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One spring afternoon in 1987, a psychology student trying to shake off an upsetting memory took a stroll through a park in Los Gatos, Calif., distracting herself by darting her eyes back and forth. The sting of the memory quickly faded, and the student, Francine Shapiro, glimpsed her future.
In the ensuing years she developed a popular, if controversial, therapy for trauma that has attracted devotees worldwide: eye movement desensitization and reprocessing, or E.M.D.R.
“I noticed that when disturbing thoughts came into my mind, my eyes spontaneously started moving very rapidly back and forth,” Dr. Shapiro wrote in her textbook on the therapy. “The thoughts disappeared, and when I brought them back to mind, their negative charge was greatly reduced.”
Dr. Shapiro died on June 16 at a medical facility near her home in Sea Ranch, Calif., north of San Francisco. She was 71. Robbie Dunton, a longtime friend and associate, said the cause was uncertain, but she had been unwell for more than a year with respiratory and other problems, he added, and had declined suddenly.
Dr. Shapiro built the case for therapy based on eye movement one person at a time, experimenting first on herself and then on friends and colleagues. The technique she settled on, after working with some 70 people over six months, was straightforward: People would bring an upsetting memory to mind and at the same time track her fingers as she moved them back and forth, for 20 to 30 seconds.
She integrated this technique into a variant of what is called exposure therapy, in which people engage and reprocess painful memories in an effort to blunt their sharp edges, and then reinterpret them by repeated recollection, or exposure.
This work became her Ph.D. thesis and, in 1989, the basis for an article in the Journal of Traumatic Stress.
The reception was mixed. Some therapists tried the eye-movement technique and found that it helped, and quickly, even for many people with chronic post-traumatic stress.
“I was skeptical at first,” Roger Solomon, who was a psychologist for the Washington State Patrol at the time and now consults with government agencies on the therapy in Arlington, Va., said in a phone interview. “But I went to see her speak, began trying the technique, and found it worked.”
He added, “I have found E.M.D.R. to be extremely powerful, effective and efficient, and I find it effective for any psychological disorder that involves disturbing memories.”
Many other therapists were intrigued, and Dr. Shapiro began giving seminars and demonstrations around the country and, in time, all over the world.
The scientific community was harder to persuade. The central question was whether the eye-movement technique reliably added value to classic exposure therapy, which is often effective on its own.
Studies published by Dr. Shapiro and her allies were almost all positive; several reported an 80 to 100 percent cure rate in three sessions for people with post-traumatic symptoms from a single incident, like a car crash or a rape.
Studies by outside researchers were not nearly so consistent, and some found no added effect. E.M.D.R. practitioners countered that the authors of those studies had not practiced the therapy properly. The fight boiled over in the late 1990s and early 2000s into online forums and academic journals.
“Many people regard E.M.D.R. as merely one of the many therapeutic fuzz-balls that litter the landscape of psychology today,” Richard McNally, a trauma expert at Harvard and one of the therapy’s most prominent critics, wrote in a 2000 issue of the Journal of Anxiety Disorders. “Others deem it destined to transform clinical intervention, from the treatment of post-traumatic stress disorder to the treatment of premature ejaculation.”
One of the stickier questions was how simple eye movements could color the emotional face of a presence as ghostlike and commanding as a lifelong memory. Therapists, including Dr. Shapiro, had their theories, but the science of memory has remained a work in progress, and those theories have needed continual updating.
A good answer has emerged in recent years thanks to research led by Iris Engelhard of Utrecht University in the Netherlands. (She is not associated with the E.M.D.R. network.) When people recall an upsetting visual memory, the imagination routinely intensifies the image: The reds are harsher, the faces more contorted, than they were when the memory was originally stored. The work of Dr. Engelhard and others has shown that the eye movements tax working memory to such an extent that that same disquieting memory is in fact deflated and dimmed.
“I’ve changed my mind,” Dr. McNally said in a phone interview. “I’m willing to do that based on new evidence. It looks like there’s something going on there; the representation of the trauma seems to be reconsolidated in a way that doesn’t distress people as much when later recalled.”
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Hundreds of therapists made that decision years ago, and some professional organizations, including Britain’s National Health Service, have approved the approach for specific kinds of trauma, often combined with other approaches, like cognitive behavior or interpersonal therapies.
“Put it this way: Since she died, I have been getting about 300 emails a day, from Sri Lanka, Bangladesh, everywhere,” said Dr. Dunton, the administrative director of the EMDR Institute. “I’ve given up trying to respond to them all.”
Francine Shapiro was born in the East New York section of Brooklyn on Feb. 18, 1948, the eldest of four children of Daniel and Shirley Shapiro. Her father was a car mechanic who owned an auto-parts store, and her mother ran the household. Her sister Debra died in 1965, her sister Marion in 2015. She is survived by her husband, Robert Welch; her brother, Charles Shapiro; and a stepson, Jamie Welch.
After graduating from Thomas Jefferson High School in Brooklyn, she studied English at Brooklyn College, graduating with a bachelor’s degree in 1968 and completing a master’s in 1975. She was nearing completion of a Ph.D. in literature at New York University when she received a diagnosis of breast cancer in the early 1980s. It led her to put aside her dissertation and move to California to study psychoimmunology, the effect of stress on immune function.
She beat the cancer, switched careers and received a Ph.D. in clinical psychology in 1988 from the Professional School of Psychological Studies, in San Diego. She acquired a license to practice in California and began building a network of therapists who trained to perform eye-movement therapy.
In 1995, Dr. Shapiro published the first edition of her textbook on the approach, “Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures.” She wrote or co-wrote dozens of studies of E.M.D.R. as well as another half-dozen books, including “Getting Past Your Past” (2012), which lays out the approach for general readers.
In a recent interview with the website Careers in Psychology, Dr. Shapiro was asked what qualities she considered important to becoming a successful therapist.
“Many people become therapists feeling like they have all the answers and they are going to be the ones to tell the client what to do,” she answered. “With E.M.D.R., it’s important to develop a healthy respect for the healing potential of people and to learn to be the facilitator of that healing.”
