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Can EMDR make some patients worse?

The key element for EMDR to be effective is to “activate” the emotions from the past. This activation normally opens a can of worms. If the clinician is not well versed in trauma, autonomic dysregulation, dissociation, positive affect, memory consolidation, etc., it may not know how to contain all the worms coming out at the same time.

Even if it’s not all the worms, sometimes opening the can may feel too intense, too painful, too disturbing. I never do EMDR before my clients have developed a whole set of regulation skills and have increased their tolerance to experience strong emotions without feeling overwhelmed.

If the therapist doesn’t know how to direct the EMDR sessions to make them safe, the opening of the emotional channels can cause retraumatization. Then, the client feels worse than before, and could be worse than before. The symptoms could increase and could even put the client in danger.

Many clinicians have been going to EMDR training because there are so many people with trauma symptoms, and EMDR offers a fast and inexpensive option. But the reality is that EMDR is only a modality to process traumatic memories, but trauma treatment is much more than just processing. These clinicians really believe that they can just save years of training by applying a formulistic protocol and heal trauma. That doesn’t happen. I have said before that EMDR is a great tool for traumatic memories in the hands of an expert. It’s like a scalpel in the hands of a surgeon. But if you put a scalpel in the hands of a physiotherapist, it can be lethal.

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