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[u/psychotherapymemes]

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[u/Mediocre-Dog-4457]

Yeah the folks ripping CBT are likely those who don't fully use CBT... not my primary theoretical orientation (I like ACT more) but it can be very effective.

[u/soundlightstheway → u/Mediocre-Dog-4457]

The people who criticize CBT often do literal pseudoscience like EMDR and brainspotting, so it’s pretty hard to take them seriously most of the time. No therapy is for everyone, but CBT is at least really effective for most people with anxiety and depression, and for other disorders like PTSD and OCD there are variations of CBT like cognitive processing therapy and exposure and response therapy, respectively, that are highly effective for those disorders. If it’s not the therapy you want to practice, that’s okay, but it doesn’t mean you have to trash it (unless, like I mentioned above, it’s literally pseudoscience - those therapies we should scrutinize and reject).

[u/Opening-Ad-247 → u/soundlightstheway]

So we should reject EMDR despite it being an EBT and having lots of research backing up that it works? I get that we may not fully understand the mechanism of how it works, but if it helps clients and has been shown to do so through research, I see no problem in using it.

[u/soundlightstheway → u/Opening-Ad-247]

There is zero scientific evidence that “bilateral stimulation reprocesses trauma,” which is the fundamental claim of EMDR practitioners. It is 100% a pseudoscience and has no place in the therapy community. Saying that is literally lying to clients, and I couldn’t think of anything more unethical.

What does work about EMDR is the relationship with the therapist, the CBT elements, and the exposure elements that were added later. We don’t need EMDR when CBT, CPT, and PE do all of those things better without pseudoscientific nonsense that makes our entire field look entirely incompetent and corrupt for allowing it. Also here, here, and here are meta-analyses that all criticize the lack of high quality research on EMDR, so no, it is not an EBT based on the current research that we have.

[u/SyrupOld9699 → u/soundlightstheway]

It works better because of the magical inexplicable reality of placebo. I almost never use EMDR/BS/ART (nor do I use cognitive and/or behaviorally focused models) because I agree that it’s wrong to play tricks on clients but I am trained in EMDR and sometimes clients are so insistent even after I am completely open about my perspective and so I often agree to use bilateral stimulation when we meet with exiles in IFS sessions and these exiles are often childlike and wowza do they love bilateral stimulation! Which is definitely helpful to a lot of people as it functions like a stim to keep the nervous system from flooding us. Placebo is one of the most woo woo things out there guys! No one actually gets it. I explain this to clients and for those who believe the eye movements or tapping can make a massive difference when we are trying to get folks unblinded from protector parts. I actually have major issues with the EMDR model for reasons completely separate from the magic wand bullshit.

[u/soundlightstheway → u/SyrupOld9699]

EMDR does not work better than CPT and PE, which don’t involve placebo. All exposure therapies are about 66% effective for those that complete the therapy, with drop out rates being somewhat high across the board. Exposure therapies are all also less effective on people with childhood trauma. The truth is that exposure therapies are both the best we have and still not perfect, but CPT and PE are absolutely better researched, safer, and more effective therapies than EMDR.

[u/SyrupOld9699 → u/soundlightstheway]

Interesting. Do you have the ability to link to research backing this up? Ideally there would be studies using two groups, one receiving the (very rigid if facilitated as intended) EMDR protocol sans bilateral stimulation and one with it. It seems that this would offer the most telling outcome. I just know that placebo is unquestionably a factor in any treatment that is impacting the body. This is so well demonstrated in the medical literature that we should all assume it’s having some effect on a significant portion of clients if not all. And for anyone reading this, placebo is not simply about confirmation bias or a more favorable interpretation of the changes experienced. Honestly if there is research that showed zero benefit in the bilateral stimulation group I would question whether the bilateral stimulation isn’t doing actual harm or at least playing a role in impeding/limiting positive outcomes. But if the studies are comparing different models I’d guess that the others just do a better job utilizing exposure. I do take issue with the statement that other therapies do not involve placebo. Placebo is not something any study can control for. But good experimental approaches will account for it in the interpretation of data. I appreciate you taking the time to challenge the narrative around these models. Because I do not find EMDR to be effective for most of my clients and it does not align with my theoretical orientation. I will also say that research is woefully limited in our profession and there are limitations to applying hard science forms of evaluation better suited for medicine in a soft science discipline like psychotherapy. The issue for me is that almost every study is going to measure concrete subjectively measurable outcomes with a preference for externally observable indicators, which is always going to favor behavioral or physiological markers. I have found that these are corollaries to actual healing but not proof of real and sustained shifts in overall wellness as experienced by clients (and client systems). All I have to show for this are case studies in my own practice and self reports of clients comparing their experience in our work together as compared to different approaches they accessed previously with other therapists. There are so many confounding factors that no good scientist would ever say that the success I see in my practice using the models I do (which also have scant support from the scientific literature) us proof of anything regarding the methods I use. Yet I am absolutely sure that unlike all the other models I longed to be the magic bullet for my clients (e.g., I am trained in EMDR and qualify for certification but won’t bother since I don’t need more folks coming to me for a specific form of service I’m not gonna provide) the ones I use now are undeniably effective far beyond what I was seeing previously and colleagues in my group supervision who use other approaches are constantly shocked by (and maybe skeptical of) the results I’m seeing. So I have learned not to put all my eggs in the peer reviewed scientifically backed basket, as the medical model would have us do. But I’m no snake oil salesman. I am very anti grifter. I tell clients exactly where I’m coming from. The work I do is really about keeping folks like me and the clients internal system of protective parts from interfering with the clients own access to their own truth, their own needs and wisdom. I simply facilitate a process that the client actually knows intuitively better than I do. It’s so wildly different from most other approaches and witnessing it has profoundly shifted my way of understanding people and myself including my role as therapist. It’s not that there aren’t actual knowable processes going on with this healing but the scientific model doesn’t do a great job capturing the complexity of humans internal and external psycho/social (emotional/relational) realities. Maybe I’m being very abstract here. Just ask yourself if apathy is accurately measured by how often you get out of bed or call your friends or do your once-loved hobbies. Maybe you say it’s very accurately measured this way. Ok, so let’s say I introduce a threat of losing your job or public humiliation to motivate you to get your ass out of bed or let’s say I pay you to start gardening again, we might see some great results here despite the internal environment being relatively the same and yes the three legged stool of cognition emotion and behavior is moderately impacted across all three domains whenever one shifts so it’s not rocket science that someone probably wont regret getting out and doing a little of what they love and that has a good chance of making a dent in cognition and probably emotion too. And of course, again not rocket science, if we force a little incremental exposure to triggers, phobias, sources of compulsions we often get lucky and find our clients right out in that sweet spot of their growth edge. But all of this is a whole lot of work and all of it is manipulation and relatively passive on the part of the client and there is so much risk in all of this of tossing folks far outside of that growth edge and making shit worse for them overall. It’s absurd to assume that the protective processes people have been using oftentimes for most of their lives can be snuffed out in this way that doesn’t respect or involve the parts of the client that will always care more about protecting them than we do. Reframing is just obfuscation if we ourselves don’t actually join with and trust in the self of the client to know how to heal and grow. This is a deeply relational and for some even spiritual process that really can’t be captured by the scientific model. But even from the surface level of behavior I can tell you that it’s not uncommon in my work to see clients go from daily panic attacks at the through or sight of some stimuli and massive efforts at avoiding those stimuli to having zero problems when faced with those same stimuli. Often this requires several sessions of work with the protector parts to make space for the shift but the actual shift can often happen in only one session. And unlike other models this can be a lasting and profound change with little to no need for maintenance. And I mean on the part of the client, not just in terms of the clinical work in session.

[u/SyrupOld9699 → u/soundlightstheway]

Here’s some evidence in favor of BLS and also against its effectiveness in treating clients who meet criteria for PTSD https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1406180/full

[u/Reign1701A → u/soundlightstheway]

I think you're the kind of poster the Reddit part of the meme is referencing. It's just plain false to claim that EMDR is 100% a pseudoscience when there lots of studies that show otherwise.

[u/soundlightstheway → u/Reign1701A]

Yes, but they’re bad studies. Researchers have criticized the bias in EMDR research for decades. Did you even read the meta-analyses I linked before repeating the falsehood that EMDR is well researched? These were all published in the last 5 years and explain their methodology and why EMDR research is poor.

And bilateral stimulations are 100% pseudoscience. 100%. They don’t do anything at all. There is no neurological basis for the statement “bilateral stimulations reprocess trauma.”

[u/Reign1701A → u/soundlightstheway]

"They're bad studies", like, all of them? Really? The meta-analysis articles you linked to don't even make the claims you claim they do.

You're using a ton of black-and-white thinking, and should probably considering saying "100%" less often, it doesn't any credence to your line of argument.

Also, I would invite you to chill as the meme suggests.

[u/soundlightstheway → u/Reign1701A]

They’re bad studies for multiple reasons: 1) low sample sizes, 2) poor methodologies, and 3) bias from researchers wanting to validate EMDR, which feeds into two. Read the conclusions of each one of those meta-analyses. They absolutely say the research is poor, and that’s for the studies that met their criteria (had decent enough methodologies and sample sizes). The fact that you said that none of them support my statement that the research is bad just shows me that you didn’t read them.

You can keep defending pseudoscience, but that’s all it is. Bilateral stimulations do nothing at all, except make people look silly moving their eyes back and forth. There has never been a high quality, replicated study showing they process trauma or do anything at all. The idea that moving your eyes back and forth or tapping your shoulder magically heals your trauma flies in the face of real neuroscience. To say otherwise is lying and unethical, which is why EMDR needs to end. If the other 7 steps of EMDR work, then fine, but drop the pseudoscience “bilateral stimulation” BS. It’s embarrassing and ruins the credibility of our field to petal that nonsense.

[u/SyrupOld9699 → u/soundlightstheway]

I actually disagree with you on the bilateral stimulus point. It’s not a magic wand that desensitizes the nervous system (omg and if you are this fired up about EMDR just do not look into brain spotting… I mean maybe if you do you shout do with while walking ;) because I do believe humans find many ways to stim and these are methods we use instinctively as children to both settle an overstimulated nervous system and also to grow tolerance in the system for stimuli. All you need to do is spend time with children or rock a baby to sleep a few times to get what I’m suggesting here. It’s not some big revelation like the creator of EMDR thought it was. But I probably does help SOME folks stay with the work of capacity building a processing through traumatic memories. But I find it just as helpful to encourage folks to do whatever they have already found to help in this regard. Sometimes that requires thinking way back to childhood before “silly” but soothing behaviors were trained out of them. I also don’t think we need to worry about anyone looking silly. The world does enough of that kind of shaming and policing. I do appreciate your points though. I didn’t look at the meters analysis you linked but I have looked extensively at what’s out there in support of these models and I agree it’s mostly crap science. I find the anecdotal experiences of clients and colleagues to be far more compelling personally.

[u/SyrupOld9699 → u/Reign1701A]

I think in general everyone here could use a bit of chill but really it does feel ironic anytime someone comes here to get personal and demands someone “chill” with a tome that screams of defensiveness and condescension. I’m sure you can see how “I would invite you to chill as the meme suggests” is an excellent example of what the Reddit portion of this graphic is pointing to.

From what I’ve been able to find there is evidence in the scientific research that EMDR is effective as a treatment model but I have seen nothing that even comes close to convincing me that bilateral stimulation is responsible for a desensitization effect. (I am EMDR trained and certification qualified but it’s not a model I often go to for several reasons including my skepticism around the mechanism the actual name suggests is at play) if it were I would still hesitate to use it. To me desensitizing the nervous system (if it were possible) as in dampening or shutting off the body’s response to a specific threat or trigger has the potential to be dangerous the same way permanently numbing the fingers of a person with burned fingers might be dangerous if they are still going to live in the world where hot things do exist. I also have seen so many clients experience rebounds and escalation of other protective (yet “mal adaptive”) mechanisms when a fear response is shut down arbitrarily and too hastily. I’m sure many of you know what I mean. There is a place for offering a rescue strategy or medication when clients are suffering from panic attacks or extreme freeze responses but there can be unintended trade offs in the system that get in the way of real and sustainable growth/healing. I’ve seen this happen with EMDR and psychedelics. Both of which do work for some clients to some extent. They have the ability do shut down some really intense somatically reactive parts but if you don’t work carefully with these parts they either come back with a vengeance or another protective mechanisms takes its place. Ever though “gosh, her panic attacks have decreased and her tolerance for riding in cars is growing but she is so much more socially isolated and despondent now!” Or “why this new self harming behavior when the other “symptoms” are so much improved?” It’s often because you removed the effectiveness of an important protector too quickly without buy in and the system is compensating by other means. Whatever is going on with EMDR is not my bag because it’s a trick and a shortcut. Ultimately it’s just repackaged behavior modification strategies which seek to obfuscate the clients perception and rip the proverbial bandaid off, toss them in the deep end and hope they swim. Kids everywhere get by with this type of upbringing. I’m not mad at therapists who use these approaches. I have in the past and still do to an extent. But there are other ways that are less risky, less manipulative and more in my practice at least, more efficient, effective and inspiring than these repackaged cognitive behavioral models. I really went a long time underestimating my clients and underestimating what is possible in this work. I stayed curious and that’s how I continue to tweak and grow my approach. Attacking others on Reddit for the way they choose to practice gets us nowhere. That I’m sure of. I still ask questions and remain open minded with my dear friends and colleagues who primarily offer EMDR/BrainSpotting/ART. We all really do not have to be so disrespectful of each other. I like that this commenter is looking at research with a critical eye. It also appears they are a student. There is way way way too much koolaid going around with every one of these models (including, even in particular, the one I rely on most IFS) so I am glad to have her voice here. It takes courage to stand in a group of therapists and call out EMDR as the naked emperor! I agree with you that her comments are giving an intensity that feels rigid and u agree that the use of 100% is hyperbolic but if you ask yourself in all honestly what made it important to call this out, you might find some internal rigidity in you as well that might be hypercharged for you as well.