David V. Baldwin
Note: Draft "preprint" of one of three invited reviews of Shapiro's (1995) text to appear in Contemporary Psychology, September 1996, under the group title Eye Movement Desensitization and Reprocessing: Three Views. [Other reviews written by Jeffrey M. Lohr, and by Richard J. Roberts and Craig S. Holt.] Please do not quote this draft version.
Eye movement desensitization and reprocessing (EMDR) has emerged as a significant -- and controversial -- clinical method for treating a variety of disorders related to posttraumatic stress. This pragmatic book is important as the definitive presentation of the EMDR method.
Shapiro's text describes an efficient and structured clinical method in psychology. Because it focuses on a unique approach, this book differs from other treatment texts on posttraumatic stress disorder (PTSD) and related disorders. Written primarily for clinicians and clinical graduate students engaged in direct treatment, the book's audience extends beyond those direct care practitioners who adopt its insights to academics and clinical researchers with the resources to investigate cognitive and other processes of trauma resolution. It might best be used in a graduate clinical practicum course on treating trauma following a class covering varieties of traumatic-stress responses.
Sadly, how one responds to this book may depend heavily on one's openness to experience, exposure to PTSD sufferers, or perhaps one's position along the scientist versus practitioner split within our field. Similar controversies have historically arisen in other sciences around innovations where epistemic standards (and perhaps values) differed across subgroups (Baldwin, 1996; Laudan, 1996). Thus, the controversy surrounding EMDR may be inevitable. Clinicians, looking for detailed descriptions of a therapeutic method said to facilitate client insight and speed recovery from flashbacks or other PTSD symptoms, will be drawn to this book. Those comfortable adopting the method as described (particularly if they are able to receive supervised experiential practice), will likely incorporate EMDR within their clinical repertoire with those clients for whom it is appropriate. Most clinicians surveyed following EMDR training reported satisfaction with the method (see the book's Appendix D).
The heart of this responsible text delineates a complex approach to PTSD and related disorders. Clinicians will welcome its detailed explanations, honed over five years' experience using EMDR and training practitioners in the method. Researchers, particularly those less familiar with trauma practice, may find these lengthy clinical descriptions tedious. Eight phases of treatment are described in turn, of which desensitization (typically via eye movements) is but the fourth aspect of a more comprehensive method. Separate chapters present varied protocols designed for special situations (such as recent trauma, single-event trauma, excessive grief, phobias), and for specific populations (e.g., children, sex abuse victims, combat veterans, people with dissociative disorders). The text carefully explicates the procedure's use in actual practice, including common difficulties and effective clinical responses. However, supervised practice is recommended for comfort with the method - seven chapters include specific suggestions for practicing more difficult or experiential aspects.
Three chapters bracket the clinical material. Two opening chapters provide background and overview Shapiro's theoretical accelerated information processing model, a working hypothesis guiding EMDR practice. A concluding chapter reviews clinical research on this method. Inevitably -- because EMDR was not developed from a theoretical position and because it is relatively new -- these chapters do not carry the authority of the book's descriptive clinical material. Clinicians frustrated by the irrelevance of much clinical research for their specific concerns are likely to find these sections persuasive. Researchers, searching for a theoretical rationale from which this method was derived, may be disappointed by a melange of interesting hypotheses with limited, but growing, empirical support. Some, perhaps intrigued by the enigma of EMDR, will contribute original research toward understanding what works in effective interventions following emotional trauma (e.g., the systematic clinical demonstration approach of Carbonell & Figley, 1996). Others, disaffected, may turn to more accessible research problems. The author seems to be speaking of these skeptics (as well as challenging clients) when she quotes from a Native American initiation rite: "As you go the way of life, you will see a great chasm. Jump. It is not as wide as you think" (p. 244). Subsequent volumes will no doubt expand on theoretical aspects of the method and forthcoming research on its components.
Despite the controversy, Shapiro's book may contribute toward healing this pervasive rift within psychology. She thoroughly describes a cognitive-behavioral, therapeutic method clearly open to investigation, and calls out for research concerning its efficacy. The book raises penetrating questions concerning how clinical research might best be designed and therapeutic change measured (pp. 324-338). Some researchers may take umbrage here, but most clinicians are apt to view the accompanying suggestions as eminently reasonable. Such criticism of the status quo seems a necessary step toward initiating constructive dialog between clinical and research subgroups who now maintain fundamentally differing views on consequential scientific and clinical issues (e.g., Alpert, Brown, Ceci, Courtois, Loftus & Ornstein, 1996).
This is a well-written book. The language throughout is clear and informative, and obvious care went into detailed descriptions of the clinical procedures and related cautions. Several case examples and five annotated transcripts nicely illustrate subtleties in the method and the therapist's client-centered role. Brief appendixes offer useful checklists for screening and treatment planning, discuss client safety issues (e.g., guidelines for use with dissociative clients), describe training resources, and summarize survey results of clinician experiences with this therapeutic approach.
Another group stands to be affected by Shapiro's book: the PTSD clients suffering from relentless symptoms that seldom resolve without treatment. Those "living in hell" may not read this book, but many can find hope with skilled practitioners who do. Indeed, we may all benefit as clinical researchers -- doubtless beginning as skeptics -- continue to investigate the fascinating mechanisms of recovery tapped by this innovative clinical method.
Alpert, J. L., Brown, L. S., Ceci, S. J., Courtois, C. A., Loftus, E. F., Ornstein, P. A. (1996). APA working group on investigation of memories of childhood abuse: Final report. Washington, DC: American Psychological Association.
Baldwin, D. V. (1996). Innovation, controversy and consensus in Traumatology. Traumatology, in press (fall 1996), WWW URL: http://rdz.stjohns.edu:80/trauma/traumaj.html.
Carbonell, J. I., & Figley, C. R. (1996). A systematic clinical demonstration methodology: a collaboration between practitioners and clinical researchers. Traumatology, 2(1), Article 1 WWW URL: http://rdz.stjohns.edu:80/trauma/traumaj.html.
Laudan, L. (1996). Beyond positivism and relativism. Boulder, CO: Westview Press.