Deany Speaks to an Enthusiastic Audience at the 2023 EMDRIA Conference

Few people are better able to talk about the past, present and future of EMDR Therapy than Deany Laliotis. She was among the first therapists to train in EMDR with its founder Francine Shapiro. And she has been an empassioned EMDR evangelist as it's evolved from a desensitization technique in 1989, to EMDR as an intervention for PTSD in 1990, to EMDR therapy in 2010. Her address tracks the evolution of EMDR and celebrates the spirit of innovation in the EMDR community that gives rise to new integrations, specialized protocols, applications for special audiences or situations and the acceptance of EMDR as a Relational Psychotherapy—a model of psychotherapy that addresses any presenting problem that is based in the human experience. Here is the complete text of Deany's Plenary Address from the 2023 EMDRIA Conference on August 25, 2023

Changing Lives With EMDR Therapy: Past, Present and Future Directions

After I trained in EMDR with Francine Shapiro in 1992, like most of you, it not only changed my practice, EMDR changed my life.  It was new, and it was controversial.  And it was developed by a woman.  That, too, made it controversial.  It also challenged our existing paradigms of what constitutes change.  But the changes were irrefutable. We were blown away.  And it wasn’t just a cognitive shift.  It was a bottom-up, full-body change that was permanent! At the time, I was working at the VA hospital in a PTSD program for war veterans and their families.  Our vets were from WWII, Korea, Vietnam, and prisoners of war from all three conflicts.  As you can imagine, some of them were pretty traumatized.  Up until we learned EMDR, for many of them, all we could do was take the edge off what seemed like a never-ending nightmare.  Not infrequently, their family dinner reminded them of the contaminated food they were given to eat while they were interned (yes, you can use your imagination).  Or the sounds of a helicopter flying overhead was enough to hide under the bed for the rest of the night.  Whatever it was, the war raged on.  

And so, three of us from the VA, my husband Dan being one of them, went to NYC to get trained.  Now consider the time period.  It was less than 10 years before (we’re talking the early 80’s), that PTSD even became a diagnosis, so for us working with these vets  with a diagnosis that legitimized their pain, together with the promise of EMDR was nothing short of revolutionary.  EMDR offered real and permanent relief from human suffering because the trauma could actually be reprocessed and in the past.  That, too, was a new concept.  And as we know, when the past is present for the worse, there’s going to be difficulties across the board, both at home and at work.  These vets couldn’t just pick up where they left off.  The war had changed them, and, as life would have it, everyone, and everything else had changed, too.  So, we had to help them, and their families start anew.  

Many of the spouses and children were secondarily traumatized just by being around their wounded warrior.  They, too, were struggling and needed help.  So, in addition to the family work we did, we now had EMDR to help our war veterans move beyond their hypervigilance around life and death, to learning how to live in the world,  to be able to relax with family and friends again, or to have a laugh with co-workers at work.  It was truly a new lease on life.  So now, I’d like to share a clip of Francine working with one of these wounded warriors that was taken in 1990.  This is an edited version of the tape we learned EMDR from at that time.  This is a Vietnam vet who was really triggered by an incompetent co-worker. 

TAPE

And while we do some things differently now, what you see is the foundation of this model.  You saw how he was able to reprocess his emotional reaction to the incompetent co-worker and how the reprocessing of his experience allowed him to have a cognitive, emotional, and somatic shift, changing his lived experience.  And it was a shared experience.  Francine laughs with him as he sees his situation with the co-worker as comical.  So, you have the dual attention, you have the bilateral stimulation, and you have the relationship. This is at the core of our model, along with the dual attention bilateral stimulation that distinguishes EMDR from other methods.  

Today, however, this session resembles more of an EMD treatment protocol.  And as you can see, there are also some differences in how we practice today.  Francine went back to the image rather than the memory because at the time it was still a desensitization model.   She titrated the associations by having him go back to Target more frequently and checking the SUDs, which in this case was probably a good idea.  She effectively used EMDR to stabilize him in the context of his work environment without opening up the channel of associations that would take him to the war. Whether she did that intentionally or not, I don’t know, but it’s brilliant.

So, after 25 years or more of suffering, our clients got the relief they needed.  Some, in just sessions.   Yet, the controversy that EMDR stirred up in the academic and professional community took off like an out-of-control wildfire.  Actually, it’s a wildfire that still smolders to this day.  At the time, Francine could only focus on one thing: ensuring EMDR’s survival.  That meant that there had to be research to support its efficacy, hence her slogan, research, research, research, that echoes to this day.  And yet, despite the research that was coming out on EMDR which was more than all the combined research on PTSD at that time, the controversy on the legitimacy of EMDR continued.  But Francine was a force of nature, and along with a strong, international  grass roots community of EMDR clinicians behind her, we now have a robust, evidence-based methodology backed by research that is accepted in most all professional circles! 

We have a lot to be grateful for.  The criticisms are still out there, but that’s to be expected.  But EMDR has evolved, too. EMDR went from being a simple desensitization technique in 1989 when Francine introduced EMD, to EMDR as an intervention for PTSD in 1990, to EMDR therapy in 2010.  So, in the short span of 21 years, EMDR became a model of psychotherapy that addresses any presenting problem that is based in the human experience. 

We now have the Adaptive Information Processing model.  AIP informs how we understand the problem, the principles and the procedures that bring about the solution, and it explains how change takes place.  So as a result, we’re now treating a broad range of issues in a variety of different contexts, whether it’s PTSD from a traumatic incident or series of events, or something less obvious like the absence of care and attention for a child in their formative years.  Or addressing the direct or indirect experience of racism, treating the impact of being hated, not because of anything you did, but because of the color of your skin, the neighborhood you come from or the language you speak.  Or it could be that your parents or your grandparents were interned during the Holocaust, and while you did not experience it directly, how it impacted them became part of your experience, from the stories they told to how they parented you.  

My parents were not interned, but they lived in Greece during the WWII and went through the war.  They saw others being wounded, killed, or taken away where there was no safety to be found. So, the message was to rely only on family and on myself.  And even as a woman, my father was adamant that I was never to depend on any man.  It’s also what I got as the first-born.  It was a much stronger message than I needed because I didn’t have to worry about surviving the way they did.  But I did learn to trust my instincts.  So, while no one escapes the impact of trauma, what we learn from these experiences informs how we respond in the future.  So, the past is present, for better and for worse.  That is why we need to do our due diligence with our clients to better understand how they survived their situations to appreciate their strengths and capacities, because that’s also part of what they bring to the healing journey. 

[The Present]

We’ve grown so much in a short period of time.  But, as a result, we also have growing pains.  For example, even though EMDR therapy is considered a comprehensive model of therapy,  we’re not all thinking about or using EMDR as our theoretical framework.  Some people are still using it as a tool and only take it out when the client presents with a discrete trauma.  Many are still being trained to use EMDR as a symptom-focused treatment rather than zooming out to see the big picture.  So, as one example, when the client is presenting their anxiety as the problem, that is the symptom from an AIP perspective.  The AIP question is WHY is the client anxious?  The question isn’t just, “When have you felt anxious before?”   Is the client anxious because they’re struggling with a sense of  inadequacy? Are they anxious because they feel unsafe in the world?  Are they anxious because they’re not in control of a situation, or is it all of the above as is often the case with complex trauma? That’s not to say that offering symptom relief isn’t important, because it is.  We all want relief when we’re symptomatic.  

This is a reflection of the gap between the origins of EMDR as an intervention and its evolution to a therapy approach that is about getting to the root causes of the client’s difficulties, and in so doing, helping them grow and change beyond symptom relief.  So, we need to evolve our thinking, our teaching, our practice, and our language.   Our model has evolved so quickly that we’re struggling to keep up with it! We often use the same language to mean different things.  For example, we still refer to reprocessing as the Desensitization phase. We all know there’s a lot more going on than that.  

People refer to the Standard protocol as EMDR.  EMDR is not just the Standard protocol.  EMDR is not a tool or a technique.  So, let’s refine our thinking and define our terms. As part of the Council of Scholars, we grappled with this issue, and it wasn’t easy.  But I think we got there.  This is from the position paper that was published in the Journal of EMDR Practice and Research in 2021.  What is EMDR therapy? 

• EMDR therapy is an integrative, client-centered approach that treats problems of daily living based on disturbing life experiences that continue to have a negative impact on a person throughout the lifespan. Its Adaptive Information Processing theory hypothesizes that current difficulties are caused by disturbing memories that are inadequately processed, and that symptoms are reduced or eliminated altogether when these memories are processed to resolution using dual attention bilateral stimulation. The resolution of these targeted memories is hypothesized to result in memory reconsolidation. The standard application of EMDR therapy is comprised of eight phases and a three-pronged approach to identify and  (re)process: (a) Memories of past adverse life experiences that underlie present problems; (b)Present-day situations that elicit disturbance and maladaptive responses; and (c) Anticipatory future scenarios that require adaptive responses. There is strong empirical evidence for its use in the treatment of posttraumatic stress disorder, and it has also been found to be an effective, transdiagnostic treatment approach for a wide range of diagnoses in a variety of contexts and treatment settings with diverse populations.

I LOVE how this definition reads.  It took us a while to arrive at this, but it’s great.  It tells us and the world exactly what EMDR is.  You saw this definition illustrated beautifully in the tape of the war zone veteran who was reprocessing his experience of the incompetent co-worker that shifted from a life and death proposition to comical. All the core elements were in there. 

So, under this big umbrella of EMDR therapy, we proposed three categories:  EMDR Treatment Protocols, EMDR-derived Techniques, and EMDR Psychotherapy.  EMDR Treatment Protocols are just that, treatment protocols.  They’re not EMDR therapy.  They’re part of EMDR therapy.  Currently, we have around 150 EMDR treatment protocols.  Can you believe that?  

There has always been a lot of ingenuity in the EMDR community, that’s for sure!  The majority of these treatment protocols are simple modifications of the Standard Protocol that treat specific problems like depression, or specific situations like recent events, or specific populations, like children and adolescents.  As one example, we have R-TEP, the Recent Traumatic Events Protocol for individuals developed by Elan Shapiro and Brurit Laub from Israel, and G-TEP for treating groups of people who have all endured a recent traumatic event, also developed by Elan Shapiro.  These are specific EMDR treatment protocols that are designed to address recent traumatic events with the rationale being that because it’s recent, the protocols are facilitating a processing of an experience, not a reprocessing of it because the memory has not yet been consolidated as a single event.  Maria Masciandaro, from our Center, who is an R-TEP & G-TEP trainer, recently developed G-REP, the Group Resourcing Protocol in March of last year in collaboration with Elan, as a standalone technique to help Ukrainian refugees optimize their ability to cope with the chronic uncertainty and chaos of their situations until things quieted down long enough to do some processing. Thank you for your service to humanity.  Francine would be very proud.  

This is a beautiful example of an EMDR-derived technique (even though they call it a protocol).  Using the self-administered butterfly hug as the bilateral stimulation, they identify and strengthen access to resources from the client’s past and bring them into the present-day challenges in order to help themselves and others. This is an example of an EMDR-derived technique that has some of the core elements of EMDR but is not an EMDR reprocessing protocol.  It’s a technique we can all use with our individuals or with groups. Clinicians can use it whether they’re EMDR-trained or not.  Maria trained a group of intake social workers at a local non-profit center that works with victims of violence.  Here’s the part I love the most. It’s a technique that draws upon the client’s resiliency to help them endure their current circumstances.  They’re using the client’s lived experience to strengthen their ability to respond adaptively by lighting up existing memory networks of experiences and bringing them into the current challenge situation.  It’s simple, it’s elegant, and it’s brilliant. Why?  Because we’re using the same AIP principle that the past is present. It’s not unlike working with a depressed person.  They can’t think of a happier time, but that doesn’t mean it’s not there.  We have to look for it.  We have to find it. And when we find it, we have to bring it into the forefront where it’s more available and it can be used in the present-day context.

We have EMDR treatment protocols, EMDR-derived techniques and EMDR Psychotherapy.  Okay, now some of you might be thinking, wait a minute, isn’t EMDR therapy a comprehensive psychotherapy approach?  If that’s the case, then why do we need this additional category? Good question.  The rationale for the category of EMDR psychotherapy was to help distinguish between specific applications of EMDR such as EMDR Early Intervention protocols R-TEP and G-TEP,  and IGTP that can be applied as brief interventions in the field, in a hospital, individually or in a group, and that it may not be a service that is delivered in the context of a psychotherapy relationship.

So, that brings us up to today, where we have a continuum of EMDR therapy applications. On one end of the continuum, we have EMDR that can be offered as a brief treatment intervention as we just discussed, that can be delivered in the office, online or in the field, and where the goal is symptom relief.  From there we have a continuum.  On the other end of the continuum where we’re treating clients who have complex trauma and dissociative disorders which requires a longer-term psychotherapy and perhaps a more extended preparation phase to increase stability for clients with unstable complex PTSD.  

So, in addition to the goal of symptom relief, I would propose that for most of us in this room, it’s about helping our clients grow and change.  Would you agree?   This isn’t just for adults, either.  We have EMDR Psychotherapy for children.  Ana Gomez, Ann Beckley-Forrest and Annie Monaco, Robbie Adler-Tapia and Carolyn Settle, and Debra Wesselman and her group.  They’re all working with traumatized children, adolescents and their families that need psychotherapy.   

EMDR Psychotherapy is also about filling in the developmental milestones that are missing because the absence of the negative doesn’t always translate into the positive.  The adaptive information isn’t there.  We have to provide it.  It’s also about helping our clients learn for the first time how to be in relationship with themselves as well as how to be in relationship with others because we’re treating developmental trauma which is about attachment.  

It’s also about helping to recalibrate our client’s neurobiology to a new normal, restoring their Window of Tolerance so they can better regulate themselves because they didn’t get enough co-regulation as children. Essentially, EMDR Psychotherapy is about parenting and reparenting our clients, which takes more time, but it doesn’t have to take a long time.  It can be ongoing,  or it can be delivered in increments over time.  Not infrequently, our job is to help our clients grow up and leave home so they can live their lives with love, security, and a sense of connection and belonging.

My client, Emma, came to me asking me to help her learn how to be in a healthy relationship.  She was 29 years old at the time, with 9 years of sobriety under her belt from alcohol and other drugs, was the youngest of two in a family where her father was a raging alcoholic, and her mother was preoccupied with his drinking and their marriage.  So, it’s no wonder the client struggles with low self-esteem, relationship problems and self-regulation issues. Can she learn how to be in a healthy relationship in a matter of weeks or months?  Not really. As we’re working through these memories of uncertainty and chaos, being scapegoated, frequently left alone, she arrived at an unexpected place.  It was about having to relinquish the child’s story in favor of an adult perspective. For her, that meant knowing what was true about her childhood and being able to see her parents more clearly. And if she could see her parents more clearly, she could also see herself and others more clearly.  And, as a result, make better relationship choices in her life.  It took us three years to get there, but in the end, she made a good decision about her life’s work and chose a life partner that appeared to be a good match for her.  If she was more ambivalent or avoidant, less stable, or if she didn’t have the resources to sustain an ongoing therapy process, then it would have taken longer, or even a different course.

So, we now have categories of EMDR therapy to help us better define what we’re offering which is good for clients and clinicians alike.  It’s really great as an EMDR therapist to have a broad range of clinical choices to choose from as every client is different, the environments we work out of are varied, the agencies we work in have different resources available, and the communities we serve are also diverse.  So, these categories offer us a continuum of choices that give us the necessary flexibility to do what we can based on how we understand what is needed and what we can offer. From using EMDR with individuals, couples and families to groups. 

There has been a proliferation of EMDR in groups, which is most often applied to recent traumatic events.  Since 2010, more than 60 studies have been published on group EMDR, using EMDR Early Intervention protocols, and these studies show very positive findings on the efficacy of processing in groups.   I’d like to share a recent innovation I’m super excited about! It is EMDR Group Psychotherapy!   A colleague, friend, and fellow EMDR trainer, André Montiero from Brazil, is conducting a once weekly, 2-hour group session that is ongoing.  He describes the process as something that is similar in concept to psychodrama where what is happening for one client in their reprocessing is stimulating a collective reprocessing!  André has coined the term criss-cross reprocessing, referring to the synergistic effect of processing in a group where the clients can choose to “Go with that,” based on what’s coming up for them internally, or to “Go with that,” based on what’s going on externally from other peoples’ statements about what’s coming up for them in the reprocessing.  So, the idea here is to stimulate a collective reprocessing experience where they are part of one another’s experience, navigated by the group EMDR facilitator.

So, I’d like to show you this 5-minute clip of a group reprocessing session that André is conducting.  Let me bring you into the scene:  In this group therapy session, the clients were asked by André to identify what triggered them the most from earlier in the group session when each client was sharing where they were at, like a group Revaluation phase.  From there, typically they’re invited to take the present trigger and float it back to get to a foundational memory.  But this time, in this segment, there was so much overlap around the themes of loneliness and vulnerability around aging, that they all targeted whatever had triggered them earlier in the group discussion.  Once everyone has their Assessment set up, everyone starts the reprocessing at the same time. Typically, the reprocessing continues until everyone completes their set before they share what’s coming up for them.  In this segment, one participant needed more time, so she was encouraged to continue while the others started sharing.

TAPE 

Currently we have over 80 RCTs examining the application of EMDR therapy to a broad range of clinical problems which has resulted in a high degree of confidence in EMDR by clinicians worldwide.  One of the most common problems clinicians address is depression. Research on the treatment of depression suggests that there is strong evidence that EMDR is an effective treatment for both primary and secondary depression.  It is also being studied as an adjunctive treatment as well as a  primary treatment.

The EDEN group (European Depression EMDR Network) has been studying the treatment of depressive disorders using EMDR therapy since 2010.  They have conducted five controlled clinical studies using their model for the treatment of depression using EMDR Psychotherapy, including three RCTs (randomized controlled studies).  They just published a book, Treating Depression with EMDR Therapy:  Techniques and Interventions published by Springer.  Our fellow EMDRIA colleague, Marilyn Luber is also an author.  It’s a great contribution to the field and we should all be very proud.

The AIP conceptualization is that the symptom of depression is informed by disturbing life experiences, particularly attachment traumas, that are unresolved, and contribute to one’s proclivity towards depression.  While this is not new,  Luca Ostacoli from Italy, who is one of the members of the EDEN group as well as a co-author, is taking it to another level in his work with clients who suffer from depression primarily due to neglect.

How many of you find that depression is difficult to treat?  It IS hard.  It’s hard because clients who have had a depressive episode are more likely to have another one, especially when adult-onset experiences like separation and loss trigger their unresolved attachment traumas of childhood.  But how do you target something that didn’t happen?  It’s much more challenging to target the absence of care and attention.  There are two components of neglect:  the neglect that was perpetrated by the client’s primary caregivers, and then the neglect that is being perpetrated by the client with their own self-abandonment.  The central precept to this work is that we are relational by nature and that the most important relationship we have and are responsible for is the one we have with ourselves.  So, part of the work is to help our clients learn how to give to themselves what they didn’t get so they can be more connected to themselves and others.  So the problem is the client’s lack of connection, lack of relationship with themselves that is manifesting in the low self-esteem, their difficulties in relationships with others and difficulties with self-regulation.

SO, after reprocessing some primary targets (experiences of empathic failure, rejection, abandonment), the therapist invites the client to consider having a relationship with the neglected inner child.  So, in the Reevaluation of the Target Memory, Luca invites the client to check in with the wounded child to assess the level of connectedness.  It is not unusual for the “neglected inner child” part to still be stuck in trauma time even after the memory has been reprocessed. 

VIDEO 

“New Normal,” which is about the repair that ultimately takes place between the adult who neglected the child and the child who is able to forgive the adult for neglecting them.  This internal rapprochement, this new connection, is what allows for new possibilities. Part of the healing journey, then, is to help our clients mourn what they were entitled to as children but didn’t get.  Psychotherapy is that protected space where this grief can be processed.  Consider that most of our adult clients who struggle with these formative attachment wounds have organized their entire life to avoid feeling that pain. Our role is to help them approach and lean into the grief, using the relationship with us where the client feels most understood. When the client is able to approach the core affect of sadness and grief in the context of their connection with us, often, the transformation happens naturally.    So, grieving the loss of connection in a connected space with a kind and trusted other is part of healing the wounds of attachment trauma with EMDR therapy.      

That brings me to Relational EMDR Therapy.  

I’ve been teaching Relational EMDR Therapy since 2010.  I would classify it as an EMDR Psychotherapy that uses an attachment lens with an added focus on the parallel process between therapist and client.  As I briefly mentioned earlier, how we relate to our clients and how our clients relate to us, both in and out of reprocessing, is more central to the process when we’re treating complex developmental trauma.  

Treating developmental trauma is about attachment.  And of course, how we relate to our clients is also based on our attachment histories.  So, how we relate to our clients and their experiences, both in and out of reprocessing, is very much part of the new memories we make with our clients. 

TAPE 

[The Future]

So, this is where we are.  Pretty good stuff, right?  Obviously, these categories have overlap.  Do clients grow and change in brief treatment?  Of course!  We know from the study comparing EMDR with Prozac that was done years ago, that the clients who only had 8 reprocessing sessions continued to report changes more than 6 months out!  That’s the beauty of this methodology.  But as you can see, the treatment goals are different. 

So, where are we going?  Up until Francine died, we counted on her to be the keeper of the model, the one who held the beacon of light in the darkness and shed light on the path ahead. We have an inheritance that bestows upon us a RESPONSIBILITY to be the ambassadors of EMDR to the world, to our colleagues and to our clients. It’s up to us now to preserve the integrity of this powerful and effective methodology, while at the same time encouraging innovations that help us get better at our craft.  So, what do we do with the future of EMDR therapy in our collective hands?

For starters, there will always be naysayers and copycats.  We have endured these challenges from the beginning from hypnotherapists using BLS and calling it Eye Movement Integration to Accelerated Resolution Therapy or ART.   I guess imitation is the best form of flattery. But we also have innovations within the community like MAX TAX EMDR which is supposed to be EMDR on steroids based on the working memory taxation model.  So, instead of 1-4-hour sessions, a target can clear in 5-25 minutes.  So, again, it depends on what the treatment goals are, right? 

Then there’s self-help apps and AI nipping at our heels.  I must confess, it overwhelms me to think about an AI therapist on an app administering EMDR procedures.  But iEMDR (internet delivered EMDR) is being carried out today without a therapist!   We’re going to have to be vocal as an organization and as a community about what EMDR is and what people can safely do on their own versus working with a trained, qualified professional.

At the risk of sounding like Francine, we need to do more research! The majority of the current research that is being conducted in EMDR is coming out of Europe.  There’s more research being done in Asia, Australia, the Middle East, and China.  Unfortunately, given how research is conducted in the US, research is mostly privately funded.  That means we have to fund the EMDR Research Foundation and the EMDRIA Foundation.

The best way to ensure the quality and integrity of EMDR therapy, how it is taught and practiced, is mentorship.  Francine’s greatest gift to me personally was the gift of her mentorship. She was truly a visionary.  She had an exquisite ability to see other people’s gifts and then exploit them for the greater good.  I stand here before you because Francine took me under her wing. Through her I discovered my gift of teaching, and I learned that I, too, could be brave by watching her be brave. I watched her deliver the Basic Training innumerable times, and I never tired of it.  I always heard and understood something just a little bit differently. She embodied every word she used.  I watched her handle the naysayers who would challenge her while she presented a paradigm that challenged them.  I learned from her to stay the course regardless.  I had a front row seat to how she stayed steady in the midst of a professional community that was both awed by her brilliance and threatened at the same time.  I learned to hold the complexity without having all the answers and stay humble with what I do know.

The other thing we need to do is make our services more accessible to underserved populations.  EMDR has a tradition of humanitarian assistance.  Soon after the Oklahoma bombing in 1995, groups of us went to Oklahoma City for two-week rotations and treated the first responders as well as train every therapist in the state of Oklahoma, for free, to ensure that everyone who needed treatment had access.  There are individuals who have been rallying to help the Ukrainian refugees abroad and who are donating their time and their services.

If you work in an agency, great.  You’re already in the trenches.  If you are in private practice, how many slots in your practice can you slide your fee for, or even offer services pro bono, even for a short-term treatment?  If you’re a trainer or have a training institute, we have to make our trainings more accessible by offering a BIPOC tuition right out of the gate.  Instead of creating additional barriers to access, let’s make it easy and attract more people of color into the EMDR community! And if you don’t have a training organization, donate.

If we’re going to be EMDR psychotherapists, we have to be willing to do ourselves what we ask our clients to do with us every day.  We have to do our own work.  Our clients can only go as far as we can accompany them.  We have to continue to train and continue to be in case consultation. Everyone on my faculty is in an ongoing case consultation group.  Why? Because can’t do this work alone any more than our clients can.  And we don’t need to.  We need to be committed to our ongoing personal and professional growth. 

Finally, be relational.  You don’t have to choose between the protocol and the person.  You can do both.  Francine did that from the very beginning. Fidelity IS important.  But it’s fidelity to the model, not just the procedures.  When we truly embody the model, we can be more integrative and bring in other skills sets into an EMDR framework as you have seen here today.  But for that to work, EMDR therapy needs to be your mainframe where those core elements of EMDR are at the foundation, informing every clinical choice you make. Staying out of the way IS important. But it’s not sufficient for clients who have complex trauma.  The healing space is co-created between two people, so let’s get in there and be brave! And trust the process.