Ep. 18: Dr. Esly Carvalho – Exploring the EMDR Method for Healing Trauma

00:00 – excerpt from the episode
01:30 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

02:05
Dr. Maya Novak:
Many years ago I came across a powerful technique that was mind-boggling to me. It was simple and yet whenever I played with it I experienced a shift in how I perceived my reality. And that’s why I’m so excited about today’s talk. In this interview, I’m joined by Dr. Esly Carvalho who is a Brazilian-American clinical psychologist, trainer and author in the area of EMDR, emotional healing and recovery. She directs the TraumaClinic in Brasilia, and spends extended time training EMDR professionals. She is absolutely fluent in three languages (English, Portuguese and Spanish) and is well-known for the many books and manuals she has authored, including Heal Your Brain Heal Your Body, and Healing The Folks Who Live Inside. Esly, I’m so honored to have the opportunity of talking to you… So thank you for joining me…

03:06
Dr. Esly Carvalho:
Thank you so much. I'm honored to have the invitation.

03:10
Dr. Maya Novak:
Absolutely. Let's get into your story and background because I'm very interested in this. So why did you decide to study psychology and how did you get into EMDR?

03:22
Dr. Esly Carvalho:
Wow, funny story. I was born in Brazil, but I was raised in Texas. I went back to Brazil when I was almost sixteen years old, and in Brazil, when you go to university, you take the university entrance exams. But you already choose the profession that you want to go into because a lot of the groundwork is done in college. In the United States, for example, we wind up doing that in high school. So I had to choose, and I remember when I was about sixteen years old, my mother once said, "You should become a psychologist." And I said, "Not me, mommy. I'm not gonna work with crazy people." She said, "No, psychologists can't work with crazy people. They work with normal people who have problems, and they guide them and give them..." You know, this was fifty years ago. I don't know. And I said, "No way," What do mommies know when you're 16 years old, right? [chuckles]

04:16
Dr. Maya Novak:
Nothing. [chuckles]

04:16
Dr. Esly Carvalho:
They don't know... but my mom said, "Honey, you have a gift. You know the kids come over, you talk to them, they come for advice. You have a gift." But many years later - I'm a deeply spiritual person - I was in church, praying and asking God what I should do. And I just felt in my heart that I should do psychology as my first choice because we had to make several choices, and writing and being an author as a second. I thought, "I can't write anything, and everything I know how to write is in English." So I signed up for psychology school, and five or six years later, I graduated as a clinical psychologist, and I never looked back. So really my mother was right. It really is my gift. I love doing what I do. Early on, I learned psychodrama, even before I graduated. I started as a psychodrama therapist, group therapist. I love group therapy, and eventually went on to become a trainer of psychodrama, and I loved it. I love it because of its creativity. You just never know what's going to happen. It's very unpredictable. I like that. It's challenging in the beginning, and it was in 1995. Many years later, I had remarried a Canadian who had been raised in China, and I met him in Ecuador. So that's part of my story. That's how I wound up learning three languages. It wasn't by choice. It was how my life turned out. We went to Colorado Springs, and I had something that was really bothering me, and he said, "Well, we have an insurance plan. Why don't you go and check it out? I think you have like six sessions for free." So I went, and the therapist looked at me and said, "Oh, I think you have a good reason to do EMDR." I had never heard of this. It was 1995. Things started developing this after 1997, so this was still very new, and she explained it all to me, and I kind of looked at it and it said, "You wiggle your eyes, and your trauma goes away." I said, "I got to see this to believe it." Ah, but I came out of my first session so impressed. So impressed that I came home and said, "Honey, pull out the plastic. I'm gonna get the credit card. I'm gonna learn how to do this," and God willing, many years later, if we ever go back to Ecuador, I will take this to Ecuador with me to train other people to do this. So that's how I got in. I wound up becoming an EMDR therapist and then a facilitator and a consultant and eventually a trainer and trainer of trainers. So we've trained 4,000 professionals in Brazil already through the trauma clinic, and we also have trained about eight or ten trainers, some of them in Brazil, some of them in Latin American, Spanish as well from the years I lived in Spanish-speaking countries. I love it, and I love the integration of both.

07:13
Dr. Maya Novak:
Yes, well, as I said at the beginning, when I first heard of it, it was probably about eight years ago or something like that. It was mind-boggling how something so simple could have such a big effect. Now, I cannot wait for us to go deeper into this. Before we do, let me just ask you this: because we are talking about heavy physical trauma, physical trauma, such as injuries, illnesses, wounds, and so on, often surprises people in an unfortunate way. Many are not prepared for the emotional and mental suffering that comes hand in hand with physical suffering. So, why do you think that injuries, surgeries, wounds, lesions, and so on have such a big impact on our psyche?

08:05
Dr. Esly Carvalho:
Ooh, that's a very good question. I think I got the explanation many years later, but I'll tell you about the experiences that led me to it. I had a patient, it must have been 35 or 40 years ago, at least. She was one of my first patients and had been born with a heart defect, a hole in her heart. The doctors told her that she had to have surgery to sew this up so that she could have a normal life. When she finally got married and decided she wanted to have children, that's when she finally got the courage to do it because she knew she couldn't get pregnant without fixing this or she really would die. So she came to therapy and said, "Can you get me ready to do surgery?" This was open-heart surgery way back when, 40 years ago, and it was something still fairly new. There weren't a lot of places that did it, so she had to go to the big capital city to be able to do these things. We prepared her, and she went. Four or five months later, I had been in touch with her, and she showed up on my doorstep and said, "I'm gonna die, I'm gonna die, I'm gonna die, help me, I'm going to die." I thought, "Oh my goodness, she doesn't look like she's gonna die. I wonder what happened." So I started asking her, "What did the doctor say?" “Well, the doctor said I'm fine." I asked, "How did the surgery go?" Because I remembered she had said that it had gone well. She said, "Oh, everything's fine. They did find that the hole was much bigger, and my condition was much worse than they had truly thought, but they sewed everything up. I'm fine.” “Can you have babies now?" She said, "Yeah, the doctor says if I want to get pregnant." But she kept saying, "I'm gonna die, I'm gonna die, I'm gonna die, help me." I thought, "How do I put this together?" Over the years, thinking about it, I realized that her body did not realize how bad the situation was until she got cut open. So her body thought she was doing okay, even though the doctors were telling her, "You know you're tired, your color is not good, you need to do the surgery." Her body was saying, "But you know we're fine." But when she got cut open and explained to me what they did, you know because they cut your bones, they stop your heart, the blood circulates outside of your body, they sew up her hole, then stick it back again, and then they give it a couple of shocks to get it beating again. I thought, "Oh my goodness, just listening to it hurts." And I began to put this thing together, and I realized, "Oh, you know what? The body does not like to be cut open.” It really resists it, and sometimes we have to do these things. Some things are you know you're not going to die over appendicitis. I mean, you're going to have surgery, and you're going to take the thing out, you're going to sew up the hole in your heart, but the body says, “I don't like this. This hurts me. This is not the way it's supposed to go.” I think we were made with skin so that the stuff on the outside stays on the outside, and the stuff on the inside stays on the inside.

I had another friend - this was back already in the EMDR days. I learned EMDR around 1996-1997 and I had the privilege of learning it from Dr. Francine Shapiro herself, of blessed memory. She had these terrible migraine headaches whenever she sat in front of a bright light. She would get a migraine and it was so notorious in her family that her children would say, “Mommy don't sit there because you're gonna get a headache.” And she'd gone to the doctors. She'd done the tests. She'd taken the medications, and nothing worked. And then one day she went and did an EMDR session with a colleague about a surgery she had been submitted to recently. She had had some internal bleeding and things like that and so she had to have the surgery, and the surgery went fine. It wasn't any big deal. But during the session her brain slipped back to the memories, because that's what the brain does. It picks up everything that's on the same line. The thread line, I say, all the knots that are on that line of thread. And she went back 15 years to another surgery that she had had where she had almost died. It was one of those belly open blood, all over the place things, and it was a very difficult recovery. She recovered the memory that she had woken up in the middle of surgery and when she woke up in the middle of surgery she was under the bright lights of the surgical center. And she said she couldn't remember this moment at all. But she remembered that the doctors were there and what they were wearing and what how they were spaced out. They didn't say anything. They just kind of you know, elbowed the anesthesiologist and said, “Put her under!” She didn’t have any physical pain from the surgery but the pain in her eyes when she opened them and the headache she got and the nausea stayed with her. Well, she processed this memory and she has never had another headache again. And I talked to her every once in a while and I asked her about it and this was 8 or 9 years ago, and that's when I really finished putting all of this thing together. The body does not like to be cut open. It doesn't like surgery. It doesn't like physical injury, doesn't like to be hurt. Nobody likes to be hurt and nobody likes to be physically hurt.

13:22
Dr. Maya Novak:
Absolutely.

13:22
Dr. Esly Carvalho:
But the body says, "This is not how you're supposed to be treated," and it's traumatic. It's traumatic, no matter how simple the issue. For example, I had an adult who had pneumonia one month after she was born. She stayed in the hospital for a month, but they couldn't get it under control. It took her months to recover. When she came out of the hospital at two months old, half of her life had been spent in the hospital. Can you imagine what this does for attachment and bonding with a mother? It creates safety issues, and she was getting pricked and put on oxygen in the hospital. These things impact people, and we don't realize it. That's my point.

14:12
Dr. Maya Novak:
No, we don't realize it, and doctors either don't know or don't have enough knowledge about it. So here's an example: you get a cast, and you're told to go home and come back in three weeks to see what happens. But you're sent home without any tools or anything, and you just believe that everything will be okay after three weeks.

14:39
Dr. Esly Carvalho:
Yeah.

14:40
Dr. Maya Novak:
But what is happening during that time is a real turmoil - emotional, mental, spiritual, not to mention physical, of course. So it is important that we talk about these topics. You mentioned one thing about this lady that she remembered her previous surgery and how it had an effect on her, but any kind of trauma from the past can have an impact on the physical body. Now, can we talk a bit about why it is so important to heal or treat any kind of trauma, especially when we're talking about a physical injury? Something that potentially may not be connected from the past but could actually have a significant impact on how the body reacts.

15:36
Dr. Esly Carvalho:
We don't have just a physical injury, because we are not just a body. [chuckles]

15:41
Dr. Maya Novak:
Yes.

15:42
Dr. Esly Carvalho:
You know some people say that we're a body. We're a soul. We're a spirit. If we talk about our soul - that's the part that feels, it has a will that thinks, and things like that. So you go home with a cast. What does this mean? For three weeks, you can't walk. You can't make your own coffee. You can't even brush your teeth, right? I mean, what does this mean in terms of changes in your immediate lifestyle, things that you can or cannot do? I broke a rib almost a year ago, fell down the stairs, and couldn't get in and out of bed for six weeks. My husband had to assist me. Now, what does that do for a person who's as independent as I am, who has all these things that I love doing? You want to sleep at three o'clock in the morning, and then you have to ask for help to go to the bathroom. This is not the way things should be. It's not just a physical injury, and I often talk about the doctor who lives inside. I have this book called "The Doctor Inside You." The name isn't as good in English as it is in Portuguese or Spanish, but we all have inner doctors. I tell my doctors that if you do not convince the inner doctor of your patient, they will not follow your orders, obey the treatment plan or do what you instructed them to do. For instance, my endocrinologist, who I had when I had thyroid cancer eight or nine years ago, always talks about the patient's inner doctor. “Did I convince your inner doctor that you really need to get off of sugar? You are diabetic, and it's the truth.” Once I went to another dermatologist and had some really serious face issues which I had never had before, like pimples and stuff like that that you have when you're young. The doctor said, "Well, we're going to do three months of antibiotics." I asked, "How come?" and she said, "Because you have this and that."
And I went home and looked at that prescription, and my inner doctor looked at it too. My inner doctor said, "We're not going to take this." I replied, "No, we're not going to take this. We're going to figure something else out, but we're not going to take three months of antibiotics." We found another solution, but we didn't take the prescription. Sometimes people don't understand the power of our inner doctors. Some call this our intuition. Sometimes people submit to certain treatments because that's what the doctor says, but their intuition or body says, "I don't think so." Other times, they are so convinced it's the right thing to do that they get better beyond anything anyone had thought possible for them. We are not just physical bodies. We have feelings, emotional pain. If you suddenly can't do what you used to or slowly notice your memory slipping and have a history of Alzheimer's in your family, how do you deal with it? It's not just the brain that needs fixing. It's my whole life, what I've done. Even if it's temporary, like breaking a leg and putting it back together, the body remembers and if something else triggers it, it says, "Oh, the sky is falling, the sky is falling, the sky is falling."
I had thyroid surgery when I was fifteen years old. It was my first surgery, and I still lived in the United States. I had a benign tumor on my thyroid, and back then, they had to cut you open to find out if it was cancerous or not because everyone died of cancer back then. But praise God, and thank goodness, I didn’t have it. However, when I was 59, I was diagnosed with a very treatable form of thyroid cancer, and I had to have surgery again. When the doctors told me I needed surgery, I initially said okay, but when I got home, I freaked out. It wasn't so much because I thought I was going to die, but because I knew what I was going to have to go through for the next few months, having gone through the surgery before. This time was worse because I had to go off my medication, among other things. I went to a therapist and had a few sessions to help me confront my fear and anxiety about the surgery. I needed to talk to the 15-year-old child inside of me who had been operated on before to calm her down and told her that we were not going to die from this and that everything was going to be okay in order to face this surgery that I did need to do at an older age. I think we need to take into consideration that we have many roles and emotions inside us. I refer to them as different people inside. We have pain, we have memories, we have doctors, and rebellious 15-year-olds. We have a scared kid that's five years old, and a two-year-old who still wants to sleep with her teddy bear. There was a soccer player from Uruguay who once bit off the ear of his opponent – this was public, it was in all the newspapers. And I turned to my husband and said he may be 28 years old on paper, but he just acted like a 2-year-old. He couldn't control his anger. This is why people sometimes have a hard time controlling the emotional aspect, to the point where they cannot follow through with necessary medical treatments or diets. Something inside says “I’m not gonna do this. Not this way” We need to do some negotiating inside ourselves to be able to do what we need to do.

22:11
Dr. Maya Novak:
Absolutely. Now, when we are talking about trauma - any kind of trauma, It can be physical trauma, it can be an accident, it can be trauma from childhood... Let's go into EMDR. So what is actually EMDR and how it works and how is this connected to trauma?

22:32
Dr. Esly Carvalho:
Okay, let's go back a little bit in the history of things. Francine Shapiro was walking in the park in 1987, thinking about some of her own health issues - some very distressing things that she was going through. And she realized that all of a sudden, the distress was gone. And so, being the researcher that she was, she said, "Hmm, I wonder what happened?" And she paid attention and realized that her eyes had moved from one side to the other, and then when she did that, the distress had decreased. So, she began experimenting with this, and she wound up publishing her first article on this in 1989. To make a very long story short, what she discovered, I think the best way to describe it - we really don't understand all that goes on to make it work - but I think for me, the best explanation is that it imitates what happens to us when we sleep. All of us, when we sleep, we go through different stages. We go several times through the cycle of sleep, and part of this cycle is the rapid eye movement (REM) sleep. And this is when our eyes go back and forth very quickly. This is when we're processing the things that happened to us during the day. So we process them, we have dreams - you know, we dream and we have those crazy dreams sometimes. "You know, I was doing this, and then I was flying, and then I turned into a dinosaur," all those crazy things. But when we're doing all those crazy things in our sleep, we're processing and putting things into the memory that will become long-term memory - the past memory - the memory that is consolidated, because it takes a few months for it to become consolidated. But when we have a traumatic experience, and when I use the word "traumatic," that's why I kind of like the word "adverse experience," because people think, "Well, I never had a trauma. I never had a car accident. I was never raped. I was never, you know, saw anybody die," which nobody argues that those are traumatic, but there can be other things that are very traumatic, and they can have a big influence and impact on your life. I remember when I did my training to become an EMDR therapist, in the practical part of it, I worked on a little memory of when I was six years old in Texas. I realized then that I was an immigrant child. I had returned from Brazil to the States for the second time at the age of 6, so I was learning English. I realized that sometimes I understood the words but not the meaning. When I processed this memory of going to school and not understanding what the teacher was trying to tell me, I realized why I still introduce myself as being a foreigner. In my memory, when I wrap it all up the way I ended it, which was not how it ended, but how I gave it a happy ending, was that my first-grade teacher, Mrs. Lee, stood in front of the class holding my hand and said, "We need to be patient with Esly. She's still learning how to speak English. She doesn't always understand things. She's a foreigner. So if she asks a question that sounds a little crazy or off, it's just because she's a foreigner. She's not dumb. She's not stupid. She just doesn't understand the words sometimes." That's when I realized that to this day, because I am what they call a Third Culture Kid (TCK), my parents were one culture, and I was raised in another culture. My daughter is like this, and I married one; my stepchildren are TCKs. My grandfather was one, my great-grandfather was too. This is something in my family. When I realized that, it was the first time I felt normal because I always felt like “I don’t fit here. I don't fit in the United States. I'm too Brazilian to be in the United States, and I don't fit in Brazil - I'm too American, and all my friends think I'm very ‘gringa.’" [laughs]

26:16
Dr. Maya Novak
[laughs]

26:18
Dr. Esly Carvalho:
They think that I’m very American and say, "Oh my goodness, Gracious” And then I realized I am never going to fit into these cultures. But I can fit into my identity of being a third culture kid, and I recovered this memory in a practicum. Somebody who was doing their first EMDR session, the power of healing of this thing is so amazing because it goes into our brain. And it processes it, helps our brain do what it knows how to do, but that for some reason, the memory was trapped. Even a little memory like that, you know, it wasn't something, "Oh my goodness, I had a trauma." No, it was an unusual experience. But it was traumatic for me as a six-year-old, so these experiences can get trapped into our neural networks, and they, for instance, sometimes they, like, they get frozen, and then we can't access that information, like my friend who couldn't remember what had happened to her in surgery. Or we can't use the skills that we do have because they're disconnected from the parts of our brain that are functioning daily, and so I don't have access to those files. So what EMDR does is it gets the memory, which is usually in one part of the brain, and all the other skills and all the other aspects of the memory, which many times are lodged in another part of the brain, and we imitate what sleep does. We have people move their eyes back and forth and with, you know, in a protocol that we have eight steps in this protocol that, you know, help us, you know, guide how we're supposed to do this, and we give a jumpstart to the brain. And so the brain gets past that frozen spot and it begins to process by itself spontaneously, then it can do what it was created to do. Can do it by itself, and that's why in one sense, it's so fast because brains are fast. Brains are, you know, you thought about it, it's done, and if we can get those memories, we can find them and we can reprocess them. We can heal those areas of the brain, and so now the rest of my brain is connected to those networks, and what's most amazing is that these are what I call neurochemical changes. As a result, we practically do not see relapse from these memories, and so people say, "Oh, but you know, I got to think about it." Well, you need to think about it for maybe a couple of hours, for 15 minutes, for, you know, once or twice. But then, you're going to be free from this for the rest of your life, and you'll be able to do the things that you were not able to do before. You can choose how you want to behave. I can choose if I'm going to eat the Easter Bunny chocolate or not. I can choose if I'm going to exercise or not. I'm going to choose what I do, whereas trauma makes us, it imposes on us, it mandates that we repeat unhealthy behavior. We repeat the traumatic behavior because we're stuck in it. We're stuck in that rot. We can't get out of it. You know, we really have no choices. So health always means the possibility of being able to choose, and trauma takes that away from us. Trauma takes away our ability to learn. We think, "Oh, that kid is hyper." That kid isn't hyper; that kid is probably dealing with anxiety and stress from home or school bullying in school, or a father or mother who isn't giving him or her the kind of attention that they really need, and this manifests in school as being hyper as an attention deficit and things like that. Who could pay attention if you don't know if your dad's going to come home drunk or not tonight, you know.

30:09
Dr. Maya Novak:
Mmmm…

30:10
Dr. Esly Carvalho:
If you're going to get a beating or getting beat or things like this, or you're not going to have enough to eat, or you don't have nice clothes like everybody else. You know, you wear dirty clothes to school because nobody cares for you, or your mother's so depressed she never gets out of bed, or she's got a mental problem. She's bipolar or borderline or something, and she doesn't know how to care for you. So I think a lot of that keeps us from being able to learn. Children don't learn if their brain is connected to danger, and if they feel that they are in danger, they can't learn. So we can't choose. We can't learn. We're obligated to repeat unwanted behavior. So there are many things that can trigger flashbacks, like the ones I mentioned earlier. Obviously, I'm not going to have surgery every day, but if I had to have the same surgery again, I wouldn't be able to face it. There are other triggers as well, like if you earn a living by traveling on airplanes and you had a bad accident on one. I had a friend who experienced this; the landing gear didn't open, and the plane had to land on its belly. Nobody got hurt, praise God, but it was exactly what they teach you to do - you lay down and then slide down the ladders. But my friend has never been able to get on an airplane again, and her husband buys packages for them to travel to Europe or other places, but she can't do it. With just one or two sessions, however, she was able to overcome her fear and get on an airplane again. These triggers can have ongoing effects; if you can't get on an airplane and you earn a living by traveling, you might lose your job. This can really affect the quality of life, which is very hurtful. We can also help people in disaster areas. Right now, we're working on a project in Ethiopia where we've been able to show how EMDR-related interventions can be used to help people dealing with psychosocial trauma caused by war, hunger, and other social traumas. We can do things to help people get over these traumas more quickly. So yes, it's a moving experience.

32:20
Dr. Maya Novak:
Yes, this is so important! Now, for those listeners who potentially just heard of EMDR for the first time, can you just tell us in a few sentences what EMDR is? So that someone who is right now wondering, “But what is EMDR? Okay, I understand that I'm moving my eyes but what actually is it?” Can you just share a few sentences for those listeners who don't know what it is?

32:49
Dr. Esly Carvalho:
Sure. So in our eight steps we take the history so that we have the story and teach them some stabilizing resources. Then we help the person by targeting the memory. We ask what they want to work on, such as a car accident, and look at the aspects of the memory, including the image, beliefs, cognitive beliefs, emotions, and physical feelings. We measure these aspects, which is why EMDR is recognized by even the World Health Organization as helpful for trauma. We ask the person to think about the memory, and then we apply what we call bilateral stimulation. This is usually eye movement, but it can also be tactile, like a hug, tapping of arms or legs, or auditory, such as sounds from one side or music from one sound to the other. This helps give a jump start to the brain to start processing. We then let it run on its own pace, and sometimes the brain remembers many other things, or sometimes the memory was so old they don't remember visually what happened, but the feelings or sensations can still be processed. When we have trauma, we believe lies about ourselves, such as "I'm no good" or "I'll never amount to anything." EMDR helps break the power of these lies and provides a reality check to the brain, saying “That's over, and you can choose what you think about yourself.“ We go into the fifth phase, which is positive beliefs about oneself, such as "I'm intelligent," "I'm smart," "I can learn," and " I may not have the ability right now but I can develop the skill." Or “I'm not endangered, that was back when I was 5, now I'm 35, this doesn't happen anymore.” And so I get the notion that we have a sense of time and we can also clean up any of the physical symptoms that may have become residual to the memory. And so, by the time we do all of this, and this can happen within 45 minutes to an hour or two, the person is free from the physical and emotional disturbance. She can think about what the car accident was like, or whatever the memory was like, without that high level of distress, sometimes even with no distress at all, and even in a positive way. You know, in one sense, I say that we have parts of our brain that have no sense of time. Freud talked about our unconscious mind, but we do have parts of our brain which have chronological time. Like my husband who's a radio man, and believes that a minute has 60 seconds. So it takes that memory out of the unconscious mind, out of the limbo of "It's always happening, it's always going on," and puts it into the framework of chronological time. We have these steps that we do, including some sessions on my YouTube channel for the trauma clinic, where you can see how I have seen a patient, seen a colleague, and treated them within an hour. You can see the difference that 60 minutes can make in a person's life. It's amazing and it's fast because of the brain. It's the brain that does the healing.

36:40
Dr. Maya Novak:
Thank you for explaining this. I am always just so impressed by how powerful we are and what we can do. Even if we had either traumatic or adverse experience in our past or in our childhood, we still have the opportunity to resolve this, so it's not like - I'm sorry to say this - I’m screwed for the rest of my life, right, because something happened to me? We can actually resolve so much, and while you were talking I was thinking if there are any instances when EMDR is potentially not a good idea. Any kind of situation? Or is any type of trauma okay to go forward with EMDR?

37:29
Dr. Esly Carvalho:
Yeah, the contraindications. I think that EMDR can be used practically with just about any diagnosis, but it depends on the hands of whom. Now, we have a colleague, a psychiatrist colleague, Paul Miller, who uses EMDR with a protocol he developed with schizophrenia with psychosis, which most of us would not dare to do because we don't have the training for that, and you need to be able to do it in a much more careful and safe way. The more fragile the person, the more careful we need to be because we're talking about severe trauma that was ongoing for many years, especially in a child's life when they were the most vulnerable and the most fragile. So I think it has more to do with the training than with the method itself. The approach can be used with practically anybody, but the person has to have the right training, the right empathy, and the right sense of timing because it's not just reading a protocol. This is a relationship with another human being who is in terrible pain now. EMDR is so powerful I often tell my students that it's going to work in spite of you. Basic stuff is still going to work because this is what we do when we sleep. But there are things, like if a person has epilepsy or has had convulsions, we never do eye movements with them because it could trigger convulsions. If you have had certain physical situations, for example, during pregnancy, we usually don't have a big problem doing this, but I had a patient who called up and said, "You know, we were going to do a one-day intensive today, but this is my third attempt to get pregnant. I just got pregnant, and I think I'm miscarrying." I said, "Nope, you stay home until you're ready because we're not going to run the risk of powerful emotion putting the life of this potential baby in jeopardy." So I think it's a matter of prudence, which is a word that nobody uses anymore, but I grew up with it, you know, good sense, clinical judgment, common sense, and training. You can do it with practically anybody, but you have to have the appropriate training. Some therapists will do it, and some therapists will say, "No, I think I'd rather refer you out to somebody else who is more experienced in that field."

39:57
Dr. Maya Novak:
So right now I am absolutely positive that some listeners are trying to figure out how do you then choose the right therapists who is right for you? Do you have any advice how we can choose the right therapist that is let's say competent enough for our situation?

40:18
Dr. Esly Carvalho:
Well, I think you have to go to one of these sessions with your inner doctor, your inner psychotherapist as well. Okay, we have doctors, psychologists, and therapists who live inside as well. But what I always recommend is that you call up the person that you're seeing or write to them and ask them about their training. How trained are you in EMDR? Did you just do the course and never use it again, or do you use it regularly? How often do you use this during the week, and how many years have you been doing this? Have they gone on to get certified and received advanced training? Are you trained in this area of the problem that I want to tackle? Do you deal with psychosomatic illnesses, autoimmune diseases, physical pain, and chronic diseases? This is my niche; I love early trauma, especially the first five years of life. Although I don't work with children, I work with the children who live inside the adults and treat them. So this is what I like to work on. If somebody comes and says, "Well, I know I have borderline or bipolar. I've been diagnosed," I will probably refer them to somebody else. That's not my training. People need training in dissociation or if they have a psychotic or schizophrenic person, sometimes the damage that mental illness has done to a person is so great that we can improve it, but we can't heal it. There are other situations; I have a friend whose daughter has Down syndrome. We can heal her nightmares, but we're not going to heal Down syndrome, obviously. [chuckles]

41:52
Dr. Maya Novak:
Yes. [chuckles]

41:53
Dr. Esly Carvalho:
But we can make her have a better life. So write them, call up and ask them about their credentials and their experience, because therapists need to be able to share with you what kind of training they have. Sometimes they'll have a session and they'll do 1 session with you to evaluate if you are a good candidate for what they do, and if they aren't maybe they can refer you to somebody who is more in line, or you can read up and look around. You know the internet today. It can tell us everything. [laughs]

42:26
Dr. Maya Novak:
Yes. [laughs] Esly, thank you so much for empowering people because I think that sometimes we are afraid to ask questions or to interview those who we would love to work with. And it's because I think that potentially we never had the opportunity to choose in regard to, let's say a doctor, so when something was wrong, you needed to go to that doctor and it doesn't matter…

42:54
Dr. Esly Carvalho:
And obey!

42:55
Dr. Maya Novak:
And obey! Exactly! And I think that so many people now have problems with asking the question or putting themselves first and not just obeying exactly what you said.

43:08
Dr. Esly Carvalho:
Yeah, because we're taught from childhood to obey our elders, you know, obey the adults, obey our mommy and daddy, do what they're told. The teachers said that we have to learn this, we've got to do this, and that, and do our homework to be able to study and get a good grade. And so doctors, in general, you know, professionals, the health professionals, they come into our lives, and we oftentimes feel like we're small children or adolescents, and we just do what we're told. They say we have to do this treatment, and so I'm going to do it, and we don't question it. And so when we go to these sessions or appointments, we need to go with our adults. We need to go with our inner doctor, our inner psychologist, our inner therapist. You know, sometimes it's even good to take your mother along because some mothers have really good perception. You go with your inner mother, "My mother let me do this or not," you know, and be able to speak up, ask, write down the questions you have before you go to the appointment because we get there, and we kind of freak out and forget, and then we leave ten minutes saying, "Oh, I forgot to ask this, and I forgot to ask that." No, put them all on paper, and then you can go through them. A good professional does not feel challenged or intimidated by this, and I include myself. We are prepared. We are here to make people understand what the procedures are that they would go through, what the consequences are. This is what we call informed consent, and so the person needs to know what we do, how we do it, why I am qualified to do what I say that I can do, and you can still go home and decide, "Am I going to take that antibiotic or not?" In my case, it wasn't life-threatening. It was just a matter of the beauty issue, more than anything else, perhaps. But in other situations, you need to obey these doctors, you need to be able to do that. But you also need to ask questions, ask for a second opinion, go to another doctor, ask for a third opinion, ask around with your friends, Google it. Not everything that's on Google is true, it's not always trustworthy. But read up from good, trustworthy sources, and then make your decision. Put them all on paper. Think about it, meditate, pray about it. Consult your innards, because until all of your body, soul, and spirit agree to some kind of treatment, I don't think you should go forward because it's not going to work as well as it could unless it's an emergency life-and-death situation. I had to have some kind of surgery. It took me five years to get to the point where it wasn't life-threatening, obviously, five years to get to the point where I was ready to get cut open again. You know, I wasn't ready. Yeah, ask the questions, and I got ready. And then there was Covid, and then there were vaccinations, and there weren't vaccinations. Should I get vaccinated? What did that do, you know? So I think there are a lot of things that go into these factors, and we should respect ourselves, trust ourselves, and ask the questions we need in order to be able to feel good not only about the doctor but the procedure.

46:13
Dr. Maya Novak:
Exactly and if I just obey and am not in the driver's seat, what can happen if we are in the passenger seat is that when something goes wrong, we point the finger at everybody else. But not ourselves because we weren't driving that that car, right? So it's really important that we take that responsibility for ourselves and for our health and well-being.

46:44
Dr. Esly Carvalho:
That’s right - be in charge.

46:46
Dr. Maya Novak:
Now I know that we cannot do an EMDR session here, but we talked a bit what we can do for the hands-on work and I was wondering if we can do the flash technique that you mentioned to me a few days ago.

47:05
Dr. Esly Carvalho:
We can do a little bit. How about I walk you through it and our listeners can follow along if they want to.

47:12
Dr. Maya Novak:
Exactly.

47:13
Dr. Esly Carvalho:
And so we can do it together. This is a preparatory exercise. It's not EMDR as such, not traditional EMDR, but it will give you an idea. You know, I used to think that EMDR was kind of crazy. You know, wiggle your eyes and get well over trauma, and it's true. You wiggle your eyes with the procedure. A very scientific procedure, and things like with the flash technique it is even more interesting, I think, because we can get well from certain things. Or we can at least feel better about certain experiences without thinking about them. So before we start I'm going to explain to you: I want you to put your hands on your arms like you're hugging yourself. And we're going to tap one arm and then the other one arm. And then the other. This is called the big hug. Then we also have a butterfly hug. But today we're just gonna do the big hug. So this is what we're gonna need to do our exercise. Okay, you understood how to do that. And you can blink 3 times one after the other?

48:10
Dr. Maya Novak:
Yes.

48:13
Dr. Esly Carvalho:
So when I say “Flash,” I'm going to ask you to blink 3 times and do the alternate hug. If you have to stop the hugging to be able to blink that's okay, not all of us are that coordinated that we can do all of these things together. [chuckles] So that's what we need to be able to start. And I'm going to ask you to do something real fast and then we'll continue with the technique. So I want you to think about something horrible that happened to you. Terrible on a scale of 0 to 10 where ten is the worst thing in 0 is nothing; something like 8, 9 or 10, got it? And I want you to put this into a healing box next to you somewhere. And it's an amazing box and you can put it in there. Put it in there right now. Don't even think about what you're gonna work, just you and me. Stick it in the box, put the put the top on really well, really tight. Okay, you remember how much it is. Okay, let's go.
So now I want you to think about your favorite food. We can think about food. It has no calories when we just think about it. Okay, but I wanted to think about your favorite food and I want you to do the tapping on your arms and when I say flash you blink 3 times. Probably think about your favorite food. You have a favorite food from Slovenia that you like to eat?

49:35
Dr. Maya Novak:
Well I think that it's more like from Italy.

49:40
Dr. Esly Carvalho:
Okay. Flash! 1 2 3 blink.

49:41
Dr. Maya Novak:
Let's say pasta.

49:45
Dr. Esly Carvalho:
Okay. Flash 1 2 3. Yeah, I like things from Brazil. Flash 1 2 3. We have a lot of Italian in Brazil, too. Okay, and think about other things that you like to eat. Flash 1 2 3. … One more time, flash 1 2 3. … And one more time flash 1 2 3. Now take a deep breath. We can stop tapping. We can take a deep breath. We let it out and I want you to have a peek from really far away at that box we had put aside. Remember we had that healing box. We put it aside, you just kind of take a little peek at it from really far away. Has something changed in it?

50:41
Dr. Maya Novak:
Absolutely.

50:43
Dr. Esly Carvalho:
Yeah, so it's different. Is it better? Is it worse?

50:49
Dr. Maya Novak:
It’s better.

50:49
Dr. Esly Carvalho:
You don't have to say what's inside. I don’t want to know what's inside, just tell me in little general terms if it changed. And 0 to 10 how much does it bother you now? 10 is the worst, zero is nothing.

51:05
Dr. Maya Novak:
It would be probably 2 to 3.

51:08
Dr. Esly Carvalho:
Okay, and what was it when we started.

51:11
Dr. Maya Novak:
It was about 8.

51:14
Dr. Esly Carvalho:
Okay… So we had a little drop from 8 to 2, 8 to 3. Okay, stuff it all back in the box and put the top on real tight. And let's think about a beautiful sunset, a beautiful landscape. Okay? So let's do the tapping on our arms. The big hug and when I say flash you blink three times as you think about a beautiful landscape and a sunset or a sunrise that you've seen. Okay? … Flash 1 2 3… Mhm… Flash... Flash... Flash... Flash... Mhm. Take a deep breath. You can stop tapping. And one more time. Let's have a little peek at that box and the stuff that we put there. Has it changed some more?

52:36
Dr. Maya Novak:
It has! [chuckles] And I'm smiling because it’s again so mind-boggling because the situation is not funny but now I am smiling while thinking of looking at that box and whatever is inside. Because I have to say that when I put stuff inside there was a bit of anxiety. Like, “Okay now I'm putting it away.” It was almost like, “But who am I without that?” And now it's a completely different feeling. That’s my experience

53:13
Dr. Esly Carvalho:
Wow, that’s amazing. And then you can look back on the radio time and see how many minutes it took to do that.

53:19
Dr. Maya Novak:
Yes.

53:20
Dr. Esly Carvalho:
And that's a very safe technique if you do exactly what I say. You don't connect to the bad memory. You put it in the box and you close the top. You keep it far away and you think about something positive I made some suggestions just to make it easier and faster for us. You can think about anything positive, but you need to think about something very positive while you do the blinking and the tapping on your arms. And we call it a Desensitization Technique that Dr. Philip Manfield developed several years ago. It is amazing and now we're even using it in groups. This is one of the techniques we're using in Ethiopia with the war victims. It's an amazing exercise.

54:05
Dr. Maya Novak:
It is. I can confirm that it is really an amazing exercise, and it is, again, mind-boggling for me. But I love these kind of simple, but yet so powerful techniques that can really give us what you said before: the opportunity to live our life differently. So yes, I'm very, very, very grateful to you for guiding us through this technique now. Esly, I know that you have to go, so I'm going to let you go. I just have one other question for you. But since I have a feeling that we just scratched the surface of this topic if in the future you had another hour, I would love for you to come back and for us to go even deeper. You can think about it…

54:57
Dr. Esly Carvalho:
I would be delighted.

54:58
Dr. Maya Novak:
Yeah? Great. Thank you! Now, one last question that I have is a fun question, out of the box question. We put something into the box. But now it's out of the box. [laughs]

55:09
Dr. Esly Carvalho:
[laughs]

55:10
Dr. Maya Novak:
If you were stuck on a desert island with an injury - any kind of injury - and you could bring only one thing with you to help you heal amazingly? Well, what would that be and why.

55:24
Dr. Esly Carvalho:
Well, I would take my Bible because it is full of instructions for living, for life, for recovering from emotional, spiritual, and physical pain. We have no idea how much it can be helpful. We often talk about the importance of positive thinking, that we need to tell our brains to think positively. The Bible teaches us, from two to three thousand years ago, that what a person thinks in their heart is what they are. So, if I think positive things, I'm going to be able to get better. If I can think about what is good, trustworthy, and honorable, and focus on the good things that are happening to my body, I can imagine my body healing, and my brain will obey. It's amazing how many of these autoimmune and psychosomatic diseases are trauma-triggered, and when we can fix and heal those things, our brain thinks differently. The Bible helps us renew our minds and think about things that are good. So, without a second thought, that would be the book I would take with me.

56:48
Dr. Maya Novak:
And whenever we are recovering from any kind of physical trauma, having faith and trust and hope is also so important. So it makes sense what you just described.

56:59
Dr. Esly Carvalho:
Yeah, and that sometimes we even get a miracle.

57:01
Dr. Maya Novak:
Absolutely because we do have that Miracle Worker inside of us, right? It lives there.

57:10
Dr. Esly Carvalho:
Yeah, and so sometimes miracles are instantaneous, but sometimes they take weeks and months, but they're no less a miracle. If somebody who has survived a car crash that they should not have survived, they are living a miracle for the rest of their life.

57:22
Dr. Maya Novak:
True. Esly, where can people find more about you if they want to contact you? How can they do that?

57:30
Dr. Esly Carvalho:
I have a website called traumaclinicinternational.com. I'm the founder of Trauma Clinic. It's a very big thing in Brazil, in Portuguese, and Spanish somewhat, but in English we're just starting off. But my contact is at traumaclinicinternational.com and you can write me, my name is esly@traumaclinicinternational.com. My books are on Amazon. I have 4 of them on EMDR. I have Healing the Folks Who Live Inside. I have Heal Your Brain, Heal Your Body. I have a Deal With Your Past which are descriptions of sessions that I've done, and I also have one called Rupture and Repare which is the description of 9 sessions with 1 patient who very generously let me tell his story. Obviously with some changes so that we can't identify him, and what he had was he was the last person his father talked to before he committed suicide, and so how in 9 sessions we were able to help him with many difficult situations that he had faced before. Not only with his father. He had a sister for whom he was also an organ donor and then you can see how this works, how does EMDR therapy work. I describe it step by step for people to understand. You can't learn to do it through my book, but it will give you a very clear idea of how to do it, and you can find it on Kindle, you can find it paperback. It's in English, it's in Portuguese, and Spanish as well. So if you speak other languages you can find it in your preferred language.

59:14
Dr. Maya Novak:
Of course. Yes, and I will also put the links on to my website under the show notes under your episode so people can very easily find all of this. Esly, I am so extremely grateful and I cannot wait for us to have another conversation. I'm already like a kid so on Christmas Day. So thank you for being here and for sharing your knowledge and your wisdom. I really appreciate it.

59:41
Dr. Esly Carvalho:
Thank you so much for the invitation. I hope it will help other people as well.

59:48
Dr. Maya Novak:
This wraps up today’s Mindful Injury Recovery Talk with Dr. Esly Carvalho. If you haven’t done it yet, subscribe to the podcast on whatever platform you’re using to tune in, and… consider leaving a review so we can reach even more people who should be hearing these lessons. To access show notes, links, transcript, and video of today’s conversation go to mayanovak.com/podcast and click on episode 18.
Until next time – keep evolving, blooming, and healing.