On Fidelity
The issue of fidelity has been around for as long as EMDR has been in existence. In the early days, before any training and accreditation standards existed, we discussed our cases together informally. We shared our fears and our mistakes as well as our triumphs. Francine published a newsletter with a column titled, Stray Thoughts, and wrote about experiences clinicians were having with their clients and what we could learn from them. It was the equivalent of the wild west where there were a few dirt roads but no maps of the territory. We didn’t have internet, never mind a list serve. We were blazing trails in the wilderness, hoping for the best and getting a first-class education on “letting whatever happens, happen,” while quietly holding our breaths.
Fast-forward to today, everyone who enrolls in an EMDRIA-approved Basic Training has had at least 10 hours of consultation by the time they have completed the course. As a training facilitator and consultant, I distinctly recall what a difference it made with the trainees. They HAD to talk about their cases, and it helped them learn to “trust the process,” which translated into tolerating the inherent uncertainty of memory reprocessing. Yeah, they made a lot of mistakes just like we did when we were learning. But they also discovered, like we did, that our clients do well despite our mistakes and our lack of experience.
We Have Arrived
As a community of EMDR therapists, consultants, and trainers, we now have over 30 years of experience under our collective belt. We have a model of psychotherapy which includes a three-pronged approach, eight phases and the Adaptive Information Processing model that explains how change takes place. Our model guides us in our understanding of our clients’ problems and how we treat them. We have specific protocols and procedures that we follow, and fidelity to the protocol and the procedural steps is paramount. We now teach EMDR as a comprehensive psychotherapy approach and our Basic Training manuals have gone from a dozen pages of single word bullet points to hundreds of pages of materials, appendices, worksheets, references, and a list of the current research.
Being a Good EMDR Therapist
What has been a constant for every clinician trained in EMDR throughout the years is the inherent demand of learning to become a good EMDR therapist. Most trained therapists would confess that EMDR appears deceptively simple, but it is not easy. Frequently, the instruction of “let whatever happens, happen,” is as scary an idea to the clinician as it is for the client! So, instead of learning how to tolerate uncertainty and stretch our windows of tolerance for painful emotions, we lean into the certainty of the protocol and the procedural steps. Sigh.
It is without exception that whenever I give an advanced training, EMDR therapists express gratitude and relief for giving them permission to be themselves, releasing them from the shackles of administering the protocol and the procedural steps with total precision. Their responses continue to shock me. Since when did being a therapist become about getting it right rather than doing what’s best for each client???
Survival Mode
We are all in this profession to help our clients. We are all EMDR therapists because we want to help our clients heal from their traumatic experiences. And we do help our clients heal, every day. But why does it feel to many EMDR therapists that they’re “not allowed” to be relational, or that they must choose between being authentic and following the protocol as if they are mutually exclusive? I would propose that EMDR has its own trauma history, and we would do well to understand it, appreciate it and put it in its proper perspective. Many of us who were around in the nineties remember EMDR being likened to snake oil and Mesmerism. It was scoffed at by the academics on a good day, and Francine herself was ruthlessly criticized, which fueled the need to prove EMDR’s efficacy and legitimacy if it was going to survive. This, of course, created a culture of fidelity because we were constantly having to defend ourselves and our model. EMDR has been in survival mode for much of its life which is why Francine’s refrain was “research, research, research.” Sadly, our need to continue to prove ourselves to the rest of the profession remains a challenge, despite its proven effectiveness as an evidence-based approach.
We are the Ambassadors
As EMDR therapists, consultants, and trainers today, we no longer need to be in survival mode. We are now the ambassadors of EMDR therapy, and we need to assign value to both the integrity of the model and to the clients and clinicians who use it. EMDR therapy is an evidence-based practice, which, by definition, includes the trifecta of the model, the clinician, and the client. It means that we apply the best research we have to date and translate it into our clinical work, so yes, fidelity is important. It also means that we factor in client and clinician variables, which means we need to be flexible in our application of the model based on the humanness of our clients, the relationships we have with them, and the context in which we are working. Further, we also know that most clients who report positive experiences in therapy attribute the effectiveness of their treatment to the relationship they had with their therapist, not the methodology.
EMDR therapy is here to stay. We don’t have to choose between our model and our relationship with our clients. We don’t have to allow our own memory networks of experiences about "getting it right" to overrule our best intentions. Our mission, should we choose to accept it, is to model Francine’s courage, which is to be brave and to trust the process. How else will our clients be able to do the same?