EMDR (Part 1/4)

This is the first of a series of four articles I wrote on EMDR therapy.

I believe that, grosso modo, I have outlined the basic tenets of EMDR therapy. I will begin with Van der Kolk’s work first. What I think he is onto is many of the basic tenets of primal therapy but in a less organized fashion. For example, he states rightly that for trauma to be resolved there has to be a high level of arousal since the trauma was stored under conditions of that level of arousal. He emphasizes that traditional therapy focuses on reducing arousal either through the use of tranquilizers or in attempting the calm the patient’s arousal level, also known as anxiety. The question is can his therapy produce the same arousal? Bereft of reliving the trauma I don’t think so.
We control every session in terms of vital signs. During a reliving of the early trauma, and that means pre-birth and birth, which is not in the parlance of EMDR therapists, we see body temperatures climb three degrees (F) in minutes; systolic blood pressure over 200 and heart rate exceptionally high, as well. We have done salivary cortisol studies (stress hormone) on before and after therapy with reduction in levels after one year of therapy; plus four separate brainwave studies where we found, inter alia, changes in the power distribution between left and right hemispheres, which is what Kolk wants to achieve.
We have done several EEG studies on hemispheric laterality. Early in our therapy there is a change in the right hemisphere amplitude. Long term changes, on the contrary, affect the left hemisphere. In an eighteenth month follow-up of fifteen patients there was a statistically significant increase of left hemisphere activation. More important, increased left temporal activation was significantly correlated with the patient’s improvement. (As measured by blind ratings by therapists) What the researchers concluded was that there was an overall greater harmony of the two brain hemispheres. Another conclusion was that with a slight shift in power to the left side there was better control of own’s feelings and impulses.
Some conclusions of our EEG laterality studies: 'Several studies have been done on hemispheric amplitude asymmetry in primal patients. This author (Hoffman, E.) found that primal therapy initially affected the right hemisphere the most, while long-term changes primarily showed up on the left side, in an 18 months follow-up study of 15 primal patients at the New York Primal Institute, a statistically significant increase of relative left hemisphere activation was found for the anterior temporal areas. Increased left temporal activation was significantly correlated with the patients' improvement in therapy as rated blindly by their therapist.
In a recent long-term EEC brain-mapping study at the LA Primal Center a similar significant increase of left temporal activation was found in a group of patients after therapy. In most patents, following one year of therapy, alpha amplitudes were nearly symmetrical in the right and the left temporal] lobes.
Neuropsychologist Rhawn Joseph writes:
"Thus. the left and nght halves of the brain and the mind can, in fact, be influenced and overwhelmed by these limbic unconscious forces simultaneously, independently. These impulses can be transmitted “first through the unconscious mental system maintained by the right brain to be acted on because the limbic system maintains rich interconnection with both halves of the brain.... Whereas these impulses are almost complete; they are foreign to the language-dependent conscious mind, and the left half of the brain. The right brain, being more involved in emotional functioning, is able to discern and recognize these limbica!ly induced feeling states and desires for what they are."

Thus, higher amplitudes in the right hemisphere, as we see in most normals, may indicate that this side of the brain is closer to and more integrated with feelings originating deeper in the brain. If upshooting Primal Pain interferes with left hemisphere functioning we may expect mental disturbance of a psychotic dimension accompanied by larger amplitudes on the left side. This is exactly what several studies have shown. Our hypothesis was that both hemispheres can be differentially influenced by deep unconscious, limbic/
brainstem forces. The right side is more attuned to deep-lying stored feelings. Remember, it is this side that develops earlier and is more responsive to very early emotional imprints. We have found that intrusions of painful imprints impact the right side more than the left. When there is long-term stored trauma the right side of the brain is called upon for the heavier work; it is activated during recall and reliving. It then shifts some of the burden to the left side for control and integration, hence the enhanced harmony. When someone is awash in old pain and cannot integrate there is a right side dominance.
In my book, “The Biology of Love,” I discuss arousal levels and their importance. The point of all this is that Dr. Kolk is on the right track but it is doubtful that any therapy other than a complete neurophysiologic reliving can accomplish that. Secondly, every reliving of a certain trauma, such as being left alone for days after birth (perhaps due to the illness of the mother) produces the same vital signs as the session before. It is one way of many that we can verify the veracity of the reliving. It is accompanied by a later developed, articulated feeling of hopelessness. In these cases the vital signs drop significantly. One can feel hopeless long before one has the cortical wherewithal to articulate it.

More on the Difference Between Awareness and Consciousness

May I respectfully suggest that most of the current problems in psychotherapy today lie in the inability to differentiate between awareness and consciousness; thus, the cognitivists and insight therapist believe that if the patient is aware she will make progress. And I suggest that awareness has little to do with progress unless you are happy to get well from the neck up and leave the body behind.

So, let’s define things: awareness involves the last evolved neurologic system, the neocortex where ideas, beliefs and perceptions lie. Consciousness involves the three levels of consciousness, the three key brain systems working in harmony and fluidity. Consciousness involves all of us and particularly our history. Awareness is ahistoric and since we are historic beings we cannot hope to get well if we leave our past behind; if we ignore our history and what happened to us from our life in the womb onward.

When we rely on awareness we are dealing with a thin sliver of brain function, disconnected from physiologic processes which areprimal the motor for how and what we think. Thinking and beliefs (which is what we are asked to do in cognitive therapy, believe the therapy and therapist) are ultimately malleable and change with the wind; not so with lower brain processes which involved survival, and should not be so malleable. When we rely on awareness we are avoiding our life blood, our feelings; that is what makes us feeling human beings.

Why is feeling so important? When we speak of “quality of life,” we are dealing with feeling. So we have one brain, the left, that is fragmented and the other that sees the whole. To become whole we must manage to recruit the fragments of our lives into a complete picture; for that we need both brains hemispheres working in harmony. That is one definition of consciousness and its differentiation from awareness. In therapy we see how this works when after a feeling, the patient will begin a litany of, “That’s why I did this and why I did that.” The fragmented behavior begins to make total sense. It has a gestalt context—consciousness out of unconsciousness.

The Problem with Left Brain-Centered Psychotherapy:

Unfortunately, we tend to glorify left brain awareness to the neglect of the right feeling brain. We expect the left brain to fight our battles, particularly, the internal enemies. We do this without taking into account that left-brain development came into being much later in evolutionary history than the right brain, and in each of our individual lives, in part as a means of disengaging us from the other side. One kind of brain tissue cannot do the work of another. The left brain developed different abilities to avoid a redundancy between left and right. The left brain’s activity helps soothe and calm us. It allowed and continues to allow us to defend against feelings that were too much to bear. We use the left hemisphere to rationalize a hurt or insult so it won’t create so much pain. Or at the mercy of needs of which we may be only dimly aware, the left brain can superimpose all kinds of needs onto a romantic object and imagine her to be wonderful, only to be disappointed two years down the line because it didn’t see reality. It didn’t listen to the right because communication was either reduced or non-existent. When perception is detached from need and feeling, we misperceive. For instance, if we need a strong protector, we will overlook the other person’s weaknesses and ignore his flaws. We "see" protection where it may not exist, or we get protection accompanied by total domination.

It is difficult to know what is real about humans if we take words alone as a sign of reality.

The left frontal area is also where we conjure up or embrace beliefs(*). Insights given by a therapist are ultimately beliefs to soothe and ease pain. So of course the therapy patient feels better after a session. She has knocked down painful feelings; that is one of the key roles of the top level neocortex—suppress feelings. Indeed, the words of a therapist, no matter whether right or wrong, can be soothing to our agonies. It is not only the content of what the therapist says, but just his words offered in soothing tones. Oddly enough, that tone affects the right brain, not the left. The content of the insight remains in the left. We can be fooled into thinking that the content of an insight is what makes us feel better, but in reality it is the reassuring tone, all along. It dampens right side pain, the pain of a father who never cared, was never soft, and whose tone was unrelentingly harsh. The therapist’s presence says, “I’m here now. It’s going to be all right.” Just being in his office can make us feel better. In other words, the left side allows us to be partially oblivious to ourselves. This is particularly egregious when it comes to psychotherapy, which traditionally has been left brain focused for over 100 years.

It is now apparent, due to an abundance of new research, that psychotherapy must address the right brain and consider how to affect right-left brain connections—as this is the way feelings become integrated. Psychotherapy must work to help not only ourmental state but our entire neuro-physiologic system. This is the difference between dealing with words (left brain) and the use of images, scenes, and feelings (right brain). The former is what occurs when we “reflect” on our past, while genuine emotional retrieval, which is what is needed for integration and genuine healing, requires access to the right brain feeling structures. Once again we see that it is not possible to use ideas and thinking processes, which literally came along millions of years later in brain development to affect what is lower in the brain, and developed millions earlier.


(*) The right frontal area is as involved as the left, although the contributions to the ideas are different. The right will tend to “like” grander ideas.