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175. Is EMDR a Revolutionary Psychotherapy or Pseudoscientific Sham? · Radically Genuine

• Roger K. McFillin, Psy.D, ABPP (00:01.135) Welcome to the radically genuine podcast. I am Dr. Roger McFillin. The psychotherapy field is very tribal. It's filled with people trained under various theoretical orientations and by thought leaders who dedicated their academic careers to developing specific treatments. A lot of ways I see it as the wild wild west filled with acronyms EMDR CVT IAPT ACT EFT PCT I could go on. Taraleigh Stemler (00:11.15) . Roger K. McFillin, Psy.D, ABPP (00:30.597) But how does the public understand what is actually legitimate when in my experience, many practitioners aren't able to really fully evaluate the differences. I've been supervising doctoral students for two decades. I've conducted countless interviews and it's rare for someone to articulate a comprehensive understanding about what is normal human resiliency and what are the core mechanisms that lead to people overcoming challenges. Taraleigh Stemler (00:51.79) Okay. Roger K. McFillin, Psy.D, ABPP (00:59.511) I've personally come to the conclusion that the training of therapists is highly flawed. Most therapists are trained to parrot what was told to them versus having genuine depth of knowledge, intuitive understanding and high level critical thinking skills. It's just not a focus of the training. And there's big money in creating a mental health therapy. That's why you see so many of these different acronyms and there are literally hundreds of orientations. And now we have large companies training therapists with artificial intelligence. So what do these therapies actually mean? What are the mechanisms of action? How do we communicate to the public? What works for whom and why today we'll get into one such treatment that appears to be universally lauded and highly followed as an evidence-based psychotherapy called EMDR, which is eye movement, desensitization and reprocessing. Taraleigh Stemler (01:45.422) Okay. Roger K. McFillin, Psy.D, ABPP (01:57.593) Is this a fad sham treatment or is this legitimate? And if legitimate, what aspects are therapeutic and what are speculative? Who would benefit? Why? And under what conditions? I don't offer EMDR nor does anyone at my center for reasons I hope to articulate on today's show. Nonetheless, I'm very grateful for an EMDR. trained practitioner who has reached out with a willingness to address this topic in thorough detail. Since it is widely available and disseminated, it's important for me to challenge my misconceptions and also try to understand nuances within this. And hopefully we get into some critical debates and conversation about, you know, what works for whom and why. Today's guest, she's based out of Nashville, Tennessee, Tara Lee Stemmler. She's a licensed marriage and family therapist and EMDR trained clinician, certified integrative mental health professional. She's been in practice for the past nine years. She's been trained in EMDR. She's completed her EMDR basic training in 2016. She's received specialized training and using EMDR to treat a range of conditions, shame, guilt, and moral injury. She was trained by E.C. Hurley, who was a EMDRI approved consultant and was trained by Dr. Francine Shapiro, the founder of EMDR. Lee focuses on complementing EMDR with an integrative approach to mental health. So she has experience of in implementing this particular therapy and we'll be interested to know the details and some of her outcomes. Tara Lee Stemler, I wanna welcome you to the Radically Genuine Podcast. Taraleigh Stemler (03:37.017) Thank you. Appreciate the introduction. like I said, long, long time coming as far as listening to you back in 2023. So it feels again, surreal that we're having this conversation, but I'm excited for our radically genuine conversation. Roger K. McFillin, Psy.D, ABPP (03:53.553) Thank you for reaching out and coming on. Let's just start with your interest in EMDR. I mean, you chose to practice in a very specific way. Tell me about, you know, what led you down that direction? Taraleigh Stemler (04:01.4) Mm-hmm. Taraleigh Stemler (04:06.166) Okay, so it was in college in my undergrad experience when I first was introduced to it and one professor in particular who was one of my psychology professors, he was a counselor himself and he used EMDR with his patients. So he wasn't just teaching out of a textbook, he wasn't just teaching from theory. He actually had experience with his clinical practice. And so he would come in and he would talk about these stories of the concepts that we were talking about in our textbook. And then he would be able to utilize it with his clients and be able to say, this is what I was able to help my client overcome specifically with EMDR. And so that really intrigued my curiosity because I knew that I wanted to be a therapist since I was a junior in high school. And I didn't know specifically what I was going to do, but I just knew I wanted to help people. And I wanted to balance the therapeutic process with subjectivity and objectivity. I wanted to honor and value the different lived experiences that clients were going to present in the therapy office. And I didn't want to just treat everybody the same. At the same time, I wanted to balance it with objectivity. wanted to use something That was going to work. That was going to help people move toward healing. That it wasn't just they were going to come in and review their problems over and over again. And then I was just going to collect a paycheck. I wanted to help them toward healing. So when I heard this professor in college, I was immediately struck with curiosity. So he actually let me sit in, given the client's permission. He let me sit in on a session with a client. And I thought that I was peeking behind the curtain of This is how healing can take place. Just one of the modalities. And I went into grad school knowing I wanted to become trained in EMDR. So after I completed my grad school experience, I went on to become trained by E.C. Hurley, as you read, in January 2016 is when I began my basic training. And he was the same instructor of the professor that I had learned about EMDR from. So was kind of this lineage. Taraleigh Stemler (06:31.606) of EMDR and it getting results for people. And so I guess I was just next in line and here I am over nine years later having done it with my clients. Roger K. McFillin, Psy.D, ABPP (06:42.479) Okay, so let's describe to the audience what the treatment entails first. So what it would look like in clinical practice, what someone would go through who chose to, who chose to undergo EMDR, and then we'll get into clinical populations, like when it would be something that's applicable. Taraleigh Stemler (06:59.938) Okay, so it's an eight, like the number eight, it's an eight phase process. So the first couple of phases are stabilization, we're assessing for the client's safety, we're assessing for suicidality, all the things to make sure the client is stable enough to go through EMDR. We're also doing history taking. we, that's when a lot of the talk therapy part comes into play. where we are gathering information about the client's overall issues they're wanting to address in therapy. And then we are creating their treatment plan. So we're identifying past negative, disturbing or traumatic experiences that feed into the overall issues they're wanting to address. Then we make a list of present triggers. So those are situations, people or places today that bring up negative reactions tied to the past. And then we're making a list of future templates. So if these present triggers were to appear in the future, how would you like to see yourself handling that in the future? So we're dealing with the whole span of time. And then once we have that treatment plan solidified, then we start moving into phases three through seven. That's when we're doing the reprocessing. That's the bilateral stimulation. We're setting up the target, whether that's a past event or a trigger. We're identifying The worst part when someone's thinking about a traumatic event, what's the worst part that comes to their mind about it? We're identifying a negative cognition that they have about themselves tied to that event. We're identifying what would they like to believe about themselves instead of that negative cognition. We're identifying the validity of that cognition. So how true does that positively feel tied to that past traumatic experience? We're also identifying negative emotions that are tied to the event. We're identifying the emotional charge or the level of disturbance that is tied to that event. And then we're also identifying where do they feel it in their body. So it's, we're getting all the elements that are tied to that particular event stirred up. And so we take them through phases three through seven to the point where it's at a zero. It doesn't bother them anymore on a scale from zero to 10. Taraleigh Stemler (09:18.604) The positive belief that they would like to believe about themselves is at a seven on a scale from one to seven where it feels completely true to them. And then we have a clear body scan. So the body's not holding onto any tension or tightness that there is a full, clear body scan. So we're bringing the somatic experience to it as well. And then phase eight is reevaluation. So after we complete a target, whether that's pastimate or a trigger, we're going through questions to make sure that. it's fully processed through. And then if it's still at a zero, then we go back to the past list or the trigger, the trigger list. We identify the next target and then we go through phases three through seven. So after we go through the entire treatment plan, then we do an overall evaluation, making sure we have cleared out everything that we came to clear out and cover that's tied to their overall treatment plan. And then we're finished. Roger K. McFillin, Psy.D, ABPP (10:16.131) Okay, so let me get into specifics. I don't fully understand what happens in phase three to seven or why that's done. First, define what bilateral stimulation is and why that is theoretically assumed to be a value. Taraleigh Stemler (10:33.016) So bilateral stimulation can take place in three forms. So the main form that EMDR eventually, you know, essentially started with was eye movements. And actually in Francine Shapiro's book, Getting Past Your Past, she mentioned she wishes she could have gone back and labeled it reprocessing therapy instead of EMDR because I think that eye movements really catch people off guard or it can be a big distraction. as if, well, if we just do eye movements, then the client's gonna be fine. So there's three, but there's three types of bilateral stimulation. One is eye movements, so moving back and forth from the left to the right. There's also tactile bilateral stimulation. So the client holds two tappers, one in each hand, and it vibrates in each hand. And then there's also auditory. So they would be wearing headphones and it would be thin each ear. Typically, Roger K. McFillin, Psy.D, ABPP (11:29.497) Is this all at the same time or you choose one? Taraleigh Stemler (11:33.556) No, you can choose one, particularly if it's individuals who struggle with dissociation, particularly if they have auditory hallucinations, the headphones might be the best to help them drown out auditory hallucinations. I remember when E.C. Hurley, my instructor, he showed us video footage from clients and they had the headphones on and they also had the tactile, you know, the tappers in their hands. For me personally, I just use the tappers. I don't do eye movements anymore. I don't seem to get a lot of movement with that. And then the headphones, just, haven't purchased it yet, nor have I dealt with any clients that dealt with auditory hallucinations. But the whole premise behind it is when one vibrates as far as the tappers. If it taps and it vibrates in the left hand, it's accessing the right side of the brain, the right hemisphere. And then when it taps in the right hand, it's accessing the left hemisphere. So it's creating this brain lateralization experience where the brain is having, it's talking to each other because what trauma, the whole premise behind EMDR is that trauma gets stuck in the brain and it causes the body to not talk to each other about it. So the bilateral stimulation helps to facilitate that brain lateralization experience because we want the client to fully integrate this experience and not have it create maladaptive behaviors. So the bilateral stimulation seems to help that experience of triggering the left side of the brain, the right side of the brain while focusing on one particular event at a time. Roger K. McFillin, Psy.D, ABPP (13:28.313) Okay, so let me challenge you on that. So one of the reasons I definitely did not get into EMDR because I found no legitimate scientific evidence that would suggest that bilateral stimulation has any added benefit to the treatment at all. In fact, I think I have legitimate questions about like misrepresenting how someone overcomes trauma. You used one of the words trauma gets stuck in the brain. So I would say that's a pseudo scientific statement. Trauma doesn't get stuck anywhere. You're talking about a memory and how do memories get processed? So PTSD is a debilitating condition that Taraleigh Stemler (14:06.703) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (14:25.957) You know, approximately it affects two out of every 10 people who've been exposed to a traumatic event. If you ever worked with somebody who has PTSD and debilitating PTSD, it's very clearly a different condition than someone who's just has painful memories or painful events or was exposed to something that would even be identified clinically as a traumatic experience, but yet the person didn't develop PTSD. So first of all, you know, Taraleigh Stemler (14:31.458) Mm-hmm. Taraleigh Stemler (14:41.678) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (14:55.749) We're very resilient. Human beings are very resilient. We're talking about just for you and I to be here right now. We had ancestors who had to survive long enough to procreate in some of the most harshest of conditions. Just to be here in the United States, somebody immigrated here, right? Came across an ocean, probably with nothing, lost infants, saw loved ones die of sickness, know, war and so forth. So we throw around the word trauma in Taraleigh Stemler (15:07.905) Right. Roger K. McFillin, Psy.D, ABPP (15:25.935) this contemporary mental health field a little too haphazardly. What would you let's let's start there. You said it's used for for people who experienced trauma and somehow you're, you know, you're determining that by emotions, right? Like if they have emotions around it, then well, then it's traumatic or they have a certain belief around it. Well, then it's traumatic. I would also argue that that's a bit pseudoscientific. So first define what is Taraleigh Stemler (15:29.402) Yeah. Taraleigh Stemler (15:47.566) you Roger K. McFillin, Psy.D, ABPP (15:54.993) is trauma. And do you distinguish somebody who is actively in post traumatic stress, which we could all agree is a fairly debilitating condition that affects somebody different than if they just had a traumatic experience in their past? Would you agree with what I'm saying? Taraleigh Stemler (16:13.354) Yes, I would agree that in our culture, we are using the word trauma for way too much. And I agree with you that we are resilient. I actually at the end of working with a client, I will give them the post-traumatic growth inventory, PTG, PTGI, because I want the client to not just believe that all the work that we did was to decrease anxiety or be able to cope better with depression, but I want them to understand that you are resilient. You actually grew from this, that you created a different skill set or you are forming a healthier identity outside of what these traumatic experience have defined you as. Go ahead. Sure. Roger K. McFillin, Psy.D, ABPP (16:59.633) Can I challenge you then because I want to start with the questions. How would bilateral stimulation in any way facilitate post traumatic growth? Taraleigh Stemler (17:08.183) Thank Well, it's an element of the overall treatment. So we're not just depending on the bilateral stimulation. Roger K. McFillin, Psy.D, ABPP (17:20.783) I understand that, but how would that piece, because I first have to get into what my concerns are with EMDR, right? If I can focus on areas that really are robust and really are well-known mechanism of action, I would do that. Why add in, how does bilateral stimulation influence post-traumatic growth, for example? Taraleigh Stemler (17:27.726) Sure. Taraleigh Stemler (17:43.849) So, okay, so I'll go to answering at least one of the first questions you mentioned, which what is trauma? So how I understand trauma is that it is when we take in lived experiences that are too difficult for us to digest or metabolize according to the AIP model. So the adaptive information processing model of EMDR, what it's based on. We take in lived experiences like we take in food and drink and we digest it. We integrate it into our life. We keep what's healthy, we excrete with a waste of it. So when trauma happens, when lived experiences that are way too big for us to really conceptualize or way too big for someone to digest, like a child who is living in a home with an alcoholic parent, or we see like a 9-11 happen, it's really difficult for us to process. So that's where it's not fully digested. Roger K. McFillin, Psy.D, ABPP (18:43.409) What do you mean by that? You keep using the word digest or difficult. If we say that most overwhelming majority of people can face those things that you've said without the residual consequences of PTSD, we would say it's normal for somebody to process even painful events, even ones that are fatal, know, sexual assault, seeing somebody murdered, being in war, 9-11. Taraleigh Stemler (19:08.652) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (19:13.303) it's more likely than not that someone has all the ability to process that and they do and they don't have any residual effects and don't require formal treatment. So then we're saying there's a population that doesn't that's not and requires formal treatment. Taraleigh Stemler (19:13.4) Sure. Taraleigh Stemler (19:24.334) Sure. I don't know, honestly, which is what I said in my first email of having a radically genuine conversation with you of there's going to be times where I don't know. It could be religion. Roger K. McFillin, Psy.D, ABPP (19:31.449) Okay. And what is your, what is your viewpoint then on, on why, why that is? Like what makes them different? Taraleigh Stemler (19:54.048) Right? Like it, I'm a Christian, so I do believe ultimately in the healing power of God. So maybe they have a particular faith that is helpful to them. We, do believe that religion, particularly the Christian faith can help with processing very difficult things because that is part of the Christian faith. It could be that they have a great support system, that they have people that they can talk to. But I still believe in a way those individuals are going to have repercussions from those experiences that it may not show up immediately. And it may not be a clinical level like PTSD, but it probably will still show up in other ways, whether it's somatic experiences. I think the last time, or maybe not the last time, but one of your recent episodes. I forget his name, but he was a doctor and he was talking about like emotions and thoughts and how that might contribute to. Can you, can you help me with the premise of Yale's conversation? Roger K. McFillin, Psy.D, ABPP (21:03.409) Yeah, and I don't disagree with that with fact, but that's a population of people with that unprocessed, you know, trauma experience. so I want to make my point clear is that, you know, it is quite natural. I would say it's, it's natural, just like in like, for us who if we've lost a loved one. Taraleigh Stemler (21:12.238) sure. Roger K. McFillin, Psy.D, ABPP (21:23.435) And it's certainly more socially acceptable, culturally acceptable to grieve too. And so it's the experience of that emotion internally. Maybe you do have support of your family, support of your community that allows you to process what happened to you. know, so, if we looked at emotions, for example, as energy that has to be moved. and if you understand memories are something that like we have to replay in our mind over and over again, and they're associated like with, with emotional distress and Taraleigh Stemler (21:28.375) Yes. Taraleigh Stemler (21:37.794) Right. Roger K. McFillin, Psy.D, ABPP (21:53.169) pain. And you're afforded the right and time to kind of work through that without invalidation or without judgment. We see people are tremendously resilient, and they often take what happened to them and they even drive it or move it in a direction that's even positive like that post traumatic growth, they grow from the experience, they help other people, it helps reshape their identity. Life is very painful for we're conscious beings on this earth and Taraleigh Stemler (22:11.858) Right. Roger K. McFillin, Psy.D, ABPP (22:20.837) We're aware of our own mortality. We understand that we love people and their time is here is, it's time limited. And so we're going to face hardships and we're going to face struggles and overwhelmingly as a, as a human race, we're incredibly resilient, but there's a portion of people who do not. And that's when it, it enters into like a phase of where they really are stuck in a process. Taraleigh Stemler (22:32.686) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (22:46.267) they might experience those somatic symptoms, nightmares, hypervigilance, a dysregulated fight or flight system, right? Like it's just, they have all these very clear symptoms and those are associated with a range of health consequences. I think under chronic stress, there's decreased immunity. Obviously you have sleep related problems. You're gonna pull back from key relationships. Your quality of life is really, really poor. And so where, Taraleigh Stemler (22:57.002) Right. Right. Roger K. McFillin, Psy.D, ABPP (23:16.365) I have concerns is we've taken this mental health field, and then we've tried to apply it to almost every human being, we've fragilized people in ways that actually interfere with natural processing and natural coping. think EMDR is at the forefront of that. It's become an industry that's applied to all kinds of conditions that haven't shown any research support. If we say that people who are in active PTSD states, Taraleigh Stemler (23:28.978) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (23:45.105) then we can then sit there and we can highlight EMDR for a specific population. We can look at the available research and say, hey, what components of that might be therapeutic? But in clinical practice, I mean, I've seen people, people have come into me like with clearly no history of PTSD, but they were provided EMDR because their parents got divorced. I've seen it for people who have an eating disorder, obviously clearly no available evidence to suggest it's going to have any effect on an eating disorder. I've seen it. Taraleigh Stemler (23:58.646) . Roger K. McFillin, Psy.D, ABPP (24:14.641) used for grief and loss, range of anxiety disorders, you know, and so there's not available science or research that has stated that it's effective. And I think because people have a hard time articulating what actually are the components of that therapy that are effective and who's it designed for. And so I want to make my point clear. Taraleigh Stemler (24:24.718) . Roger K. McFillin, Psy.D, ABPP (24:43.633) to the audience is the bilateral stimulation has no added benefit. And it kind of comes across to me as some woo woo aspect of like, hey, something stuck in your brain, this is a brain condition, there's something broken with you. If I can do this woo woo bilateral stimulation, this is a key component to the treatment. But the most reasonable conclusion from my standpoint to be drawn from the extent of literature and EMDR is that it's no more effective than standard treatments that rely on exposure to anxiety provoking stimuli. And there's a Harvard psychologist, Richard McNally, he said, what is effective in EMDR is not new, and what is new is not effective. So importantly, what they're saying is the most effective elements of EMDR for people who may have PTSD is that they're bringing up the memory and the image of that and they're facing it. They're processing it. They're talking about it in ways they hadn't previously. So somebody with PTSD, PTSD is maintained by avoiding coping mechanisms. When you talk to the person who's gone through a traumatic experience, they have not allowed themselves to think about it. They don't allow them to feel it. Taraleigh Stemler (25:47.386) Mm hmm. Taraleigh Stemler (26:03.873) Right, right. Roger K. McFillin, Psy.D, ABPP (26:06.819) it's way way too distressing for them and they become afraid of their internal experience. So essentially what happens is there is a fear of that internal experience like if I have that memory, it's the same as reliving it. I'm going to go crazy. It's too overwhelming for me and they get very distracted. They might get focused on survival mechanisms right there. They become hyper vigilant to any cues related to that trauma. There's tons of avoidance. Taraleigh Stemler (26:14.126) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (26:36.079) So in my opinion, the literature is very, clear in mechanisms that maintain PTSD, it's avoidance, right? And that could be cultural too. Like if you have a family or lack of support that like just tells you to get on with it or invalidate your experience, you could learn not to think about these things. And I do think memories have to go through a... Taraleigh Stemler (26:58.453) Sure. Roger K. McFillin, Psy.D, ABPP (27:03.331) a process of storage and retrieval. Right? So a great example would be this, like, let's say, you know, we're living in Stone Age periods of time and we, you know, leave our cave with our family of eight to go hunting. And we come across this big oak tree near another cave and out comes a predator animal and we get attacked by the predator animal and we survive. And we head back to our cave and Taraleigh Stemler (27:28.278) you Roger K. McFillin, Psy.D, ABPP (27:32.933) we're in a stress response or hypervigilant, you know, we're scared about protecting ourselves and we're, we know that not too far as a predator animal. So we would be hypervigilant and we would be replaying in our mind over and over again, anything that put us in a dangerous position. So there might be like associative learning, like, okay, that oak tree is a good clue or indicator that something bad is really going to happen. Taraleigh Stemler (27:49.614) Great. Roger K. McFillin, Psy.D, ABPP (28:02.705) Does that mean every oak tree is that indicator? No, it's here at this spot near this cave where this predator animal is living. So it's like designed there to be an important cue and to provoke anxiety for us and for us to learn that that's a dangerous situation. But if we go northwest and we go take our hunting away from that cave, we might have a reaction to the oak tree. that's up there, but it's not associated after we revisit that multiple times, we learn and we integrate that and we know, okay, this is an area of safety, that's an area of danger. These are built in survival mechanisms. The same thing happens, you know, in any situation that causes, you know, danger or harm to us, we get really vigilant to cues. They could be smells, they could be sounds, they could be song, there could be events, right? Taraleigh Stemler (28:52.613) Right. Roger K. McFillin, Psy.D, ABPP (28:55.511) Naturally speaking, what is natural recovery is people play all that stuff out on their own, they cry, they think about it, they learn, they put themselves back into situations, they reintegrate into their life, even though it's distressing, and they adapt. They adapt well. Not everybody though, right? Not everybody copes that way. And then that's the specific population that we have to say, okay, what works and what doesn't work? Okay, so A lot of this research has been going on over the course of my training and career. So EMDR was pushed out there in the 1990s. By the time I was in graduate school in the early 2000s, people who were really into the science of this were kind of disregarding EMDR. And it became kind of like a cult-like treatment based on that original founder and building up all these workshops and all these theories around it. in the mental health field, we're always looking for the magic bullet. We're looking for something like really, really easy. It also came up in the time we were identifying almost everything as a brain illness, right? So if you can, if you can look at this aspect of the brain that has activity when this memory is up and I can do these things to activate it, that's somehow correlated with some healing process. Not true. Taraleigh Stemler (30:01.68) Sure. Roger K. McFillin, Psy.D, ABPP (30:21.745) And in 2017, which was only like five years into, you know, me starting my practice here, and I was hearing about this research leading up to 2017, you know, for years, is that there was, the American Psychological Association was developing clinical practice guidelines for the treatment of post-traumatic stress disorder in adults. And the guidelines were looking at all available treatments for PTSD only. Taraleigh Stemler (30:21.862) Okay. Roger K. McFillin, Psy.D, ABPP (30:52.433) and then making recommendations based on the overall review of the science. So was very saying, okay, what are the most robust interventions? What are the most effective treatments? What are we uncertain about? What has low magnitude? What has high magnitude? Okay. And when that came out in 2017, it was enough for me to not ever revisit EMDR again, because this was their Taraleigh Stemler (31:03.95) Okay. Roger K. McFillin, Psy.D, ABPP (31:22.097) These were the clinical guideline recommendations. And of course, there's problems with standardized research. There's certainly flawed scientific practices in our field. Let's just assume that to be true. EMDR is identified as an evidence-based treatment for PTSD. But among adult patients with PTSD, the panel suggested that EMDR should only be offered when there's no other available intervention. Taraleigh Stemler (31:33.102) Great. Roger K. McFillin, Psy.D, ABPP (31:50.905) So what that means is EMDR shows a positive effect compared to nothing. And EMDR shows a positive effect compared to what's called a treatment as usual, just basic counseling doing nothing, just being a listener. Okay. So it shows effect in response to that, but it's actually a low strength of evidence of a medium to large magnitude benefit for the critical outcome of Taraleigh Stemler (32:07.502) Yeah. Roger K. McFillin, Psy.D, ABPP (32:20.145) PTSD symptom reduction. If you have PTSD, you don't want to have PTSD anymore, right? And it's got really low effectiveness and is an inferior treatment compared to others that target PTSD more directly. So it was not a frontline treatment that's recommended based on the science. And so I came to the conclusion, like if we have better treatments, and then we can understand what's happening in those treatments, then we can flexibly apply them to clients who are really suffering. So was inferior when compared to prolonged exposure therapy. So I see EMDR as having a component of exposure, but generally not sufficient or long enough to get the most robust effect and the best long-term effect. It's also inferior to cognitive processing therapy, which focuses to a degree on exposure, but mostly on what was learned from the experience and also has exposure based components to it. Okay. So, so these general two more active targeted treatments have much more effect than EMDR does. So EMDR, in my opinion does have an effect because it gets a person to face that memory. And it does it in ways that also are somewhat confusing, misrepresent recovery. People don't get to fully understand why they developed PTSD and what to continue doing in the future. And it also sends messages that you kind of communicated when you were explaining it, which is that if you have an emotional reaction to something, that somehow that's pathological and that you have to get rid of it. Taraleigh Stemler (33:42.722) Okay. Roger K. McFillin, Psy.D, ABPP (34:11.909) which is different than what PTSD is. When we have somebody with PTSD, we're not saying that your emotional reaction to a stimuli or an event in itself is necessarily pathological. We're actually saying to what extent does that control you? To what extent is that interfering? I might work with a rape victim, for example, and she might get upset, like even after the treatment, when... Taraleigh Stemler (34:17.934) . Roger K. McFillin, Psy.D, ABPP (34:39.915) you know, she's she's talking about something she saw on the news. That's not enough to say that she has PTSD means she's a human being who has a reaction to some somebody else in an empathetic, empathetic kind of loving, compassionate way, you know, that that happened to me. And that's painful. And that person's allowed to have that emotion. And I don't know, like sending the message that, you know, our treatments are about just the reduction in that emotional response to a memory. Taraleigh Stemler (34:42.698) Mm-hmm. Taraleigh Stemler (34:59.549) Right. Roger K. McFillin, Psy.D, ABPP (35:08.637) is the full capacity of understanding what post traumatic stress is. And that's why I think it might get widely applied to anyone who's having emotional distress, which is part of the problem I feel like is in the field. It's why people turn to anti depressants drugs is because we've developed this relationship, this fear of all emotions, and it's almost been pathologized. So I went off a lot of on there. And so I want to offer you the floor now and kind of rebuttal back. But that's something that I just feel so strongly about and Taraleigh Stemler (35:18.19) Sure. You and I are in agreement about the Roger K. McFillin, Psy.D, ABPP (35:39.013) want to get your thoughts on. Taraleigh Stemler (35:46.272) the pathologizing of emotions, particularly when it comes to pushing SSRIs onto people. That is why I've had a lot of clients come to me saying, I don't want to be on medication long-term. I've tried other therapy or it's interesting. I've noticed that a lot of my clients, they're not like first time goers. They are well-therapized. I don't even know if that's a word, but I'm just making it up that They know the language, they know the things to say, and they just want something to change. They want something different. And so I, I certainly am an agreement with you that I don't want to pathologize emotions. but there's things that are getting in the way. are barriers to what they're wanting to experience, like healthier relationships or the ability to get through the day without having an anxiety attack. And so. EMDR at least is a way for me and the client to again, bring it to the forefront, bring context to why they're having that anxiety attack, like normalizing it, but also at the same time, like, do you need to respond that way anymore? It was functional at some point, absolutely kept you safe, know, whatever that trauma or whatever that disturbing experience is, but It's coming, it's fully integrating it to the point where I don't need to have an anxiety attack or I don't need to lash out in anger anymore. I can healthily show my emotions, whatever it may be, so that they can move on to healthier relationships. They don't have to pop a pill anymore. So it is about integration. And certainly, as you're saying, not pathologizing emotions. Roger K. McFillin, Psy.D, ABPP (37:36.943) Yeah, I I thought you just did a nice job of bringing up therapeutic components that are not necessarily, you know, just EMDR. They're any good effect of therapy. let's just say that someone is having a panic attack. If you understand its contextual factors, so you understand what may be influencing it, it could be a particular stimulating. Taraleigh Stemler (37:53.614) Right. Roger K. McFillin, Psy.D, ABPP (38:03.473) Provoking situation there's associated beliefs, maybe even memories to it that just walking that person through and understanding the factors that relate to them and then helping them kind of cope with what's happening would be a component of Effective therapies, right? It's cognitive behavioral therapy most likely, right? So that's not unique to EMDR. So we can't say well EMDR does that we would say Taraleigh Stemler (38:23.647) Right. Sure. Right. Roger K. McFillin, Psy.D, ABPP (38:31.597) any therapeutic intervention that gets people to understand contextual factors related to emotional struggles could be a piece of why somebody overcomes it, right? And then normalizing, accepting emotions, and then putting them in situations they would previously avoid helps them learn how to self-regulate that, right? So you have this idea in your mind that it's a... Taraleigh Stemler (38:45.013) Sure. Roger K. McFillin, Psy.D, ABPP (38:56.625) dangerous situation, you expose them to it by, you know, entering whether it could be a relationship, or it could be an event, or it could be a situation, or it could be a memory. When you repeatedly put them back in that situation, they gain mastery over it, because they learn that it's not dangerous, and they have this inherent capacity to self regulate. So my question is, why not just do that instead of EMDR? Taraleigh Stemler (39:21.186) Yeah, it's, it's part of it, which is why I don't want to say that I do CBT because I don't want to take away from what you do. I feel like there is that component. So like when we are breaking down an event, so let's say, I don't know, let's say a woman was a little girl growing up in home and the father was emotionally and physically abusive and he was an alcoholic. So let's say there was a particular event where she saw her dad walk in, he was drinking and he slammed her mother against the wall and he was coming after the little girl. Okay, let's just say that's the event. Well, We break down that event by all those components. So what was the worst part about that experience? So again, there is that level of exposure, like you're alluding to, we're break... Sure. Sure. Roger K. McFillin, Psy.D, ABPP (40:08.689) That's exposure. That's exactly what exposure is. That's so that's that's in that's a component that's in other treatments. And then I would say that's the key mechanism of the EMDR. What if EMDR is going to have an effect? It's because it's that that's what's going on. The other stuff is just added components that have not been proven to yield any additional benefit. But may may actually have some, you know, negative benefits. Taraleigh Stemler (40:29.166) you Roger K. McFillin, Psy.D, ABPP (40:38.531) or negative consequence to it. Taraleigh Stemler (40:42.259) Okay. All right. Roger K. McFillin, Psy.D, ABPP (40:43.419) So yeah, but let's just think through it, right? Right? Like I think you're, you know, what you're saying is that if that, if we agree that one thing that gets somebody stuck is they don't want to think about that memory, right? It's affecting them on levels. We would both agree. It doesn't have to be on a conscious level. It could affect them somatically. It's their body still in that. Taraleigh Stemler (41:01.867) Sure. Taraleigh Stemler (41:05.354) Right, Roger K. McFillin, Psy.D, ABPP (41:09.987) stress response survival state because it hasn't necessarily be processed. And that could be something that happened to you when you were six and you could be 26, right? So we agree that's true, right? The difference between somebody who would require professional help and wouldn't require professional help is that that person would have a strong physiological reaction to replaying that memory, right? Because, and that's a good indicator that they, you know, haven't necessarily processed through it, they might cry, they might shake, they could be really overwhelmed by that memory. So that would be the good therapeutic indicator, like, okay, they do need to process through these things. So if, if, like clinical guidelines around PTSD say, hey, this that exposure process, prolonged exposure, being a standardized treatment, if that is going to be the most robust and effective way to help that person process that memory, Taraleigh Stemler (41:43.535) Right. Right. Taraleigh Stemler (42:04.338) Okay. Roger K. McFillin, Psy.D, ABPP (42:09.615) My question always to EMDR people, which I never get an answer to, is why would you not do that? And I only come to the conclusion is, well, I don't know that. I was taught something else. And now we're in this place in this field where everyone is tribal. You know, it's like, I'm an EMDR person. So I, this is what I do. And I got trained by this person who was trained by that person. And that's where I focus. And that's where I, and that's where my college professor, you know, told me they did. And now you're in this tribalism and you just do, just do that while ignoring all the other kind of science that, that exists. And it never made sense to me. Like if that's the key component, then how do we maximize that? How do we optimize that in a therapy where someone doesn't have to be in therapy for life, where they can have the best longterm out. Taraleigh Stemler (42:42.518) Mm-hmm. Taraleigh Stemler (43:02.222) Yeah. So that, okay. So that's where I think the bilateral stimulation could come back into the conversation. Um, because after we have stirred the pot, like again, we're identifying what's the worst part. We're bringing that exposure piece to it. What's the negative cognition. We're bringing the cognitive component of that experience into the mix. We're identifying what's the negative emotions that you experience it, not pathologizing it, but just. That's what they're actually feeling. We're identifying, okay, so when you're thinking about this event now, how much does it bother you on a scale from zero to 10? And then where do you feel it in your body? So we're bringing all of those components together and with the bilateral stimulation, we're having both sides of the brain talk to each other. So we're working with the brain, the mind and the body. So we're working with the brain in the sense of like I was alluding to at the bilateral stimulation, we're having the left side of the brain, which is more so the logical narrative side where like you could tell me or the client could tell me a sob story, but not shed a tear. And the right side of the brain is more responsible for emotions, the physiological experience that comes with that. So the bilateral stimulation, when we are administering sets, that helps both sides of the brain talk to each other. about that particular event rather than just, well, I'm just exposing myself to the actual thing that happened, which is obviously important. But we're also bringing forth the brain as well and having them talk to each other at the same time. We're also having them from a central nervous system perspective, we're activating their sympathetic nervous system so that adrenaline, the cortisol, that stress response, their heart rate is going up. But then over time, we're helping to access the parasympathetic nervous system. So the part of you that goes, my gosh, that's a snake. And then it's actually a stick. So the body's coming down from that. And you could also see it as we're helping the client calm down the amygdala response, that fight, flight or freeze response that is associated with that particular event. Taraleigh Stemler (45:27.646) So the bilateral stimulation helps the body and the brain experience all of this at the same time to the point where it doesn't bother them anymore, where they feel more stable. When they think about that event, they fully integrated it. They've gotten all of those body sensations out of their system, if you will. and that is why it's important to bring all of those components to the forefront. and have the brain and the body work together, bilateral stimulation seems to help facilitate that. Roger K. McFillin, Psy.D, ABPP (46:04.431) Okay, we'll put that one to rest after because I don't I don't I don't agree with that at all. I don't think there's any evidence to suggest a bilateral stimulation provides any added value. I don't think the human beat that I don't think human beings are a collection of all parts that wouldn't necessarily communicate with each other or engage with each other that without the therapist help. Taraleigh Stemler (46:08.215) Sure. Roger K. McFillin, Psy.D, ABPP (46:29.297) In fact, I don't even like the idea. I don't like communicating the idea that being in the therapist doing the bilateral stimulation is a component that regulates the nervous system. I don't think that's true. I think we're naturally able to seek out homeostasis. You know, when people do recover from a traumatic event without professional help, they're not doing any bilateral brain stimulation, but yes, they are thinking, they are feeling those things happen at the same time. Taraleigh Stemler (46:55.662) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (46:58.959) Yes, they are exposing themselves to new situations. So I think all that is unnecessary and not supported by science and that's pseudoscience. When the most important pieces is that person's willingness to face that and feel that not just out of session, but in session. like working with a belief, for example, I don't think holding something in your mind Taraleigh Stemler (47:20.002) Sure. Roger K. McFillin, Psy.D, ABPP (47:26.109) and all and trying to activate parts of your brain is how we learn and I don't think that's how beliefs are changed. So for example, if someone has the strong belief that I'm unlovable, I don't necessarily think that's going to be changed or altered by anything a therapist will do a therapist will say or wagging a finger back and forth. Their willingness to change that belief is only under the conditions that you accept that might not be partially true. and that they've lost the opportunities in their life to rather kind of disconfirm or confirm that. So let's say you are an abused child and you put yourself only into relationships of other abusive individuals. Well, that in itself is going to kind of maintain this belief that you're unlovable because you're gonna be treated similarly in what you've learned when you were young. I think the only way that that belief gets changed is Taraleigh Stemler (48:10.23) Mm-hmm. Taraleigh Stemler (48:19.597) Right. Roger K. McFillin, Psy.D, ABPP (48:24.089) a willingness to recognize your value and then enter into more healthier relationships. And over time that changes it. I do see the relationship with the therapist as possibly something that helps move that, but that's like the therapist helping that person see something different, that therapist engaging with unconditional positive regard and caring for that person and helping them see something differently and being consistent for them. But ultimately, it's going to be what falls under the umbrella of an Taraleigh Stemler (48:51.805) . Roger K. McFillin, Psy.D, ABPP (48:54.083) in vivo exposure, you're gonna have to seek out new partners that are like more kind and more loving, you're gonna have to learn from the decisions you may have made in the past. So I don't want to, there's a lot that you describe there that sounds very medical. You know, this part of the brain, that part of the brain, the nervous system regulates this self regulates that and It's really just theoretical and it doesn't have any added value to the client other than for them then to learn like, this is something medical that's outside of me and I'm doing this thing to heal when all that healing is ultimately going to come from within. They don't just have to revisit the memory in the session. There's between session homework. It's going to pop into their head when they're driving in a car and hear a song and that you don't have to be afraid of it. Taraleigh Stemler (49:43.982) Right. Roger K. McFillin, Psy.D, ABPP (49:52.249) One of the things that you know about people who struggle with PTSD, and you'll hear it over and over and over again, is they actually do believe they'll go crazy if they think about the memory or they feel the associated emotions. And so they have to go through that to learn that I can handle this. That this isn't going to make me crazy. It's actually the opposite. The more you try not to think about it, the more likely you're going to struggle emotionally and certainly physically too, right? Taraleigh Stemler (50:13.838) Right. Roger K. McFillin, Psy.D, ABPP (50:22.063) So I want to, if someone's going to come in to me with PTSD, I want to focus fully on the things that are robust, are really going to create change and not confuse clients with nonsense. You know, like all these, like these things, like it's a, some brain condition, or we make the brain communicate with each other, or this helps self-regulate. No, it's the exposure. It's going to decrease the reactivity to it. I mean, you only have to do like a one day training on prolonged exposure. to reflect back on your life when you had some painful events, you face them, you might get really upset about them, you cry about them, it's painful at one time, and then a later time in your life, it doesn't have the same reaction anymore. You can talk about them. You can think differently about them, which is, guess, activating the part of your brain you mentioned. You might get a, you know, a maybe sad when you think about a time in your life, but it's not overwhelming, right? So we can think about this in all aspects. Taraleigh Stemler (51:00.27) Right. Taraleigh Stemler (51:10.238) Right. Roger K. McFillin, Psy.D, ABPP (51:21.615) loss, painful memories. And so it's so important for us to communicate to our clients that it is from it is within you to heal. There's nothing broken about you. Your natural process of coping got was interfered with because you were trying to survive because you were taught that it was dangerous to think about it, to feel it because you were invalidated, right? There's reasons why you are natural coping mechanisms. Taraleigh Stemler (51:40.428) Right. Roger K. McFillin, Psy.D, ABPP (51:51.249) were halted, but to see it from within you. And so when you think of, you look at everybody who's overcome trauma in your life, they're never gonna say, you know, I was doing these bilateral movements of my brain and you know, all of a sudden, you know, that's how I got through it. So that's why like I'm vehemently opposed to such ideas, not to take away from some of the things that you are doing in your session. Taraleigh Stemler (51:51.726) Right. Sure. Roger K. McFillin, Psy.D, ABPP (52:18.309) that actually are robust therapeutic effects, it just got confused and misrepresented and understood under this package called EMDR that right now I just see it as completely out of control. That it's, you know, it's become its own industry. You know, you can go ahead, you know, I'm going to do an EMDR training, I'm going to do this, I'm going to do that. There's EMDR certified people and there's lots of people making money off of it. But in the one, the one large scale evaluation that's been done on PTSD treatments, it's just, it's inferior to other ones. And when you try to talk to a practitioner about that, it's, stop there, right? They, don't evaluate that and they just make up things in order to support what they, they do. And Taraleigh Stemler (53:17.646) I guess a genuine. Roger K. McFillin, Psy.D, ABPP (53:19.099) they're unable to get into critical analysis of that. And that's where I struggle in our field. If you have a key component in your therapy that is working, why not try to maximize it? Why still do the same thing that was studied in the 1990s? Taraleigh Stemler (53:44.046) question or not question and observation is for my practice. I don't know why I'm seeing clients who have seen other therapists and then they're coming to me and they're actually getting results. Maybe it's because of some of the components you're alluding to. There's It's one client. it's not like all the clients I've seen over the past nine years, but one in particular that I'm starting to see on this upcoming Monday. She had voiced to me that she has sexual abuse in her past and she had been in therapy since she was 12 on and off, think. And she mentioned that she's been through all the different types of therapy, IFS, DBT, CBT. and nothing seems to create movement or improvement for her overall. There's still some of that reactivity, that post-traumatic stress type of response. So when I explained to her EMDR and the whole process that I would take her through, she seemed to have, excuse me, she seemed to have a sense of hope of, that doesn't seem like I'm just gonna go in and talk about what happened to me. And again, I don't know, DBT, CBT, I know that you've talked about both of those, so I'm certainly not taking away from that. But what I'm seeing, I can only tell you what I'm seeing, is that clients are coming to me after having been well-therapized, after having gone through medications, not a big fan of that. And nothing's getting better. But after the work that I do with them with EMDR, they're not in therapy every single week. Right? They're, being spaced out to once every three months, or they just terminate and they move on with their life. So, you know, what specifically about that is working. That's where we need more research. but that, that's just a, an observation that that I come to you with saying, I don't know why it's happening. but, but it is happening. Roger K. McFillin, Psy.D, ABPP (55:55.665) I do. Yeah, it's definitely happening. It happens to me as well. it's, I do, I don't think we need more research. I think it's actually pretty clear. if, if our job is to do a case formulation and try to understand history and context and try to make sense of why the person is experiencing what they're experiencing. Okay. So, if, if it does get rooted back, Taraleigh Stemler (56:00.514) Sure. Taraleigh Stemler (56:15.608) Mm-hmm. Mm-hmm. Roger K. McFillin, Psy.D, ABPP (56:25.201) to PTSD, complex trauma, abuse, then it would make sense that you'd be the first person that might acknowledge that and then provide a trauma focused therapy, which is, you know, what this person went through has not been adequately dealt with. And they've been all you did was say letters, know, the a CBT, DBT, all these things that gives us no real information because Taraleigh Stemler (56:46.03) Right, right, absolutely. Roger K. McFillin, Psy.D, ABPP (56:54.627) Most people are saying they're doing these things and they don't have the competency to do these things. So first of all, like dialectical behavior therapy is a cognitive behavioral therapy, but it's a therapy for a specific kind of group of people or presenting problem. So where dialectical behavior therapy may be beneficial is, okay, so let's imagine, you this was a 12 year old girl who was sexually abused. And then at 14, she started abusing alcohol. At 16, she had an eating disorder. She's self-injurious. So she has all these multiple presenting problems, right? And she only knows how to deal with her emotional pain through numbing or cutting or all these other aspects. Taraleigh Stemler (57:26.466) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (57:38.033) dialectical behavior therapy is a treatment for multiple presenting problems with emotion dysregulation. So a person has coaching calls, learn skills training, they're trying to stop the substance abuse, the self injury, because you can't really do with trauma therapy while a person is, doesn't even have basic coping mechanisms, you're just going to enter into those behaviors more. And so that's, so that's where it's validated. And so the person might get that treatment and stabilize those conditions. And then it would be phase two. Taraleigh Stemler (57:49.858) Thank Taraleigh Stemler (57:54.37) Sure. Sure. Okay. Roger K. McFillin, Psy.D, ABPP (58:07.343) phase two in dialectical behavior therapy is prolonged exposure. Why prolonged? Why prolonged exposure? Well, because it has the highest evidence base. Now it doesn't help everybody entirely. There's a like, when we look at this outcome data that there's, you know, good 70 % of people recover, which is still strong, but there's still people that aren't for various reasons. Taraleigh Stemler (58:20.178) Sure. Sure. Taraleigh Stemler (58:30.988) Sure. Roger K. McFillin, Psy.D, ABPP (58:34.447) And that's where we have to be really good critical thinkers. Like maybe that person hasn't fully agreed to do that therapy yet. Maybe they don't trust the therapist. Maybe there's things going on in their home life where still represent some concerns for danger, right? And so you're going to ask somebody to face things that feel very overwhelming to them and they're too scared to do that. Or maybe they've even like have real lapses in memory. Taraleigh Stemler (58:47.822) Sure. Right. Roger K. McFillin, Psy.D, ABPP (59:04.151) And so there's, when you work with people who are suffering, of course, like, there's so many different factors and variables to why they may be struggling. And if someone's been abused too, of course, like there's going to be a degree of even distrust, maybe distrust of you. And so there's a lot of things that have to be, you know, taken into account. So it's, it's in all likelihood, maybe a number of things, right? Maybe she trusted you, right? Taraleigh Stemler (59:20.514) Yeah. Sure. Yeah. Roger K. McFillin, Psy.D, ABPP (59:32.817) And there's something about you and the way you related to her and talk to her is very validating and soothing. And she's at a point in her life where she's ready to face what happened at age 12. And then you allowed her to face it under context and with memories. And so that would be the therapeutic effect. It's got some value. All I would say to you is, all right, those other components are not necessary. We should critically analyze why they may be problematic. Taraleigh Stemler (59:48.05) . Roger K. McFillin, Psy.D, ABPP (01:00:02.679) And is there a way to actually like enhance the other aspects of the exposure that can give, you know, your clients a more greater benefit? And so that's how I kind of look at, you know, that kind of question. Taraleigh Stemler (01:00:17.725) Gotcha. No, it was just an observation. Certainly not combative in any sort of way, but just I don't know why clients are coming to me. And again, maybe EMDR is so normalized or it's promoted so much. I had another referral come to me this past week and they were referred to me by a psychiatrist and I was pretty surprised. because I thought the psychiatrist would just put this client on two or three medications and send them on their way, but they recommended EMDR for, for trauma that the individual, reported. So that, mean, it's a genuine observation and a genuine curiosity that I have and what, what is helping people get to a point is it they're doing CBT for a while again, to stabilize and then. they're moving on to EMDR or is it the therapeutic relationship like you're alluding to? It's certainly a lot of questions that I have and I appreciate you bringing that up. Roger K. McFillin, Psy.D, ABPP (01:01:18.991) Okay, so let's get into my concern about the EMDR community, making it a one size fit all treatment. So anyone who's experiencing any emotional distress is being offered EMDR. Do you support such an idea? Taraleigh Stemler (01:01:41.336) I believe that if you have a mind, a brain, and a body that through the reprocessing experience that you can have through EMDR that it could be beneficial. Roger K. McFillin, Psy.D, ABPP (01:01:54.971) So then everybody, so then any human being could then experience EMDR or should experience EMDR. Taraleigh Stemler (01:02:05.588) Yes, I believe that they could benefit, sure, if they come up against any maladaptive behaviors that are not serving them well. Roger K. McFillin, Psy.D, ABPP (01:02:19.097) Okay, what so what what would that mean? You're saying that, like, but you would say that there would be like this massive public health benefit if we widely applied EMDR to all mental health related problems. Taraleigh Stemler (01:02:39.181) Possibly. I think that everybody has their own unique way of coping with stress and with disturbing experiences and with what we know about the brain and the mind and the body. The concept of psychological self-healing is actually what Francine Shapiro had alluded to about the AIP model and what EMDR is based on. And so I'm not saying that it's going to heal everybody, but that there could be some benefit for anyone who is experiencing some sort of emotional distress. Doesn't mean that they need to go to therapy yesterday, but I think that it could. Roger K. McFillin, Psy.D, ABPP (01:03:30.885) So you would then view someone experiencing emotional distress as a problem that requires professional help. Taraleigh Stemler (01:03:41.556) If it gets to a maladaptive, if it creates maladaptive behaviors, if it's getting in the way of relationships, healthy relationships, if it's impairing, you know, healthy self-care activities, if it's leading to, you know, high levels of drinking alcohol and substance abuse, you know, all those sorts of things that present as problems in therapy, I think that it possibly could. Roger K. McFillin, Psy.D, ABPP (01:04:11.821) Okay. But what if there's no evidence of a trauma history and no PTSD? Taraleigh Stemler (01:04:21.676) We all have attachment wounds. There's actually other issues that present in therapy that EMDR can be used for. Attachment wounds in relationships, nightmares, panic attacks, some addictions, which is usually rooted in attachment or relationships. So there's so many different issues that it can cover when it comes to the human experience and what might create emotional distress. So it's not just tackling PTSD as far as like the diagnosis. Roger K. McFillin, Psy.D, ABPP (01:05:02.683) Do you believe that like we should have good scientific support before making like such claims? Are you concerned about, you know, how just saying like anyone who's experiencing a maladaptive reaction in their life, then they have, you know, for example, a trauma, an attachment wound, or it's based in a attachment theory, any, you know, concerns that You know, that's not necessarily a valid claim and there's plenty of people who experience problems in their lives that is normal across the lifespan. It's certainly not related to attachment theory. Taraleigh Stemler (01:05:40.296) That there would like we would want more through research to back that up is what you're saying Roger K. McFillin, Psy.D, ABPP (01:05:45.669) Well, don't you think there should be sound science to support EMDR for all those other conditions if we're going to apply them? Taraleigh Stemler (01:05:53.582) Sure. Which is why like when you go to the EMDR, the EMDR International Association library of all the research, you know, there is some information there about EMDR and attachment wounds and relationships. But that's again why I say I'm open. I want more research on these sorts of things because this is what's being presented in therapy and I seem to be at least getting a lot of movement and improvement with my clients, again, with an EMDR, but also with the components that you've alluded to as well. Roger K. McFillin, Psy.D, ABPP (01:06:36.485) Well, I also say that in a lot of those situations, like, let's say, I mean, if we're going to say that anyone struggling at any one good, any one time in their life would require professional help, then we'd say that the entire population of the earth can, you know, benefit from it. And then we would say that if they got better after it, it was because of the professional help. Taraleigh Stemler (01:07:02.734) Sure. Right. Roger K. McFillin, Psy.D, ABPP (01:07:04.613) which doesn't make a whole lot of sense because this idea of natural recoveries, most people don't require professional help. They're going to get better anyway. So that post hoc ergo proctor hoc fallacy after this, therefore, because of this truth of the matter is, is if you saw any one person in an eight to 10 week period of time, when they're going through something, you're just now. Taraleigh Stemler (01:07:19.657) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (01:07:28.453) you're along for the ride of what is their natural process to go through what a struggle would be. they, you know, maybe they did screw up in a relationship, right? Maybe they were jealous or insecure. And now all of a sudden, the therapist is conceptualizing this as previous attachment wounds that interfered with their ability to maintain a relationship. When it was just someone who's immature and had to grow and learn through that, they, you know, they grew up in a Taraleigh Stemler (01:07:52.973) Sure. Right. Roger K. McFillin, Psy.D, ABPP (01:07:56.719) I mean, a very loving family, you see this all the time, nothing clearly stands out, but people have struggles. And so the therapist then creates in their own mind based on their training, what that person's problem is, communicates that, and now is creating a narrative with their clients. So you see this all the time. You know, the person going through that relationship in their 20s, Taraleigh Stemler (01:08:04.369) Great. Roger K. McFillin, Psy.D, ABPP (01:08:24.131) no longer is just something to learn from or grow from. It's now I have an attachment wound. I reacted this. had a previous traumatic experience when I was 13, when my mom and dad were fighting. It's almost creating a narrative about what it means to go through a lifespan through a pathological lens. So I just, you know, I'm really against the idea that everyone requires therapy, and it could be beneficial because then I don't think you're really thinking about all the potential harms related to it. And we're in this therapy culture. There was a great book, Abigail Shrier called Bad Therapy, where it's Yeah, I mean, I think she does a good job with some really good research, especially in resilience, about how this therapy culture that we Taraleigh Stemler (01:09:00.842) I actually read that. Yeah. Roger K. McFillin, Psy.D, ABPP (01:09:13.955) live in actually produces outcomes that we're not really necessarily looking for, right? Including like rumination of past events and obsessing over certain things or developing a collective narrative about who we are in relationship to others that is largely based out of a therapy industry that EMDR pushes it. I mean, you were throwing out all the lingo, attachment, wounds, maladaptive behaviors, it could be beneficial for anybody. Taraleigh Stemler (01:09:19.808) Right, right. Taraleigh Stemler (01:09:28.494) Right. Roger K. McFillin, Psy.D, ABPP (01:09:43.653) because that's what's pushed. That's exactly what's pushed within that industry. And more people that do EMDR, the more money those people make. And it's not really necessarily open for critical analysis. If the therapeutic industry was so widely effective and it's so ingrained in our society, we would see much better outcomes than what we do. But the truth of the matter is when we started pushing therapy on everybody as the sole manner in which to deal with the struggles of one's lives, it's kind of gone in the opposite direction. So that's why I just have an automatic reaction to anyone who says, hey, this is just good for anything at any particular time. Taraleigh Stemler (01:10:14.903) Sure. Sure. no, I think that that's certainly well-founded critique. and that's why I appreciate this conversation because it gives me things to think about as well. I, I guess I want to say overall that as a Christian, I do believe that ultimate healing ultimate, being made whole is is from the Lord. do believe that. And then past that, you know, if someone wanted to pursue healing, I don't know that it always has to go through therapy. But I at least know that EMDR can be beneficial. And we may differ on that, which is totally fine. But I do find that healing can happen. It's just going to be different for everybody. Roger K. McFillin, Psy.D, ABPP (01:11:28.741) Yeah. So my final point on, on this is that I don't think we should be using treatment packages and acronyms, and letters. we shouldn't say EMDR is effective. That's a misnomer. It's miscommunicating to the public. What I would say is there are aspects we know about human resiliency and coping that we can emphasize in our therapy to assist you to grow through this experience. And EMDR has some, it does include that. So it's not that I disagree with you or saying what you're doing is not helpful work. I hope that's not what came across today. What I'm saying is there's components of what you do is that in the field needs to communicate it better. It needs to articulate what are these mechanisms of action and train those very well. So if those, you know, if those mechanisms of action are going to depend on a case formulation, Taraleigh Stemler (01:11:58.665) Yeah. Taraleigh Stemler (01:12:08.708) No, not at all. Taraleigh Stemler (01:12:17.102) sure. Roger K. McFillin, Psy.D, ABPP (01:12:26.757) You know, for example, like, you know, we're understanding all those contextual factors, but we also know that people may need to develop skills. Like, so for example, if I'm going, like I'm treating, if I'm treating somebody who's, you know, vomiting, two to three times a day, or, know, or every day with pretty severe bulimia, even if they did have a potentially traumatic experience, I have to be aware that that bulimia is a potentially life threatening condition. Taraleigh Stemler (01:12:36.134) Right. Taraleigh Stemler (01:12:54.798) Right. Roger K. McFillin, Psy.D, ABPP (01:12:55.825) And you need to be able to assist that person with being able to self-regulate and learn skills and develop a behavior plan and a lifestyle that gets them to slowly start decreasing that and eliminating the bulimia. Now the bulimia probably was serving a function. It was a way that person was dealing with whatever happened to them. And that could range from trauma or it could just range from like body image concerns or Taraleigh Stemler (01:13:14.603) Right. Taraleigh Stemler (01:13:18.542) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (01:13:22.129) You know, number of other related problems, especially in the way they're coping, but I have to use my knowledge based on, okay, you were using this to feel better and we're going to help you to face what has happened to you and learn new ways to, feel better. And then evidence-based therapy for me is you're measuring those outcomes. So if I have somebody who comes into me and they're Bilenik twice a week, um, well, I want to be measuring this. Um, and if that, you know, Taraleigh Stemler (01:13:31.516) Yes. Taraleigh Stemler (01:13:39.014) . Roger K. McFillin, Psy.D, ABPP (01:13:51.821) if at week six, eight or 10, you know, there's still, you know, the same amount of times binging and purging within my therapy isn't effective. And so these things are like really necessary that we have a degree of accountability for measuring over time, but the field only advances is when we move away from these treatment packages, and we say, what is working with who under what conditions for what reason, then we can articulate it to the public. So I would hate to, to Taraleigh Stemler (01:13:55.598) Mm-hmm. Taraleigh Stemler (01:14:18.848) Right. No. Roger K. McFillin, Psy.D, ABPP (01:14:22.041) have you come to the conclusion that I'm like saying there's nothing about EMDR that works. What I'm saying is I believe that there's components of EMDR that have no added effects, so why do it? And we also have other similar treatments, similar mechanisms, but are emphasized more fully, why not do that if it's proven to show a little bit of a greater effect? And then if for a large group of people, they don't need any of those, they just need maybe a short-term problem solving or Taraleigh Stemler (01:14:47.215) Sure. Taraleigh Stemler (01:14:51.11) Sure. Right. Sure. Right. Roger K. McFillin, Psy.D, ABPP (01:14:51.569) their own opportunity to say, this is what's going on in my life. I want to talk it through. And really we're just kind of co-passengers in that case. And we say, Hey, you're naturally resilient. You're going to move through this and you keep it relatively short. And that person gets better. If you would have done EMDR in that time, that person would have gotten better anyway. It had nothing to do with EMDR. And that's the scientific, you know, part of this. And this is why research is important. And we do have research, there's tons of it, like there's tons of research. I I tried to prepare for this by looking at the EMDR research. And I came to the conclusion that it's better than nothing, that it can be superior to other alternatives in cases of PTSD, but most of the research is of very low quality, very low power. It's not compared to more efficacious treatments or alternatives. There's all this, you know, what amounts to be very poor research driving this entire brand. And it's kind of become a brand. And this is a, this is a problem with CBT as well, is it becomes a brand and then people are just doing something out of like a workbook and they believe what's effective. so same thing with DBT. DBT is a one year long treatment. Taraleigh Stemler (01:16:09.484) Right. Roger K. McFillin, Psy.D, ABPP (01:16:20.303) It's very complex. It includes coaching calls, skills training, a consult group for the therapist and an individual therapy. And now we have a wide range of people saying they do DBT because they integrate mindfulness or a workbook in individual therapy. It's a complete watered down mental health system. And that's why we have to move away from saying EMDR helped or DBT helped. Taraleigh Stemler (01:16:38.877) Right. Right. Taraleigh Stemler (01:16:44.708) Right. Roger K. McFillin, Psy.D, ABPP (01:16:49.071) or CBT helped or this helped. No, we have to say what were the of that therapy. And we also see differences in therapists. There's some just better therapists. They're just smarter, more insightful, they're more caring, they're more passionate. And that person responds to them because it's somebody that really cares about them. There might be an energy or belief system about them. While someone else says they're doing EMDR and they're a little cold or they're mechanistic and they wouldn't have the same outcomes. Taraleigh Stemler (01:16:50.847) Sure. Taraleigh Stemler (01:17:00.92) Sure. Right. Roger K. McFillin, Psy.D, ABPP (01:17:18.949) Well, then the mechanism of action is the therapeutic relationship. So that's why it's so important we stay away from that. And if we're going to really advance the field, I believe informed consent is that we have to be able to articulate to our clients well so they can make an informed decision. Taraleigh Stemler (01:17:19.421) Sure. Taraleigh Stemler (01:17:23.97) Right, right. Taraleigh Stemler (01:17:38.994) Yeah, no, I and I, the whole time that I've listened to your podcast, going back to 2023, I've really appreciated how much you have emphasized informed consent. And I've really tried to do a better job of bringing that to the forefront in my session. So I do appreciate how much you have talked about that. I'm interested to see, because I I really appreciate how you're talking about the, know, some of the components of EMDR and CBT. Like some of these things are working, but we don't need to just paint it over with a particular acronym. I'm really interested to see what about EMDR in the, it was a 2024 study that came out last February and I forget if I sent it to you. So my apologies if I didn't. It alluded to epigenetic changes of clients who went through EMDR versus I think trauma focused CBT. Now, small population, it was just 30 people. But there was changes in inflammatory and immune response or immune related signals with or genes. So I know that I'm not saying it perfectly, but I'm interested to see like what does that mean within the EMDR protocol versus a trauma focused CVT? Like what's actually working or what is getting those type of results? Like what component of EMDR like you've alluded to? Roger K. McFillin, Psy.D, ABPP (01:19:17.839) Yeah, the problem with that study, unfortunately, is that it is low power, it can't really come to any real conclusions. And TFCBT is generally a treatment for kids who are traumatized. That includes parents, and it's developmentally appropriate for that age range. And epigenetics is such a complicated and complex understanding. It basically means that Taraleigh Stemler (01:19:26.219) Okay. Taraleigh Stemler (01:19:31.937) Okay. Taraleigh Stemler (01:19:39.564) Okay. Roger K. McFillin, Psy.D, ABPP (01:19:47.311) you know, environment influences the expression of genes. And so you can't account for what was outside of the therapy. It could be accounted to that person's unique environment. Do you understand? And that's why you need good science and it has to be really controlled. like, you know, you and I, you know, might have the, let's say we have like a similar gene. Taraleigh Stemler (01:19:59.872) Okay, sure. Roger K. McFillin, Psy.D, ABPP (01:20:12.047) And then we enter into, you know, we live in a different part of a country. We have different parents, we have different partners, we have different relationships. We do different, we eat different food. We have different lifestyle that would all influence the expression of that, that gene. And so, yeah, basically what I take away is that, you know, environment is so important. Mind might be very important too. Some of the advanced understanding of this is like we can work within our own mind. Taraleigh Stemler (01:20:16.686) Mm-hmm. Taraleigh Stemler (01:20:29.58) Right. Roger K. McFillin, Psy.D, ABPP (01:20:41.829) to create expressions of genes, right? So like our mind can create danger, our mind can create safety. So Wei, you sent it to me and I thought it's like the best example of really, really poor science trying to work under a brand, right? Like, so somebody, you can tell someone really wants EMDR to do well, but didn't spend the time, you know, creating a paper. Taraleigh Stemler (01:20:45.442) Mm-hmm. Right. Taraleigh Stemler (01:20:56.536) Okay. Taraleigh Stemler (01:21:03.743) Right. Roger K. McFillin, Psy.D, ABPP (01:21:09.413) that fully articulates the problem with that design and all the other reasons that can account for it. And then the lay person is going to read that and believe, you know, like EMDR, you know, alters our genetic expression. And so it's just like, that's a, you know, that's a problem with where we are and why there's institutions aren't, you know, Taraleigh Stemler (01:21:26.698) Right. Roger K. McFillin, Psy.D, ABPP (01:21:33.947) trusted. John Gynonitis is a Stanford professor and medical researcher. He's made it his life work to kind of challenge this. And he's known as a meta researcher and his expertise has like propelled him to the forefront, leading authority on the credibility of medical research globally, something applies for psychiatric and psychological and psychotherapy research. He asserts that 90 % of the published medical information that we rely on is flawed. So Taraleigh Stemler (01:21:47.822) Thank Taraleigh Stemler (01:22:03.841) Yeah. Roger K. McFillin, Psy.D, ABPP (01:22:04.271) Right? If you're going to read the abstract and you forwarded it to me really quickly, I'm sure it's like, Hey, look at this. This is what, it's a great example is that you're just influenced by, you know, the paper's title or something of that nature. and so many practitioners rely on a headline and abstract or conclusion. And you just look at EMDR research is often underpowered with very small sample sizes. It does not distinguish aspects of the therapy that may be helpful from other aspects such as Taraleigh Stemler (01:22:11.47) Sure. Taraleigh Stemler (01:22:18.584) Right. Roger K. McFillin, Psy.D, ABPP (01:22:33.561) exposure to trauma memories and what we worked, you we talked on today. And it's not replicated over time, comparing it to other safe or efficacious treatments, right? So, well, where I'll support you is saying, okay, if like, if you are working in a rural part of Tennessee, and someone has PTSD, and you take their insurance and you know, EMDR, well, then you should do EMDR because that's better than nothing. Taraleigh Stemler (01:22:41.678) Sure. Roger K. McFillin, Psy.D, ABPP (01:23:03.569) And what I'm saying is there's another level to this. There's actually a little bit better treatment doing similar things that you're doing, but more focused and from a sounder scientific perspective that can help a person in future aspects of their life. And that's kind of where I'll shut it down. That's kind of my takeaway on all this. Taraleigh Stemler (01:23:18.129) Sure. Yeah, now, and I was sending that to you because again, I had read through as much as I could, but I was curious your perspective of it because again, I remembered you mentioning the gentleman who had said, you know, 90 % of research is essentially, it's bought and paid for. There's actually a vaccine book that I'm reading and it's alluding to the same thing. So any research is certainly to have skepticism toward. So that's why I was curious, your perspective looking at that. Roger K. McFillin, Psy.D, ABPP (01:24:05.241) Yeah, I really appreciated you to sending it off to me. actually do believe psychotherapies do have the ability to alter gene expression. Of course. It's a it's a relationship with another person that's getting you to focus on on things that are, you know, perceived to be beneficial and it has been shown to change behavior in positive ways. So, you know, I would say that EMDR and Taraleigh Stemler (01:24:14.402) Yeah. Taraleigh Stemler (01:24:27.478) Mm-hmm. Yeah. Roger K. McFillin, Psy.D, ABPP (01:24:31.663) Lots of other therapies might be able to yield that result if you evaluate it and study it, but it's not like the EMDR did it. It could be other components. It could even be something that that therapist motivated in that person during the course of their therapy, things that you don't account for, you know, just like a very genuine moment between a therapist and a client. Taraleigh Stemler (01:24:51.178) Sure. Roger K. McFillin, Psy.D, ABPP (01:24:55.749) that altered the way that the client viewed themselves or approach their day or something like that. So those are the things that are hard to measure. Taraleigh Stemler (01:25:01.859) Right. Yeah. Which, is again why I appreciate you bringing that to the forefront because I've been a therapist for just shy of a decade and I, I still am learning how to communicate about these things to clients. And so I want to make sure that I'm representing like this, you the science, whatever that means anymore. certainly not in the Fauci way, but what the, you know, what the science says, you know, what is reliable information, you know, with the things that we can control. But I know that I influence the interaction in my clients' experiences. And so I can't really measure myself. But I appreciate you giving me a different perspective or a way to verbalize that to clients moving forward so that I can represent that as accurate as possible. Roger K. McFillin, Psy.D, ABPP (01:25:58.831) Yeah, I've found myself, you know, after all the years I've spent, you know, reading the literature and I used to, you know, I used to, if you talk to me, probably five, 10 years ago, I would say like, if you're not doing prolonged exposure therapy for someone who's exhibiting PTSD, you're acting outside the evidence base. And I wouldn't go as that far anymore. I would say things like. And this is what I'm going to communicate to my clients. You know, over all the years, you know, from studying these things, I really do believe in your own natural ability to face what has happened to you and to get, and to get through it. And I do think at, you know, at this point, there are reasons why that you've developed PTSD and then, you know, I'll communicate those in detail. Here's what I would propose that we, we do, and it would include work in our sessions and outside of our sessions. Taraleigh Stemler (01:26:34.164) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (01:26:53.143) And my experience is that, you know, seven, eight out of 10 people are going to feel much better after going through that, although it may be really, really hard. And it also can propel us to doing other work, which is like changing some patterns of behavior that have come as a survival mechanism since this event in particular. and, but I do always say, know there's, you know, there's a lot of other factors in this and not everyone gets better from therapy. And, Taraleigh Stemler (01:27:20.842) Right. Roger K. McFillin, Psy.D, ABPP (01:27:23.173) You know, and it also, you know, means that you might get better working with someone else outside of me, which means we want to measure this and always have feedback. And I want you to talk about your experience in working with me and let's make sure that we're really a team together. And I feel like that's, you know, informed consent. You know, it's, believe in this, we're going to do these things. I believe they're supported by good sound research, but there's a lot more to it than just this. Taraleigh Stemler (01:27:40.391) Yeah. Yeah. Totally sounds good to me or you know different different ways that I can incorporate that into my interactions with my clients because I I never want them to I Never want them to walk away thinking that EMDR is the magic bullet. I think like you alluded to that description But I do want them to know that in working with me I'm going to give them everything that I've got to help them work through some really difficult things that maybe they have struggled to get through on their own to this point, you know, to that point in their lives. So that's some good language to use. Roger K. McFillin, Psy.D, ABPP (01:28:30.193) Yeah, and I would say that in itself is really, really powerful. Right? Really, really powerful and probably a stronger component or mechanism of action than, you know, we recognize. That combined with your willingness to go to places that, you know, are hard for the client. You know, in some bad therapies, they're very passive and they just allow the client to take them. Taraleigh Stemler (01:28:35.16) Yeah. Taraleigh Stemler (01:28:51.746) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (01:28:57.595) wherever they choose to not recognizing the power of avoidance. But if you really trust a person's ability to get through something really difficult and you feel strongly that there are some events in their life that led to them getting stuck or developing PTSD or the reasons why they're depressed or having a panic attack or whatever that may be, your willingness to go there fully with courage communicates to your clients that they can handle it. And that is... Taraleigh Stemler (01:28:58.67) you Taraleigh Stemler (01:29:17.313) Okay. Taraleigh Stemler (01:29:25.479) Right. Roger K. McFillin, Psy.D, ABPP (01:29:25.815) That is so powerful. And then that's the powerful part of the EMDR is the courage to face it, the willingness to do it. I can have this memory and it's not going to make me go crazy or overwhelm me or have a panic attack. And that's so, so, so strong. And so I do believe that's the power of that intervention. I just want more people who are trained under it to understand really what's going on and find ways to amplify it. So. Taraleigh Stemler (01:29:32.195) Right. Taraleigh Stemler (01:29:41.827) Yeah. Taraleigh Stemler (01:29:53.143) Yes. Roger K. McFillin, Psy.D, ABPP (01:29:55.503) I want to thank you so much for your courage to come on here. I mean, it's certainly not easy to come in and have this discussion with me, especially because I feel so passionately about this. I think we emailed that one given time and I said, you know, I really don't, I really don't support EMDR. So you knowing that, and then your willingness to come in and talk about it. It's, you know, really grateful for that. So thank you. Taraleigh Stemler (01:29:55.843) Right. Taraleigh Stemler (01:30:09.134) you Taraleigh Stemler (01:30:20.206) Well, like I said last summer when I emailed you, it probably wasn't the best timing for me. And quite frankly, like I was just scared. And, you know, even coming into the conversation today was a little bit on pins and needles, but I at least appreciated the opportunity to come on. And I certainly have not felt you being combative or aggressive in any way. but I at least appreciate the opportunity for a conversation. Roger K. McFillin, Psy.D, ABPP (01:30:52.655) Yeah, thank you. mean, we have to have more conversations like this. Like our field is so fragmented and so tribalized. just like, you know, it's hard to get people onto the podcast to talk about things that where there's some contention or disagreement because because of that fragmentation. So I think doing that allows, you know, people to hear where concerns lie or how people think of things differently. And again, this is my this is my viewpoint. This is my opinion. This is Taraleigh Stemler (01:30:56.172) Yes. Taraleigh Stemler (01:31:16.056) Sure. Roger K. McFillin, Psy.D, ABPP (01:31:21.541) what I take from the research. doesn't mean I'm perfect. It doesn't mean I'm right. It just means this is what I believe. This is how I've made sense of it. This is how I create an argument around it. And then this is how I approach my treatment. I have concerns about the medicalization of our field, but it's possible that you have clients and you use the words of communicating between hemispheres of the brain and Taraleigh Stemler (01:31:29.23) Sure. Roger K. McFillin, Psy.D, ABPP (01:31:49.617) you know, all these parts and that makes them feel better or makes them believe and belief is powerful, believes that something's getting, you know, healed. And so there's a percentage of people that might do better. Like all these things are possible and we just have to recognize the possibilities. So Terri Lee Stemler, I want to thank you for a radically genuine conversation. Taraleigh Stemler (01:31:57.284) Sure. Taraleigh Stemler (01:32:01.294) Sure. Yeah, I agree. Taraleigh Stemler (01:32:16.152) Thank you.