The Enigmatic Method

The origin story of EMDR, a popular but contentious form of psychotherapy most often used to treat trauma, goes something like this: One afternoon in 1987, Francine Shapiro, a doctoral student in clinical psychology, was walking along the Vasona Reservoir in Los Gatos, California, a suburb of San Jose. “It was spring,” she later wrote. “Ducks were paddling by, and bright blankets full of mothers and babies were laid out on wide green lawns.” Shapiro had recently recovered from breast cancer and left behind a potential career as a literary scholar to explore the connection between the mind and the body. “As I walked along,” she continued, “an odd thing happened. I had been thinking about something disturbing; I don’t even remember what it was, just one of those nagging negative thoughts that the mind keeps chewing over (without digesting) until we forcibly stop it. The odd thing was that my nagging thought had disappeared. On its own.” She kept walking, and she observed that when a negative thought came to mind, her eyes moved diagonally, very quickly. When she returned to the thought, it had lost its emotional charge.

Shapiro soon began testing her observations on friends and clients. While they thought about something negative, she quickly moved her index finger diagonally and asked them to follow. She joked that she was “flicking” people’s anxiety away, but she was actually beginning to consider the movement as a means of desensitization, an approach used in behavior therapy to dull stress. By trial and error, she developed a procedure she called Eye Movement Desensitization and Reprocessing, better known as EMDR. Its main advantage, she realized, was that its combination of image processing and physicalizing did not require a client to narrate an entire traumatic event; what’s more, it could catalyze an accelerated processing of distressing memories and alleviate symptoms of post-traumatic stress disorder, or PTSD. These attributes made it an immensely promising treatment to some trauma therapists. Eventually, she and other clinicians would use EMDR to treat war veterans, victims of rape and childhood abuse, as well as survivors of natural disasters and terrorist attacks.

In the decades since Shapiro’s discovery, EMDR’s supporters have tended toward the language of miracle when describing its efficacy. One man, a veteran of the Vietnam War, told me of “revelations” he’d had with EMDR’s help that led to greater self-awareness. An EMDR practitioner said that, if done properly, the therapy provokes “spontaneous healing.” One woman who had been sexually assaulted told me that her recovery after EMDR was like an “act of God.”

Most EMDR therapists I’ve met characterize Shapiro, who died in 2019, with almost hagiographic passion; an obituary in the Journal of EMDR Practice and Research proclaimed that “few people walk this planet with the gifts that Dr. Shapiro had.… Her greatest gift was her insight into the human mind, what caused suffering, and what therapeutic methodology could relieve it.” Shapiro herself confided in friends and family that she hoped EMDR might heal the world. 

EMDR has received endorsement from major institutions: the Departments of Defense and of Veteran Affairs, the World Health Organization, and the International Society for Traumatic Stress Studies. The American Psychological Association “conditionally” recommends EMDR for PTSD. An estimated 100,000 clinicians worldwide are trained in the therapy, with numbers growing. Yet deep skepticism persists.

Indeed, when EMDR exploded onto the psychotherapy scene in the mid-1990s, it courted fervent supporters and, in turn, provoked ardent detractors. One skeptic, Harvard psychologist Richard McNally, compared EMDR’s rise to mesmerism, a controversial eighteenth-century treatment that existed somewhere between religion and science. The most strident critics called EMDR a pseudoscience, while others contended that it was nothing more than exposure therapy with a bit of hand-waving. Some clinicians still contest its efficacy, as research into EMDR remains plagued with quality issues like small sample sizes and limited follow-up data. McNally summed up the criticism with one neat line: “What is effective in EMDR is not new, and what is new is not effective.”

Much doubt centers on the fact that EMDR’s exact mechanism of action continues to be subject to debates. Lisa Sager, an EMDR trainer based in St. Louis, said the therapy was almost impossible to explain—though she added that today there’s more evidence for EMDR’s efficacy than when she first started learning the therapy nearly twenty years ago. “We’ve got all these theories about why it works,” she said, “but until you’ve experienced it, or seen it happen with somebody else, it doesn’t even seem realistic.”

Some researchers say the eye movements mimic what happens during rapid eye movement (REM) sleep, when the brain processes memories. Others point to various cognitive phenomena that cause the brain to file away, or respond to, traumatic memories in healthier ways. Shapiro argued that the therapy changes neural networks in the brain. But, to the frustration and bewilderment of critics and practitioners alike, she was never able to pinpoint exactly how.

On a sweltering morning last July, a group of twenty-five therapists convened at the Water’s Edge counseling center in Rogers, Arkansas, for their first day of EMDR training. Throughout the week, several of them would confide in me that they hadn’t been sure what to make of EMDR, but they’d come to the training because colleagues had praised it. I myself was there because I was curious about the therapy—not just how it functioned, but what the decades of polarizing responses to it could reveal about how mainstream American society conceptualizes PTSD and healing. 

A gathering of therapists is, in many ways, exactly what you might expect. They spoke gently, constantly validating one another in conversation. Many of them responded to my questions by asking how I was thinking and feeling. Some of the therapists lived in the area; others had driven from Missouri and Oklahoma. Their focus ranged from addictions to domestic violence to religious trauma. Over the course of the training, they’d learn about the theoretical basis behind EMDR, its applications with various types of diagnoses, and how to administer the therapy. “I’m hoping it’ll be good for kids, because they can’t always verbalize what they’re going through,” one child counselor told me.

Lisa Sager, the EMDR trainer from St. Louis, approached a lectern at the front of the room. Petite, blond, and partial to summer dresses, she spoke softly but was all business: She had forty hours’ worth of content to get through in five days. After introducing herself, Sager addressed potential concerns about how EMDR worked. “It had a lot of resistance in the beginning from the whole cognitive-therapy world,” she said. “It didn’t make sense on that level.” A few counselors nodded. “Thick skepticism,” Sager continued, “is sometimes very helpful. It’s okay to be a skeptic. I totally understand that. But I’d like you to listen with curiosity and see if you can create some openness to this.”

Over the next couple of days, the therapists would dive into various types of EMDR practice addressing their own negative beliefs. During the training sessions, in which they performed the roles of both client and patient, they were to follow EMDR’s eight phases: History taking and treatment planning; preparation; assessment; desensitization; installation; body scan; closure; and reevaluation. In her 2012 book Getting Past Your Past, Shapiro wrote that, as a whole, the therapy targets memories associated with negative emotions, body sensations, and beliefs about oneself. As the client thinks about their distressing memory and its attendant negativity, she argued, bilateral stimulation—either through eye movements or newer developments like tapping on knees—rewires their brain. “What is useful is learned, what’s useless is discarded, and the memory is now stored in a way that is no longer damaging.”

The first three phases, which involve understanding the client’s mental-health history and determining the target memory and the beliefs that stem from it, go in chronological order. The middle three stages—the actual bilateral stimulation—are less fixed. In the desensitization phase, the client pictures their negative image; over the course of treatment, their level of distress associated with that image is intended to decrease. In the installation phase, the client focuses on a positive belief until it feels completely true. During the body scan, the client examines where they hold comfort or discomfort in the body.

These middle phases don’t necessarily progress in any linear way, but often repeat or double back when the therapist thinks it might be useful. The client’s mind wanders, making associations. Unexpected thoughts and memories emerge. Discussion is discouraged. “The more they talk, the more they’re staying cognitive,” Sager told me. “The point is to keep them processing.”

On the fourth day of the training, two therapists sat across from each other in a small room furnished with a shelf of figurines. (Water’s Edge specialized in play therapy.) “The situation we decided to work on today is about when you had lost your hair when you were forty,” Darryl Schafer, a counselor based in Springfield, Missouri, said, following an EMDR script he’d modified to match the specific scenario. “What picture represents the worst part of that memory?”

Karie Talkington, a forty-five-year-old child counselor based in the Choctaw Nation of Oklahoma, paused. She wore a baggy shirt and capris, and a long brown wig cascaded down her back. “When I finally decided that it was bad enough that I had to shave my head,” she said.

“What words go best with that picture that express your negative belief about yourself?” Schafer asked. 

Talkington paused again, and after nearly a minute, she said, “It’s kind of a toss-up. I’ve had the thought, I’m ugly, but I’ve also had the thought that I am different.” 

Schafer jotted down notes. What would she like to believe about herself instead? (“That I’m fine the way I am.”) How true, on a scale of one to seven, did that belief feel? (A five, somewhat true.) On a scale of zero to ten, how disturbing did her original image—the moment she decided to shave—feel? (A six or a seven, moderate.) Where did she sense that disturbance in her body? “It’s not really in my chest,” Talkington said, “but in my heart.” 

She closed her eyes, and Schafer gently tapped his hands on her knees, one side, then the other. For thirty seconds, they were silent. Then he asked, “What do you get now?”

“I’m really tense. My shoulders, they’re really tensed up.” 

“Go with that,” Schafer said, resuming the taps. 

For the next half hour, they remained in this loop: Schafer tapped, Talkington offered a sentence or two on what was going through her mind and body. Her mother didn’t support her as she was losing hair. During their separation, her abusive ex-husband told her that no one would ever love her because she was bald. She felt angry, and agitated, and tight in the chest. Her voice broke. She left much unsaid—the point of the therapy is to talk as little as possible—but, as she later told me, the agony of her hair loss was deeply bound up in these troubled relationships.

About fifteen minutes into the loop, Talkington brought up a positive thought. “I’m thinking about when my husband now actually approached me and actually messaged me and told me that he was interested in me,” she said. “I sent a picture of myself bald.” In response, he told her that she was beautiful.

By the twenty-minute mark, Talkington reported feeling calmer. At twenty-one minutes, Schafer asked her to reexamine her earlier assessments. She still felt calm. Her body felt good. Her disturbance was “a point five” out of ten. Meaning: The pain, both emotional and physical, was nearly gone.

One afternoon, a few of us went to lunch at a Vietnamese spot in a strip mall nearby and debriefed on everyone’s impressions of EMDR. Lyn Williams, a couples’ therapist based in Springfield, Illinois, leaned over his meal. “I think for therapists,” he said, “you have to let go of your own ego to trust in the process. It’s not, ‘this thing I said’ that was so helpful.” 

“I found it hard not to say anything,” agreed another therapist. 

I asked Williams how he thought he would incorporate EMDR into his practice. “An issue with some of my couples,” he said, “is they can come in really triggered from past events. They almost, like, change states. It’s not their partner, but it’s what their partner is representing to them at that time. We work through it, and at a cognitive level they get it, but at a deeper level, it’s still there.”

“I do a lot with infidelity,” he added, “and we’ll get through it, but there will be this lingering thought they have of, What if?” Even if someone fully trusts their partner again, he told me, there’s a small part of them that feels betrayal buried in the body. 

As someone whose brain and heart often don’t match up, this made sense to me. So many of us in the United States—myself included—are taught to think our way through loss or trauma, to resolve problems efficiently through discipline and logic. But logic only gets you so far.

Before turning to psychology, Shapiro, who was born in Brooklyn in 1948, pursued a Ph.D. in literature at New York University, where she studied the poetry of Thomas Hardy and, in her words, “reveled in the glory of human suffering transformed into art.” At the same time, she was also reading psychologists Andrew Salter and Joseph Wolpe, whose work examined how the environment and other people’s mental states influence learned behaviors. Both Salter and Wolpe were interested in hypnosis as a way to condition human actions. Adjacent to hypnotherapy, Wolpe developed a type of exposure therapy known as “systematic desensitization,” in which clients imagine or are exposed to anxiety-inducing stimuli and use relaxation techniques to mitigate their anxiety. Years later, Shapiro would acknowledge her intellectual debt to Wolpe’s work, and, in turn, Wolpe would become a fervent defender of EMDR. 

Gerald Puk, Shapiro’s first husband, described her during those years—what he called their “hippie days”—as “intellectually curious” and spiritual, engaged in Eastern philosophy, yoga, meditation, and social justice. Even then, twenty years before she developed EMDR, Shapiro held ambitions to end the world’s suffering. She was energetic, academic, he said. Intense.

Then, when Shapiro was thirty, a routine mammogram turned up troubling spots. The biopsy came back positive: She had breast cancer. Shapiro sank into a depression. After radiation and surgery, her cancer went into remission, but her brush with mortality left her questioning life’s purpose. She quit her Ph.D., sold her belongings, and, with the help of Puk, with whom she’d separated but remained friends, fixed up an old Volkswagen van and traveled across the country. Shapiro took mindfulness and nutrition workshops across the Western United States and Hawaii. In this period, she said, she used her “mind and body as a ‘laboratory’ to see what things worked.” Eventually, she ended up in California. 

In the 1980s, California was a hotbed for New Age thinking, a place where Shapiro delved into theories of the self and empowerment that would ultimately shape her approach to psychotherapy. In San Diego, she enrolled in a clinical psychology doctoral program at the Professional School of Psychological Studies and worked with Irv Katz. His work fell under the umbrella of transpersonal psychology, a model that looks at a person holistically, through the integration of the cognitive, emotional, psychological, and spiritual. Galvanized by her bout with cancer, Shapiro focused on the burgeoning field of psychoneuroimmunology, which examined the interplay between emotional stress and physical disease.

With a classmate, Shapiro set up a business called the Human Development Institute, a self-help oriented nonprofit to aid people in becoming more creative and less fearful. They hosted spiritual speakers like Stephen Levine, who wrote on death and dying; Ram Dass, a spiritual leader focused on mindfulness; and Gerald Jampolsky, a psychiatrist who worked with children facing terminal illness. They also held workshops with Tony Robbins, who was then on the cusp of self-help celebrity and staged fire walks as a way to conquer fear. Through this early work, Shapiro aimed to develop techniques for people to “master our own minds and bodies.”

Many of those workshops focused on neurolinguistic programming, described in 1988 by the Los Angeles Times as an “amalgam of linguistics and hypnosis,” which is today widely regarded as pseudoscience. Developed by linguistics professor John Grinder and his colleague Richard Bandler as a way to understand how certain people became “super-achievers,” neurolinguistic programming unpacked how people experienced the world through one of three perceptual systems: visual, auditory, or kinesthetic. The theory, according to its proponents, established a connection between neurological processes and language and learned behavioral patterns. These patterns, Grinder and Bandler argued, could be changed through therapeutic “programming” to model the skills of exceptional people. Shapiro spoke effusively about neurolinguistic programming to the Los Angeles Times, describing how Grinder and Bandler studied people who “were able to set up an instant rapport with others, to tap into how people were communicating and thereby influence and guide that person to whatever decision or direction they wanted.”

All of this was marinating in her head when Shapiro took her walk around the lake and observed that moving her eyes helped calm her thoughts. Through trial and error, she developed EMDR, the tool she’d been searching for this whole time. She performed a randomized controlled study on twenty-two people suffering from traumatic memories, including veterans of the Vietnam War and survivors of sexual assault. She found that, after just one session, people reported that their traumatic memories were less intense and that they had “altered their cognitive assessments of the situation.” That study was published in the Journal of Traumatic Stress in 1989. 

When EMDR began to trickle into the mainstream, much initial news coverage was glowing. Lynn Sherr, a correspondent for the ABC program 20/20, described EMDR in 1994 as “a process that mysteriously unlocks the trauma of times past.” Around a decade later, CBS2 News, a local station in therapy-conscious Los Angeles, did a feature on EMDR focusing on a man who survived a car plowing into the Santa Monica farmer’s market, for whom the crash had triggered earlier traumas. After EMDR, he reported feeling physical and emotional relief. “I realize there’s a lot of things that I’ve carried along with me from the past that now I was able to let go of,” he said. 

Backlash came just as swiftly as the praise. In a 1994 Los Angeles Times article, “The Amazingly Simple, Inexplicable Therapy That Just Might Work: Is EMDR Psychology’s Magic Wand or Just Some Hocus Pocus?” Nancy Wartik wrote that critics accused Shapiro of “adopting the role of guru ministering to a devoted flock.” One charged that Shapiro had a “cultish” following.

Neurologists and trauma clinicians claimed Shapiro marketed her therapy as effective without having the research to back it up. And as the therapy evolved away from eye movements, detractors and observers alike questioned EMDR’s wide range of techniques and the growing list of disorders it could supposedly treat—PTSD, anxiety, phobias, eating disorders, and schizophrenia, among others. Meanwhile, people in the neurolinguistic-programming world accused Shapiro of appropriating elements of their practice, though Dunton, Shapiro’s friend and colleague, denied the two techniques had anything to do with each other.

It’s not unusual that an influential therapy will stem from a single founder. The psychiatrist Aaron Beck is considered the father of cognitive behavioral therapy, a treatment aimed at changing a person’s faulty ways of thinking. Psychologist Marsha Linehan created dialectical behavioral therapy, a treatment that combines mindfulness and other skills with elements of cognitive behavioral therapy and was developed for people with a high risk of suicide and is now used to help people with borderline personality disorder. (Linehan, like Shapiro, created an institute and a certification process.) 

But EMDR is different, critics say, because of its especially spotty research. In 2013, Christopher William Lee, a professor of psychiatry at the University of Western Australia, and Pim Cuijpers, a professor of clinical psychology at the Vrije Universiteit Amsterdam, published a meta-analysis of twenty-six trials to determine whether EMDR’s eye movements were effective in helping people process distressing memories. The meta-analysis cautiously concluded that eye movements do “alter the processing of emotional memories.” But in 2020, Cuijpers and other researchers published another meta-analysis, this time of seventy-six randomized trials, including studies that sought to examine the effects of EMDR on disorders other than PTSD. Its conclusion was more hesitant. “EMDR,” Cuijpers and his coauthors wrote, “may be effective in the treatment of PTSD in the short term,” but “the long-term effects of EMDR are unclear and…there is certainly not enough evidence to advise its use in patients with mental health problems other than PTSD.”

The problem, Cuijpers told me, is that the quality in EMDR studies is “horrible.” Group assignments in randomized controlled trials, he said, should be truly randomized, with people not involved in the study assigning participants to either the control or the experimental group in order to avoid bias, and other independent individuals, unaware of each participant’s assigned group, assessing outcomes. Furthermore, every participant—even those who did not finish the study—should be included in evaluation. Of around eighty clinical trials Cuijpers and his coauthors examined, only one met all of the standards for quality research. “There is some evidence, but it’s very low, extremely low quality,” Cuijpers said.

In his book Repetition, philosopher Søren Kierkegaard speaks of the titular practice as the structure within which an ethical life is organized. For Kierkegaard, repetition is a forward movement, an inverse to recollection, which looks back in time. In his dialectic, based on the Danish word gjentagelsen, repetition is not simply the act of doing something already done. Repetition also involves gaining insight and meaning with each iteration of an act. To repeat is to move toward understanding.

To me, EMDR’s looped middle phases seem to echo Kierkegaard’s notion of repetition, a chiseling away at memory until some sort of answer is achieved. Rachel Dawson, a thirty-year-old communications manager at a church in Richmond, Virginia, described to me her experience of EMDR in similar terms, as a “push and pull.” She’d been raped as a teenager, and, in addition to having immense anxiety and depression, had struggled romantically. After a preparatory session, she participated in only two ninety-minute sessions of EMDR, but both were so exhausting that she slept for hours afterward. “It was really overwhelming,” she told me over the phone last winter. All of her senses were stimulated. Yet she left those sessions feeling freer, the weight on her psyche from past trauma lightened. 

Dawson described to me the power of occupying two psychic spaces at once: the dark space of her memories and the bright space of her therapist’s office. If it seemed like she was going too deep into either place—staying too talkative and present with her therapist or engaging too intensely with her trauma—her therapist would guide her back to the loop. It was as though she were watching her memories unfold on a video at high playback speed, observing her teenage self rather than embodying her. Dawson felt a great tenderness toward the younger Rachel. “There was always this rewriting of the story because I was still in the room now,” she told me, referring to her therapist’s office. She constantly toggled between “you’re there and you’re remembering, but you’re also here and you’re safe and this is real too, and you made it through that, and you’re alive.”

I would come to understand EMDR as a push and pull, too, though I didn’t know anything about its background when I tried it myself in the winter and spring of 2021. I’d had PTSD-like symptoms on and off for years, after being sexually assaulted at age eighteen, but only recently had a therapist diagnosed me. At the time, for whatever reason—perhaps because I felt isolated and directionless during the pandemic, or maybe it was some combination of the personal and the global, the way the whole world seemed to be collapsing in on itself—my symptoms had returned with terrible force. My therapist, whom I’d been seeing online for a few months, told me I might benefit from EMDR, which she said could speed up the therapy process. “Here’s the beautiful thing,” she told me: I wouldn’t have to recount my entire traumatic experience out loud. 

I was uncertain. I wondered whether I was too stuck in my brain—too apt to overanalyze, to doubt and question—for something like EMDR to work. But trying was better than doing nothing. My therapist and I decided to meet in person—she was located in North Carolina—for two hour-long sessions of EMDR every week for a month. 

In retrospect, these were not ideal circumstances for intensive trauma therapy. By briefly relocating to North Carolina that spring in order to commit to these sessions, I found myself in a city where I knew no one, and since it was the middle of a pandemic, I was anxious about infecting my therapist with Covid, so I didn’t bother trying to meet anyone, either—all of which added a layer of isolation to an already lonely experience. At first, our sessions seemed disjointed, and I had trouble getting out of my mind and into my body. My therapist hadn’t taught me how to contain or calm down from distress, tools that I later learned were part of EMDR’s curriculum, and between sessions, I’d suddenly break down while driving or grocery shopping.

Gradually, though, I felt myself improving—one of my negative cognitions, in EMDR speak, seemed to be weakening. But I didn’t know where this would all lead, and I was anxious that my time with my therapist would run out before I’d fully engaged with my assault. Still, after some sessions, I’d leave the room feeling lighter. 

For our last session, my therapist asked me to create a new image of myself, one that could overlay the original whenever I felt myself becoming anxious, or emotional, in relation to my sexual assault. I closed my eyes—we were using handheld buzzers that sent vibrations into my palms—and pictured my current self approaching my younger self, the one who’d been assaulted, and walking with her, hand in hand, out of the city where it had happened. It felt like the perfect narrative arc: I’d started therapy with the image of my assault and finished with an image that was hopeful. I’d describe this final session to a friend as “stunning.” Perhaps, I hazarded to hope, I really was better. 

But just a few months after I finished the treatment, I relapsed. My symptoms returned. My depression was worse than before. By then, I was no longer seeing my therapist; we were uncertain whether I was allowed to continue as an out-of-state client. I blamed my brain, yet couldn’t help but wonder: What exactly had gone wrong? 

On the last day of training, Darryl Schafer raised his hand to ask a question. By now, I’d come to think of him as one of the more inquisitive counselors of the group. Early on, he’d commented that his therapy work sometimes felt like “palliative care” when it came to addressing issues of systemic injustice. When he asked how EMDR “fit in with a systemic world that just is out to get people,” I surmised, based on Sager’s indirect response, that the answer required more time than her quick-paced training allowed. Now, he wanted to know more about treating clients with dissociative identity disorder, or DID, a condition usually caused by past trauma that results in multiple personalities. 

“One of my buddies is relatively okay now, but he was trafficked when he was a kid, by his dad, and so he has DID,” Schafer said. The other therapists collectively sighed. “I told him I’m doing an EMDR training, and he got really, really angry. He said he’s seen four different EMDR therapists and they all left him really damaged.” 

Sager, who considers complex trauma one of her specialties, had been lecturing on how to address patients with dissociative disorders. “I don’t know what he sought out, but they need to specialize in DID,” she said. 

“That’s what I was wondering. I’m drinking the Kool-Aid, let’s EMDR all the things”—the therapists laughed—“but I don’t want to push him,” Schafer said. “His heart walks with a limp now.” 

About a week later, I called up Schafer’s friend, James. When he answered the phone, he warned me he was “excessively blunt.” James, who was forty-two, has been in and out of therapy since age seven, and is wary of practices that market themselves as “the be-all, end-all.” A sports massage therapist in southwest Missouri, he’s talkative and fond of dark humor—something that helps him cope with his past. For seven years when he was a child, his father abused him and trafficked him for sex. At thirteen, he finally became strong enough to overpower his father physically. The sexual abuse stopped, but psychological abuse continued into his twenties, until he cut off all contact with his father.

James’s mother, a doctor who did a residency at a psychiatric hospital, didn’t know about the abuse but thought he had issues with anger and authority, and seemed uncontrollable. She’d heard positive things about EMDR and suggested he try it. “EMDR works for everybody,” she told him. “Especially for people who everything else doesn’t work for.”

By then James had blocked the abuse from his memory. “I thought I was just a fuckup,” he told me. He couldn’t hold down a job or a romantic relationship; he drank excessively; and he’d spent stints living in his car. He was willing to try anything. So twice a week he drove six hours each direction to Omaha for EMDR. In the sessions, his therapist tried every technique—handheld buzzers, knee-tapping, hand-waving, closed-eye movements. James didn’t have the language for his dissociative identity disorder then, but in retrospect, he realizes that different adolescent personas—scared, aggressive, childlike—were emerging during his sessions. Outside of therapy, his drinking worsened. He raged at everyone in his life. Finally, when it was clear he disagreed with the therapist’s treatment, his therapist ended their sessions.

Over the next decade, James tried EMDR three more times. The last time, his therapist intentionally triggered him, asking him to recall the sights, smells, and sounds of the places where he was abused. Then they started the eye movements. “It was horrible,” James said. “You’ve got me triggered to the point where I’m a frightened six-year-old, but physically speaking, I’ve had, at this point, twenty years of jujitsu and have done numerous firearms trainings.” After their sessions were up, James would return to his day-to-day life—agitated, afraid, and enraged. As with his first EMDR experience, his mental health deteriorated perilously. After a year, he quit EMDR for good. 

James’s case is the worst possible outcome: Clinicians, however well-intentioned, effectively doing more damage than good to a traumatized person. This, Sager warns, is what can happen when someone is not sufficiently trained in EMDR for people with complex trauma. Sager used to start her treatment with history taking—asking clients about their traumatic pasts—and her clients would disassociate. Even attempting to screen clients for disassociation can cause them to disassociate. “Gee, I did it all the time,” Sager told us, flatly, during the training. Later, she learned to work on building her clients’ emotional resources first, taking a client’s history only when they seemed stable. (James told me that this process did not happen at any time during his experience with EMDR.)

Indeed, there are many caveats to EMDR that tend to be excluded from its marketing as a rapid therapy. Certain clients require months of preparation prior to the desensitization and reprocessing phases. And while further training is available for disassociative and schizophrenic clients, “it has to be the right time” for EMDR, Robyn Nelson, Sager’s colleague, said.

In her 1995 textbook on the procedure, Shapiro wrote that “if EMDR is not used appropriately, the client may be retraumatized and may become immobilized in the process.” She also wrote that clinicians should expect a success rate of 80 to 90 percent for “appropriately selected clients,” and “if this level of success is not being achieved, the clinician should take responsibility for becoming more skilled in the method,” suggesting that problems lie within the clinician, and not the procedure. She was more reluctant to acknowledge that EMDR might not work with everyone. 

The American Psychiatric Association added PTSD to its Diagnostic and Statistical Manual of Mental Disorders in 1980, just seven years before Shapiro developed EMDR. In that initial entry, which had its origins in the experience of Vietnam War veterans, the DSM-III stated that PTSD should come from some stimulus that is “generally outside the range of usual human experience.”

Since then, scientific thinking on PTSD has evolved to encompass a wider range of possible stimuli. But much is still unknown about why certain people develop PTSD, and how the brain changes as a result of trauma. Studies have shown that people suffering from PTSD have smaller amygdalae, the part of the brain that processes and responds to threats, while neuroimaging has displayed decreased activity in parts of the prefrontal cortex, the area of the brain responsible for executive functioning and rational thinking. One affected area seems to be Broca’s area, which is implicated in speaking. Some researchers speculate this is why traumatized individuals have difficulty categorizing and talking about their experiences—and Sager, along with other EMDR therapists, argues this is why talk therapy is generally unhelpful for people with PTSD. “That sort of therapy is logical and comfortable,” she said. “Trauma is body based and if all you’re doing is thinking, you are not getting relieved.”

PTSD is a narrative breakdown, the intrusion of the past into the present. It forces the ontological dissolution of the self; its sufferers often report feeling like strangers to themselves. Healing from such psychic unraveling is a murky and nonlinear process, and while the APA recommends eight different interventions for the treatment of PTSD—including three cognitive therapies, prolonged exposure therapy, brief eclectic psychotherapy, narrative exposure therapy, four types of medication, and EMDR—there are many other possibilities, from mainstream procedures to alternative treatments such as acupuncture and psychedelics. 

Cuijpers, the clinical psychology professor in Amsterdam, is wary of EMDR’s marketing, and cautions that the people who support EMDR might not have enough distance from the treatment to properly evaluate it. “Sometimes it feels like they are salesmen, not selling toothbrushes but EMDR,” he told me. But, he said, quality problems exist in all psychological and biomedical research, and his qualms didn’t mean he was against using EMDR. (He emphasized in our conversation that he didn’t fall into either camp, of supporters or detractors.) It does seem to work with some people, he said, and it has the advantages of being simple and straightforward. “If it helps somebody,” Cuijpers said, “why would it be less valuable?”

The polarizing response to EMDR shows just how little we really know—about PTSD and healing, about what works and doesn’t, and how. Shapiro’s early flirtation with self-help, and her followers’ eager acceptance of EMDR, illustrates how survivors grasp for any chance at recovery, no matter how far-fetched such treatments may seem. And though the treatment emphasizes deep body work, EMDR’s reputation as a breakthrough, rapid therapy speaks to our larger cultural impulse to “get over” our deepest pains quickly. EMDR, in its swirl of devotion and controversy, has come to represent something much larger than hand-waving and eye movements. At the same time, unrelenting skepticism toward EMDR negates the experience of people who really do benefit from the treatment. The business of healing is messy. People start and stop therapy, are triggered years after their traumatic event. They get better, and worse, and better. Or they don’t. Why should an eye-movement therapy work? Why should it not? Perhaps EMDR, with its loops and repetitions, its movements, its quiet, echoes this illogic. Perhaps, in doing so, it reminds us that healing doesn’t fit a single script. 

In the summer of 2021, a year before I went to Arkansas and a few months after I’d tried EMDR for myself, I drove to Sea Ranch, California, the last place Francine Shapiro had lived until her death in 2019.

The drive to Sea Ranch took me up Highway One, a coastal route that hugged wildflower-spotted cliffs and curved north toward the windswept, melancholy parts of the state. As I turned off the highway, I saw sleek modernist wood houses with single-pitch roofs hidden behind tangles of pine and redwoods. The community, built in the 1960s, had as its motto “live lightly on the land.” Its architects had envisioned a community at harmony with nature, with houses built from cedar and redwood that mirror the colors of the forest and coastal bluffs.

I pulled up to a two-story home nestled in a thicket of cypress. Bob Welch, a man with silvery hair and thin-rimmed glasses, opened the door. He was Shapiro’s widower. At the kitchen table, he handed me three sheets of paper with typed answers to questions I’d emailed him (he’d requested them in advance of the interview). I glanced over the sheets. He’d answered many in single sentences. To the question about his impressions of Shapiro, he’d answered in two parts. 

A.  At first (looking at the photo she sent me) I thought she was too good to be true. 

B.  Smart, very verbal, and independent.  

“I met her through a singles magazine,” Welch told me. It was the late 1980s. He was recently divorced and looking for something casual; he’d written “not interested in long-term relationships” in bold, to get the message across. Shapiro responded to his ad with a photo, and they talked on the phone. Welch, who was working as an experimental psychologist for NASA, told her he studied perceptual and visual adaptation. “Wow,” she responded, “I’m very interested in stuff that involves eye movements.” 

In time, they’d move in together. They’d stargaze in their backyard, walk along the bluffs, take trips for EMDR trainings and conferences——to Italy, Argentina, New Zealand. In the beginning, as they started dating, the research-oriented Welch was skeptical of unorthodox treatments for trauma. He urged her to perform controlled studies on her procedure. In the end, he said, she did “good research” and “it seemed to work,” but he emphasized the fact that she’d never developed a theory for how EMDR functioned.

More critical of her ideas than others in her orbit, Welch also argued that she “overgeneralized.” “She thought it could take care of all kinds of things. But there’s no therapy that does all those things, and hers didn’t do all those things,” he said. He specified: “For example, she thought she could treat psychosis with it, and I didn’t think so at all.” 

Welch was pragmatic and straightforward, wholly unsentimental. When I asked what Shapiro had taught him, he paused, then said, “She probably helped me get a little more touchy-feely than I normally was.” Shapiro was spiritual, though he wasn’t quite sure what that meant—“feeling oneness with the universe or something like this.” She loved meditating; he couldn’t quiet his mind long enough. He’d tried EMDR himself, just once, in the early days of the procedure. “It was a little awkward for me,” he said. “I really wanted Francine to succeed but I had biases about what you could do with that therapy at the time.”

Her death came as a surprise. In June 2019, when she was seventy-one, she fell after getting out of bed. This itself was not unusual. She’d had a second bout of cancer which had left her health in decline, but her mind was alert as ever. Welch took her to a medical facility in Gualala. He last saw her on June 15, 2019. “I said goodnight to her and went home, and the next morning, early, at 7 or something like that, I got a call saying she had died.” Eventually, he buried her ashes in the hollow of a redwood near the Gualala River. 

After talking for a couple of hours, Welch and I said goodbye. I walked to the bluffs where he and Shapiro used to stroll. Delicate purple lupines sprouted from wild grass. Gull cries cut through the thick marine layer. Salty spray misted my face. I wondered what Shapiro had felt living here—all of her senses stimulated, surrounded by flowers and sea, as she grappled with the fact that she was sick again. It was late June, and I, a few months post-EMDR, was in the midst of my depression, prone to panic attacks and sudden emotional outbursts. In the fall, the depression would begin to recede, and by the following spring, any lingering signs of distress would, for the most part, vanish. 

Today, I chalk much of this up to circumstance and environment. I moved, and in this new home I feel a strong sense of community and purpose, a stark contrast to the isolation of the first pandemic winter. Trauma never disappears entirely, but surely all that has helped. Still, I sometimes wonder: Maybe EMDR did change something—much like Shapiro, I now find solace from anxiety through long walks outdoors. Maybe, then, EMDR spurred a months-long healing process that has taught me to cope. But maybe it didn’t. I’ll never really know.