PSYCHOTHERAPY - Psychoanalysis - Systemics - Pnl - EMDR

EMDR and psychoanalytic clinical theory

For some years I harbored the strong conviction (today I would say the belief) that the psychoanalytic clinical theory tallied with one and only one way of therapeutic approach. I also used to think that this one-to-one correspondence was the desideratum and the stamp of a consistent and well built clinical theory.


The variety of theoretical models in the post-Freudian world didn’t seem to contradict this claim of theoretical and methodological compactness. I saw very clearly the direct relationship between the here-and-now fury in kleinian transference interpretation with its statement that everything that counted had already been played in preverbal stages of development, nor
did I deem inconsistent the silence and oracular lacanian interpretation with the hoping to get the master signifier out of its narcissistic lair, without becoming entangled in the thickets of thought, primarily considered as saturating imaginarization.


Theoretical models could be different (Kleinian, Winnicottian, Bionian, Lacanian, etc.), that was inevitable and desirable, but the clinical theory of psychoanalysis united them all instead in a universe in which even with different accents all of them stressed that primal inaugural truth which Freud had stated from the very beginning in the
Studies on Hysteria: defense is the true pathogenic agent. Freud had not discovered the unconscious mind, which had happened long before. What he had done was something even bigger; he had found the pivot on which all psychopathology turned round. Either neurosis or psychosis, the symptoms were all either solutions to the conflict between love and hate or struggles for psychic survival. Mental suffering was the result of an excess or an anachronism of defense against the anxiety generated by moral conflicts or narcissistic injuries, or brought about by the disappearance of the libidinal world out of an irreparable loss.


We could talk out whether or not psychic structures were impervious to each other, or about behaviors being either more characterial or more symptomatic, or over the self-healing role of delirium, about the original trauma versus chronic daily cumulative microtrauma, about the proportions within dream between wish-fulfillment and resolution of vital concerns, we could take sides by emotion or by the signifier but basically no one would argue that the question was always in the mind’s reaction to the anxiety generated by conflict and that today’s symptom had been yesterday’s solution. The dynamic unconscious had been created by the mechanism of defense, from the first discovered repression until the later frightening dissociation and psychotic repudiation (in my opinion “foreclosure” does no justice to the French term “forclusion”). This unconscious (the proper Freudian one) continued to be our ideal course of action and we defended in every case the best chance among its various paths to that Shangri-La, the personal journey in which we proposed to keep company
with our patient, in order to rescue his ghosts, morphed into monsters by dint of not aging, and bringing them back to time and mortality.


That was then. I have related elsewhere (
¿Qué hacemos los analistas cuando no hacemos psicoanálisis?) how I discovered other ways of operating. I found that there are several ways to do the same, for example combining psychoanalytic listening with systemic prescriptions. In the meantime Erickson had reinvented hypnosis and through neurolinguistic programming, I was convinced that patients who do not speak are better not to be tortured to do it, and as I had always liked general psychology I enjoyed happily the cognitive bloom, which I still consider a much better psychology than therapy.


All these developments had taught me something valuable and I am sincerely grateful. In spite of their differences they all agreed on something I had learned in Freud, Erickson and Lacan, namely the unconscious works, and even though sometimes its creations become mysteriously painful, it can also invent new strategies not always symptomatic. The initial statement by which each clinical theory had its unique method had been much modulated of course, and along the way I had found very great coincidences between all of them. I even started a list of “amazing coincidences” between different clinical models that I was never to write, it was physically impossible to separate thinking and operating as much as all those “allergic-to-close-contact” authors had wanted.


I have needed all this preamble to talk about the impact that finding of EMDR had on my professional life, on which I have also written something elsewhere
(El estrés postraumático y la terapia del EMDR).

Some years ago I found in the first pages of Shapiro’s book that “much of what we consider to be mental disorder is the result of the way in which information is stored in the brain. Healing begins when we unlock this information and allow it to emerge”. EMDR then is a method to promote and expedite the processing of these representations which have become pathogenic precisely out of the locking conditions through which they have been stored.

And so we come easily across, unawares, with the pathogenic quality of the proper defense, since as Shapiro reminds us the trauma is never what happens to us but how our mind reacts to the unbearable stimulus. If our mind tries to bury it in its depths and succeeds in do it (encapsulating the stimulus but thus preventing its processing), the return of the living dead is virtually assured, with all its train of flashbacks, nightmares, anxiety attacks, feelings of danger and constant alertness.


In Freudian key we would say exactly the same as Shapiro, i.e a representation (there are of several classes in Freudian metapsychology) acquires its pathogenic quality whenever
it stumbles upon the opposition of some defense mechanism, (prototypically repression), forbidding its connection with other representations. Laing, another Scot now somewhat forgotten had said it with his knotted style: to repress an idea is to forget it and then forget the forgetting itself.


The EMDR is a procedure that involves bilateral stimulation and its administering protocol. Millions of apples had fallen from the trees until Newton saw his own one.
Tragedians and poets had described it: Who has not dreamed of marrying his mother? Jocasta warns Oedipus, but it took Freud to discover the drama to which he put the name of that poor wretch. As usual, someone with a gift for observation (Shapiro) had the genius to see something where everyone had seen nothing. Eissler considered the invention of free association equivalent as to inventing the telescope. I agree, and I want to add that I consider EMDR bilateral stimulation as an heir and outstanding disciple of free association.


The up side is that EMDR works, to a greater or lesser extent, perhaps sometimes
as little as all therapeutic methods do sometimes, and although I prefer to attribute to EMDR a psychoanalytic clinical psychology (we all have our preferences) cognitivists can also find theirs, pointing to reconfiguration of beliefs and of course behavioral desensitization has here a splendid example of the benefits of divesting a representation of its burden of anxiety to promote change as EMDR brings it on.


I remember in my EMDR training a teacher who insisted that “this is not Freud” and in order to
illustrate the difference drew a chart on the board, representing the psychic apparatus as Freud had sketched it comparing it to the one entailed in EMDR. I still remember my perplexity on watching carefully that picture, dominated by vertical lines. She was right, that was not Freud… that was Fairbairn, (the same drawing) another great Scottish analyst, contemporary of Melanie Klein and steady revisionist of the drive theory, who advocated for the existence of multiple dissociations and egos.


I’ll gladly accept the criticism that
I’m working this argument a bit to my own advantage, and that things are not so simple: not all defenses are reduced to Freudian repression, the haunted self manages pretty badly against structural dissociations and so on and so forth. Okay, okay, but I may say, if you please, that others can also argue to their own advantage because EMDR calls forth the perfect counter-example against the blatant absurdity of my old aspiration, that each clinical theory had one and only one method. When I had abandoned the search for one thing I found exactly the opposite.


Bilateral stimulation duly protocolized has that charm, it can be explained from various clinical theories, and even though we may not know exactly what it does to succeed (it would not be the first case in the world of psychotherapy), our ignorance does not prevent the succeeding, and you may account for it as you please. Or the EMDR pivots on a powerful common denominator of various therapies or they are not so different. The fact is that it works, achieving results that are not only substitutions between symptoms, attitudes and behaviors. Anyone who has
had rigorous experience of its administration, in personal drilling and with patients can attest how EMDR generates intrapsychic changes, how it generates and integrates visual images with sensations with internal dialogue in a way that turns into an idle debate, either the exclusion of body in verbal therapies the verbal or rejection of the word in the body therapies. Those who, as I once did, now aim at finding one and only one EMDR clinical theoretical model I wish them luck, they might find it and we’ll gladly recognize it.

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