What To Expect During EMDR

Are you interested in Eye Movement Desensitization and Reprocessing (EMDR) but nervous about what it actually looks like in practice? Read more to learn about the entire step-by-step process of EMDR.

EMDR is typically broken down into eight phases that help guide a therapist and their client through the steps needed to reprocess trauma safely. 

What does it mean to “reprocess” something? 

When discussing trauma, the term “process” refers to the integration of a memory into our sense of self and understanding of the world around us in a way that is no longer distressing. However, when we experience trauma, the intensity of that event may be difficult to functionally integrate into our self-narrative, meaning that we haven’t been able to process it fully. EMDR is built on the belief that PTSD symptoms are the result of these unprocessed memories, and to alleviate post-traumatic symptoms, we must work with a therapist to process them again or reprocess.

Phase 1: History-Taking

A relationship is built between the therapist and the client. The therapist learns about why the client is seeking therapy and their history of trauma. The client shares their history and triggers to help guide the process. Then, a treatment plan is discussed by identifying target goals for therapy, and additional resources outside of therapy are assessed to ensure client safety between sessions.

Phase 2: Preparation

Next, the therapist will explain EMDR, how it works, and what to expect. The therapist will help the client build additional coping skills and resources for when they become triggered during or after the reprocessing begins. One common exercise is the “safe space,” where the therapist helps the client build a safe space in their mind that evokes feelings of security and comfort. To ensure client safety, Phases 1 and 2 may sometimes span many sessions.

Phase 3: Assessment

In this phase, a target memory is identified. The therapist assesses how the client currently feels about the memory using the Validity of Cognition (VC) and the Subjective Units of Disturbance Scales (SUD). 

Phase 4: Desensitization

Reprocessing begins by desensitizing the client to the memory. The therapist will ask the client to focus on the target memory and engage in some form of bilateral stimulation, which may take the form of moving one’s eyes side to side, alternating taps, or sound that alternates between ears, any physical activity that alternates between stimulating the right and left hemispheres of the brain.

The therapist will then ask the client to discuss any related thoughts or feelings that come up in association with the target memory and encourage them to follow that train of thought. This will continue until the memory is no longer distressing.

Phase 5: Installation

Next, the client will be asked to focus on a positive thought about themselves in association with the memory. They may also visualize what it will look like to be completely free from the hold of this memory. During this step, positive associations are made between the memory and oneself.

Phase 6: Body Scan

The client will scan their body head to toe and identify any lingering distress or tightness remaining in the body. Bilateral stimulation will be repeated to reprocess any remaining distress.

Phase 7: Closure

Steps are taken at the end of every session to return the client to a calm state, whether or not they have finished reprocessing the target memory. If they have not finished reprocessing, steps will be taken to ensure the memory stays contained and the client is safe between sessions.

Phase 8: Reevaluation

At the beginning of the next session, the therapist will review the VC and SUD scales, and if the client still reports distress, they continue to reprocess this memory. They will move on to another memory if there is no reported distress. 

While every therapist may practice EMDR with slight variation, they will always follow these general phases. Remember, you can always ask a potential therapist to teach you more about EMDR during your consultation to see if their practice is right for you.

Sources

1. Kaufman, S. (2021, August 13). The eight phases of EMDR therapy. EMDR International Association. https://www.emdria.org/blog/the-eight-phases-of-emdr-therapy/
2. American Psychological Association. (2017, July 31). Eye Movement Desensitization and Reprocessing (EMDR) therapy. American Psychological Association. https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing