Public Topics: Articles: Psychotherapy Innovation

Rapid-Acting Psychotherapy Methods: An Overview

Brief overview, history and issues regarding EMDR, EFT, TFT and other therapies believed to be rapid-acting for many problems.

Robert A. Yourell, LMFT

This article addresses a deep subject, but is a fairly brief overview with links out for additional information. I have been following the subject since the early 1990's, and have been directly involved, especially as an EMDR-trained (level II, 1992) therapist and participant in online discussion forums. I co-coordinated the first conference to address the topic and developed the first sound for EMDR-inspired processing, still widely used.

This article gives a basic overview of therapies that might be called rapid-acting therapies. The strengths and limits of these approaches have been repeated very consistently in many conversations I have had with therapists, people who have experienced the treatments and in thousands of discussion list posts (example of a public discussion list on EMDR, at Behavior.net, and the very active EFT discussion list). This may not be scientific, but is something I have drawn on in rounding out the article. After much more research over some number of years, a scientific consensus will emerge, but word on the street will always tell us quit a bit, and well in advance of a scientific consensus. Enough decades have passed, that I can say these treatments are no fad.

Some History

One of the first and most credible sources of widespread attention to rapid acting psychotherapies in the mental health field arose from the work of Charles Figley, Ph.D. (Hear him speak on this topic, and learn more about his projects.) He became interested in treatments for the effects of psychological trauma after a colleague suicided. This colleague treated trauma. Dr. Figley knew that some therapists thrived while treating trauma, and others did not do well. He used the Internet to poll therapists, asking them to identify the methods used by the therapists who were coping best. The methods most often identified were EMDR (Eye Movement Desensitization and Reprocessing), TIR (Traumatic Incident Reduction), TFT (Thought Field Therapy), and VK/D (Visual Kinesthetic Dissociation) which comes from NLP (Neurolinguistic Programming.) In 1995, he conducted innovative research called the Active Ingredients Project comparing them, with favorable results for all.

These approaches all had other things in common. Each was reputed to provide rapid and usually lasting reductions in a variety of symptoms, particularly those of PTSD and anxiety.

They also had striking differences in research support and methodology. Even at that time, EMDR has a good deal of research support. Now it has much more. It was the most researched treatment for post traumatic stress disorder.

Special Focus on EMDR

EMDR (and TIR) is more highly developed as an overall therapy approach than most other rapid therapies. A tremendous number of therapists have trained in EMDR. Francine Shapiro, Ph.D. developed EMDR. Because EMDR is so unique, and because of the dramatic claims made about it, criticism has come from many directions. There is much less criticism now that so much research has taken place. In fact, the U.S. Veterans Administration and other official organizations have accepted EMDR. Proponents of EMDR feel that much of the criticism of EMDR was uninformed or based on research that didn't really use EMDR.

EMDR was originally applied to post traumatic stress disorder, but therapists report that it can be of value in numerous other problems. The way EMDR assists in activating innate psychological recovery abilities will probably explain its flexibility. Also, it is not simply a single technique. The eye movement that it is famous for is one component of a sophisticated multi-phase treatment that incorporates all skills of the therapist.

The reason for EMDR's effectiveness is not known, but a widely accepted theory of its effectiveness is called the Accelerated information processing theory. It tells us that when trauma symptoms are naturally resolved, this happens because our bodies have specific means for causing this improvement, and that it can be enhanced through EMDR. The accelerated information processing theory states that at the time of trauma, the information (that is, the sensory experience) overwhelms the body in such a way that the body's natural ability to heal the shock is unable to process the experience. EMDR, according to this theory, accelerates this information processing by enhancing it and by reducing the psychological barriers to it. Thus EMDR resolves symptoms that did not improve on their own. Many of these cases are quite serious.

EMDR is known for its use of eye movement, and many believe that back-and-forth stimulation of some kind is important to the treatment. There is some research that calls this belief into question, yet many practitioners and clients report that there is a very palpable difference when bilateral stimulation is omitted. Other stimuli used for bilateral stimulation include tapping (not related to energy psychology) and sound.

I developed the first sound used for EMDR-inspired processes, now called UpLevel.

Some Generalities

These rapid therapies seem to help the most with anxious reactions, ranging from mild performance anxiety to serious post traumatic stress disorder. This may not sound like much, but this can mean the difference between being able to function and hold a job, or control violent impulses.

They can also accelerate therapy by helping people reduce their psychological defenses and reduce their reactivity. This can do a lot to liberate one's resources for further progress. This kind of generality seems to apply to all of these approaches, though the most well-known and best researched method is eye movement desensitization and reprocessing, and it is the method that I have the most experience and training with and have had the most discussions about.

As of this writing, there is still controversy regarding the significance of research on EMDR. Because of varied means of studying it, some of which attempted to dismantle it into one component, it is not easy to make sense of all the studies. A conservative view of the results would be that EMDR is at least as good as exposure therapy for phobias, and at least as good as other specialized therapies for trauma, works faster, and is perhaps as inconsistent as other therapies in how long-lasting the results are. There are well-informed arguments that are much more supportive of the superiority of EMDR to other approaches. In my experience, and much communication with other EMDR-trained therapists, EMDR often has very striking results, especially considering the speed and how positive the experience tends to be for clients themselves.

As of this writing, many therapists are integrating elements of rapid acting therapies in attempts to improve outcomes and safety. Comparing and contrasting methods such as these will help us better understand the ingredients that make therapy effective and to make improvements to psychotherapy methods.

Risks, and High-Risk Populations EMDR has shown itself to be an excellent part of treatment for people with serious trauma histories that have led to problems such as dissociative disorders, including suicidal feelings. However, for more complicated problems, it is no magic wand and can't substitute for specialized clinical training pertaining to the problem. Many people highly trained and experienced with such serious problems rely on EMDR as an important part of treatment. However, they all stress (as is stressed in the EMDR training) that many such clients are not ready for EMDR right away and must make some progress in areas such as tolerating their emotions first. EMDR may be performed in an inpatient setting where a client with risk of destabilization or suicide can be better supervised and supported.

Clients with a history of severe and ongoing trauma can reach a certain point in EMDR sessions where progress is very difficult or stops. Adding energy psychology work can eliminate this problem for many clients. I neither support or argue against the theory behind energy psychology (discussed below), and I feel that, even if the theory proves false, that doesn't change the results. Another theory will prove to be on target.

EMDR therapists are trained to screen carefully for problems that may not be appropriate for EMDR at the start of therapy. Proponents of energy psychology say their methods are less likely to cause problems for clients prone to destabilization, but I hope this is not taken to mean that specialized training in the problem is not required. Clients with serious problems who treated by people without specialized training have had very bad experiences.

Performance Many people have made improvements in sports, sales, public speaking and other endeavors, even though there was no clear-cut psychological problem requiring treatment. EMDR has been used a great deal for such performance. I have used it a great deal in helping people prepare for challenging situations such as court testimony. I combine it with mental exercises that target the reptilian brain to specifically address anxiety and motivation for such problems.

Stress Management EMDR is an excellent way to help clients develop deeply relaxed states which enhance their ability to meditate or do visualization. Most importantly, because it can improve the way we react to stress, and reduce anxiety in general, it appears to be of great help for stress management. Relaxing during meditation or in a therapists office is of little use if you spend most of your time feeling anxious in your daily life. I hear few people say meditation prevents spikes of anxiety in the situations that trouble them, but I consistently hear about this kind of improvement with EMDR and other rapid therapies. There is research that is quite supportive of meditation in terms of overall stress and health factors, but it has not proven itself for people who are having serious anxiety problems. I believe that adding EMDR, and then self-applied EMDR can significantly improve the art of stress management because of its tendency to have lasting effects.

Energy Psychology

Energy psychology believes that there is sufficient evidence of an energy system, although that is not accepted by western science. In fact, the first energy psychology approach that gained widespread interest in current times is thought field therapy (TFT), which was inspired by applied kinesiology, which in turn drew from Chinese medicine and focused on health problems more than psychological ones. Roger Callahan, Ph.D. (sometimes misspelled as Roger Callaghan) developed Thought Field Therapy in the 1970's and initially promoted it on television as a phobia cure.

Energy psychology methods involve tapping acupuncture points and have become very popular, even being accepted by some cautious and conservative individuals. A well-known offshoot of TFT is Emotional Freedom Technique (EFT) It was designed for the general public for self-use as well as for therapists. It is simplified as a single protocol, although there are advanced methods. According to those involved in these tapping treatments, the full range of problems they can help with is not clear, because there are numerous reports of improvements in health problems and pain, as well as various psychological problems.

It is widely reported that improvements from energy psychology methods may be undone by exposure to substances that to which the person is sensitive or allergic, but can be regained by repeating the procedure. Many believe that allergies and sensitivities can be improved or cured with energy psychology methods. There are acupuncture protocols intended to treat allergies as well. Whether the energy system is involved, and what the real effectiveness of this is not adequately researched. There is a neurolinguistic programming method for reducing or eliminating allergic responses that does not involve energy psychology, and does not use transpersonal methods. Instead, it creates an alternate response primarily through visualization in a way that is much like numerous other neurolinguistic programming methods. I experienced a surprising level of cat allergy reduction with that method, and it has lasted a long time.

The tapping therapies will probably have an uphill battle for credibility among therapists because of the more mysterious phenomena claimed by some, but not all, practitioners. For example, in surrogate testing, a practitioner mentally aligns him or herself, or another person, with the client's energy to become a surrogate. Then the treatment or diagnostic work is performed upon the surrogate. Such practice is based upon a belief in transpersonal effects of intention, and amount to distance healing. There is also the belief that the body is sensitive to energy fields of substances, people and so forth, so that is is possible to determine the appropriateness of things such as supplements or foods by testing muscle strength and reaction during exposure to it. The object may even be a piece of paper with the name of the substance written on it. Many practitioners are not inclined toward these more adventurous transpersonal beliefs, and limit their work to point-tapping and other non-transpersonal procedures.

On the other hand, EMDR is not based on any transpersonal beliefs.