Healing Trauma with EMDR, Solving Puzzles, Brain Stuff and More: An Interview with Certified EMDR Therapist Andrew Kushnick

I recently had the pleasure of being interviewed for a video podcast that seeks to demystify therapists. Among the topics discussed: my journey from the law to psychotherapy, how EMDR works, how Attachment-Focused EMDR differs from regular EMDR, what sessions are like, and the importance of understanding and honoring the unique nuances of each client.

Below is a transcript of the clinical portion of the interview, lightly edited for clarity.

My host was the wonderful Kealy Spring, a Licensed Marriage and Family Therapist in the San Francisco Bay Area.

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KEALY: Hi everybody, my name is Kealy Spring. I'm a Licensed Marriage and Family Therapist in the State of California. And today I have with me Andrew Kushnick, who I know through professional organizations here in the San Francisco Bay Area. Looking forward to speaking with you Andrew, and learning a little bit more about you and how you practice. So without further ado, I'll pass it over to you to introduce yourself, the niches you work with, and go from there.

ANDREW: Great, thanks for having me, Kealy. It's great to be here. The types of clients I commonly work with, usually people who are very stuck in their heads, in narratives, in their thoughts. So they're cognitive thinkers, they're analytical thinkers. And those thoughts can be distracting. It can keep them up at night, and keep them from being able to concentrate at work. I would say that's like my typical client.

They might benefit from getting in touch with what they're feeling and not just their thoughts. Lots of folks in tech specifically. I'm writing a book on the mindset of the tech worker. So anyway, that's the majority of my practice. I'm in private practice as a Marriage and Family Therapist. 

KEALY: Yeah, the tech industry here in the Bay Area is so big. I think that book will probably be well received because there's a lot of people in need. I definitely see a lot of tech as well, being in the area here. So I look forward to seeing that when it comes out. You'll have to let me know.

ANDREW: I will, thanks.

KEALY: So, Andrew, could you share with me how you decided to become a clinician? How did you come to this path?

ANDREW: Of course. Years ago, therapy helped me a lot. And I remember, in the therapy room, there would almost be these two processes happening at once. I'd be answering the therapist's questions and participating in the session, but another part of me would be fascinated by the behind-the-scenes. “Why was she asking the questions that she's asking?” “How does this all work?” That led me to reading self-help books, absorbing anything I could alongside talk therapy.

I had been practicing law. I was an attorney for about 10-11 years. It was exciting. I was in the courtroom as a prosecutor, a criminal defense attorney and then I went into civil litigation. But I never found it to be truly fulfilling. I found the legal system to be dysfunctional and unwieldy, not always producing the best results, or a just result. And I also was never able to see the result of my work on a day-to-day basis. What I was doing sometimes felt detached from doing good for other people, so that was frustrating. Years later, I started asking my brother about his work; he’s a psychologist in Manhattan. I kept thinking to myself, “What do I really want to be doing?”

And he would tell me about his craft, and his love for the work. And I just thought to myself, “That sounds amazing.” So I started to look into it more, and found myself back in grad school again, and that led me on this path. I’m so glad I did it. 

KEALY: Yeah, it's quite the journey there… detour to law, back to therapy. So what do you like about being a clinician? What do you like about being a therapist?

ANDREW: Well, in contrast to my experience in the law, being able to see progress over time with my clients just feels so great. As you know, when they first come to us, they're just describing what's happening in their life. What's not working, what's bugging them. And sometimes it's almost myopic. Understandably, they can't really picture what life would look like if things were to change. But seeing those changes over time, seeing them talk about improved relationships and improved performance at work and being able to find direction, or patterns not playing out the same way anymore… it just feels great.

KEALY: That privilege of watching somebody go through the journey, that healing growth process.

ANDREW: Absolutely. Also, each client is like a puzzle, and solving that puzzle is one part of bringing positive change to their life. Everyone has different ways of thinking and acting and ways that they respond to stress. The ways that they are in relationships… And it's so unique to everyone.

And then there's what we bring as the therapist. Our schooling and our training, all these models and methods. So I think it's like an intellectual exercise in a way, to figure out, “What do I have? What can I do? What do I know that I can bring to this person? Will it match with what they're needing?”

KEALY: Yeah. I love that puzzle analogy. I love puzzles as well. I think of science often as puzzles, and that there's different pieces that maybe are in the wrong place or not being integrated in some way. And how do you kind of incorporate those things. I also like the intellectual piece that you brought up. Sometimes there's people that I think I'm having like a chess match with. There's this intellectual kind of push and pull of like what would the research say, what does that actually translate to in the actual room with somebody, and how do we bring that all together into one cohesive integrated human whole.

ANDREW: It's so true. I've heard someone say in a training that we should be one step ahead of the client in terms of where they are, what they're comfortable with. Because they’ll have these patterns that have been put in place over time. Parts of them will essentially push back on us. So we can’t go so far ahead of them to, you know, where it's scary and really distressing. But just 'Hey, how about this?'”

KEALY: Yeah. It's that window of tolerance, you know, when somebody is in that space and they can tolerate a little bit, but not too much. 

ANDREW: Right. We don't want someone to feel like, '”Oh, that's ridiculous.” Or “The therapist really doesn't get me,” or “Why aren't you listening?”

KEALY: All the things. Well, that leads me to my next question. What are some modalities that you practice in?

ANDREW: I'd start with EMDR. When I got trained in Attachment-Focused EMDR, I think it was 2017, it really transformed my practice.

Prior to then, my approach had been mostly cognitive, mostly analytical. I guess what you'd expect from an attorney. And then I realized that true change doesn't occur unless it's at the level of the brain. When we're in childhood and adolescence, we develop these patterns, these ways of being, ways of interacting with our environment. And it's encoded in neural pathways in our brain. And trauma gets lodged in the right side of the brain in fragmented, undigested form. Unless we actually link that to the rest of the brain, the part of the brain that contains narrative, that can weave a story around your experience, then it just sits there waiting to be reactivated and re-triggered. So that's what I found, why EMDR is so helpful.

It rewrites the way that memories are stored in our brain and allows integration. It's like a recording that's created long ago. When we then encounter new experiences or triggers in our environment, it’s like pressing play on the recording. The person feels it as if what happened back then is happening now.

KEALY: And you mentioned EMDR has come up in some of these conversations with others just because it is such a popular, well-evidenced modality. That said, I don't know about the nuance of that attachment piece. You were kind of speaking to it clearly in what you were just saying. But for those who might be curious about how Attachment-Focused EMDR is different than traditional EMDR, could you maybe explain a little bit of that?

ANDREW: Absolutely. So the standard EMDR protocol has the therapist asking the client to identify the image, the emotion, the body sensation that they feel now when they think of a traumatic memory. But the system can easily get overloaded and the person can feel overwhelmed. So Attachment-Focused EMDR pays special attention to a feeling of safety in the client, in the moment. So we're tracking how they're doing and making sure that nothing feels like too much, that they're not getting re-traumatized by thinking about what happened back then, and that they're really monitoring how they're doing, moment by moment. This allows the bilateral stimulation in EMDR to do its thing without any interference, without the system getting flooded.

KEALY: Just to go back to one of the terms we were just talking about is that window of tolerance. What you're talking about is making sure people are within that window for EMDR purposes, so that they can feel safe and able to explore those deeper, more triggering, potentially memory-filled moments. 

ANDREW: Yes, because an EMDR client needs to be present with how they're feeling. They need to be noticing what comes up during sets of bilateral stimulation. And actually that leads into another portion of my work, which is parts work. And as you know, Internal Family Systems therapy is a leading method of parts work.

And the reason I added that to my practice is I found that different aspects of clients were interacting with the EMDR. And so for the client to be able to get in touch with what's happening, it optimizes EMDR. I'll give an example real quick. I mean, I'm a perfectionist. A lot of us are perfectionists. Say there's a perfectionist part of a client, and they start with EMDR. And that means that it's very likely they're having this thought in the moment, “Am I doing this right? Am I doing this well enough?” It can be distracting and it can even take over and hijack their experience to the point where they're not noticing the images, the sensations that naturally happen during sets of bilateral stimulation.

And so by working with that, we can get those parts to actually relax and not feel like they need to take over in that moment. So that's what we do.

KEALY: That's so interesting; I know I work with perfectionism often, it's one of my niches. I haven't even thought about it in terms of the parts work but maybe I will; this is very interesting. 

ANDREW: Yeah, it's natural, it's understandable, and it's almost like a part of them that needs to be recognized and validated. There's a reason why a perfectionist part, for instance, or a self-critical part comes along and does its thing. It has good intentions.

KEALY: And what I know from the research and things around perfectionism is there is a piece that comes largely from our childhoods and different things that we incorporate into those ideas of what expectations are, what we're supposed to meet, where we're supposed to go, how we're supposed to do things, that get embedded. So I can see how that work beautifully aligns there. 

ANDEW: Absolutely. And that usually comes from messages we get from our parents, as children what we sense that we need to do to feel loved and to feel worthy. 

KEALY: I appreciate you sharing that. With that said, I know that EMDR is a little bit more of a structured style. What does a normal session with you look like? I imagine it depends on what they're coming to you with, and whether you're treating an individual or a couple. But could you share a little bit?

ANDREW: Of course. There really is no typical session, as you said. I work mostly in the afternoons and early evenings. So a lot of my clients are putting an hour break on their schedule and it's in the middle of their workday. And very often they just came from a meeting like 10 minutes earlier, and they're feeling it. Maybe it was a frustrating meeting with their manager, or they're trying to code something and the code isn't compiling, or they just saw an upsetting text from their significant other or a friend. So they're feeling it. That actually can aid the work if we can work with what's happening in the moment, getting them to look inside, to listen inside and notice, “What's happening within me right now?” 8We can make use of it, and it actually benefits the trauma work. 

So I would say maybe a third of the time or more, what the client is coming in with right when the session starts, we work with it. But sometimes if the mind is more clear and someone is doing okay, then we're just continuing on wherever we were in the work. I work pretty heavily with healing trauma, so it might be getting them in touch with what's happening inside in general - that’s parts work. Or it might be preparation for EMDR, which can include mapping out the traumas that we're working on that might be impacting them in the present day. Or it could be resourcing, which prepares the system for EMDR. So anyway, no typical session, but it might involve any of that.

That's with individuals. I also do couples work as well.

KEALY: And you mentioned resourcing. So when you say that, could you explain to the audience what you're touching on there?

ANDREW: Of course. Resourcing is a step in preparation for EMDR. It gives your brain the experience of what you needed back when the bad stuff happened, but didn't have. So for instance, if a child feels controlled by a parent, or a child is afraid of a parent's angry outbursts or even just expressiveness on their face, the child likely didn't feel safe or didn't feel like they had control back then. So we commonly use tappers… It’s a colloquial term for these buzzers that you hold and they vibrate alternatingly, they buzz. That same bilateral stimulation, left, right, left, right, can be used in resourcing. And so what we do is we give the brain now the experience, the feeling or the quality that you didn't have back then. 

So for that child who felt controlled or overwhelmed or afraid of a parent, we have the adult client think of people or situations in which they did feel a sense of control, protection or safety. And we then use the tappers. It creates neural pathways in the brain that link that resource with that feeling. It also helps to rewrite the way that the traumatic memory is stored.

And the brain doesn't care that we're using your imagination. The brain just craves the experience of the safety, the protection, the control that you were missing back then.

KEALY: Well, do you think all the research would say that memories are flawed, right? That's why eyewitness testimony is deeply flawed, because the brain just fills in the gaps. And so what you're talking to is filling in those gaps in a healthier way so that the brain has something more integrated… integrated memory that is more healing or cathartic in some way.

ANDREW: Yes, and that's an example of linking the trauma brain with the rest of the brain. When trauma happens, it just gets dispersed in fragmented form. We may have a memory of the dad's angry face or loud voice, but it's not linked to the adult brain, the part of you that knows, “I am safe,” “I'm okay now,” “I'm an adult now.” And so filling in those gaps is integrative. 

KEALY: Super powerful. Thank you for clarifying, adding some flavor there. I think it'd be helpful for people. Okay. So is there anything in the therapeutic process that still surprises you, when you’re with clients?

ANDREW:  It happens all the time. You know, here I am talking about all these trauma terms, all this fancy terminology, as if that covers everything. And still people surprise me: the complexity, the diversity of how people show up, the unique flavor that each person brings, their beliefs and thought patterns, how they feel, what happens when they're stressed, what parts of them take over.

As therapists, we develop constructs in our brain, just as everyone else does. We label what we’re seeing, to understand what’s in front of us. And just when I think I'm able to accurately label what I’m seeing, another session will happen and there'll be a curveball.

Just when I think, for instance, “this is classic hypervigilance,” the client will introduce another wrinkle, and I'll have to rethink it. And I'm glad that happens, because each client deserves to be seen for their uniqueness.

KEALY: I definitely feel similarly to what you're describing there. 

ANDREW: And EMDR and other trauma modalities will work that much better if we're able to tailor our language to this specific client - what their thoughts are, what their beliefs are. Not just what the therapist has read about, or what the therapist commonly sees.

KEALY: There's less resistance when we use other people's language that they already have incorporated into their own mind.

ANDREW: Yeah.

KEALY: Is there anything that you wish people knew or understood about therapy?

ANDREW: This may be a stock answer, but that’s okay. It's not just for crazy people. It's not just for people who are really struggling. Yes, it helps them too. But I feel like everyone can benefit, even people who are holding down jobs, doing okay in relationships, but have this general feeling of discontent. Maybe it's hard to pinpoint what it is, but they're not feeling like life is going the way they want it to, and they might just need little tweaks to what they’re doing. That's why I wish therapy was more widely available to more of the population.

Especially these days, given the state of society, I think everyone could really benefit, not just those who could be diagnosed with a disorder.

KEALY: Yeah, I agree with what you're saying. I do think that's part of the medical model that we clinicians are always coming up against. I don't work with insurance, but I do provide superbills. And insurance wants a diagnosis, which puts people into these boxes. And then they're only going to provide reimbursement if you have some sort of diagnosis that they think is correct. As compared to what you’re describing.

There's people on all parts of the spectrum that need help to work through little things, or to dive into patterns, all the way up to what can be diagnosed, what the medical model would say is needed.

ANDREW: I agree. We call it “the worried well.” With the trauma work that I do, people will contact me and they'll say, “I'm a people pleaser,” or “I don't trust anyone,” or “I get really angry.” If we were to pose those to an insurance company, they'd be like, “OK, what diagnosis? None of those are diagnoses. We're not going to cover that.”

KEALY: “Which box are they in?”

ANDREW: Yeah. They want to reduce it to these limited categories.

KEALY: Yeah. Totally agree. What is a tool that we could share with our audience that could be accessible for them to utilize or try?

ANDREW: Early on in my work with a lot of clients, I introduce them to a concept from Dan Siegel. He's a psychiatrist at UCLA, author. Very well known. 

KEALY: I'm going to see him at the Evolution of Psychotherapy Conference, coming up in Anaheim.

ANDREW: Oh wow, that’s great.

KEALY:  He's very, very prominent.

ANDREW: He is. And so Dr. Siegel describes what happens when we label or put words to what we're feeling. He says that the left side of our brain sends soothing neurotransmitters to the right side of the brain, providing an anesthetic effect. So when we do that for ourselves, or when someone does that for us, it actually feels good, just having it named. It's maybe surprising that it works that way. But that's why I introduce that to many clients early on. See if you can actually tell yourself, “Oh wow, I'm feeling upset right now.” Or “Oh wow, my heart is beating really fast… I think I'm anxious right now.” It may sound dumb or silly, but it actually works. It actually has an effect.

KEALY: Yeah, it's almost kind of stepping out of the experience of it, to be able to name what is happening and see it from an external stance. Have you ever heard of the book Emotional Agility by Susan David?

ANDREW: No.

KEALY: She talks about this concept as well. And now that I'm thinking about it, I wonder if she took it from Dan's work. But she talks about the power of that naming as well. She calls it “data points.” With tech people, they can relate. You see the feelings, the things coming through your mind, the thoughts as feelings or thoughts, and naming it as such, rather than viewing it as permanent.

ANDREW: Yeah. It actually kind of dovetails with language from IFS as well, where you're in an observer stance, observing what's happening within you. You're naming it, as opposed to it completely taking over and flooding you, getting blended with it or hijacked by it. Where the rest of your day feels like it's ruined, and you can't think about anything else. You're just “in it” as opposed to naming it to the point where it starts to dissipate somewhat.

KEALY: Yeah, it gives it less power, essentially. That idea makes it accessible for people who think in terms of data. They like the concept of feelings or thoughts as data points, rather than that experience of it.

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This interview and others can be found on Kealy’s YouTube channel (“Therapeutically Aligned”), or through her website, www.kealyspring.com.

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Andrew Kushnick is a Certified EMDR therapist who primarily works with clients in the San Francisco Bay Area, and was trained by the Parnell Institute in EMDR and Attachment-Focused EMDR. As a former practicing attorney, Andrew’s approach is practical and concrete, using science-based and evidence-based methods. Video appointments are available during afternoons and evenings. To schedule a complimentary 15-minute phone consultation, email andrew@andrewkushnick.com.—