EMDR and Coaching: What a Coach Can and Cannot Do

EMDR, or eye-movement trauma reprocessing, is a clinical therapy for distressing memories. Francine Shapiro developed it. In a session, a person brings a memory to mind in short sets while following side-to-side stimulation, usually eye movements. It is delivered by trained clinicians. In clinical trials for post-traumatic stress disorder, it tends to do about as well as trauma-focused cognitive behavioural therapy. A coaching session is not set up to deliver it.

What it is

In the clinical version, a trained therapist asks a person to bring to mind a distressing memory, the belief attached to it, and the feeling in the body. Then short sets of side-to-side stimulation follow while the person notices what comes up. Between sets the therapist checks in, and the work moves in small steps.

The approach rests on a model that treats distressing memories as not yet fully processed. That model is debated, and the research it has generated is summarised below. The question this page answers is narrower: what a coach can talk about with someone who has been through trauma, and where the work belongs with a clinician.

Where it comes from

Francine Shapiro developed the procedure. Her 1989 paper reports a study of its efficacy with traumatic memories (Shapiro, 1989).

Later trials and meta-analyses compared it with other trauma treatments (Seidler & Wagner, 2006; Bisson et al., 2013). Their findings are summarised below.

Also known as eye-movement trauma reprocessing.

The principles underneath

Memories that have not been processed

The working model is that a distressing memory has not been fully processed, so it keeps returning with its original charge. The model is contested.

Side-to-side stimulation during recall

Brief side-to-side stimulation, usually eye movements, is the feature that gives the approach its name. Its mechanism is not settled, and trials have not shown it to be more effective than trauma-focused cognitive behavioural therapy.

Short sets with check-ins

Work proceeds in short sets, and the therapist checks how the person is before the next set.

Steadying before processing

Preparation includes building ways to feel steady, such as a calm image of a safe place, before any memory is touched.

How a session runs

A trained clinician takes a history and decides whether this approach fits the person's difficulties, and whether other treatment should come first.
The clinician explains the method and prepares the person with ways to feel steady, such as a calm place to return to in the mind.
Together they choose a specific memory, the belief it carries, and the feeling in the body that goes with it.
Short sets of side-to-side stimulation follow while the person notices what comes up. The clinician checks in between sets.
Each session ends with a closure that leaves the work settled, and the next session begins by reviewing what has changed.

When it tends to fit

A memory of something frightening keeps breaking into your day, and talking it through has not made it quieter.
During a coaching conversation, a client begins describing a frightening event in detail, and the conversation starts to feel beyond what coaching is for.
You are wondering whether an eye-movement technique could be part of coaching, and where the boundary lies.

What the research shows

Evidence: Randomized trials or meta-analyses

For the parent treatment, the evidence comes from clinical trials and meta-analyses in post-traumatic stress disorder. Shapiro (1989) reports a study of the procedure's efficacy with traumatic memories. Seidler and Wagner (2006) reviewed studies from 1989 to 2005, identified eight publications comparing the approach with trauma-focused cognitive behavioural therapy, meta-analysed seven, and concluded that the two tend to be equally efficacious. Bisson and colleagues' Cochrane review (2013) included 70 studies with 4,761 participants. It found that individual trauma-focused therapy and the eye-movement approach both reduced clinician-rated PTSD symptoms more than waiting list or usual care. We found no outcome study of eye-movement work in coaching.

Where the evidence is thin: The trial evidence is for treatment of PTSD by clinicians, not for coaching. The Cochrane authors describe the evidence for each comparison as "very low quality". The comparisons found equal results with trauma-focused cognitive behavioural therapy, not superior ones. In these sources we did not find a test of the eye-movement element on its own.

Sources

Where it stops

Trauma-related distress, dissociation, or thoughts of harming yourself need a trained clinician now. If you are in immediate danger, contact emergency services.

Eye-movement work done outside a clinical setting can stir up memories with no one trained to hold them. For that reason this approach is not something to try alone, or to use as a coaching exercise.