The use of EMDR with dissociative systems: A call to neurodivergent-affirming practice

Under the neurodiversity paradigm, developmental and acquired differences are seen as adaptive, not problems to be cured (Milton, 2020). Marich’s (2024) EMDRAA keynote identified dissociation as neurodivergence. Community surveys show that many dissociative systems identify as neurodivergent, with 97% citing functional multiplicity and not fusion as their goal (The Plural Association, 2024).

Treatment models and International Society for the Study of Trauma and Dissociation (ISSTD, 2011) guidelines are based on the Theory of Structural Dissociation, which views dissociative identities not as individuals, but parts of one personality (van der Hart et al., 2006). Treatments including EMDR are used to integrate traumatic material previously held separate by parts, with fusion into a single identity a desirable treatment goal (e.g., Huntjens et al., 2019; Knipe, 2019; van der Hart et al., 2016; Paulsen, 1995, Braun, 1988). Dissociative identities are seen as pathological, and goals based on functional multiplicity rather than fusion are described as phobic (van der Hart et al., 2014; Brand et al., 2012) or narcissistic (ISSTD, 2011). This conflicts with a neurodivergent-affirming approach. Shapiro (2018, p.343) states that EMDR may result in spontaneous fusion when dissociative barriers are no longer required to contain trauma. An ethical concern is whether this risk is fully disclosed to dissociative systems when seeking informed consent.

This presentation will examine how EMDR for dissociation can be approached from a neurodivergent-affirming lens, incorporating perspectives of those with lived experience. Further research is needed into spontaneous fusion, including iatrogenic causes, to ensure treatment accords with clients’ goals.