EMDR

Eye Movement Desensitization and Reprocessing (EMDR)

Since its beginning in 1987, Eye Movement Desensitization and Reprocessing (EMDR) has been getting a lot of attention from mental health professionals as well as the public.  EMDR utilizes bilateral stimulation, usually by moving eyes back and forth, just like in REM-sleep, in aiding individuals break free from their past and move towards a healthy and productive present and future. Research has proven that EMDR is an effective treatment for Post-Traumatic Stress Disorder (PTSD) and it is utilized by such organizations as the U.S Department of Veteran Affairs. According to Francine Shapiro, the developer of EMDR, this therapy approach aims to:

1. Help clients learn from the negative experiences of their past.
2. Desensitize the client to current triggers that cause distress and cause disruption in daily living.
3. Help the client identify useful behaviors for the future that help the client be successful in anything they wish to pursue.

Ultimately the goal of EMDR is to help the client gain more self-efficacy and feel more in control. EMDR follows a three-pronged EMDR protocol, which means that the targets of therapy are in the past as well as the present while helping the client develop new, more adaptive ways of handling any future issues that may arise. 

EMDR therapy is structured into eight phases. These phases are geared towards identifying maladaptive negative beliefs about the self and the world as well as memories that may have not been stored appropriately and then processing this information in a way that is more adaptive.

Phase One: Client History

In phase one the therapist gathers client history and determines if they are a good fit for EMDR. Therapist asks questions about what brought the client into treatment, their social support, general physical health, and any barriers to engaging in treatment.  It is also important to understand the client’s goals for treatment. It is important to be very open and honest in this first initial phase so the clinician can determine if EMDR is a good fit and if treatment is likely to be successful.

Phase Two and Three: Preparation and Assessment 

Phases two and three are devoted to preparing the client for processing old trauma memories. The most important thing that happens in phase two is creating something called the therapeutic alliance. This means mutual trust and a feeling of comfort between the client and the therapist. In phase two the therapist also explains to the client the reasoning behind EMDR (See FAQ at the end of the post) and tests the eye movement or other bilateral stimulation to make sure it isn’t uncomfortable for the client. Phase two also involves creating a safe/calm place for the client that is available for the client anytime they need it, during session or outside of session.

Phase three starts when the client and therapist feel that processing old trauma memories is safe. This is when the client identifies a picture that comes up when thinking about the traumatic event. Clients also identify a negative belief that they have about themselves because of the image as well as a positive image of what they would like to believe. It is also important to identify an emotion and bodily sensations that goes along with the traumatic image. After these have been identified, the actual memory processing can begin in phase three.

Phases Four to Seven: Desensitization, Installation, Body Scan, and Closure

Phases four to seven is where the processing of information takes place. During the processing, it is important to remember that the client is in control, and it is the client’s brain that is doing the healing. The client is invited to let anything that happens, happen while the client observes, sort of like being a passenger on a train and looking out the window watching the scenes change. Any information that comes up is treated as important and somehow connected to the original traumatic memory. As the processing occurs, usually the emotional response to the traumatic image gets less and less intense. The negative thoughts and beliefs about self are replaced by positive thoughts and beliefs as the processing continues. Phases four to seven can occur during one session or continue over several sessions. It is important to end each processing session with a visualization exercise, such as the safe/calm place described earlier. It is important to record any new memories, thoughts, emotions, or dreams related to the traumatic memory in order to use them for processing during the next session.

Frequently Asked Questions about EMDR

Who is a good candidate for EMDR? Who would you not recommend EMDR for?

Anyone who has experienced a traumatic event that they feel is causing them significant distress and disruption in daily life currently. The client should have no medical or neurological conditions that might prevent strong emotional states and memory reprocessing. Epilepsy or any pain in the eyes are also causes to reconsider EMDR.  The client should have some social support outside of therapy so they can reach out for help in case of any distress in between sessions.

It is not recommended that anyone with a current addiction attend EMDR. Any person with a history of substance abuse should get involved in a 12-step program or an equivalent before starting EMDR. Both therapist and client should be able to commit to treatment and not have any upcoming trips that would disrupt the treatment process. Lastly, anyone with a Dissociative Identity Disorder (DID) is discouraged from trying EMDR unless the therapist is specifically trained in dissociative disorders and has a supervisor who is also knowledgeable in the disorder.

What is the theory behind EMDR?

When a traumatic event happens, it often seems to get locked in the brain with the original picture, sounds, thoughts, feelings, and everything else that was happening at the time of the trauma. Because all these things are locked in the brain, every time a similar situation, sound, or a thought can touch on the trauma, the individual gets triggered, as if the original trauma was happening all over again. However, the individual themselves may not understand why they are re-experiencing the trauma or experiencing discomfort that seems to come out of nowhere. This understandably causes feelings of helplessness, fear, anxiety, and feeling out of control.

The eye movements in EMDR seem to unlock the parts of the brain that store the trauma reminders, allowing the memories to be processed and stored properly so that they no longer trigger the same emotional response. The processing that occurs during eye movements in EMDR is like the processing that happens during rapid eye movement (REM) sleep. 

What makes EMDR different from other trauma treatments?

EMDR does not require that the client discuss the traumatic events in detail, which can be a relief for many clients who wish not to verbalize what happened to them. EMDR also does not assign any time-consuming homework in between sessions, although new information or memories might continue to come up in between sessions. EMDR is designed to help the brain resume its natural healing process and help the brain resolve traumatic memories in the brain that have not been processed appropriately. EMDR can also be completed in fewer sessions than many other psychotherapies.

How long does EMDR take?

EMDR sessions are 60-90 minutes long. Each client is unique and therefore it is difficult to give an estimated number of sessions that are needed. Processing one traumatic memory can take several sessions, or it can be resolved in a single session. Going through treatment is not the goal of EMDR and the therapist will take care to continuously assess each client’s needs to determine length of therapy.

Eeva Edds, MA LPC is a trauma-informed therapist who specializes in helping trauma survivors recover from their past and move forward towards a value-driven life. Eeva is trained in Prolonged Exposure Therapy (PET) and Eye Movement Desensitization and Reprocessing (EMDR) and utilizes both modalities with success to help her clients.

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