EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR) EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR) Basic Principles, Protocols, and Procedures SECOND EDITION www FRANCINE SHAPIRO, PH D THE GUILFORD PRESS New York London © 2001 Francine Shapiro Published by The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved Except as noted, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 987654 LIMITED PHOTOCOPY LICENSE These materials are intended for use only by qualified mental health professionals. The Publisher grants to individual purchasers of this book nonassignable permission to reproduce material from Appendix A. This license is limited to you, the individual purchaser, for use with your own clients and patients. It does not extend to additional clinicians or practice settings, nor does purchase by an institution constitute a site license. This license does not grant the right to reproduce these materials for resale, redistribution, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, and handouts or slides for lectures or workshops). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. Library of Congress Cataloging-in-Publication Data Shapiro, Francine. Eye movement desensitization and reprocessing: basic principles, protocols, and procedures / Francine Shapiro.—2nd ed. p. ; cm. Includes bibliographical references and index. ISBN-10: 1-57230-672-6 ISBN-13: 978-1-57230-672-1 (cloth: alk. paper) 1. Eye movement desensitization and reprocessing. 2. Post-traumatic stress disorder—Treatment. 3. Psychic trauma—Treatment. I. Title. [DNLM: 1. Stress Disorders, Post-Traumatic—therapy. 2. Desensitization, Psychologic—methods. 3. Eye Movements. 4. Psychothreapy—methods. WM 170 S5395e 2001] RC489 .E98 S534 2001 616.85′210951—dc21 2001022141 With gratitude for the guiding lights of each generation In memory of my grandparents, Charles and Lena Sumner, and my sister, Debra P. Shapiro and for the loving support of my parents, Daniel and Shirley Shapiro, and one of my life’s greatest blessings, Bob Welch www Freedom is what you do with what’s been done to you. Jean-Paul Sartre www About the Author Francine Shapiro, PhD, the originator and developer of EMDR, is a se- nior research fellow at the Mental Research Institute in Palo Alto, Cali- fornia. She is the founder and President Emeritus of the EMDR Humanitarian Assistance Programs, a nonprofit organization that coor- dinates disaster response and pro bono trainings worldwide. She has served as advisor to a wide variety of trauma treatment and outreach or- ganizations and journals. Dr. Shapiro has been an invited speaker on EMDR at many major psychology conferences, including two divisions of the American Psychological Association and the American Psycho- logical Society Presidential Symposium on PTSD. She has written and coauthored numerous articles, chapters, and books about EMDR, in- cluding Eye Movement Desensitization and Reprocessing (Guilford Press), EMDR (Basic Books), and EMDR and the Paradigm Prism (American Psy- chological Association). She is a recipient of the Distinguished Scien- tific Achievement in Psychology Award presented by the California Psy- chological Association, and of the International Sigmund Freud Award for Psychotherapy presented by the City of Vienna. w vi w www Acknowledgments This book could not have been written without the unswerving support of Robbie Dunton, who freed my time and mind for the task. I am thankful for her organizational skills but even more for her loving- kindness and generosity of spirit which have never failed me. Special thanks go also to Robert Welch and Margot Silk Forest, who put their great intelligence and skill into editing these chapters. My gratitude goes also to Pat Ryley, who skillfully created a number of the illustra- tions, and to A. J. Popky, who has consistently provided valuable techni- cal support. The content of this book is based on the clinical experiences of hun- dreds of clinicians, and I hope I have done them justice. The task of communicating the information was aided by many people, but special thanks go to Howard Lipke and Steven Silver, who served as the pri- mary readers of many of the versions of most of the chapters. I am grateful to the many people who took the time to read differ- ent chapters or who offered suggestions at various stages of the book’s development. These people, in alphabetical order, are Lonnie Barbach, Pat Boudewyns, Jac Carlson, Robbie Dunton, Catherine Fine, Gary Fulcher, Eirin Gould, Tom Horvath, Lee Hyer, Steven Lazarove, Marilyn Luber, Jeri Marlowe, Sandra Paulsen, Gerald Puk, Curt Rouanzoin, Mark Rus- sell, Roger Solomon, Landry Wildwind, and Walter Young. Many thanks to the Guilford staff and especially to my editors, Kitty Moore, for her astute suggestions, and Anna Brackett, for her careful shepherding of the book through the production process. Introducing an innovation to the psychology community is notori- ously difficult, but I have been blessed with an expanding circle of openhearted, masterful clinicians whose ability and integrity reassure me that we are on the right path. To those EMDR trainers, facilitators, and clinicians who had the vision to try something new and the courage to spread the word about their experiences—although it may seem like hubris to thank you for things you did out of a sense of personal respon- sibility and purpose—I will be endlessly grateful. w vii w www Acknowledgments for the Second Edition This revised edition is the product of the work and thought of many cli- nicians and researchers. I am grateful to them all for their help and sup- port. My special thanks go to Louise Maxfield, whose exceptional tal- ents and extensive knowledge of the EMDR literature have served this edition well. Special thanks also to Robert Stickgold for his theoretical acumen and assistance in refining a number of the sections on neurobi- ology. I am also grateful for the additional feedback of Howard Lipke, David Servan-Schreiber, Robert Tinker, and Curt Rouanzoin. For the many tasks necessary to bring a volume into final form, I am grateful to Marcy Smith for her technical support, and thank Oliver Sharpe and Kitty Moore of The Guilford Press for shepherding the book through the final publication process. Finally, for providing his scientific rigor, patience, and unswerving support, I thank my husband, Bob Welch. w viii w www Preface Blessed is he who has found his work; let him ask no other blessedness. Thomas Carlyle THE PATH OF DISCOVERY The opportunity to introduce a revised edition brings to mind a quote by the early philosopher Heraclitus: “You cannot step twice into the same river, for different and ever different waters flow down.” Given the ever changing nature of healthcare, life, and thought, it is gratifying to see that most of the book has remained relevant to the practice of Eye Movement Desensitization and Reprocessing (EMDR). It has aged well. At the same time, this revision has given me an opportunity to ad- dress certain basic misconceptions and offer the latest theory and re- search governing EMDR practice. Although the suggested parameters of research are unchanged from the previous edition, this volume points out additional areas of potentially fruitful investigation along with some promising new protocols. The extensive controlled research on EMDR is updated as well. It has also been gratifying, over the last 5 years, to witness through- out the professional community practicing EMDR the growing interna- tional commitment to the healing of suffering. In fact, the first edition of this text appeared only a few days after the Oklahoma City bombing. At the request of an FBI agent who had undergone EMDR treatment, volunteers traveled at their own expense to offer assistance to the trau- matized community. Those Oklahoma clinicians who had already been trained in EMDR opened their offices and spread word of the opportu- nity throughout the area. Over the subsequent 4-month period, two to three EMDR clinicians per week traveled to Oklahoma and offered pro bono services to those in need, starting with the traumatized mental w ix w x w Preface w health professionals, who then requested services for the frontline pro- viders and survivors. At the end of the 4 months a pro bono course of training was offered to all licensed mental health professionals in Oklahoma City, enabling them to continue the work. This spontaneous outpouring of service marked the inauguration of the EMDR Humani- tarian Assistance Programs (see Appendix C), emphasizing the need to combine scientifically evaluated treatments with heartful clinical ser- vice worldwide. As we join together in this global commitment, we can truly fulfill our obligation as a profession. To repeat my statement in the previous edition: We went from Kitty Hawk to a man on the moon in little more than 50 years. Yet de- spite such monumental technological advances, millions of people suf- fer unremitting pain and a cycle of violence continues unchecked worldwide. Surely as a society we need to redirect some of our vast re- sources and pay greater attention to the alleviation of global suffering. Surely we need to change our level of expectations regarding the poten- tial for healing and interpersonal development. But part of the problem may also be caused by a variety of attitudes inherent within our own pro- fession. Although the integration of knowledge in the hard sciences has allowed for continued developments and refinement of applications, which have moved rapidly from Edison to the Internet, the field of psy- chotherapy has somehow not kept pace.