EMDR-Web.org

Journal of Humanistic Psychology
52(4) 401–422 What Makes a Good © The Author(s) 2012
Reprints and permission: http://www.
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0022167811431960
http://jhp.sagepub.com

What Makes a Good EMDR Therapist?

Exploratory Findings
From Client-Centered
Inquiry

Jamie Marich1

Abstract

There are several qualities of good EMDR (eye movement desensitization
and reprocessing) therapists that must be examined to understand what
clients most value in this specialized treatment. These qualities, as defined by
former clients, include therapist personality, an ability to empower clients,
flexibility, intuition, a sense of ease and comfort in working with trauma, and
a commitment to the small measures of caring that clients identify as helping
them feel safer. This article highlights the importance of honoring client safety
in EMDR treatment by further exploring a theme from a phenomenological
parent study on the use of EMDR with women in addiction continuing
care. The parent study offered qualitative evidence showing that there is a
place for EMDR as part of a comprehensive women’s addiction recovery
program when applied properly. In this article, participants’ descriptions
of their EMDR therapists and how these therapists were able to establish
safety are described in greater detail than the parent study article allowed.
Implications for emphasis on client-centered factors in the training and formation
of EMDR therapists are discussed using the data extrapolated from
the clients’ experiences, and further directions for researching the client-
centered perspective in EMDR are presented.

1PsyCare, Inc.,Youngstown, OH, USA

Corresponding Author:

Jamie Marich, PsyCare, Inc., 2980 Belmont Avenue,Youngstown, OH 44505, USA
Email: jamie@jamiemarich.com

Journal of Humanistic Psychology 52(4)

Keywords

phenomenology, therapeutic alliance, client safety, client-centered EMDR,
EMDR training, EMDR protocols, EMDR therapists

The lived experience of 10 women who participated in eye movement
desensitization and reprocessing (EMDR) treatment during addiction continuing
care revealed that, when applied properly, there is a place for EMDR
as part of a comprehensive addiction recovery program (Marich, 2010). Four
major themes emerged from a major study that inform clinicians how to successfully
implement EMDR into an addiction recovery program. One theme
stressed the importance of ensuring client safety before beginning major
EMDR work. The purpose of this article is to go into greater depth than the
parent study allowed on the role of the therapeutic alliance in EMDR treatment,
especially as a strategy for assuring client safety. When examining the
theme in greater depth, there are several qualities of a good EMDR therapist,
which can be highlighted in order to bolster understanding of what former
clients value as important in EMDR treatment. These qualities include therapist
personality, ability to empower clients, flexibility (vis-à-vis rigidity to
set EMDR protocols), intuition, a sense of ease and comfort in working with
trauma, and a commitment to the small measures of caring that former client’s
identify as helping them feel safer. Emphasizing the importance of these
factors within the psychotherapeutic professions predates the discovery of
EMDR as an approach to psychotherapy. Most writing on EMDR by professionals,
including EMDR founder Francine Shapiro, emphasizes fidelity to
set protocols that are unique to EMDR as a major factor in ensuring client
safety. Thus, the information derived from this exploratory, client-centered
inquiry has the potential to challenge extant knowledge about what elements
of EMDR are the most important to those who receive it.

Literature Review

Developed by psychologist Dr. Francine Shapiro in 1987, eye movement
desensitization and reprocessing (EMDR) evolved from a simple desensitization
technique into a comprehensive, eight-phase therapeutic approach.
Desensitization with bilateral stimulation (e.g., eye movements or acceptable
alternatives such as alternating tactile motions or audio tones) constitutes
only one of the phases (F. Shapiro, 2001). Elements from several major
schools of psychotherapeutic thought, including client-centered philosophy
and its emphasis on letting the process of therapeutic change organically

Marich 403

unfold, are present in the EMDR approach (Bohart & Greenberg, 2002; Moskovitz,
2001). Many significant clinical bodies (American Psychiatric Association,
2004; Chambless, 1998; Department of Veteran Affairs & Defense, 2004; Foa,
Keane, & Friedman, 2000) classified EMDR as an efficacious treatment for
posttraumatic stress disorder (PTSD). Moreover, a variety of clinical presentations
that do not necessarily merit a formal Diagnostic and Statistical Manual
of Mental Disorders—Text Revision (American Psychiatric Association,
2000) diagnosis of PTSD but are connected to unresolved, antecedent memories
can be successfully addressed with EMDR (Grey, 2011; Korn, 2009;
Maxfield, 2007; R. Shapiro, 2005; R. Shapiro, 2009; Zweben & Yeary,
2006).

Several meta-analytic studies validate the use EMDR in treating PTSD
(Bisson & Andrew, 2007; Ironson, Freund, Strauss, & Williams, 2002; Maxfield
& Hyer, 2002; Power et al., 2002; Van Etten & Taylor, 1998). Furthermore,
the comorbidity between substance use disorders and PTSD has been well
established in the literature (Kessler, Sonnega, Bromet, Hughes, & Nelson,
1995; Najavits, Weiss, & Shaw, 1997; Ouimette & Brown, 2002; Peirce,
Kindbom, Waesche, Yuscavage, & Brooner, 2008). Since the discovery and
clinical dissemination of EMDR, the treatment has been successfully used
with clients who have a substance use disorder, justified by the established
comorbidity between PTSD and substance use disorders (Brown, 2003;
Lipke, 2000; Shapiro, Vogelman-Sine, & Sine, 1994; F. Shapiro & Forrest,
1997; Zweben & Yeary, 2006).

The parent arm of this study (Marich, 2010) continued an emergent wave
of research on successfully implementing EMDR in the treatment of addictions
(Abel & O’Brien, 2010; Brown & Gilman, 2007; Cox & Howard,
2006; Hase, Schallmayer, & Sack, 2008; Marich, 2009; Ricci, Clayton, &
Shapiro, 2006; Zweben & Yeary, 2006). Marich’s (2009) case study was the
first on EMDR and addiction to convey a truly phenomenological perspective.
Phenomenology rejects the Galilean notion that an individual’s worldview can
be quantified (Crotty, 1998; Giorgi, 1985). Examining the subjective, human
experience is the essence of phenomenological inquiry (Marich, 2010), and it
is a perspective historically missing in EMDR writing. Although many case
studies and field reports of real-world EMDR clients appear in the literature,
the therapist’s third-person view serves as the primary voice. Recent pilot
research by Stewart-Grey (2008) and qualitative research by Edmond,
Sloan, and McCarty (2004) and Ricci and Clayton (2008) began giving
direct voice to the client experience by using open-ended, experiential
methods.

Journal of Humanistic Psychology 52(4)

According to client experience, the quality of therapeutic alliance between
client and clinician is an important mechanism in facilitating meaningful
change for clients with complex PTSD (Fosha, 2000; Fosha & Slowiaczek,
1997; Pearlman & Courtois, 2005). Since the client is active in that alliance,
it is important to obtain their perspectives in assessing the role of the alliance
in EMDR treatment. Dworkin (2005) asserted that relational issues between
client and clinician often affect whether EMDR results are positive or negative
for clients.

Even with her consistent emphasis on fidelity to the protocols of EMDR,
Shapiro acknowledges the importance of the therapeutic alliance in EMDR
treatment. She described the execution of EMDR as an essential interaction
between client, method, and clinician (Dworkin, 2005; F. Shapiro, 2001). In
her 2001 text, she indicated that because the potential for disturbance between
EMDR sessions is high, the need for a strong therapeutic alliance becomes
extremely important. She suggested that having truth-telling agreements in
place are key and that the therapist must be able to impart safety, flexibility,
and unconditional regard. Several other EMDR authors have made reference
to relational issues in their writing (Greenwald, 2007; Leeds, 2009; Lipke,
2000; Luber, 2009; Maiberger, 2009; Parnell, 2007), although elements of
technique, protocols, procedures, scripts, and explanatory models seem to
take precedence in these works. Of these texts, Greenwald and Parnell most
directly acknowledge the synergistic effect of protocols and procedure with a
solid therapeutic alliance. Dworkin and Errebo (2010) proposed a process for
better training EMDR therapists to repair ruptures in the therapeutic alliance,
a task that they identified as overlooked in most EMDR training, but one that
is essential to the overall success of EMDR treatment.

In examining literature from the psychotherapeutic professions at large, it
can be argued that F. Shapiro’s (2001) position of client, method, and clinician
interacting equally puts too much emphasis on method (see Wampold, 2001,
2007). Rosenzweig (1936), in response to the numerous philosophies of
therapy asserting superiority in his era, published the concept of the four
common factors. The common factors emphasize the similarities, not the differences,
of successful psychotherapies. These common factors are the clients
and their extratherapeutic factors (e.g., assets brought to the therapy process
and situations out of the control of the clinician), models and techniques that
work to engage and inspire the client, the therapeutic relationship/alliance,
and therapist factors. In their systematic review of over 60 years of psychotherapy
research, Duncan, Miller, Wampold, and Hubble (2009) contend that
Rosenzweig’s original hypothesis is supported by the literature:

Marich 405

We conclude that what happens (when a client is confronting negative
schema, addressing family boundaries, or interpreting transference) is
less important than the degree to which any particular activity is consistent
with the therapist’s beliefs and values (allegiances) while concurrently
fostering the client’s hope (expectations). Allegiance and
expectancy are two sides of the same coin: the faith of both the therapist
and the client in the restorative power and credibility of the
therapy’s rationale and related rituals. Though rarely viewed this way,
models and techniques work best when they engage and inspire the
participants. (p. 37)

Applying this logic to EMDR, it is insufficient to rely on EMDR method and
protocol for the sake of relying on it; rather, EMDR clinicians must be flexible
in their application of method so that a client remains engaged. Part of
this engagement includes knowing when to deviate from the pure technique
of EMDR protocols and to rely more on the humanistic, empathetic responses
that are indicative of client-centered approaches. One of the major differences
between client-centered therapy and EMDR is that although both rely
on the organic flow of a session to facilitate change, EMDR uses eye
movements (or other bilateral stimulation), where client-centered therapy
makes use of empathetic responses to stimulate this flow of information
processing (Bohart & Greenberg, 2002; DiGiorgio, Arnkoff, Glass,
Lyhus, & Walter, 2004). Humanistic, client-centered therapists typically
integrate the two approaches, knowing when to adjust EMDR protocol if
it seems too artificial or contrived for a specific client (DiGiorgio et al.,
2004; Marich, 2011).

Using a collection of empirical research studies and chapters from the
psychotherapeutic professions, Norcross (2002) demonstrated that a combination
of the therapy relationship, together with discrete method, is critical to
treatment outcomes. Norcross further concluded that relational skills can be
honed by therapists, and that it is the therapist’s responsibility to tailor these
skills to the needs of individual clients. Collected volumes by Duncan et al.
(2009) and Norcross (2002) comprehensively support the significance of
relational elements that Carl Rogers (1957) introduced. The classic Rogerian
constructs of empathy, genuineness, and unconditional positive regard that
constitute the foundation of client-centered therapy still have relevance in
the modern era where the influence of the medical model has placed more
emphasis on standardization, treatment protocols, and manual-driven therapy
(Duncan, et al., 2009; Eugster & Wampold, 1996; Yalom, 2001).

Journal of Humanistic Psychology 52(4)

Method

The author used a qualitative, phenomenological design that incorporated
semistandardized interviewing as the primary modality of data collection
in the parent arm of the study (Marich, 2010). Guided by the work of
McCracken (1998) and a qualitative study on the use of EMDR with sex
offenders (Ricci & Clayton, 2008) in composing the instrument, further refinement
of the instrument occurred following a field-test interview (Marich,
2009). The field test case was not included in the parent study because the
case was the author’s former client. For the parent study, the author decided
to obtain a sample of female clients that she did not treat to ensure a greater
degree of objectivity. Participant recruiting was a combined effort between
the author and the partnering women’s treatment facility.

The research design used a blend of purposive and criterion sampling.
Purposive sampling is primarily employed in exploratory research. Cases are
selected based on the unique qualities that these cases offer in addressing a
research problem (Mertens, 2006; Neuman, 2006). To meet criteria for participation
in the study, at least 6 months needed to have passed between
engagement in EMDR treatment and the time of the interview. Six months is
a time frame established by the author to allow for perspectival reflection.
Identification as an alcoholic or addict was not necessary to participate, but an
addiction treatment episode must have occurred (Marich, 2010). A formal
diagnosis of PTSD was not necessary to participate since the emphasis of the
study was on the recovery experience and because practice evidence indicates
that EMDR can be useful in presentations other than PTSD (Maxfield, 2007;

F. Shapiro & Forest, 1997; R. Shapiro, 2005, 2009; Stewart-Grey, 2008).
Following institutional review board approval by the author’s academic
institution, the partnering facility invited several hundred alumnae of its program
by mail, phone, and public announcement to participate in the study. All
reasonable attempts were made to contact adult (i.e., 18+) alumnae treated at
the facility since their initiation of EMDR programming in the mid-1990s. To
allow for the possibility of negative case analysis, the author asked that all
eligible participants be invited to participate, not just those participants who
had good experiences with EMDR. Interested participants contacted the liaison
from the partnering treatment facility, who obtained release of information documents.
The author conducted a brief telephone screening to determine appropriateness
(e.g., 6 months since last EMDR session and acknowledgement of
informed consent parameters). The author interviewed the first 10 women to
come forward, and others were put on a waiting list. Participants were given
a short orientation to the interview process and debriefed about what to

Marich 407

expect. With the written permission of the participants as part of the informed
consent process, all the interviews were audio recorded and then transcribed
(Marich, 2010).

The author conducted the interviews over a 2-month period in early 2009.
The 26 questions on the semistandardized interview instrument covered three
major areas: demographic information, background questions about life in
addiction, the EMDR treatment experience, and EMDR’s impact on overall
addiction recovery. Only one of the questions on the 26-item interview
directly posed, “What role did the EMDR therapist play in your treatment?”
(Marich, 2010). Because the parent study focused on the role of EMDR in the
overall recovery experience, one question seemed appropriate at the time of
instrument construction. The remainder of this article will demonstrate that
this one question yielded a wealth of information.

A well-selected data analysis procedure is a critical aspect of a qualitative
research design. Data analysis procedures for qualitative data give researchers
a step-by-step method to follow for reading, coding, and interpreting
information. Otherwise, a qualitative researcher can be easily accused of scouring
the data to locate passages that she is looking for to support her own preconceived
contentions (Marich, 2010). Giorgi’s Descriptive Phenomenological
Psychological Method (Giorgi & Giorgi, 2003), a four-step procedure for
coding the verbal data, identifying the meaning units within the data, and
translating those meaning units into identifiable psychological themes, was
selected to analyze the data in the parent study. The Giorgi method was chosen
because of its solid basis in phenomenological philosophy and its recognition
by an American Psychological Association publication as a viable
qualitative research strategy (Camic, Rhodes, & Yardley, 2002). The author’s
dissertation committee chairwoman listened to all the interviews as an
accountability check to ensure that the author, a certified EMDR therapist, was
coding with the Giorgi system and not her own beliefs (Marich, 2010).

The study participants ranged in age from 27 to 52 years (mean = 41.7;
median = 46.5) at the time of their interviews. Four of the participants identified
as African American (or Black), five identified as Caucasian, and one
identified as mixed European-Iranian. The time in continuous sobriety
reported by each participant ranged from 1 to 6 years (mean = 3.75 years;
median = 3.625 years). Various primary addictions of choice were represented,
with several of the women considering themselves cross-addicted to
multiple substances and maladaptive behaviors (e.g., sex, overeating). The
participants reported a variety of religious, educational, and parenting/family
experiences. Eight of the participants reported prior addiction treatment episodes,
one participant reported no prior treatment, and one participant reported

Journal of Humanistic Psychology 52(4)

prior treatment in a correctional facility only. According to the Director of
Trauma Services at the partnering facility (personal communication, March 9,
2009), EMDR was incorporated into the treatment plans of each participant
based on her respective treatment team’s evaluation of her needs and readiness.
Thus, the time of EMDR implementation varied (from 1 month of observed
sobriety to 2 years among the sample) because of the facility’s individualized
treatment plan philosophy (Marich, 2010). All the participants in the study
worked with a primary counselor (non-EMDR), several different group counselors,
case managers, and their EMDR therapists.

Results

Four major thematic areas emerged from the interview data in the parent
study:

1.
The existence of safety as an essential crucible of the EMDR experience
2.
The importance of accessing the emotional core as vital to the
recovery experience
3.
The role of perspective shift in lifestyle change
4.
Using a combination of factors for successful treatment
All 10 women, to some degree, credited EMDR treatment as a crucial component
of their addiction continuing care, especially in helping with emotional
core access and perspective shift (Marich, 2010).

Thematic Area 1, the existence of safety as an essential crucible of the
EMDR experience, offers valuable, client-centered insight into how EMDR
can be best implemented into addiction treatment programs. Four subthemes
demonstrate the various ways that safety was established and assured for the
participants: the treatment setting itself, quelling initial skepticisms about
EMDR, the role of the EMDR therapist, and features of the EMDR approach.
Even though just one of the subthemes directly addresses the characteristics
of EMDR therapists, the EMDR therapist was responsible for executing all
four functions identified by the former clients as being important, often using
client-centered therapeutic techniques that are not unique to EMDR. These
elements will be expanded on in each subthematic area.

Subtheme 1: The Treatment Setting

The participants needed to feel that they were not going to be attacked or
belittled. This assurance was crucial for them to “open up” in the meaningful

Marich 409

way that EMDR fosters. The collective experience of the participants revealed
that there were three major ways in which the treatment setting created a safe
environment. Being surrounded by women with similar histories was one
component; however, the other two components related to staff members
(especially therapists) who operated the facility: the trauma-informed nature
of the program and optimistic reception by facility staff and therapists.

One of the most significant examples of how the treatment program created
safety is from Fadalia’s experience. Fadalia (pseudonym), an Iranian
American treated approximately 25 times prior, the most of any of the participants,
shared: “The people that I worked with here communicated to me
somehow that they believed that I could really stay clean. I never really experienced
that before.” Fadalia believed that if she was greeted cynically like
she had been at other treatment centers, she would not have gotten sober and
well. The staff at these other centers doubted her ability to get sober, which
reinforced her inner sense of shame. Fadalia needed empowerment, and the
staff provided that. She expressed that she would not have felt safe to open
herself up for EMDR had she been received with cynicism, and other participants
related to this experience (Marich, 2010).

Subtheme 2: Quelling Initial Skepticisms About EMDR

Nine of the 10 participants initially experienced some level of skepticism
about EMDR. This skepticism ranged from mild hesitation to blatant fear
that the treatment facility was out to control them. There were several factors
that ultimately allowed the women to feel comfortable with the EMDR
approach (e.g., simple education from counselor, mustering internal willingness,
hearing positive experiences about EMDR from other members in the
therapeutic community, an existent trusting relationship with a reliable counselor).
For the purposes of this article, it is important to note that two of those
four factors directly involved therapist action and/or presence. Denise
(pseudonym), a marijuana addict with bipolar disorder and a history of
molestation, shared that she originally harbored a great deal of skepticism
about EMDR, and as a result, it did not seem to work. In her interview,
Denise shared that as she developed trust in the EMDR therapist, the more
confident she felt about the therapy and the more it seemed to work for her.
The majority of the participants described similar experiences. For several
other participants, the therapist’s willingness to provide them with information
about the therapy helped them feel more assured about proceeding with
EMDR. This simple, educational process lessened some existent fears that
the counselors, and the facility itself, were trying to “control” or “manipulate”
them, legitimate fears for survivors of trauma.

Journal of Humanistic Psychology 52(4)

Table 1. Adjectives Used to Describe EMDR Therapists

Positive Experiences Negative Experiences
Caring Rigid
Trustworthy Scripted
Intuitive Detached
Natural Anxious
Connected Unclear
Comfortable with trauma work Uncomfortable with trauma
Skilled
Accommodating
Magical
Wonderful
Commonsensical
Validating
Gentle
Nurturing
Facilitating
Smart
Consoling
“The bomb”

Subtheme 3: The Role of the EMDR Therapist

In summary, feeling that they were in capable hands with their EMDR therapists
facilitated fulfilling EMDR experiences for the women (Marich, 2010).
Eight of the 10 participants described their EMDR therapists in positive
terms, and these adjectives appear on Table 1. This table showcases little,
if any, emphasis on the therapist’s technical competence; instead, the table
showcases adjectives that are indicative of client-centered approaches to therapy
predominate. An interesting aspect of the parent study is that 7 of the 10
participants had the opportunity to work with two or more EMDR therapists
during their time in the treatment program. Two of the participants, Cindy and
JoElle, indicated that they needed to switch EMDR therapists before they
were able to experience good results from the treatment.

Cindy (pseudonym), a recovering heroin addict with multiple mental health
issues (PTSD, bipolar disorder, borderline personality disorder), believes that
she experienced virtually no progress with her first EMDR therapist, who she

Marich 411

described as rigid, scripted, and not comfortable with trauma work. Cindy, a
Caucasian lesbian in her 30s, shared that her first therapist seemed overly
concerned with getting scale readings throughout the session (e.g., subjective
units of distress on a 1-10 scale) that inhibited forging a connection. Cindy
revealed that she was able “to really process and get stuff done” when she
switched to another EMDR therapist. Looking back on her experience, Cindy
views EMDR as “something that’s very personal and very involved and I
think it takes a special kind of counselor to pull stuff out of you.” Cindy
described the therapist who she ultimately connected with as intuitive, natural,
and very comfortable with trauma work. For Cindy, this was significant
because her good therapist:

Played a very significant part in knowing exactly what she needed to
say to me to either bring stuff out or to move onto something else or to
focus on this. And I think it was huge, actually, in making that connection
that was so important.

Highlighting Cindy’s experience is very significant to this inquiry because
Cindy is one of the few participants from the study who directly credited her
current sobriety specifically to EMDR treatment and not a combination of factors.
At the time of the interview, Cindy was working on her bachelor’s degree
in substance abuse counseling, with the goal of going on to be an EMDR
therapist herself.

JoElle (pseudonym), a biracial woman who identifies as Black, shared
similar experiences when it came to switching EMDR therapists. JoElle developed
a heroin addiction in her late 30s following 23 years of abstinence from
marijuana. Both Cindy and JoElle were heroin addicts with multiple prior
treatments, and both grew up in homes where rigid religious beliefs reinforced
shame-based identities. For JoElle, a connection with her EMDR therapist
was an important component of her perceived progress. JoElle shared that her
first EMDR therapist, the same one that Cindy had a problem with, made her
feel uncomfortable. JoElle revealed, “She didn’t make it really clear to me that
I could just do nothing, so I felt uncomfortable.” In essence, this therapist did
not emphasize the nonjudgmental, organic flow that can make EMDR sessions
inherently client-centered. JoElle further indicated that the therapist
seemed overly anxious after each set about seeing some kind of effect, and
when nothing out-of-the ordinary happened, JoElle felt like she was doing
something wrong. Like Cindy, JoElle began to experience immediate results
with EMDR when she switched to the same, “natural” therapist that Cindy
also experienced as positive. JoElle expressed:

Journal of Humanistic Psychology 52(4)

She was a natural for this job. I could think something and she would
say it. She was just amazing and she knew so much . . . she just knew
a lot about me and she was really easy to talk to. She used, to me, a lot
of common sense along with counseling. That’s not always done. She
was the greatest.

Like Cindy, JoElle also indicated that the new counselor seemed to have a
solid understanding of trauma that enhanced JoElle’s overall comfort level.
Moreover, the new counselor had a way of making JoElle feel empowered.
“With her,” JoElle shared, “I did not seem like just a number.” The adjectives
that Cindy and JoElle both used to describe the inferior EMDR therapist also
appear on Table 1.

Subtheme 4: Features of the EMDR Approach

Many participants credited certain features of the EMDR approach, such as
preparation, orientation, and session closure, because these strategies enhanced
their personal safety. EMDR preparation, orientation, and session closure are
covered by F. Shapiro (2001) in her basic text and readdressed in other
guides for EMDR therapists (Greenwald, 2007; Leeds, 2009; Lipke, 2000;
Luber, 2009; Maiberger, 2009; Parnell, 2007). These are the only three features
of the EMDR approach to psychotherapy that the participants directly
recognized as being important during the interviews. From the perspective of
the participants, these elements were not simply procedures but an extension
of their EMDR therapists’ humanistic care and concern.

Mae (pseudonym), an African American recovering alcoholic with 6½
years of sobriety at the time of the interview (the longest in the sample),
shared an example of this concern. Mae noted that her EMDR therapist
always ensured that she “would never go out of this office messed up.” The
therapist achieved this by simply talking to Mae in regular conversation at the
end of their EMDR sessions about what happened during the session, and
assuring Mae that she could call the program’s crisis counselor at night “if
anything else kicked up.” For Mae, taking the time to review this safety plan
was very important, because the issues that she processed in the EMDR session
(e.g., childhood abuse, her mother’s abandonment, and having her own
children removed from her custody) were the issues that she previously
“drank over.”

The majority of the participants indicated that the therapist’s willingness
to carefully prepare and orient them before major EMDR trauma processing
commenced helped build trust. Mae indicated that it was important not to be

Marich 413

rushed into such major trauma work. Fadalia revealed that it was critical that
she had the skills not to come “unglued” before she began addressing her
traumas. For participants like Nya (pseudonym) and Denise, having their
questions about EMDR answered in a scientific manner helped quell their
skepticism about EMDR. Although addressing such questions is a simple
function of orientation, for these participants, the careful execution of this
function by the therapist was critical to their EMDR success. Linda’s
(pseudonym) EMDR therapist was able to arrange a very direct form of
EMDR orientation: Linda observing her minor son’s EMDR sessions. For
Linda, one session of observation erased her doubts, identified as a major
reason she allowed the EMDR to work for her.

Discussion and Implications

The results illustrate how a group of former clients describe a good EMDR
therapist and how an EMDR therapist can competently provide a safe context
for the therapeutic experience. Many of the qualities described by the participants
parallel what Rogers (1957) and Yalom (2001) posited about the nature
and the importance of the therapeutic relationship (see Table 1). For instance,
the women in the study used Rogerian terms such as caring, accommodating,
connected, gentle, nurturing, trustworthy, and consoling to describe their
EMDR therapists. The participants also cited common sense and being natural,
therapist traits that Yalom esteemed. Adjectives such as skilled and smart
hopefully evidence some manifestation of therapeutic training.

These conclusions may seem obvious because the psychotherapeutic professions
have long embraced the importance of the therapeutic relationship.
However, it is of great significance to reiterate such findings in the modern
era in studying specialized treatment approaches like EMDR. The teaching
and dissemination of specialized approaches often places excessive emphasis
on theory and technique as being the prime variables that ensure client safety,
and the literature demonstrates that this trend clearly applies to EMDR. This
exploratory inquiry indicates that it is the humanistic, client-centered functions
that are likely yielding the greatest benefit in ensuring client safety and
success in EMDR. Therapists who practice these principles, even if that
means adapting prescribed protocols to better suit the needs of a client, make
the best EMDR therapists.

Comfort with trauma work was an admirable therapist trait that many participants
directly identified as essential to their safety. This positive trait
report has direct implications for informing the way that EMDR therapists
are trained. Greenwald (2006, 2007), Parnell (2007), and Curran (2009) all

Journal of Humanistic Psychology 52(4)

contended that clinicians who have a solid understanding of trauma and its
impact on human behavior seem to learn and to implement EMDR more easily
than those clinicians who do not. Greenwald et al. (2008) presented preliminary
evidence, which shows that teaching trauma-related insight to a
group of paraprofessionals and mental health professional led to increased
empathy with challenging clients and increased comfort/confidence in their
work as helpers. Additionally, comfort with addressing client trauma can
arguably be a function of a therapist’s willingness to work on his or her own
trauma issues (Parnell, 2007). The exploratory findings of this study suggest
that understanding trauma and being comfortable with trauma affects therapist
efficacy in using EMDR with clients.

The data from this exploratory study support Dworkin’s (2005) contention
that relational issues between client and clinician can effect whether EMDR
results are positive or negative for clients. Cindy and JoElle’s disclosures
reveal that changing from an EMDR therapist who both experienced as ineffective
to a therapist who both experienced as dynamic in multiple domains
can have an impact on outcome. With EMDR’s founder placing so much
recent emphasis on fidelity to EMDR protocols and procedures as primary
factors in successful EMDR outcomes (Luber & Shapiro, 2009), Cindy and
JoElle’s experiences suggest that method may be the least important element.
Both noticed that the same, ineffective therapist presented as too scripted, rigid,
and eager to see an effect of the eye movements. These are qualities indicative
of a therapist who is not comfortable with trauma work, reading directly from
a scripted protocol.

The EMDR community, currently led by the EMDR International
Association, needs to investigate if the positive qualities articulated by clients
(such as the ones in this exploratory study) are the result of EMDR training
or other factors. These other factors can include personality, an ability to
empower clients, flexibility, clinical intuition, personal experience with
trauma, prior work with trauma in clinical settings, and commitment to client
safety, which includes practicing the small measures of caring and concern
that are inherent in humanistic approaches. The experiences shared by the
participants in this study clearly demonstrate that what allowed EMDR to
work for them in a way that honored their safety and dignity is not unique to
the EMDR approach to psychotherapy. Rather, time-honored, client-centered
principles that happen to be included in the EMDR approach are of utmost
importance. A good EMDR therapist, as described by the findings of this
exploratory inquiry, will likely emphasize these principles over those of protocol,
procedure, and method.

Marich 415

Limitations

Exploratory inquiry extrapolated from a larger, phenomenological study is
not intended to be used as a basis for large-scale conclusions. The hope is
that these client-centered, exploratory findings from a group of 10 women
can be used to launch broader study on issues of therapeutic alliance, defining
what constitutes excellence in EMDR therapists, and EMDR therapist
training/formation. The primary limitation of the study is that only women
who had a positive experience with EMDR responded to the recruiting, leaving
information about predominantly neutral or negative experiences with
EMDR largely unaddressed (Marich, 2010). Another limitation is that the
author, a certified EMDR therapist, conducted the interviews herself. The
credibility of the study could have been further enhanced if someone with a
neutral opinion about EMDR conducted the interviews. This limitation was
mitigated by the author’s academic dissertation committee diligently confronting
any bias in her coding or interpretation.

The all-female sample described in this article represents a reasonable
diversity of socioeconomic, racial, educational, religious, and sexual backgrounds.
However, because the parent study was designed to examine the role
of EMDR in gender-specific addiction treatment presents a major limitation in
this specialty article. It is important to note that the experiences of male clients
and clients without addiction issues are not represented in the discussion
points made in this article.

Recommendations for Further Research

Future research on the role of the EMDR therapist in EMDR treatment will
need to include the experiences and perspectives of men, children, adolescents,
and nonaddicts. Each of the discussion points made in this article
represents an area of future research that will add to the depth of knowledge
on how to most effectively implement EMDR into clinical settings. The first
point of discussion looked at the positive qualities that a group of previously
treated clients used to describe their EMDR therapists. More data can be
gathered in this area by duplicating the semistandardized interview used in
this parent study with a larger, more diverse sample and then coded with
grounded theory strategies. Quantitative measures can also be introduced to
correlate treatment outcomes with characteristics of EMDR therapists (and
the EMDR therapeutic alliance) identified by former clients.

Journal of Humanistic Psychology 52(4)

A major conundrum still exists on how to best research if (or how) current
EMDR training methods influence the development of these positive
qualities. At this point, with the relative dearth of research on EMDR training
outcomes, any research has the potential to offer a valuable contribution. The
most obvious, simple continuation of this study (as it relates to therapist formation
issues) would be to interview the therapist who participants Cindy
and JoElle credited with facilitating a positive, impacting EMDR experience
for them following their negative experiences with another therapist. Case
studies of treated clients constitute a significant portion of the literature on
EMDR, but a meaningful case study on the training and formation of a therapist
who actual clients identify as successful is missing.

A major discussion point in this article is that a solid understanding of
trauma and its impact on human behavior can influence how effectively a
clinician learns and implements EMDR into their practice settings. Research
is needed to determine if the current teaching of the adaptive information processing
model in EMDR training programs constitutes sufficient education in
principles of trauma. The exploratory findings in this study preliminarily suggest
that a clinician’s ease with trauma work could be more important than
their strict adherence to the traditional Shapiro protocol, an idea that Parnell
(2007) previously proposed.

Grounded theory research, the goal of which is to develop an explanatory
theory of basic social processes (Starks & Brown-Trinidad, 2007) by interviewing
participants who have experienced the phenomenon under many
conditions, can be implemented to answer some of these questions posed in
the discussion. This strategy could be achieved by interviewing more former
clients about their experiences with EMDR therapists/therapy and also interviewing
the EMDR therapists who treated them regarding their experience
with EMDR training and implementation. Open-ended questions would need
to be written that specifically correspond with the purpose of the inquiry.
Since grounded theory sampling is typically larger than phenomenological
sampling so that broader conclusions can be drawn, such a study would constitute
a major effort of time and resources. Nonetheless, such a design may
be most reflective of what happens in usual care settings.

Quantitative measures can also be implemented by using the Barrett–
Lennard Relationship Inventory, the California Psychotherapy Alliance
Scale, the Empathy Assessment Index, or the Working Alliance Inventory
with clients and comparing those measures with outcomes in EMDR treatment.
Such a study could also incorporate a comparison with a therapist’s
degree of fidelity to the original Shapiro protocol as measured by an

Marich 417

independent rater. Although trauma competence and therapist ease with
trauma are somewhat more difficult to measure than therapeutic alliance and
client satisfaction with a therapist, correlational survey research on trauma
competence and experience of implementing EMDR following training can
be a solid starting point. Taking it a step further, these survey data can then be
compared with a therapist’s EMDR outcomes over an established period of
time.

Author’s Note

This article is a portion of a larger dissertation study that the author completed during
her affiliation with the School of Human Services at Capella University.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication
of this article.

References

Abel, N. J., & O’Brien, J. M. (2010). EMDR treatment of comorbid PTSD and alcohol
dependence: A case example. Journal of EMDR Practice and Research, 4(2),
50-59.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders (text revision). Washington, DC: Author.

American Psychiatric Association. (2004). Practice guidelines for the treatment of
patients with acute stress disorder and posttraumatic stress disorder. Arlington,
VA: American Psychiatric Association Practice Guidelines.

Bisson, J., & Andrew, M. (2007). Psychological treatment of post-traumatic stress disorder
(PTSD). Cochrane Database of Systematic Reviews, 3, 1-82. doi:10.1002/
14651858

Bohart, A. C., & Greenberg, L. (2002). EMDR and experiential psychotherapy. In

F. Shapiro (Ed.), EMDR as an integrative psychotherapy approach: Experts of
diverse orientations explore the paradigm prism (pp. 239-261). Washington, DC:
American Psychological Association.
Camic, P. M., Rhodes, J. E., & Yardley, L. (2002). Qualitative research in psychology:
Expanding perspectives in methodology and design. Washington, DC: American
Psychological Association.

Journal of Humanistic Psychology 52(4)

Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-
Christoph, P., et al. (1998). Update of empirically validated therapies, II. The
Clinical Psychologist, 51, 3-16.

Cox, R. P., & Howard, M. D. (2007). Utilization of EMDR in the treatment of sexual
addiction: A case study. Sexual Addiction & Compulsivity, 14, 1-20.

Crotty, M. (1998). The foundations of social research: Meaning and perspective in the
research process. London: Sage.

Curran, L. (2009). EMDR and EMDR related techniques for effective trauma treatment.
Eau Claire, WI: PESI, LLC.

Department of Veteran Affairs & Department of Defense. (2004). VA/DoD Clinical
Practice Guidelines for the Management of Post-Traumatic Stress. Washington,
DC: Author.

DiGiorgio, K. E., Arnkoff, D. B., Glass, C. R., Lyhus, K. E., & Walter, R. C. (2004).
EMDR and theoretical orientation: A qualitative study of how therapists integrate
eye movement desensitization and reprocessing into their approach to psychotherapy.
Journal of Psychotherapy Integration, 14, 227-252.

Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (Eds.). (2009). The
heart and soul of change: Delivering what works in therapy (2nd ed.). Washington,
DC: American Psychological Association.

Dworkin, M. (2005). EMDR and the relational imperative: The therapeutic relationship
in EMDR treatment. New York, NY: Brunner-Routledge.

Dworkin, M., & Errebo, N. (2010). Rupture and repair in the EMDR client/clinician
relationship: Now moments and moments of meeting. Journal of EMDR Practice
and Research, 4, 113-123.

Edmond, T., Sloan, L., & McCarty, D. (2004). Sexual abuse survivors’ perceptions of
the effectiveness of EMDR and eclectic therapy. Research on Social Work Practice,
14, 259-272.

EMDRIA Board of Directors. (2009). EMDR definition updated. EMDRIA Newsletter,
14(4), 24-28.

Eugster, S. L., & Wampold, B. (1996). Systematic effects of participant’s role on the
evaluation of the psychotherapy session. Journal of Consulting and Clinical Psychology,
64, 1020-1028.

Foa, E. B., Keane, T. M., & Friedman, M. J. (2000). Effective treatments for PTSD:
Practice guidelines of the International Society for Traumatic Stress Studies. New
York, NY: Guilford Press.

Fosha, D. (2000). The transforming power of affect: A model for accelerated change.
New York, NY: Basic Books.

Fosha, D., & Slowiaczek, M. I. (1997). Techniques to accelerate dynamic psychotherapy.
American Journal of Psychotherapy, 51, 229-251.

Marich 419

Giorgi, A. P. (1985). Phenomenology and phenomenological research. Pittsburgh, PA:
Duquesne University Press.

Giorgi, A. P., & Giorgi, B. M. (2003). The descriptive phenomenological psychological
method. In P. M. Camic, J. E. Rhodes, & L. Yardley (Eds.), Qualitative
research in psychology: Expanding perspectives in methodology and design (pp.
243-273). Washington, DC: American Psychological Association.

Greenwald, R. (2006). The peanut butter and jelly problem: In search of a better
EMDR training model. EMDR Practitioner. Retrieved from http://www.emdrpractitioner.
net. Abstract available at http://www.childtrauma.com/pubpbj.html.

Greenwald, R. (2007). EMDR within a phase model of trauma-informed treatment.
Binghamton, NY: Haworth Press.

Greenwald, R., Maguin, E., Smyth, N. J., Greenwald, H., Johnston, K. G., & Weiss,

R. L. (2008). Teaching trauma-related insight improves attitudes and behaviors
toward challenging clients. Traumatology, 14(2), 1-11.
Grey, E. (2011). A pilot study of concentrated EMDR: A brief report. Journal of
EMDR Practice and Research, 5(1), 14-24.
Hase, M., Schallmayer, S., & Sack, M. (2008). EMDR reprocessing of the addiction
memory: Pretreatment, posttreatment, and 1-month follow-up. Journal of EMDR
Practice and Research, 2(3), 170-179.

Ironson, G. I., Freund, B., Strauss, J. L., & Williams, J. (2002). Comparison of two
treatments for traumatic stress: A community-based study of EMDR and prolonged
exposure. Journal of Clinical Psychology, 58, 1071-1089.

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Post-
traumatic stress disorder in the national comorbidity survey. Archives of General
Psychiatry, 52, 1048-1060.

Korn, D. (2009). EMDR and the treatment of complex PTSD: A review. Journal of
EMDR Practice and Research, 3(4), 264-278.

Leeds, A. (2009). A guide to the standard EMDR protocols for clinicians, supervisors,
and consultants. New York, NY: Springer.

Lipke, H. (2000). EMDR and psychotherapy integration: Theoretical and clinical
suggestions with focus on traumatic stress. Boca Raton, FL: CRC Press.

Luber, M. (2009). Scripted EMDR protocols: Basics and special situations. New
York, NY: Springer.

Luber, M., & Shapiro, F. (2009). Interview with Francine Shapiro: Historical overview,
present issues, and future directions of EMDR. Journal of EMDR Practice
and Research, 3, 217-231.

Maiberger, B. (2009). EMDR essentials: A guide for clients and therapists. New York,
NY: W. W. Norton.

Journal of Humanistic Psychology 52(4)

Marich, J. (2009). EMDR in addiction continuing care: Case study of a cross-addicted
female’s treatment and recovery. Journal of EMDR Practice and Research, 3(2),
98-106.

Marich, J. (2010). EMDR in addiction continuing care: A phenomenological
study of women in early recovery. Psychology of Addictive Behaviors, 24(3),
498-507.

Marich, J. (2011). EMDR made simple: 4 approaches to using EMDR with every client.
Eau Claire, WI: Premier Education & Media.

Maxfield, L. (2007). Current status and future directions for EMDR research. Journal
of EMDR Practice and Research, 1(1), 6-14.

Maxfield, L., & Hyer, L. (2002). The relationship between efficacy and methodology
in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology,
58, 23-41.

McCracken, G. (1988). The long interview: Qualitative research methods (Vol. 13).
Newbury Park, CA: Sage.

Mertens, D. (2006). Research and evaluation in education and psychology (2nd ed.).
Thousand Oaks, CA: Sage.

Moskovitz, A. (2001). Lost in the mirror: An inside look at borderline personality
disorder (2nd ed.). Latham, MD: Taylor Trade.

Najavits, L. M., Weiss, R. D., & Shaw, S. R. (1997). The link between substance abuse
and posttraumatic stress disorder in women: A research review. American Journal
on Addictions, 6, 273-283.

Neuman, W. L. (2006). Social research methods: Qualitative and quantitative
approaches (6th ed.). Boston, MA: Pearson.

Norcross, J. (2002). Psychotherapy relationships that work: Therapist contributions
and responsiveness to patients. New York, NY: Oxford University Press.

Ouimette, P., & Brown, P. J. (2002). Trauma and substance abuse: Causes, consequences,
and treatment of comorbid disorders. Washington, DC: American Psychological
Association Press.

Parnell, L. (2007). A therapist’s guide to EMDR: Tools and techniques for successful
treatment. New York, NY: W. W. Norton.

Pearlman, L. A., & Courtois, C. A. (2005). Clinical applications of the attachment
framework: Relational treatment of complex trauma. Journal of Traumatic Stress,
18(5), 449-459.

Peirce, J. M., Kindbom, K. A., Waesche, M. C., Yuscavage, A. S., & Brooner, R. K.
(2008). Post-traumatic stress disorder, gender and problem profiles in substance
dependent patients. Substance Use and Misuse, 43, 596-611.

Power, K., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., Swanson, V., &
Karatzias, A. (2002). A controlled comparison of eye movement desensitization

Marich 421

and reprocessing versus exposure plus cognitive restructuring versus waiting list
in the treatment of post-traumatic stress disorder. Clinical Psychology and Psychotherapy,
9, 299-318.

Ricci, R. J., & Clayton, C. A. (2008). Trauma resolution treatment as an adjunct to
standard treatment for child molesters. Journal of EMDR Practice and Research,
2(1), 41-50.

Ricci, R. J., Clayton, C. A., & Shapiro, F. (2006). Some effects of EMDR treatment
with previously abused child molesters: Theoretical reviews and preliminary findings.
Journal of Forensic Psychiatry and Psychology, 17, 538-562.

Rogers, C. (1957). The necessary and sufficient conditions of therapeutic personality
change. Journal of Consulting Psychology, 22, 95-103.

Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy.
American Journal of Orthopsychiatry, 6, 412-415.

Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles,
protocols, and procedures (2nd ed.). New York, NY: Guilford Press.

Shapiro, F., & Forrest, M. (1997). EMDR: The breakthrough “eye movement” therapy
for overcoming stress, anxiety, and trauma. New York, NY: Basic Books.

Shapiro, F., Vogelmann-Sine, S., & Sine, L. (1994). Eye movement desensitization
and reprocessing: Treating trauma and substance abuse. Journal of Psychoactive
Drugs, 26, 379-391.

Shapiro, R. (2005). EMDR solutions: Pathways to healing. New York, NY: W. W. Norton.

Shapiro, R. (2009). EMDR solutions II: For depression, eating disorders, performance,
& more. New York, NY: W. W. Norton.

Starks, H., & Brown-Trinidad, S. (2007). Choose your method: A comparison of
phenomenology, discourse analysis, and grounded theory. Qualitative Health
Research, 17, 1372-1380.

Stewart-Grey, E. (2008). De-stress: A qualitative investigation of EMDR treatment.
ProQuest Dissertations & Theses: Full Text. (UMI No. 3329984)

Van Etten, M., & Taylor, S. (1998). Comparative efficacy of treatment for post-traumatic
stress disorder: A meta-analysis. Clinical Psychology and Psychotherapy,
5, 126-144.

Wampold, B. E. (2001). The great psychotherapy debate: Model, methods, and findings.
Mahwah, NJ: Erlbaum.

Wampold, B. E. (2007). Psychotherapy: The humanistic (and effective) treatment.
American Psychologist, 62, 857-873.

Yalom, I. (2001). The gift of therapy: Reflections on being a therapist. London, England:
Piatkus Books.

Zweben, J., & Yeary, J. (2006). EMDR in the treatment of addiction. Journal of
Chemical Dependency Treatment, 8(2), 115-127.

Journal of Humanistic Psychology 52(4)

Bio
Jamie Marich, PhD, LPCC-S, LICDC, is in private practice
with PsyCare, Inc., in Youngstown, Ohio, where she specializes
in the treatment of trauma and addiction interaction. She is the
author of EMDR Made Simple: 4 Approaches for Using EMDR
With Every Client, and her work in EMDR research was
awarded by the EMDR International Association in 2008. The
owner of her own consultation and training business, she offers
continuing education trainings around the United States. She is
a contributing faculty member for several online schools, and

she is also an accomplished folk musician with several recordings to her credit.

Read more at www.jamiemarich.com.