mercoledì 29 agosto 2018
Una riproposta in versione inglese dell'articolo
Psicoterapia analitica ed EMDR:
un avvicinamento possibile?
in Studi Junghiani, n. 20/luglio-dicembre, pp. 127-144
Il crollo del ponte Morandi a Genova, insieme alle molte vicende traumatiche che stanno caratterizzando il tempo attuale, ripropone il tema della psicologia dell'emergenza e l'utilizzo di strumenti quali l'EMDR.
A 14 anni di distanza dalla sua pubblicazione in italiano ripresento, questa volta in versione inglese, l'articolo "Psicoterapia analitica ed EMDR: un avvicinamento possibile?" Studi Junghiani n. 20/luglio-dicembre 2004, pp. 127-144: una riflessione sull'uso delle stimolazioni bilaterali alternate anche in ambito psicologico analitico.
Jungian analysis and EMDR:
a possible rapprochement?
The first time I heard about EMDR (Eye Movement Desensitization and Reprocessing) was during a seminar on emergency psychology. When Isabel Fernandez, president of the EMDR Italian Association, introduced Francine Shapiro’s method used in emergency situations in particular for the treatment of traumatic memories I thought it was one of the therapies popular at that time. In that context I had a small experience of the eye movements – I found the method’s ability to evoke images and stimulate our memory interesting – but that was about all.
Then a colleague, a psychiatrist and psychotherapist whose professional expertise and competence I valued, told me he had attended an EMDR training course and had started treating some clients with this technique; despite his initial skeptical approach to EMDR he had to change his mind when confronted with the outcome: some of the traumatic nuclei which could not be reached and transformed with talk therapy were, so to say, “miraculously” unlocked with EMDR.
I listened to his experience with great curiosity and decided to try Francine Shapiro’s method myself in order to personally assess what it was; I must admit, at hindsight, that this experience has totally shattered my initial skepticism.
Such transformation from initial prejudice to a keen interest and appreciation for the method is frequent among those who tried EMDR; this is remarkable for at least two reasons: on the one hand it testifies the method’s clinical value, and on the other it shows that EMDR is not proposed as an “alternative” to other therapies, but as a clinical device which must be integrated within different therapeutic paradigms; EMDR in fact, does not claim to sic et simpliciter“heal” psychological traumas and disorders, but is offered as a tool supporting the methods used by therapists, aware of their own psychological metaphors, in order to increase the self-healing natural tendency of the body.
Therefore, the competence and professional skills of the psychotherapists who use EMDR for the treatment of somatically encoded traumas and psychological disorders are essential to achieve therapeutic effects; in this framework one can understand that EMDR used by an analytical psychologist can become a therapeutic tool with a surprising synergic potential.
But let us see now how Francine Shapiro herself describes the effectiveness of eye movements:
“EMDR is based on a chance observation I made in May 1987. While walking through the park one day, I noticed that some disturbing thoughts I was having suddenly disappeared. I also noticed that when I brought these thoughts back to mind, they were not as upsetting or as valid as before. Previous experience had taught me that disturbing thoughts generally have a certain “loop” to them; that is, they tend to play themselves over and over until you consciously do something to stop or change them. What caught my attention that day was that my disturbing thoughts were disappearing and changing without any conscious effort.
Fascinated, I started paying very close attention to what was going on. I noticed that when disturbing thoughts came into my mind, my eyes spontaneously started moving very rapidly back and forth in an upward diagonal. Again the thoughts disappeared, and when I brought them back to mind, their negative charge was greatly reduced. At that point I started making the eye movements deliberately while concentrating on a variety of disturbing thoughts and memories, and I found that these thoughts also disappeared and lost their charge. My excitement grew as I began to see the potential benefits of this effect.
A few days later I started to try it out with other people: friends, colleagues, and participants in psychology workshops I was attending. […] In short by working with some 70 people over the course of about 6 months, I developed a standard procedure that consistently succeeded in alleviating their complaints. Because my primary focus was on reducing anxiety (as that had been my own experience with the eye movements) and my primary modality at that time was behavioral, I called the procedure Eye Movement Desensitization (EMD)”
(Shapiro 1995, p. 2)
After this chance finding and the introduction of the method to the scientific community (Shapiro 1989, pp. 199-223; Shapiro, 1989a, pp. 211-217, 1989), Francine Shapiro modified its protocol in 1991 and added to the EMD (Eye Movement Desensitization) method, the term “Reprocessing” (Eye Movement Desensitization and Reprocessing), in order to highlight the accelerated information processing feature, which constituted its main change.
The author explains the method transformation as follows:
“While EMDR was initially named for the eye movements, which in 1987 appeared to be the most salient part of the method, over the past few years the name has appeared to unduly limit the appreciation and application of the methodology. […] EMDR is a complex methodology that includes many components; in addition, many other stimuli besides the eye movements have proven useful. If I had it to do over again, I might name it simply Reprocessing Therapy.”
(Shapiro 1995, viii)
* * *
But what is EMDR, and what does the Accelerated Information ProcessingTheory,which is EMDR general reference model, consist of?
As I previously mentioned, the change of name from EMD to EMDR marked an important watershed in the transformation of the therapeutic paradigm – mainly focused on desensitizing the anxiety associated with traumatic memories – into the more complex and integrated Accelerated information processing, where information “reprocessing” plays an essential role.
The present paradigm uses the terminology of the information theory formulated by G. H. Bower in “Mood and Memory” (1981, pp. 129-148) and P.J. Lang in “A bioinformational theory of emotional imagery” (1979, pp. 495-512) and posits the existence of a neurophysiological information processing system in the human brain, capable of transforming the information until reaching and maintaining a state of psychological health. Similar to our body, which activates its self-healing mechanisms when we are hurt, the Accelerated information processingtheoryassumes that the brain too has a natural tendency to heal and physiologically processes the information received; but when a trauma or a severe stress affect our neurological balance, the system loses its self-healing capability and freezes; EMDR has a direct effect on the system loss of flexibility and drives it to an adaptive recoding of the information, thus allowing the processing of the traumatic memory.
The concept of accelerated information processing is in turn related with the concept of memory networks, that is the information system where the memories, thoughts, images, emotions and feelings associated with the traumatic memory are stored and interconnected like in a network of metaphorical “channels”. EMDR treatment enables to reprocess and integrate in conscious awareness the entire psychophysical associations with the traumatic memory, stored in the dysfunctional memory networks; this is why, when clients are asked to focus on a traumatic memory, a disturbing dream image or a physical symptom, their attention is actually simultaneously focused on the traumatic “node” and, indirectly on all the related experiences of the physiologically associated dysfunctional material. Each set of eye movements (or other alternate stimuli) “clears” the traumatic channel from the distressing associations, while a new coding level is reached at each reprocessing stage, where the psychophysical framework of the memories, thoughts, emotions and feelingsis increasingly more functional, until the entire traumatic channel is reprocessed (see Shapiro. 1995, pp. 32-33).
Francine Shapiro continues and writes:
“TheAccelerated information processingmodel was developed to explain the rapidity with which clinical results are achieved with EMDR, and the consistency of the many patterns of response to it. […] Briefly stated, the model regards most pathologies as derived from earlier life experiences that set in motion a continued pattern of affect, behavior, cognitions, and consequent identity structures. […] The continued influence of these early experiences is due in large part to the fact that present-day stimuli elicit the negative affect and beliefs embodied in these memories and cause the client to continue acting in a way consistent with the earlier events. […] The dysfunctional nature of traumatic memories, including the way in which they are stored, allows the negative affect and beliefs from the past to pervade the client in the present. EMDR processing of such memories allows the more positive and empowering present affect and cognitions to generalize to the associated memories throughout the neurophysiological network and leads spontaneously to more appropriate behaviors by the client. Clinical pathologies are therefore viewed as amenable to change if the clinician appropriately targets the information that has been stored dysfunctionally in the nervous system. Part of the clinical history-taking process is to identify the memories that have helped form the client’s negative self-concepts and behaviors”
(Shapiro 1995, pp. 13-14).
In other words, the rationale for EMDR posits that, when a person is exposed to a serious trauma, the brain excitatory-inhibitory balance is disrupted, probably consequent to changes occurring in the neurotransmitters or adrenaline levels; once traumatically disrupted, the information acquired at the time of the event is stored in its state-specific anxiety-provoking form also at a neurological level, continuously triggered by the chain of internal and external stimuli associated thereto, and appears as the so-called “positive symptoms” of PTSD (nightmares, flashbacks, intrusive thoughts). Following the EMDR protocol, the rhythmic (saccadic) eye movements restore the neural balance, resolve the somatic-psychological pathology, and transform the cognitive, emotional and imaginal levels associated with the traumatic event. (see Eshenröder (editor) 1997).
The desensitization and cognitive restructuring issues in the EMDR protocol can therefore be considered a “byproduct” of the information reprocessing, which remains the central element of the process; this is the theory on the basis of which the Accelerated information processing modelexplains EMDR therapeutic effects and forecasts the success in its application in a wide range of psychological problems:
“One principle that is crucial to EMDR practice (but not specified in other theories) and which is suggested by the consistent application of the procedure, is that there is a system inherent in all of us that is physiologically geared to process information to a state of mental health. This adaptive resolution means that negative emotions are relieved and that learning takes place, is appropriately integrated and is available for future use. The system may become unbalanced due to a trauma or through stress engendered during a developmental period, but once it is appropriately activated and maintained in a dynamic state by means of EMDR, it transmutes information to a state of therapeutically appropriate resolution. Desensitization and cognitive restructuring are viewed as byproducts of the adaptive reprocessing taking place on a neurophysiological level.”
(Shapiro 1995, p. 13).
These short remarks clearly show the matching between the theoretical hypotheses underlying the EMDR paradigm and the results of the latest neuroscience research on the way our mind works and with the studies on the dissociative effects of trauma.
Just consider Joseph Le Doux’s studies on the relation between the “emotional brain” and the “cognitive brain”; Le Doux has shown that fear is not learned through the brain cortex but through the limbic system, and that the wounds suffered by the latter may remain latent for years and reactivate at any time; this is why traumatized clients may re-experience emotions no longer remembered by the rational mind (Le Doux 1996). Furthermore, Le Doux posits that the plasticity of the brain exposes the mind to a continuous risk of dissociation, as well as to the possibility of a continuous creative transformation; this makes the synaptic Self a “curse” when thoughts, emotions and motivations dissociate and are shattered, but it can also be a “blessing” for the continuously new connections waiting to be made in the brain (Le Doux 2002,).
Allan Schore’s studies on the work of the emotional mind have also shown that trauma is “burnt” in the right brain hemisphere with an indelible mark and, under specific circumstances, is reactivated as responses, emotions and actions totally disconnected from the conscious memory; his research has helped highlighting how early traumatic experiences negatively affect brain development, attachment modes, affect modulation, stress modulation and a feeling of the self as a whole, and why psychotherapy can be a corrective intervention by re-modulating the right brain hemisphere (Shore 1994; Shore 2001; Shore 2002).
On the other hand, Antonio Damasio’s theorization of the unconscious brain systems “underlying” consciousness (proto-self, core-consciousness, extended consciousness) has provided an essential contribution in enhancing the value of the bodily dimension in the scientific discussion on mind and brain; in particular, Damasio’s concept of “somatic marker” highlighted the connection between body and consciousness in the decision-making process, stressing the need to consider how the brain works in relationship with the body to which it belongs and with the environment (Damasio 1995; 1999; 2003).
Considering the possible rapprochement between analytical psychology and EMDR, although the terminology used by Francine Shapiro to formulate the Accelerated information theory and identify the phases of the clinical protocol is, as we have seen, very distant and totally different from the psychological-analytical one, thorough Jungian analysts cannot fail to notice, for instance, how much the “self-healing” concept proposed by Francine Shapiro resembles the Jungian concept of “psychological self-regulation” which has an essential heuristic function in the psychological-analytical model: the mind is viewed as a dynamic and self-regulating system; for each hyperfunction (or block) of this system, a compensation mechanism activates in our body in order to restore its natural psychophysical balance. When the body balancing functions are unable to compensate the psychological and physical disruptions, symptomatic behaviors are formed, and they are actual indicators, among other things of the dysfunctions in the body self-healing processes. This is why in Jungian analysis, analytical psychologists do not aim primarily at symptom remission – their disappearance is the consequence of a better overall balance achieved – but rather look for the unconscious images underlying the symptoms, in order to help clients to gain awareness of their bodies’ demands and enhance their balancing functions. (Tibaldi 2003a).
It is interesting to remember the dynamic connection between affective-tone complexes activity and personality dissociation mechanisms, identified by Jung; it is known that analytical psychology theorizes that emotional/cognitive cores, constituting affective-tone complexes, act in the unconscious as actual autonomous personalities, symbolically perceived as dreams, symptoms and spontaneous images; in this respect, psychological pathology may be considered, as postulated by the Accelerated Information Processing Theory, an effect of psychological dissociation, the product of an abnormal balancing process activity, regulating the relationship between the mind conscious and unconscious side.
“The psyche is a self-regulating system that maintains its equilibrium just as the body does. Every process that goes too far immediately and inevitably calls forth compensations, and without these would be neither a normal metabolism nor a normal psyche. In this sense we can take the theory of compensation as a basic law of psychic behavior”
(Jung 1934, § 330)
On the other hand, with reference to the transformation effects of psychotherapy, it is worth recalling some of Jung’s thoughts on the emotional changes connected to the constellation of spontaneous images; Jung considered the conscious and unnaturally unilateral attitude of neurotics as balanced by the complementary or compensatory contents of the unconscious, experienced in particular through the emerging of spontaneous images:
“The road the individual follows is defined by his knowledge of the laws that are peculiar to himself; otherwise he will get lost in the arbitrary opinions of the conscious mind and break away from the mother-earth of individual instinct.
So far as our present knowledge extends, it would seem that the vital urge which expresses itself in the structure and individual form of the living organism produces in the unconscious a process, or is itself such a process, which on becoming partially conscious depicts itself as a fugue-like sequence of images. Persons with natural introspective ability are capable of perceiving fragments of this autonomous or self-activating sequence without too much difficulty, generally in the form of visual fantasies, although they often fall into the error of thinking that they have created these fantasies, whereas in reality the fantasies have merely occurred to them”.
(Jung 1935, §§12-13)
By attending the unconscious images, patients expand their awareness and their view of the world and change them substantially both from an affective and from a cognitive standpoint. In this sense, according to Jung, attending to the images leads to the creation of new syntheses through which clients free themselves from a limited and oppressive understanding of the self, and are released from the obstinate egocentrism limiting their view of the broader horizons of their social, moral and spiritual development; by allowing the natural vital process to work, the therapist contributes to the development of the clients’ creative potential (see Jung 1929 §82).
In recent years, the psychoanalyst and researcher Wilma Bucci (1997) has proposed an integration of psychoanalysis and cognitive psychology, postulating a hypothesis concerning the activity of the analytical process; according to Bucci, the analytical relationship is to be considered the activator of what she calls the “referential process”, the mind’s main integrative process, linking the parallel processing of somatic, imaginal and verbal information. In her “Multiple Code Theory” images play an essential role in reintegrating the dissociated cognitive schemes. Inasmuch as they connect all the modalities of the non-verbal experience (sub-symbolic and symbolic) with the verbal-symbolic system, images represent the first level of the symbolic processing, before accessing the verbal processing; in this sense the images and their transitional properties, the actual pivots of the referential activity, organize the non-verbal system, facilitating its connection with the symbolic-verbal one.
Furthermore, it should be noted that, in parallel with the “images of the emotions” in the analytical experience, unconscious images play an essential role in EMDR too during the processing of traumatic memories and their psychophysical associations; Though Francine Shapiro’s method and Carl Gustav Jung’s analytical psychology use different modalities for images constellation, both relate to images with respect and with a non-interpretative attitude, allowing the body imaginal and self-healing processes to find their way and follow their own path (“let it go” in EMDR; “geschehen lassen” in analytical psychology).
Another point of comparison between analytical psychology and EMDR worthy of consideration relates to one of the hypotheses formulated by the Accelerated information processing theory to explain EMDR functioning and effectiveness: that is that there may be a parallelism between EMDR deliberately induced eye movements and the REM (Rapid Eyes Movements) phase in dream sleep – that is between the “alert dreaming”, stimulated by the alternate movements, and emotions processing physiologically occurring in dreams during REM sleep.
Laurel Parnell, a psychodynamic-trained EMDR therapist, claims, with reference to this hypothesis, that dreams clear the mind and body from the day’s residues, and that some particularly vivid dreams, related to past events, represent an actual healing activity of the body and mind. When dreams contents are emotionally very intense, emotions’ processing occurring during REM sleep is often disrupted by a sudden awakening, preventing dream completion and reprocessing of the day’s residues. Unlike dream activity, EMDR therapists maintain clients in their dream, by having them move their eyes back and forth and helping them focus on the traumatic events. “This – Parnell writes – allows the event to be fully experienced and reintegrated” (Parnell 1997, p. 7).
Obviously, the hypothesis that alternate attention in EMDR may have an effect similar to REM sleep when the information is processed in the memory and during memories consolidation requires the most careful consideration and thorough investigation of researchers, and in our case of analytical psychologists.
On the other hand, it is worth remembering, with reference to the possibility to imaginally recall unconscious material, what Antonio Damasio wrote on the brain systems “behind” the mind, and on the hypothesis that the relation between mental images and the brain occurs due to the synchronization of neural activities taking place in separate but interconnected brain regions:
“For the purpose of investigating the relation between mental images and the brain, I have long used a framework suggested by results from experimental and clinical neuropsychology, neuroanatomy and neurophysiology. The framework posits an image spaceand a dispositional space. The image space is that in which images of all sensory types occur explicit. [...] The dispositional space is that in which dispositions contain the knowledge base and the mechanisms with which images can be constructed from recall, with which movements can be generated, and with which the processing of images can be facilitated. Unlike the contents of the image space, which are explicit, the contents of the dispositional space are implicit. [...] Dispositions hold some records for an image that was actually perceived on some previous occasion and participate in the attempt to reconstruct a similar image from memory. [...] In terms of an overall mental picture it is likely that binding requires some form of time-locking of neural activities that occur in separate but interconnected brain regions.”
(Damasio 1999, p. 331 foll)
Based on these preliminary remarks we could formulate a question: could both alternate movements and REM sleep be some form of synchronization?
It can be easily understood that this question opens a broad area for research and consideration, and encourages “all those who, anywhere in the world, burn with the passion to heal and understand” (Servan-Schreiber 2003) never to stop searching and questioning.
It is worth noticing, in any case, that because of the innovative charge of its protocol and of the paradigm suggested by the Accelerated Information Processing Theoryto explain the nature of the therapeutic process, Francine Shapiro’s method has a very special place in the present psychotherapeutic arena; if, on the one hand, as I previously said, its disconcerting simplicity leads to immediate prejudice and suspicion, on the other, its capability of accelerating psychophysical changes in the client is really surprising when experienced.
Furthermore from an unprejudiced verification standpoint the Eye Movements Desensitization and Reprocessinghas been subjected to many controlled studies, gaining good results objectively demonstrating its therapeutic effectiveness, in particular on Post-Traumatic Stress Disorder (PTSD) (Shapiro 1996).
In 1995 the American Psychological Association Clinical Psychology Department carried out a research to assess the effectiveness of Francine Shapiro’s method, and concluded that EMDR is not only effective in treating Post-Traumatic Stress Disorders, but that it achieves the highest level of effectiveness in treating this diagnostic category. Recently, after the American Psychological Association, the International Society for Traumatic Stress Studies (ISTSS) and the US Department of Defense, the AmericanPsychiatric Association’s Guidelines for Clinical Practice have attributed to EMDR an effectiveness similar to other forms of cognitive-behavioral therapies and included it among the evidence-based therapies. However, the methodological limitations of the researches conducted on EMDR do not allow yet to draw a final conclusion on the specific contribution of this technique, which is considered a mixed form of exposure and cognitive reprocessing (Roth & Fonagy 1996, page 164).
Let us have a look now on the EMDR protocol, which in its “classical” forms consists of eight phases.
Actually, the very fact that EMDR is a clinical tool that can be used in different therapeutic settings indicates that the potential forms of the protocol can be very diversified. The way of introducing the protocol to the client and the sessions devoted to each phase of the protocol vary according to the problem, the situation and the therapist.
I shall now briefly describe the eight phases of the basic protocol, and shall try to highlight the issues that can be significantly enhanced through psychological-analytical proficiency:
1. client history and treatment planning: the first phase consists of the client history and the treatment planning; its purpose is to assess if the client can successfully be administered EMDR without risks; the therapist assesses how much can the client tolerate to re-experience the traumatic memory and the associated material. In this phase, analytical psychologists can successfully avail of their psychodynamic skills to assess the client’s situation also from the unconscious dynamisms standpoint, as well as verify the deep issues favoring and hindering the possibility of this type of work.
2. preparation: the therapist introduces the EMDR procedure to the client, discusses its basic assumptions, provides a perspective of the therapeutic effects, and prepares the client to any eventual disorders likely to occur between sessions; in particular, the therapist verifies the situation of the client’s internal and external resources. Also in this case Jungian analysts can avail of their specific listening skills to assess clients’ Ego “resilience” when confronted with dissociated traumatic material and ability to access their positive internal images supporting the traumatic memory processing.
3. assessment: the third phase includes focusing on the target traumatic memory (or any other emotionally-laden element); in this phase clients are helped to verbalize the negative self-assessment when the traumatic memory is recalled, and focus on the positive self-image they would like to have when they think of the traumatic situation. Jungian analysts used to confront unconscious images, cannot fail to see the analogy between the activation of internal images elicited in EMDR and what occurs in active imagination: in both cases clients focus their attention on internal images and after careful observation, they allow them to generate the associated material unconsciously connected thereto; Jungian analysts’ skills in facilitating this type of process may significantly enhance this phase of the EMDR protocol (see Tibaldi 2002, pp.119-126).
4. desensitization: bilateral stimulation is used in the fourth phase and the desensitization and reprocessing of the emotions, feelings and disturbing thoughts associated with the traumatic image starts. Though this is the most characterizing phase of Francine Shapiro’s method, analytical psychologists cannot fail to notice the analogy between the process of activation and transformation of spontaneous images occurring during the bilateral stimulation processing, and what spontaneously occurs in the active imagination process when the Ego is directly confronted with the unconscious images; in this respect I think I can say, at least preliminarily, that the constellated image sequence in EMDR tends first to rotate around a layer of personal complexes, and then to open in a transpersonal archetypal dimension carrying highly individuative requests.
5. installation:the fifth phase of the protocol aims at activating and integrating a positive image of the client with respect to the traumatic memory in order to create a new emotional-cognitive connection between the traumatic event and the image of the self. In terms of analytical psychology one could say that the purpose of this phase is the de-identification of the consciousness from the original negative image of the self to the construction of a new relationship with the positive aspects recovered through the processing of the psychophysical setting associated with the traumatic event; also in this case the process constellated by EMDR is similar to the emotional and cognitive restructuring occurring in the Jungian experience of active imagination (see Tibaldi 2001).
6. body scan: the sixth phase aims at reprocessing the existing somatic tensions; clients focus on their physical tension and this becomes the starting point for the transformation of the associated dysfunctional experiences. Due to the ability to reach the somatic unconsciousness and convert it into conscious awareness, this phase is of particular interest for analytical psychologists, who are used to the “imaginal” listening also of physical symptoms; EMDR speeds-up this kind of transformation process of such types of experience, and scales-down the transference-countertransference dynamics, which is known to be particularly difficult and critical in the case of body-encoded traumatic experiences (see Tibaldi 2001a).
7. closure: this phase marks the end of the traumatic material processing; analysts help and check that clients have reached a state of emotional balance which they are able to hold on to between sessions; in this phase therapists may use interweaves to help clients master the process; the imaginal skills of deep analysts can significantly enhance this closure phase; in fact, thanks to their ability to use images considering the transference-countertransference experiences existing in the therapist-client relation, the most appropriate imaginal interventions for the clients’ emotional-cognitive problems can be selected.
8. reevaluation:actually this phase occurs during the session following the one when the EMDR protocol was completed; the purpose of the reevaluation is to summarize the information gathered during EMDR, and to check if, upon processing completion, any new dysfunctional material to be eventually targeted with another EMDR sequence has surfaced
A short comment on the side:
an interesting issue of the EMDR method which is somewhat related to modalities used by analytical psychologists in their clinical practice, resides in the request to the client to keep a log where anything occurring between sessions should be noted; the somatic-psychological transformation process activated by EMDR stimulation continues, in fact, autonomously even after the session, and therefore it is essential to objectify it in writing.
Jungian analysts, accustomed to imaginal confrontation with the unconscious psyche cannot fail to consider the importance of using writing in analytical psychology; similarly to what occurs in EMDR, the objectification of autonomous psychological processes helps clients to create an appropriate distance from the unconscious images, and to develop a more appropriate attitude also with respect to the traumatic experiences of the past (see. Tibaldi 1995).
The importance ascribed in EMDR to the development of the so-called “dual focus of attention” related to the client’s present reality on the one hand, and to the traumatic past on the other, recalls the “double objectification” imaginal modality, a psychological-analytical method, granting the Ego the paradoxical opportunity to observe itself from a totally external standpoint while being fully involved in the emotional situation occurring at the time (see Tibaldi 1999; Tibaldi 2003; Tibaldi 2003b).
* * *
Going back to my encounter with EMDR, after starting my clinical training, as I said, and beginning to gather information on emergency psychology and psychotraumatology, I started wondering to what extent could a tool so distant from analytical practice be used also by depth psychologists, and if, and to what extent, could the two paradigms and their respective clinical methodologies be bridged in clinical practice.
The results? A project for an integrated setting, where EMDR treatment can be offered to clients in the course of non-analytical sessions included in the initial contract.
In the 5th EMDR European Conference, held in Stockholm in June 2004, I have presented the theoretical assumptions of my hypothesis; in the Congress “EMDR and psychotherapies integration”, held in Bologna in November 2004, I have proposed a clinical integration, aimed at using EMDR to process “opaque” somatic symptoms, that is symptoms encoded in the somatic memory, which hardly reveal their imaginal horizons .
Treatment of these symptoms with EMDR substantially improves the emergence of split emotions and images; these are then processed in parallel on a mutually-connected double track: the “objective” track is processed with EMDR, and the “symbolic/narrative” track with Jungian analytical tools. This integrated approach provides the therapist and the patient direct access to the body language and its imaginative expressions, facilitating the rapprochement of the “body/mind” opposites (see Schwartz-Salant, Stein, 1986); this integrating experience is constantly monitored from the transference-countertransference standpoint, with a particular focus on the dynamics activated in the session by the bilateral sensory stimulation (see Tibaldi 2004).
In this first stage of bridging between the two settings many are the emerging considerations; I noticed, for instance, among the many considerations, that the integrated use of analytical psychology and EMDR activates the constellation of chains of memory images linked to a complex whose simultaneously personal and transpersonal emotional tone had a strong individuative value; that clients’ dreams show a clear symbolic correlation with the “feeder memories” used in EMDR to activate and check the development of the therapeutic procedure; that, considering the explanations provided by the current brain research on clients’ psychophysical changes, occurring as a consequence of the direct processing of the “unconscious body knowledge”, there is probably an analogy between the images stimulated by alternate movements in EMDR, and those constellated in Jungian “Sandplay”.
Regarding this last aspect, the relational mode of “empathic dance” (as defined by McCann and Colletti, 1994), which in the analytical process consists of repeated transference-countertransference experiences, allows the therapist to “keep the client’s body in mind” – with the memory traces of the emotional brain – allowing the spontaneous surfacing of clients’ metaphorical images to restore the sensory, emotional and imaginal connections between their dissociated brain centers; in fact, recent studies have shown that metaphors have a characteristic role in facilitating the surfacing of the dissociated nuclei and in restoring the connection and integration between brain hemispheres; thanks to their sensory, imaginal, emotional and verbal settings, metaphors are considered able to simultaneously activate several brain centers (see Pally 2000, p. 132)
The Jungian analyst Margaret Wilkinson writes:
“The neurosciences have made us more aware of the effects of trauma on the brain, of the science of loss and recovery of memory, of the need for right brain engagement of the therapist with right brain aspects of the patient in therapy if profound dissociative defenses are to be undone in those for whom poor early experience with the primary caregiver has resulted in trauma. Only alongside such affective encounters does it become possible for the left brain to fully process traumatic experiences”
(Wilkinson 2003, p. 250)
With reference to this last issue, also the Jungian analyst Harriet S. Friedman (2002) and her colleague Rie Rogers Mitchell (2002) find a similarity between EMDR ability to activate the brain right hemisphere with Jungian Sandplay, and see in both techniques an imaginal processing modality of the encoded emotional traces in the brain right hemisphere:
“When working with traumatized people, brain right hemisphere activation is important, since this is where the trauma is stored. A therapeutic approach speaking the same language of the brain right hemisphere, a non-verbal image-oriented language, activates the memories of the trauma and provides a language through which they can be conveyed. Among the types of therapy mentioned in the literature which succeed in accessing the brain right hemisphere are art therapy, EMDR, movement and Sandplay”.
(AA.VV. 2002 (edited by F. Castellana and A. Malinconico), p.126)
The rapprochement of EMDR and analytical psychology and the hypothesis of their clinical integration should then be considered in line with the most advanced neo-Jungian approaches, identifying in the involvement of the bodily experience and the somatic memories encoded in the “emotional brain” a new and great opportunity to process the most hidden and inaccessible aspects of the unconscious mind (see Ramos 2004).
Finally, I think EMDR undeniably represents today a border territory, a therapeutic boundary requiring and stimulating the creativity and divergent thinking of those who decide to use it; this is why a confrontation between analytical psychology and EMDR is a revolutionary research stimulus, in proportion with the creative spirit of the analytical psychologists who decide to accept it, a synergy with an enormous transformation potential, in the direction of a treatment for the psyche, able to process even the neurophysiological level of the psychological pain.
With reference to the opportunity of adventuring into new theoretical-clinical pathways within a psychological-analytical framework, Giuseppe Maffei, in his book Le metafore fanno avanzare laconoscenza?states that our mind needs “theoretical passion” and “coordinates and bases on theoretical visions”, in addition to empathy and subjectivity: an essentially subjective-centered psychological-analytical epistemology, featuring a focus on the unrepeatable uniqueness of each individual, must be paired with an attitude of research on the new answers arising from the new questions as well as an availability to learn to observe also what is happening in those therapies based on innovative theoretical concepts:
“Each man is different from the others, each therapy develops with a specific style. But sufficing with that, and failing to develop a theoretical potential capable of in-depth investigation, risks to exclude an important part of psychological activity, that is the epistemophylic part, deep-rooted in child curiosity, which enables us to remain curious and open to new venues […] Jungian analysts confined themselves to repeating Jung’s thinking, and have not been able, all in all to climb on Jung’s shoulders and explore further away than he did, nor to go down and find their own different interpretation patterns.”
(Maffei 2001, pp. 29 and 27)
I do not know if the encounter between analytical psychology and Accelerated information theorycan be an incentive to new ways of considering analytical psychology, trying to see further away than Jung did and finding other interpretation patterns; the bridging between analytical psychology and Accelerated information processing theorycertainly stimulates the formulation of new questions and the quest for new answers by the many colleagues in the field.
A saying attributed to Confucius says: “It does not matter how slowly you proceed, provided you do not stop”: the bridging between analytical psychology and EMDR requires analytical psychologists to be capable of “not stopping” at their consolidated certainties and to proceed, although slowly, in the understanding and the translation of the different languages of the psyche, accepting that, in any case, behind each psychological endeavor is the body-mindnatural tendency to dynamic balance and to the creation of myths of the meaning.
AA.VV. (2002). (F. Castellana e A. Malinconico editors), Giochi antichi. Parole nuove. Milano: Vivarium;
Bower, G.H. (1981). “Mood and Memory”. American Psychologist, 36, pp.129-148;
Bucci, W. (1997). Psychoanalysis and Cognitive Science. A Multiple Code Theory. New York: The Guilford Press. It. tr. (1999) Psicoanalisi e scienza cognitiva. Teoria del codice multiplo, Roma: Fioriti;
Damasio, R.A. (1994). Descartes’ Error: Emotion, Reason and the Human Brain. New York: Grosset/Putnam. It. tr. (1995) L’errore di Cartesio. Emozione, ragione e cervello umano. Milano: Adelphi;
Damasio, R. A. (1999). The Feeling of What Happens. Body and Emotion in the Making of Consciousness, New York: Harcourt Brace & Company. It. tr. (2000) Emozione e coscienza, Milano: Adelphi;
Damasio, R.A. (2003) Looking for Spinoza. Joy, Sorrow and the Feeling Brain. New York: Hartcourt. It. tr. (2003) Alla ricerca di Spinoza. Emozioni, sentimenti e cervello. Milano: Adelphi;
Eshenröder, C.T. (1997) (editor). EMDR. Eine neue Methode zur Verarbaitung traumatischer Erinnerungen, Deutsche Gesellschaft fuer Verhaltestherapie – Verlag, Tuebingen. It. tr. (2003), EMDR. La nuova tecnica fondata sul movimento guidato degli occhi che fa superare traumi, fobie e ansia, Novara: Red edizioni;
Friedman, H.S., Rogers Mitchell, R. (2002) “La rilevanza della ricerca sul cervello per il Gioco della Sabbia”, in AA.VV. (2002) (a c. di F. Castellana e A. Malinconico) Giochi antichi. Parole nuove. Milano: Vivarium;
Jung, C.G. (1929). “The Aims of Psychotherapy“. CW, 16.
Jung, C.G. (1934). “The Practical Use of Dreams Analysis”. CW, 16.
Jung, C.G. (1935). “Principles of Practical Psychotherapy“. CW, 16.
Jung, C.G. (1961). Erinnerungen, Träume, Gedanken von C.G. Jung. It. Tr. (1978), Ricordi,sogni, riflessioni di C.G. Jung. Milano: Rizzoli;
Lang, P.J. (1979). “A bioinformational theory of emotional imagery”. Psychophysiology, 16, pp. 495-512;
Le Doux, J.E. (1996). The Emotional Brain. New York: Philip & Schuster.
Le Doux, J.E. (2002). The Synaptic Self. How Our Brains Become Who we are. London Basingstoke & Oxford: McMillian.
Maffei. G. (2001). Le metafore fanno avanzare la conoscenza? Sguardi sul mondo junghiano. Milano: Vivarium;
McCann, I.L. & Colletti, J. (1994). ‘The Dance of empathy: a hermeneutic formulation of countertransference. Empatht and understanding in individuals who have experienced early childhood trauma’. In Countertransference in the Treatment of PTDS, ed. J.P. Wilson & J. Lindy. New York & London: The Guildford Press;
Pally, R. (2000). The Mind-Body Relationship, London: Karnac;
Parnell, L. (1997). Transforming Trauma. New York: Norton;
Roth, A., Fonagy, P. (1996) What Works for Whom? A Critical Review of Psychotherapy Research. It. tr. (1997) Psicoterapie e prove di efficacia. Roma: Il Pensiero Scientifico;
Samuels A., Short B., Plaut F., (1986) A Critical Dictionary of Jungian Analysis.It. tr. (1987) Dizionario di Psicologia Analitica. Milano: Cortina;
Schwartz-Salant N., Stein M. (1986) The Body in Analysis. It. tr. (2004) Il corpo in analisi. Roma: Ma.gi.:
Servan-Schreiber, D. (2003). Guérir. Paris: Editions Robert Laffont.
Shapiro, F. (1989). “Efficacy of the Eye Movement Desensitization Procedure in the Treatment o Traumatic Memories”. Journal of Traumatic Stress Studies, 2, 199-223;
Shapiro, F. (1989a). “Eye Movement Desensitization: A new Treatment for Post-traumatic Stress Disorder.Journal of Behavior Therapyand Experimental Psychiatry, 20, 211-217;
Shapiro, F. (1995).Eye Movement Desensitization and Reprocessing. Basic Principles, Protocols and Procedures. It. tr. (2000) EMDR. Desensibilizzazione e rielaborazione attraverso i movimenti oculari. Milano: McGraw-Hill;
Shapiro, F. (1996). “Eye Movement desensitization and reprocessing (EMDR): Evaluation of controlled PTSD research”. Journal of Behavior Therapy and Experimental Psychiatry, 27, 209-218;
Shapiro, F. (1997) EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress andTrauma. New York: Basic Books;
Shapiro, F. (2002) EMDR as an Integrative Psychotherapy Approach. Exoperts of Diverse Orientations Explore the Paradigm Prism. American Psychological Association Books;
Shore, A.N. (1994). Affect Regulation and the Origin of the Self. Hillsdale, NJ: L. Erlbaum;
Shore, A.N. (2001). ‘Minds in the making: attachment, the self-organizing brain and developmentally-oriented psychoanalytic psychotherapy’. British Journalof Psychotherapy, 17.3, pp. 299-328;
Shore, A.N. (2002). ‘Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder’. Australian and New Zealand Journal of Psychiatry, 36, 9-30;
Tibaldi, M. (1995). “Psicologia analitica, esperienza della scrittura e consapevolezza di sé”. Rivista di Psicologia Analitica, n. 52/1995, pp. 19-31;
Tibaldi, M. (1999). “In forma narrativa. Scrittura autobiografica di sé”, in AA.VV., Un oscuro impulso interiore (Anima). Bergamo: Moretti & Vitali, pp. 71-81;
Tibaldi, M. (2001). “La passione narrativa. Appunti per una scrittura autobiografica dell’anima”, in AA.VV., Per nascosti sentieri (Anima). Bergamo: Moretti & Vitali, pp. 191-206;
Tibaldi, M. (2001a). “Sintomi e immagini”, in AA.VV., Genitori e figli. Conoscere per avvicinarsi. Roma: Edizioni Universitarie Romane, pp. 101-106;
Tibaldi, M. (2002). “Come dare avvio al confronto con le immagini inconsce. Due esempi di immaginazione attiva”, in AA.VV., Immaginazione attiva(F. De Luca Comandini e B. Mercurio editors). Milano: Vivarium, pp. 119-126;
Tibaldi, M. (2003). “Immagini cinematografiche e costruzione dell’Io immaginale. Lo psicologo analista tra immagini esterne e immagini interne”,in Ciak. Si vive. Grande schermo e piccoli gruppi. Roma: Ma.gi., pp. 67-71 ;
Tibaldi M. (2003a). “Mens (in)sana in corpore sano”. Anima Mundi, 8/2003, pp. 8-10;
Tibaldi, M. (2003b). “Doppia oggettivazione e formazione dell’Io immaginale”, in Alchimie della formazione analitica. Milano: Vivarium, pp. 329-338;
Tibaldi, M. (2004) “Psicologia analitica ed EMDR: integrazione della stimolazione bilaterale alternata nell’analisi junghiana” in Atti del Convegno EMDR e integrazione dellepsicoterapie, Bologna 26-27-28 novembre 2004;
Wilkinson, M. (2003). ‘Undoing trauma: contemporary neuroscience. A Jungian clinical perspective’. Journal of Analytical Psychology, 48, 235-253.
(Translation Silvio Cohen and Marta Tibaldi)
Francine Shapiro,the originator and developer of EMDR, is a Senior Research Fellow at the Mental Research Institute, Palo Alto, California. She serves as Executive Director of the EMDR Institute in Pacific Grove, California, and the President Emeritus of the EMDR Humanitarian Assistance Programs, a non-profit organization that coordinates disaster response and pro bono trainings worldwide.She has written and co-authored more than 50 articles and chapters and three books- EMDR: Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures(Guilford Press, NY, 2001), EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress and Trauma(Basic Books, NY, 1997) and EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism (American Psychological Association Books, 2002).Dr. Shapiro is a recipient of the Distinguished Scientific Achievement in Psychology Award presented by the California Psychological Association and the 2002 International Sigmund Freud Award for Psychotherapy presented by the City of Vienna in conjunction with the World Council for Psychotherapy.