Made Simple: EMDR with Complex Trauma

In one sentence: EMDR Basic Training teaches you how to deal with simple trauma, but to work effectively with complex trauma clients (who make up much of your caseload) you will need to make reasonable accommodations to match the nervous systems that are in front of you.

In one paragraph: Using EMDR to treat clients with severe and complex trauma or CPTSD has always been challenging. Finding workable strategies that retain what is remarkable and transformational in EMDR therapy, yet are tolerable to the profoundly wounded clients that we serve is a different process for every client. The key is to make sensible modifications to the EMDR Standard Protocol when working with clients with complex trauma.

Throughout my blog posts, podcast episodes, EMDR trainings, and my recent book EMDR With Complex Trauma I have always focused on the difficult transition from foundational EMDR training to working more effectively with clients with complex trauma.

EMDR Basic Training focuses heavily on teaching therapists how to work effectively with relatively healthy clients. Many therapists leave these trainings with the impression that EMDR therapy is a kind of magic wand that will finally allow them to work safely, effectively, and efficiently with the clients who most motivated them to attend EMDR training—the clients with complex and hard-to-treat traumas.

Most therapists leave Basic Training without the skills needed to use EMDR therapy safely and effectively with the severely complex clients who are already on their caseloads. They understand Standard Protocol well enough, but they have little awareness of what to do when standard approaches to EMDR therapy do not work with their clients who most urgently need to heal.

As much as we need to train more EMDR therapists, we urgently need to figure out how to retain more of those we train. Using our limited data, it seems that many of the therapists we train end up not using EMDR therapy in their practices in the months and years after training. I am convinced that clinical outcomes and therapist retention are improved by understanding clearly what EMDR therapy is, understanding clearly what complex trauma is, and working in ways that are sensible to both.

When clients do not have enough of the needed adaptive information, therapists need to help them construct it.

EMDR Therapy Has an Admission Price

For clients to do EMDR therapy well, they need to be capable of the following core tasks:

1. Tolerate the activation of relevant memory content.
2. Possess enough adaptive information for the difficult material to be metabolized.
3. Demonstrate the ability to slow down, be present, and notice distress for substantial periods of time.

Many clients with CPTSD will struggle with some or all of these core tasks:

1. Complex trauma doesn’t want to come in tolerable and digestible pieces and the cumulative tax of carrying trauma severely impacts the window of tolerance.
2. CPTSD clients might only have limited adaptive information available to them.
3. Most clients with severe trauma have survived by not slowing down, not being present, and not noticing.

The core tasks of EMDR therapy are not only difficult for clients with complex trauma, they directly contradict their long-held survival strategies. When clients are phobic of activation, slowing down, being present, or noticing, the therapist must show them how to do these things tolerably before EMDR therapy can be conducted safely.

Let everything you know about complex trauma shape how you do EMDR therapy, not the reverse.

We Teach the AIP Model Well, But Not Its Implications

Most of the practitioners that we train understand the core concepts in EMDR’s Adaptive Information Processing (AIP) model: They understand that the nervous system wants to heal, that trauma gets stuck in ways that prevent resolution, and that EMDR therapy helps connect the stuck information to the already-present adaptive information.

However, EMDR therapy requires the prior presence of a substantial amount of adaptive information to be effective. In many cases of complex trauma, developmental disruptions may have prevented the formation of much of the adaptive information needed for EMDR therapy to be effective.

EMDR therapy works by bridging adaptive and maladaptive information held in different parts of the nervous system. But you cannot connect a lie to a lie. This is one of many reasons why EMDR is magical for relatively healthy people, but often very difficult for the clients who most need to heal. When clients do not have enough of the needed adaptive information, therapists need to help them construct it.

That process takes time, and Basic Training often does not adequately cover this very common case. Instead, we train you to endlessly go back to Phase Two to repeat what didn’t work the first time.

EMDR Therapy is Not a Machine

EMDR therapy is not a machine that we shove our clients through—it is not one-size-fits-all. Clients with complex trauma will not safely be crammed into a machine built for a differently shaped nervous system.

These clients need therapists who understand complex trauma. Fortunately, most already do. By and large, the therapists I encounter as a trainer understand complex trauma better than almost anyone else on the planet. They have spent more face-to-face time with clients with complex trauma than they have spent interacting with their own children or family members.

My consistent advice has been to let everything you know about complex trauma shape how you do EMDR therapy, not the reverse. We can become so obsessed with protocol fidelity that we lose sight of the very client in front of us. There are very few problems that clients with complex trauma have that are solved by strict adherence to Standard Protocol alone.

One risk with CPTSD cases is that we approach them in ways that do not match the realities of the client’s nervous system. Perhaps the even bigger risk is that we are so overwhelmed by the complexity that we don’t start tackling the case at all.

The Good News

Many EMDR consultants are able to help you make reasonable adjustments to match the unique and complex nervous system that is in front of you. Many resources are available to describe clearly why the Standard Protocol, including starting with first or worst memory, makes perfect sense with many clients but why modifications may be needed when working with others.

Working with complex cases is seldom easy. It is rarely fast. The marketing of EMDR therapy consistently gaslights therapists and clients about what complex trauma is and how recovery occurs. EMDR therapy is a beautiful, slow, and effective way to heal when complex clients are working at the intersection of what is productive and what is tolerable.

---

Curious to learn more? Check out Thomas’ new book EMDR With Complex Trauma, a concise and engaging guide with strategies and resources for your most complex trauma cases.