Addressing Suicidal Ideation with EMDR Therapy: A Clinician’s Perspective
Suicidal ideation is a complex and distressing experience that can emerge during therapy, particularly when clients are processing deeply rooted trauma. Eye Movement Desensitization and Reprocessing (EMDR) therapy has proven to be an effective treatment for trauma, and while it is not a contraindication for those experiencing suicidal ideation, clinicians must approach these cases with caution and care.
EMDR Therapy and Suicidal Ideation: Not a Rule-Out
Contrary to what some clinicians might assume, the presence of suicidal ideation does not automatically rule out EMDR therapy as a treatment option. Research indicates that trauma often underlies suicidal thoughts, and by addressing this trauma through EMDR, clients may experience a reduction in the frequency and intensity of these thoughts (Shapiro, 2018). However, safety and stability must be assessed continuously throughout treatment to ensure that a client is emotionally equipped to engage in reprocessing.
Client Stability is Key
Before engaging in the reprocessing phases of EMDR, clinicians must prioritize establishing a solid foundation of client stability. This involves assessing the client’s current mental health, including any acute risks of self-harm or suicide, and ensuring that the client has the internal resources necessary to manage difficult emotions. Techniques such as Resource Development and Installation (RDI) can be useful in helping clients build coping mechanisms that will assist them during reprocessing sessions.
Clients should also have access to a clear safety plan, which includes emergency contact numbers, coping strategies, and crisis intervention resources. Once a sense of stability is achieved, the clinician can move forward with more confidence, knowing the client has the support they need.
What Happens if Suicidal Ideation Arises During Reprocessing?
It’s not uncommon for suicidal thoughts to emerge during the reprocessing phases of EMDR therapy. When this happens, it’s important for the clinician to stay calm and support the client through the process. Pausing the reprocessing isn’t always necessary. In fact, by continuing, the clinician may help the client work through underlying traumatic material that is fueling these thoughts. The key is to ensure that the client feels safe and supported throughout the session, and that the therapist remains attuned to any shifts in emotional intensity or risk factors.
As Francine Shapiro (2018), the developer of EMDR therapy, points out in her work, Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures, the goal is not to avoid painful thoughts or emotions but to process them in a safe, structured manner. EMDR therapy provides the framework to do this effectively, even when the material is difficult.
Regular Risk Assessments Are Crucial
Clinicians must be prepared to continuously evaluate the client’s risk for suicide. Suicidal ideation is dynamic, and risk levels can fluctuate during treatment. Frequent check-ins and open communication are vital. This open flow allows the therapist to adjust the pacing of EMDR or shift focus to stabilization techniques when necessary. Incorporating grounding exercises and mindfulness can also help clients stay present and manage distressing emotions.
In cases where suicidal ideation becomes overwhelming, a temporary shift back to stabilization phases or crisis intervention strategies may be required. The flexibility of EMDR therapy makes it well-suited for these kinds of adjustments.
EMDR Therapy as Part of a Broader Treatment Approach
While EMDR therapy can be incredibly effective in reducing trauma-related suicidal ideation, it is important to remember that it works best when integrated into a comprehensive treatment plan. Suicidal ideation is complex and multifaceted, and it may require interventions that go beyond trauma work.
That said, EMDR therapy can complement these approaches by addressing the traumatic roots of suicidal thoughts, helping clients achieve long-term healing.
EMDR therapy offers clinicians a powerful tool for addressing trauma and, in turn, reducing the severity of suicidal ideation. By maintaining a client-centered approach, prioritizing stability, and integrating continuous risk assessments, EMDR clinicians can help their clients navigate even the most challenging emotional terrain. While suicidal ideation requires careful handling, it does not mean the end of EMDR therapy treatment—in fact, it can mark the beginning of deeper healing.
Consider taking our 6 CE OnDemand course, Suicide: Assessment, Intervention, and Prevention--Skills and Resources to Stop the Pain
Reference:
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures. New York: The Guilford Press.
