedures then became the beginning of of EMDR how did you select what was productive and wasn't well the expectation was that it would work with
4:43 everyone and that there was a certain amount of disturbance that was being removed each time I did this set of eye movements therefore if it didn't change I immediately tried something else in order to see if I would add in so it was a uh trial and error yeah over periods of time where it was an expectation of seeing a change and if it didn't exist do something that would allow it and so it was that experimentation that allowed it to work what did you experience when you found out it worked so well the beginning work was with people who had various things that bothered them you know something at work or something with a spouse or you know but it but in
5:30 general it wasn't people who were suffer suffering intensely but in moving towards the dissertation to do the dissertation and looking to find a group that had a diagnosis that was homogeneous um work I decided to work with old memories and the ones that seem to have most difficulty with old memories um were trauma victims and um the diagnosis of post-traumatic stress disorder had just arrived in the the diagnostic manual yeah um about seven years before in 1990 so I decided to see concentrate to see if it would work with PTSD uh people
6:16 and I went to a um a veterans Outreach Center to see if they would allow me to work with someone who had a major trauma and they did and it was someone who had been haunted from Vietnam yeah with something that had happened to him and so using the procedure with this person and seeing something that had haunted him for 20 years disappear within a few moments yeah was wonderful it was it was it was wonderful the flip side was watching all of the TV programs of all of the trauma victims being paraded across after disasters after Wars after accidents and realizing that there was
7:02 something there that I had that could help and the push to be able to do it and at that that time not having the ability to have it out there and widespread so that this is always been this has always been the flip side of of the um of the discovery how much it can do and also how much needs to be done at the same time how did you develop EMDR from this beginning and how did you bring it into the world initially um doing a lot of presentations about hundreds of presentations to different psychology groups the American Psychological Association the the um every every every
7:51 organization I could find to do presentations to show the research that I had done and people started giving me their cards to say when I was ready to teach it that they that they wanted to learn and during that period of time also developing standards of practice of what would what would work to teach it to teach it well I was teaching individual therapists at that time and getting feedback from them of the type of the of effects that they were getting and then when those people came and learned it many of them felt that it had a strong potential and they wanted to make it known and they went back to their own local um uh communities and
8:37 organized to sponsor workshops there so I gave many workshops during those first years many trainings in order to um to let it be known as widely as we could and and many of us therapists were so happy with the results we were seeing for our clients that that almost uh from there there this dedication to help spread EMDR yes well you see that's the the beauty of certain types of clinicians because I met many during those first years and some that would come and say as you just did I see the potential and I want other people to have it I want I will do what I can to make sure it's widespread but then there were other clinicians who came and said
9:24 I see the potential and I don't want anyone else in my community to do it it I want to be the one to do it and it was those that saw it as as an advantage for themselves really not for what it could do for others the beauty of what's happened over all of these years is that clinicians such as you who really from their heart want to see people healed that that these organizations now are in in in Europe in Latin America and the United States are dedicated to that and being able to bring it out world worldwide that's that's the beauty of of it being able to touch Hearts such as yours I think you have changed the lives of many therapists and also of millions
10:11 of clients all over the world how does that make you feel when you realize that and it it is the same as it was at the beginning that it's wonderful in terms of what it can do and there's also the pain of how much more there is to do um certain doors that have are still closed because of misunderstanding of of of ignorance of um of uh criticism based on Old information or old misunderstandings and so the for instance the fact that EMDR is able to eliminate Phantom limb pain and there are millions of people
10:58 suffering from it from war from accidents from landmines from diabetes from from so many different areas and the amount of suffering that these people are going through in their lifetime which could be eliminated yeah within 12 sessions there's a good chance that it would be eliminated and yet these people are still suffering this is still very painful for me so it's always that again that two side of the coin the The Joy at what it can do and the pain it's not being allowed to do in the early years of you got a lot of negative reactions coming your way it's like contempt and Scorn and uh
11:44 people made fun of you you were accused of having a sect and EMDR was an elite thing and uh it was about making money lots of money and I wondered many times how did you manage to cope with that well early on I discovered those in the spotlight were like a blank screen that people would project themselves onto it and I knew the reasons I was doing what I was doing which was uh client safety yeah and believing that people needed to be trained in order to work with clients seemed very obvious to me so the critic ISM began because I
12:30 insisted on trainings and had people sign agreements that that this was experimental at the time it needed to be remember that time yeah um because I found when I didn't have these agreements I discovered after doing the first two workshops in the United States that clients were getting hurt there was a the clinician I knew who was doing uh um workshops for spouses of Abused Women and he recommended EMDR to the group for them and for their their wives and one of the men said to him oh my wife has had that and it was terrible for her I would never let her do that and we investigated and discovered that someone
13:16 I had trained a clinician I had trained had turned around and trained a hypnotist who did not have any clinical background and and that's where the harm was coming from it wasn't an isolated case people were teaching those who were not clinicians with no background in their version of it with not even understanding what they had been taught so I felt ethically I had to make sure that the clients were protected and I had people sign agreements if they wanted to be trained by me they needed to agree it was experimental and they were not to train others until they were approved to do so this caused a great uproar within the behavioral Community
14:03 like this was the um domain making or or something so was a sacked EMDR was an elite thing and uh it was about making money or being important or right hard to get Etc yeah that's what exclus the the blank screen you know so it was research and research from the very first moment of EMDR talking of research uh a lot of research has been done on outcome but also there has been quite a lot of research on uh the process underlying EMDR and what are the results so far and especially what
14:50 are your own thoughts on this um that's one place that needs to be done and it is a sticking point causing the uh continued criticism okay all right because the critics have said of EMDR that it's simply an exposure technique um with Superfluous eye movements all right now anyone that does EMDR know that neither are true MH because it violates all of the standards that you would need to do for good exposure therapy yeah and the eye movement certainly see the change as soon as we bring in this eye movement or other form of bilateral stimulation but
15:36 scientifically the eye movements are not proven there are at least a dozen studies that have been done in the Laboratories with the eye movement and isolation Okay that have shown uh decrease in arousal decrease in vivid imagery change of emotionality um um how it elicits episodic memory how it changes attentional flexibility there are so many studies like that that have been shown and that are helping to guide us in understanding of what the underlying basis is but they are ignored by the critics who want to see definitive studies that show treatment
16:21 outcome differences and the problem is that the previous studies that have been done evaluate the effect of the eye movement within the procedure have been done very badly have used it for instance only with combat veterans and try to judge differences on the basis of after two sessions or after treating only one memory and then wanting to see differences in overall PTSD scores which you're not going to do because these are multiply traumatized individuals and to take to treat only one memory is to taking only one One log out of the fire to see the difference so that's that wasn't well done then other studies that were done for instance using only seven
17:08 and eight people in each condition when the good research says standards say it must be done with 30 to 35 and so these earlier studies that were done badly are the ones that have essentially poisoned the field to think that the eye movements are superfluous but it's understandable because the good research was not done it's important now very important that good research studies been done of component analyses of EMDR with and without the IM movement with diagnosed PTSD patients that are uh with with measures single single stressor PTSD patients
17:57 with a appropriate measures that would show uh symptom differences until that's done the field will continue to say it's the perlu eye movement and it's up to those who are working with the MDR to do the appropriate research so that it answers that question and then once you determine definitively that the IM movement or other bilateral stimulation makes a difference than these individual studies to determine what's underlying it are are extremely important is it the orienting response is it working memory is it both is it because it links into REM sleep or not is there a difference
18:43 between bilateral and fixed is there a difference between eye movement and hand Taps and tones none of these Studies have been done now for a moment let's forget about the field and let's forget about the results of research and tell us your own thoughts about this how do you think uh EMDR works well from the beginning I felt that it links into the processes of REM sleep it just seemed to make sense that you would be going to sleep and uh before you go to sleep you're worried about something you're disturbed you sleep and wake up having a better understanding of it and at the very beginning back in '89 they they actually believe that the eye movement
19:28 had no purpose except for scanning the dream environment you know but it but again it just it felt that it was something that made sense uh Robert stick gold analysis of it subsequently and the new research that emerged saying that yes indeed REM sleep was a time for consolidating for processing survival information and memory information so now it it makes more makes more sense to the field and people such as Bob stick gold are putting the the neurobiological underpinnings into that understanding of it and that's where I think the answers are are going to be found but indeed since we're also doing it in waking State I believe it's bringing in more
20:14 factors as well I think also when we look at the uh across the field in terms of what the neurobiological understanding is the field of uh cognitive behavior therapy has an information processing model the faux emotional processing model and it it is generally only applied into the anxiety disorders and with that there was there's the sense of um you have to you have to access the the uh memory Network what they call the fear structure which of course makes sense and then the change occurs because of uh the incorporation of corrective information which also makes sense and this is what
21:01 uh the Adaptive information processing model says as well but where it's separated you see is that with um the information processing models of CBT which are believe which are working with therapies that are based on an Extinction model there's the notion that the corrective information is more or less externally induced because you're manipulating the beliefs or you manipulating the behaviors and keeping the person concentrating on that memory Network and not allowing any associations to be made because this is Contin uh considered in avoidance um and that by keeping the focus on only that
21:47 memory and uh showing that the worst expectations do not arise that the corrective information comes in by evaluating one's own behavior and reaction in in response to this as well as the um that they're in a safe environment and not going into a panic attack and not dying Etc and so they're getting the corrective information that way EMDR is saying no it is because of the connection of the internal memory networks that the changes are being made that it's the accessing of the target memory Network and uh active ating the information processing system which allows the appropriate connections
22:34 between the internal memory networks allowing the target memory to be assimilated within the larger uh memory networks this is where the connective information occurs not from the observation of the out of the outside reaction but rather the internal connections the you have new uh other memories that are coming up that are providing the corrective information you have the internal insights that are coming up you so what you're doing is taking the target memory that has the image the thoughts and sounds the emotions the physical Sensations the beliefs that were there at the time of the event which were encoded and by
23:21 accessing this and stimulating the information processing system that memory transmutes along that information processing track as the more adaptive networks are able to link in and this memory itself the target memory is changed the image changes the thoughts and sounds the emotion physical sensation what's useful is incorporated within the larger memory networks what's useless is able to be discarded and this transformed memory becomes restored in this new adaptive form where exposure therapies Extinction therapies are now understood
24:09 neurobiologically not to change the original memory but rather to form a new one that competes with it you the extinction memory the uh the original memory is believed to be remain intact in the brain and this would explain the relapse that occurs with exposure therapy if it's in a situation very similar to the one where they originally were traumatized I do not believe EMDR works with this process I believe it works with a process that has now been given the name of reconsolidation which is that the original memory is changed after it is accessed and it's restored it's stored
24:56 in a new way and that's why we transed it's transformed and stored in a new way so the original memory is altered in the MDR whereas It is believed with exposure therapy the original memory is not altered so when we see research in PTSD that says ah well it has the same effect size of EMDR and exposure that's because it's measuring only the overt symptoms of how many flashbacks or in inions or the change of arousal and also the fact that in most cases you're dealing with an additional 50 hours of homework to achieve those effects but all of the other effects that we see the personal
25:42 growth that emerges the Insight the personality changes the trait changes that we observe with the MDR these have not been um evaluated these have not been measured and so comparing only Expos exposure effect on overt symptoms and EMDR Expo effect on overt symptoms might be the same even though with exposure it takes so many more homework hours the other domains have not been affected have not been evaluated and so that also needs to be done in research to evaluate the difference between let's say exposure therapies and EMDR Therapies in terms of relapse rate Insight per personality
26:28 change trait change all of these things would be predicted by the Adaptive information processing model to be different because the original memory has been stored differently and is therefore the foundation of a different sense of self you see yeah all right and so the difference between ex uh Extinction neurobiologically and reconsolidation neurobiologically is extremely important and that that research needs to be done so I'm basically saying that when we say what is the underlying of basis of EMDR it's not going to be only one thing it's not going to be any only one thing
27:14 for any form of psychotherapy and we know we don't know even what's the underlying basis for most forms of pharmaceuticals you see so we need not to fixate only on the movement because there are many procedures in EMDR other than the eye movement or other form of bilateral stimulation that is having an effect and there there's going to be changes throughout many cortical structures one of the one of the problems in looking at neurobiology is that it's almost become the new mythology you know yeah that people say ah well we have to decondition the amydala but all we know are pre imposed we know that the amydala is responding the lyic
28:01 system is responding in one way before and it's responding in another way after but to say we have to decondition the amydala is making a statement which is there's no proof of because the amydala doesn't have an executive function to begin with so to make statements about neurobiology when it's still only in its infancy you see can be very reductive and what we need to do is keep our mind open to all of the new advances that are being made and to try to be as rigorous as possible in looking for the neurobiology but within the clinical standards that are appropriate that is what is the appropriate kind of patient
28:47 to use for the study what are the appropriate measures to use that are going to give us the whole larger picture and not just one little aspect of it and then maybe within the next 10 20 years we'll have a better idea of the neurobiology because it's just beginning now many times you emphasize that EMDR is not a technique it's a Psychotherapy and why is this distinction so important to you okay well EMD originally was a technique it was very structured we would go with the um the image and the negative belief and continue to return to it after each set of ey movements you know any anybody
29:32 could really master that in a very short period of time EMDR is quite more than that so it it has to be guided by an understanding that allows it to be customized to e each individual that's that's the first part but the more and the most also significant part is that it's not always a applied the same way it's not applied to only one thing it the the critics again say EMDR is an a theoretical technique an a theoretical exposure technique with Superfluous eye movement and this is incorrect all the way through compliment it is incorrect all
30:19 the way through it's not a technique EMDR is a form of psychotherapy it's on par with psychodynamic therapy and with cognitive behavior therapy because it's a form of treatment that's Guided by a distinct information processing model it is an information processing therapy now information processing again is used in cognitive behavior therapy but primarily for the anxiety disorders EMDR is used for anxiety disorders and much more the basis of it as a form of psychother therapy is if you are practicing psychodynamic therapy the model that is being used is that the treatment is of
31:06 INTC psychic conflicts there is the use of transfers transference and is the working through of the these different problems verbally and this is a structure of psychic dynamic therapy that's going to be recognized by anyone looking at it cognitive behavior therapy is a form of psychotherapy that is based on the notion that the path basis of the pathology are the irrational beliefs and the dysfunctional behaviors and the treatment is the deliberate manipulation of the beliefs and the behaviors and this is a form of psychotherapy that is also recognizable by anyone that's doing
31:53 it EMDR is a form of psycho therapy Guided by the Adaptive information processing model that states that the root of the pathology are the dysfunctionally stored Memories the dysfunctionally stored memories are the roots of the pathology the beliefs the negative beliefs are not the cause they are the symptom the negative behaviors are not the cause they are the symptom we do not use the deliberate manipulation of behaviors and and beliefs to make the change we do not use working through and transference to
32:39 in order to make the change we use the accessing and processing of these targeted memories to make the change and the incorporation of other memory experience in order to enhance more towards adaptive resolution so as an information processing therapy it is another form of psychology and to call it a technique is missing the boat the fact that it is another form of psychology gives a widespread understanding of the entire clinical picture and a widespread understanding of how it can be applied and it's very important to recognize it for what it is by now it's has become clear that EMDR is not a therapy for trauma alone but it
33:27 can be applied to many other symptoms and other kinds of pathology right what are your thoughts and concerns about that from the very beginning there again in 1990 there was the understanding that it wasn't simply desensitization when I originally named it as desensitization back in 19 88 it was because I came from a behavioral Orient ation and believed that what we had was a desensitization technique like systematic desensitization and that we were doing was simply getting away getting rid of anxiety and fear and the repetition of going back and back and back was like
34:15 systematic desensitization but the but that the eye movement I believed was the relaxation device the internal relaxation device so it was desensitization and applying it primarily to trauma came from the fact that that was the first study now I was working with people before then who had problems in these different areas but again was focusing on the anxiety and fear and that's when you're right in the middle of the anxiety disorders y but in the beginning very beginning of the trainings again starting from 1990 it was describing to people how it could be used for self-esteem issues how it could be used for the different clinical
35:00 complaints but the research that was done over the years was to find to get it accepted by the mainstream field of psychology and so most of the studies that were done were done on on post-traumatic stress disorder and that's where the concentration was also to teach the field I introduced the notion of small te trauma because people understood that PTSD was caused by an event and then we could explain this this event was stored in memory in a certain way and it was causing the pathology but also to get across to people that just because something was Criterion a horor and and and death
35:47 potential and therefore could be used for diagnosing PTSD that there was still at the basis of path ology life experiences and that we could call them small te trauma in order for people to understand that just because it didn't wasn't Criterion a it could still be a trauma and have a long lasting negative effect on a person so it was a teaching device to get people to understand the problem is that some people or many people hooked on to that and started thinking of it as only trauma and so the conversation became of it as trauma the people in who were trained in EMDR understood that small T trauma made was
36:35 a wide area of what it could be applied to but the rest of the field continued only to heal hear trauma and so EMDR then becomes pigeon hold as only trauma but it's not that at all and so the way to think about it is General life experiences that are highly disturbing and disrupt that information processing system that we all have gets stored in the brain in a certain way and it becomes the root of of perhaps all pathologies that we're looking at except those that are caused by genetic factors by physical insult you know damage or lack of information that most or if not all
37:22 clinical complaints are either caused or EXA acerbated by these earlier life experiences that are stored in memory in a dysfunctional form that has not allowed them to link up with anything more adaptive and that have the image the thoughts and sounds the emotion the physical sense and the belief that was there at the time therefore the information processing model the Adaptive information processing model that's the guide to how to apply EMDR as a Psychotherapy says to look at the symptoms and I and Target the memories that are at the basis of it and the
38:07 prediction will be if it is not caused by physical um insult as in Phantom limb pain that's being caused not because it's a phantom pain but because of the neuropathy because of the actual d damage to the nervous system if the Phantom limb pain is there that is not the physical cause of of the nerve damage it is because of the earlier event that's stored in the brain with the physical Sensations so the prediction of the model is the processing of the earlier events will transform the memory allow the physical sensation to be disgarded and therefore
38:54 the physical sensation of the Phantom Lim pain is going to be eliminated and this prediction has been supported so far by numbers of researchers that have done clinical trials what's needed are the randomized controlled studies to give it that other forms of of using EMDR within personality disorders is recognizing that a personality disorder is a configuration of characteristics and each of the characteristics is based on the earlier life experiences which are the memories that are dysfunctionally stored and so with any personality
39:40 disorder you're not you are looking to Target the individual memories that are causing these different characteristics so I feel wonderful about it being appi uh applied across the board because that's its purpose as a form of Psych therapy to be able to address the clinical picture okay I have only one question left the last question what are your hopes for the future of EMDR we see globally so much violence going on throughout the world areas of genocidal violence um and what we see so often it is that
40:30 trauma and violence of course has a negative impact not only on the culture on the family on the individual trauma would cause a a woman more often than not to react with depression and anxiety while the research also shows that for males the reaction is one of of anger and with all of the political reasons for turf wars and for all of the political reasons that go and that need to go on and the inequities of wealth which we have to deal with as as a world there's also looking at what can we do for those individuals in pain whether
41:18 because of natural disasters or man-made disasters such as War to alleviate the suffering so that instead of the continual reaction of anger rather than the continual stories of seeing oneself in the pictures of all of the earlier wounds and all of the earlier stories of of of of um of demeaning behaviors or humiliations that have occurred that keep separating people to allow the processing of these memories so that people can perhaps begin to see the Comm and den denominators between them that they're not automatically responding in pain and violence but are able to get to
42:03 that that shared sense of humanity to be able to allow us to get Beyond and below the political Intrigue that continues all of this and again go to the Grassroots where EMDR originally started to have enough clinicians worldwide in every country who are working with their own populations to alleviate this suffering and to have these clinicians worldwide to understand that they are bonded together by a desire to alleviate suffering and are using a tool that allows each to be willing to confer with another and the ha organizations to know that if one country is in need other
42:49 countries are going to come to their aid to be able to bring the the the world together in that way way that's the hope to be able to allow EMDR there worldwide where it's needed and perhaps to make some inroads in bringing peace together uh thank you very much for this interview you're welcome and I would like to tell a story from my from my part reacting to to what you told us about your hope for the future I had the honor of being H in a EMDR training in the Gaza area and uh we were working with the participants and there was this one young male Palestinian clinician and
43:38 he did work with EMDR on his own issues a cousin of his was uh killed and he worked on that and afterwards he told us that in the weeks before he many times thought that he wanted to be a suicide bomber to do something with his anger and his need for Revenge after the EMDR he said I now have discovered there's better ways to help my people to help my Palestinian people by being a good therapist and that touched our [Music]
44:25 heart thank you I love you you know that
