Phil Manfield, Ph.D. - Guest
Phil Manfield, Ph.D has been licensed as a Marriage and Family Therapist since 1975. He has authored or edited five books about psychotherapy and the use of EMDR, including: EMDR Up Close: Subtleties of Trauma Processing, EMDR Casebook, and Extending EMDR: A Casebook of Innovative Applications. He has taught in the US, Canada, Australia, South America, Europe, Asia and the Middle East. Currently, he is the Northern California Regional Coordinator for the EMDR International Association. |
W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Dr. Sutton: (00:22)
Welcome to Therapy on The Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute For The Advancement of Psychotherapy. Today I'll be speaking with Phil Manfield, Ph.D., who is a licensed marriage and family therapist and EMDR trainer. He has authored and edited a number of books, including EMDR Up Close Subtleties of Trauma Processing, EMDR Casebook, and Extending EMDR: a Casebook of Innovative Applications. He is also the developer of the EMDR technique, the Flash Technique, and has taught throughout the world. And is the Northern California Regional Coordinator for the EMDR International Association. Let's listen to the interview. Hi, Phil. Welcome. Thank you for joining today.
Phil Manfield, Ph.D.: (01:14)
Pleasure.
Dr. Sutton: (01:15)
Well, great. I've been really interested in your work. I have known about you for some years. You're one of the EMDR trainers in the Bay Area. I've actually had a number of my associates who are training under me go to your level one and level two training. Bart Rubin, who was part of my practice and actually the person that trained me. I know that you know him well. And so I wanted to learn a little bit more about kind of your work and the evolution of your thinking. And I know you've also begun using a new technique called the Flash Technique, which has been really interesting. I've learned a little bit about it. Bart actually did a training for us and showed some video of a session. I would love to just kind of start off and hear a little bit about your career and how you got to do it and what you're doing.
Phil Manfield, Ph.D.: (02:05)
Well, let me see. I came to California as a theoretical mathematician. I went to Cal and was working on my dissertation and got myself into personal therapy. And after a while, I started saying to myself, Well, let me see. What do I wanna do with my life? Do I want to write papers that maybe 10 people in the world can understand, or do I wanna change people's lives the way mine had been changed? So I transitioned into psychology. You know, there I was a graduate student at Cal and was more interested in psychology than mathematics, but I was on a fellowship that was paying my way. I had no choice but to do mathematics. And so I went over to the psychology department, and I asked, you know, what I could take that was clinical while I was still in the math department.
Phil Manfield, Ph.D.: (03:24)
And they said, “We don't really have any clinical courses.” In the old days, college just ran mice through mazes. But the closest thing they had to clinical was a group course. A course in group Dynamics, 400 people in a big lecture hall. But then they had everyone divided into groups of 20, and people would meet in their subsections and they would function as a group. So I went to my subsection and the leader came up to me afterward and said, “Well, you're a graduate student, right?” And I said, “Yeah.” And he said, “Well, we're short a few group leaders here, and how would you like to lead a group?” And I said, “Well, I'm in math.” He said, “That doesn't matter.” So, I led a group for a semester, and it was just a blast.
Phil Manfield, Ph.D.: (04:26)
I just loved it and that basically decided it for me. So for 40 years, I think it was that long, but I was licensed in 76. And I was always looking for a way that I could make an impact that was as big as the impact that had been made on me. And I thought I was a pretty good therapist, but I never really hit the home run like the therapist I had done for me. And then I wrote a book on analysis and the year that it was being published my brother who was a psychologist in Portland, Oregon the two us were sitting on mount ta PAs drinking wine. And he told me about this nutty technique that he had read about.
Phil Manfield, Ph.D.: (05:37)
He had read both of Shapiro's papers and he had said, “You know, this feels like it could be something important.” And he had tried just doing it on his own with no training and had gotten some good results. So the following week I saw an ad for the first and only training in Berkeley and I took it. AI I have to say, I was not impressed by the bureau. I was not impressed by much of the training, but I was totally blown away by my experience in the practicum. And that told me there's something here that I really need to pay attention to.
Dr. Sutton: (06:24)
That's a big part of the EMDR training is practicing on each other.
Phil Manfield, Ph.D.: (06:29)
Yeah. That's accurate really.
Dr. Sutton: (06:31)
That experience, which I think is really unique to EMDR. You might role-play or something like that, but not really have that powerful experience of actually doing EMDR with somebody else and having them do it with you.
Phil Manfield, Ph.D.: (06:46)
Yeah, it's the real thing. I had been in analysis, union analysis for a year and a half because I'd been rear-ended at a traffic light. I'd seen the car coming from a quarter mile away, and I'd watched in my rearview mirror as they just came up and just slammed into me. So I had symptoms. I couldn't sit still at a traffic light if someone was coming up behind me. And the same with the stop sign. So, it had been a year and a half, some of it was two times a week on the couch. And in 35 minutes of the practicum with a therapist who had never done this before I resolved the problem. So it was like, sit up and take notice.
Dr. Sutton: (07:35)
I know with my experience with the EMDR and learning it and training others in it. And during, it's like there's almost a magical quality to it, which I think is why a lot of people oftentimes see it as very woohoo. Especially, I don't know about you, but I come from more of an evidence-based and practical kind of background. And so I was actually pleasantly kind of surprised in learning about it when I got trained many years ago by Bart. So it ended up impacting you and you thought that you got more interested in that. Tell me more.
Phil Manfield, Ph.D.: (08:11)
Yeah, and I was fortunate because Shapiro was looking for ways to legitimize EMDR in the eyes of academics. And I had just published this book on analysis, object relations. So he invited me to be part of the organization and facilitate the training, facilitating the practicums. So, I was not a great EMDR therapist at the time. I really shouldn't have been a facilitator, but there I was doing it. And it's a great way to learn.
Phil Manfield, Ph.D.: (08:52)
So I became a really good EMDR therapist, basically by teaching.
Dr. Sutton: (08:59)
Great, and so how long have you been teaching EMDR now?
Phil Manfield, Ph.D.: (09:06)
Well, I was a facilitator for about 10 years. I think in 1999 or 2000 I started actually teaching my own training. And I've been teaching training ever since. I've traveled a lot and taught, and I've been teaching in the Bay Area, West Coast, and Portland.
Dr. Sutton: (09:32)
So I came to EMDR, I guess it was 2006 when I was in my pre-doc. There's a lot of skepticism in the field, or especially the CVT folks, who seem to have a lot of issues with EMDR. And I know it was put as evidence-based by controversial. Although I know that it's now an A-grade treatment by the American Psychological Association. It's one of the treatments of choice by the Veterans Administration and Health Organization and World Health Organization. And so you might know more about the history cause I kind of just dropped in, I think midway. Can you tell me a little bit about that?
Phil Manfield, Ph.D.: (10:23)
I'll just try to restrain myself. I just finished a lengthy email exchange with the clinical director of a large counseling center because he came to part one training. And he was unhappy that I was so negative toward a particular exposure. So we went back and forth and he was giving me all the arguments why exposure was the treatment of choice. And I was explaining why those arguments were not valid. But the history of EMDR has been very controversial. EMDR started around the same time as the introduction of exposure.
Dr. Sutton: (11:19)
Prolonged exposure
Phil Manfield, Ph.D.: (11:21)
Right, I think one of the big differences that really charted the course was, first of all, Shapiro was kind of an abrupt person. She made a lot of enemies. Also, people could be trained in exposure in a fairly brief amount, whereas EMDR required two weekends. And back then, now there's also a consultation requirement, but back then there wasn't. So, very quickly, there were many more therapists doing exposure than there were doing EMDR. And, the science behind psychology, unfortunately, is very political. And, the more people you've got in your camp, the better your results you're gonna look. But the big thing was that in the beginning when people did comparisons between exposure and EMDR, there was a 30% dropout rate in exposure.
Phil Manfield, Ph.D.: (12:46)
And virtually none in EMDR, very low dropout rate. And some of the early papers just ignored their dropouts. And so when they compared EMDR and exposure, they said, “Well, the results were comparable.” Never mentioned the 30% that I consider to be clinical failures because they didn't make it. And because that was what was done in the beginning and it got published, it became the thing that was done. All these comparison studies, one after another, would ignore the dropouts. And to me, it's a very sad chapter of psychotherapy research because just recently, I think about two years ago, someone got access to the subjects in one of those studies. They chased down the dropouts and found out why they dropped out and a lot of them dropped out because they were getting worse as a result of the treatment. So, disregard not counting them as failures were problem number one, but also not even following up to see why they dropped out. It to me is so sad. So there was this ongoing controversy about which was better EMDR or exposure and that controversy should have never existed. Because if they had been responsible about reporting the results, it would've been clear partially because of how all this evolved.
Phil Manfield, Ph.D.: (14:55)
They started all going to exposure and there was a really disruptable meta-study that was done. And the conclusion of it was that EMDR was just flash. So why research EMDR? Why not just put all the research money in flash? It was what the NIMH did for 10 years. Until that meta-study was discredited. But, that was a critical 10 years. During that 10 years, there was more research done in Holland on EMDR than in the entire United States.
Phil Manfield, Ph.D.: (15:33)
Yeah. Before that, uh, before the IMH clamped down, EMDR had more randomized controlled trials than any other treatment of trauma, so, mm-hmm. , um, it was, it's really tragic.
Dr. Sutton: (15:49)
How do you describe what EMDR is doing? I was actually just looking for it. I can't find it right now. The paper from 2018 on looking at all the kind of different theories of what EMDR is doing and kind of how it's working. And I reached out to the author because I wanted to interview them also. How do you describe it, or how do you conceptualize it?
Phil Manfield, Ph.D.: (16:14)
Who is the Author?
Dr. Sutton: (16:14)
It'll take me a moment to find it. He actually just wrote back today. But yeah, I'll find it here. How do you conceptualize or how do you communicate what's going on in EMDR? Because I have a similar experience. You know, I've not gotten trained in prolonged exposure. I've kind of used the manual with a client that didn't feel like they wanted to, or were ready to do EMDR. But sometimes in the training, I describe it as EMDR, which I feel opens the door for the client to walk through. Prolonged exposure is kinda like driving a Mac truck through the door. It's like a very intense and telling the same story over and over and recording it and listening to, it’s you know.
Phil Manfield, Ph.D.: (16:53)
Doing homework.
Dr. Sutton: (16:54)
Yeah. It can be very hard for some folks. Not that EMDR is not hard also because it's also accessing all those unprocessed emotions and the pain.
Phil Manfield, Ph.D.: (17:04)
Right. But it's relatively brief.
Dr. Sutton: (17:06)
There's something more palatable about that I found.
Phil Manfield, Ph.D.: (17:10)
The amount of time that the person is accessing the disturbance is way less and there's no homework. A single incident trauma normally gets resolved in two, or three sessions.
Dr. Sutton: (17:27)
So, how do you describe what's happening?
Phil Manfield, Ph.D.: (17:35)
Well, there are a bunch of theories. There's that file out of stimulation, taxes, and working memory that the orienting response is a big part of it. That it's like REM sleep. I think all the theories are probably right. There's probably some of everything, but my own internal model of what EMDR does is it causes the client to be in the present as an adult, as an observer of what happened to them. And at the same time to have one foot in the past and be recalling the experience. And so, I mean, I don't think there's any woohoo to it, really. If you take someone, people have a disturbing, traumatic experience, the brain doesn't work properly during that experience, and they come away with conclusions that don't make sense. They're irrational and usually, there's a distortion in the sense of self.
Phil Manfield, Ph.D.: (19:01)
And all you really have to do is get that person to integrate an adult perspective with their memory of the incident. And as they start thinking as an adult, then all those distortions basically go away. Sometimes you need to help them go away a little bit, but that's the basic, to me, that's the basic mechanism. And as those distortions go away, then the person's saying, “Well, it wasn't really my fault,” or “I'm not a bad person.” I mean these distortions just dissolve and I think that really sort of takes the teeth out of the trauma.
Dr. Sutton: (19:47)
It's like that dual awareness is allowing them to access that kind of adult present mind with that past trauma mind, or especially with childhood trauma with that child mind. I actually do CBT, anything about CBT is top-down processing and then the EMDR is the bottom-up that somebody might know rationally it's not my fault, but emotionally they still have the reactivity related to it.
Phil Manfield, Ph.D.: (20:12)
Exactly. if it's not viscerally held then every time a person gets triggered, they have to say to themselves, “Now what did Dr. Jones tell me about this? How I should think about it?” And it's a roundabout way of dealing with it. Whereas with EMDR, the memory gets altered while it's in working memory, and then it gets stored back as a changed memory and then there's no having to work at it because that becomes a person's reality.
Dr. Sutton: (20:47)
Yeah. That kinda really shifts it.
Phil Manfield, Ph.D.: (20:50)
You know, I am getting on a soapbox, but just, another little bit of how I think about this. You know, when you have trauma memory and you're getting all this release of norepinephrine, and the hippocampus sort of freezes and doesn't really do its job properly. You get data that normally would be sorted through and a narrative would be created and it would be, I like to think of it as a jpeg. It becomes a condensed form and then it gets stored in long-term memory in that condensed form, that's normal memory. But with trauma memory, if the hippocampus gets frozen, a lot of that, or at least some of that memory of the trauma gets stored in a raw form. And what makes me say it is that when people have PTSD, they're often able to replay the trauma in minute detail as if it's happening right now. And normally that's not possible because we discard most of the data. So I think of the healing of PTSD and severe trauma. I think of it as that raw data gets run through the hippocampus, a narrative, an appropriate narrative gets added to it, and then it gets stored in long-term memory. And then flashbacks are not possible because we don't have the data anymore.
Dr. Sutton: (22:35)
The way I conceptualize it, it's like puzzle pieces that are strewn throughout the mind that aren't put together and filed away in long-term memory. And so when those puzzle pieces get triggered, we end up reacting disproportionately in the present due to that past experience.
Phil Manfield, Ph.D.: (22:49)
Exactly. It feels like it's a present experience because that raw data doesn't have a date stamp on it.
Dr. Sutton: (22:56)
Yeah and the EMDR I've found too, what I really like about it is that it's integrating those kinds of verbal and nonverbal. Like in one EMDR, I give an example of my client, I said, you know, after the bilateral stimulation saying, “What's going on for you now?” And he says, “I feel cold.” And I said, “Okay, go with that.” And we did more bilateral stimulation and I said, “What's going on now?” He said, “I'm remembering after the abuse, I was dropped on the bathroom floor and the tile was so cold”, this kind of puzzle piece of the cold was not integrated into the experience. And I could have been like, “Well, you know, I'll turn up the heat and here,” or something like that. But instead, I knew just keep on going. Because that might be a somatic aspect of the trauma that's getting processed here.
Phil Manfield, Ph.D.: (23:40)
So, hopefully, we'll have time to talk about the flash technique.
Dr. Sutton: (23:46)
Yes, we'll get to that.
Phil Manfield, Ph.D.: (23:46)
Then when we do the flash technique almost invariably the first comment from the client is, first of all, they think it's weird because they don't know what just happened to them. But then they say, “well, it seems further away.”
Phil Manfield, Ph.D.: (24:12)
It seems it's not as vivid or it's further away, it seems it's always that kind of comment. And in my mind, that comment is basically saying the raw data has already gone, started going through the hippocampus, and is being re-coded.
Phil Manfield, Ph.D.: (24:41)
And, um, already a lot of the raw data has been discarded. And that's why it seems further away because it's foggier, it's vaguer, and It's not as vivid. And so as soon as they report that I say to myself, it's just gonna be a few more sets and it's gonna seem like history coming through.
Dr. Sutton: (25:02)
So please talk about your approach, the flash technique I think I heard about it two or three years ago. I don't know how long you've been doing it or when you started using it but please tell me more.
Phil Manfield, Ph.D.: (25:16)
Well, our first paper was published in January 2017. So it's recent and it grew out of, you know, EMDR started out as processing signal incident traumas. It wasn't really a robust treatment and still, most of the research is about signal incident traumas. Much harder to research something that's gonna take a lot of sessions. And you have to have a lot of money available to do that. So, almost everything is on single incidents, but what happened is that people started doing EMDR and these single incidents and they were like blown away. What happened? We're getting results in a few sessions. For almost a whole century people were saying it's impossible to treat PTSD. All of a sudden people come along saying, I can do it in three sessions. Naturally, there was controversy, but what happened is that people started working with more and more complex cases using EMDR. And they were out in the swamp because there wasn't any research on complex cases doing EMDR.
Dr. Sutton: (26:56)
I was talking to a colleague most recently and they were actually saying, “Yeah, EMDR doesn't work with complex trauma and PTSD.” And I was kind of a bit surprised by their kind of thinking around that. But yeah, it sounds like what you're saying is that, again, it moves you very quickly, but definitely more complex. There's more to it.
Phil Manfield, Ph.D.: (27:17)
Well, there is almost no research on EMDR with complex trauma. That doesn't mean it doesn't work, it just means that doing the research is way too expensive for anyone in my pay grade. So, there is only one study, it was done by Bethel Van Deko way back.
Phil Manfield, Ph.D.: (27:45)
It was sometime around 2000 and he got a lot of money to do it. And they did two sessions of intake, then they had eight sessions of treatment. And I won't go into it in very careful treatment. Everything was videotaped. Each session was discussed by a committee to decide what would happen in the next session. Not your typical level of treatment and then they came out initially and they were saying, “Yeah, we were successful.” And at follow-up the PTSD score, the CAP score was at the normal level on average. 20 is the cutoff and it was below 20 and that was at a nine-month follow-up. But a closer look at the actual study and the results revealed that it all depended on whether it was early onset trauma or late onset trauma.
Phil Manfield, Ph.D.: (28:56)
The people with late-onset trauma that is at some level of adulthood did very well. And many of them got down to a lack of disturbance, complete lack of disturbance and that affected the average really strongly. But the other half who had early onset trauma were the ones with complex PTSD and they really didn't. They improved, but they didn't improve that much. They didn't get their PTSD resolved. So, the study really didn't show that EMDR was effective for complex PTSD. It showed that it had some influence. And that's the only study so hopefully, someday there'll be so much interest in EMDR that they'll make money available to do a legitimate study. Not that the other study wasn't legitimate but it's the only one.
Dr. Sutton: (30:01)
More focus on that early childhood trauma complex PTSD.
Phil Manfield, Ph.D.: (30:04)
I do think we know a lot more about treating complex trauma with the EMDR now than we did when Vander Colt did his study. I think only three of the 40 or 48 subjects had resourcing.
Dr. Sutton: (30:30)
Oh, Wow.
Phil Manfield, Ph.D.: (30:31)
But resourcing is really essential for creating complex PTSD. So, it really wasn't a good test. The only problem is if you spend enough time resourcing, it's gonna take more than eight sessions. And it was a new area at that time, and I think they made a mistake.
Dr. Sutton: (30:52)
I think complex PTSD is such a whole big subject and I love Pete Walker's work in that area and Anita Fisher's. I'm actually doing a 47-hour training right now which it's really great. So, take me back to the flash technique.
Phil Manfield, Ph.D.: (31:08)
So, you said, where did it come from? Where it came from is the need to be able to work with complex PTSD. So, what the EMDR world was doing four years ago with complex PTSD is, when there were memories that were totally overwhelming. They were doing usually hypnotic techniques or some kind of techniques to reduce the level of disturbance in the memory. So that it could be processed so people could tolerate thinking about it. And then once that reduced version was processed, they could go back to the original process. So that was basically what was being done and I was using one of those techniques that were developed by a woman named Christina Kowski in British Columbia. And she was using something like Peter Levine's titrating a pendulating technique.
Phil Manfield, Ph.D.: (32:18)
And she was doing it with EMDR. So she was having people think of a positive image then for just a brief moment, think of the edge of what Levine would call the trauma vortex and come back to the positive. And, gradually increase the amount of time that the person would be focused on the disturbance, and of course, that was dropping. And then they could go more and more into the vortex. So, I thought that was great. I mean, that to me was the best solution available. And so I applied to present that at the EMDR conference, EMDR International Association and was accepted. And then I was preparing my presentation and I started thinking I was also integrating it with memory consolidation theory.
Phil Manfield, Ph.D.: (33:22)
I was preparing the presentation and I said to myself, “There seem to be some processing effects that happen with this equation because the memory becomes less disturbing and that's why people can entertain more and more of the actual disturbance. So, I also noticed that the briefer, the connection to the trauma, the less disturbing the connection to the trauma, and the more of a processing effect that I was getting. And so I said to myself, “how much can I reduce that disturbance?” And I reduced it to nothing at all. And will that increase the processing effect? And in fact, it did. And, we've seen since seen studies, particularly by Paul Siegel. He's written nine papers that are about basically what he calls unreportable stimuli, that is stimuli that don't trigger the amygdala to get into fight or flight. And, so he's shown with fMRI that if you don't stimulate the amygdala, the prefrontal cortex becomes more active and can more effectively deal with the trauma. The traumas he was working with were phobias and fear, but we believe that's the mechanism with flash.
Dr. Sutton: (35:17)
You're not stimulating the amygdala or not stimulating that fear response and so it keeps the frontal lobe engaged.
Phil Manfield, Ph.D.: (35:25)
Exactly. I mean, you stimulate the amygdala, but not in a reportable way. Not in a conscious way. Not in a reporting way.
Dr. Sutton: (35:31)
. Okay, not in a conscious fantasy.
Phil Manfield, Ph.D.: (35:33)
So the amygdala. It doesn't stimulate the amygdala in a way that towards the prefrontal cortex, which trauma normally does.
Phil Manfield, Ph.D.: (35:47)
So, basically flash is a way of processing trauma without stimulating the, we create a distraction, a positive distraction. We create a powerful enough distraction that when the person's focused on the distraction, they're not thinking of their disturbance. And we have them periodically check in briefly on the disturbing memory, but not actually think of any of the details. You know, initially, they report well, seems further away. And then over relatively few sets of this kind of engagement they often, they don't feel any disturbance at all. If they do feel a disturbance and it's not continuing to diminish, we switch to the rest of the standard EMDR protocol. Because of this, we developed this for the preparation phase of the standard EMDR protocol. I believe that can be used, should be used with exposure, and should be used with cognitive behavioral therapy. The application is enormous.
Dr. Sutton: (37:07)
Can I describe my understanding of the fatigue or the technique? I don't know if you don't want to give away that piece to have them come from my understanding. Is that you're having them, particularly in a part of resource installation? EMDR is bringing up a safe place. And actually, we do some of the bilateral stimulation usually to kind of install that. And then the person is having that safe place in mind.
Phil Manfield, Ph.D.: (37:34)
I just wanna interrupt.
Dr. Sutton: (37:35)
Yes, of course.
Phil Manfield, Ph.D.: (37:36)
The safe place doesn't apply.
Dr. Sutton: (37:37)
Okay.
Phil Manfield, Ph.D.: (37:38)
It's not a positive memory.
Phil Manfield, Ph.D.: (37:42)
It can be a positive memory, or It can be anything that's distracting really.
Dr. Sutton: (37:52)
Just thinking about something that's not the trauma.
Phil Manfield, Ph.D.: (37:55)
Sort of, I have a woman who loves hats and kittens. So a lady on YouTube called The Cat Lady has these videos that she produces every week of kittens that she's fostering. And she has them do these incredible, cute things. My client loves those videos, so when we do flash, she's looking at YouTube and watching these little kittens and she is totally engaged. That works perfectly.
Dr. Sutton: (38:24)
There you go and then I think that what I remember from the video, you were kind of saying that we're going to kind of move through it almost as quickly as kind of moving your hand through the flame of a candle.
Phil Manfield, Ph.D.: (38:37)
That's the old version.
Dr. Sutton: (38:38)
Oh, saying I'm behind them.
Phil Manfield, Ph.D.: (38:41)
Yeah. Way behind them and that's what was described in the initial paper that we published.
Phil Manfield, Ph.D.: (38:48)
So we had people if you think of what I said about Kowalski's protocol. We basically were extending that to its extreme and basically saying, you're gonna start from the positive, then you're gonna touch on the trauma memory. But so briefly flashes that you don't get any of the details, you don't get any of the disturbance.
Phil Manfield, Ph.D.: (39:12)
But after a while, I started saying to myself, “Well, I think basically we're doing this so briefly in a way they're not connecting to trauma in any conscious way. So why have them go even to the trauma? So, now we don't even do that. We just, once they've accessed the disturbance, assume it's now in working memory. And then when it comes to accessing it, we say just, “I'm, I'm gonna say the word flash, and you're gonna link your eyes three times rapidly.” And that's the exposure basically.
Dr. Sutton: (39:52)
Wow. Okay. I'm gonna say flash, and you're gonna connect with that.
Phil Manfield, Ph.D.: (39:57)
You're not connecting your disturbance at all. You're not thinking about it.
Dr. Sutton: (40:01)
Wow.
Phil Manfield, Ph.D.: (40:02)
Because in the early days we were telling people, “Well, you're gonna think of the trauma, but so briefly you're not gonna get disturbed.” That was a complicated instruction, and people often either couldn't get it quite. It would take quite a bit of time for them to understand what we wanted them to do. Now we say, “just blink.” And that's easy.
Dr. Sutton: (40:23)
And then in the subjective units of distress, the 0 to 10 who are disturbing or so on, significantly reduced just by that flash aspect. And in part you're saying sometimes it'll even go down to zero. I'm wondering and there's a part of me that's like because through the EMDR oftentimes it's such a journey of kind of processing and the person really kind of coming to this understanding. And this really significant shift sometimes using interweaves and me bringing in protective figures and going in, comforting their abused child herself. Does that come in the complex? Does that come in with a flash or do they get to the positive cognition?
Phil Manfield, Ph.D.: (41:16)
You know, think of it this way. I mean, EMDR is not rocket science. I mean, EMDR is mostly just kind of a head slap. It's like, “what could I have been thinking?” That's really what happens, you know? And what causes that to happen is a person gets into an adult perspective and says, “Well, God, I was only five years old. How could I possibly think it was my fault?” So, it is a head slap and that head slap occurs all by itself, usually with a flash. As a person gets an adult perspective, they become an observer rather than the person that it happened to. And, so normally we don't have to do any kind of cognitive work with them at all just comes spontaneously.
Phil Manfield, Ph.D.: (42:11)
Now, sometimes the distortion doesn't quite unravel by itself and then people have a choice. They can switch to the standard EMDR protocol where they work with cognitions and they do cognitive interweaves and they do interventions that directly resolve the cognitive distortion. Or they can do the equivalent of a cognitive interweave with flash. We don't really teach that because what made Flash legitimate in the beginning, before there was the research that was done within the context of the EMDR protocol. And it started in the preparation phase so when you were teaching it as something you do until you switch back to the standard protocol. But really every time we do a demo, we take it to zero using flash. Almost every time.
Dr. Sutton: (43:14)
Interesting. I'm excited to do the training. You were so gracious to send me the link to get it through your website.
Phil Manfield, Ph.D.: (43:22)
We do a six-hour webinar every two months or so.
Dr. Sutton: (43:28)
You can get there through your website to sign up.
Phil Manfield, Ph.D.: (43:34)
www.flashtechnique.com
Dr. Sutton: (43:38)
I was actually surprised during this pandemic, I'd never actually done EMDR remotely. But now since everybody was shut down last March they started doing it and I’m just blown away. Like how effective it is even over Zoom, even doing pieces of training with breakout rooms for therapists and doing it online just tapping on themselves and having like amazing results. Flash technique also I'm assuming?
Phil Manfield, Ph.D.: (44:13)
Absolutely, and the funny thing is both the Flash webinar and the EMDR training, there's always someone at the end of the training who says, “We do this remotely and they just finished doing the practicum remotely.”
Dr. Sutton: (44:31)
Well, great and I think too that. The people that have that powerful experience doing the training too are oftentimes the people who are more likely to go on and use it with clients. And so unfortunately not everybody has that kind of significant experience in training or so on. And so I always encourage people to check it out or try it again or so on once.
Phil Manfield, Ph.D.: (45:01)
My philosophy, first of all, is for people who haven't had the experience or haven't seen it. If they've taken my training, they've seen it because I do live demonstrations Saturday and Sunday. And people see the magic of EMDR firsthand, one of their people and I don't select, it is whoever comes up and volunteers to be the subject. I work with them. And those demos are almost always completely successful and people go to zero. So, people have the experience, even if they don't personally experience in the practicum, but usually, they do in the practicum. But those people who've, for instance, taken the training from someone else and they really haven't seen the magic. I have a website, www.EMDRvideo.com, that has 44 full-length sessions. And it's free and people can see most of them are very powerful sessions. And you don't watch that and say, “Now is this real? Is this person trying to be compliant?” No, it's really nitty gritty.
Dr. Sutton: (46:18)
And by the way, I found that, the article that I was mentioning earlier. It's, How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systemic Review on Suggested Mechanisms of Action by Raymond Landon Romero, Anna Moreno Alcazar, Marco Pagani, and Benedict Amann. So they're from Sydney, Australia. So anyway, I'll send that to you, but it's for people that are interested in neuroscience.
Phil Manfield, Ph.D.: (46:53)
I will throw in that there's a fellow in Amsterdam and he's, at this point, he's published about 175 papers. He's very prolific and he has a clinic that works with a lot of trauma patients. And he's a strong advocate that what you're doing is taxing working memory with EMDR. And if you tax working memory, then the vividness of the memory diminishes because it can't be held in working memory, while working memory is being taxed in other ways. So he has people dancing around in some complicated step and he's dancing around in front of him, moving his hands, and they're moving their eyes. I mean in my opinion, what he's doing is distracting clients. He's just doing flash. But, he believes that you're, he's taxing working memory, but he does get very powerful results. So, I mean, the others may be right too, but pretty clearly he's got something that's working there.
Dr. Sutton: (48:18)
Well, thank you so much for taking the time today. This is great and I can't actually wait to take the training, you've got a lot of really great information. Thank you so much. I really appreciate it.
Phil Manfield, Ph.D.: (48:30)
Well, my pleasure. This has been fun.
Dr. Sutton: (48:32)
Take care. Bye-bye.
Phil Manfield, Ph.D.: (48:34)
Bye.
Dr. Sutton: (50:24)
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Welcome to Therapy on The Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute For The Advancement of Psychotherapy. Today I'll be speaking with Phil Manfield, Ph.D., who is a licensed marriage and family therapist and EMDR trainer. He has authored and edited a number of books, including EMDR Up Close Subtleties of Trauma Processing, EMDR Casebook, and Extending EMDR: a Casebook of Innovative Applications. He is also the developer of the EMDR technique, the Flash Technique, and has taught throughout the world. And is the Northern California Regional Coordinator for the EMDR International Association. Let's listen to the interview. Hi, Phil. Welcome. Thank you for joining today.
Phil Manfield, Ph.D.: (01:14)
Pleasure.
Dr. Sutton: (01:15)
Well, great. I've been really interested in your work. I have known about you for some years. You're one of the EMDR trainers in the Bay Area. I've actually had a number of my associates who are training under me go to your level one and level two training. Bart Rubin, who was part of my practice and actually the person that trained me. I know that you know him well. And so I wanted to learn a little bit more about kind of your work and the evolution of your thinking. And I know you've also begun using a new technique called the Flash Technique, which has been really interesting. I've learned a little bit about it. Bart actually did a training for us and showed some video of a session. I would love to just kind of start off and hear a little bit about your career and how you got to do it and what you're doing.
Phil Manfield, Ph.D.: (02:05)
Well, let me see. I came to California as a theoretical mathematician. I went to Cal and was working on my dissertation and got myself into personal therapy. And after a while, I started saying to myself, Well, let me see. What do I wanna do with my life? Do I want to write papers that maybe 10 people in the world can understand, or do I wanna change people's lives the way mine had been changed? So I transitioned into psychology. You know, there I was a graduate student at Cal and was more interested in psychology than mathematics, but I was on a fellowship that was paying my way. I had no choice but to do mathematics. And so I went over to the psychology department, and I asked, you know, what I could take that was clinical while I was still in the math department.
Phil Manfield, Ph.D.: (03:24)
And they said, “We don't really have any clinical courses.” In the old days, college just ran mice through mazes. But the closest thing they had to clinical was a group course. A course in group Dynamics, 400 people in a big lecture hall. But then they had everyone divided into groups of 20, and people would meet in their subsections and they would function as a group. So I went to my subsection and the leader came up to me afterward and said, “Well, you're a graduate student, right?” And I said, “Yeah.” And he said, “Well, we're short a few group leaders here, and how would you like to lead a group?” And I said, “Well, I'm in math.” He said, “That doesn't matter.” So, I led a group for a semester, and it was just a blast.
Phil Manfield, Ph.D.: (04:26)
I just loved it and that basically decided it for me. So for 40 years, I think it was that long, but I was licensed in 76. And I was always looking for a way that I could make an impact that was as big as the impact that had been made on me. And I thought I was a pretty good therapist, but I never really hit the home run like the therapist I had done for me. And then I wrote a book on analysis and the year that it was being published my brother who was a psychologist in Portland, Oregon the two us were sitting on mount ta PAs drinking wine. And he told me about this nutty technique that he had read about.
Phil Manfield, Ph.D.: (05:37)
He had read both of Shapiro's papers and he had said, “You know, this feels like it could be something important.” And he had tried just doing it on his own with no training and had gotten some good results. So the following week I saw an ad for the first and only training in Berkeley and I took it. AI I have to say, I was not impressed by the bureau. I was not impressed by much of the training, but I was totally blown away by my experience in the practicum. And that told me there's something here that I really need to pay attention to.
Dr. Sutton: (06:24)
That's a big part of the EMDR training is practicing on each other.
Phil Manfield, Ph.D.: (06:29)
Yeah. That's accurate really.
Dr. Sutton: (06:31)
That experience, which I think is really unique to EMDR. You might role-play or something like that, but not really have that powerful experience of actually doing EMDR with somebody else and having them do it with you.
Phil Manfield, Ph.D.: (06:46)
Yeah, it's the real thing. I had been in analysis, union analysis for a year and a half because I'd been rear-ended at a traffic light. I'd seen the car coming from a quarter mile away, and I'd watched in my rearview mirror as they just came up and just slammed into me. So I had symptoms. I couldn't sit still at a traffic light if someone was coming up behind me. And the same with the stop sign. So, it had been a year and a half, some of it was two times a week on the couch. And in 35 minutes of the practicum with a therapist who had never done this before I resolved the problem. So it was like, sit up and take notice.
Dr. Sutton: (07:35)
I know with my experience with the EMDR and learning it and training others in it. And during, it's like there's almost a magical quality to it, which I think is why a lot of people oftentimes see it as very woohoo. Especially, I don't know about you, but I come from more of an evidence-based and practical kind of background. And so I was actually pleasantly kind of surprised in learning about it when I got trained many years ago by Bart. So it ended up impacting you and you thought that you got more interested in that. Tell me more.
Phil Manfield, Ph.D.: (08:11)
Yeah, and I was fortunate because Shapiro was looking for ways to legitimize EMDR in the eyes of academics. And I had just published this book on analysis, object relations. So he invited me to be part of the organization and facilitate the training, facilitating the practicums. So, I was not a great EMDR therapist at the time. I really shouldn't have been a facilitator, but there I was doing it. And it's a great way to learn.
Phil Manfield, Ph.D.: (08:52)
So I became a really good EMDR therapist, basically by teaching.
Dr. Sutton: (08:59)
Great, and so how long have you been teaching EMDR now?
Phil Manfield, Ph.D.: (09:06)
Well, I was a facilitator for about 10 years. I think in 1999 or 2000 I started actually teaching my own training. And I've been teaching training ever since. I've traveled a lot and taught, and I've been teaching in the Bay Area, West Coast, and Portland.
Dr. Sutton: (09:32)
So I came to EMDR, I guess it was 2006 when I was in my pre-doc. There's a lot of skepticism in the field, or especially the CVT folks, who seem to have a lot of issues with EMDR. And I know it was put as evidence-based by controversial. Although I know that it's now an A-grade treatment by the American Psychological Association. It's one of the treatments of choice by the Veterans Administration and Health Organization and World Health Organization. And so you might know more about the history cause I kind of just dropped in, I think midway. Can you tell me a little bit about that?
Phil Manfield, Ph.D.: (10:23)
I'll just try to restrain myself. I just finished a lengthy email exchange with the clinical director of a large counseling center because he came to part one training. And he was unhappy that I was so negative toward a particular exposure. So we went back and forth and he was giving me all the arguments why exposure was the treatment of choice. And I was explaining why those arguments were not valid. But the history of EMDR has been very controversial. EMDR started around the same time as the introduction of exposure.
Dr. Sutton: (11:19)
Prolonged exposure
Phil Manfield, Ph.D.: (11:21)
Right, I think one of the big differences that really charted the course was, first of all, Shapiro was kind of an abrupt person. She made a lot of enemies. Also, people could be trained in exposure in a fairly brief amount, whereas EMDR required two weekends. And back then, now there's also a consultation requirement, but back then there wasn't. So, very quickly, there were many more therapists doing exposure than there were doing EMDR. And, the science behind psychology, unfortunately, is very political. And, the more people you've got in your camp, the better your results you're gonna look. But the big thing was that in the beginning when people did comparisons between exposure and EMDR, there was a 30% dropout rate in exposure.
Phil Manfield, Ph.D.: (12:46)
And virtually none in EMDR, very low dropout rate. And some of the early papers just ignored their dropouts. And so when they compared EMDR and exposure, they said, “Well, the results were comparable.” Never mentioned the 30% that I consider to be clinical failures because they didn't make it. And because that was what was done in the beginning and it got published, it became the thing that was done. All these comparison studies, one after another, would ignore the dropouts. And to me, it's a very sad chapter of psychotherapy research because just recently, I think about two years ago, someone got access to the subjects in one of those studies. They chased down the dropouts and found out why they dropped out and a lot of them dropped out because they were getting worse as a result of the treatment. So, disregard not counting them as failures were problem number one, but also not even following up to see why they dropped out. It to me is so sad. So there was this ongoing controversy about which was better EMDR or exposure and that controversy should have never existed. Because if they had been responsible about reporting the results, it would've been clear partially because of how all this evolved.
Phil Manfield, Ph.D.: (14:55)
They started all going to exposure and there was a really disruptable meta-study that was done. And the conclusion of it was that EMDR was just flash. So why research EMDR? Why not just put all the research money in flash? It was what the NIMH did for 10 years. Until that meta-study was discredited. But, that was a critical 10 years. During that 10 years, there was more research done in Holland on EMDR than in the entire United States.
Phil Manfield, Ph.D.: (15:33)
Yeah. Before that, uh, before the IMH clamped down, EMDR had more randomized controlled trials than any other treatment of trauma, so, mm-hmm. , um, it was, it's really tragic.
Dr. Sutton: (15:49)
How do you describe what EMDR is doing? I was actually just looking for it. I can't find it right now. The paper from 2018 on looking at all the kind of different theories of what EMDR is doing and kind of how it's working. And I reached out to the author because I wanted to interview them also. How do you describe it, or how do you conceptualize it?
Phil Manfield, Ph.D.: (16:14)
Who is the Author?
Dr. Sutton: (16:14)
It'll take me a moment to find it. He actually just wrote back today. But yeah, I'll find it here. How do you conceptualize or how do you communicate what's going on in EMDR? Because I have a similar experience. You know, I've not gotten trained in prolonged exposure. I've kind of used the manual with a client that didn't feel like they wanted to, or were ready to do EMDR. But sometimes in the training, I describe it as EMDR, which I feel opens the door for the client to walk through. Prolonged exposure is kinda like driving a Mac truck through the door. It's like a very intense and telling the same story over and over and recording it and listening to, it’s you know.
Phil Manfield, Ph.D.: (16:53)
Doing homework.
Dr. Sutton: (16:54)
Yeah. It can be very hard for some folks. Not that EMDR is not hard also because it's also accessing all those unprocessed emotions and the pain.
Phil Manfield, Ph.D.: (17:04)
Right. But it's relatively brief.
Dr. Sutton: (17:06)
There's something more palatable about that I found.
Phil Manfield, Ph.D.: (17:10)
The amount of time that the person is accessing the disturbance is way less and there's no homework. A single incident trauma normally gets resolved in two, or three sessions.
Dr. Sutton: (17:27)
So, how do you describe what's happening?
Phil Manfield, Ph.D.: (17:35)
Well, there are a bunch of theories. There's that file out of stimulation, taxes, and working memory that the orienting response is a big part of it. That it's like REM sleep. I think all the theories are probably right. There's probably some of everything, but my own internal model of what EMDR does is it causes the client to be in the present as an adult, as an observer of what happened to them. And at the same time to have one foot in the past and be recalling the experience. And so, I mean, I don't think there's any woohoo to it, really. If you take someone, people have a disturbing, traumatic experience, the brain doesn't work properly during that experience, and they come away with conclusions that don't make sense. They're irrational and usually, there's a distortion in the sense of self.
Phil Manfield, Ph.D.: (19:01)
And all you really have to do is get that person to integrate an adult perspective with their memory of the incident. And as they start thinking as an adult, then all those distortions basically go away. Sometimes you need to help them go away a little bit, but that's the basic, to me, that's the basic mechanism. And as those distortions go away, then the person's saying, “Well, it wasn't really my fault,” or “I'm not a bad person.” I mean these distortions just dissolve and I think that really sort of takes the teeth out of the trauma.
Dr. Sutton: (19:47)
It's like that dual awareness is allowing them to access that kind of adult present mind with that past trauma mind, or especially with childhood trauma with that child mind. I actually do CBT, anything about CBT is top-down processing and then the EMDR is the bottom-up that somebody might know rationally it's not my fault, but emotionally they still have the reactivity related to it.
Phil Manfield, Ph.D.: (20:12)
Exactly. if it's not viscerally held then every time a person gets triggered, they have to say to themselves, “Now what did Dr. Jones tell me about this? How I should think about it?” And it's a roundabout way of dealing with it. Whereas with EMDR, the memory gets altered while it's in working memory, and then it gets stored back as a changed memory and then there's no having to work at it because that becomes a person's reality.
Dr. Sutton: (20:47)
Yeah. That kinda really shifts it.
Phil Manfield, Ph.D.: (20:50)
You know, I am getting on a soapbox, but just, another little bit of how I think about this. You know, when you have trauma memory and you're getting all this release of norepinephrine, and the hippocampus sort of freezes and doesn't really do its job properly. You get data that normally would be sorted through and a narrative would be created and it would be, I like to think of it as a jpeg. It becomes a condensed form and then it gets stored in long-term memory in that condensed form, that's normal memory. But with trauma memory, if the hippocampus gets frozen, a lot of that, or at least some of that memory of the trauma gets stored in a raw form. And what makes me say it is that when people have PTSD, they're often able to replay the trauma in minute detail as if it's happening right now. And normally that's not possible because we discard most of the data. So I think of the healing of PTSD and severe trauma. I think of it as that raw data gets run through the hippocampus, a narrative, an appropriate narrative gets added to it, and then it gets stored in long-term memory. And then flashbacks are not possible because we don't have the data anymore.
Dr. Sutton: (22:35)
The way I conceptualize it, it's like puzzle pieces that are strewn throughout the mind that aren't put together and filed away in long-term memory. And so when those puzzle pieces get triggered, we end up reacting disproportionately in the present due to that past experience.
Phil Manfield, Ph.D.: (22:49)
Exactly. It feels like it's a present experience because that raw data doesn't have a date stamp on it.
Dr. Sutton: (22:56)
Yeah and the EMDR I've found too, what I really like about it is that it's integrating those kinds of verbal and nonverbal. Like in one EMDR, I give an example of my client, I said, you know, after the bilateral stimulation saying, “What's going on for you now?” And he says, “I feel cold.” And I said, “Okay, go with that.” And we did more bilateral stimulation and I said, “What's going on now?” He said, “I'm remembering after the abuse, I was dropped on the bathroom floor and the tile was so cold”, this kind of puzzle piece of the cold was not integrated into the experience. And I could have been like, “Well, you know, I'll turn up the heat and here,” or something like that. But instead, I knew just keep on going. Because that might be a somatic aspect of the trauma that's getting processed here.
Phil Manfield, Ph.D.: (23:40)
So, hopefully, we'll have time to talk about the flash technique.
Dr. Sutton: (23:46)
Yes, we'll get to that.
Phil Manfield, Ph.D.: (23:46)
Then when we do the flash technique almost invariably the first comment from the client is, first of all, they think it's weird because they don't know what just happened to them. But then they say, “well, it seems further away.”
Phil Manfield, Ph.D.: (24:12)
It seems it's not as vivid or it's further away, it seems it's always that kind of comment. And in my mind, that comment is basically saying the raw data has already gone, started going through the hippocampus, and is being re-coded.
Phil Manfield, Ph.D.: (24:41)
And, um, already a lot of the raw data has been discarded. And that's why it seems further away because it's foggier, it's vaguer, and It's not as vivid. And so as soon as they report that I say to myself, it's just gonna be a few more sets and it's gonna seem like history coming through.
Dr. Sutton: (25:02)
So please talk about your approach, the flash technique I think I heard about it two or three years ago. I don't know how long you've been doing it or when you started using it but please tell me more.
Phil Manfield, Ph.D.: (25:16)
Well, our first paper was published in January 2017. So it's recent and it grew out of, you know, EMDR started out as processing signal incident traumas. It wasn't really a robust treatment and still, most of the research is about signal incident traumas. Much harder to research something that's gonna take a lot of sessions. And you have to have a lot of money available to do that. So, almost everything is on single incidents, but what happened is that people started doing EMDR and these single incidents and they were like blown away. What happened? We're getting results in a few sessions. For almost a whole century people were saying it's impossible to treat PTSD. All of a sudden people come along saying, I can do it in three sessions. Naturally, there was controversy, but what happened is that people started working with more and more complex cases using EMDR. And they were out in the swamp because there wasn't any research on complex cases doing EMDR.
Dr. Sutton: (26:56)
I was talking to a colleague most recently and they were actually saying, “Yeah, EMDR doesn't work with complex trauma and PTSD.” And I was kind of a bit surprised by their kind of thinking around that. But yeah, it sounds like what you're saying is that, again, it moves you very quickly, but definitely more complex. There's more to it.
Phil Manfield, Ph.D.: (27:17)
Well, there is almost no research on EMDR with complex trauma. That doesn't mean it doesn't work, it just means that doing the research is way too expensive for anyone in my pay grade. So, there is only one study, it was done by Bethel Van Deko way back.
Phil Manfield, Ph.D.: (27:45)
It was sometime around 2000 and he got a lot of money to do it. And they did two sessions of intake, then they had eight sessions of treatment. And I won't go into it in very careful treatment. Everything was videotaped. Each session was discussed by a committee to decide what would happen in the next session. Not your typical level of treatment and then they came out initially and they were saying, “Yeah, we were successful.” And at follow-up the PTSD score, the CAP score was at the normal level on average. 20 is the cutoff and it was below 20 and that was at a nine-month follow-up. But a closer look at the actual study and the results revealed that it all depended on whether it was early onset trauma or late onset trauma.
Phil Manfield, Ph.D.: (28:56)
The people with late-onset trauma that is at some level of adulthood did very well. And many of them got down to a lack of disturbance, complete lack of disturbance and that affected the average really strongly. But the other half who had early onset trauma were the ones with complex PTSD and they really didn't. They improved, but they didn't improve that much. They didn't get their PTSD resolved. So, the study really didn't show that EMDR was effective for complex PTSD. It showed that it had some influence. And that's the only study so hopefully, someday there'll be so much interest in EMDR that they'll make money available to do a legitimate study. Not that the other study wasn't legitimate but it's the only one.
Dr. Sutton: (30:01)
More focus on that early childhood trauma complex PTSD.
Phil Manfield, Ph.D.: (30:04)
I do think we know a lot more about treating complex trauma with the EMDR now than we did when Vander Colt did his study. I think only three of the 40 or 48 subjects had resourcing.
Dr. Sutton: (30:30)
Oh, Wow.
Phil Manfield, Ph.D.: (30:31)
But resourcing is really essential for creating complex PTSD. So, it really wasn't a good test. The only problem is if you spend enough time resourcing, it's gonna take more than eight sessions. And it was a new area at that time, and I think they made a mistake.
Dr. Sutton: (30:52)
I think complex PTSD is such a whole big subject and I love Pete Walker's work in that area and Anita Fisher's. I'm actually doing a 47-hour training right now which it's really great. So, take me back to the flash technique.
Phil Manfield, Ph.D.: (31:08)
So, you said, where did it come from? Where it came from is the need to be able to work with complex PTSD. So, what the EMDR world was doing four years ago with complex PTSD is, when there were memories that were totally overwhelming. They were doing usually hypnotic techniques or some kind of techniques to reduce the level of disturbance in the memory. So that it could be processed so people could tolerate thinking about it. And then once that reduced version was processed, they could go back to the original process. So that was basically what was being done and I was using one of those techniques that were developed by a woman named Christina Kowski in British Columbia. And she was using something like Peter Levine's titrating a pendulating technique.
Phil Manfield, Ph.D.: (32:18)
And she was doing it with EMDR. So she was having people think of a positive image then for just a brief moment, think of the edge of what Levine would call the trauma vortex and come back to the positive. And, gradually increase the amount of time that the person would be focused on the disturbance, and of course, that was dropping. And then they could go more and more into the vortex. So, I thought that was great. I mean, that to me was the best solution available. And so I applied to present that at the EMDR conference, EMDR International Association and was accepted. And then I was preparing my presentation and I started thinking I was also integrating it with memory consolidation theory.
Phil Manfield, Ph.D.: (33:22)
I was preparing the presentation and I said to myself, “There seem to be some processing effects that happen with this equation because the memory becomes less disturbing and that's why people can entertain more and more of the actual disturbance. So, I also noticed that the briefer, the connection to the trauma, the less disturbing the connection to the trauma, and the more of a processing effect that I was getting. And so I said to myself, “how much can I reduce that disturbance?” And I reduced it to nothing at all. And will that increase the processing effect? And in fact, it did. And, we've seen since seen studies, particularly by Paul Siegel. He's written nine papers that are about basically what he calls unreportable stimuli, that is stimuli that don't trigger the amygdala to get into fight or flight. And, so he's shown with fMRI that if you don't stimulate the amygdala, the prefrontal cortex becomes more active and can more effectively deal with the trauma. The traumas he was working with were phobias and fear, but we believe that's the mechanism with flash.
Dr. Sutton: (35:17)
You're not stimulating the amygdala or not stimulating that fear response and so it keeps the frontal lobe engaged.
Phil Manfield, Ph.D.: (35:25)
Exactly. I mean, you stimulate the amygdala, but not in a reportable way. Not in a conscious way. Not in a reporting way.
Dr. Sutton: (35:31)
. Okay, not in a conscious fantasy.
Phil Manfield, Ph.D.: (35:33)
So the amygdala. It doesn't stimulate the amygdala in a way that towards the prefrontal cortex, which trauma normally does.
Phil Manfield, Ph.D.: (35:47)
So, basically flash is a way of processing trauma without stimulating the, we create a distraction, a positive distraction. We create a powerful enough distraction that when the person's focused on the distraction, they're not thinking of their disturbance. And we have them periodically check in briefly on the disturbing memory, but not actually think of any of the details. You know, initially, they report well, seems further away. And then over relatively few sets of this kind of engagement they often, they don't feel any disturbance at all. If they do feel a disturbance and it's not continuing to diminish, we switch to the rest of the standard EMDR protocol. Because of this, we developed this for the preparation phase of the standard EMDR protocol. I believe that can be used, should be used with exposure, and should be used with cognitive behavioral therapy. The application is enormous.
Dr. Sutton: (37:07)
Can I describe my understanding of the fatigue or the technique? I don't know if you don't want to give away that piece to have them come from my understanding. Is that you're having them, particularly in a part of resource installation? EMDR is bringing up a safe place. And actually, we do some of the bilateral stimulation usually to kind of install that. And then the person is having that safe place in mind.
Phil Manfield, Ph.D.: (37:34)
I just wanna interrupt.
Dr. Sutton: (37:35)
Yes, of course.
Phil Manfield, Ph.D.: (37:36)
The safe place doesn't apply.
Dr. Sutton: (37:37)
Okay.
Phil Manfield, Ph.D.: (37:38)
It's not a positive memory.
Phil Manfield, Ph.D.: (37:42)
It can be a positive memory, or It can be anything that's distracting really.
Dr. Sutton: (37:52)
Just thinking about something that's not the trauma.
Phil Manfield, Ph.D.: (37:55)
Sort of, I have a woman who loves hats and kittens. So a lady on YouTube called The Cat Lady has these videos that she produces every week of kittens that she's fostering. And she has them do these incredible, cute things. My client loves those videos, so when we do flash, she's looking at YouTube and watching these little kittens and she is totally engaged. That works perfectly.
Dr. Sutton: (38:24)
There you go and then I think that what I remember from the video, you were kind of saying that we're going to kind of move through it almost as quickly as kind of moving your hand through the flame of a candle.
Phil Manfield, Ph.D.: (38:37)
That's the old version.
Dr. Sutton: (38:38)
Oh, saying I'm behind them.
Phil Manfield, Ph.D.: (38:41)
Yeah. Way behind them and that's what was described in the initial paper that we published.
Phil Manfield, Ph.D.: (38:48)
So we had people if you think of what I said about Kowalski's protocol. We basically were extending that to its extreme and basically saying, you're gonna start from the positive, then you're gonna touch on the trauma memory. But so briefly flashes that you don't get any of the details, you don't get any of the disturbance.
Phil Manfield, Ph.D.: (39:12)
But after a while, I started saying to myself, “Well, I think basically we're doing this so briefly in a way they're not connecting to trauma in any conscious way. So why have them go even to the trauma? So, now we don't even do that. We just, once they've accessed the disturbance, assume it's now in working memory. And then when it comes to accessing it, we say just, “I'm, I'm gonna say the word flash, and you're gonna link your eyes three times rapidly.” And that's the exposure basically.
Dr. Sutton: (39:52)
Wow. Okay. I'm gonna say flash, and you're gonna connect with that.
Phil Manfield, Ph.D.: (39:57)
You're not connecting your disturbance at all. You're not thinking about it.
Dr. Sutton: (40:01)
Wow.
Phil Manfield, Ph.D.: (40:02)
Because in the early days we were telling people, “Well, you're gonna think of the trauma, but so briefly you're not gonna get disturbed.” That was a complicated instruction, and people often either couldn't get it quite. It would take quite a bit of time for them to understand what we wanted them to do. Now we say, “just blink.” And that's easy.
Dr. Sutton: (40:23)
And then in the subjective units of distress, the 0 to 10 who are disturbing or so on, significantly reduced just by that flash aspect. And in part you're saying sometimes it'll even go down to zero. I'm wondering and there's a part of me that's like because through the EMDR oftentimes it's such a journey of kind of processing and the person really kind of coming to this understanding. And this really significant shift sometimes using interweaves and me bringing in protective figures and going in, comforting their abused child herself. Does that come in the complex? Does that come in with a flash or do they get to the positive cognition?
Phil Manfield, Ph.D.: (41:16)
You know, think of it this way. I mean, EMDR is not rocket science. I mean, EMDR is mostly just kind of a head slap. It's like, “what could I have been thinking?” That's really what happens, you know? And what causes that to happen is a person gets into an adult perspective and says, “Well, God, I was only five years old. How could I possibly think it was my fault?” So, it is a head slap and that head slap occurs all by itself, usually with a flash. As a person gets an adult perspective, they become an observer rather than the person that it happened to. And, so normally we don't have to do any kind of cognitive work with them at all just comes spontaneously.
Phil Manfield, Ph.D.: (42:11)
Now, sometimes the distortion doesn't quite unravel by itself and then people have a choice. They can switch to the standard EMDR protocol where they work with cognitions and they do cognitive interweaves and they do interventions that directly resolve the cognitive distortion. Or they can do the equivalent of a cognitive interweave with flash. We don't really teach that because what made Flash legitimate in the beginning, before there was the research that was done within the context of the EMDR protocol. And it started in the preparation phase so when you were teaching it as something you do until you switch back to the standard protocol. But really every time we do a demo, we take it to zero using flash. Almost every time.
Dr. Sutton: (43:14)
Interesting. I'm excited to do the training. You were so gracious to send me the link to get it through your website.
Phil Manfield, Ph.D.: (43:22)
We do a six-hour webinar every two months or so.
Dr. Sutton: (43:28)
You can get there through your website to sign up.
Phil Manfield, Ph.D.: (43:34)
www.flashtechnique.com
Dr. Sutton: (43:38)
I was actually surprised during this pandemic, I'd never actually done EMDR remotely. But now since everybody was shut down last March they started doing it and I’m just blown away. Like how effective it is even over Zoom, even doing pieces of training with breakout rooms for therapists and doing it online just tapping on themselves and having like amazing results. Flash technique also I'm assuming?
Phil Manfield, Ph.D.: (44:13)
Absolutely, and the funny thing is both the Flash webinar and the EMDR training, there's always someone at the end of the training who says, “We do this remotely and they just finished doing the practicum remotely.”
Dr. Sutton: (44:31)
Well, great and I think too that. The people that have that powerful experience doing the training too are oftentimes the people who are more likely to go on and use it with clients. And so unfortunately not everybody has that kind of significant experience in training or so on. And so I always encourage people to check it out or try it again or so on once.
Phil Manfield, Ph.D.: (45:01)
My philosophy, first of all, is for people who haven't had the experience or haven't seen it. If they've taken my training, they've seen it because I do live demonstrations Saturday and Sunday. And people see the magic of EMDR firsthand, one of their people and I don't select, it is whoever comes up and volunteers to be the subject. I work with them. And those demos are almost always completely successful and people go to zero. So, people have the experience, even if they don't personally experience in the practicum, but usually, they do in the practicum. But those people who've, for instance, taken the training from someone else and they really haven't seen the magic. I have a website, www.EMDRvideo.com, that has 44 full-length sessions. And it's free and people can see most of them are very powerful sessions. And you don't watch that and say, “Now is this real? Is this person trying to be compliant?” No, it's really nitty gritty.
Dr. Sutton: (46:18)
And by the way, I found that, the article that I was mentioning earlier. It's, How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systemic Review on Suggested Mechanisms of Action by Raymond Landon Romero, Anna Moreno Alcazar, Marco Pagani, and Benedict Amann. So they're from Sydney, Australia. So anyway, I'll send that to you, but it's for people that are interested in neuroscience.
Phil Manfield, Ph.D.: (46:53)
I will throw in that there's a fellow in Amsterdam and he's, at this point, he's published about 175 papers. He's very prolific and he has a clinic that works with a lot of trauma patients. And he's a strong advocate that what you're doing is taxing working memory with EMDR. And if you tax working memory, then the vividness of the memory diminishes because it can't be held in working memory, while working memory is being taxed in other ways. So he has people dancing around in some complicated step and he's dancing around in front of him, moving his hands, and they're moving their eyes. I mean in my opinion, what he's doing is distracting clients. He's just doing flash. But, he believes that you're, he's taxing working memory, but he does get very powerful results. So, I mean, the others may be right too, but pretty clearly he's got something that's working there.
Dr. Sutton: (48:18)
Well, thank you so much for taking the time today. This is great and I can't actually wait to take the training, you've got a lot of really great information. Thank you so much. I really appreciate it.
Phil Manfield, Ph.D.: (48:30)
Well, my pleasure. This has been fun.
Dr. Sutton: (48:32)
Take care. Bye-bye.
Phil Manfield, Ph.D.: (48:34)
Bye.
Dr. Sutton: (50:24)
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