The Path Forward
EMDR therapy stands at the cusp of two crossroads.
EMDR therapy is at a developmental crossroad. With maturity, there is now a considerable body of evidence to demonstrate its effectiveness, particularly in the treatment of trauma. It is clear from the literature that EMDR therapy is at least as effective as other therapies when treating trauma and its correlates. This body of evidence should be a point of pride for those who pioneered EMDR over the last three decades. Its recognition is reflected in recommendations in the recent PTSD guidelines published by the International Society for Traumatic Stress Studies (ISTSS), the US Department of Veterans Affairs and Department of Defense, and the World Health Organization.
In the last two years the American Psychological Association (APA) and the UK’s National Institute for Clinical Excellence (NICE) have both downgraded recommendations regarding EMDR therapy.These benchmark reviews of treatment effectiveness did not find the evidence for EMDR compelling enough to ensure its inclusion as a top-level treatment. This fact suggests a need for the EMDR community to critically examine its research base and to identify important steps in moving forward. Development of a collaboratively defined research agenda could begin to address knowledge gaps and needs.
The public recognition of EMDR therapy as an effective and vital treatment is essential on multiple levels: for clinicians seeking insurance coverage for treatment, researchers submitting grant applications, and universities wanting to incorporate EMDR into curriculums. Recognition is also important, as the EMDR community seeks to scale up services, in response to the call for “trauma informed care.” The growing global awareness of the prevalence of trauma and its impact on health and well-being is a great untapped opportunity to advocate for scaling EMDR therapy in various systems. A vital and as yet relatively undeveloped area of inquiry is how EMDR can improve health outcomes and decrease healthcare costs and utilization. This opportunity could better be embraced with relevant epidemiology and cost/outcome studies that show the benefit and impact of EMDR therapy from a public health and health economics perspective.
Definition of EMDR Therapy
As EMDR therapy has matured, because of the presence of the founder and pioneers, there has been cohesion and consistency in EMDR therapy. However, dozens – perhaps hundreds – of new protocols have been developed. While some have been researched, most remain untested. The field lacks a cogent definition of EMDR therapy and a consistent way to determine if a new protocol is an innovation, or a modification, or an adaptation. The community stands at a crossroad, where an indiscriminately open stance endangers the essential unique elements of EMDR therapy, and an orthodox stance risks losing important developments and responsiveness to new research findings. Past research has tended to focus more on investigating potential mechanisms of action rather than on identifying active treatment components, and not enough is known about EMDR’s active ingredients. An analysis of the literature may provide some understanding of these essential issues and identify important areas for future research and policy recommendations.
Empirical Standards for Training
Although standards have been established for therapist certification and training, there appears to be a lack of objective criteria concerning the knowledge, skills, and competencies that will best ensure successful outcomes. Combining field tested mechanisms and competency statements with knowledge garnered from emerging research on clinical outcomes and training will ensure that EMDR practitioners are fully prepared and equipped to deliver necessary and effective care. There are steps and processes that the EMDR community can implement and improve to ensure continual renewal and training excellence over time as the therapy matures and new knowledge emerges.
At the same time as new global opportunities are presented to the EMDR community, and as both need and opportunity for EMDR therapy come into a sharper focus, the field faces a generational crossroad. Many of the pioneers and early adopters of EMDR therapy are retiring or reducing their professional activities and contributions. This has the potential to create a void or diffusion of intellectual, theoretical, and clinical capacity, as the founding, organizing, and unifying voices for EMDR look to the next generation to continue the advancement and dissemination of the healing power of EMDR therapy.
There is a need for the professional community at large to come together, taking stock of progress made, while charting the future course, and building EMDR’s global intellectual and scholarly capital and capacity. The wisdom of the early adopters, who fought many legitimization battles for EMDR therapy must not be lost. At the same time, as the early adopters pass the torch, the new scholars and intellectual leaders need a forum to learn from each other, define and collaborate on important research that must be conducted, and help translate the emerging knowledge from research to clinical practice, and training content, standards, and competencies.
The Future of EMDR Therapy Project and Council of Scholars
Considering EMDR’s developmental and generational crossroads, the Journal of EMDR Research and Practice (JEMDR), supported by EMDRIA, has developed the Future of EMDR Therapy (FOET) Project. Led by Co-Chairs Deany Laliotis and Suzy Matthjessn and a steering committee, approximately 30 international thought leaders in EMDR research, training, and practice are being invited to participate in the FOET Council of Scholars. The FOET Council of Scholars will gather in a series of symposium meetings over the next several years, and will engage in related working group projects throughout the year to accomplish identified goals.