Seen
Seen
Who is EMDR Not Good For?
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Hello friends! This episode features Cassandra and Garth, as they talk about who EMDR is not a good fit for, common misconceptions about EMDR therapy, and the “yield signs” therapists watch for before beginning trauma processing. They walk through medical considerations, emotional readiness, safety concerns, and why most people can still benefit from EMDR with the right preparation and support.
You can learn more about Cassandra and her practice at: seentherapy.org. Get a taste for the episode below. If you enjoy your listen give us a follow, share, or five star review. Have a good one!
“Just about all of these are pauses, not stop signs. Most of the situations people worry about when it comes to EMDR aren’t reasons someone can’t do the therapy. They’re yield signs. They tell us we may need to slow down, stabilize, or prepare a little more before moving forward with trauma processing.”
Hello, hello, hello friends. Welcome to the podcast where we simplify everything about mental health. Just kidding. But here's what we are gonna do. We're gonna sit down together, a licensed mental health professional, that's me, and a regular old Joe, as my husband Garth would describe himself. We're gonna talk about the nitty-gritty of the MBR, some nervous system mapping, how couples can help each other heal, what's healthy parenting actually look like, maybe a little bit of good old banter mixed in. All with the goal of making mental health a little bit simpler for you. Which note, because my lawyer says that I have to. I'm a therapist, but not your therapist, unless I am. Even if I am, this is still just a podcast, okay? Now have a good listen. Hello friends. This is Cassandra, and I am joined by Guard.
SPEAKER_02Guess who's back?
SPEAKER_00Guess who's back? I love how we're still acting like you're like a guest.
SPEAKER_02Well, I am.
SPEAKER_00Oh, okay. So we're I'm gonna count after this. How many episodes in together, and you're not a co-host, you're still a guest.
SPEAKER_02I mean, you can fire me at any point, so I think I'm a guest. You can ask me not to come back. I could fire you at any point.
SPEAKER_00Okay, today we are talking about who is EMDR not good for. We always say that we're gonna try to keep things brief. I won't commit to keeping this one brief. I am going to commit to, though, trying to keep each individual point brief because we have a lot to go through here.
SPEAKER_03Okay.
SPEAKER_00Who is EMDR not good for? And the simple answer is almost no one. Right. Under most circumstances. So for most folks, there are specific protocols that we can use, specific modifications that we can use, and still proceed forward with most of the phases of EMDR. Um, and so we are going to uh hash that out today and talk about the the few exceptions. All right. That being said, Garth, let us bant before we move on.
SPEAKER_02What's your favorite movie?
SPEAKER_00Okay, well, we've talked about this before, but you know that none of my favorites stay favorite.
SPEAKER_02Yeah, I know. Right now.
SPEAKER_00Well, first of all, I don't remember the last time I watched a movie that wasn't a kid's movie.
SPEAKER_02Right?
SPEAKER_00Like an entire movie. Oh my goodness. I legitimately have no idea. Can you answer first? And I'm gonna kind of uh sit and think. Well, I don't know. Because I always answer first.
SPEAKER_02I have lots of favorites.
SPEAKER_00You don't know what yours is? Yeah. See, I can't even think of one, and you're gonna have trouble picking one.
SPEAKER_02Yeah, I've got a punch.
SPEAKER_00Meeny meeny miny monit, sir.
SPEAKER_02I guess if I had to say my favorite movie right now. I don't know, this is kind of a hard question. When you really start to think about it. Lots of really good movies out there. Hmm. Mm-hmm. I would say The Matrix. I just really enjoy The Matrix and like all the like sci-fi stuff that comes along with The Matrix and you know the dual live situation. It's just up on thought experiment.
SPEAKER_00Oh, I have one.
SPEAKER_02Okay.
SPEAKER_00Because I have watched a movie recently, and I have a special reason why this one's my favorite right now. Our four-year-old is, when I say reading, I mean being read to. Our four-year-old is being read the Harry Potter series for the first time. Yep. And girlfriend is jacked.
SPEAKER_02She's into it, she's pretty into it.
SPEAKER_00So finished the first book and got to watch the first movie, and she was so, so excited.
SPEAKER_02Yeah, that's a rule around here. You can watch the movie after you read the book.
SPEAKER_00Yeah. Yeah. So that was a pretty exciting day here in our family. I say day. We watched it over multiple days.
SPEAKER_02Three or four, wasn't it?
SPEAKER_00Yeah, they're very long movies. But have I sorry, circling back to your answer. Have I seen The Matrix? You remember these things better than I do.
SPEAKER_02I probably haven't.
SPEAKER_00I don't know that I have.
SPEAKER_02It's very good. Keanu Reeves, 90s.
SPEAKER_00I don't love that I haven't seen your favorite movie. We should watch that. Yeah. I hope there are parts of it that haven't aged well.
SPEAKER_02No, it it it's aged pretty well. It's aged pretty well. Yeah, I think. It's been it's been a while since I've seen it.
SPEAKER_00We'll rewatch it and assess.
SPEAKER_02Okay.
SPEAKER_00Awesome. Are you enjoying the Harry Potter movies too?
SPEAKER_02I mean we were only one in, but you're I'm enjoying reading the books to our little girl more than anything else.
SPEAKER_00Yeah. So that was part of the fun for me is you know, we read through the first book, and I had never read a book and watched a movie so close together. I say that it's well, yeah, I haven't because I was reading the books as they were coming out and then watching the movies as they were coming out.
SPEAKER_02So um there was like a five-year gap between the books and the movies.
SPEAKER_00I mean, I don't know what exactly what it was, but yeah, there was quite a bit of gap. Okay. Well, thank you for banting, as always. Of course. I uh and this was not food related.
SPEAKER_02Look at me growing.
SPEAKER_00Though we'll throw that in here. What's Gar's favorite food while he watches a movie? It's pretty steroid. I you know, favorite snack, popcorn, period. The man loves some popcorn. I love it. Okay. All right, who is EMDR not good for? You ready to get into it?
SPEAKER_02I'm ready.
SPEAKER_00Okay, we're gonna start simple.
SPEAKER_02Okay.
SPEAKER_00If you or a client that you're working with has had a recent stroke seizure or TBI, you need to consult with their neurologist. So if I have someone come in that has had, you know, seizures in the past, uh, has a serious TBI, has had a stroke in the the past uh, you know, two years, three years, I will tell them we can proceed, but I am going to need a letter from your neurologist. And obviously, clinician keeping that on file um for you, but also really like we're wanting to legitimately make sure that this client you're cleared for this. Yeah. Well, that this client is yeah, is not gonna be harmed by this. So that's kind of basic one. Another basic kind of physical thing to consider is just a retinal injury. Obviously, that would just be eye movements that the client wouldn't be able to participate in depending on the injury. So we do know that eye movements are the most effective form of bilateral stimulation that we use in EMDR. And so even if they've had an eye injury, if they feel comfortable trying, and again, they have a release from um optometrist, ophthalmologist, I think is an eye surgeon. Oh boy. Um don't ask me, then you know, you could proceed forward at that point. Okay. Couple other things to consider individuals who have had recent cardiac events or pregnancy. Okay, both of these things, I'm lumping them together because we're monitoring those for the same reason. The other pieces that I gave you were concerned about bilateral stimulation. These two pieces were concerned about increased heart rate, blood pressure, things of that nature. So if you've had somebody who has had a recent cardiac event, obviously any therapy that gets them to a place where they're very activated may not be the right choice at this time. Yeah. Uh with pregnancy, I'm not really concerned unless the client is reporting that like provider is starting to get worried about blood pressure. The and even then it would depend on where I was at in my work with the uh client that's pregnant. If we've been working together for a while and that client is pretty good at containing, uh, meaning that they can become distressed, but then pretty quickly de-escalate, desensitize and de-escalate, then I'm not really too concerned that they're leaving and they're gonna be activated and that blood pressure is gonna stay high. Does that make sense? Um so those are a little bit more gray, but again, those two were worried about like activation. Um, and then the others that I mentioned were worried about bilateral stimulation and and how that could play out for for those folks.
SPEAKER_02So that's it, huh? Those that's all the people that shouldn't do EMDR.
SPEAKER_00That's not it. And even those folks, again, it's not that they shouldn't, it's that we need to take a step further for inquiry. Yeah, just about all of these are pauses, yeah, not stop signs, they're yields, yield signs, yield signs, okay. So thus far we've only thrown up yield signs. Okay, active suicidality. Okay, the term active suicidality is a stop sign, but someone who is actively suicidal, it's a yield sign. We don't want to really be focused on EMDR until we have them to a place where they are no longer actively suicidal. I was actually planning on saving this until the end, closer to the end, but I think it pairs well with active suicidality. And that is, and I'm gonna get on a soapbox for just a second here. If someone's basic needs are not met, yeah. And you probably know my soapbox here. My soapbox is if someone's basic needs are not met, yeah, why are we providing therapy? Period. And I know some people are like, yeah, we need case management services, folks. If you are trying to provide therapy to somebody whose basic needs are not met and you're not getting anywhere, there is a reason for that. Case management services.
SPEAKER_02So my background in education, I saw this all the time. We would in in the educator preparation courses, we would talk about Maslow's hierarchy of needs. I'm sure that's something you studied as well whenever you were schooling it up. But yeah, if you don't have those basic needs met, you're not able to grow. You're not able to flourish, you're not able to learn new strategies, you're not able to heal. Like you gotta have food, you gotta have shelter to your own.
SPEAKER_00Right. No, thank you.
SPEAKER_02Your brain won't do it. Your brain's like, nah, it's more important to focus on like where I'm sleeping.
SPEAKER_00And someone who's actively suicidal, their basic needs aren't being met either.
SPEAKER_02For sure. They don't feel safe. Safety is a basic need, right? That's yeah.
SPEAKER_00An active suicidality. Actually, a lot of American adults are passively suicidal. So passive suicidality is you say a lot. Yeah, so I'll go there in just a second. Passive suicidality is not a contraindication, which is a fancy word for saying that's not a stop sign for EMDR or even a yield sign. Passive suicidality is things like I, you know, client saying, I just don't really want to wake up tomorrow, or I'd just like to not exist, right? That's passive suicidality. Active suicidality is I have a plan right to act that out. And we won't go further into that, but there's a a big jump there. One in three adult Americans report being act or being passively suicidal at some point in their adulthood.
SPEAKER_02Oh, at some point, okay.
SPEAKER_00Yeah, not at any given moment.
SPEAKER_02Yeah, yeah.
SPEAKER_00Okay. But that being said, a lot of people are and have experienced passive suicidality. So yeah, that is not a contraindication, but active suicidality and not having other basic needs met. Let's get some case management services, let's make sure that person is safe and then we can jump in. Yeah. Okay.
SPEAKER_02Yep.
SPEAKER_00All right. Here's I'm gonna get into some language that I use in session. And so please you listen carefully, and if there's anything that I'll flag it. Yeah, isn't clicking for you, let me know. Just providing titles, the client is activated and unable to regulate. So, what I mean by titles, I when I'm first meeting a client, will say something along the lines of, I noticed this in your intake that you um described this. We don't have to go into it today. But when you said this, this, and this, and I'll reference a specific memory that maybe they put in their intake, could you just give that a title for me? Or I might say something like, It seemed like, you know, you had put in your intake that middle school was a really rough time. Could you give middle school a title for me? Or are there a couple memories from middle school that you want to give a title?
SPEAKER_01Yeah.
SPEAKER_00If in just providing those brief, what I call titles, but we're actually we're developing EMDR targets. If in just identifying those titles the client is activated and they have difficulty regulating without a lot of assistance from me, that's indicating to me, whoo, we need to slow down and not do no parts of EMDR. Right, but we need to not move past phase two for a while, which involves resourcing and preparing for the rest of the process of EMDR. Yeah. Does that make sense? Yeah, complete. Basically, if we're going into the shallow end of the pool and we're already having trouble, we're not going to the deep end yet.
SPEAKER_01Right.
SPEAKER_00Yeah. And then along with that, if I am assessing that this individual has no or very little support and resources, right? So if that's the case, and we've talked about this quite a bit on the podcast before, again, we need to live at those that phase two for quite a while before we're moving on to the rest of of EMDR. So the if this is an individual that's low resource, low support, that would indicate a yield sign to me. Yeah. Again, it's not a full stop, but these are yields. I told you.
SPEAKER_01So all right, we'll come back to that.
SPEAKER_00Yeah.
SPEAKER_01Misleading title of the pod episode, huh?
SPEAKER_00Hey, yeah. Okay. Who is EMDR not good for? These are common questions that we're getting, right? So I didn't come up with that on my own. Um, but yeah, the thing is not very many people, because again, there are a lot of modifications of different protocols that we can use.
SPEAKER_02Well, and I think that comes back to you if you're seeking EMDR care, you need to be seeking EMDR care from someone who knows what they're doing. Because almost anyone can participate in EMDR therapy and see some benefits, but there may be some stop points that need some more attention or some different techniques that are used, is is what I'm gathering from you here. That it's really for everybody almost, but you you may need to do some different work before you actually jump into EMDR to really see those benefits.
SPEAKER_00Well, and you need to know an experienced EMDR clinician knows like at what phases of EMDR are we slowing down?
SPEAKER_02Right. Yeah.
SPEAKER_00Or pausing. Yeah. Okay. Here we're we're moving on to another kind of in my brain, this is a different section. Someone that is in active psychosis, active intoxication, long-term amphetamine use. No, obviously, for active psychosis and active intoxication, again, case management services, folks. But the reason that I lumped these three together, active psychosis, active intoxication, and long-term amphetamine use, is these folks do not have the ability to maintain dual awareness.
SPEAKER_02Right.
SPEAKER_00That means they would not have the ability to get to the point where they could say, I understand I am here with you in the present, and this memory that we are referencing occurred 10 years ago.
SPEAKER_02Yeah.
SPEAKER_00If they can't get to that point, there's really no point.
SPEAKER_02Right. Right. Because that's that's how EMDR works. Yeah. You can't do it without being able to do that step of it.
SPEAKER_00Right. We're working towards the ability to hold two dual ideas that I am present and this is past, right? And so yeah, if they don't have the ability to do that, then it it's really irrelevant. And another thing to consider is that cognitive delays can also hinder someone's ability to hold dual ideas.
SPEAKER_02You know, there could be someone with an intellectual disability that might not be a good candidate for this specific type of therapy.
SPEAKER_00Yeah. And there's no line in the sand on that. I think that clinicians need to start with an IQ of around 70 to 75, need to start considering whether or not this is the best option. And so again, no line in the sand. That's just again a suggested kind of yield point. Yeah. If we would either see previous assessments with that IQ or we would be kind of need to dig a little deeper to make sure things are going to be okay.
SPEAKER_02Yeah. Yeah. Yeah.
SPEAKER_00And again, that we're not going to be better serving that client with a a different type of therapy. And then another piece that a lot of people don't consider, but there's actually been quite a bit of research into this. Benzodiazepines are it we encourage clients to, with their provider, their prescribing provider, to get off benzos eventually if they can. They dampen emotional response and reduce arousal. And we really with EMDR need some level of activation in order to reprocess. In order to desensitize. Right. So, you know, if you have a client that is on some type of benzodiazepine, it's just something to kind of keep in the back of your mind that if we're not making some steps forward, that that is a possibility that that's impacting that. Yeah. Okay. Last thing to consider, we've done well. I like I said, there's been a lot of points, but we are moving on through.
SPEAKER_02Let's keep tracking. Okay. Let's go. Is today gonna be the day? Sub-20?
SPEAKER_00No, we're already over 20. Yeah. Well the last thing to consider that I think also sometimes we well, I'm gonna back it up. Last thing to consider that I think we need to be really clear with clients on. Okay. And I have this in our consent forms, and this is something that I process through with clients. If you are in legal proceedings as a client for something like an assault, and you're pursuing EMDR for that assault, something that you need to consider is that the point of this is that your reaction to this memory is desensitized. Yeah. And a jury won't necessarily understand that.
SPEAKER_03Right.
SPEAKER_00And so I have processed with clients before, you know, discuss with your lawyer whether or not you'd like to proceed right now. Yeah. Ultimately, it's obviously the client's choice. Sure. But they need to be able to make an informed choice. Yeah. And making an informed choice looks like Us telling them, hey, you know, again, the point of this is that you have a desensitized memory of this, meaning that when you pull up this memory in your mind, you will not have as strong of an emotional reaction. I understand that. Hopefully, your lawyer understands that. Will everyone in the courtroom understand that if you're testifying? Yeah, absolutely not. And so that that's rare for somebody to be giving an in-person testimony in a legal proceeding, but it happens. So it's it's it's something to consider and something that I just wanted to briefly mention. I mean, if EMDR is a bulk of what you do in your career, like you're you're going to run into that. Yeah.
SPEAKER_02Eventually. Yep.
SPEAKER_00And so something to to just keep in mind. Okay. I think I can there's a lot of points, but I want to run us back through really quick. Okay. Are you ready? I'm ready. Some physical things to consider: recent stroke, seizure, TBI, retinal injury, bilateral stimulation is the big thing here. We need to have clearance from the relevant providers there. On the heart rate and blood pressure side, cardiac events, recent cardiac events, and pregnancy. Again, I'm not too concerned about pregnancy unless there's uh high blood pressure or history of high blood pressure, but clearance from providers, relevant providers, again, probably a good idea. Active suicidality and other basic needs. So if basic needs are not met, basic safety needs, we need to turn to emergency and case management services before we do EMDR. If a client is providing a target name or as I call it, a title, and the client is activated and unable to regulate without a lot of assistance from the therapist, there's going to be need to spend a lot of time in like preparatory phases, like phase two, before we're moving on to later EMDR phases. In addition to that, no or little support or resources outside of therapy, that would be another indication that we're going to need to spend a lot of time in preparation, like in phase two. Yep. Okay, active psychosis, active intoxication, long-term amphetamine use. These are going to be things that are going to impact dual awareness. If I do not have the ability to say I understand that I am in the present and this happened in the past, not just how it feels to me, but I think this and know this that I am going to struggle with EMDR. Clinicians should also consider ability to maintain dual awareness when cognitive abilities are lower. So whenever we have an IQ of around 70 to 75 or lower, we should be assessing whether or not someone can hold dual awareness. They reduce, oh my goodness, words.
SPEAKER_02I'm doing the ability to be activated.
SPEAKER_00Yes. Yeah. Thank you.
SPEAKER_02Yeah.
SPEAKER_00And so it again, it's not a stop sign, it's a yield. If you as the clinician are noticing that there's a real lack of progress, consider whether or not that might be impacting it. And then last but not least, it does happen if especially if someone is giving in-person testimony in a legal proceeding proceeding. We need to give them a really good informed consent so that they can make an informed decision about whether or not they move forward with EMDR at this time.
SPEAKER_02Wonderful.
SPEAKER_00Thank you. 26 minutes. Let's wrap it up. Pretty good. Folks, thanks so much for joining. This one was packed into a fairly short amount of time. We banted for a little bit. Yeah, we could have been way windier. We were not nearly as conversational as we usually are. Way to go.
SPEAKER_02Yep. I hope you're not listening for that.
SPEAKER_00All right. Thanks everybody. Hope you learned something. Who is EMDR not good for? I am sure we missed some things. If you would like to go to Imdria's website, there is a list of contraindications, which I had mentioned that word earlier. I know fancy word for things that would indicate that EMDR is contraindicated. Yeah.
SPEAKER_01Yellow flags. Or red. Or red.
SPEAKER_00So go to imdria.org and search for contraindications, and you will find a whole list of MDR's contraindications. It won't be in the exact language that I just laid out for you. Some of these I threw in there of my own and also talked about some fun things like titles. Imdria is not going to call targets titles, but here we are. Thanks again. Have a great rest of your day. We'll talk to you soon. Bye-bye.
SPEAKER_02Bye.
SPEAKER_00Well, that's all, folks. Please see our show notes for ways to connect with us or go give us a follow on Instagram. You can find us at Simply Mintal. If this episode resonated with you, send it over to a friend. Give us a five star rating, subscribe, download all the things that cool kids are doing these days. Thanks for having me listen.