If you heard last week’s episode, you know, it’s possible to heal our brains in a variety of different ways. One of those ways is through EMDR, a powerful tool to help patients move forward, or as Dr. Lili Wagner so perfectly stated, “move past our past”.
In this episode, we dive deeper into EMDR and discuss the benefits, who it may be good for, and who might not find it a great fit.
What is EMDR?
Dr. Lili Wagner: EMDR is a mouthful. It stands for Eye Movement Desensitization and Reprocessing. It’s basically a type of psychotherapy that helps those that are stuck in the past whether it’s PTSD, complex trauma even single incident trauma be able to put that aside and say, ‘okay, that was then, it doesn’t have to impact me in the present moment as well as in the future,’ We work with the brain and it affects how we think. It changes the perception of what we are thinking at the time versus getting stuck in the past dangers that we have experienced. So, it helps us move past our past.
When I first describe it to people, a lot of times people are like, ‘oh, that just sounds weird. That sounds very cool. It sounds very bizarre.’ It wasn’t until I got the training and, within that training, I volunteered to be a subject. That’s when I was hooked because there was an incredible physiological sensation that happened.
There were tears that came out, which is very normal in EMDR. We hold on to a lot of stuff that we need to release in order to be able to move forward. EMDR, allows us to go into that subconscious unconscious level where usually when we’re alert, our consciousness prevents us. So, it allows us to go into that underneath layer that we want to get to so that we can allow the brain to heal.
In a way, it’s also brain training because it’s allowing the brain go, ‘oh, okay. I can connect the dots together. And, I could put two things together and recognize that “okay, this is not happening now”.’ I can feel safe when I am safe, instead of misreading cues and facial expressions. So, when a person comes in, there are eight-phase stages of EMDR that we have to go through. So, we develop the treatment plan. I get history. We do the preparation first before we go into the process.
Basically, we want to figure out what memory is being created. Let’s pick a car accident, for example, a single traumatic experience. A car accident that now, every time you get in a car, you’re kind of hypervigilant and you can’t relax. You’re white-knuckled on the steering wheel, constantly looking around and you have heightened anxiety because of the past accident that you’ve experienced.
So, then we talk about, what’s the memory that’s causing all these anxieties in the present moment. And, what would be the image that represents the worst part of that memory? Sometimes people can’t bring up an image. So, we just go with like physiological sensation. Some people say, ‘I feel it in my chest. I feel it in my gut, I feel it on my shoulders,’ those are, or ‘my throat’.
You know, those are your usual areas where people sense their events, their traumatic event, or just a disturbing incident that has happened to them. Once they have a specific image, then we talk about, ‘well, what’s the negative cognition? When you think about that image, what’s the negative belief that you have about it’ One thing if you’ve had a car accident would be, I’m in danger, I don’t feel safe. I can’t trust other people. I can’t trust myself.’ So, those are some of the negative cognitions. Then, we think about, ‘well, what would you like to believe about yourself?’ ‘I am safe. I can trust myself. I can trust people whom I wish to trust who I can trust.’ And, with that, we go into finding out, how true does that feel to you now?
They take a scale from 1 to 7, where 1 is completely false, and 7 is completely true. And, they say, “Well, how true does it feel when you bring up that image and the words ‘I am safe’?” And, they’ll say, “Well, it’s like a 2,” which is almost completely false.
The goal is to try to get that belief, the positive belief to a 7. We can bring that left brain, and right brain together. We can integrate the frontal lobe and the amygdala and all the areas where it’s fear-based and put it all together so that we can have a holistic kind of imagery or memory of this incident that we can reprocess so it’s not triggering us in the present moment. And then, we do a body scan just to see where we are, where we’re noticing again, as well as figure out how disturbing that experience feels to us now.
For some people it’s a scale from zero to 10; zero is none or neutral, and 10 is the highest disturbance. And, of course, our goal is to get to almost a 0 or a 1, or as much as ecologically feasible. Right? I mean, some people can still have, for example, chronic illness, they’re still going to have certain symptoms that are not subsided at that time and they’re still going to experience that. Sometimes we can’t get to zero all the time, and that’s okay.
How long does it take to reprocess an event?
Dr. Lili Wagner: It’s hard to answer that question. If it’s a single traumatic event that happened later in life, it may take, I don’t know, I want to say four to eight sessions. It takes a few sessions to get into history taking, getting prepared for EMDR, and then we get into the real trauma. But if there’s a history of adverse childhood experiences, complex or chronic traumas, that may take a little longer.
It depends on what has happened. And, it also depends on the person’s openness to the process and their own coping skills, as well as how much they use the skills and tools that we talk about during therapy. A session is 60 minutes, most of the time.
We can do intensive EMDRs, which we take on a weekend, and we go through a bunch of stuff at the same time. And, some people do really well. They’re just like, ‘I just want to knock this out, get my life together. Let’s go.’
For some, it may take a while because sometimes we want to do a session of the EMDR, and then the next week we talk about what that experience was like.
I also have clients who can only do half an hour, half the session we do EMDR and then we talk about it. So, it’s very individual and the process and the progress depends on the person and where they’re at, what their comfort level is.
I usually recommend weekly sessions. Some people can do it two to three times a week. That’s really up to them, but once a week is good because it gives your brain that time to process. You got like 72 hours of processing, we do pretty much after the EMDR session. And then, you go live your life and do your stuff and then come back and we have a discussion.
Then, we continue with more processing or we continue with the processing that we were working on the past week that we didn’t finish. So, that’s another possibility is that when we do sessions, sometimes depending on the traumatic event, it may not get finished. So, we continue until we get to that, you know, zero to one scale.
Do you need to be in-person for EMDR to be effective?
Dr. Lili Wagner: With COVID, I have completely moved to telehealth, because it’s super convenient for many people, and it is just as effective as in-person.
In fact, I’ve found it’s been more effective because people are in their comfortable homes, in their safe spot and their space where they feel safe, and there isn’t all this ambient noise. People can be completely in their pajamas, and comfortable, have their tissues, and not worry about being out and about where they have to go outside into the hallway or, you know, the waiting room at a doctor’s office where they’re coming out in tears and everything. And so, it has been wonderful and there are specific platforms for EMDR. We do EMDR via eye movements visually, and you’ll see a ball that goes back and forth on your screen.
You could do it auditory depending on if the visual doesn’t work for certain people. Some people like to close their eyes to visualize, and the audio goes from one ear to the other one. It’s just a tone. Whatever tone sounds good for you. Tapping is one that unfortunately I can’t do online.
However, I’ve had people tap on themselves. And, I also have a couple of clients that have bought specific tappers for themselves. Tappers are where it buzzes from one hand to the other hand. This is bilateral stimulation where your eyes will just follow that, you don’t even have to think about it. That’s the beauty of just that automatic stuff that our brain does.
We want to go tap into the parasympathetic so that we can actually calm the controlling brain so that we can tap into those areas that really haven’t had the chance to come out and be reprocessed and looked at again to say, ‘okay, okay, let’s work on this’, because when trauma happens, you know, things are happening, things are moving, things are busy.
Things are fragmented and this is where flashbacks come in. Right? It’s like, why am I having this experience right now when I’m on my Peloton Bike? Why is that happening?
When we do therapy online, I need to see you. So, if you’re lying down, I can’t really see you, because I need to look for like a reaction, anything that I see physiologically so I can come in and help out if I notice that there’s something going on or if I notice that you are maybe dissociating and you’re no longer present, I need to watch that. So, it’s important for the visual, for the therapist to have a visual of the client.
Jackie: Well, that makes sense. Do you see that a lot? As in my experience doing EMDR, there are a few times when suddenly, I’m like making a grocery list, I have to force myself to come back and start to follow the movement again.
Dr. Lili Wagner: It does happen once in a while and that has to do with what is coming up. Sometimes, as I’m sure you’ve experienced, memories can show up and it’s like, ‘that’s not what I’m working on. Why is this thing coming up?’
It’s like the brain is saying, ‘oh, you can’t go past this thing unless you work on this thing that I’m giving you right now, because that’s more traumatic or that needs to be addressed before we can even work on this other memory.’
And, the grocery list is kind of like checking out, your brain gets tired or it has a more intense reaction or response to what is happening during the EMDR process. It is good to let your therapist know. If it gets too much, this is where we try to bring in the calm place, which is part of the beginning phases of preparation. We go into a calm place to bring that parasympathetic nervous system online, which is the rest, and digest in order to be able to continue to process.
This is where it’s really up to the therapist or the practitioner to see, where is this leading us to, is it leading to a resolution of something, because if this needs to be addressed, then I’ll let that go. And, I’ll say, ‘okay, notice that.’ But if I find that now it’s going really off to somewhere where now we’re totally off the tangent, then I’ll bring it back.
Jackie: I felt like I was on a trip or something.
Dr. Lili Wagner: I think EMDR is a nice little trip and it’s weird to experience that. The first few things that we do; the main one being creating a calm place. Some people’s places they’ve been or not been, real or imaginary, it doesn’t matter, somewhere where you feel calm and at peace. And, when we do that exercise, they’re blown away by what their brain can give them. They can actually say, ‘oh, I can actually feel the sand under my feet,’ or ‘I just felt the breeze on my cheek.’ So, the brain is extremely powerful, and this technique allows us to tap into that power of our healing brain that we have.
Jackie: Yeah. I mean, if our brain’s going to hold onto some of these negative things, why wouldn’t it be able to hold onto some positive things that we created as well? We just sometimes have to manufacture them.
After The Session
Jackie: So, let’s talk about after the session, for a minute, because I’ve done EMDR a few times; and it’s really, really powerful. I have found, on a couple of occasions, that I am wiped out mentally and emotionally for a couple of days after.
Dr. Lili Wagner: So yeah, you definitely don’t want to have a full day after your EMDR session, so you don’t want to try to do EMDR right before going to work or you have something major happening because it’s work. This is not like a wand that just says, ‘oh, you’re magically healed, go to your happy land and be good.’ And, we need to kind of trigger the events so that our brain gets into a state where it can actually bring up those memories and images in order for us to re-process them. So, we kind of need to have a little bit of that discomfort to the level where it’s comfortable for the patient. What we want to do is create either a physical sensation or something where we can start reprocessing.
Reprocessing is a lot of work on the brain and that makes us tired. When you do an EMDR session, the brain continues to work for up to 72 hours, and, that’s why we feel tired. Especially if you worked on something pretty heavy, a big, big event that has been very, very traumatic. Like, we’re talking about the disturbance level of a 10, which is the top range, and that could be a lot to go through. So yeah, a lot of times, right after the session, people are like, ‘Woo! That was exhausting.’ ‘yep, go take a nap.’
Medical Trauma
Not only does Dr. Wagner specialize in trauma, but also in the psychological ramifications of having a chronic illness or autoimmune disease. Due to her own chronic health issues, Dr. Wagner uses a holistic mind, body, and soul approach to therapy.
Dr. Lili Wagner: There’s a lot of medical trauma out there that we don’t talk about. There are a lot of chronic illnesses such as autoimmune diseases that really make a huge impact on people’s lives.
There’s a huge physiological and psychological impact that it has where we feel like our body is unsafe so there’s that concept of danger or our body is not responding the way we’d like to. We can’t trust our bodies.
We can’t trust ourselves. And so, that creates a lot of just trauma within the body, as well as our psyche, for sure. So, I work with patients that have autoimmune diseases, chronic illnesses, to be able to break that cycle of just being in that constant fight or flight state of danger. We don’t get to enjoy our life fully. So, we want to disconnect that kind of association, which is maladaptive, and take us to adaptive information processing, which is a part of the EMDR that I provide for patients.
Jackie: I have another question. Could gut issues be related to past trauma?
Dr. Lili Wagner: Yes. Our gut health is so important and when we have a traumatic experience, our gut is highly impacted by those traumas. And, that has to do with our cortisol level, our adrenaline, and all the neurotransmitters that tend to get skewed. It impacts our microbiome when we have these events that make us feel unsafe because if you think about a parasympathetic nervous system, which is our chronic nervous system, it stands for rest and digest.
So, if you can’t digest because you’re hyper-alert, hypervigilant, it’s going to impact your gut. So, if we can’t digest, whatever we’re eating, the nutrients are not being digested by our body. So, then we need those nutrients to create the neurotransmitters in our brain to function well.
This is how the vagus nerve that connects the brain and the gut communicates. If we can get to a point where we can heal our gut, as well as our brain, all at the same time, again, that mind-body-connection, getting that holistic healing that can make a much bigger impact than just doing top therapy alone.
However, we want to make sure and rule out possible physiological causes before we jump into, ‘oh, this is caused by trauma.’ There’s a cause and effect, and it’s hard to kind of sit there and say, ‘this was because of this only.’ It could be a combination. But we do see that with autoimmune diseases, in particular, we’ll see a lot more traumatic history versus those that don’t have an autoimmune disease.
Vicarious Trauma
We don’t have to have experienced a traumatic event personally for it to affect us. So how can we protect ourselves from those people in our lives who are constantly dumping their trauma on us while still being supportive?
Dr. Lili Wagner: There’s a concept called vicarious trauma. We, as therapists, any healthcare professional can experience that because of what they hear or what they see, as well as I’ve had patients whose parents exposed them to their own trauma at a much younger age than they needed to be exposed to, and so that has stayed with them because it’s like their trauma; or parents who may have had cancer and the child is there experiencing this, that becomes a part of their trauma too.
So, the brain has very interesting ways of putting memories together, as well as experiences together too. And physiological experiences are a big part of that. You hear a story– I mean, I remember seeing a story on the news one time and I was just like, ‘that’s horrible. That’s really horrible.’
And, we don’t realize how much that impacts us in our lives. So, when we reveal information to a friend, sometimes this is called Trauma Dumping. When telling anybody our story, we may want to take a step back and say, “How is this going to impact this person?” Maybe I need to talk to somebody who’s paid to do this, or a professional who understands the ramification and they have methods that they could alleviate any kind of vicarious trauma through this experience that I’m sharing. We want to be a little cautious about what kind of shares we provide others because not everybody knows how to handle the stories.
And so, people may, take a step back, disassociate a little bit, or maybe not be as in-tuned or aware of either themselves or the other person who’s actually telling the story and not have the right feedback.
Jackie: Right. Right. That’s such a great point because you don’t think about that. Sometimes when you are the one who has experienced something that feels traumatic, you just want to sort of dump that out so you can feel a little bit better, but we don’t think about that energy and how we’re shifting it onto other people.
Dr. Lili Wagner: We have a really hard time with boundaries because we’re people-pleasers, and we want to be included in things, and we don’t want to say the wrong thing, and we don’t want to insult somebody or offend somebody.
And, we may not be able to show up to say, “I appreciate that you trust me to have this conversation with, and I don’t know if I could help you the way you want to be helped or even if you want help. But for me, this is hard to hear, and I don’t know what to do with that for myself either.”
Have a real honest heart-to-heart conversation without throwing it at the other person, ‘oh, this is kind of hard for me to hear. I feel bad that you had this experience. And yet, I don’t know how to do that. I don’t know how to go through that. Maybe I can learn a few things. Maybe you can guide me.’ You know, provide that stance of curiosity and boundaries, you know, have that nice balance.
Jackie: That’s a great point because I think our reaction sometimes is, ‘I can’t hear that from you right now. I can’t handle it’ So, coming from a place of vulnerability with boundaries, I think would be more effective than, ‘stop telling me your shit.’
Dr. Lili Wagner: Right. Or, being afraid not to say anything because you’re like, ‘oh, well I don’t want to be the bad person. And, I don’t want to not be there.’ We want to look at everything in a more collective, holistic kind of way because we are all in this world together. So, we kind of have to be mindful of each other’s presence, of each other’s emotions and feelings and everything like that. And so, that takes some self-awareness too.
Having a discussion, really helps set the next stage or the next tone of just like, ‘oh, I understand that my friend here, she’s not able to handle what I’m talking about. And, maybe I could say things without really revealing every single detail.’
And, that’s a part of EMDR as well because some patients may not feel comfortable telling me all the detail, and they don’t have to. And, that’s the beauty of it. You don’t have to tell me the details because you’re going to kind of experience it in a way, you know, physiologically, emotions are going to come up, thoughts are going to come up, memories are going to come up, but it doesn’t have to be revealed if they’re not comfortable doing that.
Jackie: Right. That’s a good point. So, let’s talk a little bit about trauma. Trauma has become a buzzword. I think everyone is using it for a variety of different experiences. I’m not an expert, but I know that I can’t determine someone’s trauma versus my trauma. Like, there’s no trauma comparison, right?
Dr. Lili Wagner: So, trauma, I mean, as far as the definition goes, is something that a person experiences that is beyond what they are capable of handling. In other words, every individual has their own threshold of what is okay and what’s not okay, what can I handle? What can’t I handle? I’m sure we’ve come across people who have gone through so much stuff and they’re like doing stuff and they’re totally fine in their world, you know, resilience and everything like that.
And, others tend to take on a lot more of the traumatic experience and that gets held in. One of the other things to differentiate is when the trauma happened. So, childhood trauma events are going to have a much bigger impact because they’re before our brain is developed a hundred percent.
We don’t have the thought process in order to handle what’s happening to us. And, sometimes if it’s pre-verbal babies, that stuff is mostly, memories in our body physiologically, but we don’t have the words for it. So, if you had a car accident in your 30s or 40s, you’re going to handle it a lot differently than if you had that when you were seven or eight.
Anytime, especially when we’re younger, we hear things that sound dangerous. That’s going to put us into that heightened alert phase. That’s going to leave an imprint on our amygdala, which is our smoke alarm, the fear center of our brain, and that likes to hold onto that stuff, especially as a younger child.
We need to allow the prefrontal cortex, our kind of wiser mind, to have a discussion between the amygdala and the prefrontal cortex where it’s like, ‘oh, that wasn’t me,’ or, ‘oh, I’m not there right now. I can feel safe when I am safe.’
And, that’s that release that we need to have so that the amygdala’s not continuously holding onto that.
We’re all neurodiverse. Everybody’s brain is different. One thing we do know is that the brain will do things in order not to have painful experiences. So, part of that is, ‘I’m going to dissociate.’ or ‘I’m just going to forget about it.’ And then, a lot of times we distract ourselves, so we get into being a workaholic, alcoholic, sugarholic, anything that will provide some sense of comfort and peace within ourselves that will help us get past that.
But the good thing is the brain is highly plastic, and we can totally retrain it as long as we have the right tools, skills, and the right person. We have to remember that we don’t have to get stuck this way for the rest of our lives.
EMDR Produces Results
Dr. Wagner talks about some moments that stood out to her as a practitioner
Dr. Lili Wagner: One of the big ones that I tend to see is we’ll start the EMDR session and immediately there’s like this downward kind of expression. It’s all down, like a frown. And then, all of a sudden, towards the end, I see the lifting, and the facial expression gets calmer, and there’s like a proud, kind of lifting that happens. I think that is highly powerful.
When I see that I’m like, ‘okay, there’s the shift. That’s great. Okay. Go with that.’ And, it’s amazing. And, when I tell patients that they’re like, ‘oh really? I didn’t even notice that.’ So, there’ll be a certain directional shift too. Sometimes they’ll turn to the right or turn to the left. I’ve had a lady that turned entirely to the opposite direction, like 180, turned in her chair to the opposite direction looking for something.
Jackie: Wow. That’s wild. Normally, I’m fidgeting my feet, and then, I start to sit up straight or I just feel more grounded and in my own body.
Dr. Lili Wagner: That’s what we want. We want that connection to happen because there’s been a disconnect. And, if we can just bring it all back together, create this holistic view of ourselves and our bodies and everything, then the puzzle pieces connect and make sense to us versus having these fragments. EMDR puts it all together so that we like have that visual of, ‘okay, now that I’ve put the pieces on the puzzle together, I can put that away. I’m done with it.’
I mean, I’ve had patients come to me in their 70s and 80s wanting treatment with EMDR because they’re just tired. They’re like, I want to end this chapter at some point. And, I’m tired of having to have to live this way for 70, 80 years of my life, or however many years they’ve had since they experienced their traumatic events. And, it makes a huge impact, a huge difference.
So, we don’t get into those ages where we have regrets about not doing the good stuff for ourselves, because we deserve that. We know we deserve to heal. We deserve to have a wonderful life and be in great relationships instead of doing the same thing over and over again.
Jackie: It’s never too late to feel better. That’s what I’m getting from this.
Dr. Lili Wagner: No, never. And, we’re always a work in progress.
What to look for in an EMDR Practioner?
Dr. Wagner is licensed in California. But if you’re looking to find an EMDR practitioner in your area, visit EMDR (linked below) for a listing of therapists and practitioners. Dr. Wagner recommends finding a practitioner, not just trained, but certified in EMDR.
Dr. Lili Wagner: Some people have been trained in EMDR, but they haven’t gone through the extra training as well as the consultation in EMDR to get that certification. I mean, we get tested and we have to do a video session with a patient and do all of those things to prove that we know all the phases and how to handle certain things that pop up. So, that’s all you want to look for is a certified EMDR practitioner or therapist. And, they do not have to be psychologists.
They do have to be licensed mental health practitioners, such as licensed social workers, licensed marriage/family therapists, professional counselors, psychologists, and so on. So, that’s what you want to look for. And, each practitioner needs to be licensed in the state where the patient or the client resides. That’s important because of the law and ethics that each state has. That’s very different.
Jackie: Okay. That makes sense. And so, if somebody is a life coach who says they know EMDR, you should turn and run.
Dr. Lili Wagner: Exactly. Find a therapist that you are going to connect with. That rapport is highly powerful. If you don’t feel safe with that therapist, then you need to consider other options. When people call me, I’m happy to hear that they’re looking for other therapists as well, because you need to talk to different people just to see who is going to be the best match for you.
It’s not like a medical doctor. Our field is very different than the medical model field. So, we want to make sure we can provide the best space to hold for our clients in order for them to heal. And, if you don’t feel that I can do that for you, then it’s like, yes, definitely go see who else you feel more comfortable with. That’s a big factor in determining how that works out.
Is EMDR right for everyone?
Are there any people that Dr. Wagner finds EMDR is not right for?
Dr. Lili Wagner: Sometimes when somebody is too cognitive, the overthinkers tend to have a hard time with EMDR. I’ve noticed that they don’t want to give up that control because, with EMDR, we kind of have to take a step back, and let our brain do the healing. Our brain has answers.
Our mind has wonderful answers and knowledge and wisdom. These negative limiting belief systems stop and block those answers. We can kind of hear it once in a while, a little voice that says, “Oh, maybe you shouldn’t date this person,” but then we just push it aside. Right?
And so, for certain populations, and it’s not that it’s impossible to do EMDR, it just takes a longer time. It just depends. I mean, from my experience and my years of experience with EMDR, the ones that have a hard time are the ones that can overthink and they have a hard time just letting go and letting the process happen.
Some final thoughts from our guest…
Dr. Lili Wagner: One thing to remember, just to make it clear is that our brain is extremely, extremely fascinating. And, if we just give it the right space, it could really heal and help us get past stuff that we feel is holding us back.
So, I encourage everybody who has had any kind of traumatic event, anything, even physiological stuff that you’ve experienced such as being sick or having a chronic illness to reach out to somebody that can help because it will make a massive impact on your life.
Until next time, you are a grown-ass woman. Act accordingly.
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Mentioned in this Episode
ABOUT DR. WAGNER
Dr. Lili Wagner is a Licensed Psychologist in California with over 20 years of experience. She works with adults and the elderly, specializing in trauma as well as the psychological ramifications of having a chronic illness or autoimmune disease. She is certified in EMDR, CBT, and has several health coaching certifications. Due to her own chronic health issues, Dr. Wagner uses a holistic mind, body, and soul approach to therapy. During her spare time, she loves to cuddle with her dog, enjoys movies, music, dancing, and spending time with her family.
