One aspect of the EMDR process which appears to be crucial in allowing it to work so well is the dual focus of attention, where the person undergoing the treatment is required to focus on both inner and outer phenomena at the same time for processing of memories to occur.
Having a purely internal or external focus of attention, where the person is focusing only on what is going on inside themselves or only on what the therapist is doing, is not effective when doing EMDR therapy. Rather the patient needs to be able to hold both inner and outer phenomena in mind at the same time for the processing to be successful. Why is this the case?
There is no definitely proven answer to this yet, but the most general explanation for this is that a dual focus of attention is needed to essentially “distract” the mind/brain into letting go of a traumatic memory once it has been brought forward from the long term memory into the working memory.
It appears that focusing on something else at the same time as holding a traumatic memory in our conscious mind allows the mind/brain to “blur” or distort the image of the memory, lessening it’s intensity and thereby reducing the power it has over the person.
The short video below offers an excellent summary of this “working memory” hypothesis. Let’s look at the issue in more detail below.
A Dual Focus of Attention Explained
It could be an easy trap for someone who has just found out about EMDR to think that self administering bilateral stimulation with a video of a dot moving backwards and forwards will automatically “heal” their traumas. Unfortunately the process is not quite that simple.
Similarly, some other people may be put off from EMDR because they do not like the idea of tapping back into the worst memories of their life. “Isn’t that just going to be re-traumatizing?”, someone might think. It is not quite that simple either.
Rather, to effectively heal trauma within the EMDR framework, the client has to maintain a focus on both their internal and their external experience, in terms of the reactivated trauma and the external bilateral stimulation of the therapist’s hand moving backwards and forwards. Hitting this sweet spot of dual focus is what allows processing of trauma to occur with EMDR.
To begin the process, the therapist will ask questions to neurologically tap the client back into the feeling of a past trauma, getting them back in touch with the sights, smells, sounds that were experienced at the time. The goal is to re-activate, as much as possible, the feelings that were felt at the time it initially happened.
Once the person has been tapped back into the traumatic memory, the therapist will then get them to keep their focus on this internal state whilst also moving their hand backwards and forwards for them to follow. This is the external focus to go with the internal focus on the traumatic memory.
Focusing solely on the internally reactivated trauma could indeed be re-traumatizing, and focusing only on something external is not going to be therapeutic unless there is something “live” and visceral going on inside the person that can be worked on.
With EMDR the client and therapist usually work together to make sure this dual focus is maintained, and the person doesn’t fall into focusing only internally or externally. As long as this sweet spot between internal and external focus is maintained, then processing of the troublesome memory to resolution can occur.
The Working Memory Hypothesis
Researchers and practitioners have different views as to why this dual focus of attention is so important to the EMDR process, but perhaps the most widely cited explanation is the working memory hypothesis.
This theory simply purports that bringing a distressing memory out of long term memory into the short term memory (working memory) is what allows the vividness of the traumatic memory to return. It makes it feel as though it is happening all over again in the present, yet to be filed away into the back of the mind.
Using the hand/eye movements whilst this memory is back at the forefront of a person’s mind provides a distraction for the mind/brain – something else for it to focus on alongside the traumatic memory itself. It multi-tasks the working memory into taking some of the focus off the trauma.
In doing so, it effectively overwhelms the working memory by giving it too much to focus on at once, causing it to lose it’s fixation on the distressing memory which lessens it’s emotional intensity and charge in the person’s mind. The “sting” is taken out of it and the essentials of the memory (what happened, when, where) are filed away without any troublesome emotional dynamics attached to it anymore.
In this way the person is able to move on from the traumatic experience and not be so bothered or burdened by it anymore. It becomes just another memory instead of something that constantly comes back into their mind involuntary and continues to cause them irritation or distress months or years after it happened.
Other Views on EMDR & Dual Focus
Not everyone agrees with this working memory hypothesis however, and there are other views on exactly why this process of dual focus works so well in helping to process trauma. To this writer however, these other explanations seem to just be restating the working memory hypothesis in a slightly different way.
All the different ideas on the importance of dual focus seem to revolve around the same common denominator of taking the person out of fixating solely on the traumatic memory. Introducing the external distractions of hand movements allows the mind/brain to examine the trauma without getting too caught up in it emotionally. It puts some distance between the client and the trauma.
This is the general idea behind dual focus in EMDR, regardless of the precise mechanism by which it works. It a sense it doesn’t matter for patients how it works; it only matters that it does work. Keeping this balance between internal experience and external stimuli is what allows distressing experiences to be digested and let go of, which is the end goal of EMDR.