EMDR: The Inside Scoop
Have you ever wondered what actually happens during an EMDR session? Like you kind of know, but it still seems like a total unknown? Many of my clients come in feeling pretty unsure of what the process truly entails, so I thought I would let you in on the inside scoop!
EMDR is a fairly new type of psychotherapy, and one that can often seem strange and mysterious to those just learning of it through books like “The Body Keeps the Score” or through the positive stories of former EMDR’ers who experienced the many benefits of EMDR. Many of my clients come to their first session not knowing exactly what to expect, other than that I may end up waving my hands in front of their face (which may happen, but isn’t the full story). Let’s break down what actually happens in EMDR for those that are curious and wanting to learn more.
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. This standard protocol is the foundation for all EMDR, and it is the protocol that has been used in the 20 plus randomized controlled trial studies that found EMDR to be an effective and evidence-based therapy. Francine Shapiro, the theorist and creator of EMDR, designed this protocol to be structured so that it could be replicable for research purposes and so that many therapists could learn and use EMDR in a reliable manner. It is important to note that this standard protocol is exactly that, standard. The thing is people are not standard. People are unique and nuanced and may not always fit into a standard way of healing. Some therapists (including myself) adapt the standard protocol to meet the unique needs of their clients, therefore the EMDR process may vary and may not always follow this structure to the tee. When a therapist adapts the protocol they use research, theory, and clinical intuition to inform their adaptations, while always using the standard protocol as the foundation of EMDR therapy. Keep in mind that the following 8 phase structure can and will likely be adapted by your EMDR therapist; however, the standard protocol includes the important components of EMDR you can expect to encounter during EMDR therapy.
THE 8 PHASES of EMDR
Phase 1: the therapist reviews consent for treatment, describes how EMDR works, and asks questions about the client’s history.
Phase 2: the therapist teaches the client how to regulate their emotional experience through the use of visualization, breathing, and grounding techniques. This phase is important because it gives the client agency in the session. If processing becomes too emotionally overwhelming, the client can can use one of the aforementioned skills to shift to a more calm emotional state. The therapist will also ask the client to create a list of distressing events that have occurred in their life. The list will help to identify the memory to be processed in the next session.
Phase 3: 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 memory to be reprocessed. The therapist will ask the client to describe the memory, but they will not ask the client to go into detail about the memory unless they want to. It is helpful if the therapist knows a little bit about what the image of the memory is, but it is absolutely not necessary for the client to describe specifics, which is different from traditional talk therapies. 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 belief (e.g. I am not enough) and also come up with a positive belief 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.
Phase 4: bilateral stimulation traditionally occurs through rapid eye movement where the therapist asks the client to follow their fingers with their eyes 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 therapist will instruct the client to hold the memory image in their mind’s eye along with the negative belief while stimulation begins. 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 5: 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 6: begins when the stimulation ends, and the therapist does a body scan with the client asking them to notice any sensations in their body. If there is an uncomfortable sensation, bilateral stimulation can be used to target the sensation which often results in relief.
Phase 7: 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 8: occurs when the client comes back 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.
The phases then repeat for as many memories that need to be processed.
