EMDR

EMDR is a specific psychotherapy designed to help reduce trauma symptoms. Shapiro initially developed the EMDR model to decrease the distress associated with chronic PTSD. In some cases, this treatment can help people heal faster than in conventional forms of talk therapy.

Unlike many other conventional treatments, EMDR does not require clients to provide excess details about the past or complete homework assignments. Likewise, therapists do not need to know every part of the client’s life before appropriately intervening.

Instead, EMDR focuses on how the brain reacts to unprocessed traumatic memories. Emerging neuroscience continues to support the brain’s ability to rebuild neuroplasticity. In other words, proper interventions can change how the brain understands and processes information. Over time, it can “retrain” itself in how it responds to triggering material.²

EMDR follows eight distinct phases which allow clients to gradually feel desensitized to their targeted material. After completing these phases, it is assumed that the client has reached a point of resolution. At that point, the trauma no longer has a significant hold over them.

Intake: An intake refers to the assessment process of psychotherapy. This is a standard protocol in all mental health treatments. During the intake, your therapist will gather relevant details about your mental health history, treatment episodes, and other important information. This information helps with laying the groundwork for your therapy.

Release of Information: Although it’s not unique to EMDR, an EMDR therapist may request for a release of information, especially if the client is working with another provider. You always have the right to either authorize or deny these requests. Having this information available can help EMDR therapists understand your history and current treatment goals.

Informed Consent: Informed consent refers to your therapist reviewing the logistics of therapy, including what to expect and any risks involved. They want to ensure that you understand the process. At this time, it’s reasonable to ask your therapist any questions you have about how EMDR works.

Treatment Planning: Therapists use treatment plans to create goals and objectives for their clients. This report helps keep you on track. You always have a right to inquire about your progress. If you believe things aren’t moving in the right direction, it’s essential to speak up.

Target: A target is a specific issue that causes distress. A target can include a past event or present situation. EMDR therapists use targets to initiate their trauma-focused work.

Bilateral Stimulation: Bilateral stimulation refers to the alternating right and left stimulation. Therapists achieve this by engaging in rhythmic movements like tapping or moving their fingers. This stimulation can be either visual, auditory, or tactile. You will be engaging in bilateral stimulation while sharing your target.

 Bilateral stimulation isn’t unique to EMDR. We engage in it during our daily routines while walking or shaking our heads. It can induce a relaxing effect and help you feel a sense of distance from your stressors.

Desensitization: Desensitization refers to feeling less reactive to certain stimuli, as the intensity of anxious or depressed feelings reduces over time. The goal is to have little to no physical tension once completing EMDR.

Self-Soothe: To self-soothe means to calm and reassure yourself. People can achieve this by practicing positive affirmations and engaging in healthy coping skills that foster emotional well-being. Your therapist will teach you various self-soothing techniques during your treatment.

Resource Tapping: Resource tapping supports self-regulation and entails using your imagination to raise awareness of internal resources. When practiced effectively, this technique can help rebalance the central nervous system and decrease hyperarousal and anxiety.

Termination: Termination refers to the end of therapy. During this time, you will review your progress. Your therapist will also provide you with any ongoing referrals for additional care.

After determining that EMDR is appropriate, the work begins with your therapist inquiring about your goals and your current ability to cope with distress. Let’s review the eight treatment phases.

Phase 1: History and Treatment Planning

The first phase can take 1–2 sessions. During this phase, you will provide your therapist with a thorough overview of your mental health history. If you release information to your therapist, they may review those notes and ask you to clarify certain details.

You will also discuss the main issues that brought you into treatment. You can provide either specific details or offer a loose outline—it’s your choice. EMDR does not require that you share an in-depth analysis of your past.

Phase 2: Preparation

Preparation can take 1–4 sessions, although it may take longer for clients with extensive trauma histories or co-occurring mental health diagnoses. 

In this phase, your therapist will teach you particular techniques to cope with emotional distress. These techniques will help you self-soothe if you become anxious or depressed during the EMDR treatment.

This phase will include informed consent and a review of your treatment plan. Your therapist will teach you different relaxation skills to practice during and after the session. Some common relaxation skills include:

• Imagining a safe place
• Progressive muscle relaxation
• Grounding with your five senses
• Taking deep breaths
• Practicing positive affirmations

 Trust is essential within the therapeutic relationship. You should feel safe and secure with your therapist before diving into trauma work. Trust can take time, especially when there is a history of trauma, but this rapport is essential for healing.

Phase 3: Assessment

During the assessment phase, your therapist will ask you to review your target. You will choose a specific image that best depicts the target, and you will also select a statement that indicates a negative self-belief associated with it.

Common self-beliefs include I am bad or Everyone will hurt me. These beliefs tend to self-defeating and limiting. They can undoubtedly impact your daily functioning and create significant inner turmoil.

Your therapist will ask you to rank the level of disturbance this belief gives you on a scale from 0–10. While identifying this negative belief, you will also indicate any accompanying physical sensations or uncomfortable emotions.

You will then choose a positive self-belief that you would rather believe. This belief should integrate a sense of empowerment and control. For example, a belief might be I am able to be safe now or I am worthy of love. You will rank how accurately you feel this positive statement to be true on a scale from 1–7.

Phase 4: Desensitization

The desensitization phase focuses on your targets and all their associated elements. During this time, you may identify other similar events that have happened to you.

 Your therapist will engage in bilateral stimulations while asking you about your main target. At the same time, they will continue assessing your SUD-scale levels (subjective units of disturbance). The goal is resolution—your target should no longer have the power to cause you immense distress.

If you become uncomfortable at any time, your therapist will be there to support you. EMDR is not about pushing through complete discomfort. It’s about moving at a pace that feels comfortable and safe.

Phase 5: Installation

Installation entails strengthening the positive belief you identified to replace your negative belief. After reprocessing your target in the desensitization phase, you may tap into greater awareness and empowerment.

This process can reinforce the positive belief. The main goal is for you to fully accept this positive statement at a level 7 (meaning that it’s entirely true).

Phase 6: Body Scan

After strengthening and installing the positive self-belief, your therapist will ask you to address your original target. They will continue assessing for any remaining tension or negative thoughts.

As mentioned, EMDR sessions are not considered successfully completed until you can discuss your target without experiencing any physical distress. Depending on the trauma severity, this phase may take some time.

Phase 7: Closure

Closure means wrapping up the session and ensuring that you feel safe. Your therapist will support you in achieving a sense of equilibrium before finishing your time together.

Your therapist might also instruct you on techniques you can practice between sessions if you become activated. Practicing these can help strengthen your ability to self-soothe.

Phase 8: Reevaluation

During the reevaluation phase, your therapist will assess the treatment and review your goals and progress. This is the last step of treatment, and it’s a critical one to complete.

Research shows that nearly 1 in 11 people will experience PTSD during their lifetime.³ Like most mental illnesses, this statistic may be underreported. Ongoing stigmas and lack of accessible treatment can make it challenging to obtain accurate data.  

PTSD is a chronic condition that includes a cluster of trauma-related symptoms. These symptoms can vary in severity, but they may include:

• Hyperarousal
• Avoidance of certain places, people, or things
• Depression
• Substance use
• Flashbacks or re-experiencing the traumatic event
• Intense feelings of guilt or worthlessness
• Intrusive thoughts
• Night terrors
• Regressive behaviors (often seen in young children)

PTSD can cause significant impairment in someone’s quality of life. It can affect anyone, and symptoms can be residual for several months or years.

 EMDR can be an excellent resource for clients who have not benefited from traditional therapies. It can also be the first response for clients wanting help processing trauma.

EMDR will help clients understand their targets, practice appropriate relaxation skills, and become desensitized to the traumatic responses. It can support people with single traumas or with a history of complex trauma.

All therapists must have extensive training to provide direct clinical services. First, any practicing clinician must have a qualifying degree in counseling, psychology, nursing, or social work. They must also complete all clinical internship hours and pass all required board exams.

Similarly, EMDR-certified therapists need specialized training and certification. Specific EMDR requirements include passing an approved training and completing a minimum number of EMDR sessions with approved consultation. All therapists must complete continuing education units to remain abreast of current trends and topics.⁴

If you are unsure about a potential candidate’s certifications, ask them. Additionally, you can also inquire how long they have been practicing.

While the treatment tends to be brief, every individual responds to EMDR differently. With that in mind, there is no definitive answer for knowing how long treatment will ultimately take.

Most sessions last 60–90 minutes, and therapists may meet with their clients once or twice per week. Sometimes they will arrange for sessions to occur on consecutive days.

Single-incident traumas may be resolved in just a few sessions, but complex, developmental traumas may require more intensive work. EMDR may also take longer if you have co-occurring issues.

Despite the presenting problem, many clients report noticing significant improvements after as little as 1–3 sessions. Still, it is crucial to remain committed to your entire process. Keep in mind that dropping out of treatment prematurely can prolong healing. In some cases, it can even exacerbate trauma symptoms. If you have concerns about EMDR providing the right results, speak up to your therapist.

Even though EMDR can be highly effective, all therapies pose some inherent risk. It is important to be aware of these inherent limitations before starting your treatment. 

Some common side effects of EMDR include:

• Increased awareness and reexperiencing of traumatic memories
• Feeling lightheaded or dizzy
• Disturbing nightmares
• Recognition of new traumatic material
• Increased cravings to engage in escape behaviors after the session

 Insight can be painful, and it may feel challenging to think about some of these awful experiences. In most cases, the symptoms naturally resolve themselves as treatment progresses. If you have any concerns about reemerging or worsening symptoms, speak to your therapist.