Who Should Not Do EMDR Therapy? What You Need to Know
By: Maria Inoa
Oct 11, 2024
EMDR therapy may not be suitable for individuals under the influence of illicit substances, experiencing active psychosis, or severe mental health conditions like schizophrenia, suicidal or homicidal ideation. It may also be ineffective for those with brain injuries, significant cognitive delays, or severe dissociative disorders. Consulting with a qualified EMDR therapist is essential to assess individual circumstances and determine if EMDR is the right treatment option.
In the following paragraphs, we will discuss when Eye Movement Desensitization and Reprocessing therapy is not recommended. There are several instances where EMDR treatment may not be an effective treatment.
We will discuss those different scenarios below. Then, we will discuss other circumstances where precautions must be taken. After that, we will briefly go over other therapy options that may be beneficial. Lastly, we'll discuss how you can know if EMDR treatment is right for you.
When EMDR Might Not Be Suitable
Eye Movement Desensitization and Reprocessing therapy is a wonderful approach to helping people heal traumatic memories and traumatic events, as well as a variety of other mental health conditions, such as Post Traumatic Stress Disorder, that are keeping them from showing up as the best version of themselves. However, EMDR treatment is not for everyone.
If you are actively under the influence of illicit substances, then therapy in general, including EMDR treatment, is not recommended. The person needs to be able to stay present and focus in the EMDR session, especially during bilateral stimulation, which is difficult to do if under the influence of an illicit substance. This is separate from the prescribed use of psychedelics.
EMDR treatment is not recommended for people who are experiencing an active psychotic episode. A psychotic episode typically includes either hallucinations or delusions. Again, if the person is unable to follow through with bilateral stimulation, then EMDR treatment will not be effective for them. Until the person is out of the psychotic episode and able to maintain mental stability, EMDR sessions would not be a good choice.
In addition, those who are experiencing active suicidal or homicidal ideations would not benefit from EMDR treatment until they become stabilized. Along with that, those with more severe mental health conditions, such as Schizophrenia, may not benefit from EMDR treatment.
If you are someone who has experienced a brain injury, EMDR therapy may not be beneficial for you. It's best to consult with your doctor first to get clearance to pursue this type of therapy.
Those with significant cognitive delays would likely not benefit from EMDR sessions. Significant cognitive delays typically involve difficulty with memory, focus, learning, and more. Cognitive delays can vary, so this depends on the person and their circumstances. Again, consulting with your doctor can give you more information on whether you may be a good candidate for this therapeutic approach.
Those with more severe dissociative disorders, such as Dissociative Identity Disorder, can benefit from EMDR. However, they need to make sure their trained EMDR therapist has advanced training in dissociation and dissociative disorders. The EMDR therapist must have solid experience working with severe dissociation.
It is key to remember that it boils down to each person, their current circumstances, and how they show up to therapy.
Contraindications and Precautions
You must be upfront and honest with your EMDR therapist. The therapist must know your medical history and current medical conditions or concerns. If your trained EMDR therapist has a complete picture, they will be better able to tell you whether you are a good candidate for EMDR treatment.
Each person deals with past trauma in their own way. PTSD symptoms can look different from one person to another. A well-trained EMDR therapist will do a thorough intake during phase 1 to better understand where you are currently.
Many people distance themselves from their traumatic experiences, especially when it comes to childhood trauma. Some forget these traumatic memories and never allow themselves to think about the memory.
Phase 2 of EMDR treatment, the preparation phase, focuses on the crucial piece of emotional readiness. This means the therapist works with the client to introduce new coping strategies or internal resources and strengthen coping mechanisms that already work for them.
It's necessary for the client to feel emotionally ready before beginning the reprocessing phase, where the bulk of bilateral stimulation takes place.
Eye Movement Desensitization and Reprocessing Therapy is not a quick fix. Trauma therapy requires a slow, steady, and mindful approach.
Alternatives to EMDR Therapy
There are many therapeutic approaches available. Eye Movement Desensitization and Reprocessing is effective for helping people heal from many issues, including Post Traumatic Stress Disorder and its related trauma symptoms, as well as traumatic events in general.
It is also helpful for chronic pain, some instances of substance abuse, and mental health disorders, including anxiety disorders, such as panic disorder, dissociative disorders, eating disorders, and more. Below, we will talk about three popular treatment modalities that you can explore if you are not a good candidate for EMDR treatment.
Cognitive Behavioral Therapy (CBT)
This form of therapy is one of the most well-known in the therapy world. Cognitive behavioral therapy (CBT) is based on the idea that we may have faulty patterns of thinking that are then creating unhealthy patterns of behavior.
CBT seeks to help you challenge your patterns of thinking or negative thoughts, which are referred to as cognitive distortions. It can help you challenge unhealthy behaviors and better understand the motivation of others. CBT utilizes "homework" to help you practice your new coping skills.
Dialectical Behavior Therapy (DBT)
This therapeutic approach is known for being effective for those struggling with self-harm and suicidal ideation and for those with a suspected or diagnosed personality disorder. DBT utilizes parts of Cognitive Behavioral Therapy and focuses on the following four areas:
Mindfulness - accepting where you are and being present in the moment
Distress Tolerance - learning to tolerate "negative" or intense emotions
Emotion Regulation - being able to manage your emotions
Interpersonal Effectiveness - learning to communicate effectively with others by learning assertiveness
With Dialectical Behavior Therapy, clients typically keep a diary of their emotions, impulses, and situations between sessions, which they then review as part of their therapy session.
Exposure Therapy
Exposure therapy is where the therapist gradually exposes the client to the object that the client fears. There are four forms of Exposure Therapy:
In vivo exposure - the actual exposure to the fear thing
Imaginal exposure - vividly imagining the feared object
Virtual reality exposure - virtual reality can be used to expose the client to the feared object
interoceptive exposure - bringing up body sensations that accompany the fear to desensitize the fear
The therapist will work with the client to develop a treatment plan that best desensitizes the client from the feared object.
Medication Management
Medication can be helpful for some people. It's important to understand that medication does not "cure" anything but can decrease symptoms. Medication cannot resolve past trauma.
There are times when a client may be too anxious, such as experiencing frequent panic attacks, or too depressed to benefit from the healing process of therapy. In those cases, the therapist may discuss the client seeking an evaluation from a medical provider to determine whether medication may be helpful for them.
How to Determine if EMDR is Right for You
Consulting with a Mental Health Professional
If you are unsure whether you may be a good candidate for EMDR treatment, I encourage you to contact a certified EMDR therapist to discuss more. Most therapists offer a free 15-minute phone consultation to answer any questions you may have and ensure they are a good fit for what you're looking for.
Related: How To Find a Good EMDR Therpist
Initial Assessments
During your initial appointment, or phase 1 of the EMDR treatment approach, you can share your history and current situation with the therapist. The therapist will also discuss your medical conditions and any mental health conditions you may have been diagnosed with. Again, being honest and upfront with the therapist is crucial so they can best assist you on your healing journey.
Conclusion
To conclude, we have explored who may not be a good candidate for Eye Movement Desensitization and Reprocessing Therapy. We looked at specific mental health conditions as well as medical conditions that may prevent the client from being able to benefit from EMDR therapy sessions. We looked at various other treatment approaches that can be explored instead of EMDR treatment. Lastly, we talked about the importance of consulting with a qualified, certified EMDR therapist on your mental health care in order to determine if you qualify for EMDR treatment. It's important to remember that we are each unique individuals, and so are our mental health challenges.
