An Overview of EMDR: Eye Movement Desensitization and Reprocessing
Updated: Jul 19, 2022
Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. It is an extensively researched, effective psychotherapy method proven to help people recover from trauma and other distressing life experiences, including PTSD, anxiety, depression, and panic disorders. EMDR therapy does not require talking in detail about the distressing issue. Instead of focusing on changing the emotions, thoughts, or behaviors resulting from the distressing issue, EMDR allows the brain to resume its natural healing process. EMDR therapy allows for healing from psychological trauma much as the body recovers from physical trauma. EMDR clinicians help clients activate client’s natural healing processes and resolve unprocessed traumatic memories in the brain. Many times, in fewer sessions than other types of psychotherapies. Millions of people have been treated successfully over the past 25 years.
Bilateral Stimulation is used during the sessions to enable the healing process to begin. This stimulation is similar to that seen in REM sleep. EMDR therapy is an eight-phase treatment that allows wounds to heal, not just close. EMDR can be used to treat PTSD, Anxiety, Depression, Addictions, Phobias, and other Emotional Problems. It is used with children and adults. EMDR allows the processing of emotional distress trapped in the mind and body. Many notice a change not only in their mental health but the sensations in their bodies as well. All of this is done within a shorter amount of time than traditional talk therapy, so clients are able to get back to the lives they want to live and be stronger in their thought processes along the way.
The number of sessions will depend on the client and their needs. Research shows that EMDR works to treat single-event PTSD in as little as three sessions. Multiple-event trauma, also known as complex trauma, may take a greater number of sessions. Additionally, clients with complex trauma may spend more time developing affect management skills to help them self-soothe when upsetting emotions arise. Clients with Traumatic Brain Injury or Autism Spectrum Disorder may need more sessions. Not only does the number of EMDR sessions differ from traditional talk therapies but the structure of sessions differs as well.
EMDR is a person-centered therapy, meaning that therapists may adapt the process of EMDR when needed to meet unique client needs; otherwise, EMDR typically follows a standard protocol through eight phases. Phase one occurs in the first session where the therapist reviews consent for treatment, describes how EMDR works, and asks questions about the client’s history. Phase two occurs in the second session where the therapist teaches the client how to manage their emotional experience through the use of creating a safe space in their mind that they can always return to, breathing, and grounding techniques. This phase is important because it gives the client agency in the session. If the client becomes upset and wants to stop at any point, they can by using one of the aforementioned skills to calm themselves. The therapist will also ask the client to do one single homework assignment where they will create a list of distressing events that have occurred in their life. The list will help to identify the event to be processed in the next session. Phases three through seven occur in the third session.
Phase three occurs when the therapist and client set up the topic to be worked on in the session. They will go over the client’s list of distressing events and select a target image, which is the most upsetting moment of a distressing event. The therapist will ask the client to describe the image, but they will not ask the client to go into detail about the image. It is helpful if the therapist knows a little bit about what the image is, but it is absolutely not necessary for the client to describe specifics, which is different from traditional talk therapies. In fact, if the client does not want to describe the image at all they can say that they have a “private image” as long as they know what it is. The therapist will ask the client to describe the event and a negative thought that comes up with that image. The client will report their negative cognition (e.g. I am not enough) and also come up with a positive cognition that they would like to think instead (e.g. I am enough). The therapist then asks the client how real the positive thought feels for them in that moment and to describe any emotions that arise. The therapist will also ask about how upsetting the distressing event presently feels. Lastly, the therapist will ask the client if they notice any body sensations and then the process of bilateral stimulation will begin.
Bilateral stimulation begins in phase four. Bilateral stimulation traditionally occurs through rapid eye movement where the therapist asks the client to follow their fingers from side to side. Some therapists may use a light bar which flashes colorful lights back and forth along a horizontal bar. Another option is auditory bilateral stimulation, which occurs through the use of alternating beeps heard through headphones. Tactile bilateral stimulation can also be used by holding vibrating hand paddles that alternate pulsations and/or through alternate tapping on the body. The various methods of bilateral stimulation give the client choice in what they are comfortable using, and all methods are equally effective. The stimulation will occur for a short time and then the therapist will stop the client and ask, “what are you noticing?” The client will describe any thoughts, feelings, images, memories, and/or body sensations that are coming up. The therapist will tell the client to “go with that” thought, feeling, image, memory, and/or body sensation when they re-enter stimulation. During the bilateral stimulation, the client’s brain is doing the self-healing work of processing unprocessed memories of trauma and/or distressing events that have left a negative impact. The process will continue for as long as it needs to until the client feels less distressed about the target image. By the end of the session, clients often notice that the vividness of the imagery of their memory has faded and that the intensity of the emotional distress has softened.
Phase five is where the negative beliefs associated with the event change. The therapist will instruct the client to simultaneously think of the positive cognition (e.g. “I am enough”) and the original target event while doing bilateral stimulation. This process of pairing the positive cognition with the target event through EMDR permanently shifts the client’s belief, which changes how they view themself and the world. Phase six begins when the stimulation ends, and the therapist does a body scan with the client asking them to notice any uncomfortable sensations in their body. If there is an uncomfortable sensation, bilateral stimulation can be used to target the sensation which often results in relief. The session closes with phase seven where the therapist reminds the client of their grounding skills that they can use if they have any uncomfortable feelings come up after the session.
Phase eight occurs in the fourth session when the client comes for follow-up. The client’s distress related to the target image is assessed, and if there is still distress, the EMDR process will continue using that target. If the distress is greatly reduced and/or gone, the therapist and client will come up with a new target to work on and begin the process again, if needed.
Please see emdria.org for more information regarding EMDR therapy
Karissa Trombley is a student intern at Cypress Wellness Center working on her Master’s degree in Clinical Mental Health Counseling at Troy University and is an EMDRIA-approved clinician. She has experience working with diverse clientele and issues with relationships, codependency, 12 Step recovery, depression, anxiety, trauma, inner child healing, and chronic illness management. She is well-versed in cognitive reframing, mindfulness techniques, and helping others overcome shame through self-compassion. Kimberly (Kim) Carew was a student intern at Cypress Wellness Center working on her Master’s degree in Clinical Mental Health Counseling at Troy University. She has years of experience working with families and children from toddler to high school years of various capabilities, ethnicities, and backgrounds. Kim is trained in EMDR and Mindfulness-Based Stress Reduction.