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  • Writer's pictureJessica Miller

Navigating EMDR Therapy: What to Expect During Treatment

Updated: May 17

Trauma can leave deep emotional wounds that affect every aspect of a person's life. Fortunately, there are various therapeutic approaches aimed at addressing trauma and its consequences, and one such approach is Eye Movement Desensitization and Reprocessing (EMDR) therapy. Keep reading to learn more about the intricacies of EMDR therapy, how it’s used in session, and how it could help you to address trauma and related symptoms.

What is EMDR Therapy?

EMDR therapy is a structured psychotherapy approach developed by Francine Shapiro in the late 1980s. It's based on the idea that traumatic experiences can become "stuck" in the brain, leading to dysfunctional symptoms such as flashbacks, nightmares, anxiety, and depression. Essentially, the brain files the traumatic memory in the wrong filing cabinet – keeping it in the “Urgent! Crisis!” folder, when it should be in the “Past Events” folder. 

EMDR aims to help individuals process these experiences and alleviate their associated symptoms, allowing for healing and emotional resolution. This means the brain will file the memory away without the intensity of the trauma, so a person will be able to think of the event as just “something that happened in the past”, without the emotional activation and pain.

EMDR therapy can be beneficial for individuals of all ages who have experienced trauma, whether it be a single distressing event or prolonged exposure to adverse circumstances. It has been known to help a wide range of things, including PTSD, anxiety, depression, OCD, and phobias. Regardless of the nature or severity of the trauma, EMDR offers a structured and evidence-based approach to help individuals heal. EMDR therapy has the potential to expedite the processing of traumatic memories for certain individuals, in contrast to traditional talk therapy, which may require a longer duration to achieve similar results.

The Eight Phases of EMDR Treatment

EMDR follows a distinct set of phases to help process memories. They serve to ensure that all parts of a dysfunctional memory/memories are addressed.. 

  1. History-taking and Treatment Planning: The therapist gathers information about the client's history, trauma experiences, and current symptoms. Together, they develop a treatment plan tailored to the client's specific needs and goals. This typically takes 1-2 sessions. Note that EMDR is special in that a client does not necessarily need to share specific details with the therapist. 

  2. Preparation: This is the most important part of EMDR because it makes sure that you have the resources or coping skills to be able to manage distressing emotions that may arise during EMDR and after sessions. Establishing a sense of safety and trust is crucial before proceeding further. This will typically take 1-4 sessions and also includes education about what happens during EMDR so a client knows what to expect.

  3. Assessment: The therapist identifies target memories or experiences that will be the focus of the EMDR treatment. These targets are typically specific events that contribute to the client's trauma symptoms. The therapist will help you choose an image that represents the problem, how it leaves you negatively feeling (negative cognition), how you’d like to view yourself instead (positive cognition), and any emotions and sensations in your body. You will also be asked to rate on a scale your cognitions, which helps the therapist gauge a decrease in the disturbance (Subjective Units of Distress) and an increase in positive beliefs (Validity Of Cognition).

  4. Desensitization: This phase involves reprocessing (refiling) the target memories using bilateral stimulation, which can include eye movements, hand tapping, in-hand buzzers, or auditory cues. The client recalls the traumatic memory while simultaneously focusing on the bilateral stimulation, allowing the brain to process the memory in a less distressing way. The aim is to reduce emotional intensity and distress associated with the traumatic memory by facilitating the memory to appropriately get stored into the client's overall memory network.  While talk therapy involves a discussion about difficult memories, EMDR does not. Therapists will ask clients to notice what happened during desensitization, but are less likely to go into an in-depth conversation. This is because they want to keep the client within the feelings of the target memory, so they can be processed appropriately. 

  5. Installation: Positive beliefs are reinforced to replace negative beliefs associated with the traumatic memory. The client is guided to integrate a sense of safety, empowerment, and self-worth related to the targeted experience. Clients are also taught additional skills if needed to support positive belief.

  6. Body Scan: The therapist helps the client notice any remaining physical tension or discomfort associated with the targeted memory and facilitates its release through bilateral stimulation.

  7. Closure: The session is closed in a way that ensures the client feels grounded and stable before leaving. Coping strategies are reinforced to help manage any lingering distress between sessions. The client is informed of what to expect between sessions and encouraged to note what happens for them. 

  8. Reevaluation: In following sessions, the therapist and client revisit the targeted memories to assess progress and determine if additional processing is needed. New targets may also be identified as the therapy progresses.

Typical Session Structure

A typical EMDR therapy session lasts about 60-90 minutes and follows a structured format:

  1. Check-in: The therapist and client briefly discuss any changes or updates since the last session and identify any specific issues to address during the session. This could include how the client utilized coping skills.

  2. Preparation: The therapist provides a recap of the EMDR process and reminds the client of resources they can use during the session to manage distress, if needed.

  3. Targeting: The therapist and client revisit the prior memory they were working on. If it was resolved they will select a new memory to target during the session.

  4. Processing: The client focuses on the targeted memory while engaging in bilateral stimulation, allowing the brain to reprocess the memory and associated emotions. The therapist provides support throughout the sessions. Note that there may be less talking from both client and therapist to encourage the processing of the memory. 

  5. Closure: The therapist helps the client return to a state of calm and provides grounding techniques to ensure they feel stable before ending the session.

  6. Homework: The client may be given exercises or tasks to complete between sessions to reinforce learning and coping skills. Clients will be encouraged to use resources and grounding techniques to help with residual difficult emotions from session.

Therapeutic Techniques Used in EMDR Therapy

  • Bilateral Stimulation: This technique involves rhythmic left-right stimulation of the brain, which can include eye movements, hand tapping, in-hand buzzers, or auditory tones. Bilateral stimulation is thought to facilitate the processing of traumatic memories and promote emotional healing through filing memories in appropriate ways.

  • Resource Development and Installation: Positive memories, strengths, and resources are identified and used to increase a client's sense of resilience and self-efficacy.

  • Cognitive Restructuring: Negative beliefs and self-talk related to the trauma are identified and replaced with more adaptive beliefs and coping strategies.

  • Grounding Techniques: These techniques help clients stay connected to the present moment and manage distressing emotions by focusing on sensory experiences or physical sensations. 

  • Interweaves: When processing becomes stuck or difficult, the therapist may use various interventions to help the client navigate through the process, such as asking questions, providing reassurance, or offering alternative perspectives. 

EMDR therapy offers a structured and evidence-based approach to healing trauma and related symptoms. By guiding clients through the eight phases of treatment, employing bilateral stimulation, and utilizing grounding techniques, EMDR therapists facilitate the processing and resolution of traumatic memories, leading to improved emotional well-being and quality of life for those who have experienced trauma. If lingering effects of a traumatic experience are impacting you, and talk therapy may not be working, consider reaching out to an EMDR trained or certified therapist. 

TBH Therapy is proud to share that all of our clinicians are EMDR trained.  If you are interested in learning more, or think that EMDR may be a useful form of treatment for something you’ve been carrying around from your past for too long, please reach out today!

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