EMDR Therapy for Childhood Trauma

EMDR — short for eye movement desensitization and reprocessing — has become a go-to technique for treating trauma in adults. And it’s being used to help children, too.

EMDR is a surprising therapy that involves prompting the patient to briefly recall a traumatic experience that’s continuing to disturb them while moving their eyes from side to side or being tapped on alternating sides of the body. The desired result is that the memory becomes less overwhelming.

EMDR is relatively new form of psychotherapy, developed by Francine Shapiro in 1989. And while it’s not entirely clear how it works, it has already amassed quite a bit of support among mental health professionals. In 2017, the U.S. Department of Veterans Affairs included EMDR as one of its top three recommended treatment options for post-traumatic stress disorder (PTSD). It’s also been found to be effective in children who’ve had upsetting experiences and are struggling to recover from them.

In addition to PTSD, EMDR is being used to treat anxiety, depression, eating disorders, and substance use disorders, among other things.

“It’s quite effective for what I refer to oftentimes as emotional splinters,” says William M. Zangwill, PhD, an EMDR expert who trains clinicians in the practice. “If you’ve ever had a splinter, then you know it can cause quite a bit of pain, even when it’s touched gently or accidentally. It’s similar with emotional pain. So what we’re trying to do with EMDR is to gently take the splinter out so that the person can heal.”

EMDR is a type of psychotherapy in which, under the guidance of a specially trained clinician, patients recount memories of a traumatic event while engaging in physical stimulation on alternate sides of the body.

Shapiro developed EMDR using rapid eye movement as the stimulation, in which the therapist directs the patient to quickly move their eyes from side to side. Other stimulations can also be used, such as alternately tapping the patient’s legs or shoulders, specialized lights that flash in a programmed, alternate sequence, or handheld devices that alternately vibrate.

“Alternate stimulation, or what’s called bilateral stimulation, is one of the key components of EMDR,” Dr. Zangwill says. “It helps keep the mind focused on the present.”

Dr. Zangwill says he lets his patients choose which kind of stimulation to use but generally recommends tapping for his pediatric patients, because it’s simple and can be performed by the patient’s parents. That’s helpful so they can use the tapping technique at home as needed between sessions. And older children and adolescents can even do it themselves.

While more than two dozen clinical trials have led researchers to conclude that EMDR is effective, it remains unclear exactly how the therapy works. Researchers believe it has something to do with where and how traumatic memories are stored in the brain as compared with other memories.

Normal memories are processed as they are stored, linked to a network of other memories that puts them in context and locates them in the past. In a traumatic experience, this process may be disrupted. When these unprocessed memories are recalled, the disturbing feelings, thoughts and sensations connected with them can be experienced again.

For people with PTSD, memories of trauma are overwhelming because they are experienced as if they’re happening in the present. The goal of EMDR is to reconsolidate the memory, to overwrite the earlier version, as something remembered, as opposed to something being relived, and in a less overwhelming form.

“So the theory is that what you’re doing by tapping is you’re distracting the brain’s ability to focus, which means it can’t build the memory back up as strongly, and therefore, over time, the person feels less pain,” Dr. Zangwill says.

EMDR is most effective in children when used to treat a singular, well-defined trauma.

“It works best on patients who have been through a specific trauma that has a clear beginning and an end,” Dr. Zangwill says. “For instance, an automobile accident, a loss of a parent or relative, a breakup, a serious illness, but something that had a beginning and an end, especially when it’s a sudden kind of event.”

It can be used with kids of all ages. Dr. Zangwill says he has seen it used effectively with children as young as 2 years old.

“You can simplify EMDR, adjust it, to meet the child where they are cognitively and developmentally,” Dr. Zangwill says. “But in general, the younger the child, the more specific the event should be if EMDR is going to be of help.”

EMDR can be used to treat older kids and teens with trauma situations that stretched over a longer period of time or when they cognitively understand a threat is gone but can’t seem to get past the negative emotions.

“This other area where it’s good is when people understand something perhaps intellectually but are stuck emotionally,” Dr. Zangwill says. “For example, let’s say they witnessed their mother being abused and now the abuser is in jail. Intellectually, they know that person can’t come and hurt them, but they can’t get past the fear. When there’s a discrepancy between what you know and what you feel, 99.8 percent of the time your feelings win out. What EMDR does — in ways we’re not sure about — is connect what we know to what we feel better than anything I’ve ever used.”

EMDR, Dr. Zangwill says, can have truly impressive results. But it’s not a quick fix. “Sometimes parents have the impression that all we do is tap their child and everything will be fixed,” he explains. “That’s not the case.”

And sometimes, EMDR doesn’t work for a child or a particular situation at all. There’s no guarantee. The good news is that you’ll know in a relatively short time — usually after about two sessions, according to Dr. Zangwill — whether or not EMDR is a good fit.

And while it’s possible to find guidelines from professional organizations as to what an EMDR session will look like and how many sessions it will take to overcome a trauma — six to 12, according to this guideline from the American Psychological Association — Dr. Zangwill says it all really depends on the situation and the patient.

“It’s hard to give specifics, because every situation is different,” he says. “Some kids can sit for a 90-minute session, for example, whereas younger patients may only tolerate 15 minutes at a time.”

Some children may require more guidance and emotional handholding through the process whereas other kids may be able to talk about the trauma unprompted.

In any event, Dr. Zangwill stresses the importance of getting the whole family involved. In fact, when treating children, Dr. Zangwill says he will meet with as many family members as possible prior to beginning EMDR so he can gain a fuller picture of what’s going on with the child, which he says is crucial to the success of the treatment.

“In my experience, when there are systemic issues present, the only way EMDR — or any kind of therapy — will be effective is when the whole family is involved,” Dr. Zangwill says.

That’s because therapy can’t address problems in a vacuum. Oftentimes, Dr. Zangwill says, the trauma that brought a parent to seek therapy for their child isn’t the only challenge that needs to be addressed or even the root of the problem.

“You have to remember that when children have been through painful stuff, it happens within the context of a family — before, during and after,” Dr. Zangwill says. “So sometimes it’s not even really about the traumatic thing that happened but the fact that they didn’t feel supported by their family afterward or that the family never talked about it.”

Getting the entire family involved helps guard against “garage syndrome,” an expression he uses for parents who expect to be able drop their child off for therapy and pick them up all fixed, as you would when you take your car to the mechanic.

Another reason Dr. Zangwill insists parents are involved throughout is so they understand how EMDR works and why their child might seem more upset than usual at first. EMDR can trigger upsetting feelings in kids as they work through their traumatic memories.

“The analogy I use when I’m teaching and training people is that when your foot’s been asleep, and it starts to awaken, it hurts,” Dr. Zangwill says. “When you do deeper work, that increases awareness. Initially you can feel more pain, but then it subsides.”

Negative feelings triggered by EMDR typically get progressively better with each session, he adds.

Seeking EMDR from an experienced practitioner is important, especially when considering someone who works with children, Dr. Zangwill says. “An experienced clinician will know how far to take a session, how much handholding needs to be done and when to get out of the way so patients can make realizations and come up with their own answers.”

An experienced therapist will be able to minimize negative feelings that arise from EMDR, he adds, and will also advise parents how to support patients in the event they have difficulty between sessions.

To locate a therapist who practices EMDR, visit the EMDR International Association’s provider directory.