WHY THIS BOOK MATTERS

The field of psychotherapy has frequently overlooked or minimized the importance of culture and the impact of societal forces on an individual’s well-being. Culturally aware EMDR therapy provides a powerful alternative to this omission. From conceptual to practical, this book explores the interface of culture and EMDR therapy.

Cultural experiences and societal dynamics are fundamental dimensions of every human being’s life and should be integrated into a general clinical approach. For many people, personal identity is intertwined with cultural identity and the welfare of one’s cultural groups. Culturally linked experiences and values can be sources of great meaning and sustaining personal resources. At the same time, hostile social forces of exclusion, marginalization, stigmatization, and oppression can define or confine an individual’s sense of self and position in society. Whether explicit or more implicit, these discriminatory realities persist in the world and threaten fundamental human dignity while limiting human potential.

In the preface to the first edition of this book in 2017, I wrote that “the movement for cultural competence is gaining greater recognition and momentum within the field of mental health. Service providers are increasingly aware of the need to keep step with an evolving multicultural world and to work toward reversing the injustices that are perpetuated when cultural populations are marginalized and mistreated. As ‘culture-blind’ psychotherapy models become obsolete, new approaches for culturally aware and effective intervention must be developed.”

Over the last 5 years, there has been a powerful surge of recognition within the United States, Canada, and beyond about the realities and impacts of systemic oppression. Sparked by tragic and publicly visible acts of racist and bigoted hate crimes targeted at individuals and groups, there has been greater urgency and broader cultural awakening to and reckoning with the societal injustices and inequities that exist in our world. As will be echoed in the new and updated chapters throughout this book, some signs of progress include increased attention to understanding the dynamics of systemic oppression, more inclusion within the media of Black, Indigenous, and people of color (BIPOC) voices, political movements like Black Lives Matter, and more visible evidence of introspection and accountability among those examining their own privilege. Yet many have observed that even when shocking current events bring meaningful recognition or a problem, focus can wane over time and so it is important to maintain commitment to progress. Additionally, while the social discourse around this topic remains sensitive and sometimes divisive, it is at least happening. There is increased familiarity with evolving terminology and a greater resolve to discuss and address the long-standing and complex problems intertwined in the societal fabric of our world. And, of course, societal issues impact every person’s sense of themselves.

I am pleased to be able to say that content in the first edition of this book was, overall, attuned and consistent with this recent wave of attention to cultural dynamics. When first published, this book was the only dedicated platform addressing cultural considerations within EMDR therapy and was recognized as one of few within the field of trauma therapy in general. A review posted by the American Psychological Association lauded the book saying, “Cultural Competence and Healing Culturally Based Trauma With EMDR Therapy: Innovative Strategies and Protocols, … is a groundbreaking work that sets a gold standard for how therapists can approach multicultural competency and for how to do so within established eye movement desensitization and reprocessing (EMDR) frameworks” (Lee & Molfetto, 2017). They continued, adding that “the book’s editor and contributors understand where the mental health field is moving in regard to cultural competency. This book is on the cutting edge—it shows us the vast potential of EMDR in healing culturally based traumas that persist today and the traumas that are endemic to our cultural histories. The topics targeted could not be timelier.… Few works have the scope, breadth, and depth of information and practical tools provided to extend cultural competence that we see in [this book]” (Lee & Molfetto, 2017).

Building on a strong start, the second edition of this book seeks to update and expand its contribution to this work. Chapters by previous authors have been refreshed with new perspectives and discoveries. Seven chapters have been added with new author contributions, primarily with added attention to race, ethnicity, and socioeconomic class.

BOOK SECTIONS AND CHAPTERS

This book explores the interface of culture and EMDR therapy with a collection of chapters that cover a range of subjects and offer a variety of approaches. The book addresses the big conceptual issues as well as specific insights, strategies, and protocols that are brought to life with clinical examples. Each chapter has its own integrity and key messages. At the same time, collectively, these chapters convey a broader message to the reader about what is possible in the culturally informed application of EMDR therapy. The chapter section review that follows will prepare you to absorb the content within this book.

In Section I of the book, I have expanded my chapter contribution from four chapters in the first edition to seven. To some extent, chapters in this section build upon and reference material in previous chapters within this section. In Chapter 1, I review definitions and explore the concept of cultural competence, offering suggestions for how EMDR therapists and organizations can engage with and ultimately help lead this important trend. Chapter 2 is a new chapter devoted to integrating core human connection and belonging as a separate and meaningful domain of EMDR beliefs, including a listing of relevant negative and positive cognitions. Chapter 3 is also a new chapter and it advocates for the broader recognition of culturally based trauma and adversity (CBTA) and proposes 10 examples of types of CBTA. Chapter 4 guides EMDR clinicians to reflect upon personal cultural identities and to evaluate and set cultural competence goals within their professional practice. Chapters 5 and 6 emphasize culturally aware clinical strategies within the eight-phase EMDR and methods to address CBTA. Chapter 7 provides research from the field of social psychology that informs the Adaptive Information Processing (AIP) model with understandings of how the brain processes social information. This knowledge is integrated into EMDR strategies and a modified protocol designed to dismantle social prejudice and discrimination.

Section II includes two new chapters which offer overarching principles to guide culturally informed clinical approaches. In Chapter 8, Wendy Ashley and Allen Lipscomb offer clear and powerfully conveyed strategies for developing and implementing a clinical practice that is anti-oppressive. The chapter focuses in particular on a proactively antiracist approach with Black clients. In Chapter 9, Viviana Urdaneta shares her experiences and recommendations regarding an intercultural approach to therapy as well as clinical consultation that broaches differences by placing culture at the center rather than the margins.

Section III explores race, ethnicity, and social class, and includes four new chapters and one updated chapter. In Chapter 10, Jordanna Saunders shares her experiences and offers recommendations for EMDR therapy with American Indians. In Chapter 11, Cheryl Kenn offers considerations for working with Asian Americans. Viviana Urdaneta and Viviana Triana discuss strategies for working with Latinx clients in Chapter 12. In Chapter 13, Karen Alter-Reid and Ruth Heber present the transgenerational impact of anti-Semitism and articulate lessons that can be applied to treat the legacy of inherited trauma for other cultures. In Chapter 14, Jeff DiNardo tackles the vast topic of social class and lays valuable groundwork for this often-ignored dimension of cultural identity.

Section IV focuses on the challenges of adjustment and acculturation for immigrants as well as refugees and asylum seekers. In Chapter 15, Cecilia Penailillo offers information and clinical recommendations for Latinx clients immigrating from Latin American countries and reminds trauma-informed clinicians to learn about pre- and post-migration experiences. Barbara Lutz writes in elegant detail about her culturally aware EMDR therapy with a recent immigrant in Chapter 16. Her writing reveals how she uses self-reflection about her own cultural background to strengthen the therapy. In Chapter 17, Italian EMDR practitioners Paola Castelli Gattinara, Antonio Onofri, and Cristina Angelini provide an update into their ongoing work with refugees and asylum seekers. Their adaptations of the EMDR approach to meet the most pressing needs of their clients are instructive.

Three chapters in Section V explore different dimensions of identity as it relates to LGBTQIA+ issues. In combination, they dispel myths and misinformation, and help break down dichotomous binary definitions of gender and sexual/affectional orientation. In Chapter 18, Sand Chang offers valuable information about affirmative care for transgender and gender nonconforming clients, and provides sage guidance for clinicians. John O’Brien talks about the realities, needs, and struggles for gay men and lesbians in Chapter 18. Earl Grey provides a fascinating assessment tool for helping a client understand their sex, gender, and affectional orientation along a continuum of characteristics in Chapter 20.

Section VI includes several chapters that offer knowledge and insight into the experiences and needs associated with specific cultures, including the stigmas they may battle. In Chapter 21, Joseph Yaskin and Andrew Seubert draw from their long-standing expertise in working with individuals with intellectual disabilities and speak of the power of EMDR therapy as an approach to overcoming socially dismissive attitudes. In Chapter 22, Liz Royle presents her work with uniformed service workers in the United Kingdom who must overcome mental health stigma to receive EMDR treatment. In Chapter 23, Robin Shapiro offers clever strategies for helping clients undo the effects of culturally imposed social messages relative to physical appearance, aging, and social class.

Section VII explores two specific innovative protocols. In Chapter 24, Natalie Robinson outlines several straightforward methods to integrate EMDR work into the context of a client’s cultural ancestry and conveys the potency of these methods. In Chapter 25, Brazil-based EMDR psychotherapist and trainer André Monteiro shares procedures for providing EMDR reprocessing experiences within the context of ongoing group-based therapy. He makes a compelling case for the added meaning that comes with reprocessing with group support.

Finally, Section VIII includes lessons learned from EMDR outreach and training efforts to regions of the world with limited mental health services. In Chapter 26, Rosemary Masters, Elizabeth McConnell, and Josie Juhasz provide updated detail on their important work in Uganda. With an attitude of cultural humility, they portray not only what they taught, but what they learned from those they met. In Chapter 27, John Hartung builds upon his international training which was reported in the book’s first edition. In this chapter, he distills several key lessons that he has learned in working with diverse cultural populations globally, which he has found relevant in working with the increasingly diverse cultural populations growing within practitioner’s home communities.

EDITORIAL CONSIDERATIONS

Consideration was given to the book title and the term “cultural competence.” Some people prefer other terms that are also used within this book and are sometimes more relatable or fitting, such as cultural awareness, cultural responsiveness, cultural attunement, and cultural humility. Yet, we use the term “cultural competence” because this is a book for mental health professionals, and the term “cultural competence” continues to be the term most often used in fields such as medical healthcare, mental healthcare, education, and other human-centered fields. One of the intentions of this book is to link EMDR literature with the broader professional discourse on culturally informed trauma intervention. As you will see detailed in Chapter 1, “cultural competence” is depicted in the literature to include many important subcomponents, including cultural humility and cultural responsiveness.

This book is primarily written for EMDR therapists, EMDR leaders, supporting organizations, and others who want to understand and develop what EMDR therapy can offer as a culturally competent intervention. The book is presented with the assumption that readers are EMDR trained and have a basic understanding of the core elements of EMDR therapy. So that attention could be focused on the integration of cultural issues, references are frequently made with limited explanation to the AIP model, the eight-phase approach of EMDR therapy, the three prong protocol, resourcing, and additional protocols and strategies that are frequently discussed in EMDR literature. Please make use of the references provided and other EMDR texts as needed to further understand these fundamental EMDR concepts.

Developing common language about culture is both a challenge and a goal of this book. Efforts were made to use language that is current with updated perspectives, understandable, and acceptable to the social groups being named. Having said that, keeping up with ever-evolving terminology is a challenge and personal preferences for terminology vary. In some cases, editorial decisions were made; for example, when discussing race and ethnicity, the term Black is used rather than African American, and both Black and White are capitalized in reference to race. With respect to privacy, please know that all clinical examples have been disguised to protect the identity of the client while maintaining the clinical truth of the points that are demonstrated.

HELPING EMDR THERAPY BE ON THE FRONTIERS OF TRAUMA-INFORMED CULTURAL COMPETENCE

This second edition continues to aspire to the prospect that EMDR therapy can make meaningful contributions at the intersection of trauma-informed interventions and cultural competence. EMDR interventions have already demonstrated effectiveness across a wide range of cultural contexts, and EMDR humanitarian and membership organizations have reached out to serve culturally marginalized or under-resourced populations throughout the world. The teachings of Francine Shapiro, the originator and developer of EMDR therapy, conveyed great compassion for victims of trauma globally and offered principles and procedures that can be attuned to an individual’s cultural context. EMDR therapy’s evidence-based effectiveness in trauma treatment can be readily directed toward healing the impact of CBTA.

And yet, each individual practitioner must make a deliberate and informed commitment to embrace cultural competence. This book offers EMDR clinicians information and guidance to move cultural awareness from a worthy goal to an integrated aspect of psychotherapy practice. Though the desire for cultural competence is an aspiration that is never fully achieved, its pursuit is inherently rewarding, and the content of these pages illuminates the attitude, skills, and knowledge (ASK) needed to move in this direction.

The authors and I hope that this book helps inspire discussion, collaboration, writing, and research to more deeply embed cultural awareness into EMDR therapy. Most importantly, we will consider our contributions a success if they are put to effective use with your clients.

REFERENCE