Interview with Philip Mansfield

Flash Technique – A Mild Trauma Intervention

Text: Carien Karsten
Translated from EMDR Magazine 2020 – 22

Abstract

The Flash Technique, developed by Philip Manfield, is a trauma treatment method that allows patients to process traumatic memories without needing to vividly recall or describe them. It offers an alternative when EMDR (Eye Movement Desensitization and Reprocessing) is too overwhelming or ineffective.
Initially, the technique required brief exposure to the trauma image while taxing working memory. The newer version (Flash 2.0) no longer involves directly focusing on the trauma. Instead, the patient identifies a troubling memory in broad terms and shifts attention entirely to a Positive Engagement Focus (PEF) — a positive memory or activity. While focusing on the PEF, the therapist uses bilateral stimulation (like tapping or eye blinking triggered by the word “Flash”) to help process the trauma at a subconscious level.
Research and theory suggest the technique may work by minimizing activation of the amygdala, the brain region involved in fear and emotional memory, allowing for subliminal processing. Early studies (e.g., Siegel, 2017) and clinical experience indicate that this method can reduce emotional charge quickly, often within minutes.
A clinical example illustrates how a patient with burnout-related fears experienced a significant drop in distress (SUD score from 8 to 0) after a short Flash session. The technique also appears to generalize — treating one trauma may lessen the impact of related memories.
Manfield emphasizes that Flash should only be used when EMDR is not tolerated, as EMDR remains the more robust method. However, Flash is especially valuable for clients with vague or early childhood trauma, shame-based memories, or those who avoid exposure due to fear or obsessive-compulsive tendencies.
Therapists report positive results, and Flash is now taught globally through webinars. An RCT is in preparation to further validate its effectiveness.

For most trauma therapies, including EMDR, it is important that the trauma is clearly in the picture before you can treat it. That could be a disadvantage. Especially if the image is too intense for the patient to even dwell on it. In order to be able to offer help in such a situation, Philip Manfield introduced the Flash technique. With its new version of the Flash technique, if EMDR does not work enough, you can also treat a trauma.

In EMDR Magazine 16 from 2018 Priscilla Doornhein-Semmelink, Ad de Jongh and Marit Peter describe how the first version of Flash works. The bottom line is that the traumatic image is called up very briefly, after which working memory load is applied, with the aim that the patient can keep the memory in mind ever longer.  Where treatment with EMDR therapy becomes possible.

Meanwhile, Philip Manfield has developed a new version of the Flash-technique, in which the traumatic event is no longer in sharp focus at all and only needs to be named in general terms – or not. The patient then thinks exclusively of positive things and regularly blinks with the eyes. So this is not about taxing the working memory, but a distraction that makes it possible to process a nasty memory subliminally.  

Why a new Flash?

For Manfield, the reason for adapting his earlier version of the Flash technique was the rejection of his first article on Flash for the Journal of EMDR  Practice and Research. The editor-in-chief only wanted to post his article if he came up with a plausible explanation as to why Flash works. Manfield then suggested three hypotheses to explain the rapid rate.

1. These are non-reportable, subliminal processing, bypassing the conscious resistance;
2. The recollection shall be stored;
3. It works by strengthening the spectator position, rather than letting it relive the trauma.

There was no scientific evidence for any of these hypotheses. “Then I’m going to figure it out myself,” Manfield thought.  He takes the first hypothesis because he considers it most likely to.  He tests the hypothesis by letting his patients tell as little as possible about the trauma. It may remain a vague indication, or merely the indication of the age at which the trauma occurred. It’s like summarizing a newspaper article just by mentioning the headline. What he did find important was that there was no prior reminder of the aforementioned trauma. If that is the case, this will be taken as the target. This, too, is important to refer to it as briefly and generally as possible. Then he immediately asks for a positive experience and applies the bilateral stimulation to it by blinking his eyes as soon as he says ‘Flash’.  To his surprise, Manfield noticed that this will shorten the average processing over time of the trauma of 20 minutes at Flash to ten minutes.

Mechanism

In his November 2019 webinar, Manfield suggest that the technique is likely to work because the amygdala, the area involved in emotions such as anxiety, is barely activated in subliminal, hidden, exposure.  In Paul Siegel’s 2017 fMRI study, Manfield finds evidence for the treatment of spider phobia. In that study, people with spider anxiety will briefly see a picture of a spider. So short that they don’t even realize they’ve seen the picture. The fMRI-research shows that certain areas of the brain are active in unreportable exposure, thus removing the memory of the spider from its anxious charge. That something can be stored unconsciously in your implicit working memory shows the previously published article by Hassin (2009).  

The technique

For subliminal exposure, it is necessary for the patient that he is distracted considerably.  This is done with the Flash technique by allowing them to focus on positive distractions, on which they really feel involved: the Positive Engagement Focus (PEF). That positive distraction can be anything: to do something active with your (small)child, walk along the beach, enjoy sports experiences, horseback riding, a walk in the meadows. After focusing on the PEF, tapping on the thighs and repeatedly blinking his eyes quickly, you ask the patient how the traumatic memory has changed. If the patient says that it seems to be further away, less lively or he doesn’t feel so connected to it, ask about the height of the SUD. Manfield adjusts the original Flash technique.  He trains therapists in this method through a webinar  in which you learn the technique, and a webinar for advanced ones. I was happy to follow both webinars. In April 2020 Manfield will teach courses on this in England and Belgium. More than 3,000 Flash therapists are now active around the world, they their experiences through a google group.

The treatment of Gijs

I applied the Flash 2.0 more or less by chance to Gijs (38), because the next client was already waiting. If it doesn’t work, it doesn’t harm, my opportunistic premise was. Gijs is a documentary filmmaker. He’s very busy and he’s afraid he’s becoming burn out again. While he’s just recovered from burnout. He and his wife, who also works full-time, have two children:  a four-year-old daughter and a son of one and a half.  The son suffers from ear infection and often wakes up at night, so Gijs gets little sleep. Recently, his father died unexpectedly in a rather dramatic way. His father looked after the kids a lot. His mother has become very forgetful lately, suffers a lot from fears and often appeals to Gijs. ‘This is all going to pass again’ Gijs told himself. Meanwhile, his stresssyteem was in overdrive.  

With EMDR I treat Gijs for the traumatic side of his father’s death. With ten minutes left at the end of the session, I decide to treat Gijs with Flash with the target his fear of relapse. It has a SUD of 8. As a positive focus Gijs chooses a moment when he and his son are in bed on Sunday morning.  That doesn’t seem like a good idea, this focus easily mixes with the memories of his son’s insufferable crying outbursts because of the ear infection. I ask him to focus on another positive experience. He quickly got it:  at the fair with his eldestdaughter.

In less than ten minutes, the SUD drops from 8 to 2. For him it feels as if the fear is covered by the positiveexperience, which makes him unable to summon the fear experience. But why still as much as a 2?  “I think it’s so bad that my son has earache,” Gijs replies. I get that.  But does help his son dealing with his suffering? Well, no, and this time the SUD becomes 0. He does a mental video check on how he comforts his son with earache. “I’m doing well enough” is the spontaneous thought that comes to mind.  The cognitive interweavethat I applied, because the SUD was not yet 0, is called a blocking thought by Manfield. If the SUD doesn’t drop easily, he indicates, it can be because of a blocking thought.

Flash as mild form of trauma treatment

I apply the Flash-technique more often now. It is a mild form of trauma treatment that is also nice for the therapist to do, if only because you focus on pleasurable experiences. As a therapist, you have to be aware that the patient’s memory is more or less self-contained. If it turns out that the memory derives its emotional load from previous memories (feeder memory), then you have to treat the latter. You can use the body-focused flatback to find out if the patient has had the aforementioned feeling before.

So far, all therapists who participated in the webinars and trained in flash technology have not had any negative experiences with this technique.  You often hear that with a follow-up after six months patients no longer know what they had brought in. Manfield recommends that if you want to follow up, to indicate the nasty experience with a core word.

Indication for the Flash

I’m glad Gijs is so easily rid of his specter for relapse into burnout. But was it a good idea to use Flash 2.0 for this? Manfield is very firm: if you can apply the regular EMDR protocol, you have to do it. It’s more solid than the Flash–technique. You can switch to the Flash-technique when patients feel resistance to the EMDR protocol, dissociate, or be afraid of the feeling that can come up through a memory. The Flash-technique is also easy to use if the patient has a vague memory from early childhood. The details of the memory are not important for this technique. This way you can also treat traumas that the patient is so ashamed of that he or she does not want to go into detail. For the same reason, the Flash-technique works well in patients with obsessive compulsive disorder who avoid seeing their anxiety in detail.  

Extra Flash exercise

Ask the patient to bring up two nasty memories. Then use the Flash technique to treat one of those memories. Then ask if anything has changed about the other memory. That happens a lot. According to Manfield this shows again how easily you process something when you call it up, but don’t think about it. We know this from the EMDR: if you have dealt with the most similar memory, the SUD of the other memories has also often decreased.  

Flits, Flash or Blink?

Among Flash-therapists arose online a discussion about the use of the word Flash. An Australian therapist found it difficult to use that word- because it also allows for just as quick lifting your sweater to show off your breasts. They suggest saying ‘blink’, instead of flash. Manfield believes that the attention value of flash is greater than ‘blink’. Flash indicates something is about to happen. It seems to me that it doesn’t matter much whether you say flash, flash or flash. It’s also about the ritual. In that light, it might not be so crazy to say flash, if you’ve indicated that you’re using the Flash-technique.  

At the last webinar in January 2020, Manfield indicated that he would probably start the first RCT soon. Suzy Matthijssen and Ad de Jongh will also do an RCT to improve the effectiveness of the flash–technique.

Learn more

• More information can be found on the website: www.flashtechnique.com..  There you will also find the possibility to    register for the interactive webinars. 
• On www. EMDRvideo.com you will find  two  video demonstrations of the latest version of the  flashtechnique.. 

Literature

Hassin, R.H, et al., Implicit Working Memory, Consciousness and Cognition, 2009: 18-3: 665-678

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, 195-205.

Siegel P, Warren R, Wang Z, et al. Less is more: Neural activity during very brief and clearly visible exposure to phobic stimuli. Hum Brain Mapp. 2017;38(5):2466–2481. doi:10.1002/hbm.23533

Attachments

1. Framework

Basic steps Flash technique

1. Have the patient pick up a nasty memory. The eyes can stay open, but it can also be closed. Ask patient: What would the SUD be if you switched your feelings on this memory, subject or perception?? But don’t encourage the patients to do this and feel very nasty!!  Make sure you get the first feeder memory.  This is where things often go wrong.
2. Decide with the patient for a Positive Engagement Focus (PEF). It must be a memory or activity that evokes an immediate sense of pleasure. Also explicitly say that the patient should not think about the trauma.
3. Start when the patient is ready, the bilateral stimulation with tapping on the thighs or eye movements. Tap along yourself. In the meantime, ask the patient to focus on the PEF. It also works well if the patient tells you about, for example, riding and bravely telling details by asking questions.
4. Ask the patient to blink with the eyes three times quickly when you say Flash.  
5. Keep tapping, say flash every now and then. On that command, the patient flashes the eyes three times. You repeat the    Flash five or six times.
6. Ask the patient to think back to the memory and ask if he or she experiences any difference. So not like EMDR: what comes to mind?
7. Continue to call flash five times if the SUD is not 0 (step 5). If the SUD drops slowly or no longer, you can proceed to the treatment phase of the EMDR protocol and apply an intensive working memory load à la EMDR 2.0. If the SUD is 0, do the Body Scan, or the Mental Video Check (open eyes when there is turmoil and continue with Flash). Slute off asking what’s most important that someone has learned from the Flash. 

[End of frame]

• Schedule

Flash 1.0	Flash 2.0
Motivation	Motivation
Break fear of evoking a traumatic image, allowing the image to stay in the working memory ever longer.	Quick, not burdensome treatment of traumatic image. By global retrieval of memory, does not evoke fear, pain or resistance.
Treatment Target	Treatment Target
Recall a specific image.	A nasty description traumatic image meets.
Use the image provided by the patient.	Detect possible blocking thought and/or earlier memory.
	If there is a rather, similar reminder, take this as a target.
Desensitization	Desensitization
Recall the traumatic image so short calls that it is not painful. Combine with slow eye movements.	Ask to focus on a positive image. Blink your eyes three times when you say “Flash.” Combine with tapping on thighs. Repeat “Flash” five times.
Sud	Sud
Ask how high the SUD is and possibly switch to EMDR or EMDR 2.0	Ask: what has changed?At SUD > 0: why so high?
Purpose	Purpose
Keep memory in working memory for as long as EMDR is possible.	Processing trauma by not thinking about the trauma. Instead, focus on positive image.

 

Interview with Rafaële Huntjens

Questioning Structural Dissociation in DID

Abstract

In an interview, Professor Rafaële Huntjens challenges the traditional view of structural dissociation in Dissociative Identity Disorder (DID). According to Huntjens, there is no scientific evidence for multiple distinct personalities within one person. Instead, DID symptoms can be better understood as shifts in psychological modes within a single personality.
She advocates moving away from the long-standing three-phase treatment model and instead working directly with patients’ emotional needs as they appear in various states. Her research has repeatedly shown that people with DID do not experience true amnesia between states, undermining the basis for the structural dissociation model.
She is critical of EMDR protocols based on structural dissociation, warning they may unnecessarily reinforce unproven concepts or even risk inducing false memories.
Finally, Huntjens stresses that no valid diagnostic tools exist for DID in children and warns against prematurely labeling children with DID, calling instead for further research.

Dissociation: Acknowledge It, Don’t Reinforce It

“There is no scientific evidence for the existence of something like structural dissociation of the personality. Rather than spending extended time stabilizing the patient, it’s often better to start working directly with the different personality states as experienced by the patient,” says Professor Rafaële Huntjens, appointed Associate Professor of Experimental Clinical Psychology at the University of Groningen since December 1, 2020, with a chair in trauma-related and dissociative disorders.

Treatment for people with Dissociative Identity Disorder (DID) can last over ten years. This is partly due to the prevailing assumption that individuals possess distinct split-off personalities, each with its own perception, emotion, consciousness, and memory. These personalities are thought to require long-term stabilization before trauma can be addressed and integration can occur (the three-phase model). Twenty years ago, this was the common view. But by now, there’s ample evidence to suggest that these “personalities” are better understood as mental constructions, and that one personality can experience different modes or states.

This newer view, according to Huntjens, offers better chances for faster recovery because it bypasses the need to align and stabilize these supposed different personalities. Instead of “calling a meeting,” clinicians can immediately focus on the core needs the patient experiences in their different states—for example, the need for safety.

“The model of separate personalities—structural dissociation—can be compared to a tray with different pastries. But I believe it’s more accurate to see dissociative modes as different slices of the same pie.”

Research

Research shows that when people recount traumatic experiences and then listen to the audio recording of their own story while in an fMRI scanner—switching between different personality states—differences can be observed on the scan. For example, the amygdala (associated with fear) may be activated in one state, showing more emotional response, while in another state it might not. But what does that really tell us?

Don’t try to lift avoidance, thinking there’s a real memory underneath.

“It’s not evidence of trauma-related amnesia. People who report alien abductions show similar brain responses. It only indicates they believe their experience—it doesn’t prove the event occurred.”

Amnesia

Some individuals with DID report that one personality doesn’t remember what another experienced. Huntjens’ research has focused on whether true amnesia is present.

“We’ve tested this in many ways, such as word list tasks designed to be easier for someone with amnesia. If someone truly doesn’t remember List 1, learning List 2 should be easier—due to less interference. But DID patients showed no advantage. We also tested this with trauma-related word lists selected by clinicians treating DID patients. Same results—no amnesia. These findings have been consistently replicated over the past 20 years.”

They also examined procedural memory (e.g., playing piano). Someone who learns to play in one state can still play in another.

“Some claim knowledge transfers unconsciously—but our tests involve explicit memory. Empirical research strongly suggests the assumption of structural dissociation doesn’t hold.”

Treatment of DID

“You can acknowledge that patients feel like they have split-off parts, but you shouldn’t reinforce this belief—don’t say things like ‘the little people inside you.’ Acknowledge dissociation like you would other psychopathologies (e.g., anorexia, psychosis): respect the patient’s experience without treating it as literal truth.”

Terms like derealization, depersonalization, and identity confusion are preferable to “split-off parts.” Normalize the experience:

“Say, ‘you’re distancing yourself from the experience,’ rather than suggesting multiple identities.”

Mode Model

“From a transdiagnostic view, people with DID aren’t so different from those with other disorders. That’s why we developed the ‘mode model’—in collaboration with Marleen Rijkeboer—which helps reduce inner chaos into manageable modes. It recognizes the patient’s experience and helps identify the functions and needs behind various states.”

Schema Therapy

Schema therapy fits well with this model. Its experiential exercises, which evoke old emotional patterns and apply “reparenting,” are suitable for DID.
Imagery rescripting is also effective. In this approach, the therapist first steps into a memory image (e.g., to protect a child from a threat) and eventually teaches the client to do this as a “healthy adult.”

“With DID, this process is slower due to avoidance, so more intermediate steps are needed.”

Evidence

Evidence for schema therapy’s effectiveness in DID is still being gathered. One pilot study is ongoing, and a larger one is being launched. Treatment takes about three years.
Some patients struggle to let go of the concept of split personalities after years of three-phase model treatment, but many succeed—and regaining autonomy is key. Huntjens also emphasizes that care systems should avoid taking over too much from patients.

Connection with EMDR

Imagery rescripting in schema therapy resembles cognitive interweaves in EMDR, such as inserting a healthy adult figure into traumatic memories. Other schema therapy components (e.g., experiential and grounding exercises) can be integrated into EMDR.

“But I’m critical of the modified EMDR protocol by Spanish therapists Anabel Gonzalez and Dolores Mosquera—they assume split-off personalities and adapt EMDR accordingly, which isn’t necessary.”

Another concern is using EMDR when the patient cannot recall a traumatic event. Some techniques (e.g., “tip of the finger” or Knipe’s LOUA procedure) avoid full memory recall.

“That contradicts working memory theory—the mechanism behind EMDR’s effectiveness. Don’t try to lift avoidance thinking a real memory lies underneath; that risks inducing false memories.”

Children

Huntjens warns that there are no valid tools for diagnosing DID in children.

“We also lack effective treatments, and once diagnosed, the treatment trajectory is long. Children typically don’t report split-off personalities—so don’t reinforce that idea. Let’s start with research first.”

For older children (age 12+), adult tools like DES and SCID-D can be used. Huntjens sees major opportunities to improve care for DID patients through more effective, evidence-based treatments. She continues to pursue this through research with her PhD students.