EMDR in the Perinatal Period
Early in my career while working in community mental health, my supervisor often said, “it’s all trauma.” After a few years of experience, I recognized her wisdom and understood more clearly that my clients’ struggles did all seem to stem from early stressful experiences. As soon as I was able, I signed up for Eye Movement Desensitization and Reprocessing (EMDR) training, an evidenced-based trauma therapy. After the first weekend of training, I was intrigued by the research and my own positive experience in the training practicum. I quickly ramped up using EMDR with clients and continued to be astonished at how effective it seemed to be and how quickly and deeply my clients healed. I now use EMDR with 95% of my clients, all perinatal women, and I am grateful to have this incredible tool in my arsenal.
What exactly is EMDR?
Developed in 1987 by Francine Shapiro, EMDR seeks to integrate unprocessed and maladaptively stored traumatic memory using bilateral stimulation (BLS) through alternating eye, tactile or audio movement/sound. The technique is based on the Adaptive Information Processing (AIP) model, which theorizes that all pathology comes from prior stressful life experiences and that the information stored from these experiences has been inadequately or maladaptively processed by the nervous system. By calling this information into working memory and then using BLS, we facilitate communication between the hemispheres of the brain, the sympathetic nervous system is down-regulated, and all aspects of the memories are integrated through our various brain structures. The result is that the memory is no longer distressing and one’s belief about oneself positively shifts, thereby reducing current post-traumatic stress activation.
EMDR encompasses eight different phases of treatment and focuses not only on past memory but also on current triggers and future desired outcomes. Standard EMDR treatment begins with a detailed history-taking and case conceptualization and planning, determining client goals and viewing their presenting problems through an AIP lens. We then move on to preparing clients for reprocessing, which might include resourcing, grounding, somatic tracking and containment skills and parts work. This phase of treatment might take hours or years, depending on the severity and complexity of the client’s trauma history. Once the client is prepared enough to handle the distress they may encounter during the assessment and reprocessing of a specific memory, this next phase of treatment can proceed. However, preparation, assessment and reprocessing are not always a linear process and there might be backtracking and further development of resources throughout processing. After each session, we follow up to reevaluate what changes clients have experienced in their daily lives and what other memories may need to be processed. Once complete, a more holistic client change has occurred, not just shifting negative self-beliefs, but also how clients feel in their bodies.
How do I use EMDR with perinatal clients?
The short answer is that we use EMDR in the exact same manner as we would with any other client. Using EMDR to address the concerns of perinatal clients means conceptualizing their presenting problem through this AIP/trauma lens and reprocessing the relevant maladaptively stored material. For example, if a client is experiencing perinatal anxiety, the source of the anxiety is explored and reprocessed. If they have experienced a recent perinatal loss, we might use an EMDR recent events protocol if there are any pieces of the experience which have been inadequately processed. We know that this stage of life brings distinctive challenges and opportunities. This continues to be the case in using EMDR as a healing modality. We continue to hold space for emotion, build therapeutic alliance, validate, normalize, highlight distorted self-beliefs, educate on healthy relationship/attachment as well as defining needs and asking for them to be met. In using EMDR, how we see those things and address them shifts.
What does this actually look like in practice?
It’s often helpful to use actual practice examples to understand EMDR fully, so let’s look at two simple case studies that illustrate how trauma and developmental wounding can be reactivated in the perinatal period and can be a factor in triggering perinatal mood disorders:
Birth Trauma Case Study – Anne
Anne came to me two months after the birth of her first child. She reported that her birth was traumatic and that scenes from the experience were replaying in her head. She stated that she couldn’t sleep and was worried that something bad would happen to her baby. Anne stated that the most upsetting moment in the birth was when she found herself alone in the room during transition. She said she felt this as pressure in her chest and believed that she was unsafe. In our work together, we traced this belief and sensation back to a moment when she lost her mother at the store one day when she was a preschooler. After resourcing and preparation, we processed the memory of Anne losing her mother at the store and other memories that spontaneously came up that felt similar until she felt calm and her belief was that she was safe now. Anne reported that she no longer had intrusive images, was sleeping better and felt calmer in mothering her son.
Postpartum Depression Case Study – Samantha
Samantha, who was four months postpartum, told me that she felt both angry and resentful towards her husband and overwhelmed and hopeless. She tearfully told me she was failing as a mother, didn’t have any time to herself and slept only 4-6 hours a night. She also noted that she struggled on and off with irritable bowel syndrome (IBS), alternating from constipation to diarrhea. As we explored what she was feeling in her body and what was going on at home, we realized that she felt inadequate and responsible for everyone not only as a mother and wife but in many areas of her life and that she was unable to create healthy boundaries or ask for her needs to be met. We found this was related to early life experiences in which Samantha needed to care for her emotionally immature parents and ignore her own needs, believing she was unimportant. After resourcing, psychoeducation and parts work, we targeted memories of feeling inadequate and responsible, addressed current triggers in her life and developed templates about how she might respond/behave in the future. Over the course of many months, Samantha reported that she felt more confident, less irritable, and more hopeful. She also noted that over the course of treatment, her IBS dissipated and she felt more energetic and healthy.
What does the research say?
While there is abundant research on the efficacy of EMDR in treating PTSD (Maxfield, 2019) and increasing evidence showing the efficacy of EMDR in treating depression (Guahar, 2016), anxiety (Faretta & Dal Farra, 2019; Valiente-Gómez et al, 2017), OCD (Nazari et al, 2011; Scelles & Bulnes, 2021) and grief (Meysner, 2016; Sprang, 2001), there is less research on its use with the perinatal population. Some studies have found that EMDR has been effective in the treatment of perinatal PTSD stemming from traumatic birth (De Bruijn et al, 2020; van Deursen-Gelderloos & Bakker, 2015) but other research on its use with this population is limited. There is a connection between stressful birth experiences and the development of postpartum depression (Bay & Sayiner, 2021; Grisbrook et al, 2022), as well as connections between the stressful process of infertility and PTSD (Bhat & Byatt, 2016; Corley-Newman & Trimble, 2017). We also understand that adverse childhood experiences have been shown to correlate to poor birth outcomes (Hardcastle et al, 2022; Mersky & Lee, 2019). One might deduce from the above that high levels of prior stress might be a mediating factor for some of the mental health struggles that the women we treat experience. We know that distress decreases (Sack et al, 2008) with EMDR use. We might argue that there is enough evidence of EMDR efficacy in the treatment of these disorders in the general population to warrant using EMDR with perinatal clients. Clearly, more research, especially random controlled trials, is warranted and necessary but there is enough evidence to warrant EMDR use in treating various perinatal mental health complications.
Is EMDR safe to use during pregnancy?
There have been numerous conversations on social media and elsewhere about whether using EMDR is safe during pregnancy. While research has been limited, a small study by Baas et al (2022) found that EMDR was safe in treating pregnant women with a fear of childbirth. But otherwise, there has been a dearth of studies measuring safety of not only EMDR during pregnancy but also other therapies such as CBT and Interpersonal Psychotherapy. We do, however, have ample research about the impact of stress and prior trauma on the fetus and birth outcomes (DiPietro et al, 2003; La Marca-Ghaemmaghami et al, 2017; Yildiz et al, 2017), as well as the impact of perinatal mood complications on children (Hoffman et al, 2017). Since trauma and its correlated stress hormones are already occurring in a pregnant woman’s body, perhaps the question isn’t so much whether EMDR is safe in pregnancy as whether we can afford not to use EMDR to treat women in pregnancy. In addition, as part of the due course of therapy and being in alignment with a client, we would always proceed with each client based on what they need at the time. For example, suppose our client was early in a tenuous pregnancy and very anxious. Those mothers might need stabilization and resourcing (EMDR Phase 2) first before proceeding to addressing underlying stressors (EMDR Phases 4-7).
Looking back on my years as a birth doula, lactation counselor and prenatal yoga teacher, I now understand that so much of what birthing and new moms were struggling with was trauma related. In fact, so much of what I struggled with myself as a new mom was trauma related and one of my biggest regrets as a mom was not healing that trauma with EMDR before having kids. Yes, learning and using EMDR is both a time and financial commitment. But helping my clients to heal underlying trauma has profoundly changed how I work with mothers and using EMDR to heal myself has completely shifted how I feel in my own body.
Find out more about EMDR and find a local EMDR therapist at www.emdria.org.
Beth has been working with new and pregnant moms since 2005, first as a birth doula, then as a lactation counselor. She graduated from University of New Hampshire with her MSW, focusing on Reproductive Psychology. She is currently in private practice in New Hampshire and Massachusetts, specializing in women’s health and reproductive issues such as perinatal mood complications, infertility, loss and birth trauma. She is also the co-founder and Coordinator of the Pentucket Perinatal Mental Health Coalition, whose mission is to improve local maternal emotional health through education, collaboration, support and advocacy. Beth has been trained and certified in perinatal mental health by PSI, certified in Eye Movement Desensitization and Reprocessing (EMDR) by the EMDR Institute and is currently working towards becoming an EMDR Consultant. Beth has her 200-and 300-hour teacher certifications from YogaLife and 85-hour prenatal yoga certification from Pranakriya Yoga at Kripalu. Beth is passionate about supporting women at their most vulnerable and empowering them to feel like strong and competent mothers. For more information about Beth or the coalition, please go to www.findyourstillwater.com or www.pentucketmoms.com.
You can follow Beth on Instagram at @findyourstillwater and on Facebook at Stillwater Counseling.
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Both CBT and EMDR effective in treating grief.
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