Hey there,

Have you ever had someone tell you EMDR is “pseudoscience”?

Maybe it was a colleague in case consultation, or a professor back in grad school. Or maybe it was a client who read something online the night before their first session, worried they were signing up for something that doesn't work.

How did it make you feel?

Defensive?

There are a number of criticisms that come up again and again, and some of them have a grain of truth. So this week I want to walk through the most common criticisms of EMDR (including the ones that are partly fair) and share how I think about each.​
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"EMDR is pseudoscience."

"It looks like science, but it isn't," in other words.

Francine Shapiro first noticed the effect of eye movements on distressing thoughts during a walk in 1987. The early years of EMDR came with big claims and small studies, and some researchers (including a number of prominent psychologists) saw it as more commercial than scientific.

Over the following decades, EMDR was tested in dozens of randomized controlled trials across different populations and countries. Today it's recommended for PTSD by the World Health Organization, the International Society for Traumatic Stress Studies, and the 2023 VA/DoD clinical practice guideline.

The VA/DoD guideline even lists it alongside Cognitive Processing Therapy and Prolonged Exposure as a first-line trauma-focused psychotherapy. That's a long way from where this “pseudoscience” label started.

"The eye movements don't do anything."

This is probably the most interesting criticism.

Early dismantling studies compared EMDR with and without eye movements, and a 2001 meta-analysis by Davidson and Parker found the eye movements didn't add much. For years, that was the go-to citation for critics.

Then in 2013, Lee and Cuijpers (researchers at Murdoch University in Australia and Vrije Universiteit Amsterdam) ran a new meta-analysis and pointed out methodological problems in the earlier one. They found that eye movements had a moderate, significant added effect in treatment studies. In lab studies the effect was large, with eye movements reducing how vivid and emotional distressing memories felt.

Brain imaging studies give us important clues. One showed eye movements activating parts of the brain responsible for vivid memory recall (Pagani et al., 2012). Another demonstrated parts of the brain responsible for intense, overwhelming emotion are suppressed (de Voogd et al., 2018). Combining these two goes a long way to explain how eye movements can support a larger window of tolerance, putting the brain in a state that is ripe for healing.

Another leading explanation involves working memory. When you hold a memory in mind while doing something demanding (like tracking eye movements) there's less mental capacity left for the memory, so it comes back less vivid and less charged.

Is the mechanism fully settled?

No.

However, not fully understanding how a treatment works is true of plenty of approaches in psychotherapy, and it doesn't change the outcome data.

"It's less evidence-based than CPT or PE."

There's some truth here, depending on which guideline you read.

Recent American Psychological Association's PTSD guidelines gave EMDR a conditional recommendation, while CPT, PE, and CBT received strong ones. Other guidelines, including the VA/DoD's, place EMDR at the same level as CPT and PE.

Head-to-head comparisons generally find EMDR performs about as well as other trauma-focused therapies.

Where it differs is in how it gets there.

In EMDR, there's no homework, and the client doesn't have to describe the trauma in detail, which is part of why adaptations like the blind-to-therapist protocol are possible. For many clients, the difference decides whether they stay in treatment at all.

Additionally, one study compared EMDR to 12 other treatment modalities and concluded EMDR ranked highest in terms of cost-effectiveness and quality of life indicators (Mavranezouli, I. et al, 2020).

"It's just exposure therapy with a gimmick."

There's a well-known line from one of EMDR's early critics, roughly that what's effective in EMDR isn't new and what's new isn't effective.

It's true that EMDR involves exposure, since the client brings the memory to mind. The exposure in EMDR, though, looks different. It's brief and interrupted instead of prolonged, the client is encouraged to let their mind move freely instead of staying fixed on one memory, and the process sits inside the Adaptive Information Processing model instead of a habituation model.

The lab findings, then (where eye movements changed how memories felt even outside of therapy) are hard to explain if the eye movements are just decoration.

"EMDR gets used for everything."

This is the criticism I think we should take most seriously.

The strongest evidence for EMDR is for PTSD. There's growing research on depression, anxiety, addiction, and other presentations, but it's thinner, and some of what gets marketed in our field goes beyond what the data currently supports.

I'm a big believer in the AIP model as a lens for understanding almost any client (I wrote about that a while back). Using AIP to conceptualize a case is one thing, whereas telling a client EMDR is proven for their specific condition is another.

I use several protocols beyond the standard protocol, supporting clients with chronic pain, addiction, depression, performance issues, etc. and I know it’s impossible to ignore the incredible outcomes I see despite a lack of research. But it’s ok to be honest about some applications of EMDR not being as supported by research as others.

When we're honest about where the evidence is strong and where it's still developing, we earn more trust and give critics less to work with.

"It's hard to access."

This one is mostly true.

Only about 2 out of every 100 licensed therapists specialize in EMDR, and more than 120 million Americans live in a designated mental health professional shortage area. Training is expensive and time-consuming, and many therapists who finish basic training never go on to certification.

Part of the bottleneck is what happens after basic training:

Finding a consultant, tracking hours, and finding colleagues to learn from are all harder than they should be, and that slows down how quickly skilled EMDR therapists enter the field. That's the piece we're working on at Helicon.

It won't fix training costs or the broader therapist shortage, but making the path from trained to skilled easier is one way to get more EMDR clinicians to the people who need them.

When You Hear These Criticisms

When a colleague or client raises one of these, I think the best response is curiosity. Ask what they've read, acknowledge the parts that are fair, and then share what the research says now, including where it's still uncertain.

Clients tend to trust an honest answer more than a perfect one, and knowing the evidence well enough to explain its limits is a big part of what makes EMDR credible.

Which of these criticisms do you hear most often?

Hit reply and let me know.

And if you'd like to learn alongside other EMDR therapists asking the same difficult questions, you can join the Helicon notification list here.

Until next time,
Chris

Thanks for reading Helicon's EMDR Therapist Weekly, where we aim to provide a weekly dose of insights, tools, and opportunities for EMDR therapists; designed to support your growth, sharpen your practice, and connect you with what's next.

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Disclaimer: The information contained in this article is for informational purposes only. This is not legal or clinical advice and we make no guarantees about the outcomes or results from information shared in this document. Proceed at your own risk and discretion.​
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