Transcript for Episode 106: EMDR Therapy Training for Social Workers

Elisabeth Joy LaMotte:
From the National Association of Social Workers, this is Social Work Talks, and I'm your host, Elisabeth LaMotte, and I am so excited to welcome to our conversation Deany Laliotis. Deany is a social worker. She is a nationally and internationally renowned speaker, consultant, and psychotherapist who teaches EMDR therapy using a relational approach to treating complex trauma. Deany is the founder and the director of the Center for Excellence in EMDR therapy, which offers a range of trainings from basic to master courses. Deany has also authored and co-authored several book chapters and articles on EMDR, and she's currently working on a book on relational EMDR therapy, which we will get to hear some about today. Deany lives in Washington, DC with her fellow trainer and husband, Dan Merlis. Deany, welcome to Social Work Talks. Thank you so much for joining us today.

Deany Laliotis:
Thank you, Elisabeth. It's my pleasure to be among my own people. Thank you.

Elisabeth Joy LaMotte:
Yes. And we social workers are very interested to hear what you have to say today. Many of our viewers and listeners already know about EMDR. They may have trained in it either with you or somewhere else, but some do not. So may we begin with just a quick overview of EMDR and EMDR therapy before we dive into more of our details today.

Deany Laliotis:
Happy to. So EMDR was developed by Dr. Francine Shapiro in 1989 as a simple desensitization technique for the treatment of post-traumatic stress symptoms. And from there it went to EMDR, EMDR therapy, and now it's a methodology that treats any symptoms, any problems that's based in memory because what EMDR does is it addresses the way memories are coded in the brain and allows our system to reprocess the experience and in so doing, it's stored differently and it lives in our system differently. In doing so, it frees us up to just be more fully in the present rather than just be triggered and hijacked by daily life experiences that look like, feel like, sound like, must be like, how it was when we were five years old.

Elisabeth Joy LaMotte:
Yes. One of the things, and I should share that I've had the deeply enriching experience of training Deany, both with you and with your husband Dan, and one of the most striking things is just how succinctly the approach works for people and demonstrates a shift and a change. Can you say a bit more about what drew you to this approach way back when? As a pioneer of this way of working, how did it all begin for you?

Deany Laliotis:
So at the time, Dan and I were both working at the VA, and so at the VA hospital we were working with Vietnam veterans, POWs, Korea vets and POWs, and World War II vets. And this was about 10 years or less since PTSD became a diagnostic category. So it was revolutionary to even be thinking about trauma in this particular way, but here we were dealing with severe PTSD, and really it was like putting a bandaid on a gaping wound.

And so when we read about it and then heard about the training, we went and it changed everything. These Korean vets who were interned, could then look at a bowl of spaghetti for what it was rather than what it was triggering for them just to not be more graphic, but it allowed them to go to sleep at night rather than hovering underneath the beds. All the things we could talk about and help them develop coping strategies for. But the hyper vigilance, the startle, none of that ever went away. And so we were so heartened to see that in a matter of sessions, these guys were sleeping, they were smiling, they were talking, and it was a game changer.

Elisabeth Joy LaMotte:
A game changer, and Deany from there, at that point, the way that you were working was much more EMD standing for the desensitization element and EMDR, which stands for eye movement desensitization and reprocessing. And from there and here I do think it's important that you not hold back or be modest. You trained very directly with Francine Shapiro who discovered and researched and cultivated this approach. You are a pioneer there. In 2015, you were awarded the Francine Shapiro Award for excellent service and clinical expertise. What was it like to work with her back then to co-author articles with her, and what has been your role in taking it to the next level with relational approach to EMDR therapy?

Deany Laliotis:
Well, first of all, if we could all be so lucky as to have a mentor like Francine Shapiro, to me, she was bigger than life. Her vision for healing the world was always front and center to her. So she was always an inspiration and she was battling the academic establishment from the beginning where people were challenging her and this methodology and saying, "Oh, it was just mesmerism". And she persevered. And so that actually fueled a lot of the research in the early days, because she wanted to prove that EMDR was effective, that this wasn't just snake oil or it wasn't some made up racy new thing. And so her bravery, her courage, her perseverance was always something to learn from, to marvel at. And she took me under her wing. She saw that I too was passionate about EMDR.

I was a good teacher. It came naturally to me and I learned as a little girl to translate the world for my mom in particular, who was an immigrant from Greece. And so I learned how to explain things and she could see in a way in me something I hadn't fully actualized for myself. And so she was always that way. She was always looking to identify the gifts that we all brought to this and to help bring them forward. And so she kept giving me more and more opportunities to do so. And in so doing, I helped to rewrite the curriculum, to make it more of a psychotherapy model, rather than just an intervention. I became her clinical director. So I was part of training the faculty as well as training our students, the full robustness and the comprehensiveness of this model, as a model of psychotherapy. And so that was really quite a stimulating and exhilarating time to be part of someone so brilliant and to be in a community of like-minded people who were really passionate about healing trauma.

Elisabeth Joy LaMotte:
My postgraduate training is in the systemic frame, and there is a concept that is especially central in training for supervision called isomorphism that references the handing down of skills, of wisdom, of training. And there is so much of what she accomplished that comes through you to the people you train and then to the work that they do. And I want to just share one quotation from an article that you co-authored with her in 2010, if I may. This article is titled EMDR and the Adaptive Information Processing Model.

And you write, "This conceptualization offers a more contemporary definition of the unconscious and is both complimentary to an explanatory of clinical phenomena that are the hallmarks of various orientations such as transference in psychodynamic therapy, negative beliefs in cognitive therapy, and systemic impasses in family therapies. Most mental health professionals, social workers and others alike I would add would agree that clinical issues are based at least in part on previous life experiences. However, the hallmark of EMDR therapy is the emphasis on the psychologically stored memory as the primary foundation of pathology and the application of specifically targeted information processing as the primary agent of change". Can you speak to that a bit? Because the unconscious is an element here.

Deany Laliotis:
Yes, of course. So the human psyche is exquisitely designed to help us cope, to help us make sense of our life experiences and how we make sense of our life experiences informs how we go forward into the future. So the past, present and future are intimately and always intertwined. Our brain is always forward thinking because we have to anticipate what might happen so we can be prepared. So her model is an information processing model. So the data that we collect over the years, we use to associate to other similar experiences so we can make sense of them. And when those connections are adaptive, it really helps us be more adaptive, to make adjustments, to be flexible and to really be more fully in the present and access all of our resources both internally and externally.

But in the same way, when too many bad things happen to us and we're unable to metabolize them and make sense of them in a way that helps us cope and adapt to the future, then it becomes difficult for us to learn from our experiences in a way that helps us going forward into the future. So transference the experience of a client that is having a reaction to their therapist or even counter transfers, how we react to our clients is all based on those previous experiences for better and for worse. And so the same thing happens in families, right? We all have the experience of leaving home and then coming back and regressing in our own ways, being triggered by things that we haven't thought about or reacted to in years because the past is present for better.

Elisabeth Joy LaMotte:
This is why they make movies about going home for the holidays. Exactly. Could you share an example of this in a current frame of someone that you've worked with or a trainee has presented, just as an example of exactly what you're describing or close to?

Deany Laliotis:
Actually, I saw a lovely young woman in her thirties who actually had been working with another EMDR therapist on her anxiety. And part of the symptom that she brought was not remitting. She came with a misophonia, which is a hyperacusis to sound. So she had trouble filtering sounds that were more important versus sounds that were less important. So for example, she would be triggered by the sound of people chewing.

Elisabeth Joy LaMotte:
Chewing is a common...

Deany Laliotis:
Oh, right. And so here she is a year later, working on her self-esteem, working on her anxiety, but no symptom relief from the misophonia. So in she comes and I agree to treat her. And what is interesting about this symptom is that there's always a good reason for something like this to persist. So if there were a good reason for her to be so interested in sound, what would it be? And so we went back in time and discovered that at the time when her parents were fighting, being the oldest in her family, she would be at the door of their bedroom listening oh so carefully to every word so she could predict what might happen next so she could be prepared and protect her younger siblings. So at that time, she wanted to hear everything, but long after that situation was no longer in her life...

Elisabeth Joy LaMotte:
Before she met with you and sat with you, had she ever entertained the relationship between those two parts?

Deany Laliotis:
No.

Elisabeth Joy LaMotte:
Gosh. And so this is such an interesting example, if I followed, she was working in the EMDR frame before she began with you, and even trained EMDR therapists can feel stuck at times. And this went to a next level with your master level expertise. What could you say about getting stuck here and where you go with that?

Deany Laliotis:
Sure. So not uncommonly, especially with the proliferation of cognitive behavioral therapy approaches. Clinicians are often trained to treat the symptom as the problem. And so when we treat the symptom as the problem, we may or may not get symptom relief. When you're treating PTSD and you're treating the symptom, that's usually connected to one or more discreet events or a type of event that would explain the onset of that symptom. Here we also need to look at the onset of the symptom, but we also need to understand why the client has the symptom.

And so being a more attachment focused relational therapist, I'm looking for how this symptom was useful to her in the context of her relationships with others. Wherein the other therapy, they were much more focused on her anxiety as a symptom and the sources of her anxiety that had a negative impact on her self-esteem. And from what I can understand, they thought about and treated the symptom, the misophonia as a symptom, not really getting to what had once been a very adaptive response to a chaotic situation. And so sometimes we need to look beneath the surface of the tip of the iceberg to get to the root cause of the problems.

Elisabeth Joy LaMotte:
And for our viewers and listeners who may not know as much about EMDR therapy and EMDR, what would next happen is... Would you like to describe it? I can guess, but would you like to describe it?

Deany Laliotis:
Well, I'm happy to. Of course, we had to identify a representative experience because this was not a single traumatic event. This was not one fight that happened one time and then something terrible occurred. This was an ongoing situation that didn't have a discrete memory. So we identified a representative scene of this 11 year old at the door of her parents' bedroom because it didn't happen once. It happened over and over and over again. And so one of the ways that we work with EMDR that is distinct to EMDR therapy is that we're not looking to remember what happened. We identify the part of the experience that continues to be disturbing or confusing to the client. And so that's how we go in, so we can access what remains confusing, what remains disturbing, what remains arousing to the client.

Elisabeth Joy LaMotte:
And in going in part of what we're talking about is identifying maladaptive beliefs of self. And part of how we're going in is using bilateral stimulation, which is right brain, left brain processing that on some level we don't quite know how it works, why it works. But we do know that the most restorative part of sleep is REM sleep, rapid eye movement sleep, in which there is rapid bilateral stimulation. Am I describing this appropriately in building on your description?

Deany Laliotis:
These have been the working models for a long time. In truth, we still don't know fully what accounts for the treatment effects we consistently see in our clients. There are more recent theories around working memory taxation, working memory is the short-term memory where we can only hold in, plus or minus seven bits of information. So when there's too much information coming in at once, things have to move. So the brain starts to push things forward.

And so that's another working hypothesis. The one that really helps me is around the orienting response because the orienting response gives us the opportunity to always orient to our current conditions at any given moment. And we use the eyes, the ears, and the neck to do that. So one way to think about that is with that idea that we have one foot in the present, I know where I am at any given moment, while I'm going down memory lane in the past, the orienting to the current conditions allows the client's system to do now what it couldn't do at the time without getting overwhelmed, without getting re-traumatized. But in fact, allowing the system to reprocess the distress and the confusion and get to the other side of it once and for all.

Elisabeth Joy LaMotte:
Yes. It's so powerful to see it happen for someone and to see them move that way. In my experience, sometimes it happens so clearly and succinctly, and sometimes it's a different kind of a path. I will share. I trained in EMDR in the late nineties. I had finished graduate school for social work. I had worked, I had done additional training. I was finally starting out in my practice and my supervisor said, "I know you're done, but there's this training I just did, and you have to go do it. It's going to blow your mind". And I was like, "But I just finished school no more, no more". And he said, "This will change everything. You've got to do it". And I did it. And even back then, it was so powerful. And at that time, because I wasn't at a VA and I wasn't at a rape crisis center, there wasn't the frame for it that we have now as a therapy.

And I was doing more attachment based work in couples in family therapy. However, it stayed with me and I revisited it through training with you and training with Dan. One of the things that is similar then to now is the way that in the training, part of how you learn is that you work with your colleagues and you practice on each other. And even in those short moments, I had very powerful experiences learning how to do it, which then showed me the potential for this. And I'm curious, what is that part like for you as the trainer and the teacher?

Deany Laliotis:
I trained over 30 years ago, and I still teach the basic training and I teach it because I love to watch the discovery that takes place in the training, that comes out of the personal experience, the personal transformative experience of something that's been confusing, annoying, difficult, just releases and creates space for something else to happen. So I love inspiring people, and there's nothing like having a direct experience. We can't ask our clients to go there to go into the darkness of their earlier life experiences if we're not also willing to go there ourselves and know what it is that we ask of our clients.

Elisabeth Joy LaMotte:
That is so beautifully said. Exactly. And building on that, an adjacent concept to what you're describing is a principle that I think I learned the first day in graduate school for social work to be where the client's at, to respect their shoes and do the best we can to be where they're at. How would that principle apply to EMDR and EMDR therapy?

Deany Laliotis:
So irrespective of our methodologies, we meet our clients where they're at to really understand them, to connect with them and for them to feel understood by us. But then as part of the journey, we ask our clients to meet us, because as is often the case, we don't fully understand why we struggle in the ways that we do. And so it's a process of exploration and invitation to be able to understand the impact of our life experiences and make the decision to go into that emotional territory that is often unchartered and somewhat protected, if you will. We started our initial conversation about the unconscious. The unconscious is there for a good reason and part of the reason as it's there to defend us and to protect us from the early hurts, the early confusions, and to help us cope. And so as we get older, we don't need quite the same level of protection, but in fact, we can make it more of a journey of self-awareness and understanding.

Elisabeth Joy LaMotte:
And for our listeners and our viewers who are social workers or anywhere in the mental health field, who I imagine may be very motivated listening to you, to want to train in EMDR, information about your center will be in the show notes. Of course. What would you suggest that people read or watch in order to learn a bit more as they are considering training in EMDR therapy?

Deany Laliotis:
I think they need to talk to colleagues that they know or know of who are EMDR therapists and have been training for some time. We have people that come to the center and ask questions about our training. I welcome people to do that because mostly when people are getting trained in EMDR, they've already decided they want to be trained in it. And then the question becomes, what is the best training for me based on who I am, based on the kind of practice I have, the kind of environment I work in, the kind of clients I see.

And so because we actually have a longer training, we stretch it out over the course of six months so that the clinician has the opportunity to practice what they're learning all along the way. We have the case consultation as part of every training segment, and then the case consultation continues after the last part three of our training. And so we take pride in really accompanying the trainee all through the process and that our training groups stay together as a cohort for the entire time, which I think is a bonus. I think it's great to go through this journey, this personal, as well as professional journey with one another because it is both personal and professional.

Elisabeth Joy LaMotte:
Absolutely. And the way that you've structured it, is so thoughtful and so thorough and allows trainees to take in a lot of information and begin to metabolize it and use it and learn more and keep growing. There are different levels in which to practice EMDR, part of how I've heard it described is that initially it can be a tool when you've done the basic training and then at a next level it can be a therapy. But yet there's a next level where many clinicians choose to completely transform the way that they work and be true EMDR therapists. Is that how you view it or how would you touch on that piece of it in terms of ways that people can apply it where they are?

Deany Laliotis:
So we teach a comprehensive psychotherapy approach. So that means that by the end of the basic training, you have a continuum of clinical choices. From treating someone who's just had a recent traumatic event and only need to come in for 1, 2, 3 sessions, to someone who has chronic difficulties with self-esteem and relationships and self-regulation. So we cover the whole continuum and we encourage our clients to practice while they're in the training with us because we want to give them the opportunity to make mistakes while they have all the support that they need. And of course, we encourage people to continue the support, but some people will want to adopt it in a more integrative way. Other people will continue to use it as a tool. We teach all of that and we encourage people to adapt it to their clinical practice based on what's best for their clients. And so we teach flexibility. And for most of us who treat complex trauma, we encourage a more attachment focused relational approach because how we show up in relationship to our clients is just as important as the methodology that we use.

Elisabeth Joy LaMotte:
Is there a place where you see trainees get stuck or what would you say about that part?

Deany Laliotis:
So we all bring ourselves to this work, and so we too have memory networks. Again, for better and for worse, our past experiences inform our present day moments. And I think it's important for clinicians to do their own personal work because the more we can resolve for ourselves, the more present we can be for our clients because our clients can really only go as far as we can accompany them. And one of the common challenges that clinicians, particularly newly trained clinicians have, is with the arousal. When you're accessing the emotional pain of a disturbing memory, it's hard for the clinician, because the clinician is more accustomed to comforting and soothing and supporting and moving the client away from the distress. And what we do in EMDR therapy is we move the client through the distress so it's no longer something they need to manage. And so the window of tolerance of the therapist is directly correlated to how far the client can go.

Elisabeth Joy LaMotte:
I think you're speaking in part to my own experience when I was in my twenties and first working this way, just from the weekend long training in Baltimore in the nineties and seeing how powerfully it worked, it stayed with me. And I think had I had a better frame for how to keep going, I would have, and I found myself at times getting stuck and referring out for EMDR and when I came back to it, I could tolerate it in a different way. I think that is so true.

Deany Laliotis:
Yeah, that's a common struggle, that really is. I just really appreciate your sharing that with us.

Elisabeth Joy LaMotte:
What might be another example of a case that you could share with our listeners, either connected to this with a trainee or whatever is coming up as we keep going?

Deany Laliotis:
Well, I see all kinds of clients with a broad range of clinical issues and difficulties. I am thinking about someone who came to see me who was a therapist in a training where I was giving a presentation and she came for a very simple problem where she would be anxious when she would sit down to read a book for pleasure. And we had done years of analytic therapy and no one really understood what that was about. And of course, the symptom never shifted. And the model is so elegant in its ability to get to why these symptoms are being manifested. And so long story short, we went through the present, the difficulty with the book she was reading, we floated it back, we asked the brain to go to that unconscious connection that it's making and bringing it into conscious awareness. And it was connected to a six year old experience of her learning to read Cinderella for the first time. And in that experience, she was struggling with a word and she went to her aunt and asked for help, and the aunt said, "Not now. Your grandmother just died."

So in that moment, and this is a great way to understand the neurobiology of memory, in that moment, her brain linked her pleasure in reading, so the activity of reading, to her grandmother's death, her grandmother who she was very attached to. And so from that moment on, those two things were connected. Now, she never understood that until we got to that through the unconscious memory mapping that we call the float back technique, because what we think is connected to our present day difficulties may or may not be because our brain has its own way of cataloging and associating and making sense of our experiences.

Elisabeth Joy LaMotte:
So that she was able to do worthwhile good work in therapy, and yet this crystallizing experience remained untouched until the EMDR and working in this way.

Deany Laliotis:
And this had been going on for over 50 years. We resolved it in one session. Were there other things that we worked on that were connected, the attachment laws, grief, all of that, of course. But that also opened up that territory that was previously unexplored.

Elisabeth Joy LaMotte:
And so Deany, you're writing a book on relational EMDR therapy. Can you tell us a bit about your book and where we'll be able to find it?

Deany Laliotis:
Well, there's actually two. The first one I'm currently working on is around the core essential skills of being an EMDR therapist. These qualities that you and I are talking about, like being brave and tolerating the unknown and having a good solid case conceptualization and understanding between the symptom and the problem, using our relationship with the client as part of the vehicle for change, because our methodologies are only as good as the strength and the integrity of the relationship we have with our clients.

And so the relational EMDR therapy piece is about the parallel process between reprocessing memory in the past and the parallel process of memory in the making. The moment to moment unfolding of experience between us and our clients and how we use our experience to facilitate the client's experience in a thoughtful and deliberate way. Actually, those are two books. One is on the core essential skills, and the second is going to be more like a text on relational EMDR therapy and how... Through an attachment lens, how we understand attachment styles, and then also, not just around the kind of memories to target, but the attachment patterns, what we learned to do in response to those wounding experiences that now take on a life of their own, independent of those difficult memories.

Elisabeth Joy LaMotte:
And as a real pioneer in this way of working, as you've seen the evolution of EMD, EMDR, EMDR therapy, what do you see as next? Where do you picture the evolution from here of this way of working?

Deany Laliotis:
I see that continuum go way beyond PTSD. We now have more research on depression, eating disorders, working with children and adolescents. And so what I see as the future is really teaching it and applying it as a comprehensive psychotherapy approach where the therapeutic relationship is more central to the process. Because while we all treat different problems, many of us are treating complex trauma and attachment issues. Our clients are coming in because they're struggling with their self-esteem and they're struggling in their relationships and they need help because the push of these unresolved memories are no contest for the client.

And so I believe that's the future, that it's going to be more relational, it's going to be applied and taught as a more comprehensive psychotherapy, but within that frame, we can still treat recent traumatic events. We can still treat PTSD, we can still treat adjustments to life difficulties without a more ongoing longer term treatment. And regardless of what we're working with, whether we're on the far end of the continuum of trauma or not, it's going to be more abbreviated than a longer term, more traditional approach because of the methodology.

Elisabeth Joy LaMotte:
That sounds exciting to me to think about that. I wish I could have gone further in that direction earlier in my career, and I'm so glad that I'm a social worker and that I can use the principles of social work practice in EMDR therapy, and as a therapist. How did you choose to become a social worker and where do you notice those principles in your work today?

Deany Laliotis:
So unlike, just as a point of reference, the scientist practitioner model that is more central in the psychology discipline, what I really resonated with from the beginning is the person in the environment and really understanding the context of a client's difficulties. Because without that, we run the risk of objectifying our clients rather than understanding the subjectivity of their experience and the context that informs the client's suffering. And I just think that's it. That's it. And our ability as social workers, both by training as well as clinical practice to really take an active interest and be curious about the client's environment, who's in it, what is it like to be them and to live their lives, is really enormously helpful and very much in the social work tradition.

Elisabeth Joy LaMotte:
Yes. And many times people reach out for help for one reason, and when you begin, you realize there's also something very meaningful that's happened or changed in another part of their environment. That's a key to it. And therein is that person in environment model that is so core to social work practice.

Deany Laliotis:
I couldn't agree more. And that's why we can't just look at symptoms.

Elisabeth Joy LaMotte:
So anything else you want to make sure we cover for our listeners and our viewers in the interest of time? I could keep going. And we do have a timeframe here, so anything else that we have not covered that you want to make sure that we do?

Deany Laliotis:
So one of the things that you've brought up in our conversation is how you received the training, but you really didn't know where to go with it next. You didn't have the necessary support that I think is essential to really learn EMDR and integrate it into your practice in a way that's thoughtful and that is client-centered. And I think that, that is in part due to EMDR's history and evolution, because we only had the basic training and even though the basic training is remarkably different now than it was 10 years ago, 20 years ago, nevermind 30 years ago, what's different for me and for us at the Center for Excellence is that we offer a continuum of training.

So after the basic, we offer intermediate training, which is also a two-part course that takes place over time. And then we offer a number of different advanced trainings, specialty training. So for clinicians who are working with children and families and adolescents, we tailor the training to them because they have unique challenges. We also have masterclasses, and we also in those master classes, really invite clinicians to work on the self of the therapist, to optimize their ability and capacities to be in relationship with their clients. So you don't have to look for the training, the support, the case consultation, everything is in our community and we learn from one another as we learn with our clients and our clinicians.

Elisabeth Joy LaMotte:
I can speak to that as well. I did the basic training obviously in the nineties, but again with your husband, Dan. His words are with me more times than I could possibly count in my work. And at that point, I was formed and evolved, or so I thought, as a private practitioner, I then continued with you in the intermediate training and more so of the same. And of course there are many places to train, but having had that experience, I was so eager to get to have this conversation with you today so that listeners and viewers of Social Work Talks could hear from you and have just a taste of your perceptiveness and talent and contribution to the social work field and to healing. So I thank you sincerely for joining Social Work Talks today, and if viewers and listeners go to the show note section, you can learn more about the EMDR Center for Excellence.

Deany Laliotis:
Thank you, Elisabeth, for your interest in talking with me and for sharing our experiences with EMDR together to our fellow social workers.

Elisabeth Joy LaMotte:
Okay, thank you.

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