StephanTobin IntemationalGestaltJoumal2W4,27/1, ??-??

The Integration of Relational Gestalt Therapy and EMDR

and reprocIn this articleI attemptto showhow the integrationof "eye movementdesensitization
powerful
in
more
results
a
approach
gestalt
therapy
relational
(EMDR)
within
a
techniqies
essin/'
as
protocot
EMDR
standard
in
the
steps
the
I
method
describe
alone.
method than either therapeutic
how
we-now
know
about
what
discuss
I
briefly
EMDR.
founder
of
Francine
Shaplro,
the
outlined by
traumaaffbctsbrain functioning and EMDR'seffectivenessin resolving"simple" trauma. I then expl,ain
how EMDR, within the contextof a relationalgestaltapproach,can help to resolvetherapeuticimthat neithertherapists
passes,enhancethe working-throughprocessof therapyand triggerassociations
nor clientsanticipateor predict.
One of the hallmarks of gestalt therapy is that its practitioners have felt free to explore other
forms of therapy. All too often, however, the result is, as Yontef (200L)has pointed out, in a "gestalt
therapy and (something else)" hybrid in which techniques or procedures from one form of therapy
are merely introjected into gestalt methodology. The result is then a monster of disparate, sometimes
incompatible, techniqueswithout an overarching theoreticalumbrella under which to subsumethem- I
take some credit in attempting to integrate self psychology conceptsand methods into gestalt therapy
(Tobin, 1982;1983;1985)but must include my efforts at that time as an introiective processrather than
what Yontef points to as a more viable approach:assimilationof the useful techniquesfrom one form of
therapy into the theoretical system of another therapy. Yontef describes the necessary steps:
". . . deconstructing assimilating and integrating that which is useful in gestaltth etapt'' (Y ontef, 2002,
p.22).
Zahm (1992),Yontef (1988;2W2), Jacobs(1992),HyAs examples of assimilation, Breshgold au..rd
cner and Jacobs(1995),Sapriel (1998),Staemmler (2002),and others have assimilated contemporary
psychoanalytic observations and concepts into gestalt therapy while maintaining fidelity to gestalt
principles of field theory, phenomenology and dialogue.
I am now faced with the assimilative task of integrating into my gestalt approach the powerful
"eye movement desensitization and reprocessing" (EMDR) techniques discovered and developed by
Francine Shapiro (1989;1995;2001).I have found myself being able to utilize the standardized EMDR
protocol very effectively in short-term treatment of people who have suffered traumatic experiences
and for specific issues such as simple phobias. I have also gtadually been increasing my usage of
EMDR techniqueswith many long-term clients and have found the therapies greatly speeded up.
Growth plateaus that frequently had lasted for years have ended with clients making important
changesin their lives. Issues that I thought had been fu1ly dealt with before using EMDR resurfaced,
and when we then used EMDR techniquesto work on them, a complete closure resulted.
I also began to realize that, although EMDR was known to be effective in helping clients work
through traum4 a possibly even more important usage was, with the addition of other useful techniques, aiding clients to accessself-strengthening resources that were potentially available to them
1

GestaltTherapyand EMDR
and they badly needed but lacked. I found that, with people who had been severely abused atrd/ or
neglected as children and had suffured rrultiple traumas, helping them develop and then intemalize
these resourceswas necessaryfor them to makp any pro$ess in their lives.
I shall briefly describein this article the thepry and methodology of EMDR and give an overview
of how I am integrating it into my relational gqstalt approach.
lNhatisEMDR?
EMDR was the original creation of Franci4reShapiro, who 4iscovered, quite by chance, In 1987,
that moving her eyesfrom side to side while thli.,ki"g emotionally disturbing thoughts resulted in the
disturbance suddenly disappearing. She also firoticedthat, when thinking the thoughts again, they
were not as upsetting or as valid as before. She tried the sarne technique with other disturbing
thoughts and memories and achieved the sam{ result. She then began to try the technique with other
people with the same positive outcomes.
After conducting a pilot study (Shapiro, 1q89),she rapidly dlevelopeda method of working with
clients and began to train therapists in the n]rethod in 1988. The methodology was expanded and
modified in significant ways by communicatipn between her alrd a network of these other EMDR
therapists. She trained other clinicians to be trainers, there wps continual research on the use of
EMDR with various groups of trauma survivprs, and the expansion of the usage of EMDR with a
wide variety of emotional disorders rapidly
been trained in EMDR all over the world. A numTo date, approximately 4O000therapists
EMDR-trained {herapists and various procedures or
ber of other techniques have been developed
"protocols" have been created to be used w
different psychological disorders. Becausethe procelth trauma victims, its efficacy is relatively easy to
dure is quite straiglrt-forward when utilized
sfudy and more researchhas been done on E DR than anv other form of trauma treatment. Most of
effective treatment for trauma survivors (van Etten &
these studies have shown EMDR to be the
Taylor, 1998),and treatment usually takes onl a few sessionswilth clients who have had a reasonably
personality disqrders.
good attachment history and do not have
however, inlluding the multiply traumatized, the
With clients who have more complex di
treatment is much more complex and takes uch longer. And it then must be integrated into more

comprehensivetherapeuticapproaches.Shap

herselfrecomrirendsits integrationinto other mo-

ible with psyphodynamic, behavioral, cognitivedalities, and suggests how it can be

behavioral and experiential approaches(Shapi 2ffi1,,pp.20ff.)i
vioral zeitgeist, fiowever, it tends to be rather techBecauseEMDR grew out o{ cogniti
nique-driven, and there is a danger for EMD
rained therapistf to be mesmerized by the powerful,
in the EMDR establishment wish to have EMDR recnovel procedures.In addition, Shapiro and
ognized alongside other widely recognized,
ualized approac$esand tend to discourageinnovators
callingwhat they do EMDR.

Tobin

i myself am finding a cornbination of a

tial to effective treatment because of the

gestalt
emphasis on

EMDR providesthe complementarymethods

t can greatly

search shows, it is still the therapeutic

capacities (Bohart & Tallman, \999) that ate
Also, in conjunction with many of the classical
ing with sub-personalities in dialogUe,
can be combined with EMDR bilateral
nessesthat emerge from the work.
But in order to discuss the EMDR
leaming about the effects of trauma on brain

ip (Horvath,
most i

TheNatureof Traumaandl

with EMDR techntquesessenlogy, dialogue and contact.

ancethe therapybut, as much re) and the client'sown self-healing

factors in effective psychotherapy.

such as the empty chair work, dealand processrather than content,
body
to "cemen in" important changes and aware-

r, I first need

v to describe what we have been

g.
on
El,ffects

andFunctioning

to be completed in a smooth, creaTrauma prevents the gestalt formation and destruction

the person's background as vague
tic effects exist
tive, lively fashion. The un-metabolized tra
The results can be either a
t
bodily
thoughts, anxiety, frightening images and
to these unfinished figures in
activitv is
rigrdity in present functioning so that almost
or she does no experiencefully what is going on in
the background, or the person is so labile that
letely occur g (Polster& Polster,1973,p.37) in
the present, resulting in figural closure never
closuremany yearsagowith a
ties in achi
conunon, everyday activities. I described the
the present (Tobin, 1971). We now
tully living
discussion of how hattgntg onto the past
types of memory and why the
di
about
brain,
know much more about the physiology of
processingof trauma frequently does not occ irnmany people.
ysis and cognitive-behavior therapy,
h as psych
One of the reasonswhy talking therapies,
affects implicit memory, located
have not been very effective at resolving tr rna, is that tra
(van
der Kolk, 1996; Siegel,1999;
in
br
of
the
mostly in the limbic system of the right
information to the cerebral
emotionally
Schorg 1994). Hippocampal activity, which
prevented
from becoming a
is
the traumatic
cortex,is suppressed.The result may be
about oneself that lies clearly in
"memory" in the usual sense of the word: a piece of informa
in time. They seem to float
anchor
are unable
one's past. Instead, elements of the past
activity, memories of unresolved
of hi
freely, often invading the present. ln the a
(Rothschild, 2@3, p. 11).
system
in
implici
npmory
traumatic incidents may remain the
it througlr then doesn't experience
and not
The individual who has experienced tra
Instead,there are flashbacks,
it
is
over.
that
realize
having survived the traumatic incident and
I re-experienci of the bodily sensations,emotions
nightmares, anxiety attacks, etc., and con
ic event keeps recumng. An exIt is as if the
and visual images associatedwith the tra
he hears a loud noise.
to the ground
ample would be the Vietnam veteran who di

Gestalt TheraPy and EMDR

As examples of the effects of trauma, I
stages. A one-year old child is bitten on the

events at two develoPmental

consider
event gets encoded in imPlicit, but
by a dog.
not been completed. Later on in life
not explicit,memorybecausethe child's cortica development
sympatheticnervous system
the individual may feel terror, vague but di rbing visual
of a dog. But there is no senseof a
at the mere
physiological arousal and even pain in her
it impossible for her to Process
of course,
self to which these symptoms are connected'
t the help of a therapeutic method
and work througlr her phobic reactions to the ight of dogs
example is a woman who is
that results in the integration of implicit and prlicit memory.
helming terror and pain, shemaY
raped by a violent sexualpredator.To protecthr:rself from
dissociateduring ttre rape imagining herself a benign, safe e{rvironment. Once again, the experience is not registered in explicit memory. But is very survival mechanism of dissociation makes it
time she see$a man similar in appearance to the
impossible to processthe events of the rape.
vity with any nian, she may begtn to experience the
rapist or starts to becomeinvolved in sexual
that occurrefl during the rape. Dissociation then
intense affective, cognitive and sensory experi
follows.
g the individuaf from overwhelmingaffectand preWhile being a survival mechanism,
,has
very limitiflg effectson the individuals contact
venting fragmentation, this dissociative ou
functions.In gestaltterms,the figural formati l/'destruction prqcessis severelyhampered whenever
situastimulus sltuaLtionis present $ extemal or intemal stlmulus
even a small part of the original traumatic si ation
ic nervous systQm,certain stress hormones, such as
tions. These stimuli then trigger the sympa
cortisol, are released and the organism is cata tted into a thghtftiillt mode of functioning. If neither
tic and parasympathetic systems are simultaneously
fight nor flight are possible, both the sym
higgered and freezing occurs.This can result a slack-muscledfesponse,such as mouse caught by a
cat or the stiffness of a deer caught in a car's
t, such as experieircing a life-threatening injury, being
The trauma can be a dramatic, single
or it can be the experiencing of multiple catastroinvolved in a catastrophe,such as an
or living in a c[untry where there is continual viophic events, such as prolonged childhood
early childhoop deficit experiences,such as a carelence or famine. Some would include as tr
taker who is cold and distant from his or her i ant, but I do not pelieve that theseexperiencesshould
ting effec! on emotional development,but the
be defined as trauma.. They certainly have a krvastating
trr be almost mlaningless.I prefer to limit the term
concept of trauma then becomes so broad
rattferthan the lack of someessentialacexperiences
trauma for the presenceof devastating
, how EMpR-related techniques can be instruquired during childhood. I will show later,
mental in helping to address deficit.
\ memory of t!'retraumatic event(s) but the underFrequently, the person may have a
ry experiencing. Or the person may have the affective
standing is dissociatedfrom affective and
and sensory experience without the cogniti component. The former is the rigid, over-controlled,
discussedby Pofsterand Polster (1973),compulsively
frequently obsessive-comptllsive type of
4

Tobin

needing to attempt closure of the haumatic

having difficulty in self-reguladon becauseof

EMDR'sEffecti
EMDR providesa methodologYto
therapy.

[. The latter is ttie emotionally labile, scattered type

constantly comfeting unfinished gestalten.

inTreatrnentof frauma
five things th{t make it a very good fit for gestalt

First, it "jump starts" the brain to process

sure of past unfinished eve4ts. This extremely
often accomplished within two or three
can be seen as a way to resolve impasses

sent gestalt formation-destruction process

influences so that they can recedeinto the
ures to form.
I spentnumeroul sessionsworking on the sequelaeof
For example, a long-terrn ex-client and I
meana beating she had suffered at the hands of her usbandthfutyyea[sbefore.This work wasvery
shame.
and
fear,
pain,
anger/
work
him during thif
ingful in that she expressedrnuch affect tow
had motivated her to stay marand why, and
ha
what
had
She seemedto know exactly
resolved- Consequently, she
not
was
still
the incident
ried to her husband after the beating.
sexual contact with him and,
ever srnce/a
had staved emotionallv distant from her

althoughhe had goneto a tlxerapisthimselfto

with him about the incidentr she had refused
She then took a five-vear hiatus from
return to treatment, we worked on the bea

solveher unfinishedbusinessaboutit comp

work and our previous atternpts to deal with
her back into the event in an immediate way
able to feel what she felt at the time, see her
voice and, perhaps most ir4portantly,
in to his beating about which she had felt s
the belief at the time that, were she to resist,
and evenhim.

Not only did we work through the inci

she expressedher resentmept toward her
an abusive boss she worked,for at the time.
Second,EMDR activateq". . . a whole
are ordinarily not accessed[n conjunction wi
As an example of this, Paul Wachtel, a
EMDR treahttent, he resolvEd an issue that

rk through the shamehe felt and beggedher to talk

frightened of him.
was still
EMDR training' Upon her
the
p'y during which I had
in two sessions,managed to re:incident again
the difference between this
make
to
y. What
t the EMDRprocessingcataPulted
trauma, was
therapy work had not. Shewas
our previous

s rageful

and his "uglt'' mouth, hearhis

't fought back. Her passively glting

why she
she then realized was motivated bY
for many
would kill her. She was now able to forgive herself

so therewas no l]ongerany emotionalchargeto it, but

I

----

L-

for the abuse],and was able, finally, to stand up to

ty of unexpecte{ feelings, images, and thoughts that
other memoriesf (Noruoss & Shapirq 2002,p.341).
relationally-oriefrted analyst, has described how, in
existed from the age of four that he had not been able

CestaltTherapy and EMDR

to resolve in his analysis. The results of this E flR work led to his concludhg, " .. . something about
the experience I have reported seems to me
lling and suggests that the EMDR experrence can
contribute powerfully to releasingsome of
stuck locks in the darker rooms of the psyche"

(Wachtel,2002,
p. 133).

Third, it can help the person to access

ground support functions.This is

and then "installing" them via the use of the
able to feel nurturing toward himself or
One would be imagining being in the
aged to experience a fulI range of emotional,
lateral stimulation is being administered.
Lest this sound unrealistically magical, I
with a variety of resourcesbefore the client
self. Among the most important therapeutic
discussedhow the self-psychologicalphen
with EMDR (Tobin, in press).
Fourth, it helps to achieve the holistic job
tions. There is evidence (van der Kolk, 2002;Si
networks that have been dissociatedas the res
Fifth, it fits with gestalt therapy becauseit i
ral information-processing abilities rather

pist. Cestalttherapistshave classically

within himself or herself to fill in needed back-

in EMDRvia the procedureof developingresources

i-llateral stimulation. For example, a client who is un-

can be helped to acquire this ability in various ways.

of a person who was nurturing while being encourphysical and sensory accompaniments while the bito add that this might have to be done many times
to experiencethe presenceof a nurfuring internal
is, of course,the therapeutic alliance arrd I have
of "transmuting intem alizatto:n" can be speeded up

integratingcognitive,emotionaland sensoryfunc1999)that it does this by integrating brain neural

lt of traumatic experiences.

aLnon-linearappnoachthat relieson the brain'snatur,equiringmuch interpretive activity from the therathe "whys" or interpretationof client materialin fa-

vor of the "whats" arrd"hows" of experience.

and Greenberg(zffiz) seeEMDR as mo$t similar
to Gendlin's focusing and Roger's clien
therapy in that the therapist is cautioned against
introducing his or her own ideas into the thera . Wachtel (2002)likens EMDR, at least in therway it's
recommended to be conducting according to t}.e manualized Standard Protocol, to early psychoanalysis,with its emphasis on free association.
How can one justify using a methodology
is so different from the usual gestalt approach of
dealing with what the client brings into the
ion, particularly when the main focus may be, as in
the relational gestalt perspectivq on dialogue
on the contact functions of the client? After all the
very probably never thought of or encountered:
therapist is introducing something the client
moving his or her eyes back and forth or doi
some other kind of bilateral stimulation.
The answer is in terms of the issue of e
tation, a hallowed aspect of gestalt therapy methodology. Although many EMDR therapists
to follow a rigid procedure that allows for ltittle dialogue between them and their clients and litt consideration of the individual differences of therapists and clients, my focus is first and fore
rln the dialogic relationship. Therefore, i always explain the rationale behind EMDR and suggest
various techniques at appropriate times as experiments to see what the client can learn from

But the client has the last word as to whether or not

Tobin

we use these techniques. In addition, my use the techniques arises from what is transpirirrg in the
therapeutic field. For example, a client began lbe afraid of me because a facial expression of mine
suddenly reminded her of an uncle who had
ually abused her as a child. After helping her to experience the physical differencesbetween her
Ie and me and the great difference between his exploitation of her and my helping her, I begao processvia the EMDR techniques the memory that
had been triggered of the abuse.
How

I]MDR Work?

Nobody knows for certain just how EMD rn'orks.Shapiro seesit as a method for providing acceleratedinformation processing of memories
t the individual has not been able to process. In the
(Shapiro,2ffi1
latest edition of her EMDR text
she discussesa number of possibilities: deconditioning as a function of a relaxation response; a
in brain statq; the enhancemenf activation, and
I attention to the past trauma while, conc'urrently,
strengthening of weak associations;and the
attending to current extemal cues.
lation is at all necessary.Siegel (1999),an expert
Some people question whether the bilateral
on brain neurophysiology and attachment
, and an EMDR proponent, suggestsit may be that
ged to focUson the emotional, sensorF/cogniduring the EMDR procedure the individual is
tive aspectsof trauma while experiencing the pport of the therapist.The result is then brain integration along horizontal (left and right hemi
) and vertical (brain stem, limbic systerm,orbistimulatiory however, may have the same result
tofrontal contex and neocortex) levels. The bil
it is well-knorvn that PTSD patients show an abas rapid eye movements (REM) during sleep
consolidation opcurs during REM sleep and that it
sence of REM sleep. Siegel believes that co
also occurs with EMDR processing.
In any case,the evidence is quite con
that information processingof PTSD does occur rn a
rvith EMDR than in other methods. Van Etten and
more rapid and efficient and thorough
hotherapeutic and pharmacological treatrnents of
Taylor (1998)found, in their meta-analysis of
PTSD, that EMDR and exposure therapies ac
similar outcoryresand were superior to other psytlhat,while expoguretreatment averaged10 sessions,
chotherapeutic treatments. But they also
vidson and Parker (2001)also did a meta-analysisof
EMDR treatnent averaged only 4 sessions"
34 difference EMDR studies and also found E DR treatment equtivalentto exposure and other cognitive-behavior approaches,wiith EMDR again ing more efficient; It has also becomeclear to me that,
t of trauma survivors with good self strength,
although it was originally used in short-term
term and longer term treatonent with the multiEMDR techniques also can be applied both in
ply-traumaized, in treatment of more severel clisturbed peoplg and at certain stagesof trreatment
with less disturbed clients who function
), well but seetherapy as a growth process. While it
wherein EMDR is integrated with other apis much harder to do research on therapy

proaches,a largenumberof articlesand books

Shapiro,2002;Manfield,1998).In addition,it

beenpublished on suchintegration (for example,

ber:n adapted for working with children and ado-

Gestalt Therapy and EMDR

lescents(Greenwald,2W1r,family therapy (
chology (Krystal, et. al"), hypnosis (Gilligan,

TheProcedure
for

, Nurse & Tfiompson,2ffi2),transpersonalpsyand even psyclroanalysis (WachteL 2002).

ingThroughTrauma

Shapiro divides EMDR treatment into eigh distinct phases.

Phase1 is obtaining a history and plannin treatrnent.
Phase2 is preparation for the EMDR p
ilsing, which reqpires establishing a therapeutic alliance,explaining the EMDR processand initi
g relaxation and safety procedures. Part of this stage
involves helping the client create a "safe
" just one of ma{ry techniques for resource development and installation (RDI). The therapist and ttre client also defermine the preferred mode of bilateral stimulation.With most peopleit is visu but with some it is auditory and with others, kines-

thetic.
The third phase is assessmentof the ta
Itobe processedand identification of the image that
best representsthe memory. The client is also sk:edto identify a negative belief or organizing principle about the self that was formed as a result tf the trauma. It ip usually something like "l am useless/worthless/unlovablelhelpless/bad." The ient then specifies a positive belief that will later be
used to replace the negative belief during
5, the installati$n phase. The client is asked to give
this positive belief a scorebetween 1 and 7 as how valid it is. The therapist also asks the client to
indicate, on a scaleof 0 to 1Q how upsetting
eventis as sherpmembersit, with 0 beingnot upset
at all,10 being the worst she can imagine.
is is a "SubjectivNUnit of DisturbanceScale"(SUD)
originally desinged by JosephWolpe (1990).
Phase4 is desensitization. The client is
to focus on the Worst part of the event and to notice
visual images, other sensory stimuli, physical iensations,
tions, emotipns and the negative cognition. The
therapist then initiates the bilateral stimulation lt is usually aboult25 stimuli but can be much shorter
or longer. After each set, the client just says w rt he experienced]and the therapist usually makes no
comment except something like, "That's fine,
go with that." The sets are repeated until the degree
of disturbance level is reducqd to 0 or 1. Many
the sets of stimulation are not sufficient in themselvesto complete processing and the therapi tlrasto use additipnal strategiesand advanced procedures, as the "cognitive intetweaver" which I r ill describelater.
Phase5 is installation of the positive belief
t the client ideptified in phase 4. This is done with
short sets of stimulation (ugually about Z)
the client expepiencesthe positive belief as "completely tr1te,"i. e., a scoreof 7. The reason that
are kept shorf is that, if made longer, other neural
networks are apt to be activated and more
tive material may arise.

Phase6 is a body scanto seeif the trauma completelypro$essed.

The client is askedto hold in
mind both the originaltargetand to scanhis or
body to seeif fhereis any residualtension.If there
is, then processingof the senpations
of tension re targeted for supcessivesets.
Phase7 is closure of the pession.Freq
, processing has hot been completed and the client is
helped to retum to a state of emotional equili um via the safe place or some other grounding and

Tobin

self-soothing method that has been acquired

keep a log of negative thoughts, dreams and

Phase8 takesplacein the next therapy

the memory targetedduring the previous
tive belief was a 7. Further processing takes
has been completed.
Note that, although I routinely use the

processing started. The client is also asked to

that may pccur between therapy sessions.

and involves{eevaluation;the therapistreturnsto

evenif the SUps levelreached1 or 0 and the posiuntil the ther{pist and client are convincedthat it
ard protocol wilh short-term clients who have come

to work through specificissues,suchas PTSD a phobia, and qccasionallywith long-term clients, I

oftenuseonly part of the protocolwith long
clients.
TheProeedures
for Dnelopi
A use for EMDR that is jUst as important
velopment and installation of positive resou
installed before the trauma processingcan be
and self-sootheneeds to leam to provide those
cult task of re-experiencing traumatic events.
regard, self-grounding self-confidence, and
clients such as borderlines, the suicidal, dissoc
from multiple traumas, abusg and childhood
self-strengthening. Kom and Leeds (in press)
tion with some of Linehan's (1993) procedures

One very important respurce is the

EMDR therapistsunderestirpate.Althouglr
with their clients exclusivelylto the techniq

and lnstalling PQsitioeResources

the rapid informf,tion processing of trauma is the deFrequently, the$e resources need to be accessed and

ed. For examplp a client who cannot regulate affect

ilities for himsellf or herself before tackling the diffiof the other positive resourcesare positive selfability to set llr{rits with others. Severely disturbed
tive identity disotders, and others who have suffered
t can be hetpfd, via EMDR techniques,to achieve
ve extensively dilscussedthe use of bilateral stimulainstallation of Sositive resources.
utic relationshilp, the importance

of which many

y effective EMQR therapists attribute their success

I believemuch df the power of their work is due to

their accepting attentive, affectively atfuned

le of relating to ttieir clients.
I have found, however, that some clients w
feel safe and se$urewith their therapists and have a
very positive alliance with tfrem when in
r, lack the objeft constancy to maintain a sense of
their therapists' presence when away from
I have discussFd in another article how the therapeutic relationship can be an additional, very
resourceth{t can be installed via EMDR (Tobin,
in press).
In gestalt therapy terms, one could seethe
Lticalliancf when doing EMDR as the ground,
aspart of the clienfs supporf system.The
can itself $ecome figural and there are EMDR
therapists who will then uge the bilateral
on the plienfs perception of the therapist
(Snyker, 1995).But I usually deal with the
p in a dialggrc way-- self-disclosure,empathic
immersion in the client's view of me and our
tionship-morerJarelptransference
interpretation.
EMDR TechniquesforI

of Positir4e
Resources

CestaltTherapyand EMDR

EMDR therapistshave beenvery creative devising metho$s for accessing and installing positive resources.One that is used for almost all c nts is the Safe P$ce installation. This is used both for
introducing them to the EMDR bilateralsti
and provid[ng a way for them to soothethemselvesif they becomevery upsetbetweensessi s. The safeplacqis part of the standardprotocol,described above.

It is beyondthe scopeof this paper to

all the other rfiethodsthat EMDR therapistshave

developed for resourcedevelopment and

but I shall nefer to a few. One is the creation of
a container in which the clierrt is hetped to put lverwhelming tr4umatic material. Then the client can
take out elements of the memory one at a
when ready to dEal with them. Another method is to
have the client remember a person in his or
Me who was poqitive and loving and affirming. This
would be appropriate for a client who has low
-esteem.
I used this method in combination with the ;talt therapy two<hair technique with very positive
effects with a young man who had a very acti intemal top-dog shaming sub-personality. We discoveredthis part by *y having him assume role of his intemal critic, putting himself in an empty
chair and indulging in overt criticism, somethi that he was only vaguely aware of but was almost
constanfly happening to him. He became
of the function of what we then called the "shamer,,,
where it came from and what its ultimate pu
were/ which he was surprised to discover, were
ultimately positive. He realized he did not w t completely to get rid of the shamer, for it served a
useful function of keeping him from making
choicesin his everyday affairs. But he also realized
that it was too harsh and extreme in the way i attemptedto accomplishits protectivefunctioruand
he wanted to soften it.
In a later sessionI suggestedthat perhaps
could use a "praise/' to counterbalancethe shamer
and he readily agreed. I asked if he knew
in his life who could serve that function and he
told me that the headmasterat the prep
he went to had been very fond of him and very supportive and encouraglng. So we installed with
setsof eye movements the felt senseof this man's
presencewith him. This headmaster had been wrestler and I was amused to hear, during our next
sessionthat, when the shamer started to shame im during the preceding week, the praising resource
had wrestled the shamer to the ground and
him there. I was impressed that the praiser accomplished the pinning with humor and even bit of affection for the shamer.
Useof EMDR

Short term would be treatment of "simple

formance enhancemenf e. g., for an actor or an a

formance. For it to be short-term, the client m

affect relatively well. I also believe that the
apy as it is in long-term therapy. van der Kolk
that EMDR even works in the treatrnent of tra
10

Shart-TerruTreatrnent
trma" (based on a single incident), phobias or perwho wishes to acquire resourcesto improve perhave had secureattachmentsand to be able tclcontain
peutic alliance is not as necessaryin short-term therone of the foremost trauma researchers,believes
when the client actively dislikes the therapist. And

Tobin

in short term treatment the EMDR standard

tive.
For example, I used EMDR with a Young
World Trade Center when it was bombed on

trauma:comingvery closeto dying, seeing

and peoplejumping to their deaths.In four

protocol seems to be sufficient and very effec-

who was staying in a hotel across from the

11, 200L.She experienced the worst of the
she knew dead on the ground, seeingbody parts
wenot only worked through the ilauma so itno
to go back to New York Crty and observe Ground
rienced.Follow-up contacts indicated that, as this is

longer brouglrt up any upset, but she was a

Zero with a feeling of awe at what she had ex
segams.
being written, she has managed to maintain

more
With longer-term treatment where clients ale dealing with more severedisturbances/or
to longcomplexproblems,suchas interpersonaldiffic ies, and the developmental arrests are due
standingchildhoodtrauma or neglect EMDR ust be used as an adjunct to a more comprehensive
can be utilized in the
treatment approach, such as gestalt therapy. slhall next discuss how EMDR
t. I shall discuss briefly using EMDR in workcontext of more comprehensive, longer-term
during the course of
ing through therapeutic impasses,processing past traumatic events that arise
rd by consciousthought, and helping to createpositive
therapy, dealing with sYmPtoms
intemal resources.
Useof EMDRfor

Througha TheraPeuticImPasse

king through impasses,I shall descibe a sessionwith

As an example of the use of EMDR for
n working for about eight years' Although handsome,
Dick, a man in his thirties with whom I had
much progress in his goal of allowing himself to be
intelligent, witry and charminp he had not
had prevented him from accomplishing the two
more emotionally vulnerable with others,
depth in his fictional writing and in forming a love
goals he most fervently desired: achieving
imd children. Although describing feelings of inaderelationship with a woman/ including marri
goodqtuacy,pain and worthlessness, he almost a avs affected an attitude of cheerfulness and
how
matter
no
anyone,
to express anger toward
humor. He also could almost never allow
y impatient with him and unempathic/ even
justified. In sessiorLI found myself feeling
when he told me of times of experiencing des
He tended to spend the first half-hour of ir; weekly sessionsrecounting all the insights he had
t that these insight and experienceswere important
had during the previous week. Sometimes I
I frequently felt somewhat distanced by him and
and that he needed to tell me about them.
would occasionally intemrpt these discoursesand attempt to focus on how he was avoidir"lgcontact
his fear that I would reject him if he were to be real
with me in the present. This sometimes
ion, he would begrr to show the sadnessand emptiwith me, and, after quite a bit of work in the
y at those times that he appeared authentic to me and I
nesshe was experiencing intemally. It was
tive depth never lasted; the next session he would
felt emotionally close to him. But this greater
11

GestaltTherapyand EMDR
aiways come in as if nothinghad happened in
cheerful, contact-avoidant self'

py the previous week, and he would be his usual

cognitive awareness during the eye movement

but would look frightened at times, and his body

with it' I
in
I decidedwe were at a therapeuticimpassq and that EMDR might be helptul dealing
he frequent\r had no
had utilized EMDR bilateral stimulation with irn before;unlike most clients,
jerked.It seemedto me that he w
occasionally

experiencingeventsthat eitherhad happenedbefore

later from which he had to dissociate.

he had learned to speak, or events that occu

ttrat he had nothing particular to talk about today' I
Then one session he said in the
he could just bring himself to the session.He thought
suggestedhe did not have to have a topic,
an image of being inside himself, seeing a pool of waabout this, becameanxious, and then desc
rather than being immersed- I asked him to stay with
ter - greenish yellow -- that he stayed
stimulation, he saw
that image and did a set of eye movements wi him. After I stopped the bilateral
but he thought was really deep. He began to feel
himself at the side of the pool, which looked s
as "art annoyance. I'm seen as insignificant, with
panic and helplessness.He thought of hi
person think:s I am'"
hostility, like an insect you'd want to brush away.I'm whatever the other
own worth'"
my
define
can
I asked what he would prefer to think about hi nself, and he said,"I
was thirty movements long he seemedto clissociate
During the next set of eye movements,
,"l'mfeeling very cold, feeting feat." Hewas afraidhe
after about twenff-five. He said, when I stop
movements. He then remembered a Stanislav Grof
would drown if he went into the pool- More
accesseda memory of his brother pushing him under
breathing workshop he had attended where
imately four, his brother being nine' His mother had
thewater at a swimming poolwhen hewas
been sitting at the side of the poof reading.
folWhile the next set of eye movements w being administered, he again looked friglrtr:ned,
he
looked
that
pointed
out
I
lowed by what looked like dissociatioru wi his eyes glazing over.
frightened and asked him if he were aware spacing out. He answered yes, and his next thought
After
was that he always has to pretend everything is okay, that he is just "irrelevant'' in the world.
he said, "I'm seeing myself in a degradeclwap as
the next set, during which he again dissocia
he
disgusting." Following the next set, which I d in a circular pattem, to intermpt the dissociation,
are doing. I'm hearing their voices." I{e meant
said, "I'm pulling away, wondering how
about the pool of water, and he said, "l should just
sounds coming from the next room. I asked h
becauseI'm worthless, but it would be best for the
go ahead and die let myself be drowned. It's
world."
with surprise, "I'm actually feeling good now, flowAfter the next set of eve movements, he
ing like I was swimming. The processis over' I{e thought of the disaster movie, "The Postlidon Adventure," which he always loved. This movie as about a huge ship that had begun to sink into the
the front of it. A group of people had survived by
ocean after having a big hole ripped out
escapingto the surfaceof the ocean.During the next
going back inside the ship to the back, and
t, after struggling to comeup for air, while his brother
set of eye movements, he suddenly realized
12

Tobin

had "playfully'' held his head under water,

come up in a different part of it. He had su
drown him. But both his motherand his
his frequent thought that he should just go

seemed to him at the time that his mother had

low him to escape from his intense shame. He

had deliberatelysunk to the bottom of the pool and

I very upsef enragedthat his brother had tried to
had ridiculedhim for being angry.He realizedthat
and d,iewas connectedto this incident, that it had
tually wanted him to die, and that dying r'rrould al-

realized that he had no recource in this atrd many

and deny alvareness
other situations with his family, except to act i arperpetuatly cheerful manner,
ily treated him and each other
of anything being the matter in the way his
we continue workI suggested,since I did not have anyone reduled during the next hour, that
ing on this very important theme. He readily
'days, to his brothels house for Thanksgtrring' His
He was going to the Southwest in the next
up and his mother
parents would also be there' His niece, a teena , had been frequently throwing
He imagined
his
brother'
had been very upset about this but had been :ming his sister-in-law and
her "behave."
taking his mother aside - "with rage" - and
given away
He also realized that the day of this sessi vrrasthe date a dog he had as a child was
bly had to be done, he felt it was accomplished by
for biting the mailman. While he realized this
it was not okay to be anhis parents in a very insensitive way, and that was a messageto him that
him thrown out of his family. But he was now feelgry and aggressive.Behaving that way would
man.
ing in the sessionpowerful and masculine and more comfortable with being an assertive
his body and
I suggestedwe do some resource installati at this point. I asked him to experience
a ferwsetsof
did
to be powerful and assertive,and
the thoughts he was having that it is okay for
and more comfortable experiencing himself as powshort bilateral stimulation sets' He became
t when he got enraged - e. g- beating upr a kid in
erful. He also remembered incidents in the
him for as-school who taunted him until he exploded wi lrage and the other kids congratulated
behis
aggressive
for
him
his mother, she shamed
serting himself. But, when he got home and
havior.
He had picked up an anti-abortionproterstorwho
Another event was recalled, from ad
and thrown him back. He had felt proud of himhad pushed a woman working at an abortion
self and had realized that, if he were defend g someoneelse, he could allow himself to bercomeanrnovements to reinforce his feeling of power and seUgry and forceful. I again did a short set of
confidence.
his Thanksgting trip that his mother seems to
The next week he told me that he realized
they show aggressivenessor assertiveness,and they
hate him, his brother and his father w
fact.He alsonoticedthat his mother got very upset
have all had to cover up their awarenessof
vacation.He realizedwhy he had neverbeenableto
when his niece came to sit on his lap during
,lially
romantic relationship with a woman aLssuming,
get married: He always started out a new,
trad to cover up this hypothesis and his emotional rewithout awareness,that she hates him. He
abouther feelings toward him.
actions rather than checking out his assump
13

Gestalt Therapy and EMDR

This sessionis a good example of how EM

kept our encounters on a vefbal, linear level,
tualized way of dealing with his issues. There
father figure who was not really interested in
have some difficulty expressing concem and j
Despite my best efforts, however, to deal with
of the EMDR techniques.We did have to do
expressing anger and making himself vulnera
working his fears through. Perhaps another
confront DicKs avoidance of contact, but I w
have the EMDR techniques d-vailable to get

AnExample
of a
EMDR
of
As an another exampleqf a gestalt
brief session I had with Jack, a very
onstration I did on the integration of EMDR
ing and successfulexperiencefor Jackand he
combined gestalt/ EMDR therapy.

He choseas his EMDR targetwaking up

sleep.This had gone on peqiodica[y for two

R can help with a therapeutic impasse.As long as we

k and I had not heen able to get beyond his intellecobviously a good deal of transferenceto me as a
irm, did not really care about him and, indeed, I did

terestin him becauseof the shallownessof his affect.

i.simpasse,we did not get much beyond it unfil use
subsequentwork on his fears of being aggressive,
with others, but thesewere pivotal sessionstoward
ist would have had the stamina to consistenfly
able to do that only sporadically. I was grateful to
the irnpasse.

Integration
Complete
GestaltTherrpy
/EMDR integratEd approactr, I shall recount a rather
professional, who wotked with me as part of a dem-

gestalttherapyiin June,2002.This was a very strikve me permission to use the sessionas an example of
y in the mornirng and having trouble going back to
I a half years, ver since his girlfriend at that time
start our work there or the most recent time he had

ended their relationship. I asked if he wanted

three weeks lefore our meeting.He preferred the
trouble sleeping. He chose the most recenf
ts altematetonesto the ears,after trying out both
audio scan, a device with headphones that
the visual and tactual stimulation.
when he woke early in the moming and he became
I had him just focus on his bodily
I
set of auditorylbilateral stimulations and the bodily
chest.
a
aware of tension in his abdomen and
couple of sets of Ftimulations, he was reminded of an
sensationsbecamemore intense. After ano
justbefore
his ex-gi nend left or afterj the death of a very dear friend. I noimportantincident,either
and comr4unicated my observation to him. He
ticed as he said this that he looked sad. I felt
ivered it gave tlim permission to feel the sadness,of
later told me that my comment and the way I
which he had been unaware,
before in a hospfltal about ninety miles from Los AnHe had been to visit this friend a few
that she wantgd to die nafurally, not haver her famgeles, and she told him and another mutual
process
along.
ily hurry the
ound 3:00 a.m., filom the hospital saying that she was
He then got a call early in the moming
dyin& and that shewanted him and the other fniend to come to seeher. He called the other man and
14

they made arrangements to go to the hospital

pointments they had scheduled, and they

be with her. This required canceling numerous aprrot leave until later that moming. When they got to

physician to have her given a lethal dose of

peaceful buf when Jackwent irL it did not ap
and meditative practices,senseda great deal
dead friend's face appeared tormented, rather
He was very angry that the family had dis
if he had communicated his anger toward the
the auditory bilateral stimulation all during thi
I would do a set and, when I sensed, from
achieved some closure, I stopped and he
aware of feeling guilty that he and his friend
I sensedthat he had some unresolved gui
and asked him if he wanted to imagine talki
ined her in the room with him, and communi
remorse about not having been at her side
he did, and he attributed forgiveness and 1o

ine. The family said the room she was in was

at all peaceful. Jack,who is well-trained in spiritual
turrmoil in the mvironment and the expression on his

the hospital,however,they found out she had ied and that her family had given permissionto the

I did more bilateralstimulation.His next

college and was a counselor in a college do
suddenly looked out the front window and sa
floor. The student had committed suicide and
visit him and were also in the lobby. I
self, which Jack affirmed, but he also said he
ing at the body. (I had spoken during the lec
survivor I had worked with and had men
jumping from the twin towers.) Jack realized
and realized now that it is natural to feel d
|ack said after the work was over that w
stimulatiorL was my caring contact with him
talk to him. He is a long-time meditator and
tual kind of way. He was surprised that the
recent incident. He also favorably contrasted
EMDR therapist he had attended that was
weeks later, that chronic headacheshe had

peaceful.
his friend's final wishes. I asked at ihis point
mily and he said he had not. We were doing sets of

recounting of the events.As is usually the procedure,

expression on his face and his breathing that he had
me what he had experienced. He bega. to, become
not left sooner to go to the hospital'
and sadnessthat was collnected with his deaLdfriend,
to her. He eagerly seized on this opportunifi imagkd, with much affect,his feelings toward her and his
she died. I then asked him to giveher a voiue,which
feelings to her.

iation was when he was a late teenager,attending

FIe was down at the front desk in the dorm when he
a studenfs body falling to the ground fronn the 19e
directly on the car of his parents, who hacl come to
if Jack felt guilty about the boy having killed himfelt guilty all those years about going out and look-

part of this workshopaboutthe World TradeCenter

her guilt at bei,ngfascinatedby the sight of people
this point that he had felt guilty for similar reasons
to sceneslike this.
made it complete for him, along with therbilateral
my suggesting he give his dead friend a voice to
he fotrnd the bilateral sounds very helpful in a spiriier situation in college was connected to this more
work with a lecture demonstration by im expert
g the dialogic nature of our session.He reported,
.havingwere gone and that he was sleeping better.

15

Gestalt Therapy and EMDR

One aspectof this sessionthat struck me w

therapy. It is important

to reiiterate that Jack is

many of whom are resistantto EMDR and not

good example of the integrative power of this c
our work together, that the sleepproblemwas

friend. But it seemedto play no part in his sy

beforehand,that an experiencein collegeover
to his sleepdifficulties and his headaches.

fire fluidity of the integration of EMDR and gestalt

representative of the typical psychotherapy

client

rly as coopera{ive as Jack.At the same time, it is a

ined approach.I actually thoughf aswe firststarted
to the endrlg of JacKs relationship with his girlAlso, neither jack nor I could have predicted,
years previotrs to this sessionwould be germane

and Conclusian
an excellent ad]iunct to my work as a gestalt theraln summary, I am finding EMDR techniq
bive-behavior ttierapy, with rather rigid procedures,
pist. BecauseEMDR came essentially out of
rate them into pther therapeutic styles, and numerit is necessaryto modify these procedures to i
g that integratipn(Shapiro,2002).I have found the
ous theorists, including me, have been a
; up the proces$of my work with long-term clients;
use of EMDR techniques verryhelpful in
from tne
the
issueslrom
metabolized$sues
incompletely metaborzed
rnished,incompletely
in achieving a more complete resolutio'n of nfinished,
pas! in increasing the intemalization of what the self psychologists would term needed self-object
plexrtyand resiliencyof self-supportfunctions.
functions; and in helping clidnts increase the
il how EMDR tdchniques can be utilized in conjuncIn future articles I will discussmore in
^- - rl^^*
^growth of clients in psychothetapy, among them, an
tion with other gestalt methods to further
of EMDR in cqnjunction with the empty chair apintemal representation of the therapist, the
proactr, and use of a combined gestalt therapy EMDRmethodvrfithvariousdiagnosticgroups'

Bohart,A. C. & Greenberg,L. (2002)'EMDRand oqientiat therapy.14F. Shapiro (Ed.), EMDR asan integratioe
Washington,
tions explorc tln pa4adigmprism (pp. ?319-261),
approach:Expertsof diause
psychotherayy
Association'
Psychological
DC: American
of actiaeselfhealing.Washington,
tlwayy wuk: Theprocess
Bohart,A. C., & Talhnan,K. (1999).Hw) clients
DC: American Psychological

Association.

of self psirchologydevelopmentaltheory into the

Breshgold,E., & zahm, S. (1992).A casefon the i

practiceof gestalttherapy. TkeGatalt lwrnal l
Davidson, P.R. & Parker, K. C. H. (2001) Eye

analysis. lourual of ConsultingandConsulting

Gilligan, S. (2002) EMDR and Hypnosis. In
approach:Expertsof diaersebrientationsexplore
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Greenwald, R. (2001) EyeMwement Desensitization
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Horvatlu A. O. (2001).The alliance' [Specialissue]:

port of theDivisionz0ras.\lq1c".]ty.tnoiPoU I.
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y supporpd therapy rel,ationships:

965-372.

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facili tated coupleand family therapy. In
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approacfu
ical Assoclation,PF. 289-316

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K. Transpersonal psyJJ, Krystal?., Fenner,P Sihapiro, ., and Shgpiro,
Krystal,S.,Prendergast,
EMDR asanintegrntive
(Ed.)
F'
chology,easternnondual philosophy and EMD tZmZl In Shapiro;

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Manfield, P. (1993) ExtendingEMDR. New York: Norton.

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asan integratiaepsychu
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Shadiro
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Rothschil{ B. (2003).ThebodVremenfuers

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Author
Stephan Tobin has been a clinical psychologist

1963 and.a certified (by Fritz Perls and Jim Slmkin) ge-

stalt therapist since 1970.He was a co-founder,

lrresident, trainer and chairman of the Certification ComIn the early 80's he introduced psychoanalyti'cself psyei;.
Los
mittee of the Gestalt Therapy Institute of
with articles and appearancesat rrational geIt
comrmunity
chology and intersubiectivity to the American
an<lhaspubthe
of
troard
lournatof HumanisticPsychology
stalt therapy conferences.He serves on the
laLte
90'she
In
the
psychology.
e:xistential-humanistic
lished articles on the integration of psychoamalysi and
wife,
hds
to
with
moved,
He
recently
practitioner.
EMDR
received training in EMDR and is now certified as
at
teaching
does
online
and
practices,
supervises
he
vr'here
the Portland, Oregon/Vancouver, Washington
College.
Ryokan
Saybrook Graduate School and ResearchInstitute

Addressfor correspondence
3L5BerwickRoad
LakeOswego,Oregon,U.S.A.
<StephTobin@comcast.net>

18