"Her death rocked me," she tells the psychologist, Francine Shapiro. "I'm still having problems putting it all in perspective."
Shapiro, who punctuates their interaction with soothing "OKs" and "all rights," begins describing the therapy method she will use to treat Angie. Known as Eye Movement Desensitization Reprocessing (EMDR), the procedure, which Shapiro developed, will help, as the psychologist puts it, "take the knife out of the heart." Trauma gets locked into the brain, Shapiro explains, and doesn't get processed. "We're going to try to link into the same process that goes into dream or REM sleep," she says.
Shapiro asks Angie to visualize an image that represents her feelings of sorrow. Angie rakes through several mental pictures: Christine playing an Alanis Morissette CD, the first time they met at rehab, the times they got high together. Shapiro asks Angie to think of negative thoughts and feelings she associates with Christine's death. "I failed her, me," Angie says clasping her hands. "I'm angry." Next, Shapiro holds the index and middle fingers of one of her hands a foot and a half in front of Angie's face, and begins flapping them rapidly back and forth. Angie's eyes track the movements, which approximate the rhythm of an accelerated tennis game. "Push my fingers with your eyes," Shapiro says. "That's good, that's good." Shapiro stops and asks her patient to breathe. "What do you get?" she asks.
After the first round, Angie remembers driving through Flagstaff with Christine, on the way to score speed. After the second, she recalls their first kiss under a brilliant, star-lit sky. Half an hour later, after several sets of eye movements -- diagonal, horizontal, at longer and shorter durations -- Angie begins rocking slowly, sobbing at the memory of Christine's autopsy. The rounds will continue until Angie's negative feelings decrease in intensity.
This demonstration, taped in Arizona a few years ago for therapists' use, may appear bizarre, but Shapiro's procedure is one of the most widely used treatments currently offered to those who have suffered severe mental trauma. Eye Movement Desensitization Reprocessing emerged from Shapiro's doctoral thesis in 1989; it was designed to treat post-traumatic stress disorder, which was recognized as a legitimate mental disorder in 1980. The disorder, which can be caused by a wide variety of factors, including war, sexual assault, and natural disasters, is complicated, its diagnosis uncertain. People who develop the syndrome become "stuck" on a traumatic event, reliving it in thoughts, feelings, or images -- the most familiar example being a Vietnam veteran who is haunted by flashbacks. Historically, as a population, post-traumatic stress sufferers had been extremely difficult, if not impossible, to treat. But with EMDR, that seemed to change. Within a short period of time -- sometimes a single session -- their trauma was resolved.
Many clinicians considered Shapiro's method to be nothing short of a breakthrough, and the technique, conceived by the then-California graduate student with a background in English literature, quickly turned the psychology field on its head. Now 30,000 therapists have been trained in EMDR, and clinicians have used the method across the globe -- in Sarajevo, Belfast, and Nicaragua, and here at home with survivors affected by the Oklahoma City and TWA 800 disasters. Both the Blue Cross and Blue Shield insurance plans cover the treatment, and Kaiser Permanente offers EMDR in its clinics.
Its widespread use notwithstanding, there is little evidence that EMDR works better than existing psychotherapies in aiding those who suffer from post-traumatic stress disorder. The bulk of research shows fairly convincingly that the eye movements -- the key element of this supposedly revolutionary therapy -- add nothing to its effect. Unsurprisingly, EMDR's growth has split the psychological community into warring camps. On the one side are clinicians, whose experience with the method has led them to support, and zealously advocate for, its practice; on the other are academic researchers who question the technique's extraordinary claims, and whether, in fact, eye movements do anything at all to help the traumatized. The latter, skeptical view of EMDR is perhaps best summarized by Harvard University psychology professor Richard McNally: "What is effective is not new. What is new is not effective."
Francine Shapiro was a student at San Diego's Professional School for Psychological Studies, a now-defunct, then-unaccredited school, when she developed EMDR. In 1987, at the age of 38, Shapiro was strolling through a park in Los Gatos, thinking disturbing thoughts, when, she says, she noticed that they had suddenly lost their edge. Intrigued, she began concentrating on what she was doing. She noticed that her eyes were moving rapidly from side to side, and the action seemed to shift negative thoughts. "It wasn't like this 'Eureka!' experience," Shapiro says. "What struck me was I thought I had stumbled upon a natural physiological process that impacted thought."
The discovery led Shapiro to experiment. She began by trying to reproduce her experience with trauma survivors being served by a San Jose outreach center and found that the results were consistent, if not remarkable. Shapiro drew on conventional behavior treatment, known as "imaginal exposure," or "flooding," which involves getting the sufferer to visualize and focus on a traumatic memory until it seems less threatening. Traditional exposure therapy, however, tends to be anxiety-provoking as clients are exposed to the disturbing image for prolonged periods of time. And it often takes up to 20 sessions before a client's debilitating symptoms subside. But with Shapiro's new method, clients turned around within as little as three sessions.