When I learned about psychotherapy as a teenager, I knew that was what I wanted to do. I couldn't imagine anyone actually getting paid to do something so fascinating. I studied psychology as my undergraduate pre-med major, endured the challenges of medical school, with a year's break for an NIMH research fellowship in psychiatry and for regrouping my battered energies. I trained as a psychiatrist 1967-1973, (with two intervening years in the Air Force during the Vietnam War), when psychiatry was mostly psychotherapy. Over the years, managed care has squeezed psychiatrists towards medication management. While I've resisted prescribing medications exclusively, it is pretty difficult to do much psychotherapy in a 15-20 minute medication visit—the amount of time allowed under managed care.

Fortunately, I work mostly with children (in a clinic and a day hospital), and am allowed the "luxury" of 30-minute sessions because I have to speak with parents, teachers, school counselors, and pediatricians, in addition to pharmacists and managed care companies—all in addition to speaking with the children.

I constantly sought to develop ways of providing psychotherapy along with the medications, but was unable within my limited timeframe to use the psychodynamic approaches I was taught as a psychiatric resident. EMDR (www.emdr.org) was a blessing to me, as well as to my clients. I was able to use EMDR with children who had post-traumatic stress disorders, as children respond very quickly to this approach -- not having barnacles on their problems like adults do. I also used EMDR to de-stress myself.

With adults, it is recommended that EMDR should be done only during sessions with the therapist. This is to prevent being overwhelmed by intense emotional releases that can occur during treatment. I found that children rarely had such intense releases, perhaps because they had not kept their hurt feelings bottled up for so long a time, or perhaps because their emotional defenses are not as strongly developed. Another factor may be that I am comfortable doing this, having used EMDR for myself without the constant guidance of a therapist.

As I usually see children with their parents, I also taught the more stable parents to guide their children in doing the EMDR. If the children were mature and responsible, I encouraged them to practice the eye movements on their own, at home or at school, whenever they were upset. This was very helpful, for instance, with nightmares, when traumatic memories were stimulated by current stresses, or where excessive angers erupted. I still worried, however, that there might be intense emotional releases which could be traumatic.

I then learned to use the Emotional Freedom Technique (EFT) of Gary Craig (www.emofree.com). This worked more quickly than EMDR and had extra advantages. Because it works rapidly and does not evoke intense emotional releases, I started offering "two (or three) for the price of one" introductions to EFT to children together with their mothers, including their fathers as well when they were present. This way, the children more often accept the therapy and comply with the recommendation to use it at home to deal with stresses. Parents are more confident of its therapeutic efficacy because they have experienced its benefits themselves, and therefore encourage their children to use it more often.

I had difficulty introducing EFT in my work settings. EMDR has an extensive research base to confirm its efficacy in treating post-traumatic stress disorders (PTSDs). On the basis of my certification in EMDR, I was able to obtain official permission (from the administrators of the child and adolescent clinic where I work) to use this with their clients. Because EFT has no research base, they would not grant me permission to use it. Giving this a hard think, I turned it around and now call it an "affirmation technique." No one has faulted me for using affirmations in therapy, and never mind what clients do with their hands on their own bodies while they recite these.

In an introductory workshop by Asha Nahoma Clinton on Matrix Therapy, Asha observed that alternating tapping the eyebrow points while reciting the standard EFT "set-up affirmation" works just as well as the entire series of EFT points. Ever conscious of my time limitations, I immediately started exploring this hybrid approach, combining aspects of EMDR and EFT.

It has been hugely successful for several reasons.

• It takes a fraction of the time that EFT requires.
   

• It allows for much greater flexibility in working on target problems within the session because it is so rapid. If the child is successful but the parent is not, or vice versa, there is plenty of time to explore alternative target symptoms or alternative methods of addressing these.
   

• It is better accepted and the compliance outside the therapy room is much higher because of this simplicity.
   

• It works marvelously well and rapidly on pains, and is excellent for allergies, though it may take several days to be effective for the latter.
   

• It is tremendously empowering as it is so simple and so rapidly effective in self-healing.

EMDR suggests the use of a "butterfly hug" as one of its self-treatment interventions, particularly for children: Your arms are crossed so that your hands rest on your bicep muscles and you alternate tapping on each arm with your hands. Instead of tapping at the eyebrows, I often have children and parents use the butterfly hug with the EFT set-up affirmation. Many find the self-hug comforting, in addition to being highly effective in combination with the affirmation.

Teenagers would often refuse to use either of these EMDR approaches outside of the therapy room. Their typical comment was, "Sure, dad! Like I'm going to tap my forehead or pat my arms in front of my friends! They'll think I'm some sort of nut case!" I speculated to myself that if they alternated tapping with their tongue on the teeth on the left and then the teeth on the right, this should work just as well, and found that indeed it does. This has been received much better by those who are shy or uncomfortable with tapping in public.

A deep breath (drawn from John Diepold's Touch and Breathe approach) following the affirmation facilitates releases.

Holding your other hand over your heart center (chakra) while you tap or touch your eyebrow points deepens the effects.

Reversals and blocks are effectively managed by massaging the sore-spot releasing point below the collar bone.

With adult clients I find the Sedona Method (http://www.Sedona.com/) is an even faster approach. This involves simply asking clients whether they are prepared to let go of their problems and then inviting them to do so (with a structured series of questions that are trademarked by the Sedona teachers). I find that younger children don't respond as well to this approach.

Clinical example (assumed name, composite case): Six-year old "Joe" had been seriously abused emotionally, physically and sexually by his mother from at least the age of two and probably earlier. He was removed from her home at age four, and had nine foster home placements before his latest foster mother suggested to the welfare worker that counseling might be helpful to him for his temper outbursts, fighting children in his first grade class and after school, inability to fall asleep till past midnight, frequent nightmares and night terrors, and bedwetting -- his more serious problems. In addition, he was unable to sit still, was impulsive, distractible, constantly forgetting and losing things, and had no friends..

I diagnosed PTSD (moderately severe) and possible attention deficit hyperactivity disorder (ADHD). I prescribed small doses of Ritalin, as this acts within minutes and, if effective, could provide rapid relief for some of his problems. He responded well to the medication and was much better able to sit and attend in class, less impulsive, and less forgetful. His other symptoms remained. He also had counseling sessions weekly with a social worker at the clinic where I work, focused on issues of relating to his new family, multiple losses, and PTSD issues.

At the initial interview, I taught Joe and his mother to use the butterfly hug. Joe chose an affirmation about one of the bad memories he had of being left in the dark cellar by his mother. He was unable to count, so I had him show me a Visual Analog Scale ("VAS"—equivalent of a SUDS) with the gap between his hands representing how big his bad feeling was when he thought about being in the dark cellar. He opened his arms wide and said, "I can't reach to show you how big the bad feeling is." Within minutes of using the butterfly hug, his hands were touching in the VAS. He had reduced the bad feelings to zero.

Over the next several weeks, Joe (with the help of his mother) used the butterfly hug daily on various fears, difficulty falling asleep, and nightmares, as well as to calm down after he had temper outbursts.

Within two months, Joe was functioning at near-normal levels of behavior in school and at home. Counseling continued for another four months and was discontinued. I have followed him for Ritalin prescriptions for two years and we have all been pleased with his excellent academic progress in school, and with his good behavioral and improved social adjustments in school and at home.

I have also had excellent results with proxy use of the EMDR and affirmation hybrid. In proxy treatments, the person receiving the treatment focuses her or his awareness on another person who is intended to receive the treatment. Therapists may do this on themselves as proxies for their clients. (While this may seem far-fetched, it has an excellent basis in research as distant healing (Benor, 2001).

Clinical example: I visited a healer who was baby-sitting a six-year old boy who has developmental delays and may have mild autism. He was severely frightened by the healer's two dogs, who were lively and playful, and nearly as frightened of her two cats. He had been in the healer's home several times previously, and was constantly on the alert, if not alarmed, by any approach of the animals to within several feet. Within minutes of surrogate tapping for his fears of the animals, he was markedly less fearful, and within a few more minutes he was even able to pet the quieter dog. He had never been that calm before in the animals' presence, and certainly would not have petted them.
 

I find that 85-90 percent of clients obtain immediate benefits from the EMDR/EFT-affirmation hybrid. When they practice this for their problems at home, there is almost universal success. (The last observation may be a matter of self-selection.)

Where it doesn't work, the most frequent problem are:

1. The client has not targeted the problem accurately in the affirmation.
    

2. They are reporting that the memory has not faded. This is an incorrect expectation, as it is the negative feelings about the memory that fade, not the factual memory.
    

3. They have forgotten to massage the releasing point when there is a block in the process.

If the above do not apply, the few remaining clients usually respond to the full EFT routine.

I see a progression in meridian based therapies (MBTs) towards greater and greater simplicity. Gary Craig, with EFT, has simplified the procedures of Thought Field Therapy (TFT). The EMDR/EFT hybrid provides a further abbreviated tapping procedure with affirmation. The Sedona method is simpler yet, requiring only the decision to release whatever the problem is.

There has been controversy and extensive discussion in MBT circles on whether the specific protocols of TFT are necessary, or whether the generic EFT protocol is adequate, with strongly held opinions on both sides. We can anticipate further discussion on the benefits and limitations of the hybrid and Sedona approaches.

EMDR has a solid basis in research, demonstrating its efficacy in treating stress related disorders (www.emdr.org). The MBTs are still in preliminary stages of organizing research. WHEE, drawing from EMDR (though clearly not following the standard EMDR protocols), can claim to have a research base to support its efficacy. See also extensive studies of EMDR with children summarized at www.childtrauma.com.

Two other aspects of WHEE (as well as of the other "alphabet soup" of approaches) deserve mention:

Having advocated for the abbreviated procedure of the hybrid, let me step back and add that I do not see this as a "cure-all." I find that the MBTs are outstanding for addressing focal traumas, fears, pains, allergies, and beliefs. For many people, relief of these focal problems is all that they want to achieve.

For others, deeper levels of work may require more elaborate approaches. I have found Clinton's Matrix Therapy (chakra based) enormously helpful to me personally and to selected clients who want or need deeper levels of work, particularly when there is an openness to including spiritual dimensions in the focus of therapy.

I truly value the stimulating discussions within the Association for Comprehensive Energy Psychology (ACEP) that will continue to innovate and clarify the best ways to help people deal effectively with their problems.

Practical considerations: The MBTs have negligible research to support their efficacy. EMDR has considerable, impressive research showing it is effective in helping adults and children deal with PTSD. By using the hybrid, the MBTs tap into the EMDR research database. (See selected samples below).

1. Begin by rating the problem on the amount of distress you feel when you think about it, using a 0 to 10 scale, with 0 being no distress, 10 being extreme distress.
    

2. Fold your arms, rest your fingers on your bicep muscles, and alternate patting your right and left biceps with your hands, about a second for each tap ("butterfly hug").
    

3. Continuing the butterfly hug and tapping, state aloud an affirmation in the form: "Even  though I [have this problem], I deeply and completely accept myself" [or end with a different strong, positive, affirming statement].
    

4. Take a deep breath or two, hugging and supporting yourself.
    

5. Reassess the amount of distress that thinking about the problem causes you on the 0 to 10 scale.
    

6. Repeat until the rating has gone down as low as you can get it.
    

7. If you have been able to get the rating down to 2 or less, you can finish by repeating the procedure with a positive affirmation. Use steps 2, 3, and 4 as above, but this time the affirmation describes what you would consider an ideal response in a situation that might have triggered the troubling emotion, such as "I can speak in front of any audience with confidence and comfort, and the Universe supports me in every way" (or "and I am supported by Spirit" or "and God loves me" or another closing phrase that evokes a positive, assuring feeling).
    

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. "Cautionary" article  about EMDR.

Benor, D.J. (2001a). Healing Research (Vol I. Spiritual Healing: Scientific Validation of a   Healing Revolution). Southfield, MI: Vision Publications. Healers describe their work, research in parapsychology as a context for understanding healing, brief summaries of 191  randomized controlled studies, plus many pilot studies.

Benor, D..J. (2001b). Healing Research (Vol 2. Professional Supplement). Southfield, MI: Vision Publications. Only the 191 controlled studies plus the pilot studies—described in much greater detail, including statistical information.

Carlson, J. G., Chemtob, C. M., Rusnak, K., Hedlund, N. L., & Muraoka, M. Y. (in press). Eye movement desensitization and reprocessing for combat-related post-traumatic stress disorder. Journal of Traumatic Stress.

Chemtob, C. & Nakashima, J. (1996, November). Eye movement desensitization and reprocessing (EMDR) treatment for children with treatment resistant disaster related distress. Presented at the annual meeting of the International Society for Traumatic Stress Studies, San Francisco.

Edmond, T. & Rubin, A. (1996, June). Evaluating the effectiveness of EMDR in reducing trauma symptoms in adult survivors of childhood sexual abuse. Presented at the annual conference of the EMDR International Association, Denver.

Goldstein, A. & Feske, U. (1994). Eye movement desensitization and reprocessing for panic disorder: A case series. Journal of Anxiety Disorders, 8, 351-362. The most substantive piece so far on anxiety disorder.

Grainger, R. D., Levin, C., Allen-Byrd, L., Doctor, R. M., & Lee, H. (in press). An empirical evaluation of eye movement desensitization and reprocessing (EMDR) with survivors of a natural catastrophe. Journal of traumatic Stress.

Greenwald, R. (1993). Using EMDR with children. Available from EMDR, P.O. Box 51010, Pacific Grove, CA 93950-6010 with formal training.

Greenwald, R. (1996). The information gap in the EMDR controversy. Professional Psychology: Research and Practice, 27, 67-72.

Lipke, H. J. (1994, August). Survey of practitioners trained in eye movement desensitization and reprocessing. Paper presented at the annual convention of the American Psychological Association, Los Angeles, CA.

Marcus, S., Marquis, P., & Sakai, C. (1996, August). Eye movement desensitization and reprocessing: A clinical outcome study for post-traumatic stress disorder. Paper presented at the American Psychological Association annual convention, Toronto.

Paulsen, S. (1995). Eye movement desensitization and reprocessing: Its cautious use in the dissociative disorders. Dissociation, 8, 32-44.

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.

Scheck, M. M., Schaeffer, J. A., & Gilette, C. S. (in press). Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress.

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

Shapiro, F. (1989b). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 20, 211-217.

Shapiro, F. (1991a). Eye movement desensitization and reprocessing procedure: From EMD to EMD/R - A new treatment model for anxiety and related traumata. The Behavior Therapist, 14, 133-135, 128.

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

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

Shapiro, F. (1994). Eye movement desensitization and reprocessing: A new treatment for anxiety and related trauma. In Lee Hyer (ed.) Trauma victim: Theoretical and practical suggestions. Muncie, IN: Accelerated Development.

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

Shapiro, F. (1996). Eye movement desensitization and reprocessing (EMDR): Evaluation of controlled PTSD research. Journal of Behavior Therapy and Experimental Psychiatry, 27, 209-218.

Shapiro, F., Vogelmann-Sine, S., & Sine, L. (1994). Eye movement desensitization and reprocessing: Treating trauma and substance abuse. Journal of Psychoactive Drugs, 26, 379-391.

Silver, S. M., Brooks, A., & Obenchain, J. (1995). Treatment of Vietnam war veterans with PTSD: A comparison of eye movement desensitization and reprocessing, biofeedback, and relaxation training. Journal of Traumatic Stress, 8, 337-342.

Sweet, A. (1995). A theoretical perspective on the clinical use of EMDR. The Behavior Therapist, 18, 5-6.

Wilson, D. L., Covi, W. G., & Foster, S. (1996). Eye movement desensitization and reprocessing: Effectiveness and ANS correlates. Journal of Behavior Therapy and  Experimental Psychiatry, 2.

Wilson, S. A., Becker, L. A., & Tinker, R. H. (1995). Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized individuals. Journal of  Consulting and Clinical Psychology, 63, 928-937.

Copyright © Daniel J. Benor, MD 2001
Reprinted with permission of the publisher and author.

Daniel J. Benor, .M.D.
P.O. Box 502
Medford, NJ 08055