A new paradigm for eye movement psychotherapy.
Article Type: Report
Subject: Psychotherapy (Health aspects)
Psychotherapy (Methods)
Eye (Movements)
Eye (Health aspects)
Eye (Psychological aspects)
Author: Vazquez, Steven
Pub Date: 12/22/2009
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2009 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Winter, 2009 Source Volume: 12 Source Issue: 4
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 216961284
Full Text: [ILLUSTRATION OMITTED]

This paper introduces an new form of therapeutic eye movement that offers another level of effectiveness. A brief history of eye movement is reviewed, a differentiation of MDEM from EMDR is listed, and the different types of eye movement are described. An original hypothesis regarding stopping points of saccadic eye movement is introduced. Then, some basic processes used in MDEM are described, including powerful original processes like slow color rotation and the therapeutic use of smooth pursuit eye movement through saccadic stopping points. The role of visual brain stimulation and precise interpersonal responses are central to this method. Finally, a review of the wide range of applications for psychological and physical conditions is done.

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The New Paradigm for Eye Movement Psychotherapy

The therapeutic use of eye movement for psychological and physical changes is undergoing a paradigmatic shift with the advent of multidimensional eye movement (MDEM). There is a long history of using some aspect of the eyes' functioning to enhance therapeutic purposes. During the last decade, eye movement desensitization and reprocessing (EMDR) has been validated as a means for relieving certain aspects of post-traumatic stress disorder and has gained widespread popularity (Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund, N.L. and Muraoka, M.Y., 1998, p.3-24; Ahmad, A., Larsson, B.,Sudnelin-Whalsten, 2007, p. 349-354; Chemtob, C.M., Nakashina, J., and Carlson, J.G., 2002, p. 99-112; Edmond, T., Rubin, A., and Wamachk, K., 1999, p. 103-116; Hogberg, G. et at, 2007, p. 54-61; Marcus, S., Marquis, P., and Sakal, C., 1977, p. 307-315; Rothbaum, B., 1997, p. 307-334). However, eye movement procedures have long been used in different cultures like China and Brazil. The new development of variations of eye movement processes has substantially boosted the potential to change and improve eye movement methods over time. MDEM provides a considerable leap forward in the precision and impact of eye movement and eye position for rapid therapeutic gains. MDEM is one cluster of processes within an overall method of Emotional Transformation Therapy[TM] (ETT[TM])--an evidence-based form of therapy characterized by extremely rapid outcomes and proficiency in accessing buried memory (Vazquez, S.R., 2004, p. 55-60).

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This new form of eye movement offers:

1. several original procedures

2. new premises

3. faster and more in-depth outcomes

4. applications for a larger variety of conditions than previous forms of eye movement psychotherapy.

Historical Contributions to Eye Movement in Therapy

Historically, the earliest use of an eye movement process used for purposes similar to today's psychotherapy was developed by a Brazilian priest, Narciso Irala, during the 1930s. His book, Achieving Peace of Heart, describes a procedure he called "external visual concentration" in which the person is instructed to attain concentration by tracing imaginary figures in the air with the person's own finger while the eyes follow the movement. Irala offers eight different figures, which range from the infinity figure to a star, and include many others.

This procedure does indeed yield rapid, impactful results. These procedures tend to help one to feel more fully present, relaxed, and focused when the movements are slow. However, under certain circumstances, these eye movements evoke distress and each different configuration may have a different effect (Irala, 1963, p. 38-40).

Optometric Visual Fields

Research in optometry has produced evidence for the existence of a visual field around the client's eyes, a field that possesses psychological significance. Optometrists standardly use visual field testing. According to optometrist Jacob Liberman, visual fields involve the following:

"A person's field of vision is his or her ability to simultaneously perceive things peripherally while looking straight ahead. The expanse of this global area left, right, up, down, and straight ahead--is known as the field of vision. Traditionally, the peripheral field of vision functions to perceive movement rather than detail and to dynamically predict how much the eyes will have to perceive the next object of interest while they are looking at the present object of regard" (Liberman, J., 1991, p. 81).

Visual field testing, then called perimetry, was first used by Sigmund Freud and Josef Breuer in the 1880s. Visual fields were measured before and after interventions like psychoanalysis to ascertain if the visual field was expanded to verify effectiveness of treatment (Breling, B., 2008, p. 17-19).

Research by Anderson and Williams has confirmed that there is a direct correlation between the size of one's visual field and the amount of unresolved stress possessed. Generally speaking, the more stress that exists, the more constricted the visual field becomes (Liberman, 1991, p. 82). With more reading activity, visual fields are impacted more, which appears to result in more visual impairment. However, optometrists' measurement of the visual field measures the periphery, not varying focal points, in a three-dimensional field as used in MDEM.

Visual Accessing Cues

In 1979 Richard Bandler and John Grinder described what they called "visual accessing cues." This neuro-linguistic programming concept states that in a "normally organized" right-handed person, the eyes will move to specific locations when retrieving a recollection, These positions are 2 o'clock and 10 o'clock for visually memories, 9 o'clock, 3 o'clock, and 4 o'clock for auditory memories, and 8 o'clock for kinesthetic memories (Bandler and Grinder, 1979, p. 25). Further research and numerous observations have shown that these specific locations do not consistently yield the types of recollections described nor are they always found in these locations. However, there are instances when these locations may be found to be accurate. Clinical observations of hundreds of cases has revealed that visual memories can occur at any position in a 360-degree range. This is also true of auditory and kinesthetic memories. However, the premise that the eyes move to specific locations during memory retrieval has been consistently validated. MDEM uses such a radical revision of the original concept of visual accessing cues that it would be unfair to use that label for it. Therefore, these saccadic stopping points will be referred to as "visual retrieval locations."

EMDR

In 1989 Francine Shapiro, PhD, published an article that described eye movement as a technique to relieve trauma (Shapiro, 1989, p. 199-223). This technique was eventually called Eye Movement Desensitization and Reprocessing (EMDR). It also incorporates bilateral kinesthetic and auditory stimulation as part of its repertoire. Dr. Shapiro's approach did what Irala did not achieve--it gained enormous popularity among psychotherapists all over the world. In fact, it was her 1989 publication that inspired this author to explore eye movement further (Shapiro, 1989, p. 199-223). These historical contributions provide important recognition about the role of eyes and eye movement in psychological processing.

MDEM versus EMDR

EMDR uses an eight-step model of psychotherapy in which the "bilateral stimulation" portion is a unique component. While MDEM also uses similar processes in several of these steps that adequately prepare the client, the MDEM component specifically contrasts with the bilateral stimulation portion of MDEM. How does multidimensional eye movement differ from EMDR? There are at least 12 ways in which MDEM differs from EMDR:

* The specific wavelengths (colors) of light entering the eyes during eye fixation and eye movement is an important factor in MDEM but not in EMDR.

* The directions of eye movements in MDEM are infinite in number and are limited in EMDR.

* Fixed eye positions play a more prominent role in MDEM and are not used in EMDR.

* Eye position or eye movement is based upon "visual retrieval locations" in MDEM.

* More speeds of eye movement are used in MDEM, and the premises upon which speed of movement is chosen differ from those of EMDR.

* MDEM provides rapid access to relevant implicit memory and affect more quickly than EMDR.

* Visual perceptual feedback is used to adjust eye movements during MDEM.

* Unilateral visual stimulation is often the focus of eye position or eye movement instead of the dual focus of EMDR.

* MDEM is only one of several techniques in the ETT[TM] method.

* MDEM, for one of its primary purposes, is used to facilitate the rapid reduction of many more forms of physical pain.

* Specific forms of interpersonal responses are used in conjunction with eye techniques that vary according to the attachment pattern of the client. EMDR emphasizes the detachment of the therapist.

* MDEM utilizes focal points in a three dimensional visual field.

EMDR rests on the premise that the bilateral portion of the Eight Step Model of EMDR is a key factor in facilitating brain changes of a unique nature that correct fixated, unresolved trauma. Based on the evidence that entirely new awareness arose in clients who had already explored the same issues with EMDR previous to an MDEM session, MDEM typically offers a process that accesses a new level of retrieval of unresolved affect and implicit memory. In addition, a more rapid shift in affective, cognitive, somatic, and behavioral changes is usually facilitated by MDEM. Given the differences in MDEM techniques and the fact that they are used counter to the basic premises of EMDR, it is unreasonable to describe MDEM as an extension of EMDR.

MDEM Methodology

MDEM methodology provides an entirely new way to use the eyes for psychotherapy. An initial intake and personal background interview takes place with a new client. The client and therapist identify issues and goals for treatment. These include recent and past distressing events, related historical incidents and attachment patterns. All ETT[TM] processes involve the identification of each client's attachment disorder so that interpersonal processes can be individualized to optimally respond to each attachment pattern. This allows maximum efficiency in regulating each client's emotions. It is also important to ensure the client feels safe in the therapeutic situation and capable of self-calming should distress occur outside of the session. If the client is not prepared to proceed adequately, further talk therapy may be necessary. If the client is ready, an exploration by the client and therapist can identify distress targets and a treatment plan. Then the eye movement portion of the procedures begins.

In MDEM, selecting the exact location for either eye position or eye movement and placing the optimal, colored visual target in that location is vital. A rich variety of potential focal points lie within a distance of about 10 feet of space vertically or horizontally from the eyes. The therapist, recognizing that any point within this range can elicit an enormous number of specific emotions, memories, and physical responses, is challenged to quickly and efficiently locate the points that correspond to the client's distress targets. These focal points are referred to as visual retrieval locations.

Identification of the spontaneous saccadic eye movements or stopping points provides the therapist with the vertical and horizontal axes for the visual focal point. However, the "depth dimension," or distance from the eyes, needs to be located in order to elicit activation of the targeted symptom. To determine the minimal distance where the facilitator should place the visual target, the therapist can ask the client to move a thumb from a point on his or her own nose outward until both eyes perceive a clear unified view of the thumb. The result is usually a location 12 to 24 inches from the eyes. Thus, the search for the optimal distance usually involves the following:

* 12 to 24 inches from the eyes

* at the angle found by observing the client's saccadic eye movements or stopping points, which occur during the exact instant the targeted emotion or somatic symptom is described by the client

* with the therapist standing to facilitate movement of the visual target through a range of locations

* by placing the optimal, colored visual target in the identified visual focal point

Before implementing the eye movement procedure, the client is asked to rate the degree of intensity of the targeted symptom. If the desired outcome is relief of emotional distress, the facilitator uses the exact point in space in the client's visual field and then keeps the client focused on it while simultaneously verbalizing the client's own description. Typically, spontaneous reflexes like blinking, changing of the facial countenance, moving the body, or yawning tend to verify that the location is accurate. The therapist encourages disclosure of any changes experienced by the client while viewing the visual target as an indication of the progress of changing symptoms. The therapist must develop the skill of identifying these brief saccadic stopping points by observing a client's eyes and recalling their precise location. This skill allows the therapist to replicate these visual focal points by directing the client's eyes using a handheld visual target to replicate the exact eye movement or stopping point. At this point the facilitator simply holds the visual target still at the visual focal point. Typically, stimulating the visual focal point elicits a slight intensification of the emotion for a brief period of time (5-10 seconds). The client is then guided toward a slow, rhythmic breathing pattern. This moderates the intensity of affect and encourages emotion to progress. The intensity usually diminishes to neutrality within 30 seconds, if not immediately.

When relinquishment of fixated emotion or physical pain takes place clients tend to spontaneously yawn, laugh, or simply relax. At this point the clients are asked to close their eyes and use a numerical rating to compare their current experience to the experience prior to the procedure. Most people find the contrast to be obvious, but some people report not being sure what has happened in spite of symptom relief. These variations appear to occur due to differences in self-awareness. Because the change is usually so complete, the client's brain appears to have integrated the shift spontaneously, making it unnecessary to input a positive replacement experience to fill the void left by the omission the distress issue.

Case Study #1

Roberta is a 50-year-old married woman and the executive director of a large professional organization. Roberta reported excessive distress and overwhelming feelings as a result of her many responsibilities. The main emotion she sought help for was frustration over experiencing loss of control over her many tasks and duties. Roberta's eye movement revealed a slight 7 o'clock (from her perspective) stopping point as she uttered the word "frustration." As I listened to Roberta's description she reported catastrophic escalation of emotion and then numbness as she disconnected from her affect, which revealed a resistant attachment pattern followed by an avoidant defense. Therefore, I re-elicited the affect by repeating her previous words about frustration and began the MDEM protocol. The color yellow was selected and placed in the 7 o'clock position, 18 inches from her eyes, while I repeated her issue and the description of frustration. She rated her frustration a 9 on a 10 scale. I asked Roberta to take a deep breath.

Within 10 seconds Roberta reported a profound relaxation throughout her entire body, especially her legs and feet. Roberta reported this relaxation even when I repeated her issues to her. She reported her level of frustration at 0 on a 10 scale. She reported that those issues suddenly did not matter anymore. She reported a warm flow of circulation throughout her body. While the affect and physiology had changed, she was still cognizant of her responsibilities, though they now seemed achievable. I asked Roberta to savor these moments in order to recall them. Roberta was told that by memorizing the visual experience of viewing yellow at the precise location she could re-activate that calming experience at a later time.

Sequential Chains of Emotions Often Emerge

Instead of the saccadic stopping point changing when an optimal, colored visual target is used, it is more likely that entirely different emotions may arise one after another, along with insights, memories, and somatic changes. This phenomenon occurs in a majority of cases. For maximum progress, the color must be changed to match the emotional tone when this occurs. This color change may produce an entire chain of emotions that quickly emerges, escalates, and then reaches completion. These changes often take place within seconds or minutes. In these instances it is color, not the location in the visual field, that would be changed using the Vazquez color-emotion resonance system, a full description of which lies outside of the parameters of this article. These changes may involve one to six colors used simultaneously as visual targets. Changing colors is necessary in the vast majority of cases.

A person who is initially very clear about an emotionally distressing symptom may be surprised by a subsequent series of emerging emotions. For example, one woman felt fear and panic attacks initially. This relinquished and led to anger about her family not being helpful when she needed them. As this second emotion discharged, sadness about feeling so alone emerged. Finally, relief of sadness resulted in calmness with no lingering residual emotion about any of the previous feelings.

The speed at which emotional relinquishment begins to slow down is an indicator that the visual retrieval location, based on saccadic eye stopping points, should be reevaluated. This typically occurs after two or three different emotions have emerged and become relinquished. At this point, the therapist takes a seat in front of the client and asks the client to close his or her eyes while the visual targets are removed. Then, with open eyes, the client is asked to describe the newly emerged emotional or somatic issues. While this description takes place, the therapist watches the client's eyes for any saccadic stopping points related to this newly emerged material. Then the aforementioned MDEM process is repeated.

This initial procedure works in varying degrees in the vast majority of cases. However, in the event that the emotion remains fixated, a second option is to slowly move the visual target back and forth through the visual retrieval location. This movement works best when it is very slow and typically requires movement through a span of space of only one to three inches. This eye movement tends to disrupt emotional fixation and allows affect to progress to fruition.

Slow Color Rotation for Rapid Transformation

A third therapeutic option involves the slow rotation, clockwise or counterclockwise, of a configuration of specific, multiple, colored visual targets. It has been observed that extremely slow and slight rotation of color elicits immediate and significant change in emotional intensity. For example, when red, yellow, and blue are in a triangle configuration with red on top, yellow to the bottom left and blue to the bottom right, a 90-degree rotation placing yellow on top, blue at the bottom left, and red at bottom right may drastically diminish a targeted emotion within seconds.

Through slow color rotation the client's emotional or cognitive symptoms tend to instantly change. For example, one 90-degree rotation may cause an emotional shift in intensity and/or physical manifestation. Then, the next 90-degree rotation may result in the presence of an entirely different emotion regarding the same issue. Another 90 degree rotation may extinguish all of the emotion associated with an issue. Sometimes the emotion will reactivate when a previously charged rotational position occurs again. However, in most cases rotational extinguishment of emotion results in long-term changes. If the correct colors are used, positive change occurs the vast majority of the time.

Resonance between color and emotion/ physiology tends to be highly synchronous, and the slightest movement of the visual target causes immediate and profound changes in the client. For example, in the case of a rape victim, the emotion of humiliation extinguished almost instantaneously when the colored targets were slowly rotated to a slight degree. In another case a man's shoulder and arm pain shifted from coldness to heat with one slow rotation, to pain moving down from his shoulder with another slight rotation, to pain moving back up his shoulder with another slight rotation, to all pain extinguishing with a slight fourth rotation.

Three Dimensional Eye Movement

The fourth option is to very slowly alter the distance of the visual target farther from the client's eyes while maintaining the same vertical/horizontal angle. When physical reactions such as blinking occur, these reflexes support the identification of visual retrieval locations. Therefore, the therapist stops the distancing movement and asks the client about experiential changes. There may be several locations of discharge of emotional intensity or locations of increased intensity. The locations of lessened intensity may be used as positive resources to titrate the locations of higher intensity by moving the visual target back and forth to high intensity and low intensity locations.

When a distinct visual retrieval location has been found that intensifies the emotion of an issue but fails to relinquish it, one alternative choice is to explore slowly varying the distance of the visual target from the client's eyes. It is also possible to vary the vertical or horizontal axis, searching for the locations in which calmness or other desirable emotions exist. Then the client is asked to recall in memory the exact visual appearance of the desirable location while viewing the distressful visual retrieval location. This procedure may have to be duplicated two or three times in order to neutralize the emotional distress. However, the entire process usually takes only a few minutes. Superimposing the positive visual resource onto the distressing visual location literally reorganizes the client's own inner resources for healing. When a distressing visual retrieval location no longer evokes distress, this change involves the full range of the visual system, often yielding a permanent change in the symptom. The primary exception occurs if there continues to be other visual retrieval locations for the same or similar experiences of emotional distress. However, a repeat of the same process in other visual retrieval locations can accomplish further relief until the symptom no longer lingers.

Instant and powerful changes often result in an experience of cognitive dissonance. For example, one rape survivor experienced the complete extinguishment of intense humiliation within seconds that she had felt for 32 years and stated, "It can't be that easy." Sometimes clients start laughing because the process, although it has clearly worked, is too far beyond anything with which they are familiar. One client with symptoms from colorectal cancer experienced complete extinguishment of all discomfort through MDED. She stated, "I cannot feel it at all anymore, but I can't believe it." Clients report that they cannot reconcile how looking at a colored wand could change their emotions or physical body. These responses provide opportunities to stabilize these changes through educating the client.

Unique Variations of Eye Movement

A sixth variation may involve a visual retrieval location that is not actually a stopping point but instead a brief eye movement. This location is accessed when, during the client's description of a specific emotional state or physical symptom, the client's eyes move instead of stopping during recollection. The therapist should duplicate the same eye movement by leading the eyes with the proper visual target. For example, when one woman described her hip pain, her eyes moved in an arc from the center position to about 10 o'clock. This specific motion occurred at the exact instant in which she described her pain. When the visual target was slowly moved back and forth at the same arc, she reported a feeling of the pain being erased with each movement until it was completely gone.

There are numerous variations of this method that utilize only one eye at a time, often involving entirely different principles than those discussed here. However, the single eye techniques are outside of the parameters of this article. Please note that there is much more to MDEM.

Types of Eye Movement

Research in optometric sciences can clarify the different types of eye activity and their functions. The most prevalent type of natural eye movement is called saccadic eye movement. This eye movement is characterized by the eyes scanning a visual scene, fixating on a point briefly, then quickly moving to another scene, with this process continuing again and again in the same manner. These brief stopping points occur for only about 10 milliseconds (Carpenter, R. 1988). Saccades move at a speed of up to three times a second.

In contrast to saccades, the eyes can fixate directly onto an immobile point. For practical purposes, the average person can observe either eye movement or visual fixation. However, optometric researchers also find "microsaccades" within eye fixation that are so subtle that they are not usually observed by the naked eye. Two types of microsaccades are drift and tremor. When the eyes are fixated upon a visual target, scientific observation reveals that the eyes subtly drift and often within this slight drifting are micro-tremors of movements (Montez, Conde, S., Macknik, S., 2007, p. 56-63: Montez-Conde, S., Macknik, S.L., and Hubbel, D.H., 2004, p. 229-240). It has now been found that microsaccades are necessary in order to maintain attention on a visual target (Martinez-Conde, Macknik, Troncoso and Dyar, 2006, p. 929-945). Research has revealed that if the eyes are forced to be immobile, everything around the visual target appears to fade from sight and even the object of focus will eventually fade. When the term "eye fixation" is used, it is a relative term because micro eye movement is taking place almost all the time during waking states.

Each type of eye movement is associated with different functions. For example, smooth pursuit eye movement (SPEM) is a form of eye movement that involves following a visual target so that the image of the target remains on the fovea. One way in which SPEM is differentiated from saccadic eye movement is that visual fixations or stopping points are absent. This continuous eye movement is much slower than saccades. SPEM moves at a maximum of 100 degrees per second (Carpenter, R, 1988). It is different from saccades in that SPEM only occurs when the eyes are tracking an object in space.

Smooth pursuit eye movements have also been found to be associated with specific psychological and brain disorders. Adults who reported childhood abuse were found to be more likely to have SPEM deficits than those who reported no abuse or neglect (Irvin, Green and Marsh, 1999, p. 1230-1236). SPEM deficits are associated with types of brain damage such as focal brain lesions due to strokes (Deleu, Michotte, and Ebinger, 1997, p. 28-35; Gaymard, Pierrot-Deselligny, Rivand, and Velut, 1993, p. 1415-1420).

Among the functions of eye movement are associations with specific psychological disorders. Eye tracking dysfunction (ETD) involves an inability to use saccadic eye movements. This dysfunction is a diagnostic feature for schizophrenia. ETD occurs in as many as 85% of hospitalized schizophrenics and half of their first degree relatives compared to 8% of the general population. ETD is not changed by neuroleptic medication. The identification of ETD in adolescents can often reveal evidence of potential schizophrenia before it emerges in early adulthood (Holzman, 1985, p. 179-205; Holzman, Levy and Proctor, 1976, p. 1415-1420; Holzman, 1973, p. 178-181).

These associations of specific forms of eye movement have shown that eye movements potentially reveal psychological diagnostic information. It suggests that eye movements serve as a feature of psychological conditions and potentially a means for contributing to their alleviation.

Why Do Saccadic Eye Movements Have Stopping Points?

When the erratic movement of the eyes was initially noticed by this author, intense curiosity emerged about why the eyes continually darted, stopped, darted and stopped. Were these eye movements totally random? What optometric scientists discovered is also important.

There are at least two prevalent hypotheses that describe the purpose of stopping points in saccadic eye movements. The first theory suggests that repeated stopping points occur in order for each portion of an image to add a fragment of each portion of a scene to develop a complete image. A second hypothesis asserts that the eyes move from position to position because memory of previous experience is used to anticipate the next location of each stopping point. The function of this anticipatory movement is to avoid being interrupted by incoming signals which allows the eyes to stay on track to achieve an objective (Carpenter, R., 1988).

These hypotheses may both be part of the function of saccadic eye movements but are limited to the functions of seeing and do not speculate on emotional factors that may be related. The evidence appears clear that emotional experience and eye movement are interrelated. Therefore, a third hypothesis is proposed to explain the function of stopping points and eye movements of saccades.

Vazquez Hypothesis Regarding Saccadic Stopping Points and Eye Movements

While mentally focusing upon issues containing unpleasant or unresolved emotion, either implicitly or explicitly known, a patient may reveal saccadic stopping positions or specific eye movements that represent locations at which potential memory retrieval related to unresolved emotion exists. The brief milliseconds during which the eyes stop or abruptly move may represent a tendency to allow affect to emerge, while at the same time, the rapidity of the eye movements may represent a defense to avoid emergence of memory and affect. During this time when one is mentally focused on relevant psychological issues, retrieval of the memory and unresolved affect would likely occur if the eyes did not move so quickly through the saccadic stopping points or related eye movements. Therefore, the brief quality of stopping points or certain eye movements appears to inhibit retrieval of memory and emotion.

Without saccadic stopping points, theoretically, unwanted recollections could emerge randomly when the eyes moved through those points, and the potential for emotional flooding would be a continual risk. This brief quality of stopping points might explain why most schizophrenics cannot track with saccadic eye movements. Since schizophrenics are often flooded by internal psychological information, their ability to track an external object would be limited due to the continual internal distraction. Hypothetically their defenses are inadequate to block internal cognition and affect which emerges relatively freely at visual retrieval locations in schizophrenics. This may result in an inability to visually track an object in space. This continual retrieval process would likely produce enough information to interrupt eye tracking movement.

The idea that these locations of stopping points of eye movement represent potential memory retrieval, and not random stopping points, is supported by a consistent observation: When a specific emotional issue remains the focus, the eyes continue to stop at these same locations when led through multiple repetitions. Reflexes such as blinking, alterations in countenance, and other reactions are also likely to occur at these same locations when a visual target is used to activate these points.

Almost all brain body functions are available to be influenced through the internal-external visual system that predominates after the third month of life to regulate the child's mind-body system by visual contact with the mother (Schore, 2003, p. 7-8). This author discovered that the direction the eyes were viewing when a strong emotional charge was experienced becomes associated with the eye position. This direction of viewing becomes a significant part of the way the memory was encoded. The eyes undergo physical changes in order to change focus when an object is viewed at varying distances. Therefore, it appears that the focal position of the eyes at the time of an unresolved emotional event literally becomes part of the memory. Then when similar memories or emotions are focused upon, the visual retrieval location emerges as a saccadic stopping point.

Specific neural networks of emotional issues are potentially accessed by each visual retrieval location. These neural networks can be elicited into consciousness awareness by an external visual target. Several brain functions are involved in these visual retrieval locations. An entire set of physical re-enactments, mental focus and neural networks reveals a complicated form of state-dependent learning and memory that may account for retrieval. Neural networks often appear to be fixated in maladaptive survival modes which are sometimes exhibited in somatic symptoms. These experiences are known to involve the amygdala, the hippocampus, the orbitoprefontal cortex and other aspects of the limbic system. Experiences may often have explicit emotional symptoms while much of the experience may be dormant in subcortical structures. MDEM possesses the attribute of being able to bypass the intellect to access the internal brain-body system.

Simply stopping the eyes at these visual retrieval locations rarely elicits relevant recollections unless the client's attention is focused on the targeted psychological material. Visual retrieval locations appear to emerge and recede as emotionally charged issues emerge and recede from awareness. When a symptom such as a need to cry, flashbacks, memories, or physical pain are present and focused upon, the saccadic stopping points or specific eye movements emerge so that these actions are visible to the therapist. Instead of allowing the eyes to move rapidly through these brief eye movements or stopping points, the therapist, using a handheld visual target, can lead the client's eyes to replicate these actions, resulting in the surfacing of dormant affect, memory, or insights. External visual focal points are not only found on a vertical and horizontal axis but a depth axis as well.

Case Study #2

Michael has a history of severe and repeated physical abuse by his parents. As we explored his response to various visual field positions by use of a colored visual target, the six o'clock position approximately 24 inches away from his eyes elicited a consistent eye closing behavior. As the visual target was held constant in this position, interpersonal support was provided. Intense fear arose initially as he recalled his father moving closer to him with his fist clenched at about six o'clock from Michael's viewpoint, in the process of hitting Michael in the stomach. In this case the recollection was only retrieved when the close distance to the eyes was identified. MDEM processes yielded relief of the physical tension and affect. The same vertical/horizontal angle at the further distance had no effect. The intrusion into his personal space at that angle was apparently encoded during memory formation. In this case the color yellow resonated with powerlessness and accelerated it conclusion. Although Michael's brief eye closure at 6 o'clock represented a visual retrieval location so severe that it lasted longer than a typical saccadic stopping point, it appeared to serve the same purpose of defending him against the retrieval of an unpleasant recollection.

Color and Emotional Resonance

A potent element in MDEM is the precise use of color as a visual target. This therapeutic use of color is primary to the method of ETT[TM], and eye movement techniques are secondary in importance among techniques in ETT[TM]. Nonetheless, eye movement and eye fixation techniques used in ETT[TM] offers an entirely new level of power, speed, and depth that is unprecedented among eye movement techniques.

When light enter the eyes, photoreceptor cells convert light into a flow of ions that produce electrical impulses. The function of seeing our physical environment is only one of numerous functions that these neural impulses activate. These impulses travel through three different pathways that involve the entire brain and nervous system and can potentially impact virtually every aspect of our experience. Each color is composed of a specific band of wavelengths of light that can be emitted from either a light source or reflected by an object. Through impulses that travel the visual pathway, each color can potentially access specific neural networks of memory when the brain is appropriately engaged in relevant mental focus. Visual color stimulation can be targeted to impact specific emotions, somatic experiences, cognition or behavior.

Our brain-body system resonates with wavelengths of external light sources. Established practices in live theater uses specific color environments to elicit specific mood states. Integral Membrane Proteins (IMP) facilitates forms of information to be transported across cell membranes. Receptor IMP's "function as molecular nano-antennas tuned to respond to specific environmental signals." These receptor antennas can read vibrational energy like light (Lipton, p.83). If an energy vibration in the environment resonates with the receptor's antenna, it will alter the proteins' charge, causing the receptor to change shape (Tsong, 1989, p. 89-92). Through this and other mechanisms, vibratory energy such as light can be converted into biochemical processes and ultimately lead to changes in brain functioning. There are many scientific studies that have shown that the visible light spectrum and other electromagnetic forces strongly affect biological regulation (Liboff, 2004, p. 41-47; Goodman and Blank, 2002, p. 16-22; Sivitz, 2000, p. 159-195; Jin, et al, 2000, p. 371-379; Blackman, et al, 1993, p. 801-806; Rosen, 1992, p. C1418-C1422; Tsong, 1989, p. 89-92; Yen-Patton, et al, 1988, p. 37-46).

When color is used to optimally resonate with an emotion it can feel like support to the client, making retrieval of implicit memory easier. It has been observed that color can literally draw emotions to the surface and speed up their progress to completion under proper conditions (Vazquez, 2007, p. 191-213). For example, if sadness was fixated, viewing green would likely advance it toward completion; if anger was blocked, with the proper focus and length of time, yellow would tend to bring it forth; if verbal expression was thwarted, blue visual stimulation would allow it to be expressed. This process works so well that color stimulation alone often achieves the therapeutic objective. However, when color is used in conjunction with eye movement and eye fixation, color is an even more potent factor. The activation of psychological activity by color resonance often provokes verbal expression and interpersonal processes.

Combining Verbalization and Eye Movement

An additional factor discovered in scientific research is that "visual impact can alter spoken language comprehension, and spoken instructions can alter visual perception" (Eberhard, Spivey Knowlton, Sedivy, and Tamenhaus 1995, p. 409-436). Because of this fact, verbal guidance during guided eye movements amplifies the internal cross-talk between cognitive, affective, linguistic, and sensory activity. As a result, verbalization and eye movement together form a synthesis that yields a far more significant outcome than either process alone. Therefore, when the therapist verbally replicated descriptions of the client's emotion at the same time the client is doing the prescribed eye movement, the process is often amplified. This keeps the client's mental attention on track during the process while relieving the client from the task of verbalizing during eye movement. However, spontaneous client verbalizations are also helpful and may serve to inform the therapist about the client's changing psychological progress so that he or she can make adjustments. Verbal expressions by the client are particularly valuable if the client's issues concerns thwarted verbal expression.

[ILLUSTRATION OMITTED]

In addition to the use of color and verbal input, appropriate empathy provides the support that also encourages disclosure and progress through fixated affect. This third factor often provides a base of safety that allows the otherwise defended emotion to emerge. Communication of attunement to the client's experience during emotional experiences reduces the tendency toward intensification of affect as well as the tendency for unresolved emotion to endure excessively. In many cases, the emotion is fixated because of the absence of interpersonal support during the original formation of the affect. Attunement during the clients' emotional experience can serve to release the fixation in these cases. Specific responses for each type of attachment disorder, revealed in MDEM training, move attunement to a higher level, but will not be the focus of this paper.

Memory Retrieval and Eye Movement

There exists both an internal and external function of vision. Once light enters the eyes it is converted into impulses that travel through the entire brain and nervous system (Liberman, J., 1991, p.81). This visual pathway is bidirectional, meaning we can retrieve information such as emotion and images drawn from within the visual pathway system or an image associated with emotion can be taken into the visual system from an external source. Of course, these two types of vision are interrelated. Certain eye activity accesses awareness of internal psychological and physical experiences by means of the visual pathway. MDEM involves observing and using external eye activity that activates internal visual pathways to facilitate change related to emotions or physical symptoms.

When MDEM is used, clients who have previously experienced EMDR often discover an entirely new awareness of memories related to their issues. Saccadic eye movement is not associated with long-term memory (Henderson and Hollingsworth, 1999, p. 243-271; Hollingsworth, Williams, and Henderson, 2001, p. 761-768). Therefore, while saccadic eye movement in EMDR can facilitate change in a known trauma, it is very limited in its comparative capacity to retrieve implicit memory. This could mean that an issue and unresolved emotions would continue to arise even though superficial relief may have taken place initially with EMDR.

On the other hand, visual fixation, gaze aversion, and eye closing have been found to aid retrieval of recollections as well as increasing the efficiency of encoding memory (Einstein, Earles and Collins, 2002, p. 65-73; Glenberg, Schroader and Robertson, 1998, p. 651-658). Eye fixation is known to take place during hypnosis which is well documented to retrieve memory (Hammond, D.C., 1990, p. 509-542). However, while visual fixation retrieves memory, the accompanying affect does not necessarily progress. First the fixation on an immobile visual target promotes the phenomenon of perceived visual fading of everything around the target. This prolonged fixation and visual fading then elicits depth retrieval through the internal visual pathway into memory and emotion. In many such cases, retrieval of memory potentially results in emotional flooding, which can re-traumatize a person who suddenly recalls a dormant traumatic memory. However, in MDEM visual targets that resonate with the emotional tone of the recollection are used to facilitate progress of affect. When this takes place along with interpersonal responses appropriate to the client's attachment pattern, retrieved affect tends to rapidly progress through its fixated state. Retrieval of traumatic memory is usually only valuable if it can be rapidly processed in order to limit re-traumatization. We consistently see clients who think they have already recovered all relevant memories through well known methods like hypnosis, EMDR, body work, bioenergetics only to discover that ETT[TM] processes like MDEM retrieve an entirely new level of related implicit memory.

Discussion and Conclusion

The implications for counseling and psychotherapy are enormous. This process has the potential to revolutionize the way therapists work. Symptoms are changed so rapidly and long-term that the use of psychotropic medications might become largely obsolete. However, its use for physical symptoms may offer an even greater breakthrough particularly in treating physical pain syndromes. MDEM possesses particular value in alleviating trauma brought about by emotional memory of intimidating eye contact, terrifying looks in another person's eyes, or seeing something that is unbearable. Reich would call these experiences ocular trauma.

MDEM has been used successfully for a wide range of conditions. It has been used for several types of trauma including the following:

* Acute stress disorder

* Post-traumatic stress disorder

* Disorders of extreme stress not otherwise specified (complex trauma) These traumas include but are not limited to crime victims, survivors of automobile accidents, rape survivors, survivors of natural disaster, war trauma, and others.

MDEM has been successfully used for relief of numerous stress-related medical symptoms. These include but are not limited to the following examples:

* Migraine headaches

* Low back pain

* Temporomandibular joint pain

* Sciatica

* Physical pain from injuries

Symptoms of numerous medical conditions have been successfully alleviated by the use of MDEM. The following conditions have experienced symptomatic relief:.

* Fibromyalgia

* Physical symptoms from surgical procedures

* Arthritis

* Cancer

However, MDEM has been used primarily with almost all affect-related symptoms and disorders which with they are associated. A partial list of issues successfully relieved includes:

* Phobias

* Anxiety

* Panic

* Anger

* Sadness

* Shame

Relief of these symptoms is often a part of the relief of conditions like depression, bipolar disorders, attention deficient disorder, and numerous other psychological conditions. It has also been used for performance enhancement and preparation for surgery.

While this article describes several original principles used in MDEM, it does not provide enough information for the reader to be able to use MDEM by simply reading this article. It would not be appropriate to risk potentially harmful recollections and abreactions through using the principles in this article alone. Professionals should be guided by a trained ETT[TM] clinician in order to use this process effectively.

This new process, combining eye movement and eye fixation with color radically expands the speed, precision and range of application of the therapeutic eye movement procedures. We already possess abundant case studies that use MDEM successfully. New scientific outcome studies that objectively measure these profound effects are needed. This research will either verify or debunk these findings. The clinical evidence of MDEM suggests that an entirely new level of efficiency for treatment may be validated. If it can be confirmed to provide better outcomes, or if other studies can clarify it's proficiency in the context of the therapeutic quality of current methods, a new level of effectiveness can be validated to exist.

Specifically, MDEM could be scientifically studied in comparative research. MDE M could be compared to EMDR, emotional freedom technique, cognitive therapy or any other method that is considered to be empirically validated as efficacious. Neither the number of studies done on a method nor the popularity of a method necessarily equates to a method's comparative effectiveness. A mere profusion of scientific research does not validate the superiority of a method; in fact, it may simply reflect that these methods were more frequently selected as topics for study. A validation by quantity alone gives the consumer the questionable message that a more often studied method is better than another less often studied method. New methods of treatment should be compared to older methods by evaluating the outcomes to ascertain if advances are, in fact, being made by the newer methods.

People have explored the use of eye movement for many years, from the ancient Chinese eye chart to a Brazilian priest's eye movement methods in the 1930s to Shapiro's EMDR method published in 1989. Therapeutic eye movement has shown evidence of value. While these great historical contributions have been significant, there is now a "new chapter" in the therapeutic use of eye movement/eye fixation that possesses the potential to provide unprecedented breakthroughs in treatment. This new chapter has already been written and is ready to proceed in the venues of training more people to use it and to proceed with scientific documentation of its efficacy.

For more information about the ETT[TM] Web site: www.lightworkassocaites.com.

E-mails to the author may be sent to srv@lightworkassociates.com.

This article is approved by the following for continuing education credit:

The American Psychotherapy Association is approved by the American Psychological Association to sponsor continuing education for psychologists. The American Psychotherapy Association maintains responsibility for this program and its content.

After studying this article, participants should be better able to do the following:

1. Recite three types of eye movement.

2. Describe the Vazquez hypothesis regarding saccadic stopping points.

3. List three processes used when the focal point in the three-dimensional visual field is located.

KEYWORDS: Multidimensional Eye Movement (MDEM), Emotional Transformation Therapy[TM] (ETT[TM]),Visual Retrieval Locations, Slow Color Rotation, Saccadic Eye Movements

TARGET AUDIENCE: Psychologists and mental health professionals

PROGRAM LEVEL: Intermediate

DISCLOSURE: The author has nothing to disclose.

PREREQUISITES: None

POST CE TEST QUESTIONS

1. Which type of eye movements have been identified by optometric researchers?

a. Saccadic eye movement

b. Smooth pursuit eye movement

c. Tremors

d. All of the above.

2. The Vazquez hypothesis regarding saccadic stopping points concern the following concepts:

a. Accumulation of fractional images of a scene

b. Anticipating where the visual gaze should stop in order to accomplish a task

c. Stopping points may represent a visual location for potential memory.

d. None of the above

3. Multidimensional eye movement uses the following factors:

a. Visual focal points in a three-dimensional field

b. Color

c. Interpersonal verbalization

d. All of the above

4. Selection of eye movements for psychotherapy is based on:

a. Bilateral stimulation, horizontal back and forth

b. Where the eyes move or stop at the instant the client describes the affective or somatic symptom

c. Rapid eye movement (REM) that occurs during dreaming.

d. None of the above

5. MDEM has been successfully used with the following conditions:

a. Rapid trauma recovery

b. Rapid relief of physical pain

c. Rapid relief of the symptoms of panic

d. All of the above

6. The earliest form of eye movement used for psychotherapy purpose is:

a. Neurolinguistic Programming

b. External Visual Concentration

c. Orgonomy

d. None of the Above

7. Visual field testing, known as perimetry, was used by:

a. Carl Rogers

b. Albert Ellis

c. Sigmund Freud

d. All of the above

8. Visual retrieval locations involve:

a. Memory retrieval

b. Saccadic stopping points

c. Potentially involves an infinite array of eye positions

d. All of the above

9. When MDEM is used, emotions often merge:

a. In sequence of one after another

b. Only once

c. All at once

d. None of the above

10. MDEM techniques include:

a. Slow color rotation

b. Alerting the distance of the visual target

c. Duplicating the client's eye movement

d. All of the above

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Steven Vazquez, PhD, is the originator of Emotional Transformation Therapy and the multidimensional eye movement techniques. He is a licensed professional counselor and licensed marriage and family therapist in private practice in the Dallas-Fort Worth area. Dr. Vazquez has trained hundreds of professionals worldwide, published numerous peer-reviewed journal articles, and presented his work at dozens of professional conferences.
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