EMDR- rapid healing of “small t” and “big T” trauma

Guest author: Lesa Fichte, LMSW

I recently received a new, unexpected diagnosis when I went to a skilled EMDR  therapist for help with chronic pain: Post-traumatic Stress Disorder (PTSD- DSM-IV definition and PTSD DSM-5 definition). Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for trauma developed by Francine Shapiro, PhD.  I have a less severe form of PTSD than many others who have been through horrific experiences. I have what Shapiro calls “small t” trauma. LOTS OF IT! “Big T” trauma is comprised of the things people typically think about as major causes of PTSD (see the chart below).

For me, one more thing happened this year and my resilience and coping efforts were just worn out. My already daily pain escalated. Many of us have “small t” trauma and our own unique levels of resiliency.  I grew up as a Campbell’s Condensed Soup kid (tomato was my favorite). Going into treatment I felt like a can of “Trauma Soup”- lots of trauma ingredients packed tightly into the can of mind/body/spirit!  Yet I never really considered these “small t’s” as causing my pain and other struggles. I felt as if I had these evil gremlins clinging to my mind and body, persistently resisting cognitive-behavioral efforts to make them let go of me.

It bothers me greatly that people often focus on the “big T” trauma and overlook the damaging power of “small t” trauma. Many of our clients have both types, and tragically for some, years of horrific “big T” trauma. “Small t” traumas  can also derail  quality of life and functioning. Universal trauma screening could identify many trauma survivors, change treatment plans,  and CHANGE THEIR LIVES!  Psychological trauma is a hidden epidemic. 90% of clients in public behavioral health settings have experienced trauma. – SAMHSA-HRSA Center for Integrated Health Solutions.

Below is a chart that shows some differences between “small t” and “big T” trauma. “Small t” trauma is sometimes called complex trauma and those with multiple incidents of “big T” trauma can also have complex trauma. 

• I have been told that it is not possible to accurately describe what EMDR feels like to someone who has not experienced it. I agree that this is probably true- even when I give a trusted person very detailed descriptions of a session. But I wanted to try in the hope that more clinicians will consider becoming EMDR trained and  more people will seek out treatment.
• Memory reprocessing is unique to each person. No judgments are to be made. There is structured EMDR protocol as well as strong clinical skill used. (Here are some EMDR Frequently Asked Questions.)
• Every EMDR treatment session feels like a miracle to me. It rapidly reprocesses the gremlins of traumatic memories in my brain so that they no longer control me. And after resolving memories in an EMDR session, it is fascinating how much easier cognitive-behavioral methods now work!
• After the basic intake information, I was asked to go back to my earliest memories and quickly give a short statement to create a log the therapist wrote of bullet points for  all of my memories. No judgments were made about what felt traumatic to me. Traumatic is a person’s perception of the experience. This list created the working plan for how we would proceed from beginning to end. Some memories are treated as individual memories, and some that have a similar theme are addressed through a cluster that enables the first, worst,  and most recent to be reprocessed and then the larger cluster is pulled together for reprocessing.
• Before starting EMDR, I was taught to make a mental container so that I could place disruptive or unfinished memory reprocessing into the container. Using the EMDR technique, the container was “installed” so that it would stick(my word) in my brain and be there to use when needed. I practiced in session and then practiced using my container in various ways during the week so that I had mastery before I needed to use it for powerful feelings and memories.
• To the best of my recollection, working on a single memory feels like this: I am asked to briefly describe it, notice and rate the distress level as well as the place in my body where I feel the trauma. I hold that focus and then starting using the eye moment as directed by my therapist. I can feel the memory changing in many ways during EMDR. After a brief period of doing the eye moment, we stop and I take a relaxing breath.  I share how the memory and feelings changed. No matter how crazy I feel about the way the memory is reprocessing (sometimes like watching a movie that I am writing as I sit there), there is no judgment- just attentive, compassionate focus from my therapist. We keep repeating the process- focusing on changing feelings, reassessing my distress level as we work to let my distress drop down to zero, and installing positive feelings/affirmations. Yes, there are tears but it still feels so effortless for me, so fast. I feel very relaxed and free the entire time, even when a tough memory makes me weary or takes 1 ½ sessions to complete the reprocessing. Sometimes we can do two memories in a one hour session.
• When I arrive for the next session, my therapist always checks in to ensure that the memory work done in the last session has remained at zero distress. In one instance, more feelings bubbled up over the week and we had to work a while longer to finish resolving the memory. That is normal.
• I am committed that I am not going to stop treatment until I get through every bit of trauma. As they say, “the way out is the way through”. I attend weekly sessions. Some people have a need or an option to go through an EMDR intensive that is usually done in a couple of days and includes multiple sessions during that time. Here are some examples of how people healed in a recent blog written by Ricky Greenwald, PsyD about the intensive EMDR treatment model.

View a client video about EMDR including the effect of PTSD on the brain (this video shows the use of EMDR equipment instead of therapist fingers for the eye movement).

Trauma is NOT about what is wrong with someone, it is about what HAPPENED to them. Needing treatment to heal and asking for it is about COURAGE, not about society’s perception that it is a weakness.

We need to remember that there two faces of trauma, “Big T” and “small t”- both deserve equal respect and a nonjudgmental approach. Evidence-based practices and a good therapeutic relationship can take you behind the human curtain and help a person heal. When trauma is not treated, people do not heal and sometimes they die. EMDR is evidence-based, fast, and life changing. We need more skilled EMDR therapists across our country, throughout the world.

EMDR International Association

Trauma Institute and Child Trauma Institute (Ricky Greenwald, PsyD) 

EMDR Institute, Inc. (Francine Shapiro)

National Center on Trauma-Informed Care

National Child Traumatic Stress Network

International Society for Traumatic Stress Studies 

Trauma-Informed Certificate Programs: University at Buffalo School of Social Work Office of Continuing Education

University at Buffalo School of Social Work Institute on Trauma and Trauma-Informed Care (ITTIC)