How Effective is EMDR with a Trauma Based Diagnosis – PTSD and Borderline Personality Disorder?

Read the first blogs in this series:
What is EMDR? Is it as powerful as they say?
What can I expect from EMDR therapy? A session to session guide.
How is EMDR different from talk therapy?
How effective is EMDR therapy with anxiety and depression?
How effective is EMDR with Adolescents?
How effective is EMDR with Children?
How effective is EMDR with Physiological Diagnosis, such as Bipolar, Neurodivergence and Schizophrenia?

Eye Movement Desensitization and Reprocessing (EMDR) is a very effective therapy that treats most mental health diagnosis and conditions.

Treating Post Traumatic Stress Disorder (PTSD)

EMDR is typically only considered as a treatment for PTSD, although it has been shown to be effective for many other diagnosis and conditions.

What is considered a traumatic experience?

Trauma is a deep wound or injury, it can be manifested as physical and/or emotional. For our purposes, it is any event that leaves a deep emotional scar. There are often expectations as to what is significant enough to be considered traumatic, instead evaluate the long-lasting impact of the event.

Symptoms of PTSD (not present before trauma):

• Intrusive symptoms
  • unwanted and upsetting memories
  • recurring nightmares
  • flashbacks
  • emotions and/or physical distress with reminders
• Avoidance symptoms
  • avoiding thoughts and feeling about the trauma
  • avoiding reminders (people, places) that trigger memories of trauma
• Negative thoughts and moods
  • amnesia for parts of the trauma
  • negative beliefs about onself and the world
  • blaming self/other for the trauma
  • negative emotions/lack of positive feelings
  • loss of interest
  • detached/isolated from others
• Arousal and reactivity
  • irritability, aggressive behavior
  • reckless/destructive actions
  • hypervigilance
  • exaggerated startle response
  • difficulty concentrating
  • sleep problems

Specific examples can include major life events – violence (physical/sexual), life-threatening accidents, natural disasters, combat experience/war zones, and medical traumas.
Smaller life events can be accumulative and lead to traumatic responses also – bullying, stalking, harassment, emotional abuse and neglect, chronic financial strain, loss, and inconsistent parenting.

What does the research say about EMDR’s effectiveness with PTSD?

EMDR therapy has been shown to reduce PTSD symptoms, reduce other trauma-related symptoms, and more effective than other trauma treatments. The VA reports that EMDR demonstrated greater symptom reduction as compared to fluoxetine (Prozac) and loss of PTSD diagnosis (no longer meeting criteria) after treatment. The Journal of EMDR Practice and Research also notes that EMDR is more efficient (faster) form of treatment than prolonged exposure. Additionally, there is less exposure to the trauma, processing time is faster which allows for more processing to occur, and less emotional activation at the end of treatment sessions.

Treating Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a very complex diagnosis, those that suffer from it struggle in interpersonal relationship and self-esteem. There is a constant drive to protect themselves from being rejected, while desperately trying to maintain intimate relationships. I Hate You – Don’t Leave Me, by Straus and Kreisman, was first published in 1989. The title clearly describes the trademark push and pull people with BPD often experience.

The research on how BPD develops is somewhat unclear. There is some thought that there may be differences in brain structures from those without it. It can often be traced back to a chaotic childhood. As children, we seek our caregivers for support when we experience emotional or physical pain. For those that experienced early abuse and neglect, that support was absent or inconsistent. For example, a child that skinned their knee and goes running to a parent. That parent has open arms to comfort them, however, when they get closer they are instead scolded for running through the park. This simple interaction sets the precedent that relationships are unpredictable and you must protect yourself.

The pushing part is out of protection – when the relationship feels too intimate and fear of rejection or abandonment starts to build. The best/only way to stay safe is to reject the other person first. Pushing them away leaves you in control and presumably emotionally safe. On the flip side, they desperately want to feel that emotional connection that was elusive in their early years. Any and every potential new relationship carries the possibilities of everything they have ever wanted, becoming very intense very quickly. BPD sufferers move from one extreme to the other, like flipping a switch.

EMDR is useful in treating Borderline Personality Disorder by identifying these early and formative memories. These experiences carry the same idea that relationships are everything, and incredibly dangerous. After working through the memories, you are able to identify your own self-worth, feel secure in relationships and set healthy boundaries.

What does the research say about EMDR’s effectiveness with BPD?

One study, shared by the NIH, reports that participants reported an improved quality of life after 10 sessions. Results were maintained at 3, 6 and 12 months post-treatment, no longer meeting criteria for BPD. Another study concluded that EMDR is safe and effective with clients that experience PTSD and BPD. One important thing to note is that preparing for the processing phases of EMDR may take longer as those with Borderline often require additional stabilization.

How do I Find a Qualified EMDR Therapist?

When looking for a qualified EMDR therapist, the first place to look is on the EMDRIA website. The EMDR International Association is the body that regulates both how EMDR is trained, and the therapists that wish to move up the credentialing process. There are companies that offer EMDR trainings, however they do not hold the same rigorous expectations, including supervised practice. Make sure your therapist has EMDRIA approval before moving forward.

There are several levels of EMDR therapists:

• EMDR in training: Currently participating in the 50 hours of training. This includes lecture, video and live demonstrations of key principles, and practicing with another trainee while an experienced EMDR therapist observes and gives live feed-back. They are also participating in 10 hours of group sessions, where they share their use of EMDR, review lecture material and learn from their peers’ experiences.
• EMDR trained: Completed the 50 hours or training, the 10 hours of group and a post-test demonstrating their knowledge. No further actions are necessary to keep this status.
• EMDR certified: After becoming EMDR trained, these therapist continue their learning by taking at least 12 hours of advanced trainings, have an additional 20 hours of oversight with a higher level EMDR therapist (including audio tapes of actual sessions), and have completed a minimum number of processing sessions. Certification must be renewed every 2 years, an additional 12 hours of advanced trainings is required at each renewal.
• EMDR Consultant in Training (CIT): After becoming certified, they continue to learn by taking another 12 hours of advanced training and have more processing sessions completed. They are also required to have a minimum of 20 hours of oversight from an Approved Consultant (the next levelup). The Approved Consultant will evaluate the CIT’s ability to correctly guide and support newly trained therapists in their use of EMDR with their clients. The audio/video used here will be of the CIT offering consultation to the therapist that is either in training or trained.
• EMDR Approved Consultant: Once all the above requirements are met, the therapist will now have the title of Approved Consultant. This credential requires 12 hours of advanced training and renewal every two years.
• EMDR Trainer: This is the highest level of credentialing for an EMDR therapist. There are believed to be less than 250 trainers in the United States. In addition to being an Approved Consultant, the trainer has to go through a rigorous screening process. The curriculum has to meet very specific criteria about content and length of time spent on topics, the in training practicum experiences, even how the learning management system works. They are also required to answer a series of questions around how they handle certain situations, learner engagement, and being culturally sensitive and aware. Trainer status is renewed every 2 years by answering the training specific short essay questions.

If you have further questions about EMDR, either as a therapist or as a potential client, please reach out to Heather Dunn, EMDRIA Approved trainer, at heather@bluehorizoncounseling.com.

Summary

There is a lot more to EMDR, it requires a minimum or 60 hours in supervised training to be credentialed. This overview is designed to help you feel more prepared before starting EMDR for yourself. Admittedly, it does seem odd that experiencing BLS could have such a significant effect. It has been tested over and over again for 40 years, with strong results supporting this therapy.

Each phase is just as important as the next and need to be done thoroughly and in order. The most common mistakes that new or inexperienced EMDR therapists make is not doing the groundwork. Phases 1 and 2 are imperative to ensure the processing is emotionally safe and tolerable for the client. Unfortunately these phases are often rushed through. Additionally, you want to make sure your therapist is intentional about which memory to start processing through. Starting with an intense trauma, especially if the client is ill prepared, can have significant long-term impacts. It’s often advised to start with a smaller memory as the client gets comfortable with the process, and the therapist can evaluate their ability to stay regulated.

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At Blue Horizon Counseling we have several therapists that are passionate and qualified in EMDR therapy. We also offer consultation for EMDR therapists that are looking for additional support as they continue to learn and grow.

You’re Not Alone. Our Therapists are here to help, in Pearland, TX.

Hang in there. This won’t last forever, even if some days feel like it might. You’re planting the seeds for future blossoms. All our therapists at Blue Horizon Counseling offer sessions both in person and via telehealth.  Find the right therapist for you. We accept most major insurance plans.

Written by Heather Dunn, Licensed Professional Counselor Supervisor and Licensed Marriage and Family Therapist Supervisor, specializing in trauma, dissociation and EMDR. Heather has been practicing for over 20 years and enjoys sharing her knowledge and helpful tips.

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