EMDR

The eight phases of the EMDR treatment protocol are:

1. History taking: In this phase, the therapist is gathering information about your history (at a pace that you can tolerate), how you cope with difficulties, your current symptoms, etc. All of these factors inform the best way to facilitate EMDR for you.

2. Preparation: EMDR treatment includes learning some helpful tools for managing emotional overwhelm and for grounding and soothing your nervous system. In preparation, your therapist is helping you learn and practice these skills, which can increase your confidence in your ability to face and cope with painful past experiences.

3. Assessment: This is typically a short phase taking only a few minutes, in which you and your therapist choose a memory to work on and the therapist will ask you some specific questions designed to help your brain pull the memory from long term storage and “activate” it so so that it can be worked on in your working memory. For example, the therapist might ask you if there is an image, emotions, or body sensations associated with the memory. Your therapist will also assist you in identifying how the experience contributed to negative beliefs about yourself and help you start thinking about a healthier way you would like to think about yourself in the future.

4. Desensitization: This is the phase EMDR clients tend to talk about the most when sharing their experiences with others. You may have heard Miley Cyrus or Prince Harry talking about their desensitization phase experiences with EMDR. During desensitization, the therapist will begin by instructing you to focus on the chosen memory or a part of the memory and will you will perform bilateral stimulation at the same time you are thinking about the memory. After about 30 seconds of thinking about the memory while performing the bilateral stimulation, your therapist will check in with you about what you noticed. You will make a brief report about what came up for you during that 30 seconds, and then the therapist will tell you what to do  next. Don’t worry about doing this wrong…in EMDR, we trust that the brain knows how to heal itself and where to go. Your therapist is trained in what steps to take next depending on what your brain is doing at any given time.

5. Installation: Remember how I mentioned above that EMDR works with both the negative beliefs associated with trauma and also strives to develop healthier thoughts about yourself? Installation is the phase in which we work on strengthening a more positive or empowering self-belief.

6. Body Scan: Trauma can get stuck in the body, causing uncomfortable or unusual tension, tightness, or even pain. EMDR can help your body and nervous system to release some of those stuck physical sensations that might be related to the trauma you’re working on.

7. Closure: Closure happens at the end of every EMDR session and is often a brief check-in with your therapist to review how the session went for you and for the therapist to assist you in connecting with calmer and more grounded feelings before you go about the rest of your day.

8. Reevaluation: Processing a single memory with EMDR can take more than one therapy session. When you leave a memory unfinished at the end of a session, your therapist will “reevaluate” progress on the memory at the beginning of the next session. This usually only takes a few minutes and you’re ready to pick up where you left off!

YES! You may have heard that there are some diagnoses that disqualify a person from undergoing EMDR treatment, such as DID (Dissociative Identity Disorder). There are some phases of EMDR that would be re-traumatizing for some people to jump right into without any preparation. However, we must not forget that phase 2 of EMDR, preparation, involves many very gentle practices for soothing the nervous system and regulating emotions. Even if an individual does not go beyond practicing exercises and learning the principles from the preparation phase, they are still participating in EMDR! Having a dissociative disorder does not disqualify someone from participating in EMDR, it may just mean there’s some groundwork to be laid before moving into the later phases of EMDR. Your therapist can educate you about dissociative disorders and will screen for dissociation to help determine how to prepare you for EMDR.

No! You cannot do EMDR wrong. At first, it might be challenging to follow your therapist’s cues and perform bilateral stimulation while thinking of a memory at the same time. That’s ok. It’s supposed to be tough to think about your target memory while also doing bilateral stimulation. It’s ok if your mind wanders, or seems to get stuck on something, or you can only think about the bilateral stimulation, or you can’t think of anything at all. When your therapist asks you what you’re noticing, just tell them what’s happening and they will know what to do next.

Usually, when we sign up for something like EMDR, we may have the expectation that we are only going to get better instead of worse. In EMDR, your therapist will ask you to “rate” your distress from time-to-time. You might find yourself feeling frustrated if you started the session rating yourself at a 5 and somewhere during the session you’re now at a 7, 8, or 9. You may even feel embarrassed to tell your therapist that you are feeling MORE distressed instead of less. You may not want to disappoint your therapist. It’s ok. You can’t disappoint us and we won’t be disappointed in you. We want to know how you are actually doing, not how you think you should be performing. EMDR therapists understand that your distress may go up before it goes down. We understand that healing isn’t always a straight line up from “suffering” to “wellness.” With EMDR, there may be moments of significant distress, but those moments usually pass quickly as your brain wants to move through the distress and toward healing.

If you first heard about EMDR in the media, you may have heard about it being used for significant traumatic events like military combat trauma, car accidents, and other “big” traumas. You may not know that EMDR can also help us work through other experiences that we aren’t sure “count” as trauma, but are nonetheless causing us distress and are seemingly impossible to let go of. We can use EMDR to work with troubling memories ranging from that time you froze while delivering your lines in the fourth grade school play, to painful breakups, all the way to those obviously “big” traumatic events.

There are aspects of EMDR that are safe to practice on your own, but an EMDR-trained therapist should  instruct you on those aspects. For example, there are some EMDR preparation exercises your EMDR therapist will teach you and then ask you to practice at home. You should not try to practice the entire EMDR protocol on yourself. You could over-activate your trauma and find yourself feeling a lot worse and without an experienced therapist to help you contain that traumatic material.

It depends. Some issues and some single-incident traumas may be resolved relatively quickly with EMDR within a few sessions. Individuals with complex histories may require many sessions of Phase 2 preparation followed by many sessions working through EMDR phases 3-8 with several different traumatic experiences from their history. Your therapist will collaborate with you to make a plan for the issues you want to address.

EMDRIA (Eye Movement Desensitization and Reprocessing International Association) is the organization that sets the standards for EMDR practice and training; certifies providers, trainers, and consultants; and provides high quality reference materials for both EMDR professionals and clients. Without an organization to oversee a modality like EMDR, techniques like EMDR can stray a long way from the original intent and standardized practice; kind of like playing a game of “telephone.” Once that happens, there is no longer any standardization of the technique so clients never know what to expect when they seek out treatment or if it will be practiced in a safe and effective way. Without the standardizing influence of EMDRIA, EMDR would be difficult to research and we wouldn’t know if EMDR was effective or not. In large part due to EMDRIA, EMDR is a standardized treatment that has been researched extensively and shown to be effective for the treatment of PTSD and single incident trauma and has also shown promise in treating various other mental health concerns.

EMDRIA, the governing body for EMDR, sets standards for and provides certification of EMDR practitioners, trainers, and consultants. There are many amazing EMDR providers who have not pursued certification or who were once certified and then decided to allow their certification to lapse. EMDRIA certification is not a requirement to be a fully competent and gifted EMDR therapist. However, I decided to pursue certification to provide an extra level of reassurance that I have completed not only basic EMDR training, but additional training and consultation to a rigorous degree in order to provide effective treatment. Certification also means I continue to keep my EMDR skills updated by fulfilling EMDRIA’s continuing education requirements every two years.