EMDR (Eye Movement Desensitization and Reprocessing) was originally developed as a treatment for Post-Traumatic Stress Disorder. It has since branched out to treat a variety of applications including: phobias, test anxiety, dermatological disorders and pain management. It is based on the concept that certain eye movements reduce the intensity of negative emotions such as in trauma.
The goal of EMDR is to facilitate accelerated information processing. It is based on the assumption that we all have a natural ability to heal. The aim is to leave a client with the emotions, understanding and perspectives that will lead to healthy and useful behaviors and interactions. ”Processing” an experience doesn’t mean talking about it. It means to make sense of it and no longer be disturbed by it.
It is a highly structured treatment with eight phases, explained below. All phases contribute to the effect although not all eight are used in each session. Each session lasts 60-90 minutes and it can take one or several sessions or much longer, depending on the client, to process one traumatic experience.
Phase 1: History and Treatment Planning
This takes 1-2 sessions and may be revisited later especially if new issues are presented. Your therapist takes a thorough history to identify the specific trauma affecting you, its intensity and potential triggers. They will discuss the behaviors and symptoms stemming from the problem.
Your therapist will then map out treatment goals and a prioritized sequential path for processing. This plan consists of three elements:
- The event from the past that created the problem
- The present situations that cause distress
- The key skills or behaviors the clients need to learn for the future
One of the features of EMDR is that the client doesn’t need to discuss any of their disturbing memories in detail.
Phase 2: Preparation
This takes 2-4 sessions for most clients. One of the primary goals is to establish trust with the therapist. Your therapist teaches some relaxation techniques the client can rapidly use if they feel uncomfortable. Your therapist explains the theory behind EMDR. how it’s done and what the client can expect during and after.
Phase 3: Assessment
You are prompted to select a target event in a controlled and standardized way. You then select an image or mental picture from the target event that best represents the memory.
You then choose a negative statement associated with the event such as “I am worthless”. You then pick a positive statement you would rather believe such as “I am safe now”. Your therapist asks you to represent how true that positive statement feels on a scale of 1-7, This is the Validity of Cognition (VOC) scale.
You also identify negative beliefs on a scale of 0 to 10. This is the Subjective Units of Disturbance (SUDS) scale. The goal of treatment is for SUDS scores to decrease while VOC scores increase. For a single trauma reprocessing should occur within three sessions.
Phase 4: Desensitization
The focus here is on your disturbing emotions and sensations as measured by the SUDS rating. You focus on an image that evokes a negative reaction while simultaneously making eye movements, sounds or taps using bilateral stimulation.
This is done in sets of about 25 seconds each. After each set you are instructed to take a deep breath and provide feedback. Depending on the intensity of your response, your therapist may adjust the length, speed and type of stimulation. Yourtherapist does this until the SUDS score is 0.
Phase 5: Installation
The goal is to strengthen your identified positive belief to replace your negative belief. The positive belief e.g. “I am now in control” will be strengthened and installed. The VOC scale is used to measure how deeply you believe your positive cognition. The goal is to measure a 7 on that scale. The process continues until your feelings of distress reduce and you feel more positive after each set.
Phase 6: Body Scan
After the positive cognition has been strengthened and installed, your therapist will ask you to bring the original target event to mind and see if there is any original tension left in the body. You then do a full body scan from head to toe. Negative sensations take the form of a somatic response such as raised pulse, raised blood pressure or muscle tension.
A core EMDR premise is that there is a physical response to unresolved thoughts. Traumatic events are stored in body memory, not narrative memory. When that event is processed, it can then move to narrative memory and the body sensations and negative feelings disappear.
If you are still experiencing negative emotions related to the set, your therapist will continue with sessions of bilateral eye movement. An EMDR session is not considered complete until the client can bring up the original target negative experience without feeling any body tension.
Phase 7: Closure
This ends every session. It ensures you leave the session feeling better than at the beginning. Your therapist briefs you on what is to be expected between sessions as some processing may continue and some new material may arise. Your therapist also guides you on how to use the journal and on self-calming relaxation techniques should the need arise.
Phase 8: Reevaluation
This opens every session It guides the therapist through the treatment plans needed to help you.
EMDR therapy is not complete until attention has been brought to the past memories contributing to the problem, the disturbing present situation and what skills the client may need for the future.
Sources
Experiencing EMDR Therapy
Exploring the 8 Phases of EMDR. 2023. American Psychological Association.
