More about Eye Movement Integration™

We are living in an age when all of us are more likely to be exposed to the tragedies of war, terrorism, natural disaster or other forms of violence. We need look no farther than the events of 9-11. In the United States tens of thousands of veterans of the wars in Vietnam, Iraq and Afghanistan have flooded treatment centers and overwhelmed the VA’s ability to respond. This is in addition to the more “homespun” causes of trauma we might experience in our own communities. But what actually happens when a soldier or civilian experiences violence, rape, severe accidents, physical or sexual abuse, or some other traumatic event?  

Memory research has helped to clarify the nature of trauma and the body’s resulting neuro-physiological reactions. As an example, scientists report that the brain’s amygdala and hippocampus heighten their intercommunication as emotional memories are formed and the body is flooded with a variety of stress hormones (Richter-Levin and Akirav, 2000). At the same time it is believed that these changes may interfere with the brain's processing of information about the event. In effect, a person's ability to deal with a traumatic situation is blocked, causing the event to remain in an anxiety producing form when stored and retrieved as a memory. As a result, some people continue to recall the full force of an event, along with the spectrum and severity of emotions experienced at the time of the trauma. This seems to prevent the brain from adequately processing and categorizing the memory as, in the past, and of no current danger to the individual. Subsequently, the memory, including its associated emotions, is "replayed" or re-experienced in the present. This occurs in the form of flashbacks, nightmares, or panic attacks.

Eye Movement Integration™ (EMI) is a brief therapy technique that is effective in treating acute and post-traumatic stress, but also phobias, the symptoms associated with addictions and negative or self-limiting thoughts. I have been using this technique in my counseling work with clients for ten years – ever since I first saw it demonstrated by Ron Klein of the American Hypnosis Training Academy (AHTA). Ron has trademarked his version of EMI, and whenever the acronym “EMI” appears on these web pages it should be understood that I am referring to the EMI approach taught by Ron at AHTA. More information about AHTA training opportunities can be viewed at www.ahtainc.com. Ron is a master trainer and a person I am pleased to consider a friend and mentor.

I was impressed from the start by EMI’s power as a rapid and successful intervention for healing trauma. After I became an experienced user of the technique, I took advanced instruction from Ron and became a certified trainer of EMI. I now enjoy teaching other therapists how effective this technique can be in resolving the problems associated with anxiety and post traumatic stress. In fact, I have become somewhat of an expert in its use myself. I have added new features of my own to EMI that, I believe, further enhance its reliability as an effective intervention.

In the clinical setting, a therapist uses EMI to interrupt the patterns that were established as a result of a traumatic event. At the beginning of the process the client is first “anchored” in a safe, secure, confident, or competent state – usually based on a previous experience of their own. The client is then asked to think about the event and/or to project a representation (memory) of the event out on a surface away from where they are sitting (therapeutic dissociation). While the client is projecting the memory, the therapist asks the client to follow the movement of a finger or pen in the foreground with their eyes. Because eye movements are thought to relate to the processing of specific types of cognitive information, it is believed that this technique allows the brain to reprocess the event without its traumatic aspects. The changes achieved are often dramatic.

Video Icon View Dr. Mike's video demonstrations of EMI at a Northern Virginia Licensed Professional Counselors presentation in December, 2012 and at the American Mental Health Counselors Association Annual Conference in June, 2012.

I have more than a casual interest in techniques for treating trauma – for a very good reason. Before becoming a licensed professional counselor, I myself suffered from Post Traumatic Stress Disorder (PTSD) as a result of childhood incest. I learned personally, and “from the inside out,” what it was like to heal from early abuse. During the course of my own healing, I was exposed to two of the most popular and “tested” approaches reported to be effective treatments for PTSD.  Based on my extensive work with EMI and my personal experience with other therapies, I have found EMI to be more efficient, safe, rapid and effective than the others. It’s also easier to learn. Of course, I’m biased, but I believe an objective comparison between EMI and other popular therapies would support my contention. Unfortunately, I’ve been unable to convince researchers that they should look more seriously at EMI – not that I haven’t tried. But that’s another story. Look for more on that topic in my blogs.

I have given presentations about EMI and demonstrated its use at a number of national and international conferences, including the International Conference on Male Sexual Victimization (2010), the Annual Conference of the Anxiety Disorders Association of America (2011), the Conference of the American Deafness and Rehabilitation Association (2011), and the Annual Conference of the American Mental Health Counselors Association (2012). I have demonstrated the use of EMI to graduate counseling programs on several occasions, and provided EMI trainings to hundreds of mental health professionals. In fact, every time I have given presentations or trainings, the results have been evaluated by participants as outstanding. There’s a reason for this. It works! But don’t take my word for it -- read what one seasoned survivor had to say:

I saw Mike present an experiential workshop on EMI at the International Conference on Male Sexual Victimization in 2010 and was incredibly impressed! Afterwards, he accepted our invitation to present a similar workshop at a Vita Cycles retreat. He was able to attain amazing healing results with subjects in both situations. I've seen many practices for healing trauma in the last 20 years, and his use of EMI was the most efficient, rapid and easy on the client. What most impressed us was his ability to help his subjects, whom he had never met, desensitize a very painful memory in less than 30 minutes. In addition, the results have stayed positive months later for the one individual I'm still in touch with. Mike was very approachable, amiable and relaxed with us. I recommend Mike very highly for whatever he does, but particularly for his mastery of EMI to help relieve the distress of traumatic memories.
Bob Faw
President, Board of Directors
Vital Cycles

I am committed to promoting greater understanding of this technique and fostering its appropriate use by mental health providers with trauma survivors. EMI has been called “softer and gentler” than other approaches. Other techniques require a “working through” of the offending events that caused the trauma in the first place – akin to facing down one’s demons. The client is urged to confront or re-experience the full effects of the trauma (immediately or gradually) as a part of therapy. In contrast, EMI is able to reduce or eliminate post-traumatic anxiety without ever having to bring to life the recalled terror. EMI is simple yet successful. Everything a therapist needs to know can be taught in 15 hours of instruction. Not only that; successful results with clients can usually be achieved in three sessions or less as described in the following case study:

EMI Case Study

(The details in this case have been altered to assure confidentiality).

I received an email from a therapist who knew of my expertise in trauma and my use of EMI. She wanted to refer a young woman who was raped by an ex-boy friend, but was refusing to talk about it.  “Mary” was having flashbacks and nightmares during which she would “see” a vivid, movie-like reenactment of what happened during the rape.  Then she would get a knot in her stomach, and her legs would tremble. In her thoughts she would berate herself for not having done more to stop him. It was then five years after the rape, and she had been seen by three different therapists. The symptoms associated with what happened were causing problems in her marriage.  She’d never explained the details to anyone. She’d been too frightened and ashamed.

Her first therapist told Mary she wasn’t ready to discuss it; she needed more time.  The second said that she would use an eye movement therapy with her, but the technique might give rise to some intense feelings from the rape.  Mary refused treatment and didn’t return for a second session. Her third therapist told me Mary wanted to resolve this issue, as long as she didn’t have to explain what happened. She also told me that Mary was probably an alcoholic, so they had been working on substance abuse issues. She asked if I could help her. 

I agreed to work with Mary, but she had to be prodded several times by her therapist and a family member to make an appointment. I tested Mary to see if she qualified for a diagnosis of PTSD. Mary’s score on the PTSD Checklist, Civilian Version, was 79, a very strong indication that she had PTSD. The test, developed at the Veterans Administration’s National Center for PTSD, consists of 17 questions with a potential range of scores from 17-85 -- the higher the score the stronger the evidence of PTSD (Blanchard, Jones-Alexander, Buckley and Forneris, 1996).  

Before we began I explained to Mary that I knew from her therapist why she had come to see me and promised she would not have to talk about what happened to her, unless she wanted to. She responded that she did not want to. I could see how anxious she was, occasionally looking at the floor and “collapsing” into the anxiety state she experienced whenever she thought about the rape. When I simply asked how she had been doing, one thing she told me was how she frequently hid in a closet, holding her arms around her knees and rocking back and forth, terrified. She reported doing that for hours at a time, only coming out when her husband was expected. She admitted “having a drink or two” to “numb” her feelings, but denied having an alcohol problem. She was able to meet her public obligations as a substitute teacher but was always afraid whenever she left home.

I commented how fearful she had to be when she was in the closet. She explained in detail what that was like, the thoughts she had and the associated feelings, giving me a baseline from which we could work. We weren’t discussing the rape but her habitual response to it. I asked if she would like to feel less fearful when she was in the closet, and she said yes. I explained how EMI might help and how it worked. I also told her that my number one goal would be to keep her safe while she was with me, never asking her to do anything she was unwilling to do. Before beginning I “anchored” her in a feeling of safety from a time in her past when she felt completely secure.

I already knew what it was like for Mary in the closet; she had told me. So I asked her to think of a recent time when she was there, a time that was typical, or a time that stood out in her mind. When she told me she had one in mind, I said I would be asking her to follow the pen I was holding with her eyes as she thought about that time.   We did one “round” of EMI and I asked her to think about the experience again and tell me if it was the same or different. She said it was different. She said, “I have less of a reaction to it.” We did it again. “It’s even less of a problem,” she said. We did it a third time. She looked more relaxed – less tense in the face, shoulders and arms, and she was breathing more evenly. She commented that she was feeling more positive – that it would be nice if she could go for walks like she used to. She questioned whether these effects would last. I told her they often did, but we would find out when I saw her next.

At her second appointment Mary reported she was still less fearful regarding her memory of that time in the closet, and she was expressing greater confidence. In fact, she had stopped retreating to the closet after our first appointment. “In general, I’m not as afraid,” she said. I explained that what we had done during the first session was a “band aid” – that we had not addressed the “real problem.” She said she understood.

When I asked if she would be willing to address the real problem, if she didn’t have to talk about it, she said yes with some conviction. She commented that she was willing to try EMI a second time, because it already seemed to help. Again, I first “anchored” her in a safe and comfortable experience from her past. Then we talked about how she felt and what her thoughts were when she recalled the real problem, while still assuring her safety and comfort. Again, I was not asking her to tell me the story, but to explain what happened to her as a result. We then did round one of EMI. I asked her if it was the same or different when we finished. She said it was “less than” it was before. I asked what that meant and she said, “I have less of a reaction to it.”  After round two, she said it was “farther away.” And after round three she said the knot in her stomach was not as tight and her legs were not trembling. She added that she was feeling for the first time like that memory was in the past. She said, “I want to move on.”

What happened next was typical of my EMI work with clients. Mary spontaneously described the worst part of the rape to me, complete with details – the information she had been holding inside for five years. I didn’t ask her to tell me. She was surprised when I pointed out that she had explained the worst of it without tears or the level of anxiety she had always experienced. She asked how I could change her thoughts and feelings about the rape so quickly, and we agreed that one day I would explain it to her.

Before our third session Mary sent me an email to let me know she had important things to share with me. We did not do EMI. She talked for the entire hour. She explained all the details of her relationship with her ex-boy friend, how she had to go through the legal system for protection and how, for the first time, she felt like she could put that behind her. But she also told me she was “angry” with me – angry because I had spoiled her plan to kill herself. It seems that she had prepared for her suicide well before our first appointment. She didn’t want to come see me in the first place. “What’s the use?” she had told herself. She was still considering suicide when she came for her second session, but she had begun to question her plan. After the second session she changed her mind after noticing a big difference in the tone of her journal entries before and after our two sessions. Mary also said she had poured all the alcohol in the house down the kitchen sink. She had no desire for a drink. She thanked me for helping her.

I saw Mary two more times -- once with her husband to help him understand the extent of Mary’s illness and the significance of her improvements. Mary told him about the planned suicide. She also explained how bad she felt about having considered ending her life, about lying about her drinking and her neglect of him while she was suffering. Mary’s final session was designed to help her let go of guilt and shame that she still harbored for her past actions. At the end of our fifth one hour session Mary’s score on the PTSD Checklist was 24, a drop of 55 points from her pretest. A 10-20 point change is considered clinically significant, so her results were remarkable.  More than that, Mary no longer qualified for a PTSD diagnosis. I then referred Mary back to her regular therapist for follow-up. I can add that Mary’s “case” is not unique, but rather a good example of the power of EMI.

One month after my last session with Mary I got an email from her therapist. This is what she had to say:

"I finally met with Mary and her husband this morning and we had a closure session.  She told me about her treatments with you.  It is amazing what you were able to accomplish with your skills.  She seems like a different person and her husband agrees.  She said that she goes to the mall alone now and went to the beach herself.  She is beginning to smell the roses.  She thanked me for being here for her these past few years and for referring her to you.  I feel confident that she will be okay now.  However, I did encourage her to get another therapist to continue working on getting to know herself."

The purpose of this case study was not to explain EMI in detail, but to portray how difficult cases of trauma can be resolved in a few sessions without requiring clients to actively relive a haunting traumatic memory. It’s also important to note that EMI can be utilized in conjunction with other therapies or by itself.   

I have used EMI with combat veterans, police officers, firemen, 9-11 first responders, rape and sexual abuse survivors, men and women who were shot or slashed in armed attacks and parents who lost children to suicide or illness. None of them had to tell their stories while we did EMI. It wasn’t forbidden, but it wasn’t necessary. A few went ahead and described what happened because they wanted to. Either way the results were just as positive. Proponents of other techniques have argued that, if a client is not discussing or re-experiencing the trauma at the time of an intervention, the results will not be as successful or durable. I have found this to be untrue. I can attest that even the most difficult memories can be resolved without re-activating the offending trauma and without undue distress during a treatment session.   

  

Eye Movement Integration History

EMI HistoryEye Movement Integration originated in the Neuro Linguistic Programming (NLP) field that formed in the late 1970s. More specifically, this technique was an outgrowth of the study of eye movement patterns by Robert Dilts and others (Dilts, Grinder, Bander and DeLozier, 1980). Dilts found that unconscious eye movements are systematic and correlate with the internal processing of different types of cognitive information. Although these results, originally labeled “eye accessing cues,” remain controversial, they nevertheless represent one of the more unique and useful of the NLP findings. I have decided not to include a separate section on NLP on this website, even though I am a trainer of NLP and a number of its presuppositions are important to understanding EMI. When I teach mental health professionals how to use EMI, these presuppositions are always covered in course materials and discussions. If you would like to learn more about NLP, one good resource is the Encyclopedia of NLP by Dilts and Delozier (2000). You can order a print version or view the encyclopedia online at www.nlpuniversitypress.com. In addition, there are hundreds of books and articles about NLP and plenty of information on the internet. Or you can take NLP courses from AHTA.

Connirae and Steve Andreas were the first to offer instruction in a specific therapeutic technique based on “eye accessing cue” research. They called this technique Eye Movement Integration. Although it originated in 1989, a recorded demonstration of the technique was first distributed in 1993 when a video was produced of Steve Andreas using Eye Movement Integration with a Vietnam veteran who suffered from PTSD. This DVD can be purchased at www.realpeoplepress.com.

Ron Klein attended a training session given by Steve Andreas before developing his own expertise in using Eye Movement Integration. After a period of time Ron added new features to the technique. A good example of Ron’s approach can be seen in a videotaped demonstration he gave of EMI with a dog attack victim (2001). Ron’s additions to Eye Movement Integration included the “anchoring” of the client in a “secure or competent” state before accessing the response to the trauma, the use of therapeutic dissociation and the use of hypnotic language. But, with the exception of these enhancements, Ron’s version remains basically true to the one originally developed and taught by Connirae and Steve Andreas. He trademarked his modified technique as Eye Movement Integration™, and he has been teaching this version at AHTA since that time. As I wrote at the beginning of this section, it is Ron’s version of EMI that I learned ten years ago.

Developing on a separate track was another version by Danie Beaulieu and contained in her book Eye Movement Integration Therapy: The Comprehensive Clinical Guide (2003). This was the first complete text on the technique, its theory and its practice. She describes her approach as a combination of the original Andreas technique and another eye movement therapy called Eye Movement Desensitization and Reprocessing (EMDR). EMDR was different from Eye Movement Integration. It was developed by Francine Shapiro (1989) and first reported at the same time that Eye Movement Integration was being introduced by Connirae and Steve Andreas. Beaulieu took a brief workshop led by Steve Andreas at the same conference in 1993 where he demonstrated Eye Movement Integration with the Vietnam veteran. Afterwards, she began to use Eye Movement Integration with clients, although she reports in her book that her initial results were varied. She found herself adding new dimensions to the technique and notes that about half of the changes she made to the Andreas’ protocols were based on her own “intuition and experience.”

About three years later she heard of EMDR and took both levels of its training between 1996 and 1997. I am not qualified to fully compare and contrast Eye Movement Integration with EMDR, because I have not had EMDR training. However, EMDR was used with me while I had PTSD, so I do have pragmatic experience with the therapy. Beaulieu, however, goes into some detail about the similarities and differences between Eye Movement Integration and EMDR. She describes in her book how she then adopted certain aspects of EMDR and made them part of her practice of Eye Movement Integration. Now that Eye Movement Integration and EMDR have been in use for over 20 years, it is apparent that the techniques have had an influence on each other, with elements of each found in the other’s practice. A full investigation of the history and interplay between these two techniques is best left as a topic for a future doctoral dissertation. However, a brief review of video demonstrations of these two interventions on the internet will show some obvious “cross-fertilizations.”

After years of using EMI with my own clients, it occurred to me that the efficacy of this technique could be further improved if I added strategic spoken utterances at the same time as the eye movements. It was important that I maintain the integrity of Eye Movement Integration as developed by the Andreas’ and enhanced by Ron Klein (EMI), while also bolstering the technique’s effectiveness with powerful NLP strategies. Among the additions were the use of reframing language and hypnotic “imbedded commands,” while the client is both thinking about the traumatic event and watching the movement of a pen with their eyes. The use of both was designed to correlate with the original eye accessing patterns reported by Dilts. One might think this could be a bit confusing for clients, but it actually works quite well.

This brief historical description may leave questions for those unfamiliar with EMI. If so, I encourage you to learn more, especially if you are a mental health practitioner. What I have endeavored to make clear is that the EMI I use with clients and teach in seminars is a direct descendent of those taught by Steve Andreas and Ron Klein. I have also drawn attention to the dynamic differences between the techniques taught by Ron and me when compared to other eye movement therapies. In our versions the client is “anchored” in safety or competence prior to beginning the eye movements (his innovation). Both Ron and I also use “therapeutic dissociation” as a part of our techniques (also his innovation). Because of these protections, the client is less likely to re-experience the multi-sensory anxiety of the original trauma while the eye movements are performed. And, most importantly, I have found that the use of EMI makes it unnecessary for clients to tell their difficult stories, for to do so unnecessarily increases the potential for severe reactions (what are called abreactions).

As I indicated, I am devoting time and energy now to increasing awareness of the simplicity and yet the remarkable effectiveness of EMI. If you have questions about training opportunities, or if you would like more information about EMI, you can contact me at drmike@deninger.com. I am available to do short term (2-3 session) therapy work with clients individually, if they are referred by their therapist, to address problems associated with acute stress or PTSD. I am also available to teach the 15 hour Level I EMI program or the 7 hour Level II to mental health practitioners (see the course descriptions below). I am always eager give presentations or demonstrations of EMI, Ericksonian Hynotherapy or NLP. As a survivor of sexual abuse, and as a board member of Male Survivor: The Organization Against Male Sexual Victimization, I also bring a consumer’s perspective to each presentation I make. Think of it as a two for one sale!

 

EMI Course Summaries

Level I

This course begins with a review of the history and development of Eye Movement Integration™ (EMI) from its origins as a part of Neuro Linguistic Programming in 1980 to the present. Participants learn several NLP presuppositions upon which this technique is based and their relevance to EMI. Participants also learn how stress-causing events, thoughts, neurobiology and sensory information interrelate in the persistence of anxiety and traumatic memories. Through demonstration and practice, participants learn how to establish rapport with a client, test for eye accessing patterns, anchor a client in safety or confidence, determine the structure of an anxiety producing memory, use therapeutic dissociation, deal with client abreactions and effectively perform an EMI session and evaluate the results using a subjective units of distress (SUD) scale and the PTSD Checklist – Civilian Version.  Mastery of the skills taught in this course prepares participants to successfully utilize this technique with clients. This course requires 15 hours of instruction and is normally scheduled on two consecutive days. A certificate of completion from Phoenix Counseling & Hypnotherapy is awarded to participants who demonstrate mastery in course content. 

Level II

Level II is designed for participants who have completed level one or who have sufficient experience in using EMI with clients (as determined by the teacher). The course begins with a brief review of the topics taught in level one followed by a question and answer period to make sure that any clarifications needed are satisfied. New skills taught in level II include the concepts of spoken “imbedded commands” and “reframing language” and how to integrate these NLP techniques when using EMI with clients. Sufficient demonstration and practice assures the acquisition of these new skills. Participants also present case studies of their own use of EMI, whether successes or failures, followed by “post mortems” and group discussion. This course requires 7 hours of instruction. Certificates of completion are also awarded for this program.


References

Andreas, S., 1993. NLP Eye Movement Integration, video, NLP Comprehensive, Boulder,  Colorado.

Beaulieu, D., 2003. Eye Movement Integration Therapy: The Comprehensive Clinical Guide, Crown House Publishing, Williston, VT.

Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behavioral Research & Therapy, 34, 669-673.

Deninger, M., 2010. Eye Movement Integration™: A “Sensational” Brief Therapy Technique for Reducing the Effects of Trauma. Presentation at Male Survivor’s 12th International Conference: Healing & Hope. March 18-20, New York City.

Dilts, R., Grinder, J., Bandler, R., and DeLozier, J., 1980. NLP (Vol. I), Meta Publications, Capitola, CA.

Dilts, R. and Delozier, J, 2000. Encyclopedia of Systemic NLP and NLP New Coding, NLP University Press, Scotts Valley, CA

Klein, R., 2001. Eye Movement Integration™: PTSD – Dog Attack (video). American Hypnosis Training Academy, Inc.

Shapiro, F., Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories, Journal of Traumatic Stress, 2(2), 199-223