Episode 138 - Patreon Selects: Is EMDR a Cultish Pyramid Scheme?
No, EMDR is not a cultish pyramid scheme. With that out of the way, why is EMDR training so expensive when its theoretical foundations are supported by dubious (at best) research? In this clickbaity-titled episode, Angela Nauss, EMDRIA-certified LMFT, joins us to describe the experience of paying thousands of dollars to “watch the dumpster fire from inside the dumpster.” Please direct all angry emails to vbtpodcast@gmail.com.
Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today’s episode is sponsored by Sentio Counseling Center – high-quality, low-fee online therapy in California with immediate availability for new clients.
Introduction: 0:00 – 9:40
Part One: 9:40 – 1:12:13
Show Notes:
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Carrie Wiita [00:00:00]:
Welcome to Very Bad Therapy, a closer look at what goes wrong in the counseling room and how it could go better as told by the clients who survived. From Los Angeles, I'm Caroline Wiita.
Ben Fineman [00:00:11]:
And I'm Ben Fineman. Legally encouraged to say that this podcast does not constitute therapeutic advice, but it will get interesting. Let's get started. Well, Carrie. So last week we did a study hall on evaluating research, but before that was our episode on Very Bad group Therapy. And I want to revisit that real quick because maybe more than any other episode we've ever done, we got emails specifically about the fact that we could not find a group therapy expert. And let me tell you, we have no shortage of future group therapy experts lined up. A lot of really thoughtful emails came in.
Carrie Wiita [00:00:52]:
I know. I was so surprised. I was not surprised by the thoughtfulness of the emails. I was surprised by how many group therapists there actually are out there. It was great.
Ben Fineman [00:01:02]:
Yeah. Can I do a bit of an inverted episode structure here and read a bit of listener mail from one of those group therapists?
Carrie Wiita [00:01:09]:
Yeah, I think that would be great.
Ben Fineman [00:01:11]:
Okay. So this person writes in, I was absolutely shocked to hear you say that you couldn't find an expert in group therapy anywhere. I work in substance use disorder treatment. Group therapy is huge in our field. I run groups once per week. In my current position, that's the lowest level of groups I've ever done. In most jobs, I've run three to four groups, including at least one that's IOP and meeting 9 hours per week. I personally am a licensed chemical dependency counselor, but many of my colleagues are master's level clinicians such as LPCC, LISW, et cetera. It may be the case that a high percentage of group therapy is completed in an Sud treatment environment, substance use disorder. But that doesn't really mean it's not therapy, as you seem to imply in your episode when stating that therapists don't do group anymore, but that maybe substance use disorder treatment includes it. So thanks to that listener for writing in. And Carrie, the emails we got really echo what that person was saying, that, yes, it does seem like a lot of group therapy takes place in, like, an addiction residential hospital, those type settings. But we got a lot of emails from people who are just your average, run of the mill therapist like us, who specialize in group therapy. So big maya Kobal on our part for not finding all of you wonderful people in advance. Yeah. Fascinating to hear from everybody.
Carrie Wiita [00:02:21]:
Yeah, I mean, I want to just emphasize, though, that it's not that I ever thought that it wasn't therapy. I just thought that nobody was really doing it anymore.
Ben Fineman [00:02:31]:
Shocking.
Carrie Wiita [00:02:32]:
But, like, so awesome. So, yeah, thanks to everybody who is still doing groups and shared that news with us.
Ben Fineman [00:02:39]:
It was helpful and this might be a good opportunity to just ask everybody listening. If you are a therapist and you feel like you have expertise in any particular topic, we find our experts oftentimes by just reaching out to the community when we don't just ask Ben Caldwell directly every third or fourth episode. So if you're listening and you feel like you have expertise that you could speak on, if we ever hear a client story about bad therapy, please feel free to send us an email vbtpodcast@gmail.com. Let us know what you feel qualified to talk about. And if we ever get a story that fits, we'd love to reach out and have you on the show.
Carrie Wiita [00:03:14]:
Yeah, that would be amazing.
Ben Fineman [00:03:15]:
Yeah. Better that than having you email us after the fact being like, Right, come on, man.
Carrie Wiita [00:03:21]:
After we go on and on about how we can find anybody.
Ben Fineman [00:03:24]:
Yeah. So how are you feeling about this particular Patreon select and the deep dive into the EMDR research that Angela Na uss did that we have the privilege of talking to her about?
Carrie Wiita [00:03:37]:
I am so excited to share this with everybody because I feel like EMDR is just such a hot topic. Hot topic in our field. And I think that there's also a lot of confusion. I think there's a lot of therapists at this point, especially ones who are just starting out, particularly in private practice, who feel like, oh, my God, I should probably go get trained in EMDR. Right. It's just kind of a foregone conclusion sometimes, I think, and so with the explosion in popularity of it so I really appreciated this deep dive because I think Angela does such a great job of sharing her own experience going down that road and sharing what she learned.
Ben Fineman [00:04:21]:
Watching the dumpster fire from inside the dumpster.
Carrie Wiita [00:04:24]:
Yeah, exactly. Which is such a great metaphor.
Ben Fineman [00:04:27]:
Yeah. But I can't stress enough for everybody listening. Don't take our word for any of this. Don't take Angela's word. Whether you agree or disagree with what she says, with what we say, we really encourage you to read the article that Angela wrote. Read the studies that are cited in that article. Come to your own conclusions. Find other research on EMDR. There's so much out there. And if nothing else, I think this episode really challenges some of the narratives around EMDR, and it's worth just kind of doing some research into it and seeing what you find. And we really do welcome people to write into us. I know at the end, we joke about sending hate mail our way, but we love to hear perspectives from people who agree, disagree. But I think we especially are curious to hear perspectives from people who have also evaluated their research, because at the end of the day, gosh, it's just so important when trying to swim upstream and figure out what is, quote unquote, true about really anything in our field.
Carrie Wiita [00:05:17]:
Oh, my God. Absolutely. And we had so many folks listening to this episode. This was originally released on our Patreon channel. If you aren't listening to that, you should definitely come check it out. You can take a look at that. You can sign up for it at www.patreon.com /verybadtherapy but yeah, I'm glad now that we're able to disseminate it to a wider audience.
Ben Fineman [00:05:42]:
Yeah. Let's take a moment and tease our patreon page just because we can. Our most recent episode is part two of our exploration into something very empirical, very scientific, where we look at bad therapist Facebook posts. Also some good therapist Facebook posts. Carrie, I think you have one of those that you almost don't even want to save for that episode. I don't know what this is. I'm curious to hear what you flagged as being so good that you want to talk about it here.
Carrie Wiita [00:06:15]:
I hope you love it as much as I do. Yeah. In those episodes, also very popular on our Patreon page, we only do Facebook posts from anonymous posters because our intention there is not to call anybody out. It's just to really kind of discuss the issues that are at the core. But this one, it was not anonymous. And I actually have permission to share the name of this poster because I loved this post so much. So this was from David Martin LPC in Idaho, who, interestingly, focuses on trauma EMDR, but this is not actually about EMDR. He posted in a Facebook group. I have a weekly client that has assumed the role responsibility over my lobby and office plants. And I can't lie, they are looking better than I could have ever done myself. And I loved this post so much because I think that we talk a lot on the show. Ben, you and I do over time, and have for a very long time over what is therapy and at its core, what is therapeutic, and what can therapy look like? Why does it look the way that we do it now? And what I liked about this was what a wonderful I think it's just a wonderful little therapeutic thing that seems to have sprung up in this particular therapeutic relationship between this therapist and this client. The client has decided, taken it upon themselves that they want to nurture the plants in this office. And I think it's so cool that this therapist I think it's awesome that he just was like, yeah, please do it. That's great. It's amazing, right? Because I feel like what might happen a lot of times is a therapist with this issue would jump into a therapist Facebook group with a lot of anxiety and concern over, is this a dual relationship, or am I unduly influencing my client? And I just love that there was no anxiety about this on this therapist part. He just loved it, and I just really liked that a lot.
Ben Fineman [00:08:23]:
I'll happily co sign the endorsement of that, although I think it's interesting because I pulled about half a dozen posts that I thought were good to talk about in our Patreon episode, and they were a completely different type of post. So it's funny how you and I interpret what constitutes a good post very differently.
Carrie Wiita [00:08:41]:
Interesting. Oh, I can't wait to find out.
Ben Fineman [00:08:45]:
Well, should we do a quick ad break and then make a lot of people angry with us?
Carrie Wiita [00:08:49]:
Yes. Ready for it?
Ben Fineman [00:08:51]:
This episode is sponsored by Sentio Counseling Center, where Carrie I work as the clinic director. We are a nonprofit online therapy center in California. Our fees start at $30, and we recently expanded our services so we have availability for individual adults, couples and teen clients. That's Sentio counseling center. Please feel free if you are a client looking for very good therapy. I don't know if I'm ethically allowed to say that. If you are a client looking for therapy that hopefully is very good therapy, you can visit us@sentiocc.org, fill out our intake form, and if you're a therapist listening, looking for a reliable, low fee counseling center to send clients to, please keep us in mind as a referral source in the state of California. That's Sentiocc.org. All right, Carrie, let's have some fun.
Carrie Wiita [00:09:37]:
Here we go.
Ben Fineman [00:09:43]:
Well, Carrie, I feel like this is the long overdue Patreon episode we didn't know was long overdue until we met Angela Nauss, who is our guest for this episode.
Carrie Wiita [00:09:54]:
Yeah, I'm not going to lie, I'm a little bit nervous about this. I'm very excited about this episode, but I'm also a little nervous because I feel it's a little bit like a live wire, this entire issue. And people that I know, it's a very hot topic in the community at large, but then I also have close colleagues who are passionate true believers and also people who absolutely reject anything about it. And so I'm just here for learning today because I want to know what the real story is.
Ben Fineman [00:10:30]:
So we are talking about, of course, EMDR eye movement, desensitization and reprocessing with the wonderful Angela Noss. And, Angela, could you please introduce yourself, and then we can get into everything that people want and don't want to know about EMDR.
Angela Nauss [00:10:46]:
Hi, I'm Angela Nauss. I'm a licensed marriage and family therapist in California and Colorado, and I'm the gal who did the EMDR Deep dive.
Ben Fineman [00:10:55]:
And the deep dive you're referring to. So this was in the CAMFT magazine. CAMFT is for anybody listening who's not familiar, the California Association of Marriage and Family Therapists. In their May 2022 issue, you had an article that was called a Review of EMDR Literature a Clinician's Skepticism. And so, with that in mind, let's start just by talking about EMDR, in case people listening don't know what it is, have a little bit of knowledge, or have a lot of knowledge, what's the deal with EMDR?
Angela Nauss [00:11:24]:
No problem. So let me tell you a narrative about EMDR that you may not have heard before. You can classify trauma treatment into two broad categories trauma focused and not trauma focused. And trauma focused just involves real or imagined exposure to triggers and memories of the traumatic event. So EMDR did not invent this. Prolonged exposure has been around a long time. It's a CBT intervention that involves imagining exposure in session to desensitize you to the traumatic event. And EMDR wholesale borrowed this imaginal exposure protocol. Now, prolonged exposure PE is not neuroscience based. It's CBT. And it believes that, like classical conditioning, if you expose yourself to triggering stimuli, your brain learns that it cannot hurt you, and it becomes less scary. You need to be real exposed, though, so that's, like, you feel actually scared. If you don't feel scared, you're not being exposed to it. Does that make sense? So EMDR made itself unique by the addition of bilateral stimulation. Later, dual attention stimulation, the point of which was supposed to be that you don't have to fully expose yourself to the trigger anymore. You could vaguely think about it, and by moving your eyes back and forth, it would do all the work for you. So, you see, it makes no sense because you're defying classical conditioning. The second way it distinguished itself was claiming to be supported and proven by neuroscience. Now, in her book, Francine Shapiro is up front that none of the theories about EMDR's mechanism of action have been proven. She's transparent about this. EMDR is a theory whose newness hinges entirely on the efficacy of dual attention, and that's waving your hand back and forth in front of someone's face or having them hold vibrating paddles. So later, other supporters, and especially Mdria, leaned into the neuroscience thing, because without it, there's no newness to EMDR. So EMDR and imaginal exposure are Desensitization protocols. And Desensitization is only one phase of trauma treatment that's meant to address intrusive symptoms. So everything under cluster B of the PTSD diagnosis and the DSM after that, you've still got clusters, CD and E, which is everything else that's distorted cognitions about yourself in the world, alterations of behavior and mood, and, of course, triggers. There's no evidence that you can use classical conditioning or exposure therapy to treat that kind of stuff. So here's the problem. At the end of the day, EMDR is only a Desensitization protocol. So people are going to stop using it after a while, right? Like, they have to treat all those other PTSD clusters I talked about. Somehow, EMDR became the tool of choice for all stages of trauma treatment. Now you can use EMDR, essentially a Desensitization protocol, to treat everything depression, anxiety, mood disorders, chronic pain, even. The theory is, I guess, expose yourself to depression, and your brain will learn to be less depressed. I don't think this was a conspiracy theory like MDA sitting in a back room somewhere. I think this probably came from individual practitioners being like, I want to use this for everything, and then they write a book about it, like how to Process Memories From Before You Were Born. I did it, and it works. The problem is there's no science behind this. I call it vegan science. Like, you know, vegan leather has no animal products in it. Well, making stuff up and testing it on your clients has no science in it. So at best, it works for some people, but at worst, you do more harm. So we can talk about the fact that claims that EMDR is supported by neuroscience are false, or the outcomes that show EMDR has the same efficacy as other trauma focused treatments, which, as I've explained, is probably because they wholesale borrowed from these other interventions. Or we can discuss the broader trends of psychology trusting neuroscience more than itself, which I would love to talk about so much.
Ben Fineman [00:14:58]:
I have the same feeling right now as I do when I read the abstract of a journal article, which is I feel like I've gotten the snapshot and the overview, but I want to dive in deeper to a lot of the different points you made to better understand. Because I also think people listening are going to hear this and assume that you are only critical of EMDR, maybe even have an agenda against EMDR. But I think more than anything, what I want to ask you about now is the fact that you actually are an EMDR therapist. So this is not just you sitting outside of MJ's headquarters with a pitchfork. Can you tell us about your experience and training with EMDR as a therapist?
Angela Nauss [00:15:39]:
My experience is I am an MDA certified person. And so there's three levels. Four, there's trained, which is you did the training, certified. You got certified, then there's instructor in training, and then you're an instructor. I think they have a different name for it. So, yeah, I'm watching the dumpster fire from inside the dumpster, like, I'm in it.
Ben Fineman [00:15:59]:
But you use EMDR with clients, is that correct?
Angela Nauss [00:16:01]:
Oh, yeah, I've done it.
Ben Fineman [00:16:03]:
Well, so help us understand that, because it sounds like you're very skeptical, maybe even cynical about EMDR. What makes you actually use it therapeutically if you feel what sounds to me, at least after the first few minutes of the conversation, very negatively about EMDR as a whole.
Angela Nauss [00:16:21]:
Right. So the reason that I am EMDR certified is because after I got trained, I started using it with clients. I didn't see great results. In fact, I saw bad results. I saw not good results. I would say less than 50% of the people I did EMDR with had any kind of improvement. So myself and I can talk more about this, I'm the most gullible person alive, right? I've fallen for every scam on the planet. So I'm like, the answer to EMDR doesn't work is I just need more EMDR training.
Carrie Wiita [00:16:48]:
Right.
Angela Nauss [00:16:49]:
I got EMDR certified, and I briefly saw client improvements. But it's worth noting that when I was doing my certification, I was at an intensive inpatient. So that's like a rehab. And so people were getting like 4 hours of group therapy a day. Plus your meeting with a case manager, plus your meeting with me. It's the most therapeutic petri dish that exists on the planet. No matter what intervention I'm using, you're going to improve. And then after I went to private practice, which is just outpatient private practice, you see me once a week or whatever, the outcomes went back to Abysmal. And I did briefly consider buying more EMDR training to see if maybe I could get it to work. But I didn't. Instead, I did the deep dive. And I was like, maybe if I educate myself more about EMDR, there's something I'm not doing that's making this not work. I went to art school, so I've got that in my head like, if you were good at this, you'd be good at this. So I did the deep dive, and that's when I found that in fact, this outcome is normal. I actually messaged I'm not going to say their name, but one of the researchers whose article I read and I was like, I've been having these outcomes. And they were like, that's actually normalized in the research that it's abysmal.
Carrie Wiita [00:17:58]:
Wow. Okay. So for the folks who haven't read the article, the deep dive you're talking about is you actually went and reviewed a lot of the literature on EMDR and then you also looked at, I guess, this connection to the neuroscience.
Angela Nauss [00:18:13]:
Yes. Can I talk about neuroscience really quick?
Carrie Wiita [00:18:16]:
I would love for you to talk about neuroscience.
Angela Nauss [00:18:19]:
The hottest new trend is that every therapy intervention has to be supported by neuroscience. Like, you know, we went through that phase in the 70s where everything was systems and went through that phase in the 60s where everything is your mom now. Everything is neuroscience now. Therapists don't do neuroscience. I measure symptomology and emotions and talk about motivation to change neuroscientists measure brain activity. There is no overlap in what we do. Full stop. Applying psychology, which is basically motivational philosophy to neuroscience. You might as well apply any other field to neuroscience. Astrology. Like, find me the SAGITTARIUS part of your brain. But there are deeper problems. Like what does it say about a field that believes it is the second most effective intervention? Like, if you believe that whatever neuroscientists and doctors do is better than whatever care you can provide to someone, what does that say about you? How can you go to work every day and believe that you are not an effective clinician? Like, you are second best, maybe helpful, but not the best treatment. Like, how do you sleep at night? So I think inviting neuroscience into psychology is like letting the fox in the hen house. I think it's like the first century etruscans watching the rise of Rome and saying, but maybe this will be fine. We can be second best. Well, you can look up the etruscans if you want. I'll stop talking about it anyway. The trends we've been seeing in psychology reflect this second best state that the field has been relegated to. Therapy is now being provided by megacorporations and apps. It's a thing you can get on the go as needed at a deep, deep discount price. Pharmacology is the new thing, which you can also get through an app, and you can get a prescription. The thinking is, why put time into therapy? Maybe it's not worth it. You can get the same outcome from a prescription. And by the way, that's the neuroscience solution to mental health. People who study brains provide medical interventions, not psychology intervention for therapists. That's what I mean when I say neuroscience is the end of psychology, because neuroscience is not psychology. The neuroscience solution to mental health will be a pharmacological one.
Carrie Wiita [00:20:16]:
So one of the things that does really deeply bother me about psychotherapy our field is that we do seem to have blinders on when it comes to other fields a lot of the time, and we feel like it's not relevant. We can't grow from learning about it, so we just don't look at anything. Neuroscience is this weird kind of exception in that I feel like we're very open to neuroscience as therapists, not because we understand it. But as soon as anyone from that side says something that makes sense to us, that seems to back up what we're doing or that we can use to support our own theories or interventions then we want to wholesale invest in it. Are you saying that therapists should not have a curiosity about neuroscience or strive to know more about current findings in neuroscience?
Angela Nauss [00:21:14]:
I'm not saying that. I think I'm saying therapists should not be endorsing neuroscience. Like, if you are a psychotherapy practitioner and you make your money off of providing therapy, you should not endorse solutions that claim to be the replacement for psychotherapy. Like, every time I hear a therapist like Stan Ketamine or Psilocybin, I'm not critiquing those treatments. I'm like, what are you doing? They literally market themselves as the replacement for therapy. And you are a therapist. What do you have to gain from this? So, not so much ignoring, because you can't ignore it. Like, neuroscience is going whether you want it to or not. More of like, we should be differentiating ourselves from them as much as possible. There's a Mad Men episode about this. It's like, how do you market yourself in a field where everyone is marketing themselves the same way? And I don't think marketing ourselves as a neuroscience based approach is competitive. I think we need to say something different than what neuroscience is saying. In fact, we have the best sales pitch on the planet. Everybody got super lonely during the pandemic, and we have human connection. I mean, that's it. That's the sales pitch. Right.
Ben Fineman [00:22:19]:
I think I'm maybe a bit confused about your argument because you could say human connection, the benefits of it are supported by neuroscience. But also it sounds like your stance about neuroscience is more about differentiating our field, almost like a marketing and sales approach. And I guess I'm curious, what is the problem with that? If a therapist can get better outcomes by incorporating things that may or may not be factual, by doing a deep dive into the studies to figure it out if a client wants to hear EMDR is grounded in neuroscience because when you wave your fingers back and forth, it does things in your brain that makes you able to reprocess trauma. If a client buys into that, what does it matter about the validity of the claim?
Angela Nauss [00:23:06]:
Yeah, right. So there's two problems with that. If you care about whether or not therapy works, it's a problem. But let's pretend you don't care for a second. Let's pretend you just read the headlines of articles. So EMDR works. It's neuroscience based. Pick any of these fatty neuroscience treatments, whatever. There's so many, and you're going to say that works. The problem with doing that is you're competing with neuroscience. And when you read into any neuroscientific research or like any of the researchers, they're upfront that our solution to this is pharmacological. It's a pill that you take and you can't compete with that.
Carrie Wiita [00:23:44]:
As a therapist, here's what I would argue. I feel like consumers, I think in the west, at least in American culture, prioritize information coming from neuroscientists, above information coming from therapists, for sure. Right, okay. So I think that they are eager to have neuroscientific answers for their problems. But at the same time, by the same token, so many of them, if they've had access to medications, it hasn't done much for them. Or there can be a generalized fear around taking those kind of medications. There's a huge lack of access to psychiatrists. For the average person who is blessed enough to have health insurance, often their closest route to access neuroscience is through their internal medicine doctor who knows next to nothing. They're just going to write you an antidepressant script and move on, I imagine. I think it seems like there's a relief for consumers when then therapists say, hey, so we're accessible, you can come to us, we are plugged into that neuroscience thing. And good news, you can access the benefits of neuroscience without actually talking to neuroscience. You could talk to us instead. This has been secretly my feeling about why EMDR works when people swear to God it works is I think it's a lot of placebo effect. And how like is that? Is that not in some measure good enough? If we're supplying to them the rationale, the myth and rationale they want to believe in and we're making it accessible and it works for them, then great. I'm not saying that's okay, but I'm just saying I kind of feel like that's what I see, but then I feel like what I'm also hearing you say is, but it doesn't work. Everyone's just saying EMDR, EMDR, EMDR works when it turns out it's maybe not as effective as everyone claims.
Angela Nauss [00:25:57]:
So you've kind of hit the nail on the head here. If you want a research based therapeutic intervention, like, everything across the board is like, it is the therapeutic relationship that's responsible. That's what you get.
Carrie Wiita [00:26:10]:
Right?
Angela Nauss [00:26:10]:
And so the fake sales pitch, I know you just came up with it on top of your head, but what you're really selling in that sales pitch was, do you want a therapeutic relationship? Like, do you want a relationship with a provider? I can give that to you. Your internal medicine practitioner who you see for 20 minutes at a clip every six months can't do that for you. I can. And I think that's still the best sales pitch for therapy and the best kind of like, treatment thing.
Carrie Wiita [00:26:39]:
I think that's the most realistic sales pitch. I agree with that 100% because that's what we're really selling. We know that. But I venture to say, if you are telling the average consumer of psychotherapy, hey, what's really successful in therapy is just the relationship. But there's science, though, too, right? And I feel like that's where EMDR kind of snuck in there and came out with all the different tools and the light bar and the binaural beats and all that shit. And it smacks to me a lot of folk medicine from prehistory these different tools that people said, oh, this is what it does, this is how it's going to affect you. And lo and behold, sometimes it worked. And I feel like that's exactly where we are with the EMDR. But I don't know, if we just package up the therapeutic relationship, people are going to be like, well, I'm not just going to pay for a friend. I have friends.
Ben Fineman [00:27:44]:
Well, something to your point, Carrie, and what you were saying as well, Angela, that the therapeutic relationship, you know, I think as conclusive as anything else in research on our field is that is the most significant part of change in therapy, at least between therapist and client. Client factors are most important. And then within the therapeutic context itself, the therapeutic alliance is more important than anything else on average. But there still has to be goals, tasks, a treatment, rationale, right? Something has to be done. You can't just have a friendship. So within a therapeutic alliance, there needs to be something that the therapist and client are on the same page about. And that's where this idea of marketing and sales and cultural discourse comes in, which is that therapists hear the narrative about EMDR and say, oh, my God, this is incredible. Neuroscience, light bars, futuristic ways of healing. Francine Shapiro walking through a park and flickering her eyes back and forth and feeling much. Better. Like, that's a great narrative, and then that passes on to the general public one way or another, whether it's like an intentional the Mdria cabal or just this is something that excites people and gets written about in the research. And then the public comes to therapists saying, OOH, I heard about this EMDR thing. And before you know it, a narrative is formed that this actually works by mechanisms other than therapeutic alliance, myth and rationale, whatever the specific factors are that are making people feel like you're actually doing something in therapy and not just having a friend. And then it works. It does work. And all of that makes me curious. Angela, to hear you talk about EMDR is just as effective as pretty much everything else. Like other trauma focused treatments, other treatments in general. It's not less effective, it's not more effective. It just kind of sits right there alongside everything else, as far as we know. So is there a problem with all of this if EMDR is actually effective as much as everything else for the most part? Or do you disagree with that?
Angela Nauss [00:29:40]:
Can I give you the highlights from my article?
Ben Fineman [00:29:43]:
Yeah.
Angela Nauss [00:29:45]:
So I'm not sitting on my couch dunking on EMDR. What I did was I read through a bunch of articles about EMDR, and this was not exhaustive. I found the ones that I liked, and then I wrote, like, a book report full of other people's conclusions about EMDR. Took me 18 months. Don't do this at home. So the main thing that people yell at me about when I talk about not liking EMDR is EMDR's mechanism of action. That means, like, what makes it work? Now, usually when I get to this part, EMDR people yell at me, and I mean yelling about maybe you just don't understand the theories enough. Now, in the second edition of Shapiro's book, she addresses skeptics, and people accuse her of using obtuse language and coming up with general neuroscientific terms and using them loosely and incorrectly. Can I just read a quote from that because I think it's important?
Carrie Wiita [00:30:30]:
Yes, please.
Angela Nauss [00:30:31]:
Her defense is using a term that does not have a precise neurophysiological reference is a particularly important to underscore the point that the efficacy of EMDR is not based on the validity of the physiological model being offered, et cetera, et cetera. She quotes somebody who calls her out for this, and she says, this unfortunate statement points up one difficulty of the review process. Specifically, if self described skeptics and critics are insufficiently versed in particular areas of neurobiology, their failure to grasp the implications of the speculations will result not in the intended intellectual stimulation, but rather an increased confusion, end quote. So you see, the default argument from the founder of the model themselves in her book written down, is if someone questions EMDR, just tell them they don't know enough about neuroscience, which my counter would be as a person who frequently gets scammed. If you ask someone how something works and they tell you it's too big brained for you, you wouldn't understand it. Don't do it. This is a scam. So I am not a neuroscientist, and I don't know a lot about it, which continues to be a big barrier to my research. It means I default to quoting actual researcher s. So I'm going to quote some people who know what they're talking about just to back this up. But let's back up. I don't need to know how a watch works. I just want to know what time it is. But since EMDR didn't work for me, now I'm asking questions like how does this work? And no one can agree about the mechanism of action for EMDR. In the beginning, I quoted the exposure theory, and EMDR is very adamant that they are not an exposure intervention because then they would be identical to prolonged exposure. So usually when I ask therapists what the mechanism of action is, they make it up. I'm going to give you the biggest ones, right, just so that you can win arguments with people if you talk about this with them. Let's start with the thalamic theory. So this one is not in Francine Shapiro's original book. Instead, she originally stands interhemispheric theory, which has since been written off. Philammic theory is the one I hear misquoted the most. So according to this one, intrusive somatic sensations experienced by PTSD survivors are the result of unprocessed symptomatic memories stored in the brain. And EMDR allegedly moves these sensations through the upper levels of cortical processing, thus resolving their intrusive quality. So the theory is in an EMDR session, I ask you to bring up a distressing memory. You are accessing the trapped sensory information in your thalamus. I wave my hand in front of your face and you follow it with your eyes. The sensory information leaves your thalamus and moves into your cerebral cortex, where it is processed accordingly, like a customer at the DMV who gives paperwork to the clerk. The clerk is your cortex. They put the paperwork in a filing cabinet. Now that's all processed, it's gone. I asked you for a Sud. That's a subjective unit of disturbance, also not invented by EMDR, and it's lower. And because the memory is processed, it's healed, gone. So there's no proof of this actually being a real thing. There are articles where researchers, actual ones, not people like me, break this theory apart and explain why it's not real. You can read real researchers explain why your traumatic memories are not customers of the DMV. Now, there was a series of articles out of Europe which did the work. They did neuroimaging before and after EMDR and all found structural or functional changes after EMDR therapy. Now, I'm not a neuroscientist, so it sounded like a slam dunk, but I found other studies by actual scientists that specifically said o these and explained away the changes so I'm going to quote the citation from 2018 that concluded kind of talks to this and it says this is a quote. These brain functional changes are not specific of EMDR, and similar neuronal effects can be observed in other forms of anxiety focused psychotherapy. Moreover, the physiological foundations of these changes are currently unknown, and therefore these neuroimaging studies cannot explain what specific mechanisms produce treatment effects in EMDR. With few exceptions, the majority of neuroimaging studies reviewed here have significant methodological limitations, including a small sample size. Pause quote these studies out of Europe that seem super promising had between five and 15 participants in them. Resume quote, lack of control conditions and inconsistent conceptualization of the parameters measured. Consequently, neuroimaging research findings should be considered promising, but preliminary and conclusions concerning the EMDR neurobiological correlates speculative. And that's from 2018. So it's recent. So if I'd read that at the beginning of my EMDR journey, I would have been like, okay, then I'm out the next theory. Can I do another theory that's important?
Carrie Wiita [00:35:06]:
Yes, please.
Angela Nauss [00:35:07]:
Okay, so this is people EMDR. People kind of go through the list. The next one is working memory theory. This is one of the original theories in her book. This one, to simplify, says, you can't hold traumatic thoughts and regular thoughts in your working memory at the same time. So it's better to tax your working memory so strongly that the traumatic imagery degrades. And that's the verbiage they use, like the emotions go away and you forget because your working memory is so taxed that you just can't remember anymore. So to use a metaphor, this one is like, there are so many customers in line at the DMV that some of them just go home. In this theory, the dual attention stimulation is taxing your working memory, and this is considered the predominant EMDR theory. And no, I am not kidding. I wave my hand in front of your face and you follow it with your eyes and the traumatic memory degrades. So the second one, the final one that you need to know about is orienting Response. This is another one from the book. It's one of the original guesses at the theory. These are all guesses. This one says, distracting you will activate your brain's investigative response, and you will go investigate and notice things you haven't noticed before and make new conclusions about your trauma. And the distraction is the dual attention stimulation. So this one says, you go to the DMV, you get curious, investigate, and come to new conclusions about the DMV. The DMV is an awful you love it. You leave happy. It's so great. So those sound like slam dunks. I'm going to quote you some research. This is a quote from the same 2018 study. First, most studies are performed in non clinical populations and therefore cannot address which additional mechanisms continue contribute to treatment effects and PTSD. Pause quote how do you do a PTSD study and not have clients who have PTSD. What? And I'll tell you why they do that. They do it because if you include people with single incident trauma that's recent, they don't meet criteria for PTSD because it hasn't been a month, but after a single treatment session, they'll improve faster. That's why you do that. Resume quote Results are often not supported by concurrent neurobiological evidence and only offer partial explanations. Research on the working memory hypothesis has also relied on conditions that do not fully match those used in the standard EMDR protocol. Pause quote that's why it's extremely important to follow protocol, and when you see therapist groups where people make up their own protocol, it's technically not research supported. Resume quote at least two different studies have found no significant effects on memory following eye movements and healthy participants. Further, the working memory hypothesis fails to explain some well documented effects of EMDR. These include the state of relaxation most patients experience after a few sets of bilateral stimulation the spontaneous generation of positive insight, the reports of increased recognition of accurate information, attentional, flexibility, and improved retrieval of episodic memory. Finally, most early psychological models ascribe to the eye movements and later to other forms of bilateral stimulation the underlying mechanism of action of VMDR, ignoring the potential additive effects of other components of the therapy. Pause. Quote, like the CBTF like parts. Resume quote Here it should be noted that dual tension does not require bilateral stimulation and or eye movement, as this effect can also be achieved by the addition of any other distraction task, e. G focusing on a point in space. And another quote to conclude from the psychological model perspective that eye movements complement traumatic memory extinction by neurobiological mechanisms that are yet as yet to be uncovered and that these models cannot address I want to read you one more because this is my favorite. This is from a 2021 review. On average, EMDR appears to be beneficial. However, the precision of this estimate ranged substantially, suggesting that the true effect ranged from large to small. Pause quote this person did a review, and because there was so much bias in all of the studies, it was impossible to actually pinpoint like an effect size. He had huge effect sizes and tiny effect sizes and was trying to make sense of this in the data. Resume quote this finding is challenging when considering the choices for best practice made by clinical mental health counselors who are investing time, money, professional identity, and client hope into such imprecise estimates. Sample size, age, sex, and time and treatment did not contribute significantly to the effects. Stated plainly, some clients may experience a substantial benefit from counselors that are trained and utilize EMDR, but there's also a likelihood that some clients will benefit more from an alternative treatment strategy. Moreover, there is an equivalent chance that future applications with similar samples could result in findings regarded as considerably or categorically ineffective, which is something you don't hear in EMDR trainings. This is supposed to be based on neuroscience. It's supposed to be work for everybody. So I can talk more about risk of bias in studies, but it's basically like when researchers accidentally influence outcomes. It's a little bit easier in studies like EMDR, where the protocols are so different. But I'd like to quote can I do one more quote, please?
Carrie Wiita [00:40:05]:
Yes.
Angela Nauss [00:40:06]:
So this one is from the 2020 paper. In my article, I'll read you the first and the last sentence. It said only four of 27 studies had low risk of bias, and there were indications for publication bias. And the last sentence is, there is not enough evidence to advise it for use and other mental health problems. But, like, I can go on like, you get the vibe it is not actually supported. It is theorized to be supported. Now, if you want, I can talk more about how much it actually costs to get trained in this model.
Ben Fineman [00:40:38]:
I definitely want to talk about that because it is shockingly expensive compared to other approaches. But I think first, for my own benefit, there's a subreddit, it's called Explain like I'm Five, where people will post they'll have questions about topics that are very complicated and ask experts to come in and distill it down so that a five year old could understand it. That was a lot of information, and I think there's a lot of really important stuff in there that I'm not quite sure I fully am taking away. So could you kind of recap everything you just said but really distill it down so that somebody like a ten year old, a five year old could understand the key takeaways of all the research you were just citing?
Angela Nauss [00:41:21]:
Yeah, no problem. They came up with the theories about EMDR before they did research on what makes EMDR work. They are now trying to lay down the train tracks while the train is still going to make it be supported by neuroscience. It is not supported by neuroscience. There are theories about neuroscience.
Carrie Wiita [00:41:44]:
So it's basically like every other modality in therapy, every other orientation, it is exactly the same.
Angela Nauss [00:41:51]:
Oh, yeah, that's even better. That's an even shorter one. Look at that. You did that in one sense.
Carrie Wiita [00:41:57]:
Okay, this is what I'm hearing. I think EMDR kind of came out of nowhere in the past, like, couple decades, maybe two decades, whatever, and took the therapy world by storm. Literally everybody I know, I mean, I swear to God, most therapists I know either are EMDR trained or want to get EMDR trained but can't afford it. And so I know it is extremely popular, and I highly suspect I know why. I mean, it is extremely specific, unlike more amorphous approaches to therapy. Ben and I did an episode on theoretical orientations where I, for the first time, really tried to understand what the hell Carl Rogers person centered therapy was, and realized how deeply nuanced it really was his writing is so dense on it and realized I would have to get another master's degree in Carl Rogers.
Angela Nauss [00:42:59]:
Just I'm going to stop you right there. That's what I'm talking about. Any approach where the sales pitch is, this is too smart for you to understand, you should be skeptical about, and I know what you're talking about, the Carl Rogers deep dive where you're like, I need another master's degree for this.
Carrie Wiita [00:43:13]:
No, you don't.
Angela Nauss [00:43:14]:
You don't need another master's degree if you can't understand it.
Carrie Wiita [00:43:17]:
No, my argument is you do need another master's degree if you want to understand it the way it's supposed to be understood. But our therapy research is clear. You obviously don't need to do that in order to improve client outcomes. You can have an idea. And it seems like what we're all doing is we're all trying to get trained as therapists. We're all trying to get trained in how to do therapy according to a certain school of thought. And very few of us reach actually, like, super trained in it. But then we go out there, and we have our success rate that has been the same for whatever, 50, 60 years, whatever. And so clearly, it's not the models. Clearly, that's not what is happening. There's other things that are going on that is making therapy successful, because turns out you don't actually need to know Carl Rogers's real thoughts on person centered therapy. To call yourself a person centered therapist and still have success. I think the same is true for EMDR, but I think it's easier for therapists to kid themselves that I actually know how to do this, because there is, like, a recipe, there's a very expensive training, and I honestly think it makes therapists feel good, feel terrible when they're spending the money. But you spend that much money, and you get such a buy the book, step by step thing. Is it possible that therapists that EMDR, quote unquote, is successful because therapists come out of it feeling like they finally know what they're doing?
Angela Nauss [00:44:48]:
Yeah. That's the definition of placebo effect is if I feel awesome and I tell you you're awesome, and you believe me, you're going to feel awesome. The problem, and I talked about this EMDR being kind of used as a desensitization protocol is that's the very first stage of therapy. So you'll get people who will go through that. They'll have, like, minimized intrusive symptoms, but they still got everything else. They're like, I still feel guilty. Can we do more EMDR to take away my guilt? Now, like I said, it's not proved to work on that. EMDR is only proved to work on intrusive PTSD symptoms. Won't touch the guilt, won't touch the depression. It won't explain the other things. So, like, you can do EMDR on everything you want. You're not going to have great outcomes.
Carrie Wiita [00:45:31]:
I want to clarify what you're saying here. Because this is what you said in the article that was so fucking interesting to me. You are saying that EMDR, as a, quote unquote, evidence based treatment that has been shown no more, no less than any other treatment and therapy for the treatment of PTSD, full stop. This creep into every other problem a client might present with that is not supported by any research, neuroscience or no, it's not supported by psychotherapeutic research. It is simply a cultural thing in our field where therapists are saying, and maybe the EMDR people in particular are saying it works. We think this works just as good for everything else. And so what you're saying is that if somebody is presenting not with PTSD, there's a much higher likelihood it is not going to be an effective treatment.
Angela Nauss [00:46:19]:
And it won't even be effective on PTSD after you do the intrusive symptoms.
Carrie Wiita [00:46:23]:
Fascinating.
Angela Nauss [00:46:24]:
Can I talk a little bit more about why it's exposed to get trained? Because, yes, I'd like to talk about the funnel.
Carrie Wiita [00:46:31]:
That's all about the funnel.
Angela Nauss [00:46:32]:
Funnel. So I don't want to get sued. So I have to say, no, it's not a pyramid scheme. Let me describe the set up for you. So I made an excel sheet about this. I can give you guys if you want. The first level is training, and I want to tell you how much this costs. So I did a little casual review. I looked at the cost of 20 EMDR trainings. So it's the first page result of Google figuring that's what most people would look at. And then I did the suggested trainings on the embryo website. So the average cost for N equals 20 was $1,604. And many of them have discounts for students or nonprofit workers, or if you register early. And the average discount cost, so N equals 15 is $1,299. So if you pay 1600 or one $200, you're trained. A note about this. Sometimes it doesn't include the full cost of 10 hours of supervision, in which case you have to pay out of pocket. Supervision is like 50 or $60 an hour. I did my training and I didn't read anything about EMDR. I just did it because I heard you could make a lot of money and I'm a sucker. And at the end of my training, I had to pay all the extra. So, anyway, the next level is certified, which is pay to play. There is no additional information to learn. If you read Shapiro's book, there's no next level of EMDR, you already learned everything. The qualifications for certification are doing a certain number of hours with clients and paying for 20 more hours of consultation, which, if you're paying $60 an hour, comes out to about another one, $200. So if you give them one $200, anybody can get certified. You also have to do extended trainings for twelve CEUs, which at $84 for four credits I looked it up, will put you at around $255. So at this point, you've put $3,205 into certification. I did the math I have in the spreadsheet. The next level is consultant in training and then trainer. And to do this, there's no new information. You just need more CEUs and another 20 hours of supervision, plus certain amount of hours with clients. You complete this, you spent $5,610. Again, there's nothing to learn. There's no secrets to the model. But if you have the money, you can get the title. By the way, these titles are only good for two years. It's $100 plus twelve CEUs every two years. I'm EMDR certified, but I'm not paying for it anymore, which is the equivalent of me putting the cost of certification in a toilet and flushing it. So you see, once you're in, you better stay in. So if you're a therapist, you can tell your therapist friends that you're now a trainer, and you can get them to do your trainings. And because you're a trainer, they can do their consultation with you. So you can make your money back by training your friends, and your friends can become trainers, and they can make their money back by training their friends and so on. Also worth noting that if you go on Facebook, which you shouldn't, you see a lot of therapists talking about their own EMDR experiences. And I get this from my therapist friends, too. There, like all other therapy, is a waste of time. I'm going to do EMDR. That's the real thing. So I think the funnel actually looks like this. You get EMDR trained, you get convinced that EMDR is the only real therapy. You do your own EMDR therapy, and now you're bought in, you're a customer. Then you keep getting more EMDR training. And the more training you do, the more real your own therapy seems, the more healed you are. So my theory, which is important to note, is not based on research. It's based on me talking with EMDR trained therapists. Because saying when something is a theory versus proven is important, is that people at this stage get fanatical. If you have done your own EMDR therapy and you've gotten trained, spent all the money, you're so emotionally invested in this model, you can't listen to any conflicting evidence, because that would invalidate your own therapeutic experience. So it's created this weird code of silence around questioning EMDR. We as a community do not discuss evidence that questions the model, because we're all customers. And as an EMDR therapist, my mental health hinges on whether or not EMDR is real. Again, I'm underscoring. There is no new information learned beyond basic training. And I've told this to people who are EMDR therapists. And the cognitive dissonance is so thick, you wonder if they walk into things with all that wool over their eyes. Common responses are, Well, I still want to get certified to combat all the bad EMDR practitioners in the world, like the cure for too much of a bad thing has never been more of the bad thing. The other one I get is, well, my trainer is really good, and I'm like, Sweetie, for one $200, you can get level one trained in literally any other modality maybe your trainer knows. Somatic experiencing for one $200, you could get the first level. Yeah.
Ben Fineman [00:50:53]:
So there's something that happens alongside everything you're describing that I think is really important to underscore here, which is EMDR is not just the most expensive, I think the most expensive approach to get trained in as a therapist, or one of the most expensive. It's also, I think, on average, one of the most expensive approaches to receive as a client.
Angela Nauss [00:51:15]:
No longer.
Ben Fineman [00:51:16]:
No longer.
Angela Nauss [00:51:17]:
So that's something I also talk with therapists about, which is, everyone's trained in it? Now, there's two thoughts to marketing, right? The first one is, everyone's trained in it? I better also be trained in it. The second one is, everyone's trained in it. It's no longer a competitive market. That's been my experience. There's an episode of The Wire about this where Stringer Bell thinks about investing in cell phones instead of drugs, but he notices the lamest member of his friend group has two cell phones, so therefore everyone must be able to afford one. I say if everyone is trained in EMDR, which they just about are, you can no longer charge $300 an hour. You used to the money used to be really good. It was there when I first got trained. But now people on insurance panels do EMDR. That market is gone, for sure.
Carrie Wiita [00:52:02]:
I have absolutely noticed that in my work with I consult with therapists on their marketing, and I have absolutely noticed that that almost everyone, and it's not helping just having EMDR on the website. This perfectly validates all of my thoughts about marketing. But just having that word on your website no longer is enough to demand a higher rate. But I think you're right. I think there's a vested interest in other therapists saying, oh, yeah, you can make more as an EMDR therapist. But it's kind of like one of my professors in grad school who was very elderly and obviously came up in the marriage and family therapy world in California in the bragged to our class about how he always had a full practice and never needed a website. And I'm like, The Internet came about in the last maybe ten years of your career. Maybe by then you had plenty of other but your concept is still you shouldn't need it. The concept of everybody now who's been an EMDR therapist and has an enviable career, they're like, oh, yeah, I make a lot of money doing EMDR. Absolutely. But I could not agree with you more. I don't think that's the case for people who are getting trained today.
Ben Fineman [00:53:21]:
So I do want to talk about what EMDR is good for because I think we all probably know people who have been clients of therapy received EMDR and it has made a profound difference whereby it and that doesn't mean that they only needed EMDR and it doesn't mean that the finger waving and all of that was why it was profoundly impactful. But EMDR is something that is used and people see tremendous benefit from it, as we're saying, not in a prescriptive way that people need it, or that EMDR is better than other approach, but for some people, EMDR has and will continue to be very important in their lives. And that is, I think, for me at least, a very good thing that people have been helped by EMDR. So, Angela, with all the context you provided, can you talk about what is EMDR good for?
Angela Nauss [00:54:10]:
I'm sorry this is so dry, but yes, EMDR is good as a Desensitization protocol. So that's, again, the first stage of PTSD for intrusive symptoms, nightmares, triggers, flashbacks, intrusive thoughts, that's the first stage of trauma treatment, right? And that's why you see so many studies focusing on recent trauma or acute stress disorder, because it's the easiest to treat, it's the quickest to treat, and it's the one that goes away. So if you have those symptoms and you use EMDR, it will be effective. However, I would argue it's not even the best Desensitization protocol. I use prolonged exposure and I have way better outcomes. The prolonged exposure thing, like I said specifically, is like, you got to expose yourself to it and you go like, full tilt. So EMDR, you rate it on a scale of one to ten. You say, I only want to think about it until I get distressed. At a four, prolonged exposure is like you're going to a ten. And what I've noticed is it works faster and it works better. So I would use EMDR as a desensitization protocol, and I do offer clients the option. I say, there's other things we can do after Desensitization, you've got the long road of trauma recovery after that. You can't use EMDR for that. What do you do when a client comes in, they're like, I don't have flashbacks, I don't have nightmares, but I just feel really guilty about what happened and I think about the guilt every day. I'm not reliving the traumatic event. I'm just thinking about how awful I feel. What do you do? You can't do EMDR on that. No way. You open your book. You got to use another theory for that one.
Carrie Wiita [00:55:41]:
My opinion, I am going to go on record right now and say that we are at the tail end of EMDR. We are at the phase in EMDR where it's all about making money. I am telling you, the next thing that's going to happen is virtual reality therapy, because they've already like, that is going to replace because that is all about exposure therapy as well. What they're proving right now, the only tested interventions. Right now in virtual reality therapy are exposure. And they're great. They're good results. But that is going to replace, and I guarantee you that is going to recapture in the minds of the consumer that this is the more scientific, the more cutting edge, the more innovative treatment. And fucking everybody who got spent sank $5,000 into EMDR is going to be crying.
Ben Fineman [00:56:29]:
It's funny. You said you feel like we're on the tail end of EMDR, because while Angela was talking just now, I was having a similar thought that give it 50 years and EMDR will be almost entirely phased out is my guess. And these things take a long time to rise and fall. But if the financial incentive for therapists continues in the direction it is, where you can't charge as much as you used to be able to, but it's still expensive to get trained. There's less of an incentive outside of the narrative, the false narrative, that this is the thing. And so once that starts to shift, there's less demand for therapists to get trained. And I think this will just inevitably kind of cascade down into the general public, where there's less of a, oh, I need to get EMDR for my trauma, because the field will have loosened its grip on EMDR as the thing for trauma. And so over time, the financial incentive, the demand, all of it is going to trend away from EMDR being something that grows. And because there is no objective science or neuroscience to say, this is why it works, at some point, I think it's just going to fall away, unless by almost pure coincidence at this point, that EMDR people are correct and they find something in the neuroscientific research that actually supports their theory. But the odds of that, I think, are probably minuscule. And so, yeah, give it a few decades, 50 years. My guess is this is just going to be a thing of the past that we don't really talk about all that much.
Carrie Wiita [00:57:54]:
Can I share my takeaway? And Angela, I want you to tell me if you endorse my takeaway from everything that you said so far. One of the things that I agonize about a lot in therapy, land and Ben knows as well, is knowing this tension between nothing works any better than anything else. So all these things that we're coming up with that we're like, this is how the mind works and this is how you fix it, those are all stories, and it's all like, pick your poison, pick your placebo, because we know that's not what works in therapy. But also, on the other hand, you fucking need it because you can't just go into a room and chat with someone without structure to therapy, treatment goals, tasks of therapy, a defined role for the therapist, all of those things, you need something to define treatment. So knowing that therapy is like, to some extent, just picking one of them and buying in as a therapist and also so that your client can buy in, that is like an uneasy detente I have decided to commit to. But what I've struggled with then coming up against EMDR is I really react against it because of everything you've said. I've heard that the neuroscience that they cite is not as subtle science as they like to make it sound. But at the same time, what Ben is saying, I can't argue that I have heard so many people vehemently say, oh, it's helped me. It's been amazing, blah, blah, blah. So taking all those things. For me, what I'm walking away from this conversation is if you love EMDR as a therapist and you have a client who's looking for EMDR because they've heard it works, first of all, chances are pretty good that just given those circumstances, it will, quote unquote, work, but it will probably work for the initial stages. The initial, you said, like, nightmares, the intrusive thoughts, those kind of things. After that, if your client is like, oh, my God, this is so great, EMDR is awesome. If the feedback is overwhelmingly positive, sure, keep going, because it can't be any worse than anything else that we have in our toolbox. But you should be extremely sensitive to any feedback from your client that this isn't working, or I'm not sure it didn't work as good, or I still feel this way. And at that's the point that you probably have, like, an ethical responsibility to pivot or offer a different treatment that may work for those other things that come after that initial stage.
Angela Nauss [01:00:37]:
Yeah, girl. I've met people who, like, not talking about clients HIPAA, but talking about humans in my life who've been in EMDR for a year, two years. And I've talked with you about this. It's like EMDR markets itself as a quick treatment. I'm like, two years. That's CBT. That's psychoanalysis. Two years. Not to mention EMDR. I mean, what are you doing in two years? How many things have you processed that's when you know it's not working?
Ben Fineman [01:01:03]:
I think that maybe the last question I have for you, Angela, is I'm really curious what the responses have been to the initial article in the Camp magazine last year. But I'm also curious what you anticipate the responses to this episode being. Just in general, how do therapists respond when you kind of show the truth about EMDR insofar as what you're presenting is the truth?
Angela Nauss [01:01:32]:
This is my favorite question. So people say EMDR is a cult, and I don't want to get sued. So, no, they are not a cult. Here are the responses to my article. Most often angry, yelling or arguing, followed by crying. 100% of the time, I have to apologize. Psychology is the only field where you have to apologize during debates. When I wrote my article, I decided to put an apology in it to kind of, like, get ahead of the reactions that I'd had from beta readers. And my editor was like, would you be open to moving the apology from the end of the article to the beginning? And I made the call like, yeah, that's the move. It's the only intervention where if you tell people, hey, I read an article questioning the efficacy, they will start yelling and cry at you. So I was on a plane with a guy who was like, deep in can I swear on the show?
Carrie Wiita [01:02:19]:
Yeah, absolutely. Yes.
Angela Nauss [01:02:20]:
I'm encouraged deep in the shit. And this is on me. I need to get better at keeping my damn mouth shut. Like, know your audience. If it was 1789, I'd be the person in front of the guillotine like, I don't think this is a good idea. I'd be gone first round. Anyway. So this guy just got back from a Somatic conference, and I was like, Maybe I can get him out of the cult. And I told him about my research, and he got so upset that we started raising our voices on this plane. And I was like, hey, I'm sorry, man. And he got off the plane, and his face was bright red angry. That's not, like, how CBT people react is what I'm saying. CBT people, you tell them I was reading this article, and they say, what's wrong with you? Get a life. EMDR people. You say, I read an article, and they say, yes, fellow scientist, I just got back from a Somatic conference, which is the thing I do in my free time. When I was doing this article, I was talking with other scientists, real ones, not therapists. Like, my sister does water testing. I was like, have you ever heard of an 85% confidence interval? So that's like a statistical thing where you measure how sure you are of your conclusions. And the usual standard is, like, 90, 92. She uses 96. I was like, 85 is like, you're not even sure 85 is like, I think. But yeah, I've had trouble sleeping this whole week because I know I'm going to get a lot of mad emails. I'm going to get Facebook comments again. People find my LinkedIn. You got to make yourself easy to find, so you can kind of like, you guys know this. You can kind of anticipate where they're going to come at you from. I'm going to get emails from people being like, I did EMDR and I'm a therapist, so therefore you should shut up. You're wrong. I'm going to get emails from people being like, I did EMDR as a therapist. And now I'm having flashbacks again because I listened to this podcast. I'm not looking forward to it. I'm ready for it. How do you guys think this is going to be received?
Carrie Wiita [01:04:14]:
I'm going to throw this out there because this is first patreon. This is a patreon, right?
Ben Fineman [01:04:19]:
Ben yeah. This is our January 2023 patreon episode. And I cannot help but imagine we will look forward to re airing this at some point in the future because it's too much.
Angela Nauss [01:04:29]:
Give me a heads up.
Carrie Wiita [01:04:32]:
I'm like, If I were you, I would relax for a while because I think our Patreon audience is far more like they're used to hearing me and Ben say highly controversial things, and then they signed up for the Patreon. So it's like, I feel like this crowd is like an amenable audience. You might get some very thoughtful emails, but it's a very amenable audience. It's when it goes on the main podcast, that's when we will call you. Maybe you should go on a retreat to Tulum or something.
Angela Nauss [01:05:04]:
Look at my Facebook. Don't look at my I did get a lot of emails from people who were in school, and they were like, I was thinking about getting EMDR trained. And now I'm not. And I'm like, good. You read the article, right? You arrived at the correct conclusion.
Carrie Wiita [01:05:16]:
That is what I'm really hoping. Honest to God, I feel like I think that if early career clinicians, maybe even folks still in school can hear this, they are going to save so much money.
Angela Nauss [01:05:30]:
Yes, I could use another annoying history metaphor, but I'm not going to the role I would like to play.
Carrie Wiita [01:05:37]:
I've really enjoyed them. Are we going back to the French Revolution?
Angela Nauss [01:05:40]:
Because can we I want to be the Jean Baptiste Bernadot. He was Napoleon's brother in law. He's like the opposite of Napoleon, and he switches sides halfway through the war, and he doesn't go back to France until after Napoleon has fallen. Like, Paris falls. And then Jean Baptiste walks in and he's like, I did this thing. People take a lot of credit for the fall of Napoleon. Like, usually it goes to Wellington, who I love, but on St. Helena, Napoleon was like, it's fucking John Baptiste did this. And people will lie about you to be nice, but they'll rarely lie to be mean. So it was John Baptiste. He planned the 1813 campaign to liberate France because he was mad at Napoleon.
Ben Fineman [01:06:23]:
Wait, okay. So let me ask you a question about you, then. Not not about EMDR, but about you. So you are and Carrie and I are to some extent invested in EMDR losing its status in our field to some degree, because our confirmation bias wants that to happen. We want to say, I knew this was not what they said it was. And so we are going to read the research with a bias that we can't turn off. We are going to evaluate. I was in an EMDR training once, and somebody was talking about shoes that were in development where they were bilateral stimulation via the shoes.
Angela Nauss [01:07:02]:
Oh, no.
Ben Fineman [01:07:03]:
And I was in the EMDR training, but I was already fairly cynical about the whole operation. And so I heard that. I'm like, well, this is just ridiculous. But I'm sure most other people were like, this is amazing, but I couldn't not hear it as being ridiculous. So all three of us are going to seek evidence about EMDR that confirms our existing beliefs. And, Angela, you want to align yourself with a historical figure who has been triumphant upon whatever I'm that's why the.
Angela Nauss [01:07:29]:
John Bapt peace metaphor is so much better than making myself Wellington, because I was in the EMDR camp. The whole reason I started researching was because I loved it so much. I just wanted to be good at it.
Ben Fineman [01:07:41]:
But is there a risk in everything you're saying? That you, Angela, are hugely biased yourself, and that everything we've talked about in this episode is just one perspective and that the things you're railing against might actually be correct. It's just hard for you to see it that way.
Angela Nauss [01:07:56]:
I mean, at this point, yes, I'm biased. It would take a lot to bring me back to Napoleon at this point.
Carrie Wiita [01:08:04]:
But this is now making me think of the CBT folks that you referenced. Right? Yeah, because the CBT folks also biased. But also, I've never seen any practitioner of CBT get their panties in a bunch about a different approach, whereas I've seen plenty of therapists get real upset about CBT. No, I mean, CBT EMDR people are.
Angela Nauss [01:08:32]:
Like, CBT is fake, CBT isn't real therapy.
Carrie Wiita [01:08:36]:
And CBT people are like, oh, God. Go ahead, go on.
Ben Fineman [01:08:41]:
EMDR has emerged, essentially, you're saying Carrie as more of an identity than an approach. If therapists are so deep into EMDR, disagreeing with the model, it's like, disagreeing with them as a human being. And so it evokes a much stronger irrational response.
Carrie Wiita [01:08:55]:
Yes. But what I'm really arguing for is I think that Angela's bias that she has is a more balanced bias because it's an investigated and challenged bias. Her original bias was bought into the surface, bought into the sales pitch. And really, from what I'm hearing, EMDR is making tenuous claims and wants you to buy it at that level. And I think what you read from Francine Shapiro suggests, don't look much deeper under the hood, because you don't get it. I mean, all these reasons, but just don't do it. Which, if that's your bias, that is an unchallenged bias. But then Angela challenged that bias by saying she tried all of the things they said she should do, and she didn't see the improvement that she wanted. So then she started looking under the hood where they told her not to look. And at that point, then I feel I personally, I don't equate a challenged bias that she now holds to an unchallenged bias, even though it uses the word bias.
Ben Fineman [01:09:56]:
It sounds like the wizard of Oz. Like, pay no attention to that man behind the curve.
Angela Nauss [01:10:00]:
That's what it is. That's literally the thought. And I've been to the meetings. I was deep in it. So I can tell you, this is how they talk about it is, they're like they will research other theories. I hear people quote polyvagal theory, somatic sensory, motor, psychotherapy, somatic experiencing gabor mate to explain EMDR, right? Because you can't explain it because it's not substantiated. So you just come up with stuff that's cognitive dissonance, right?
Ben Fineman [01:10:31]:
This has been fantastic. Is there anything else, Angela, that we haven't covered that you want to share before we say thank you for this incredible episode?
Angela Nauss [01:10:39]:
You guys are so nice. I really like talking to you. Thanks for having me on.
Carrie Wiita [01:10:44]:
Thank you. Thank you for being so brave and writing the article in the first place and then wanting to talk more about it in public. We really appreciate it.
Ben Fineman [01:10:57]:
We will put a link to the camp article in the Show Notes. Certainly. Would you like to list your website to make it easier for people to send hate mail your way?
Angela Nauss [01:11:06]:
Yes, please. It's nosttherapy.com and you can actually, ironically, this whole thing, the whole reason I started researching EMDR is I was writing another article for fun and I wanted to cite EMDR, but I couldn't find any good citations because they don't exist. And that article was about, of all things, fan fiction. So that one's up there too.
Carrie Wiita [01:11:30]:
Amazing. We will have links to all of that in the Show Notes and on our website or on the Patreon page. Angela, thank you so much for joining.
Angela Nauss [01:11:40]:
Us on the show. Thank you.
Carrie Wiita [01:11:49]:
Thank you for listening to very Bad Therapy. The views and opinions expressed do not constitute therapeutic or legal advice, nor do they represent any entity other than ourselves or our guests.
Ben Fineman [01:11:58]:
Visit us@verybadtherapy.com for more content, ways to support the podcast, or to let us know if you have a story you'd like to share on the show. If you'd like to join our Patreon community and get access to our monthly bonus episodes, check us out@patreon.com. Verybadtherapy.
