EMDR is an incredible form of psychotherapy used to treat trauma. EMDR stands for Eye Movement Desensitization and Reprocessing and it was created by Francine Shapiro in 1987. It’s important to know that when the therapy was discovered, it was through rapid eye movements. It was later discovered that eye movements were one of may ways to create the bilateral stimulation (more on this later) needed for the therapy to be successful. By this time, though, the name was well-known and it was too late to change it. When you sign up for EMDR and you start processing with your therapist, you may be doing eye movements, tapping, using little handheld tappers that vibrate, or even more creative approaches like jumping from side-to-side.
EMDR is a 3 stage, 8-phase psychotherapy. I want to break down all 8 phases for you, so you know what to expect.
Stage 1, phase 1 of this treatment may take a few sessions to complete as it lays the ground work for a lot of the processing you may be doing in your time in EMDR. You and your therapist will be getting to know each other and getting a thorough history of your previous experiences. Your therapist will want to know about your family of origin, how you grew up, birth order, relationship with parents, siblings, important people in your life. Your therapist will ask for any major events that either happened to you or happened within your family as you grew up. All of this is important information to get as it may pertain to some beliefs you have about yourself that may come up in processing. After this information is gathered, your therapist will want to make sure you have the resources you need to be able to handle processing through trauma as it can get really intense. They’ll teach you some grounding and affect management skills and help you integrate these into your daily life.
Still in this phase 1, you and your therapist will work on presenting problems and triggers and develop a target sequence plan. Basically, you may come in with something you want to work on. Your therapist will ask you a bunch of questions to assess how this is impacting you today, when you have felt this way or experienced this in the past, and see if there are any roots from childhood this could be stemming from. You and your therapist will work on identifying the belief you hold about yourself that may be acting as a block for your healing (common ones include beliefs like “I’m not worthy,” “I’m unlovable,” “I’m powerless,” “I’m incompetent,” etc.) and help you come up with a more adaptive belief that fits the situation you’re coming in with (“I am lovable,” “I can help myself,” “I can do whatever I put my mind to,” “I am capable of learning and growing,” etc.). Once you have your target sequence plan down, you’ll be able to move to the second stage!
The second stage starts to move a little faster. In stage 2, phase 2, you are preparing for processing. Your therapist will introduce the bilateral stimulation and you two will decide which method works best for you. Your therapist will take the lead with the speed and flow, asking for your feedback on if it’s too fast, too slow, if they’re sitting too close or far away, etc. You determine what feels comfortable and appropriate to you. The therapist will coach you on giving a stop signal incase things get too intense and you’ll review grounding and regulation skills.
In phase 3, your therapist will assess the memory you’ve chosen to work on. Some of this may be repeated from the previous stage, though they’ll want to double check that nothing has changed since you last met, you may have had new insight and/or gave it more thought. They’ll ask you questions such as the worst part of the experience, the negative cognition attached to it, the positive cognition you’d like to have instead. They’ll ask you how much you currently believe the new cognition and how distressing the memory is prior to the processing (they’ll ask again after to assess for changes). They’ll ask for the emotions and sensations you experienced in the memory and may ask for the location in the body you feel this experience. Once all of this is verified, again a lot of it may just be review from previous discussion, phase 4, desensitization, takes place.
Phase 4 is for desensitization. Your therapist will ask you to hold that memory, with the negative belief, in your mind’s eye as you do your bilateral stimulation. Your therapist will be reading your facial expressions and body language to try and determine “paragraphs of thought.” They’re not trying to interrupt your thought process, but they do want to check in appropriately. So they’ll do the bilateral stimulation, then ask questions like, “what do you notice?” giving you an opportunity to make comments about what this brings up for you. Now this is where some anxiety can come in for people- there is no right or wrong thing to say or do. Your brain, through the bilateral stimulation, will make the connections it needs to make. All you need to do is notice it, and verbalize some aspect of it, and let it do its thing. After you make a comment, your therapist will encourage you to continue and restart the bilateral stimulation. You’ll repeat that for as long as needed until the session needs to be wrapped up (it’s okay if it’s not fully processed, it can be revisited) OR you come towards your adaptive belief. That’s the cool thing with EMDR- your brain will work towards healing. It will, when allowed to process, open up those neural pathways and allow itself to heal. When your therapists notices a change in your responses, they’ll ask you to rate how distressing that memory is. Hopefully, that distress will go all the way down. If it doesn’t, more processing might be needed, which is more than fine! If more time is needed for processing, your therapist might end the stimulation, help you stabilize, and you can start at that point in the next appointment.
If your level of distress is all the way down, you’re ready to move to phase 5, installation! In this phase, you and your therapist will assess whether the positive, adaptive cognition still fits or if a better one came up during your processing. Your therapist will ask you how true that feels and complete another round or two of stimulation. This may happen in the same session as phase 4, or it may wait until a future session, just depending on time. You don’t want to rush the process!
Phase 6 involves a body scan. Your therapist will ask you if you to think of the incident and the positive cognition and scan your body and report any sensations. They’ll lead you through some stimulations to either solidify the sensations or process through other sensations that may have come up for you.
Phase 7 is closure. For unfinished processing, your therapist will help ground and stabilize you. You’ll debrief and discuss how processing went, any new insights, and how to apply new learning. It’s important to note that processing will continue, especially as you sleep as the bilateral stimulation mimics REM sleep. If you have completed the processing, closure will still include debriefing and discussing, stabilizing if needed, and the reminder that more processing may continue.
Phase 8 is the final phase. In this phase you’ll be reevaluating as a way to integrate neural networks and allow your brain to link and consolidate everything it has processed throughout the sessions. Your therapist will check in to see how triggers have been since processing and will assess for any new insights, dreams you had, attitudes, insights, levels of disturbances, etc. You and your therapist will decide next steps for your target sequence plan. You may process any aspect of the target that still has some disturbance, learn how to integrate the new learning into their daily life, or revisit incidents that hadn’t been addressed.
Once phase 8 is completed, you’ve successfully moved through the EMDR treatment. Congratulations! Hopefully you’ll have felt a significant amount of healing having happened throughout this time and may be ready to either work on other traumas or move on from therapy! You did it!
About the Author
Maria Mangione (she/her), M.A., LPCC is a licensed clinical counselor that specializes in dialectical behavior therapy. Maria works to help people develop the tools they need to develop trust in themselves and build their life worth living. Maria believes in having meaningful connections with her clients and believes that therapy and healing can be fun. Click Here to learn more about Maria’s experience and therapeutic style.