Summary
Dr. Kirk Honda, chair of the Couple and Family Therapy program at Antioch University Seattle, delivers a thorough solo episode covering EMDR's history, treatment protocol, evidence base, criticisms, and application to borderline personality disorder. He traces EMDR from Francine Shapiro's 1987 discovery through its evolution into a comprehensive integrative therapy that incorporates psychodynamic, interpersonal, and cognitive behavioral techniques alongside bilateral stimulation. Honda walks through each phase of EMDR treatment in detail, from client assessment and relationship building to distress regulation skill development, trauma recall, eye movement reprocessing, and positive cognition installation. He emphasizes that the eye movement component is actually a small part of the overall therapy, with much of EMDR overlapping with established exposure therapy approaches. While acknowledging that nobody knows exactly why bilateral stimulation works, he firmly endorses EMDR as an effective, evidence-based treatment that has helped hundreds of thousands of people recover from trauma.
Key Points
- EMDR was developed by Francine Shapiro starting in 1987 after she noticed her own eye movements reduced distress when recalling trauma
- Over 100,000 clinicians worldwide have been trained in EMDR as of 2017
- The eye movement component is actually a small part of EMDR; the therapy integrates psychodynamic, interpersonal, and CBT techniques
- EMDR treatment phases include assessment, treatment planning, relationship building, distress regulation skills, trauma recall, bilateral stimulation reprocessing, and positive cognition installation
- Research shows EMDR is absolutely effective for trauma, though no one knows exactly why bilateral stimulation works
- Some studies show EMDR is faster than other therapies; others show comparable effectiveness to exposure therapy
- EMDR can be applied to borderline personality disorder since BPD is often associated with complex trauma
- Bilateral stimulation can use eye movements, hand tapping, auditory tones, or vibrating pulsers
Key Moments
History of EMDR from Francine Shapiro's 1987 discovery
Dr. Honda traces EMDR's origin to Francine Shapiro noticing that eye movements reduced her own trauma distress around 1987. She developed it from a personal observation into a comprehensive therapy integrating psychodynamic, interpersonal, and CBT techniques, now used by over 100,000 clinicians worldwide.
"Around nineteen eighty seven, she noticed that when she thought about her own traumas I believe she was sexually assaulted, her eyes moved in a rapid diagonal direction side to side, so she would look up and look, you know, she'd look up into the right or I think, and then down into the left, up and to the right and left, and her eyes moved back and forth. And she noticed that this eye movement back and forth while she thought about these traumas that she had been through, she noticed that it seemed to help her recover from those terrible experiences."
Eye movements are actually a small part of overall EMDR therapy
Dr. Honda argues that the eye movement component is a relatively small part of the overall EMDR protocol, which includes extensive assessment, relationship building, distress regulation training, and cognitive restructuring. He suspects EMDR might be effective even without the eye movements.
"Is actually a kind of a small part of it. And in my estimation, if you did this, if you did EMDR and never actually did the eye movements, I would suspect that it would be at least somewhat effective, if not just as effective."
Why nobody knows the mechanism behind bilateral stimulation
Dr. Honda explains that despite various hypotheses involving REM sleep and brain lateralization, the scientific community genuinely does not understand why bilateral stimulation works. He notes that we do not even fully understand basic brain mechanics, making claims about EMDR's mechanism premature.
"To the lay person, I can imagine it being very convincing. But to people who understand the brain, I imagine they roll their eyes pretty hard. You'll hear people say that it has to do with ram sleep or something rapid eye movement sleep. And anyone who knows anything about the brain knows that these hypotheses are just initial speculations. I mean, we we don't really even understand how the brain works, and we definitely don't understand why we have rapid eye movements during sleep, So how in the world would we understand how EMDR works. And that that's the there's this big myth that is I think upheld by society and the media and maybe even biologists in their attempt to come across as as relevant. There's this big myth that we understand the brain, and we understand we've we learned new things about the brain every day, but the basic mechanics of the brain is a complete mystery to us."
EMDR endorsement and final word on its real-world impact
Despite his criticisms, Dr. Honda firmly endorses EMDR as a therapy that has saved hundreds of thousands of lives by helping people recover from trauma, reduce PTSD symptoms, anxiety, depression, anger, and suicidality. He recommends it for both clinicians and clients.
"The point is is that EMDR has helped people recover from their traumas, which can in a very real way, improve people's lives in a very real way, reduce their PTSD symptoms, their anxiety symptoms, their depression symptoms, their anger reactions, their suicidality, their homicidality. It's without a doubt clear to me that people around."
