by Dana Terrell, LCSW, EAC
I’ve been a fan and a member of EMDRIA ever since being encouraged to join during my first weekend of EMDR training, back in 1997. Founded in 1995, It was a baby organization, but operating quite capably at that stage. To give a context, EMDR research only had an 8 year history.
A little EMDRIA History
One of EMDRIA’s first tasks was to share the research with all major insurance companies and convince them to cover EMDR treatment. They were very successful at that early stage, so most major insurances did accept EMDR treatment for PTSD when I began my career as an EMDR therapist. I did not take this for granted. EMDRIA was a major force in helping EMDR to become known by professionals and the public. This is a cherished goal of every enthusiastic EMDR therapist, because they know how potent, effective and amazing EMDR is. In fact, 3 EMDR therapists who work with cops and other first responders confirmed to me this week: this elite group of clients are calling EMDR “F___ing Magic” or “FM” for short.
I especially did not take EMDRIA’s success with insurers for granted as we kept waiting for one particular insurance, Tricare, to accept the responsibility to cover EMDR for PTSD treatment. Annually a visit from EMDRIA representatives updated Tricare on the research. Annually Tricare chose not to cover it.
The most irritating thing about their refusal (for me as a Tricare provider) was this: in their list of “not covered” treatments, EMDR was the only one “distinguished” with a different color. As I recall, it looked like this in a long list that included couples therapy:
Tricare does NOT cover:
As a Tricare provider. I wrote my Senators and Congressperson about the issue, and kept tabs on EMDRIA’s efforts to ask how I could support them.
This Tricare policy appeared irrational to me because EMDR had been officially accepted by the Veteran’s Administration and the Department of Defense. My question was this: If it is good enough for the soldiers, why is it not good enough for their families? Another question, “If the heads know about EMDR, why not the foot soldiers on the insurance front?”
After 4 year of this process, around 2004 I reached a level of impatient disgust no longer tolerable. I quit Tricare. There is a happy ending to this story (you may have guessed, seeing EMDRIA’s persistence and track record), but first…
In making a report on things that still need improvement, it is necessary to mention that the Veteran’s Administration, though they approved EMDR treatment in the 90’s for PTSD, have not implemented the availability of EMDR in a uniform fashion at the VA centers. Within the VA and the active military as well, there is a strange feudalism (based on who’s in power in each small fiefdom) in which some centers offer EMDR readily (our Vet Center in San Diego offers free EMDR to veterans) and in some you can’t find it at all. In those centers either Cognitive Behavior Therapy for Trauma (CBT) or Exposure Therapy (ET) are EMBRACED. This sad, unscientifically-based fact has been frustrating EMDR therapists who serve the military for years. They have been working hard to give military and veteran personnel the choice of treatment options.
Two highly prestigious organizations have taken the position, based on the solid research from the past nearly 25 years, that all sufferers of PTSD should be offered CBT and EMDR. Britain’s Cochrane Review (of medical research to determine the most efficacious) was the first to make this simple statement. In 2013, the World Health Organization followed suit.
Our active military and veterans have high rates of PTSD and certainly deserve from a grateful nation to have a choice in their treatment for this terrible condition that impacts their relationships, hopes and goals, their daily lives, and too many of their nights as well.
Also, I don’t know if they still refuse to cover couples treatment, but there is no group put under more stress that our military families and couples. Here is the current confirmation from the Humana-Tricare website:
TRICARE covers behavioral health care only for beneficiaries with a valid behavioral health diagnosis.
Counseling services that are not medically necessary for treatment of a diagnosed medical condition (e.g., educational, stress management and lifestyle modification counseling) are not covered. Although marriage counseling and family therapy may seem similar, under TRICARE, family therapy is covered, while marriage counseling is not.
There are few groups who are more in need of couples treatment than Tricare beneficiaries. Perhaps Tricare thinks it is sufficient to offer it at other military locations. But some military members don’t feel comfortable going there.
Finally, through EMDRIA’s persistence, Tricare did approve EMDR treatment in 2007, back-approving it to 2005. I took satisfaction in this because it implied their recognition of their mistake. That I can respect – and forgive.
Current Professional Standards and Development:
2005, coincidentally, was the first year I attended an EMDRIA Conference, another EMDRIA service. I found it extremely valuable. When I sat down at one classs in 2007 and struck up a conversation with an attendee, she said, “What I love about the EMDRIA Conferences is that my colleagues are so competent! I fully agreed. This month I will attend my 6th Conference – this time in Austin, TX.
The reason I was inspired today to write this article is by seeing an outstanding EMDRIA proposal to change the process of EMDRIA Certification (something I have long believed in) to improve it even more. It’s called
Defining New Credentialing Standards: An Update on the Work of the EMDRIA Professional Development Subcommittee
EMDRIA Certification in the past has meant therapists receive 20 hours of consultation on their practice of EMDR, plus they commit to receiving at least 12 credits of advanced EMDR training every 2 years. It represents a commitment to keep current with the research and practice of EMDR.
I found EMDRIA-Certification helped me greatly to increase my skill and confidence as an EMDR therapist. Once I became an EMDRIA-Approved consultant, assisting over 40 local clinicians to become Certified, I watched that same positive process happen repeatedly.
I’ve also worked with clients who were deeply disappointed in their previous EMDR experience, offered by therapists whom they learned omitted necessary parts of the 8 phase EMDR protocol (after they described their experience to me, I let them know what was omitted). These therapists, at least 90% of the time, were not certified. For this reason, I have website directories in which I require members to be EMDRIA-Certified in order to be included. I believe the public deserves the best EMDR experience that research has validated. To me Certification is not a guarantee of getting that (as proven by my 90% statistic above), but it certainly has done a good job of improving the client experience.
The proposed Credentialing Standards are based in a competency approach, rather than a less significant hours requirement. Once a clinician demonstrates competency in an array of areas, they will be certified. It could take less than 20 hours or more, and will depend more on what the therapist puts into the process. Putting in time alone will not be enough. The goal is for all to emerge from Certification with strong knowledge, solidly practiced skills and the ability to convey them clearly to clients, colleagues and the public.
Learning to be an EMDR therapist requires a definite learning curve. EMDR has an 8 phase protocol. The choice points along the way, as to when to move to the next stage, are important and need to be tailored with care to each client. Comprehensive EMDR treatment has a 3 prong approach: Past traumatic events, present triggers and challenges, and anticipated future challenges faced with confidence and necessary skills. It takes time to learn and integrate all this into practice.
If you are a therapist interested in becoming an EMDR therapist, I strongly recommend you first receive EMDR for a single event or single issue. That way you will understand from the inside what EMDR is. Learning AIP theory and the 8 phases will come more easily. Practicing it will earn you compliments from the start, as it did me. Though I felt like an awkward beginner, my peers told me “You’re really good at this!”
The new Competency approach is not finalized yet. It’s well on its way with an excellent document just sent out 9/5/13 to EMDRIA members for their feedback. It was exciting to read the high standards and comprehensiveness, including demonstration of cultural competency, a written Case Report covering all the aspects of thorough assessment, treatment focus, therapeutic relationship, and so on. I am thrilled to have read this, and to witness the growth of this from 2 years of discussion on the listserv for EMDRIA Approved Consultants.
In fact, I want to mention that as a professional association run by volunteers of the highest standards and generosity, two of those volunteers that are key in this recent development are Sue Goodell, LMFT, EAC of San Diego, CA and Julie Stowasser, LMFT, EAC of San Luis Obispo, CA. They serve as the co-moderators for the EMDRIA Approved Consultants Listserv. Julie and Sue saw a need for this discussion group and inaugurated it in 2011. They have capably lead the discussions and kept us on track (holding us to relevant discussions for this particular list) since then. Our trusty co-moderators have made a major contribution to EMDR efficacy by their service.
Additionally, the team of EMDR therapists who drafted the credentialing document deserve to be acknowledged for their thoroughness AND elegant succinctness. I would be thrilled if I could write so succinctly (makes me chuckle just to write it. You may have noticed some wordiness here?). They include Wendy J. Freitag, PhD, Chair; Jocelyn Barrett, MSW, LICSW, Co-Chair, Standards & Training Committee; Nancy Errebo, PsyD; Regina Morrow, Ed.S, LMFT, LMHC.
In fact, I want to quote something to demonstrate how much they are saying, simply but beautifully. I’ve always loved how integrative EMDR is. This quote from page 2 of the draft conveys the profound power of EMDR and the Adaptive Information Processing system (AIP):
2) EMDR is an integrative psychotherapy approach that evolved primarily from clinical experience. Integrative has several meanings (International Integrative Psychotherapy Association, 2013).
a) It draws from many views of human functioning: client centered, behavioral, psychodynamic, cognitive, body-focused, Gestalt, and cognitive neuroscience (Norcross & Shapiro, 2002; Shapiro, 2001, 2002a).
b) It is intended to integrate the personality, bringing unassimilated negative information together with positive resources to empower a whole humancapable of love and service (EMDRIA, 2012; Shapiro, 2002a; Siegel, 2002).
c) It is intended to bring together the affective, cognitive, behavioral,physiological, and spiritual systems of a person to facilitate healing ofpsychological disorders (EMDRIA, 2012; Krystal, et al., 2002; van der Kolk,2002).
Thank you to EMDRIA! You have been a great magnet, drawing competent, sincere and enthusiastic therapist-volunteers to you to serve in countless ways. They give back to the world (through EMDRIA and the EMDR Humanitarian Assistance Program) what EMDR has given to them.
Note: To find the research citations, please go to the Francine Shapiro Library link on the emdria.org website.