Attachment-Focused EMDR vs Ketamine-Assisted EMDR™ (KA-EMDR)
A side-by-side comparison: mechanism, evidence, the conditions each treats, philosophical roots, and where they actually disagree clinically.
At a glance
Attachment-Focused EMDR
- Tradition
- Trauma-Focused
- Founder
- Laurel Parnell (2013)
- Evidence
- Emerging evidence
- Focus
- Trauma Processing + Attachment Repair
- Format
- Individual
- Duration
- Medium to long-term
Ketamine-Assisted EMDR™ (KA-EMDR)
- Tradition
- Integrative
- Founder
- Danielle Ciccone & Michele Topel (2024)
- Evidence
- RCT-supported
- Focus
- Somatic + Cognitive
- Format
- Individual
- Duration
- Short to Medium
How they work
Attachment-Focused EMDR
Core mechanism: Bilateral stimulation within an attuned relational context activates the attachment system while processing early wounds, enabling internalization of a secure base through both the therapeutic relationship and imaginal resource figures
Ontology: The self as shaped by early relational deficits — not primarily by discrete traumatic events but by chronic failures of attunement — that require both trauma processing and relational repair
Ketamine-Assisted EMDR™ (KA-EMDR)
Core mechanism: Standard 8-phase EMDR protocol adapted for ketamine integration. Client self-administers low-dose sublingual ketamine (troches) at a strategically timed point during the reprocessing phases. The psycholytic dose is intended to expand the window of tolerance and enhance neuroplasticity while preserving the client's capacity to engage in bilateral stimulation and verbal processing — unlike higher-dose psychedelic approaches that impair interactive participation.
Ontology: Traumatic memories are stored in maladaptive neural networks (per EMDR's Adaptive Information Processing model). Low-dose ketamine enhances neuroplasticity and the memory reconsolidation window, allowing EMDR's bilateral stimulation to reprocess traumatic material more effectively. The pharmacological and psychotherapeutic mechanisms are proposed as synergistic rather than additive.
Conditions treated
1 shared · 5 Attachment-Focused EMDR-only · 0 Ketamine-Assisted EMDR™ (KA-EMDR)-only
Both treat
Only Attachment-Focused EMDR
What each assumes — and misses
Attachment-Focused EMDR
Philosophical roots: Bowlby (attachment theory); Ainsworth (secure base); Main (disorganized attachment); Winnicott (good enough mother); Siegel (interpersonal neurobiology)
Blind spots: Limited independent research base; departure from standard EMDR fidelity raises questions for purists; requires both EMDR and attachment theory competence; some modifications not empirically validated independently
Therapeutic voice: Let's bring in your nurturing figure. Can you feel their presence with you? Stay with that, and follow the taps.
Ketamine-Assisted EMDR™ (KA-EMDR)
Philosophical roots: Inherits EMDR's basis in information processing theory and memory reconsolidation science. The ketamine component draws on psycholytic therapy tradition (Passie et al., 2022) — the use of sub-psychedelic doses to enhance psychotherapeutic process rather than induce altered states as the primary intervention.
Therapeutic voice: We're going to do EMDR reprocessing the way you've experienced it before, but this time the ketamine will help your brain stay in a state where it can process the difficult material with less fear and more flexibility.
Choosing between them
Attachment-Focused EMDR (Trauma-Focused) and Ketamine-Assisted EMDR™ (KA-EMDR) (Integrative) come from different traditions, which means they assume different things about what a person is, what causes suffering, and what the therapeutic relationship is for. The choice between them is often less about "which works better" and more about which set of assumptions fits the client and the therapist.
For deeper coverage: see the full Attachment-Focused EMDR and Ketamine-Assisted EMDR™ (KA-EMDR) pages, or use the interactive comparison tool to add more modalities to this comparison.