EMDR as Grief Work:
An Interview With Francine Shapiro
by Robert Zucker
I was thrilled to interview Francine Shapiro, founder of EMDR, an innovative approach to psychotherapy. A senior research fellow at the Mental Health Research Institute in Palo Alto, California, she is the author of a textbook on EMDR, and EMDR: the Breakthrough "Eye Movement" Therapy for Overcoming Anxiety, Stress, and Trauma, as well as more than thirty journal articles. Whether you are a clinician using EMDR or if you are not at all familiar with this revolutionary method of treatment, I know you will be intrigued and challenged by this interview. If you want more information about EMDR trainings or would like to know who in your region is certified to do this work, Icontact the EMDR Institute in Palo Alto, California.
Zucker: What is Eye Movement Desensitization and Reprocessing (EMDR)?
Shapiro: EMDR is an integrated approach to psychotherapy. It brings together aspects of all of the major orientations - in addition to an element of the tension of eye movement, hand taps or tones. EMDR is believed to catalyze the same processes that occur in rapid eye movement sleep, so that a rapid learning and healing is able to take place.
The whole point of the EMDR work is to put the healing back on track. People will experience what they need to in order to come to their own most helpful resolution. So it is not attempting to put anything in the mind of a client that would artificially dilute or take away any treasures that a person needs to have. Rather it allows a person to make the most helpful connections possible. A Vietnam vet, for instance, who 30 years later is still mourning the loss of his war buddy and continuing only to think of him with his head blown off, does not have the most helpful connection to his buddy. If he processed that memory, he'd be able to remember all the good times and the positive connections. He would be able to take the experience and turn it into something useful instead of being immobilized by the pain.
Zucker: There seems to be a fundamental distinction between the classic trauma experience so often associated with EMDR and the grief-related "trauma" that often involves profound separation. How is EMDR useful for those who grieve if there are no intrusive images or other classic trauma symptoms?
Shapiro: When spontaneous healing hasn't been taking place, that's when you use EMDR. Whereas most bereaved people go through a cycle or a creative time where feelings of worthlessness or failure or despair or separation from the world automatically arise after the death of a loved one, they usually move on through various stages of healing. When they are not moving on through those different stages, then we would say that the information is locked up or dysfunctional.
While in order to make a PTSD diagnosis you need to have intrusive thoughts, that doesn't mean that because the person doesn't have them they haven't been traumatized. And they don't need to have intrusive words or images for the information to have been unresolved and dysfunctionally stored. I am always looking at how perceptions have been stored and what are the ingredients of those perceptions. EMDR is a tool to catalyze appropriate rapid learning. This means that the person will learn to integrate what is useful from the event. Appropriate emotions, insights and connections will be made, and what is useless will be discarded. Most people who are traumatized are dealing with issues of responsibility - "I wasn't good enough." or "I did something wrong." or "I'm not safe in the world." or "I have no control." And as you can readily see, while those three basic issues ( a sense of failure, lack of safety and feeling out of control) apply very well for a person who has been in a natural disaster or a car accident, they also apply when a person loses a loved one. In either case I think it would be called a trauma although the field of psychology hasn't necessarily seen it that way.
Zucker: How can we embrace our feelings of guilt or self-blame and make these seemingly negative emotions our teachers?
Shapiro: Every experience is potentially a learning experience. All experiences have the seeds of growth and renewal depending upon how much we can embrace them and learn from them rather than becoming entrenched in them. If I was indeed a "bad person" - if I didn't do certain things I wish I had done, or if I was insensitive in certain ways - were these deliberate acts? Or did I act without malice or awareness? These are things that I would have to face. But what about all the good things that I did do? Can I also look at them equally? Can I recognize that it is all part of an entire fabric? Can I recognize that even if I had done something wrong, I also have the ability to recognize it, to mourn for it and then to move on with a sense of expiation? What can I do to make it more fruitful for others in the future? What can I do to learn from this and become a more sensitive person? We can take our experiences and painful feelings and make them our teachers rather than becoming stuck and letting ourselves be defined by them.
A molestation victim blamed herself for twenty years for being molested by her father because this thought went through her mind as she was being raped: "Do this! Do this! And I'll have you for the rest of my life!" This one stray thought came to define her for the next two decades. She would say, "This means I'm a whore. This means I am a terrible person" - all because that one thought emerged. When we latch on to one act, one thought, one feeling, one oversight, one behavior, and allow that to define an entire relationship, and us then we know that the information has become dysfunctionally stored. It has encompassed us and defined us rather than become grist for the mill.
Zucker: What is the relationship between trauma, guilt and spiritual crisis?
Shapiro: In every religion there is a ritual for expiation. In the Jewish religion, if you sin and you feel it, atone for it and resolve never to do it again, then it is considered gone. Other religions have forms of confession so if you are feeling remorseful and you make it known, and perform certain acts of contrition, you are absolved. In the spiritual or religious realm, God is forgiving and does not hold one act, one thought, or one emotion as defining the individual. What is important is how the person feels, in retrospect. Our spiritual task is to forgive ourselves and not descend to the level of beating ourselves up. As with anything else, any event needs to take place within the fabric of our life and any act also has to take its place within the fabric of the larger spiritual belief system. For everything, there is a past, there is a present, there is a future.
Among those who already have a spiritual connection, we see time and time again that with EMDR there is a letting go, a softening and a strengthening of that spiritual connection, allowing for peace to emerge. For those that have never thought in spiritual terms, we often see this happening as well. It is actually a hallmark of EMDR therapy when those spiritual connections happen.
Zucker: What about those of us who maintain a very pragmatic, non-spiritual and strictly scientific understanding of the world?
Shapiro: Spirituality can be defined in many different ways. You don't have to be an adherent of any formalized religion, nor do you have to use words like soul or spirit. There are those who believe in the connectedness of all living things on the planet simply because they are all made of atoms or are all birthed of stardust and when somebody dies they think of their loved one as still a part of nature. Is that spiritual or is that simply recognition that no energy is ever lost?
We simply have to remember that regardless of how intelligent we are or how spiritual we are or how educated we are, we also are physical beings. And as physical beings, we are locked in a cause and effect, physiological continuum. And if certain brain states- certain physical effects occur because of an event, we can act as a prison to our own consciousness. That's where we're looking to EMDR to open the gates of the prison when those states occur.
Zucker: There has been almost a credo among many grief counselors that we don't "fix" grief. But I hear you saying that in some ways, EMDR can fix some things for grievers.
Shapiro: If a person's arm is broken, the doctor's job is to align it so that the healing process can take place. He is not healing the arm. He is doing what is necessary to align it so that the person's own body can do what it needs to do. That much we are doing with EMDR. We are allowing the processes to be aligned so the person's own healing is able to take place. The problem is that a disruption of their memory system has occurred. Understandably, the bereaved sometimes hold on to pain as if they should, whereas if they had been raped or in a natural disaster they wouldn't necessarily feel that same commitment to keeping their pain. When someone who is grieving goes for help, they may feel that they are no longer honoring their loved one. They may believe that they owe it to their loved one to continue suffering or that if they are in agony they must be paying their dues for something they've done wrong. We simply have to remember that sometimes our body works against us and we have to help it find the right path to healing. We look at the EMDR clinician not as a healer, but as a facilitator - as one client said, "My therapist is the banister on the stairs that I climb."
It would be useful for us to re-examine a lot of our assumptions about the whole category of grief and loss. When I am with groups of clinicians I'll ask them, "If someone came to you and said, ‘I need your help. I lost my baby two years ago. I can't eat. I can't sleep. I need you to do something,' how many of you would use EMDR with her if you knew that in a couple of sessions she would say to you, ‘I feel him in my heart. I am so grateful for the time we had together. I know he's in a better place'? " And most clinicians say they would use EMDR in that situation. Then I ask clinicians, "What if she came in after only a year?" Then fewer clinicians are willing to use EMDR. They say, "No, she needs to stay with her grief." Then I take it to six months, and still fewer clinicians are willing to use EMDR. Then three months, and even fewer are willing. In one month, fewer still are willing - even though this woman is in pain and they know that after a couple of sessions she would be saying to them, "I feel him in my heart. He's in a better place." How long should pain and suffering last? Is it responsible or ethical to try to do something about the pain of grief? As long as we're dictating and putting time parameters around how intensely someone should suffer and the form it should take, then we're taking the role of dictator and judge. All EMDR does is allow clients to go where they need to go. Why would we hesitate to use a tool that can allow a woman to make a statement of connection in her heart rather than being in unbearable pain? Those quotes came directly from a woman who had been nursing her sick baby all night while she kept calling her doctor, trying to have the baby admitted to the hospital. But the doctor kept telling her not to worry. So she rocked her baby all night and when she woke up in the morning she found him dead on her chest. How do we as clinicians say to this woman, "No, you must stay with that image." "You must stay with that feeling." "You must stay with that suffering until it resolves on its own"? When there is that much pain how can we not be willing to use something that would simply take the knife out of her heart so the mourning process would be able to proceed?