Bilateral Stimulation

The next step in Phase 2 is to test bilateral stimulation. It is important to do this with the client now, before he or she is holding traumatic memo- ries in consciousness. (Prior to starting, I revisit the medical questions I asked during Phase 1, especially those related to problems with the eyes, such as a detached retina, or with the ears or nasal cavities.) I explain the three major types: eye movements, audio tones, and tactile stimulation. Then I have clients try out each form of stimulation while keeping in mind a neutral experience. This is a task-oriented event of the collaborative working alliance. I tell clients they can change from one form of stimula- tion to another anytime they wish. Remember, it is not only the modality that counts, but also how that modality is used in a co-participatory way by the client and clinician.

EMDR training, based upon research (Shapiro, 1989b), states that faster stimulation is usually better because faster seems to induce an epi- sodic retrieval not found in slower stimulation. The initial research found that slower gave a desensitization effect but not necessarily the cognitive shifts. Sometimes rapid bilateral stimulation may induce such an intense response that the client may begin to dissociate, block, flood, or shut down. In part of every EMDR training, participants are instructed to notice their clients’ nonverbal cues to help them select the number and speed of the sets. How many repetitions are best really depends upon how well the clinician is reading and relating to the client, and vice versa. When the client is abreacting safely, I may do hundreds of repetitions in one set. Shapiro originally suggested 24 to give an initial indication of whether information is processing or not. Sometimes I may do only 15, 10, or even fewer because of what I perceive happening in my client or what he or she is telling me. The key is to follow the nonverbals. This key goes beyond the working alliance and goes to the heart of how clinical judgment is used relationally.

5.4.1 A Relational View of Intermittent Bilateral Stimulation

How do I determine when to take breaks? I have found ways to make this decision in a co-regulatory manner. I explain that I will watch the way they are responding very carefully, and may suggest that they start processing material that they have accessed and experienced the stimulation of. As cli- ents begin to process, I watch their nonverbal signals of sympathetic arousal and parasympathic dearousal very carefully. The easiest call to make is when a client begins and moves through an abreaction. When the wave of emotion crests and then subsides it’s time for me to check in, because a desensitization effect has probably taken hold, and I need to hear how they are experiencing themselves. This informs me if the brain is processing information in a productive manner. If so, I get out of the way and support the process. If not, then it’s time to intervene. I spell out my thinking to my client and get their input. Based upon each client’s expressed preferences, and the methodology, we make an agreement, about how we are proceeding.

Sometimes clients are very quiet on the outside. I need to determine if I notice any nonverbals, such as tears, clenched jaws, tight shoulders, shallow breathing, or a change in the breathing pattern. These are my cues also. Sometimes I make agreements with my clients about signaling me when they are ready to take a break.

Restarting after a client reports back is complicated. The standard way is to hear their associations, and as long as desensitization or reprocessing

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is happening, stay out of the way. There are clients who will use talking as a way of diffusing affect. These clients will have a reaction, and then try to analyze it. When I read a defense coming in to close down productive processing, I instruct my client to notice their sensations in their body and start there. With these kinds of clients I actively attempt to keep them out of their heads and into their bodily experiences. Of course I do this with permission, and never go through a stop signal. The issue is to learn how to be relationally tuned into your client. This takes practice, and it takes a commitment to doing your own work. I use my body to sense the signals I get, and then use these signals, checking out with my client how accurate they believe me to be. I’ve got a good track record.

Bilateral stimulation is not used in a vacuum; it is performed interper- sonally. Induced transferential reactions can occur when the EMDR clini- cian is more determined to do it the “right way” than to notice what is going on with the client in the moment. Testing different types of stimula- tion, their speed, and the duration of sets during Phase 2 gives the clini- cian a baseline from which he or she and the client may vary when they are in the middle of processing in Phase 4. Proper preparation limits how intensely this induced transference plays out in the latter phase.

Let me give you one word about self-care for the clinician. In the EMDR Institute trainings, participants are taught to lead bilateral stimula- tion by moving their hands back and forth. This is fine and dandy for training purposes, but any practicing EMDR clinician knows that to do this regularly in daily practice may result in muscle pain. I recommend using any one or more of the fine tools made for the EMDR community. A light bar for eye movements, bilateral audio beeps, bilateral tapes and CDs, and bilateral tactile devices are available. There are even novel computerized methods. Be kind to your body. This is strenuous work.