Attachment-focused EMDR (AF-EMDR)

Reviewed by Stephanie Steinman, PhD, CSAC

Written by

therapist.com team

Last updated: 05/16/2024

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Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that allows you to work through heightened emotions or traumatic experiences. Psychologist and educator Francine Shapiro, PhD, created and developed the method in the late 1980s, and since then therapists have used it to treat posttraumatic stress disorder (PTSD), bipolar disorder, anxiety, and more.

In 2008, author and clinical psychologist Laurel Parnell, PhD, director of the Parnell Institute, created attachment-focused EMDR (AF-EMDR), a modified approach that infuses traditional EMDR with the principles of attachment theory. While both EMDR and AF-EMDR can treat trauma, AF-EMDR also helps you build new resources for healing, growing, and connecting with others.

What is attachment theory?

Attachment theory is the idea that that our very early bonds with primary caregivers shape our lifelong development. Those early experiences also lead us to develop one of four attachment styles, or ways of bonding with people:

• Secure attachment develops when an infant knows their primary caregiver will provide comfort, understanding, and safety consistently in times of stress.
• Anxious attachment develops when children form worried, insecure patterns of interacting after getting inconsistent care from their primary caregiver.
• Avoidant attachment occurs when children have learned their primary caregiver can’t meet their needs reliably, so they rely on themselves instead.
• Disorganized attachment describes children who demonstrate a combination of avoidant and anxious attachment styles.

When we don’t form secure attachments in childhood, it can lead to problems in personal relationships, as well as conditions including:

• Depression
• Guilt, self-hatred, and low self-esteem
• Anxiety and panic attacks
• Compulsive and obsessive behaviors
• Emotional numbness
• Frightening thoughts and excessive worrying
• Difficulty concentrating
• Insomnia and other sleep disturbances
• Hypervigilance

AF-EMDR and other types of attachment-based therapy can treat these and other common attachment-related challenges. An attachment-based therapist’s goal is to create a safe, secure bond with you, then help you change unhealthy patterns.

How does EMDR work?

In EMDR, a therapist uses a technique called bilateral stimulation (BLS) to help you explore and work through traumatic memories. BLS is believed to help the left and right sides of your brain communicate more efficiently, similar to what happens when you’re in REM sleep.

BLS methods can include:

• Following your therapist’s finger from left to right with your eyes
• Visually tracking dots on a screen as they move from left to right
• Listening to soft tones through headphones, alternating from left to right audio channels
• Squeezing a ball in one hand and then the other
• Holding buzzers in each hand that vibrate back and forth
• Slow, rhythmic tapping on the knees or shoulders

EMDR specialists work with clients to safely revisit the thoughts, feelings, and beliefs associated with their traumatic memories. Once the memories are accessed, the therapist adds BLS. Bilateral stimulation seems to encourage rapid processing in the brain, allowing the client to work through the trauma more effectively.

Following treatment, Parnell says, you still remember what happened but it’s less distressing: “It feels like the moment or memory happened in the past, and you’re no longer activated by that trauma.”

The limitations of EMDR

Traditional EMDR works very well on many people, says Parnell, but it can have limitations when a client has attachment difficulties or chronic relational trauma.¹ Parnell’s interest in overcoming those limitations led her to develop AF-EMDR.

For EMDR to be successful, Parnell says, the recipient has to be able to tolerate intense feelings. Research has shown that people with secure attachment styles have an easier time navigating high-intensity emotion than people who are insecurely attached.² EMDR also requires that you form a strong bond with your therapist, which can be challenging if you struggle with secure attachment.³

Principles of attachment-focused EMDR

According to the Parnell Institute, AF-EMDR has five basic principles:⁴

Client safety: The clients’ physical and psychological safety are paramount. This may mean extending how long a client needs to talk and get comfortable with their counselor before the EMDR practice begins.

The importance of the therapeutic relationship: Practitioners recognize that forming a strong bond with their clients is foundational and essential.

Client-centered practice: Practitioners aim to be flexible and can adapt according to the needs of their clients—for instance, using the client’s preferred type of BLS. Therapists should also take cultural norms into account. “People from some cultures don’t feel comfortable speaking negatively about their parents, for example,” says Parnell. “In that case, we’ll work in a different way to talk about difficult memories.”

Repairing deficits: Practitioners work to find out what psychological or developmental resources the client is missing and help fill in those gaps.

Modified EMDR (EMDR-M): Practitioners use advanced techniques to help clients access memories and repair early childhood wounds.

Learning to repair old wounds

What makes AF-EMDR stand out is the level of repair it aims for. Using their imaginations, clients are asked to fill in the gaps they perceive were left by a challenging childhood. Here’s what that process can look like.

If a client says they wish they’d had a nurturing and present father figure, Parnell will ask them to imagine that parent. “What are his different qualities? What would he look like? Describe and imagine his physical sense and presence,” she explains. “Once we have an image of him, we tap it in—meaning we use BLS and form new neural networks carrying the image of this father.”

The client then revisits moments from their childhood and adolescence when having that father figure would have been important. “I ask the client to imagine how they feel in that moment, whether it’s loved and supported or just happy,” Parnell says. “Then we tap those feelings in.”

New neural networks created by this process override the gaps left by the client’s initial deficit, easing their feelings of hurt, inadequacy, and loss. The sense of support and love the client never received from a father figure in real life then becomes a resource for them throughout their healing journey.

Find support now

If you’re interested in working with a therapist who specializes in EMDR, attachment-focused EMDR, or another attachment-based therapy, search our directory to find a licensed professional near you.