Therapists often ask me which trauma treatment they should learn: eye movement desensitization & reprocessing (EMDR) or progressive counting (PC).
First of all: Yes – you should learn EMDR or PC, if you haven’t already! Efficient, effective trauma treatment methods enable therapists to systematically guide clients in healing from their psychological wounds. This is much better than merely teaching coping skills. When you heal, you don’t have to cope with the symptoms anymore! Learning EMDR or PC is a real game-changer, and the therapists we train routinely report feeling reinvigorated in their work.
EMDR is the best of the well-established trauma therapies, in that it is at least as effective as the other leading brands, better tolerated, and considerably more efficient (Mavranezouli). EMDR can be used with children of any age, as well as adults. EMDR is complex, so the 2020training is 7.5 days (spread out over several months, including the required consultation) at a typical cost of about $1,500. At least, that’s what we charge.
PC is a newer treatment that has done quite well so far. In direct comparisons, PC was found to be about as effective as EMDR (Greenwald & Camden, 2022; Greenwald, McClintock, & Bailey, 2013; Greenwald, McClintock, Jarecki, & Monaco, 2015) while being less difficult for clients, and possibly more efficient (Greenwald, McClintock, Jarecki, & Monaco, 2015). That’s a pretty big deal, since EMDR is already better tolerated and more efficient than traditional CBT methods such as prolonged exposure. However, more research is needed. PC can be used with children age six and older, as well as adults. PC is simpler than EMDR – on a par with other exposure methods – so the training is 6 days (spread out over a few months) at a typical cost of about $850.
While EMDR and PC may share some underlying mechanisms of effect, they are different procedurally as well as experientially. EMDR tends to involve more free association, so the client may wander through many other somehow-related memories, making connections and gaining insight. With PC this also happens to some extent, but less so, and the client is more likely to stay focused on the target memory. This difference makes EMDR a bit more appealing for clients who want insight, and PC a bit more appealing for clients who don’t want to get surprises (unpredictable exposure to other memories) during the session.
I tend to use PC as the first line, because it is generally quicker and easier (less emotionally intense) for the client. And on occasion if I’m not satisfied with how it’s going, I switch to EMDR. I also know a number of therapists who are more comfortable with EMDR, but switch to PC on occasion.
In one of our treatment programs, clients are randomly assigned to EMDR or PC. Our therapists have told me that at the end of treatment, clients routinely say, “I’m so glad I was assigned to [EMDR/PC]!” In other words, both EMDR and PC are doing very well.
So which to learn?
Go for EMDR if you care most about
- having the treatment with the most research support
- offering the name brand that people will recognize
- working with children younger than age 6
Go for PC if you care most about
- offering an excellent research-supported treatment
- working with clients with low affect tolerance
- saving time and money on the training
Disclosure: I am a leading expert in EMDR, and my nonprofit org is a leading provider of EMDR basic training in USA/Canada. And I am the developer of PC, and my nonprofit org is the leading provider of PC training internationally.
Note: This post was updated on 2/21/2023.
Very sensible, useful summary. I’ll spread the link around. Thanks!
This is the first I’ve heard of PC and I’ve been practicing EMDR for over 15 years.
Nobody heard of PC 15 years ago; it was only developed in 2007. But we’ve been using it, and getting the research done, and so far it’s looking pretty good.
Thanks for sharing this information. Well balanced review and useful information.
Have been using PC for several years in my psychology practice, with acute trauma, including gunshot, hostage, abduction, loss of limb, holding relative while dying in crash, home invasion, type events.
Teach mindful breathing technique as self management of arousal, use Foa self report at end of PC each session, and SUDS self monitor and record 3 times a day report back and meta-analyse each session after PC.
All clients report recovery and no relapse. Very fast effect (4 to 6 sessions of PC) and often then move to relational psychotherapy to explore meaning and effects in their lives.
Do not understand how EMDR works, but may learn it in order to be able to work with young children and trauma.
I am new to trauma treatment. What do the acronyms FOA and SUDS stand for?
SUDS: Subjective Units of Disturbance Scale. That is, on a o-10 scale, how bad does it feel right now?
FOA??? I didn’t see that acronym used here.
Just another thought, using PC is possibly easier on the therapist when you hear a lot of trauma on a daily basis. It is nice to see the same result and not actually hear every story.
Some therapists prefer PC because it’s a bit easier on the clients as well as the therapists. OTOH some therapists prefer EMDR because the protocol entails the client telling the therapist about what’s going on, throughout the procedure; and some therapists like being clued in. Personally I’m fine either way. I just want the client to get what they came for. And if I need to know something, I’ll ask.
How does PC work with addiction?
PC helps clients to heal from their trauma and loss memories, much like EMDR does. To the extent that trauma healing is a component of addictions treatment — which IMO it should be! — PC works well for that component of addictions treatment.