L’EMDR est une thérapie intégrative créée en 1987 par Shapiro évaluée comme efficace et rapide sur les états de stress post traumatiques. En 1995, elle améliore pour arriver à ce qu’elle appelle le Traitement Adaptatif de l’Information – TAI - (« Adaptative Informational Process : AIP »), révisé en 2001 et 2006. Cette théorie postule qu’il existe au plan cérébral un système de traitement des informations capable d’intégrer les nouvelles expériences à des réseaux de mémoire existants. Depuis d’autres pathologies ont été traitées avec l’EMDR. D’autre part, en 1998, Seligman donne naissance à la psychologie positive. Au lieu de considérer la «santé mentale » comme la « réduction des troubles neuropsychiatriques », il propose non plus d’aider les gens à passer de - 5 à 0 sur l’échelle de bonheur, mais de permettre à chacun de passer de 0 à + 5 sur un continuum de bonheur. Allier ces deux perspectives pose un certain nombre d’interrogations mais ouvre également des perspectives enthousiasmantes. Trois études ont porté sur les forces de caractères avec un échantillon de 60 sujets, pour la première, 100 sujets pour la seconde et une étude de cas avec pour objectif d’évaluer l’optimisation de l’intégration des forces avec des éléments provenant de l’EMDR. Les deux études suivantes ont porté sur la création d’un protocole EMDR d’optimisme et l’étude de ses possibilités. Nos conclusions sont que, plus que jamais, une théorisation rigoureuse est nécessaire (et elle est déjà à l’œuvre dans le cadre de la psychologie positive) et la validation scientifique des assertions est déterminante pour l’efficacité des interventions alliant psychologie positive et EMD / EMDR is an integrative therapy founded in 1987 by Shapiro evaluated as efficient and fast on post traumatic stress. In 1995, she improved the therapy to achieve what she calls the Adaptive Information Processing, or AIP, later revised in 2001 and 2006. This theory posits that there is a map in the brain information processing system able to integrate new experiences to existing networks of memory. Since its inception, other diseases were treated with EMDR. Meanwhile, in 1998, Seligman gave birth to Positive Psychology. Instead of considering mental health as the reduction of neuropsychiatric disorders and help people move from - 5 to 0 on the scale of happiness, he proposed we help everyone go from 0 to +5 on a continuum of happiness. Combining these two perspectives raises a number of questions but also opens up exciting prospects. Three studies have focused on strengths of characters with a sample size of 60 subjects in the first case, 100 subjects in the second, and a case study with the objective of evaluating the value of integrating strengths with elements from EMDR in the third case. The following two studies have focused on the creation of a protocol for an optimism-based EMDR and study its potential. Our conclusions are that, more than ever, a rigorous theory is required (and is already at work in the context of positive psychology) and the scientific validation of assertions is crucial for the effectiveness of interventions combining positive psychology and EMDR

Ce travail raconte un parcours professionnel guidé par la pratique, la curiosité et l’envie de comprendre. Il propose un modèle thérapeutique pour prendre en compte plus finement la complexité des situations cliniques en tricotant dans un ensemble congruent les informations relationnelles de l’ici et maintenant avec celles de l’histoire personnelle de chacun des acteurs de la relation. Une présentation de différentes publications illustrent ce cheminement de pensée à travers des expériences diverses pour arriver à la modélisation d’une approche thérapeutique de l’individu en relation / This work is about a professionnal journey guided by clinical practice, curiosity and desire to understand. It proposes a therapeutic model to better apprehend the complexity of clinical situations by interweaving in a congruent fashion relationnal information from the here and now with the historical personal information of every individual involved. A presentation of different publications highlights this evolution of thinking as expressed in different experiences which provides a therapeutic approach model of the individual in relation with others

L'utilisation de la thérapie EMDR - Eye Movement Desensitization and Reprocessing - est novatrice dans le domaine de la douleur chronique, trois étapes ont alors composées ce travail de thèse.La première porte sur l'étude de l'apparition d'une nouvelle composante de la douleur chronique : la composante traumatique. Multifactorielle, la douleur chronique intègre quatre composantes fondamentales : sensorielle, cognitive, comportementale et émotionnelle. Une revue de la littérature sur la comorbidité entre douleur chronique et ESPT a alors été réalisée.La seconde étape constitue une recherche préliminaire qui porte sur l'utilisation de la thérapie EMDR, et d'un protocole EMDR spécifique à la douleur, qui a été testé sur trois patients en pré-test. La thérapie EMDR donne des résultats encourageants. La recherche principale de ce travail de thèse s'est enfin attachée à comparer l'utilisation de la thérapie EMDR vs. une prise en charge éclectique, dans une Unité de prise en charge de la douleur chronique, à l'hôpital. Quarante-cinq patients, répartis en trois groupes, ont alors bénéficié d'une prise en charge avec la thérapie EMDR (protocole standard), avec la thérapie EMDR (protocole douleur), ainsi qu'en thérapie éclectique. Les résultats mettent en évidence l'efficacité de la thérapie EMDR sur les composantes sensitives, cognitives, comportementales, émotionnelles mais aussi traumatiques de la douleur, avec une plus grande efficacité du protocole standard EMDR après 5 séances, et une diminution de la douleur qui se prolonge un mois après la fin du traitement. / Considering the use of EMDR (Eye Movement Desensitization and Reprocessing) therapy is an innovative approach in chronic pain management, this research was divided into three steps.The first part focuses on studying the introduction of the traumatic component as a new aspect of chronic pain. As a multifactorial issue, chronic pain includes four key components, namely sensory, cognitive, behavioural and emotional aspects. In this context, a literature review on comorbidity between chronic pain and post-traumatic stress disorder was carried out.The second step includes a preliminary research on the use of EMDR therapy and an EMDR protocol specifically related to pain, which was pre-tested on three patients. Results of EMDR therapy are encouraging. Clinical findings of traumatic memories which emerged during therapy were used as a basis for the third step.As a result, the main focus of this research was to compare the use of EMDR therapy versus eclectic healthcare in a hospital unit specialized in the management of chronic pain. Forty-five patients divided into three groups were treated by standard protocol of EMDR therapy, pain protocol of EMDR therapy and eclectic therapy. Results show the effectiveness of EMDR therapy on sensory, cognitive, behavioural and emotional but also traumatic components of pain, EMDR standard protocol being most efficient after five sessions, and a reduction of pain extending one month after therapy has been discontinued.

Eye Movement, Desensitization and Reprocessing (EMDR) är en evidensbaserad behandling som framförallt erbjuds patienter med Post Traumatiskt Stressyndrom (PTSD) i Sverige. Psykoterapeuter som arbetar med dessa svårt traumatiserade patienter kan vara utsatta för allvarliga hälsorisker. Syftet med studien är att undersöka hur EMDR-utbildade psykoterapeuter upplever sitt behandlingsarbete med traumatiserade patienter, avseende psykologiska risker och skyddsfaktorer för hälsan. Undersökningen gjordes med semistrukturerade intervjuer av sex EMDR-terapeuter enligt kvalitativ metod. Med hjälp av tematisk analys har teman gällande exempelvis arbetsbelastning, handledningsbehov och framgångsupplevelser av EMDR-metoden kunnat skönjas. Undersökningen visar att flertalet av psykoterapeuterna har upplevt risker i form av upplevd psykisk stress med arbetet, men att de också funnit robusta, skyddande och stärkande faktorer i såväl arbetssituationen, som i privatlivet. / Eye Movement, Desensitization and Reprocessing (EMDR) is an evidence based treatement that is offered primarily to patients suffering from Post- Traumatic Stress Syndrome (PTSD). Psychotherapists who treat these severely traumatized patients are at risk for turther health concerns compared to other therapists. This essay aims towards examining how EMDR-therapists perceive the risks that EMDR-therapy with traumatized patients can affect the therapist, and the factors that makes the treatment possible to continue with. The study was conducted  through semistructured interviews with six EMDR-therapists, based on a qualitative method. With the help of thematic analysis, themes such as workload, need of guidance and succesful experiences concerning EMDR has beend found. The study also shows that many of the informants has experienced risk factors such as mental stress concerning work, but also robust, protective and strengthening factors at the work place and in private life.

The first aim of this thesis was to describe the characteristics of Posttraumatic Stress Disorder (PTSD) and to elucidate its place as a symptom disorder that sometimes develops when people are exposed to a traumatic event. The current major theoretical approaches to account for why some people who are exposed to trauma develop PTSD and the mechanisms by which this occurs were described. Three classes of theories were reviewed: conditioning/learning approach; information processing theories with a particular focus on the meaning of the trauma event; and biological models with an emphasis on recent neurocircuitry and neurochemistry models. Successful treatment approaches were then reviewed which indicated two major contenders for the most efficacious treatment for PTSD: traditional cognitive behaviour therapies (CBT) using either stress inoculation or prolonged exposure; and eye movement desensitisation and processing (EMDR). Prior to the first study (Lee, Gavriel, Drummond, Richards, & Greenwald, 2002), a review of the literature indicated equivalent effects for EMDR and CBT. There had been very few direct comparison studies and each had serious methodological flaws, particularly with respect to random assignment and treatment fidelity. Therefore, the first study ensured adequate attention to these areas and involved a direct comparison between the two procedures using a sample of 24 participants diagnosed with PTSD. EMDR and stress inoculation training with prolonged exposure were found to lead to similar symptom improvement at the end of treatment, apart from a slight advantage for EMDR on intrusion symptoms. Both treatments led to significantly greater symptom reduction than a wait list control condition. At follow-up, EMDR led to greater gains on both self-report and observer rated measures of PTSD and self-report measures of depression. Overall, the findings were similar to those described in previously published studies, with a suggestion that EMDR was slightly more efficient than the standard CBT approach. Given that the evidence suggested that EMDR was a more efficient treatment, it became critical to understand the underlying processes. A process study was undertaken that examined the responses of people with PTSD receiving EMDR treatment (Lee, Taylor, and Drummond, 2006). Guided by process studies of other treatments and theories that might account for why EMDR is effective, participants’ responses were examined to see which models better accounted for symptom improvement. The main analysis tested whether or not the responses were consistent with processes that occurred during traditional CBT treatment, which prior research had identified as reliving, or whether they were more consistent with Shapiro’s proposal that enhanced information processing occurs because there is a dual focus of attention (that is, the person simultaneously focuses on an external stimulus and on the traumatic memory) (Shapiro, 1995). The responses made by 44 participants were coded by an independent rater according to whether they were primarily reliving, distancing, affect or material other than the primary trauma. The coding system was found to have satisfactory inter-rater reliability. Greatest improvement occurred when the participant processed in a more detached or distant manner, whereas reliving responses were not associated with improvement. Cross-lagged panel correlations suggested that processing in a more detached manner was a consequence of the EMDR procedure rather than a measure that co-varied with improvement. The findings underscored a difference in the processes that underlie EMDR and traditional CBT. The major question left unanswered from this second study was what causes this distancing process? Competing views were that it was facilitated by eye movement; alternatively, the therapist’s instructions to participants might have precipitated this distancing phenomenon. The third study tested these ideas by randomly assigning 48 participants to either an eye movement or a no eye movement condition under two types of therapist instructions (reliving or distancing). Participants recalled personal distressing memories, and measures of distress and vividness were taken after treatment and at follow up. Only the eye movements made a significant difference to people’s level of distress. This conclusion appeared at odds with some of the previous literature that had tested the effects of eye movement on levels of distress. A meta-analysis of some of this research had suggested that there was no significant advantage of including eye movement in EMDR treatment unless the person had been diagnosed with PTSD. However, a close examination of this meta-analysis indicated some major methodological flaws in the computation; therefore, this was recalculated. The conclusion from this fourth study was consistent with study three in that EMDR with eye movement was found to lead to significantly greater improvement that EMDR without eye movement. The results of these four studies were then discussed in terms of their implications for the theoretical models presented in Chapter 1. Aspects of learning theory that might account for EMDR efficiency were discussed as well as the failure of this model to account for treatment gains following EMDR. Information processing models were seen to better account for some of the phenomena observed in EMDR and for the findings from the four studies. Some suggestions of how eye movements might facilitate improved information processing were presented. Finally, the relative merits of EMDR and CBT treatments were discussed and suggestions made for when to combine approaches. The conclusions highlight the point that EMDR appears to be the most promising treatment for PTSD.

Les violences conjugales représentent un problème de santé public majeur. En 2011, en France, tous les 2,5 jours, une femme meurt sous les coups de son compagnon. Les violences conjugales résultent de la conjonction de facteurs individuels, conjugaux, sociaux mais également culturels, qui seront détaillés dans cette recherche qui présentera également l’état de l’art concernant les conséquences de ces violences, leurs possibilités de prise en charge et la thérapie EMDR. Quatre études ont été menées dans cette recherche. La première porte sur les conséquences des violences conjugales auprès d’un public de femmes bénéficiant d’un accompagnement social. Il s’agissait d’apporter une contribution aux résultats déjà observés dans la littérature. La seconde étude porte sur la prise en charge de 5 femmes ayant vécu un évènement traumatique en couple et s’étant séparées de leur agresseur. La thérapie EMDR donne des résultats véritablement encourageants, ce qui nous amène à la tester auprès d’un public plus lourdement traumatisé, ayant vécu des violences conjugales d’intensité et de nature variable, durant de nombreuses années (étude 3). Les résultats de l’étude 3 mettent en évidence l’importance de l’adaptation de l’outil thérapeutique à la problématique de la victime et les limites de l’utilisation de l’EMDR auprès de certains types de publics, dont les victimes de violences conjugales. Une analyse de contenu des séances EMDR nous a permis d’affiner nos analyses grâce à une vignette clinique présentée dans l’étude 4. De plus, des personnes n’ayant pas pu être intégrées dans le protocole expérimental ont malgré tout été suivies, ce qui permet une réflexion autour de l’adéquation de la méthode thérapeutique et du cadre expérimental à la victime grâce à une étude de cas, également présentée dans l’étude 4. Toutes ces observations permettront l’émergence de suggestions concernant la prise en charge des victimes de violences conjugales / Domestic violence represents a major problem for public health. In France, every 2,5 days, a woman dies by the hands of her partner. Domestic violence is the result of the conjunction of individual, domestic, social and also cultural factors to be detailed in this research that will also present the state of art, regarding the consequences of this violence, its means of management and EMDR therapy. Four studies were led in this research. The first one is about the consequences of domestic violence for a group of women benefiting from social support. The idea was to bring a contribution to the results already observed in literature. The second study is about the caretaking of five women who experienced a traumatic event during their couple life, and then split up with their molester. EMDR therapy gives really encouraging results, and it led us to test it with a public more heavily traumatized, who lived intensity and variable violence during many years (study 3). The results of the third study highlight the importance of the adaptation of the therapeutic tools to the problematic of the victim, and the limits of the use of EMDR with some public, included the victims of domestic violence. An analysis of the EMDR sessions content allowed us to refine our analyses thanks to a clinical “vignette” showed in study 4. Moreover, people that could not be included in the experimental protocol were all the same followed up, allowing a reflection around the appropriateness of the therapeutic method and of the experimental frame to the victim thanks to a case study, also presented in study 4. All these observations will allow the emergence of suggestions concerning the caretaking of the domestic violence victims

This study explored the use of adding trauma resolution therapy to standard cognitive-behavioral relapse prevention therapy for sex offenders. Ten adjudicated sex offenders with sexual abuse histories were treated with eye movement desensitization and reprocessing as an adjunct to standard outpatient sex offender treatment. Data points include self-report, other-report, assessment instruments, session transcripts, research journals, and physiological measures. Systematic treatment research and development methods (Bischoff, McKeel, Moon, & Sprenkle, 1996) resulted in a proposed treatment protocol. Emergent themes from a cross-case, grounded theory data analysis are presented. The data suggests the adjunct treatment provided some benefit both to participants and to the goals of standard sex offender-specific treatment. Implications for treatment providers, marriage and family therapy, and future research are discussed. / Ph. D.

The clinical adherence to and combination of methods with EMDR to treat PTSD has not been explored. This is of some concern as 27 000 clinicians are trained in EMDR globally. This exploratory study gained information on Australian trained EMDR clinicians' adherence to EMDR, and the methods they combined with EMDR to treat PTSD. Survey responses from 126 clinicians were analysed using predominantly descriptive statistics. The findings of this study showed that the majority of respondents perceived that they closely adhered to the standard EMDR treatment. However, respondents reported adhering more closely to the phases than the steps of EMDR. Statistically significant findings showed that more experienced EMDR level 1 clinicians were more likely to add steps and phases to EMDR, and to change the standard sequence of steps. Clinicians with greater years of experience were also more likely to change the standard sequence of steps. In addition, more experienced EMDR level 2 clinicians, were less likely to educate their clients about PTSD. Almost all respondents combined EMDR with other methods to treat PTSD. Combined methods included CBT, hypnosis / relaxation, system / solution focused methods and exposure. This research has contributed to theory and practice by uncovering that clinicians appear to use EMDR differently to researchers, by changing EMDR to meet client needs, combining EMDR with other methods and Holly Byron 16/9/99 vi therapies, and introducing EMDR in the mid stage of treatment. These findings are vital to reduce the scientist-practitioner divide by accurately testing EMDR's efficacy and enabling future controlled trials to reflect the clinical use of EMDR.

Föreliggande studie är dels ett led i att kvalitetssäkra EMDR (Eye Movement Desensitization and Reprocessing) som behandlingsmetod för barn och ungdomar och dels att utröna om behandlingen bidragit till ett förbättrat mående. EMDR som behandlingsmetod för barn och ungdomar har stöd i kontrollerade studier, men ytterligare forskning behövs. I den här studien deltog åtta barn och ungdomar med varierande diagnoser, vilka fått EMDR-behandling i barn- och ungdomspsykiatrisk öppenvård. Behandlingen ingick i en individualterapi i ett familjeterapeutiskt sammanhang. Barnen/ungdomarna intervjuades per telefon om hur de upplevt behandlingen och om sitt mående i efterförloppet. Information om diagnoser, C-GAS, antal EMDR-sessioner samt terapeutens bedömning inhämtades som komplement till intervjun. Resultaten visar att EMDR-behandlingen upplevs ha bidragit till att obehagskänslor och symtom minskade, men i olika grad, för alla intervjuade barn/ungdomar. Denna förändring kunde också noteras i terapeutens bedömning och i de bedömda C-GAS-värdena. Alla kände sig trygga under behandlingen och tyckte att de fick tillräcklig information. Hälften tyckte att konfrontationen med de svåra minnena var det mest obehagliga. Vissa detaljer i protokollet, såsom att bestämma målbild, upplevdes svårt för över hälften. Alla intervjuade skulle rekommendera EMDR-behandling till andra. Det positiva resultatet talar för att EMDR är en användbar metod för barn- och ungdomar med traumatiska minnen, och att det är värdefullt att satsa på fortsatt forskning kring EMDR med barn- och ungdomar.

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