“We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present.”
— Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
Social workers know that therapy changes lives. To find yourself in a room with a trusted therapist, allowing them to guide you through your past traumas so that you can continue to thrive in the present and future, is a monumental breakthrough. That relationship can completely change the course of one’s life.
When we think of traditional clinical therapy, most people picture talk therapy. The client sits in a comfortable chair or rests on a sofa while the therapist asks questions, listens for cues, and occasionally offers insights. And while this style of therapy has worked, and will continue to work, for many across the globe, a growing body of researchers and therapists has found incredible success with a more active form of therapy known as Eye Movement Desensitization and Reprocessing (EMDR).
Rachelle Kammer, Ph.D., Clinical Professor at the Graduate School of Social Service and Certified EMDR Therapist, is one such professional who believes EMDR can be a revolutionary practice for helping individuals with many different types of traumas.
“A lot of times, people who have experienced trauma feel like they’re crazy, like they really can’t name the reason for their trauma,” Kammer said. “They’re in a car crash, or even their parent was in a bad car crash, and now they’re afraid to drive. EMDR is amazing in that within two or three sessions, that client can be driving again — in the rain, next to loud trucks; it’s not even an issue for them anymore.”
So, what is it about EMDR that makes it so effective? We sat down with Kammer to learn more.
What is EMDR?
According to EMDR.com, Eye Movement Desensitization and Reprocessing is a “psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories.” Created over 30 years ago, therapists combine talk therapy with an external stimulus for clients to access and overcome their traumas. The physical stimulus is usually bilateral movement of the eyes (back and forth, left and right), which can be initiated by a series of sounds or “taps” cueing the client when to move their eyes, and how quickly.
Kammer said her interest in the technique began as an overarching desire to help those struggling with trauma after the September 11 terrorist attacks on the World Trade Center.
“I was working in a job where, after nine-eleven, we switched our focus to helping those experiencing post-traumatic stress disorder after the attack,” Kammer said. “I was in a position to help ad agencies with messaging through campaigns on subways, billboards, and buses, saying, ‘It’s OK to get help for this.’ That’s really where a lot of this started for me.”
Kammer added that while pursuing her Ph.D. at Columbia University, she noticed a link between substance abuse and trauma during her dissertation research while studying the effectiveness of 12 Step programs.
“I would go into these hospitals, particularly in the South Bronx, and talk to these women about their substance abuse,” Kammer said. “The phrase that would come up, over and over again, was, ‘You know, I never told anyone this, but…’ and then they would talk about sexual assault, or being beaten throughout their childhood.”
Kammer started asking questions. What do we do about the trauma? What’s underneath the substance abuse? She realized that if those traumas weren’t treated, there was a good chance that these users would relapse. But what was an effective way to help?
Experience with EMDR
In 2017, Kammer completed her EMDR certification training. While the baseline training for EMDR is an integrative process consisting of three weekends, Kammer wanted to learn more. She enrolled in a 2-year additional training program at the National Institute for Psychotherapies to further refine the craft and learn about what made this style of therapy so effective.
“I had known about EMDR before the training and knew a colleague who had done it and thought it was amazing,” Kammer said. “I’m always up for learning something new.”
So, if someone were to sign up for Kammer’s services, what would an EMDR client-therapist relationship look like?
The first meeting, Kammer said, is reserved for intake, assessment, and establishing rapport.
“We don’t want to re-traumatize people, so often I ask them to give me the headlines,” Kammer said. “What are the things you want to work on? They don’t have to give me all the details right then, but what are their support systems like? Do they go to school? Do they work?”
Next comes a series of screenings. Kammer uses a reliable clinical tool to screen for post-traumatic stress disorder, depression, anxiety disorders, and disassociation. The last one, Kammer said, is crucial to the process.
“How present are you?” Kammer said, referencing the importance of assessing a client’s disassociation level. “In order to do EMDR treatment, clients need to be able to be in the present and look back at the past.”
These assessments and screenings, Kammer said, are used to gauge a client’s stability, which determines whether or not they will be capable of successfully navigating the EMDR process.
Sessions two and three, Kammer said, are reserved for a method called “resourcing.” This is when the EMDR therapist helps the client identify a (real or imagined) calm place and nurturing, protective and wise figures that can be incorporated into the process to help the client ensure their body is calm before the session ends.
Assuming the client has proven stable enough to make it this far, and Kammer feels as though they are ready to continue toward processing traumatic memories, session four may introduce the physical stimulus. For some clients, a longer period of stabilization is required. Kammer asks the client to choose a certain trauma from their past and to score it from one to ten. This represents a sliding scale of trauma — one being the least traumatic and ten being the most. Most times, Kammer said, a clinician wouldn’t want to jump into a nine or ten trauma on the first try; starting with a three or four is better.
Kammer explained that before beginning the physical activity, she makes sure to do two things: 1.) explain what will happen throughout the EMDR process (“nothing is a secret”), and 2.) stress that this treatment is a collaborative effort between therapist and client.
“Control is a big deal,” Kammer said. “The client was not in control when the trauma happened, so the therapist must make sure there is a real sense of control, and that the client can stop the process whenever they want. Tell the client, ‘I don’t have any control over you. I’m just facilitating your mind and body. If I’m annoying you, or saying something that bugs you, let me know.’”
Kammer noted that one of the biggest differences between EMDR techniques and traditional talk therapy (aside from the active component) is that, in EMDR, the therapist is not asking the client for every detail about the trauma.
“My goal is to have a bit of understanding about the trauma, and then light up the networks in the client’s brain that are holding it,” Kammer said.
The client’s ongoing bilateral eye movement will ‘light up’ these networks and unlock thoughts and feelings associated with the trauma, with which the therapist can work to try and assist in the client’s healing. These eye movements are closely related to Rapid Eye Movement (REM) sleep cycles, where, as the name implies, the sleeping person’s eyes are actually moving behind their eyelids in their sleep. It is not a surprise, then, that we can experience vivid dreams throughout sleep, many of which include elements of a past experience.
To facilitate the client’s eye movement, Kammer will use an app that delivers audio tapping tones to the client through a headset. Additionally, she has used hand buzzers that deliver a light vibration to guide the client’s eye movements. Kammer will ask the client to ‘watch’ the trauma as if it were a movie rather than relive it — all while asking gentle questions about where the client is holding this memory in their body: can they notice where it is? Does it have a shape or a color? All of these questions seek to help the client somatically process the trauma.
“All sorts of associations in their brains start happening that they may not have accessed through traditional talk therapy,” Kammer said.
Kammer said the goal is to retreat the trauma’s level of disturbance to zero.
The Body Keeps the Score — Even on Screen
Kammer said that she can see this revelation happening in her clients as the trauma retreats to zero, simply through their physical presentation. While the client may have started the session with a heightened or tense physical state—reflecting their emotional one—as the emotions are processed, the body begins to relax.
“The nervous system is coming down, so I can see it physically,” she said.
Kammer said this is even noticeable on Zoom, where she now sees most clients.
“During the pandemic, we all had to switch from being in a room with a client to doing the sessions on Zoom,” she said. “I was like, how the heck is this going to work?”
But Kammer assured that the virtual element had no negative impact on EMDR results. Clients just have to position themselves in front of the camera so that Kammer can see most of their bodies; this is essential to reading the visual cues that will come with the treatment.
“They start a session saying, ‘I’m a total mess,’ or, ‘It’s my fault,’” Kammer said of her clients. “And after we’ve gotten the trauma to zero, they’ll say, “‘That was a horrible experience, but it’s in the past. I’m safe now.’”
However, the work doesn’t stop there. Kammer said that after the EMDR session closes, she checks in with how the client feels — mentally and physically. They check through the client’s body together. Then, in the next session, they have another check-in about the work they performed and how it has sat with the client since then — if anything new has come up that needs to be addressed.
Lastly, Kammer performs what she calls the “future template” with the client. In this process, they discuss how, now that the client has power over the traumatic experience, they can use that memory to be helpful to them as they move forward.
“I had a client afraid of taking their driver’s test, and what we found out was one of her parents had died in a car crash,” Kammer said. “She was not able to make the association between the crash and her fear of driving in a regular conversation with me, until we came to it through EMDR.”
Historical Trauma and Opportunities for Social Workers in EMDR
“Historical trauma is multigenerational trauma experienced by a specific cultural, racial or ethnic group. It is related to major events that oppressed a particular group of people because of their status as oppressed, such as slavery, the Holocaust, forced migration, and the violent colonization of Native Americans.”
Kammer said that credible sources have claimed that historical trauma has the power to be traced back as many as 14 generations. So, let’s think about the car crash example: if you were in a car crash, or one of your parents was in a car crash, in most cases, it would probably make sense to clients that it is why they are afraid of cars. However, if your trauma is being traced back to the Holocaust, slavery, or colonization, it may be so removed that you would never assume it is why you are struggling now.
“You might not connect that historical trauma to some of the things that are going on in your body now — what you’re responding to or triggered by,” Kammer said. “It doesn’t make any sense to people.”
Through EMDR, Kammer and her colleagues can help these individuals address trauma in a way that doesn’t forget it all together but leaves it in the past — a separate entity from their physical beings.
Work at the National Institute of Psychotherapies
Now, Kammer is a member of the executive committee at the NIP Integrative Trauma Program, where she received her two additional years of EMDR training. She helps run the NIP’s Trauma Certificate Program, which takes about 14 social workers and other mental health professionals annually and is “dedicated to the clinical exploration, understanding, assessment, and treatment of traumatic experiences.” Students learn about multiple evidence-based trauma treatments in the program.
A recent addition to the year-long certificate program, Kammer noted, is the inclusion of systemic trauma coverage in its curriculum, including racism, immigration, and climate change.
“I conducted a training session for the certificate program on historical trauma and intergenerational trauma,” Kammer said. “Mass traumas like the holocaust or slavery, or the genocide and misplacement of Native Americans, and helping people to understand how those get rooted in our bodies as trauma.”
If you’re interested in EMDR training as a clinical pathway, check out the National Institute for Psychotherapies’ website to learn more about how you can get started.