Discouraged by six months of conventional psychotherapy, Baumgartner turned last August to a treatment called EMDR, or “eye-movement desensitization and reprocessing.” During three 90-minute sessions, a counselor passed two fingers rapidly back and forth near her face and coaxed her to recall the rape scene while following the motion with her eyes. The first session was so traumatic that Baumgartner nearly urinated on herself. as she had during the assault. Four weeks later, she was laughing and joking on her way in and out of the clinic. Today, she says, “I’ve gone from being withdrawn and depressed to enjoying life again. And the thought of being in an intimate relationship no longer terrifies me.”
Unheard of just five years ago, EMDR has lately emerged as one of the hottest trends in clinical psychology. Thousands of traumatized people-rape victims, combat veterans, survivors of hurricanes and child abuse–are now t ing the treatment, and some 7,000 therapists have taken weekend seminars to master it. Dr. Steven Lazrove, a psychiatrist at Yale, calls EMDR “the most significant advance since the introduction of pharmacological drugs.” In an eye-catching cover line, New York Magazine dubbed it a “miracle cure.” Unfortunately, the excitement is based largely on testimonials. Proponents have yet to show scientifically that EMDR has unique advantages over other forms of therapy. They may believe it’s the best thing since Prozac, but critics suspect it has more in common with snake oil.
Francine Shapiro, the California therapist who invented EMDR, says she stumbled on the idea while strolling through a park in 1987. She was 38 at the time. and a graduate student at the now defunct Professional School for Psychological Studies in San Diego. During her walk, Shapiro noticed that a distressing thought she’d been harboring lost its edge when she moved her eves rapidly from side to side. Suspecting that her eye movements had activated some neurological housekeeping mechanism, she started trying to reproduce her experience in trauma survivors. The conventional treatment, known as “exposure.” or “flooding,” involves getting the sufferer to focus on a traumatic memory until it becomes less threatening. Shapiro drew on the exposure principle. But in keeping with her epiphany, she had her patients track her fingers back and forth while they relived their traumas.
In 1989 Shapiro published two scholarly papers (including her Ph.D. thesis), describing patients who felt they benefited from her treatment. And in 1991 she set up a company, the EMDR Institute, to market weekend training courses for psychologists and psychiatrists. “When I first saw the Shapiro study I thought it was a California cult thing,” says psychologist Steven Silver of the Coatesville VA Medical Center in Pennsylvania. “Then I went through the training and brought it back to our unit. We’ve had excellent results for three years. I’ve seen changes occur with a speed I’ve never seen before.”
Like many treatments, EMDR lacks a clear rationale. Proponents speculate that the exercise triggers some innate mechanism for filing painful memories away. It’s widely assumed that REM, the dreaming sleep phase in which our hearts race and our eyes twitch in their sockets, helps consolidate sensory data for long-term storage. As psychologist Clifford Levin of Palo Alto’s Mental Research Institute wrote recently, “EMDR may be effective because it reinitiates the kind of natural information processing cycle found in REM sleep.”
Slim evidence: But the key question is whether EMDR works, not how. if anecdotes alone could establish a treatment’s efficacy, sleeping with a pyramid under your bed would qualify as serious medicine. Since a new remedy often spawns great enthusiasm (remember primal scream therapy?), the accepted drill is to determine whether it measurably outperforms some alternative. In her initial 1989 study, Shapiro assigned 22 trauma survivors to undergo exposure therapy with or without her guided eye movements. She reported that the EMDR patients improved dramatically while those getting conventional therapy made little progress. But critics like Hahnemann University psychologist James Herbert note that Shapiro used no objective measures of patients’ functioning, either before or after treatment; she simply recorded their own impressions. And instead of having outside investigators treat and assess the patients, she handled everything herself a practice that can easily produce biased findings. Other supportive studies have had the same problems.
EMDR advocates say more rigorous studies are now achieving results consistent with Shapiro’s. But such findings have yet to show up in the scientific literature. Meanwhile, several controlled studies have found that patients receiving EMDR fare no better than those in conventional therapy. In one experiment, researchers led by Dr. Roger Pitman of Harvard Medical School and the VA Medical Center in Manchester, N.H., assigned 17 troubled Vietnam veterans to undergo exposure therapy with their eves either fixed or moving. Their conclusion: “The … procedure incorporating eye movements did not show an apparent therapeutic superiority.”
Such findings haven’t dampened Shapiro’s enthusiasm. Her EMDR Institute, based in Pacific Grove, Calif, continues to charge therapists $570 for a four-day training course. Many psychologists are appalled that she has participants sign agreements promising not to share what they’ve learned. Shapiro says she just wants to ensure that every EMDR practitioner is adequately trained. If the treatment were misused, she says, “the client could get hurt.” But critics say the main effect is to shield EMDR from impartial scrutiny -the very force that drives scientific progress.
The technique may yet be vindicated. Patients like Dawn Baumgartner already have all the evidence they need-and therapists are understandably excited when they see people’s lives transformed. “We need more studies, on different populations, from different labs, before we come to any conclusions about this,” says Pitman. But as University of Virginia psychologist David Waters wrote recently, “Our hunger for powerful, quick, and easy treatments … can easily lead us to accept them uncritically.” For now, touting EMDR as a breakthrough is premature. Glittering testimonials may inspire awe, but as every therapist should know, they don’t prove a thing.
