The Roads We Take: Pathways and Solutions

EMDR solutions: pathways to healing / Robin Shapiro, editor. “A Norton professional book”, 2005.

The roads we take: pathways and solutions

Natalia Fedunina

Myriad clinical problems and populations, myriad pathways of treating. One underlying common methodology – EMDR theory and practice, 16 solutions – facets of experience, turns of the plot, and perspectives. One book. Robin Shapiro calls it “a manual for doing EMDR with diverse client populations”. And indeed, it contains descriptions and procedures on therapeutic interventions for different problems. To a great extent it is really a possibility to add to your EMDR toolbox no matter “whether you read the book from cover-to-cover or peruse the one chapter that speaks to your client population”. Anyway, it might be more than that: in some sense it gives not only a possibility to add to a toolbox, but also a possibility to analyze and think over both one’s own therapeutic experience, one’s own road, and the roads not taken (or not taken yet).

The book seemed to me interesting and thought provoking. It covers a broad range of issues: assessing and treating multiple underlying causes of pathology and symptomatology; considering family and cultural issues; incorporation of preliminary resource development procedures for those clients who are too unstable, had affect tolerance issues, or lacked the ego strengths to withstand the potential rigor of target desensitization; modes of therapeutic work with DID, phantom pains, difficulties in decision making process, with the pain of unrequited love, codependence, avoidance, and procrastination to name but a few – probably even too much to keep everything in mind as a gestalt, yet so broad that nearly anyone can find a chapter that would be of particular interest to him or her.

EMDR is a therapy primarily known for treatment of trauma, which aims to trait change not just state change, temporary shift. It is interesting how this task implies and involves different methods and methodologies. For instance, EMDR for clients with dissociative identity disorder, DDNOS, and ego states by Joanne H. Twombly appeals to Janetian phase-oriented treatment of trauma. Even though the conceptualization of trauma disorders has changes since the times of Janet, Janetian model and the very approach to treatment seems to be of great interest nowadays. We think of and treat traumatic disorders as an anxiety disorders, while Janet considered posttraumatic stress reactions as disturbances of action, as psychological insufficiency, and only secondarily as anxiety reactions (van der Kolk, 1989). Anyhow, the conceptualization has changed the form and basic structure of treatment survived and disseminated to different therapies and approaches.

A great advantage and at the same time a big question in the book concerns detailed, sometimes nearly algorithmic way of presenting the procedures. It seems to me both helpful and dangerous. On the one hand, it brings inspiring clarity and vividness on the new strategy, and one can immediately try it in ones own practice, which is so tempting. On the other hand, therapy is not just a toolbox (one of the most widespread metaphors of the book), neither is it an algorithm. Authors of some chapter strongly recommend to augment new knowledge with trainings, other readings and consultations in order to avoid possible harm resulting from absence of necessary knowledge and skills even though led by the good intentions.

I was writing this review, thinking of Robin Shapiro’s book in terms of mind and body problem (so vividly posed in Chapter 5 The phantom limb pain protocol by Robert H. Tinker, Sandra A. Wilson, Chapter 9 The reenactment protocol for trauma and trauma-related pain by

James W. Cole, and in Chapter 4 EMDR processing with dissociative clients: adjunctive use of opioid antagonists by Ulrich F. Lanius), foundations of psychotherapy, its basic principles, conditions underlying the birth of new methods, and other very sophisticated things, when a colleague of mine came to visit me. She asked about the book, and I gave it to her for a couple of days. She called me in a day in excitement and amazement, and shouted in the receiver – “It really works!!! I’ve just tried… and, you know, it works!”. That was like a miracle, manifestation and testament of the alchemy of healing for her. When I put my receiver down, I felt interested, happy for her and intrigued – is it just a mighty device? alchemy has its philosophy. What is the philosophy of EMDR? of this particular book? since I’m sure it is more than a mere toolbox, a collection of applications, and new developments? What road it motivates us to take?

References:

EMDR solutions: pathways to healing / Robin Shapiro, editor. “A Norton professional book”, 2005.

B.A.van der Kolk, P. Brown, O. van der Hart P. Janet on Post-Traumatic Stress // Journal of Traumatic Stress, October 1989, Volume 2, Number 4.