The early years of one’s life and how one’s caregivers are attuned with fundamental emotional, biological, and psychological needs is essential to one’s brain development, sense of self, and emotional regulation. George (2025) identifies that attachment and neurological development are intertwined, and the early parent-child interactions that are guided by right-to-right brain [emotional processing, intuitive, creativity] defines one’s quality of attachment within relationships and their emotional development. A failure to meet needs in childhood can occur on many different scales and across the socio-economic and cultural spectrum. A lack of emotional attunement may occur if a parent is experiencing stress, financial hardship, systemic racism, dissociation, grief, natural disasters, inter-relational conflict, or other mental health concerns and comorbidities. It may also be a result of intergenerational patterns or transgenerational trauma, for instance, the ‘silent generation’ as children were brought up to be seen and not heard, or ‘gen-x’ who grew up without parental supervision, as latchkey kids and reminders from late night t.v. for their parents asking, “It’s 10 pm, do you know where your kids are?” If these generational approaches to parenting are not addressed through awareness, advocacy, and therapy, it is most likely that changes will not occur, and a lack of attunement, attachment, and connection will continue. Likewise, these interpersonal conflicts will also continue to arise in romantic relationships, friendships, family dynamics, and in the workplace.
Complex trauma (C-PTSD) has been defined as traumatic events that are chronic, interpersonal traumas that began early in life (Cook et al., 2003). These events can include childhood sexual or physical abuse, neglect, intimate partner violence (physical/emotional), life-threatening illness, bullying, unexpected death of a family member or close friend, motor vehicle accident, racism, genocide, war/terrorism, and displacement. Whereas post traumatic stress disorder (PTSD) focuses on single incident trauma (actual or perceived), that evolves into a conditioned fear response with re-experiencing and avoidance symptoms, C-PTSD from the ICD-11 expansion includes three additional elements: emotion regulation difficulties, negative self-concept (ie. core beliefs “I am not loveable,” “I don’t belong.”), and relationship difficulties (Karatzias et al, 2023). A simplified way to understand childhood trauma is through Dr. Gabor Mate’s analogy, which sites that children have two essential needs, attachment and authenticity. When attachment is threatened by one’s authenticity, children will mirror what their parent(s) or caregiver(s) wants and/or demands of them. This can be seen as a betrayal of self, loss of identity, and a suppression of needs, which can have long term effects on emotional regulation and self-concept.
It is important to recognize the cross over and similarities and differences of C-PTSD and borderline personality disorder (BPD). For instance, while both diagnoses may develop from early childhood adverse experiences, the biggest difference identified is that someone with BPD often has an alternating self-concept along with experiencing fears of rejection or abandonment, feelings of emptiness, impulsivity, or paranoid dissociation, while someone with C-PTSD may experience emotional numbness, fear and avoidance of relationships, and stable negative self-evaluations (Frost et al., 2020).
What is EMDR?
EMDR stands for Eye Movement, Desensitization and Reprocessing, and it is a mind-body approach developed by Dr. Francine Shapiro in the 1980’s after she made the connection while walking through a wooded area, and allowing her eyes to wander side to side, that the level of distress she was experiencing was lessening. Studies on sleep, dreaming, and rapid eye movements (REM sleep) suggest that many important things occur during these processes, for instance, memory consolidation. Hypotheses suggest that the bilateral stimulation (BLS) of EMDR may act as an artificial way to assist in integrating the various parts of the limbic system, attending to negative affect and body sensations which bring the amygdala online for EMDR desensitization and reprocessing (Bergmann, 1998).
EMDR is different than traditional talk therapy, because in some cases, client’s can process with little to no verbal communication, which decreases the chances of re-traumatization, supports cross-cultural and diverse populations, and advocates for client autonomy. It is built around an 8-stage protocol that includes: client intake and case conceptualization (1) preparation and resource installation (2), assessment and target mapping (3), desensitization (4), installing positive cognition (PC) (5), body scan (6), closure (7), and re-evaluation (8). It is important to remember that the process of EMDR includes the 8 stages, rather than just the sessions that focus on the actual BLS (rapid eye movements, tapping, auditory sounds). The therapist needs to assess for readiness and ego strength, facilitate installation of positive resources and teach containment, and collaborate with the client what the targets will be, identify negative cognitions and sourcing positive cognitions.
How is AF-EMDR Different Than traditional EMDR?
Dr. Laurel Parnell, the founder of the Parnell Institute and the attachment focused AF-EMDR trauma treatment modality, modified the approach to make it more client-centered, and accessible for people with complex trauma and early childhood trauma. AF-EMDR follows the standard EMDR protocol, while placing an emphasis on resourcing attachment figures. The more flexible approach of AF-EMDR allows for a creativity within the process, for instance while resourcing Nurturing Figures, if a client has lived a life of neglect, abandonment and rupture and does not have an actual Nurturing person to ‘tap in,’ they can access a Nurturing figure through other means, such as a person, animal, entity, spiritual figure, real or imaginary, that they have been exposed to through books, movies, stories, spirituality or religion. By front loading positive attachment figures, if a client gets stuck in the EMDR desensitization and reprocessing stage, the therapist can inquire, ‘Who do you know who has nurturing qualities, that you can invite into this memory to support you?’ By inviting in a nurturer to a looping early childhood trauma memory, one can begin to reconcile their experiences, and provide their wounded child part the support they needed, at the age and stage of that memory.
Parnell has also de-emphasized the BLS/REM eye movements and supports BLS movements such as self-tapping the body, holding the alternating buzzers (Thera Tapper or Neurotek), or alternating sounds in the ears. A benefit to the client-centered approach, is that the BLS just needs to be alternating on or with the body and encouraging of the client to bring their awareness inwards. This means if a client wants to stand up and swing their arms side to side, or alternate marching back and forth while processing, that they have the autonomy and agency to do so.
How Can AF-EMDR Help Me?
The purpose of AF-EMDR is to reduce negative affect, so that the experience(s) one has gone through feel farther away and less activating. When treating C-PTSD, abandonment wounds, and early childhood trauma, the therapist in an AF-EMDR session will aid the client in creating a map of their experiences, documenting the distress and rating the experiences using a subjective unit of distress (SUDS) scale, and connecting themes of negative cognition. Using the metaphor of a string of lights that have gone out, when the therapist and client identify the earliest and worst memories or experiences and use BLS to desensitize and reprocess, think of the lights beginning to come back on, shining bright and creating a generalization effect, decreasing negative affect of the trauma memories and experiences that may have come after that. The biggest differences between EMDR and AF-EMDR to other approaches to treating trauma, PTSD and C-PTSD, is that there is intent to heat up the amygdala (fight or flight), feeling the emotional distress physiologically and somatically, which may feel like nausea, tightness to the throat or flooding of tears, and the belief that the mind knows where to go. The free associative, mind-body approach to EMDR and AF-EMDR means that the therapist is not making associations or directing the client as to where to go. The therapist facilitates the process, watches for affect, and assists if/when the client gets stuck, is looping, or dissociates, but refrain’s from analyzing.
Conclusion
While EMDR has become more well known in therapy, mental health communities, and even the general public, it has developed some associations which may not be accurate. Many people speak of EMDR as a one-and-done therapy that can immediately treat and cure trauma. Similar to psychedelic assisted therapies, post-intervention integration is key to making change. While people may experience an immediate decrease in negative affect, processing may continue after session, and re-evaluation is essential. There is also a difference between treating single incidence trauma (PTSD) and complex trauma (C-PTSD).It’s important to remember that many different therapeutic approaches have been developed to treat PTSD and C-PTSD, because the world of therapy needs to acknowledge diversity, and both individual and collectivist approaches to mental health.
Author
Written by Melissa M White, Registered Psychotherapist and owner of Sojourn Psychotherapy located in Dundas Ontario. Melissa White, RP is a trauma and relational therapist, who specializes in AF-EMDR, and experiential processes such as AF-EMDR, Sound Therapy, Experiential Embodied Dreamwork (currently in training), and Jungian Sandplay therapy. Melissa has trained with the Parnell Institute and currently has completed level 3 (AF-EMDR 3). She also helps support post-psychedelic psychotherapy or medicine ceremony integration.
If you are interested in reaching out for a consultation for individual therapy, and/or curious about EMDR or AF-EMDR and working virtually with Melissa White, RP within Ontario (or select provinces), or in person in Dundas (Hamilton ON) please visit the contact page at https://sojournpsychotherapy.ca or email melissamichellewhite@gmail.com
Website: https://sojournpsychotherapy.ca/
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Resources
Bergmann, U. (1998). Speculations on the neurobiology of EMDR. Traumatology, 4 (1), 1-12, https://doi.org/10.1177/153476569800400102
Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B. A. (Eds.) (2003). Complex trauma in children and adolescents. National Child Traumatic Stress Network. Retrieved from http://www.NCTSNet.org
Frost, R., Murphy, J., Hyland, P., Shevlin, M., Ben-Ezra, M., Hansen, M., Armour, C., McCarthy, A., Cunningham, T., and McDonaugh, T. (2020). Revealing what is distinct by recognising what is common: distinguishing between complex PTSD and Borderline Personality Disorder symptoms using bifactor modelling. European Journal of Psychotraumatology, 11 (1), 1-11, https://doi.org/10.1080/20008198.2020.1836864
George, C. (2025). Attachment, Shame, and Trauma. Brain Sci. 15, 415. https://doi.org/10.3390/ brainsci15040415
Karatzias, T., Bohus, M., Shevlin, M., Hyland, P., Bisson, J.I., Roberts, N., and Cloitre, M. (2020). Distinguishing between ICD-11 complex post-traumatic stress disorder and borderline personality disorder: clinical guide and recommendations for future research. The British Journal of Psychiatry, 223, 403-406, https://doi.org/10.1192/bjp.2023.80
