International Society for Traumatic Stress Studies

BOOK REVIEW

Posted 1 January 1999 in StressPoints by Lizabeth Roemer, PhD and Chivi Kapungu, University of Massachusetts-Boston

Extending EMDR: A casebook of innovative applications, edited by Philip Manfield, is a collection of case studies intended "to pick up where formal EMDR training leaves off" (jacket cover). The stated goal is to assist clinicians while they apply eye movement desensitization and reprocessing to more complex cases. In each chapter, the authors provide a brief overview of their theoretical perspective and background, present a clinical case, and describe how they integrated EMDR with other forms of therapy in the treatment of the client.

The chapters target a varied assortment of presenting problems and themes described as follows: uncomplicated depression, postpartum depression, masochistic personality disorder, denial of rage, major depression, survivor guilt and writer's block, child abuse and neglect, developing a mature identity, a highly defended client, narcissistic vulnerability, and shame. Each treatment involves the targeting of certain representative emotional memories with the EMDR protocol accompanied by a host of other therapeutic interventions that vary depending on the theoretical orientation of the author.

Transcripts, along with notes detailing the therapist's reasons for various clinical decisions, allow the reader to witness the hypotheses developed, tested, and reformulated in the course of therapy. Several important themes, relevant to all psychotherapy, emerge from these chapters, such as how to facilitate the expression of avoided emotion and how to maximize a client's coping resources in order to prepare for trauma or emotion-focused therapy. The reader is often provided with more extensive detail about the author's varying theoretical orientations and how they inform interventions than about EMDR per se. One gets a sense of EMDR as a chameleon that blends into whatever theory a therapist holds, making it highly adaptable, but raising the question of what EMDR adds, if anything, to these therapeutic approaches.

It is difficult for the reader to develop a cohesive overview of the therapies presented; no summary is provided to assist in drawing conclusions for use in one's own practice. Each author has adapted the standard EMDR protocol in a number of ways; few striking similarities emerge in these adaptations and none are highlighted. The reader must sort through a lot of varied material in order to extract useful clinical observations and helpful practical suggestions regarding implementing EMDR. In the absence of any clear, consistent diagnostic or thematic classification of cases, or an overview chapter highlighting the contribution of each chapter, this is not a book that can be easily used to obtain specific information regarding a certain kind of case or certain therapeutic issue that a reader wishes to address.

The authors are careful to present the speculative nature of the work they've done; they are all clear that expansion of EMDR is experimental and that the hypotheses they have developed bear further exploration. Most also note that the outcomes of the therapy would be similar using only their more traditional approaches, although they believe that EMDR enhanced the speed of therapeutic change.

In a few places the book moves from the clinical to the scientific; unfortunately, there, this same care is not taken. In the section of the introduction titled "What is the effect of eye movements?", the editor fails to comment on the lack of evidence for specific effects of eye movements (or bilateral stimulation) in the existing literature (see Feske, 1997; Lohr et al., 1995; for critical reviews). He goes on to propose a highly speculative neurobiological theory for the bilateral stimulation component of EMDR (that it activates the corpus callosum and increases interhemispheric activity) and uses that theory to justify the extension of EMDR to other populations.

Limitations in the single study on which this theory seems to be based (i.e., no comparison group so EMDR-specific effects cannot be determined) are overlooked in this discussion. While there is certainly nothing wrong with speculating about the underlying mechanisms of a clinical technique, to do so without critically reviewing the data presented seems misleading. This lack of clarity regarding biological underpinnings carries into some of the chapters: one author concludes that a client's memory has changed from being stored in the right hemisphere to the left hemisphere. This is a profound oversimplification of neurobiology at best, and detracts from the credibility of the material presented.

In summary, this book seems most useful as a series of examples of eclectic or integrative psychotherapy using a common focused imaginal emotional processing component. The integration of imaginal techniques in the treatment of long-standing psychological difficulties may have clinical utility. However, without a carefully formulated explanation of the unique components of EMDR, the book is less useful as a resource in expanding our understanding of this particular therapy technique and its application.

References

Feske, U. (1998). Eye movement desensitization and reprocessing treatment for posttraumatic stress disorder. Clinical Psychology: Science and Practice, 5, 171­181.

Lohr, J.M., Kleinknecht, R.A., Tolin, D.F., & Barrett, R.H. (1995). The empirical status of the clinical application of eye movement desensitization and reprocessing. Journal of Behavior Therapy and Experimental Psychiatry, 26, 285­302. *