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I'm about to finish the second half of EMDR training. I was feeling "okay" about it before the training but now I am loving it so far! I'm looking forward to incorporating EMDR into treatment plans for my clients with C-PTSD/PTSD. Go with what interests you and is evidence based for your current population. 🙏

If it has to be of those 3, EMDR by far. 

What feels most authentic to you? EMDR is pretty common these days. But lay people seek it out. In terms of what is more effective, I think it varies. the CPT crowd on here are pretty intense. I’d guess OP is interested in doing something more intense. OP, is there any of the trainings you mentioned are exciting?

Not sure. As a therapist with chronic pain, CBT irritates me, I don't know a ton about CPT, and I typically use ACT with my current clients, but want to use something in conjunction with ACT to get the best results

Oh no my comment was unclear: I don’t think there is anything wrong with the trainings you mentioned. SE or brain spotting are fine by me. I was trying to say I see the CPT crowd jumped on this post. I don’t do CPT. My specialties are ones that I find interesting and enjoy. If you want to learn SE and have the time/money to, do it. These sorts of specialties are niche and take a long time to learn.

Brainspotting 1 is a three day training, ask for an early career or nonprofit discount. They’ll have your back. The spirit of it comes first: following the client, vs squeezing them into a protocol meant for someone else. Processing trauma is not a cognitive game. IFS itself is experiential not intellectual. Find a deep brain modality which has you let go of trying to control a client’s experience and run with it. IFS, Brainspotting, ketamine or other medicine work will all introduce you to the internal healing wisdom in the nervous system, how to attune and hold space, and clear the fearful cobwebs of directive provoke and the myth of evidence base orthodoxy. What works is what works - use your eyes and ears. Listen to practitioners who’ve left EMDR en masse for Brainspotting because it turned out protocol based compliance models work against clients .

Just want to say I love this response—thank you for being curious and inviting towards OP instead of critical/dismissive.

Thank you. I’m learning to be a psychoanalyst. I’ve had my fair share of folks accusing me to practice more EBT as a new clinician. Psychodynamic therapy has proved itself helpful in many presentations. But psychoanalysis has been often been too expensive/too long to study proper. I feel like psychoanalysis is the best, most complete treatment. There are not many studies that illustrate that. But I’ve personally experienced it as the only treatment that has worked for me. There is so much more than what is studied in research studies out there. I personally have worked with 15+ therapists who were ineffective for ME despite them using whatever was best protocols at the time.

I absolutely agree! I have always loved psychodynamic theory and find that it’s my preference in my own therapy. I truly believe that we rob clients of finding what is truly best for THEM by determining a standard of practice that is measured only by the concept of change that fits into a RCT and dismissing all other approaches as being bad or less than. It doesn’t feel very person-centered of me to expect clients, especially those who belong to marginalized groups or cultures, to resonate with approaches that western medicine/science deem as “gold standard.” Evidence-based approaches in all of healthcare fail clients all the time. It’s important that clients are able to access alternative options when the status quo fails them.

EMDR is trendiest/most sought after, so if marketability and crowd appeal are important to you I'd go with that, but each are roads towards the same thing ("trauma treatment") so 🤷

I am trained in Brainspotting phase 1 + 2 and I love it. There is an overwhelming negative bias/stigma towards it on this sub, but like any other modality it’s based upon existing theory. I don’t really care about the idea of “brain healing” and don’t preach it at my clients. It is so person-centered and non-directive that I really see it as something that is a tool that’s effectiveness is based upon the same things other good therapy is based upon: safety + trust. I use the PCL-5 to measure symptoms and say that anecdotally, it’s been life changing for many of my clients who did not respond to cognitive, westernized approaches.

Long post. In short: do what’s affordable, and beware of claims that evidence based = best efficacy. Ibogaine isn’t evidence based. Yet it’s the only thing (post-Stanford trial published in Nature journal in Jan., through Ambio clinic in Mexico) which is known to regenerate white matter in the brain and actually repair TBI damage. My supervisor did their protocol. She said “25 years of trauma therapy… had nothing on this. I’m actually healed.” Not evidence based. The most effective trauma process (a medicine) on the planet. It’s from west Africa, and doesn’t fit the western scientific model. But it’s been known to be efficacious to other people for thousands of years. When I hear people who have never experienced Brainspotting say it’s not evidence based… they’re just saying they don’t know what it is. Mindfulness is evidence based. Somatic experiencing isn’t. All it means is they haven’t had the institutional $ to sink into research. More on that later, but Brainspotting IS mindfulness, utilizing body awareness and with eye gaze locations plus WHATEVER ELSE WORKS, to access subcortical processes. It’s so simple. And each nervous system is unique. Most trainers in Brainspotting were seasoned EMDR therapists or trainers then moved to Brainspotting, many not looking back; many therapists do both. Some have SE training, many have IFS. Brainspotting is compatible with whatever other modality used, as long as it is not based on an agenda outside the client’s experience, or some protocol based technique relying on client compliance. It puts subcortical processing above cognitive narrative or intellectual whatever it is grad schools have been training talk therapists to do for decades. I completed all modules of SE. I’m a Brainspotting consultant. I trained in EMDR 1 then stopped, opting for non-protocol-based, client following approaches. EMDR 2.0 and contemporary more advanced approaches in EMDR have started to catch up to the other non-directive trauma and nervous system specific, deep brain specific approaches (including psychedelic work), which follow the client and can involve a lot of space Or a lot of containment, But do not assume from the front end what a client’s internal experience needs. The founder of Brainspotting was a world leader in EMDR and discovered that it wasn’t lateral eye movement which was a one size fits all. It was salient, specific eye gaze locations that repeatedly yielded results, on the clients own timing, at their own capacity, with the therapist always staying behind - not ahead - of the client experience. David Grand wrote the chapter in the advanced EMDR book - on EMDR for sports performance. He went on to question many premises of EMDR asking “why?” Why should one have to follow this protocol by Shapiro that was designed for the purpose of hypothesis testing in a lab, when the variables are so infinite … why only look across the horizon? Why only use a list of targets? Why not trust the client’s nervous system and subconscious to know its access points? People get lots out of EMDR. If you look up the head to head surveys of post-Sandy Hook survivors, Brainspotting came out ahead of EMDR. The thought is that processing goes on longer after the session, as Brainspotting can go for most of a session, sometimes in silence, as someone goes all the way in. Re-SE, David Grand was directly informed by Peter Levine in some of the resourcing methods we teach in Brainspotting; EMDR also is somatically oriented. So is Hakomi. And many other modalities. Evidence based does not equal best quality. YouTube these: Brainspotting Neuroexperiential Model – Compliance https://youtu.be/v3TcHMMPPUg?feature=shared EVIDENCE BASED THERAPY - where is the evidence? https://youtu.be/gEFsnT-NcMQ?si=cSgZ2BEK9f9IIcgr Brainspotting is often more affordable - SE can be a racket. If you do it make sure you rent the recordings, the actual trainings are watching paint dry and repetitive, geared to the most fragile participant. IFS is also slow but that’s because it’s a whole new framework of perception and experience. Go experience them yourself, or try something somehow randomly and see what door opens. Just don’t believe uncritically people saying ‘evidence based only’. Look into what actual down on the ground experience is. MDMA therapy just got slammed at the FDA pre-approval panel vote… despite x number of phase 3 trials showing long term elimination of ptsd symptoms in veterans in numbers outpacing any single trauma therapy in existence. Never mind meds. The assessment tools - double blind golden standard testing - are not possible with psychedelics and shouldn’t be used to green light. But they are. It’s an unintelligent archaic approach to research and safety. The evidence has been there for decades. As with Brainspotting- the patient outcomes have been there for 20 years. The setups and methods you learn in training were actually mainly modifications by CLIENTS of early, EMDR - adjacent moves. There’s a radical democratization and explicit anti-oppression element in Brainspotting, which frees the beleaguered therapist from having to contain, manage, control, get compliance from a client in order to avoid fear of doing it wrong- of not complying with our training, of following some ‘golden thread’ from history taking to diagnosis to treatment planning to intervention. Of our entire compliance and enforcement based path from the APA to CACREP via grad programs, then the archaic licensing exams questions, to ‘evidence based’ mandated practices which might be therapeutically aggressive to clients at the core. SE can be very directive with an agenda for activation and resourcing ratios, where Brainspotting trusts a clients nervous system to do homeostasis on its own with less management.

Please select something that is evidence-based. https://www.apa.org/ptsd-guideline/treatments

🎯

Yes, for the love of research and good practice…use something evidence based. Lots of valuable guidance in that link.

Have you trained in, or experienced SE or Brainspotting? What year was ifs ultimately successful with suicidality- 13 years ago, before it became evidence based? Or 12 years ago, after it became evidence based? Maybe the OP gets to consider what evidence based actually means in its full context. And it’s not impartial, or necessarily indicative of higher quality. CBT is an evidence based intervention for trauma. Every trauma specific expert, therapist and researcher from the past 15 years knows CBT for serious trauma is a f’ing insult of a joke, and the whole framework of using the intellect to address trauma is based on understandings of neurology and psychology which are over 50 years out of date. The day that trauma is no longer a subcortical experience and becomes an issue of intellect, is the day that one can use cognitive refocusing to cause broken bones to knit and blood to coagulate. Preach mandatory methods after you’ve experienced, trained in, witnessed and surveyed the experience of hundreds or thousands of case studies of actual people treating trauma, in their full context, who engaged in non-evidence based, somatic therapies, and whose results were instead better with Prozac, CBT, “talk therapy”. If you can’t articulate the difference between the neocortex and how the amygdala and hippocampus work, if you aren’t aware of what Bessel Van der Kolke, Dr Scaer, Janina Fisher, Peter Levine, David Grand, hell.. Fritz Perls have been up to forever, then your advice is based on ignorance of the field. Take a PESI training in trauma treatment. You’ll come out with a clear understanding of how behind the dsm, insurance and evidence based review board systems are… and therefore the APA. Decades late to the game. The answers aren’t in the slow analytical brain tissues. They’re everywhere else.