LOUA: Working Through Avoidance in EMDR Therapy
One of the difficulties that can arise in EMDR therapy is that a client may have trouble accessing the memories, feelings, or bodily sensations that need to be processed. A client might describe a disturbing experience from childhood but insist that it doesn't bother them. Another might have very little memory of childhood, or might struggle to feel anything when discussing experiences that were clearly painful.
In other cases, a client may be able to identify a traumatic memory, but when the therapist begins EMDR processing, very little happens. The client feels numb, disconnected, or unable to engage with the memory.
These difficulties can sometimes arise because of psychological defenses that developed to protect the person from overwhelming experiences.
Jim Knipe developed a valuable EMDR technique called Levels of Urge to Avoid (LOUA) to help therapists identify and process these defenses. Rather than attempting to push past the defenses to reach the traumatic memory, LOUA works directly with the client's urge to avoid.
Why Do We Avoid Painful Memories?
When children experience abuse, neglect, rejection, or other painful circumstances, they may lack the emotional resources necessary to deal with what is happening.
They cannot always escape their circumstances, confront those responsible, or find someone who will help them make sense of their experiences. Consequently, they develop ways of protecting themselves psychologically.
For example, a child might learn not to feel sadness because expressing sadness brings criticism. Another might learn to suppress anger because anger makes an already dangerous environment more dangerous. Still another might learn to avoid thinking about certain experiences altogether.
These defenses can be remarkably effective in helping a child survive difficult circumstances.
The problem is that these same defenses may persist into adulthood, long after the original danger has passed.
A person who learned not to experience sadness might become emotionally numb. Someone who learned that vulnerability was dangerous might struggle to develop close relationships. Another person might feel compelled to avoid discussing their childhood, even when they consciously recognize that those experiences continue to affect their lives.
The defense once served an important purpose, but it may now prevent healing.
The Protective Wall
One way to think about these psychological defenses is as a protective wall.
Behind the wall are memories, emotions, beliefs, and bodily sensations associated with painful experiences. The wall protects the person from encountering these experiences, but it also prevents them from being processed and resolved.
In EMDR therapy, the therapist ordinarily helps the client access a disturbing memory and process it through bilateral stimulation, such as guided eye movements.
However, if a strong psychological defense prevents the client from accessing the memory or the associated emotions, ordinary EMDR processing may stall.
The therapist might encounter several forms of avoidance:
Emotional numbness or detachment.
Difficulty remembering childhood experiences.
Insisting that painful experiences were insignificant.
Avoiding sadness, anger, shame, or helplessness.
Feeling uncomfortable with vulnerability.
Harshly judging or rejecting one's younger self.
Becoming distracted or mentally disconnected when discussing painful experiences.
It is important not to assume that every instance of emotional numbness or difficulty remembering reflects a psychological defense. There can be other explanations. However, when avoidance is involved, directly addressing it may be an important part of treatment.
This is where Knipe's LOUA technique becomes especially valuable.
What Is LOUA?
LOUA stands for Levels of Urge to Avoid.
The central idea is relatively simple: Instead of immediately processing the traumatic memory, the therapist first helps the client process the urge to avoid that memory.
For example, suppose a client remembers being repeatedly humiliated by a parent but feels nothing when describing the experience.
The therapist might ask:
'When you think about those experiences, is there a part of you that doesn't want to feel anything about them?'
The client might respond:
'Yes. I don't want to go there because I'm afraid I'll fall apart.'
Rather than attempting to overcome this reluctance through persuasion, the therapist makes the urge to avoid the focus of EMDR processing.
The goal is not to eliminate the client's capacity to protect themselves or to force them to confront experiences they are not ready to address. Instead, the goal is to help resolve a defensive response that may no longer be necessary.
Knipe's technique fits within EMDR's Adaptive Information Processing (AIP) model, which proposes that traumatic experiences can remain insufficiently processed and continue influencing present emotions, beliefs, and behavior.
Sometimes, the defenses surrounding the memory must be addressed before the memory itself becomes accessible.
How to Implement LOUA: Six Steps
The following is an overview of Knipe's LOUA procedure. It is intended to help readers understand how the intervention works and to provide a practical outline for EMDR-trained clinicians. It is not a substitute for formal EMDR training, appropriate preparation, or clinical judgment.
Step 1: Identify What Is Being Avoided
The first step is to determine what the client is avoiding.
This might be a traumatic memory, an emotion, an uncomfortable belief, or even a vulnerable part of the self.
For example, a client might say:
'I remember what happened, but I don't feel anything.'
The therapist might ask:
'Is there a part of you that doesn't want to feel anything about that memory?'
Or perhaps:
'What would be difficult about allowing yourself to feel the sadness connected with that experience?'
The client might respond:
'If I start feeling it, I'm afraid I won't be able to stop.'
Now the therapist has identified something specific: the urge to avoid experiencing sadness.
The therapist can acknowledge the protective purpose of the avoidance without reinforcing the belief that the emotion itself is dangerous.
Step 2: Identify an Image Representing the Avoidance
Next, the therapist asks the client to identify an image that represents the urge to avoid.
For example:
'When you think about not wanting to feel that sadness, what image represents that urge to avoid?'
The client might picture a large wall, a locked door, themselves turning away, or some other image that represents their reluctance.
The image helps the client focus on the defense itself rather than moving immediately into the traumatic memory.
Step 3: Measure the Urge to Avoid
The therapist now asks the client to rate the intensity of the avoidance on a scale from 0 to 10.
Zero represents no urge to avoid, while 10 represents the strongest imaginable urge.
For example:
'As you picture that wall, on a scale from 0 to 10, how strongly do you NOT want to experience that sadness?'
The client might answer:
'About an 8.'
This rating is called the Level of Urge to Avoid. It provides a way to track changes in the defense as processing continues.
Notice that this differs from the usual EMDR Subjective Units of Disturbance (SUD) scale.
In ordinary EMDR processing, we measure how disturbing a memory feels. In LOUA, we measure how strongly the client wants to avoid an experience.
A person could have relatively little conscious distress about a memory while still having a very strong urge to avoid feeling anything about it.
Step 4: Identify Where the Urge Is Felt in the Body
The therapist then asks the client to notice the physical sensations connected with the avoidance.
'As you think about not wanting to feel that sadness, where do you notice that urge in your body?'
The client might describe tightness in the chest, tension in the stomach, a sensation in the throat, or some other bodily experience.
The purpose is to help the client identify and remain aware of the felt experience of avoidance.
Some clients will initially have difficulty identifying physical sensations. This may itself provide useful information about their emotional awareness and defensive responses.
Step 5: Process the Urge to Avoid With Bilateral Stimulation
Once the image, urge rating, and bodily sensations have been identified, the therapist begins bilateral stimulation.
The therapist might say:
'Focus on that image of the wall, the urge not to feel the sadness, and where you notice it in your body. Just think about that.'
The therapist then uses sets of bilateral stimulation, such as guided eye movements.
After a set, the therapist asks what the client notices.
Several things might happen. The client may recognize why the defense developed. The feeling of fear may decrease. They may begin remembering experiences associated with the avoidance. Or they may notice that the wall no longer feels quite as necessary.
For example, a client might say:
'I remember being young and crying, and my father getting angry with me. I think I learned that crying was dangerous.'
The therapist allows the processing to continue, provided the client remains sufficiently grounded and able to tolerate what emerges.
The important point is that the therapist is processing the avoidance itself, rather than attempting to force access to the traumatic memory.
Step 6: Return to the Original Target and Reassess
After several sets of bilateral stimulation, the therapist returns to the original image and question.
'When you picture that wall now, on a scale from 0 to 10, how strongly do you NOT want to experience that sadness?'
The client might report that the original urge of 8 has decreased to 4.
Additional sets of bilateral stimulation may help reduce the urge further.
As the urge to avoid decreases, the client may become more willing to experience the emotion or memory that was previously inaccessible.
At this point, the therapist assesses whether the client is ready to return to the original EMDR target.
The purpose of LOUA is not simply to obtain a low number. A decrease in avoidance is most meaningful when accompanied by an increased ability to approach the material safely and remain present.
In some cases, the therapist can resume ordinary EMDR processing. In others, additional preparation or work with other defenses may be necessary.
An Example of LOUA in Practice
Consider a hypothetical client who experienced considerable rejection during childhood.
As an adult, he recognizes that his childhood was difficult, but he insists that it doesn't bother him.
Whenever his therapist attempts to process a painful childhood memory, he experiences very little emotional disturbance. His SUD level remains low, and he cannot identify bodily sensations associated with the event.
The therapist suspects that emotional detachment may be protecting him from feelings that were once overwhelming.
Rather than continuing to process the memory directly, the therapist asks:
'Is there a part of you that doesn't want to feel anything about what happened?'
The client pauses and says:
'Yes. I think if I really let myself feel it, I would be overwhelmed.'
The therapist asks him to picture that urge to avoid, rate its intensity, and locate it in his body.
His initial LOUA rating is 9.
After several sets of bilateral stimulation, he begins remembering how alone he felt as a child and how important it was to appear strong.
He recognizes that suppressing his feelings once helped him cope with circumstances he could not change.
As processing continues, his urge to avoid decreases.
Eventually, he finds himself able to experience sadness about his childhood without becoming overwhelmed.
Now the therapist may be able to return to the original traumatic memory and engage in more effective EMDR processing.
The important development is not simply that the client experiences sadness. It is that he no longer needs to rely so heavily on emotional avoidance to protect himself.
LOUA and Complex Trauma
LOUA can be particularly helpful in treating complex trauma.
When someone experiences a single traumatic event in adulthood, they may have relatively direct access to the disturbing memory.
However, when someone experiences repeated adversity during childhood, psychological defenses may become deeply ingrained in their way of functioning.
They may have learned to suppress painful emotions for years, perhaps without recognizing that they are doing so.
Some individuals develop a marked separation between the part of themselves that manages ordinary life and the parts of themselves associated with traumatic experiences.
This distinction appears in the Theory of Structural Dissociation, which describes an Apparently Normal Part (ANP) that focuses on daily functioning and Emotional Parts (EPs) associated with traumatic experiences.
A person may appear highly functional while remaining disconnected from considerable emotional pain.
In such cases, the problem may not be an inability to identify a traumatic memory. Rather, the person's psychological defenses may prevent them from fully engaging with it.
Knipe's approach encourages therapists to respect these defenses and work with them, rather than treating them as obstacles that must simply be overcome.
For clients with significant dissociation, however, reducing avoidance is only one part of treatment. They may also need substantial work developing emotional regulation, present orientation, and the capacity to remain aware of both the past and the present.
How LOUA Relates to Other EMDR Techniques
Knipe developed several other interventions that complement LOUA.
One is the Loving Eyes procedure, which helps clients develop a more compassionate relationship with wounded parts of themselves.
A client might look back at their younger self with disgust, embarrassment, or harsh judgment. In such cases, avoidance may involve not wanting to acknowledge the pain or vulnerability of that younger self.
LOUA principles can help reduce this avoidance, while Loving Eyes goes further by helping the client develop understanding and compassion toward that part of themselves.
Another related intervention is CIPOS (Constant Installation of Present Orientation and Safety).
CIPOS helps clients maintain awareness of their present safety when approaching traumatic material. It can be particularly useful for clients who become overwhelmed or dissociate during processing.
The distinction is important.
LOUA primarily addresses the urge to avoid an experience.
CIPOS primarily addresses the client's ability to remain safely oriented in the present while approaching that experience.
Some clients need both interventions.
A Final Thought
One of the most important insights behind LOUA is that psychological defenses should not simply be regarded as problems.
They frequently developed for good reasons.
A child who learned not to feel sadness, not to remember painful experiences, or not to acknowledge vulnerability may have been doing the best they could to cope with circumstances beyond their control.
But what once protected us can eventually become an obstacle to healing.
Jim Knipe's Levels of Urge to Avoid technique offers EMDR therapists a thoughtful way of working with these defenses. Instead of forcing a client past the protective wall, the therapist helps the client process the need for the wall itself.
As that need diminishes, the person may discover that experiences once too painful to approach can now be remembered, understood, and processed.
The goal is not to remove protection before the person is ready. It is to help the person reach a place where that protection is no longer needed in the same way.
Clinical reference: Jim Knipe, EMDR Toolbox: Theory and Treatment of Complex PTSD and Dissociation. This article provides an educational overview of LOUA and is not a substitute for training in EMDR therapy.
