Correspondence concerning this article should be addressed to Ricky Greenwald, Psy.D.

Shapiro has enjoined clinicians not to use eye movement desensitization and reprocessing (EMDR), a treatment for traumatic memories, unless trained by her organization. Some have objected, especially on the grounds that sole-source training may interfere with independent research. However, those trained in EMDR agree that such training is important. Research findings have been consistently positive when treatment was conducted according to the full EMDR protocol taught by Shapiro, and negative only when that protocol was not used. Shapiro's stance has supported the effectiveness and research integrity of EMDR.

Eye movement desensitization and reprocessing (EMDR) has recently been introduced as a treatment for traumatic memories and their psychological sequelae. It was developed by Francine Shapiro, a psychologist who noticed that her own upsetting thoughts seemed to fade with spontaneous rapid bilateral eye movement. The first study (Shapiro, 1989) reported consistent, dramatic, single-session cures for PTSD, and described the procedure in detail. Briefly, it involves having the client concentrate intensely on the distressing memory, while moving the eyes from side to side for about 30 seconds (by following the therapist's moving fingers). The client is then asked what "came up," (e.g., more vivid, more angry, less tense, etc.) and asked to refocus on that, for the next set of eye movements. This procedure is continued until the client reports no further distress, and can fully embrace a positive reframe.

The meteoric rise in popularity of this novel approach has been characterized by intense excitement and controversy (Greenwald, 1995). Much of the controversy has already been resolved, with the publication of several studies supporting EMDR's efficacy (see Greenwald, 1995; Shapiro, 1995). Considerable noise has also been generated ever since Shapiro contradicted her initial presentation, by stating that she had come to view EMDR as too complex an approach to be mastered on the basis of a journal article (Shapiro, 1991).

There have been a number of objections to Shapiro's extraordinary control over the EMDR training, with particular reference to her suggestion that no one should practice EMDR without the formal, supervised training provided by her organization (Shapiro, 1991), and to the agreement that trainees have signed which prohibits them from training others without Shapiro's authorization. Perhaps the primary objection to Shapiro's approach to EMDR's dissemination is that it interferes with the tradition of independent research, which relies on unrestricted access to information (Acierno, Hersen, Van Hasselt, Tremont, & Meuser, 1994; Herbert & Meuser, 1992; Rosen, 1992). Others have objected to Shapiro's stance as an encroachment on the individual responsibility normally assumed by trained professionals (Thomson, 1993). There has also occasionally been the suggestion that Shapiro has exercised this control for personal power or profit, at the expense of the common good (Baer, et al., 1992). Shapiro, on the other hand, has insisted that this control has been necessary for client safety (Shapiro, 1991, 1993a), and to maintain the integrity of the technique until it has been adequately researched, with the ultimate goal of EMDR being taught at universities (Shapiro, 1992). I believe that sufficient information is now available to settle these issues.

I would like to first dispose of the motivation question. Shapiro has reportedly limited her personal salary, funneling additional EMDR income into research, training and community service (Wartik, 1994). She has also written a comprehensive book on EMDR (Shapiro, 1995), which will make the teaching of EMDR in universities inevitable and imminent. These actions are consistent with her stated desire that research be accomplished so that EMDR can gain wider use--even when such use is beyond her dominion.

The question of Shapiro usurping the personal responsibility of individual professionals has been articulately presented (Thomson, 1993), and may remain an ethical dilemma for some. It must certainly be difficult for a clinician not trained in EMDR to consider depriving clients of the treatment on that account. Shapiro (1993a) has cogently addressed the ethical issues entailed in using a complex and potent treatment without adequate training. The following discussion is also pertinent.

The main issue is the effect of Shapiro's control of EMDR training on treatment and on research. A number of studies are informative in this regard.

Lipke's (1992) survey of EMDR-trained therapists found them virtually unanimous in the view that the formal, supervised training was important. It should be considered that EMDR, like many other treatments, is simply too complex to be learned from a journal article. Despite the frustration and indignation of professionals who wish to train themselves, those with full information agree that it can't be done effectively that way.

In a recent review, which covered eight controlled group studies as well as several uncontrolled group studies and numerous case reports, Greenwald (1994a) found EMDR likely to be quite effective in the treatment of disturbances rooted in a relatively small number of traumatic memories, when conducted by appropriately trained practitioners. The apparent importance of the EMDR therapist's adherence to the standard protocol (taught at the workshop) to the treatment results has remained a consistent trend in the latest reports (e.g., Carlson, Chemtob, Rusnak, Hedlund, & Muraoka, 1995; Grainger, Levin, Allen-Byrd, & Fulcher, 1994; Wilson, Tinker, & Becker, 1994; see Greenwald, 1995; Shapiro, 1994). So far, the only reports in which EMDR has not yielded positive outcomes or shown superiority to other methods have involved a sub-standard protocol related to inadequate training or practice (e.g., Bauman & Melnyk, 1994; Hammond, 1991; Jensen, 1994; Metter & Michelson, 1993; Oswalt, Anderson, Hagstrom, & Berkowitz, 1993; Sanderson & Carpenter, 1992; see Greenwald, 1994a, 1994b, 1995; Shapiro, 1993b, 1994). In two reports of varying outcomes, the poorer treatment results were accounted for by lower fidelity to the standard protocol (Lipke & Botkin, 1992; Pitman et al., 1993; see Lipke 1993).

In conclusion, all available evidence supports the position that the formal, supervised training is essential for optimal treatment results. It would follow that EMDR research, as well as practice, should only be conducted by those with the requisite training to provide adequate treatment. The concern that becoming trained in EMDR leads to an experimental bias (Acierno et al., 1994) is easily resolved by conducting well controlled studies.

As Shapiro begins to loosen her control over training, with the publication of her book (1995), I believe that she should be commended for having stood her ground. Shapiro's insistence on providing sole-source training has helped to maintain EMDR's integrity for long enough that efficacy could begin to be established, which has indeed occurred. Considering the intense controversy which naturally surrounds any potential breakthrough in treatment, and the tendency of some to publish despite sub-standard practices, it is likely that EMDR's early development was considerably enhanced by its "mother's" protectiveness. Now it will be important to evaluate the sufficiency of Shapiro's new text as a training instrument, and to determine the extent to which additional teaching and supervision will be required.

Acierno, R., Hersen, M., Van Hasselt, V. B., Tremont, G., & Meuser, K. T. (1994). Review of the validation and dissemination of eye-movement desensitization and reprocessing: A scientific and ethical dilemma. Clinical Psychology Review, 14, 287-299.

Baer, L., Hurley, J. D., Minichiello, W. E., Ott, B. D., Penzel, F., & Ricciardi, J. (1992). EMDR workshop: Disturbing issues? The Behavior Therapist, 15, 10-11.

Bauman, W. & Melnyk, W. T. (1994). A controlled comparison of eye movements and finger tapping in the treatment of test anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 25, 29-33.

Carlson, J. G., Chemtob, C. M., Rusnak, K., Hedlund, N. L., & Muraoka, M. Y. (1995, June). EMDR in combat-related PTSD: A controlled study. Paper presented at the EMDR international conference, Santa Monica, CA.

Grainger, R. D., Levin, C., Allen-Byrd, L., & Fulcher, G. (1994, August). Treatment project to evaluate the efficacy of eye movement desensitization and reprocessing (EMDR) for survivors of a recent disaster. Presented at the American Psychological Association annual convention, Los Angeles, CA.

Greenwald, R. (1994a). Eye movement desensitization and reprocessing: An overview. Journal of Contemporary Psychotherapy, 24, 15-34.

Greenwald, R. (1994b). Criticisms of Sanderson and Carpenter's study on eye movement desensitization. Journal of Behavior Therapy and Experimental Psychiatry, 25, 90-91.

Greenwald, R. (1995). The information gap in the EMDR controversy. Manuscript submitted for publication.

Hammond, D. C. (1991). In search of rapid, magical cures for trauma: The eye movement desensitization & reprocessing technique. American Society for Clinical Hypnosis Newsletter, 32(2), 7-8.

Herbert, J. D. & Meuser, K. T. (1992). Eye movement desensitization: A critique of the evidence. Journal of Behavior Therapy and Experimental Psychiatry, 23, 169-174.

Jensen, J. A. (1994). An investigation of eye movement desensitization and reprocessing (EMD/R) as a treatment for posttraumatic stress disorder (PTSD) symptoms of Vietnam combat veterans. Behavior Therapy, 25, 311-325.

Lipke, H. J. (1992). A survey of EMDR-trained practitioners. Paper presented at the annual convention of the International Society for Traumatic Stress Studies, Los Angeles, CA.

Lipke, H. J. (1993). Response to Pitman et al. paper, "A controlled study of eye movement desensitization reprocessing (EMDR) treatment for post-traumatic stress disorder", presented to the American Psychiatric Assn, May 1993. Unpublished paper.

Lipke, H. J. & Botkin, A. L. (1992). Case studies of eye movement desensitization and reprocessing (EMD/R) with chronic post-traumatic stress disorders. Psychotherapy, 29, 591-595.

Metter, J. & Michelson, L. K. (1993). Theoretical, clinical, research, and ethical constraints of the eye movement desensitization reprocessing technique. Journal of Traumatic Stress, 6, 413-415.

Oswalt, R., Anderson, M., Hagstrom, K., & Berkowitz, B. (1993). Evaluation of the one-session eye-movement desensitization reprocessing procedure for eliminating traumatic memories. Psychological Reports, 73, 99-104.

Pitman, R. K., Orr, S. P., Altman, B., Longpre, R. E., Poire, R. E., & Lasko, N. B. (1993, May). A controlled study of eye movement desensitization/reprocessing (EMDR) treatment for post-traumatic stress disorder. Presented at the American Psychiatric Association Annual Meeting, Washington, DC.

Rosen, G. M. (1992). A note to EMDR critics: What you didn't see is only part of what you don't get. The Behavior Therapist, 15, 216.

Sanderson, A. & Carpenter, R. (1992). Eye movement desensitization versus image confrontation: A single-session crossover study of 58 phobic subjects. Journal of Behavior Therapy and Experimental Psychiatry, 23, 269-275.

Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223.

Shapiro, F. (1991). Eye movement desensitization and reprocessing: A cautionary note. The Behavior Therapist, 14, 188.

Shapiro, F. (1992). Response to Johnson's review. Milton H. Erickson Foundation Newsletter, 12(2), 6-7.

Shapiro, F. (1993a). EMDR deja vu. The Behavior Therapist, 16, 187-188.

Shapiro, F. (1993b). Eye movement desensitization and reprocessing (EMDR) in 1992. Journal of Traumatic Stress, 6, 417-421.

Shapiro, F. (1994). Shapiro's response. The Behavior Therapist, 17, 157-158.

Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. New York: Guilford Press.

Thomson, M. (1993). EMDR Redux. The Behavior Therapist, 16, 113-114.

Wartik, N. (1994, August 7). The amazingly simple, inexplicable therapy that just might work. Los Angeles Times Magazine, 19-23.

Wilson, S. A., Tinker, R. H., & Becker, L. A. (1994, August). Eye movement desensitization and reprocessing method in the treatment of traumatic memories. Presented at the Annual Meeting of the American Psychological Association, Los Angeles, CA.

Greenwald, R. (1995). Evaluating Shapiro's stance on EMDR training.

Key words: EMDR, THERAPIST TRAINING

Eye movement desensitization and reprocessing (EMDR) is a new, effective treatment for traumatic memories which is already extensively researched. This paper addresses the controversy surrounding the originator's insistence on the need for sole-source training, prior to the recent publication of her text. Her stance has been vindicated by research results, in that negative results have consistently reflected failure to adhere to the protocol learned through formal training.