Why EMDR doesn’t work for complex PTSD and what actually does
Dr Sophilia Lark, the founder and CEO of Unified Wholeness Lifestyle, made a video 5 years ago about EMDR and the reasons why it does always help people who have suffered from complex trauma, particularly PTSD. In many ways, Sophilia is the kind of therapist I wish I could have had when I was at my lowest ebb. You can watch her video here:
In cases of complex developmental trauma, maladaptive schemas often originate in experiences of profound threat, coercion, or neglect, which may carry moral, spiritual, and existential dimensions (Rogers F, 2024). These schemas frequently encapsulate the affective weight of horror, terror, or betrayal, and therefore, the moral and ethical responsibility for such experiences rests with those who perpetrated the trauma, not the client.
Clinically, this highlights the need for interventions that recognise trauma as originating externally but are mindful of the fact that the effect of the trauma disturbs the pre-linguistic, pre-conceptual self-model, which operates beneath explicit cognition and internal narrative and are experienced by the client as disturbances in meaning, identity, and agency rather than as discrete maladaptive thoughts alone.
Consequently, standard cognitive or schema-focused interventions, which emphasise restructuring thoughts, correcting behaviours, or modulating modes, often overlook the role of trauma, particularly complex childhood trauma, and its associated Default Mode Network (DMN) dysregulation (Broulidakis, et al, 2022), which would suggest that, in these cases, a neurophenomenological (Moskovic, 2024) informed solution would be more appropriate. To some extents, EMDR goes some way to crossing this divide.
From the client’s perspective, dysregulation of the Default Mode Network is experienced as persistent involuntary engagement with past or future oriented self-referential cognition, including intrusive verbal and imaginal content, which limits present-moment appraisal, reduces agency, and increases vulnerability to habitual or addictive behaviours as compensatory regulatory strategies.
Put simply, in most cases of complex trauma, the damage done – the wound – lies much deeper than Cognitive Behavioural Therapy or Schema Therapy was designed to reach.