https://www.psychotherapy.net/blog/title/the-flash-technique-a-useful-tool-in-treating-trauma (Published in 2021)
I first heard of the Flash Technique (“FT”) in my Eye Movement, Desensitisation and Reprocessing (EMDR) therapy training by Dr. Philip Manfield in March 2019 in Oakland, California. EMDR is a form of psychotherapy that was developed by an American psychologist Francine Shapiro in the late 1980s. Since then, a lot of research has been conducted on the effectiveness of EMDR. Currently, EMDR is a widely recognized treatment for PTSD and other trauma-related conditions. The American Psychological Association (APA), among many others, lists EMDR as an evidence-based treatment for PTSD. EMDR consists of eight stages which typically require multiple psychotherapy sessions. During EMDR processing, the client focuses on the traumatic memory while eye movement, tapping, or another form of bilateral stimulation is used.
Dr. Manfield had developed FT in 2016, and was excited to share it with the class. Unlike EMDR, the Flash Technique does not require the client to commit to a lengthy process. It also does not require the client to focus on the traumatic memory for a long period of time. FT can be used as a part of EMDR treatment, or on its own. I thought that FT was an interesting tool, and I started using it along with the standard EMDR protocol. Sometimes I use FT to lower the intensity of the target, and then process the remainder by using traditional EMDR. My practice was both online and in person, and I used FT with both virtual and in-office clients. My interest in FT grew over time as I was getting good results, and I took the Flash Technique webinar in May 2020. In December 2020, I took the Advanced Flash Technique webinar. As of this writing, I have used FT with dozens of clients in the last two years. I have found it easy to use and very effective when working on a variety of disturbing memories and fears. It usually takes about 15 minutes to implement FT, making it very easy to fit into the standard 50 minute session.
The Flash Technique process starts with identifying a memory or fear, and ranking the level of disturbance that the client feels in that moment. The scale is 0-10, with 10 being the most disturbing. Next I ask the client to think of something fun or exciting that they can talk about for the next 10-15 minutes (i.e., a hobby, a pet, a movie, a trip). This is referred to as the Positive Engaging Focus (PEF). Then I demonstrate for the client how to cross their arms on their chest and tap on the arms (a butterfly hug). While they are tapping and talking about the PEF, I periodically ask them to blink several times in rapid succession. After five or so sets of blinks, I ask them to pause and touch on the target memory/fear. They rank the disturbance and tell me what they notice about the memory. Usually the target is less vivid and harder to pull up. Then we continue with the PEF and more blinking and tapping. Next we pull up the target again. This process continues until the target is no longer disturbing.
In the following session, usually a week later, I recheck the target memory or fear to see if there is still any disturbance. Some targets resolve in one session and the results hold over time. Typically, the easiest cases are single-incident traumas – an event that took place at one time and does not have any related memories. For example, someone who was in a car accident once and developed a fear of driving can usually process the incident in one session without any need for additional work. In other cases, usually when there are many related memories, it requires additional sessions of Flash or EMDR to fully resolve them. Multiple incidents can also be processed but may require additional sessions.
I should note that Flash, like EMDR, does not completely remove all fear. I would not want my clients to put themselves in unsafe situations following FT. Rather, FT and EMDR aim to take away the extreme disturbance associated with a traumatic event. The client still remembers that the event took place, and experiences a normal level of anxiety in appropriate situations. FT does not offer any superpowers or magical thinking. It removes the irrational fear so that the client can comfortably engage in everyday activities.
Here are several case examples in which I used FT:
FT = Flash Technique
SUDS = subjective units of distress (scale is 0-10, with 10 being most disturbing)
PEF = positive engaging focus (something positive and exciting that the client talks about during the sets)
Della, a 33-year-old Caucasian female, was mugged seven years ago on the street. Since then, she had been unable to walk alone at night. She always had to have someone walk her places after it got dark, or she avoided going out altogether. She stated, “I want to be able to walk alone at night if I need to.” Della lived in a safe suburb and did not have an urgent need to go anywhere at night. More recently, Della’s company offered to relocate her to Paris. Della was excited about the opportunity, but realized that she needed to work on this fear if she was going to move to a big city.
We discussed the mugging in more detail. The incident happened when she was in college. She was studying late at the library, and drove home to her apartment at around 2 a.m. She parked her car in a garage a block away from her apartment. As she was walking home, three people came up behind her. They kicked her to the ground, grabbed her backpack containing a laptop, and drove away. When asked to rank the disturbance associated with this memory, Della stated it was a 9 on the 0-10 scale. For Flash, we chose Paris as her positive engaging focus. “I’m excited to move there,” Della said. After five sets of Flash which took about 10 minutes, Della ranked the disturbance at 1 before the session ended.
Two weeks later, Della reported that she had chosen a safe area in her suburb as a test for an evening walk. She walked alone at around 8 p.m. Della stated, “This is something I haven’t been able to do since the mugging seven years ago.” She said that it felt good to walk around and look at the lights. In the past, she would have felt very anxious at the thought of walking alone at night. “This time, I didn’t have any physical symptoms,” said Della. She described that she did feel a little nervous, ranking the SUD at 1-2. However, it felt like a normal amount of anxiety compared to the paralyzing fear she had experienced previously. She felt good about the outcome. “I wanted to be able to walk alone at night if I had to, and now I can do that,” Della remarked.
Fear of being alone
Danielle, a 37-year-old mixed race Caucasian and Asian-American woman, sought therapy with me for anxiety and depression in July 2020. Danielle shared that her “number one fear” was of being alone, and one day, dying alone. Danielle ranked the SUD at a 10. One of the contributing factors to this fear was Danielle’s current relationship with her boyfriend of a couple years. Danielle wanted to move in together, but her boyfriend decided that he wasn’t ready, and instead rented a one-bedroom apartment in another city. Danielle stayed in her one-bedroom apartment where she was living by herself. In addition, her best friend had moved away recently. “I am afraid I will always live alone in an apartment.” The fear was exacerbated by the COVID-19 pandemic and resulting isolation.
To me, the fear seemed largely irrational as Danielle was a very attractive woman with an impressive educational background and a successful career. She had a great personality, was easy to talk to, and had interesting thoughts and ideas. We decided to use Flash on this fear, and we used food as the PEF. After two sets, SUD decreased from 10 to 7-8. When I asked Danielle what was different about the target, she stated, “I’m not in the visual anymore.” After two more sets, Danielle reported, “I feel less sad.” SUD = 6.
A few weeks later, we checked on her fear of being alone. Danielle ranked the disturbance at 3-4. I asked her to explain the source of her disturbance. Danielle replied, “My grandma died alone in a nursing home. She was a prom queen in high school–I have a picture of her. By the time she died, she was decrepit and had bad teeth. I feel guilty that I didn’t visit her.” We decided to continue with Flash. For PEF, Danielle chose comics and graphic novels. After two sets, she reported that the image had faded. “I feel guilty we weren’t close,” she said. Danielle cried and reported the disturbance at 6-7. She pointed out that the fear of being alone on its own was at 2. After the third set, she stated, “The strong emotions about my grandma have dissipated,” and was no longer crying. After the fourth set, she reported, “I feel less afraid of the memory.” For grandma, SUD = 1; for the fear, SUD = 0. She added, “There are things I can do in my lifetime.” I guided Danielle in instilling this positive belief using slow self-tapping. By the end of the session, Danielle was smiling.
The following week, I asked Danielle about the fear of being alone. She stated, “I used to think about it throughout the day, every day, but now I don’t think about it.” She said it felt like 0-1 now. Danielle added, “I am more focused on what I can do now to create a better future for myself.” She reported that she started to organize her finances this past week. She also engaged with new and old friends with the goal of having deeper friendships. I asked Danielle what she thought of the Flash technique, and she said she found it helpful.
Dad’s Addiction Issues
Claudia, a 31-year-old African-American female sought therapy with me in January 2021 to work through family issues. Claudia achieved a lot in her life; she put herself through undergraduate and graduate school where she studied biochemistry, and landed her dream job where she was succeeding. She was happily married to a wonderful young man. However, she struggled with anxiety, especially around her father’s past and current substance abuse issues. Claudia explained that her father was an active alcoholic and has abused cocaine on occasion since she was a child. I asked her to write down her 10 worst memories. Six of her 10 memories involved her father. We noted how disturbing they felt as we went over them.
In our next session, we targeted the first bad memory which was “Dad being high at dinner.” Claudia was 14 at the time. She rated the disturbance associated with the memory (SUD) at 6. Claudia picked her honeymoon as her PEF. With each set of Flash, the disturbance associated with the memory went down by 0.5-1. After eight sets, Claudia reported that the memory did not bother her anymore. “I can’t see my dad’s face anymore,” she said. In the following session, we checked the memory and the disturbance was back at 3. For her PEF this time, Claudia chose her wedding. After two sets, she reported that the event was “hard to recall.” The memory no longer had a hold on her. “I feel indifferent,” she said. The positive belief was “I’m not at fault.” I asked Claudia to close her eyes and play the event in her mind while repeating the words “I am not at fault” as she tapped slowly.
Next I asked Claudia to imagine a folder named “Dad’s addiction issues.” I asked her how disturbing it felt to think of the folder, and Claudia said 5-6. For her PEF, Claudia decided to continue talking about her wedding. After two sets of Flash, she reported that, “Specific memories are hard to pull up.” After two more sets, she reported there was no disturbance. We checked each Dad-related memory, and the disturbance was 0-1 for each. In our next session, I asked about the memory of dad being high at dinner. Claudia reported that she felt 0 disturbance. I asked if there was anything else that felt disturbing to her regarding her dad’s addiction. She replied, “Yes, I am worried about his health. He continues to drink, and he could have a stroke and die early.” This fear felt like a 2 to her.
I decided to use the standard EMDR protocol for this fear. The negative belief was “I’m not in control”; the positive belief was “I can handle whatever happens.” We worked through several channels. One aspect that was particularly painful for Claudia was that her brother was very close to their dad. She cried when she thought about the pain her brother would feel if her father had a stroke in the near future. I used several cognitive interweaves which Claudia found helpful: “You’ve done your part,” and “We don’t know when your dad will pass; he could live for a long time despite his addiction issues.” After several sets, Claudia realized that she would be there for her brother when her dad passes away, which she found to be calming.
By the end of the session, the fear of her father’s early death was no longer impacting her. “If it happens, I can handle it,” Claudia stated. We conducted a body scan which revealed that the pit in her stomach from earlier in the session went away. Claudia reported that she felt good about the work we had done, and at peace regarding her father’s addiction. She no longer felt that it was her fault, or that she should be doing something to force him to stop (which she had tried in the past without success). She felt free to enjoy her relationship with her father as it is today, and let go of fear of the future.
Fear of Cats
Georgia, a professional Hispanic woman in her late 20s, had an extreme fear of cats which made her life difficult. She couldn’t visit her best friend, Zoe, because Zoe had a cat at home. When Georgia saw cats on the street, she felt apprehensive and had to walk away immediately. Georgia was single and actively dating, but had to exclude any potential partners who lived with a cat.
It turned out that Georgia had a traumatic experience with cats as a child. She explained, “It was during my first piano exam at my instructor’s house. I was nervously waiting for my turn to play, and four cats came up to me and scared me.” The cats appeared suddenly and came up to her from behind. Georgia estimated her age to be seven years old at the time. When I asked her how disturbing this memory felt now, she ranked it a 6 on the 0-10 scale. We decided to process this memory with the Flash Technique. We used Georgia’s favorite TV dating show as a PEF. After two sets, Georgia remembered that during a sleepover in high school, a cat jumped on her bed which was scary. After one more set, the fear was 0. This process took about 10 minutes.
In our next session a week later, Georgia reported that the memory of the four cats at the piano exam was not disturbing (SUD=0). I asked Georgia to imagine visiting Zoe and her cat. She reported there was no disturbance. I asked Georgia to pull up a picture of a cat online, and she reported 0 disturbance. Then I asked her to search for a video on YouTube of a cat attacking a person. She watched the video in session and her facial expression was unremarkable; again there was no disturbance. After a few weeks, Georgia reported that the piano exam memory did not produce any disturbance. Picturing cats was not disturbing. Due to the COVID-19 quarantine, she had not had a chance to visit any friends with cats yet.
After a few more weeks, Georgia reported that the fear of cats was 0. She added, “There are some cats that walk on the fence in my backyard. I used to find it really irritating and distracting. I would try to scare them off. Every other weekend I would spray the fence with vinegar to keep them away. It didn’t work! They still came back. Now it doesn’t bother me. The other day I even thought the cat was cute.” Georgia explained that she did not fall in love with cats or anything like that, but the fear was no longer there. She felt neutral towards them which allowed her to live her life with more peace. This result was well worth the 10 minutes that she spent trying out the Flash technique.
Aside from the above examples, I have successfully used FT with other clients, focusing on a variety of negative memories and fears. Some examples include a parent’s suicide, childhood bullying, extreme fear of bugs, chronic pain and fear of becoming disabled, fear of contracting COVID-19, sexual assult, car accident/fear of driving, near drowning/fear of swimming. In some cases, the problem resolved after 15 minutes of FT with no resurgence. In other cases, FT provided some benefit but additional EMDR work was required to fully re-process the event and maintain results over time. To date, I haven’t had any negative experiences with FT. Most clients have found FT to be helpful and enjoyable. I should note that FT, like any therapeutic intervention, may not be effective for every client or situation. Clients should be aware of potential risks and limitations of FT before starting therapeutic treatment.
Client’s names and other identifying details have been changed. Written permission has been received from clients.
Articles on Flash:
Manfield, P., Lovett, J., Engel, L., & Manfield, D. (2017). Use of the flash technique in EMDR therapy: Four case examples. Journal of EMDR Practice and Research, 11(4), 195–205. http://dx.doi.org/10.1891/1933-3188.8.131.52.
EMDR and The Flash Technique: A match made in heaven? - EMDR Therapy Quarterly (emdrassociation.org.uk)
Shebini, N. (2019). Flash technique for safe desensitization of memories and fusion of parts in DID: Modifications and resourcing strategies. Oct 2019, Frontiers of the psychotherapy of trauma and dissociation Vol 3 3(2):151-164 2019 ISSN 2523-5117 print/ 2523-5125 online
Wong, Sik-Lam. (2019). Flash technique group protocol for highly dissociative clients in a homeless shelter: A clinical report. Journal of EMDR Practice and Research, 13(1), 20–31. http://dx.doi.org/10.1891/1933-3184.108.40.206