Therapists often ask me which trauma treatment they should learn: eye movement desensitization & reprocessing (EMDR) or progressive counting (PC).
First of all: Yes – you should learn EMDR or PC, if you haven’t already! Efficient, effective trauma treatment methods enable therapists to systematically guide clients in healing from their psychological wounds. This is much better than merely teaching coping skills. When you heal, you don’t have to cope with the symptoms anymore! Learning EMDR or PC is a real game-changer, and the therapists we train routinely report feeling reinvigorated in their work.
EMDR is the best of the well-established trauma therapies (as per the latest meta-analysis, currently under review), in that it is at least as effective as the other leading brands, better tolerated, and considerably more efficient. EMDR can be used with children of any age, as well as adults. EMDR is complex, so the training is 7.5 days (spread out over several months, including the required consultation) at a typical cost of about $1,500. At least, that’s what we charge.
PC is a newer treatment that has done quite well so far. As per two published comparisons, PC appears to be about as effective as EMDR, at least as well tolerated, and considerably more efficient. That’s a pretty big deal, since EMDR is already better tolerated and more efficient than traditional CBT methods such as prolonged exposure. However, these are preliminary findings and more research is needed. PC can be used with children age six and older, as well as adults. PC is simpler than EMDR – on a par with other exposure methods – so the training is 5 days (spread out over a couple of months) at a typical cost of about $650.
While EMDR and PC may share some underlying mechanisms of effect, they are different procedurally as well as experientially. EMDR tends to involve more free association, so the client may wander through many other somehow-related memories, making connections and gaining insight. With PC this also happens to some extent, but less so, and the client is more likely to stay focused on the target memory. This difference makes EMDR a bit more appealing for clients who want insight, and PC a bit more appealing for clients who don’t want to get surprises (unpredictable exposure to other memories) during the session.
I tend to use PC as the first line, because it is generally quicker and easier (less emotionally intense) for the client. And on occasion if I’m not satisfied with how it’s going, I switch to EMDR. I also know a number of therapists who are more comfortable with EMDR, but switch to PC on occasion.
In one of our clinic’s programs, clients are randomly assigned to EMDR or PC. Our therapists have told me that at the end of treatment, clients routinely say, “I’m so glad I was assigned to [EMDR/PC]!” In other words, both EMDR and PC are doing very well.
So which to learn?
Go for EMDR if you care most about
- having the treatment with the most research support
- offering the name brand that people will recognize
- working with children younger than age 6
Go for PC if you care most about
- offering the most efficient research-supported treatment available
- working with clients with low affect tolerance
- saving time and money on the training
Disclosure: I am a leading expert in EMDR, and my nonprofit org is the second-leading provider of EMDR basic training in USA/Canada. And I am the developer of PC, and my nonprofit org is the leading provider of PC training internationally.
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