Summary
Dr. Joy Harden-Bradford interviews Kelly, an EMDR-trained therapist and director of grief and trauma therapy at a Memphis behavioral health hospital, about how EMDR works and why it is particularly effective for processing unresolved trauma. Kelly explains the phases of EMDR, from history taking and creating a calm safe place to the bilateral stimulation that mimics REM sleep and helps clients become "unstuck" from traumatic memories. The conversation highlights how EMDR differs from talk therapy by accessing trauma at a physiological and cellular level rather than just intellectually. Kelly discusses the SUDS (Subjective Unit of Distress) scale for measuring progress, the envelope system for managing multiple traumas, and the four survival behaviors people develop after trauma: fight, flight, freeze, and appease. She also addresses special considerations for using EMDR with the Black community, including overcoming stigma and building trust, and notes that one EMDR session can be equivalent to five to twelve talk therapy sessions.
Key Points
- EMDR mimics REM sleep through bilateral stimulation (tappers, eye movements, or tapping) to help the brain reprocess traumatic memories
- One EMDR session can be equivalent to 5-12 talk therapy sessions, especially for PTSD in veterans
- Talk therapy keeps processing intellectual; EMDR accesses trauma at an emotional and physiological level where it is trapped in the body
- The SUDS (Subjective Unit of Distress) scale from 0-10 measures trauma severity; scores of 5+ indicate active trauma affecting daily life
- EMDR has distinct phases: history taking, creating a calm safe place, assessment, bilateral stimulation with reprocessing, and desensitization
- Certain medications like benzodiazepines and opiates can interfere with EMDR effectiveness by preventing the necessary emotional activation
- EMDR is highly effective with children because they have fewer accumulated memories and can access the target trauma more directly
- Four trauma survival behaviors are fight, flight, freeze, and appease; EMDR helps reduce reliance on these maladaptive patterns
Key Moments
EMDR accesses trauma at a cellular level that talk therapy cannot reach
Kelly explains that while CBT keeps processing intellectual, EMDR reaches clients at a physiological level because trauma is trapped in the body. She notes that some research suggests even conditions like MS could involve trapped trauma.
"EMDR encourages becoming unstuck. And sometimes CBT just cannot reach a client at that level because EMDR can be very physiological. It encourages trauma. It's trapped in the body."
One EMDR session can equal five to twelve talk therapy sessions
Kelly describes how research shows one EMDR session can be equivalent to about five talk therapy sessions, and up to twelve sessions for veterans with PTSD. She uses an envelope system where clients write trauma titles on index cards, seal them, and only open them in session to maintain a sense of control.
"I'm not asking you to deal with it at home or talk to your spouse or your kids about it. We got it on paper. It's sealed. And all of the EMDR, you know, that I do outpatient takes place in my office unless I'm seeing patients in a hospital. But often in my office, if I'm working on one thing and I assess that there are several others, and that is the case, Joy, with a lot of African-Americans, several others, meaning a theme of traumatic experiences that stand out, they really do favor and like the whole envelope system. Yeah, I can imagine that does feel a little comforting, like they can kind of contain it, so to speak. Absolutely. Yeah. So you mentioned, you know, that you found that particularly with African-Americans, they find that comforting."
The four trauma survival behaviors and how EMDR shifts them
Kelly identifies four behaviors people develop to survive trauma: fight (anger and defensiveness), flight (suicidality, drugs, and alcohol), freeze (numbness and checking out), and appease (people-pleasing to avoid being hurt). EMDR helps reduce reliance on these patterns.
"Fight, flight, freeze, and appease. You know, fight is that being angry and defensive. Flight, a lot of times, is being suicidal. Drugs and alcohol, most people that are suicidal, I don't think they want to die. They just want to stop hurting. People want to end their pain, not their life."
