A four-part series answering the "What", "Why", and "How" of each phase of EMDR.
[Part One: Phases 1 & 2]
First of all... What is EMDR?
EMDR stands for Eye Movement Desensitization and Reprocessing. The EMDR Institute defines this as: "a psychotherapy that enables people to heal from the symptoms and emotional distress that are a result of disturbing life experiences".
EMDR attends to three important time periods including: past, present and future. Using an 8-phase approach, each time period is addressed as it relates to the issue you are looking to work on in treatment.
EMDR Phase 1: History Taking and Treatment Planning
What is Phase 1 of EMDR?
During the History Taking and Treatment Planning phase you and your therapist are starting to get to know each other. Without trust, safety and connection, you most likely won't be able to get to the deeper stuff- which is where we are aiming to go with EMDR.
Together, you and your therapist are working on identifying themes (also referred to as "Negative Cognitions" or "Negative Beliefs"). Using the AIP Model (Adaptive Information Processing), you will explore past, present and future triggers relating to the issue you are working on. This is where we begin to develop a target-sequence plan.
Why is Phase 1 of EMDR important?
Often people come into therapy thinking: "This is the issue I want to work on". During Phase 1, it is common to find that the original 'issue' isn't always the only one. You may uncover additional areas of intended growth.
Collaboratively, you and your therapist will come up with a treatment plan to target each 'issue' or 'trigger' appropriately and most effectively.
How can I expect Phase 1 of EMDR to look/feel?
History taking doesn't mean that you have to tell your therapist the nitty-gritty details of your traumatic experience- actually it's typically best that you don't.
Slow is fast. You may feel an urge to pass through this phase rather quickly. It's important to slow down and take your time here. In doing so you will find ways to anticipate and create plans to manage any blocking or looping that may happen in the reprocessing phases. In turn, this will actually make the EMDR process go faster and reduce the likelihood of stalling.
An analogy for Phase 1 of EMDR is this:
If you planned to drive across country from NY to CA there are many different routes you could take... Before you get behind the wheel and start driving, you need to come up with a plan. Which roads are we taking? What do we need to bring or have with us? Where can we take breaks? Without that guide-you might get lost, you might get stuck, or it might just take a lot longer to get there. Your treatment plan is like your road map, you know pretty much what to expect along the way and you should feel safe, confident and prepared.
EMDR Phase 2: Preparation
What is Phase 2 of EMDR all about?
Phase 2 is often referred to as "Resourcing". In other words, this is where you and your therapist identify what you need in order to feel safe enough to move into the reprocessing phases.
This will include some psychoeducation. Part of trusting what is such a vulnerable and tender process that we call EMDR, requires understanding of what trauma is-how it affects us, as well as knowing what to expect during your course of treatment. Some common things that your therapist may cover during Phase 2 is understanding what your Window of Tolerance is, how your Autonomic Nervous System (ANS) has been impacted by the trauma you experienced, Co-regulating and Self-regulating skills, and much more.
Why do we need Phase 2 of EMDR?
For those with CPTSD (Complex Post Traumatic Stress Disorder) it may be too triggering to start with your history. In this case, your therapist may switch the order of the first two phases and start with preparation and resourcing before taking any history or developing a target sequence plan.
Your therapist will assess during Phase 1, what current coping tools/skills you have that have helped you manage your symptoms?
What tools or skills don't you have at this time that may be helpful to acquire and practice before reprocessing your target(s)?
How can I expect Phase 2 of EMDR to look/feel?:
"The problem is not the problem-it's a solution". Yes, this may sound radical- but it is true. Coping skills are coping skills- some may be considered "adaptive", while others appear "maladaptive". [For example, dissociation is a powerful tool that protected you from experiencing pain at the time of the traumatic event. Long-term dissociation may impact your ability to function or tolerate being present. This once adaptive coping tool may have become maladaptive over time, and may need to be replaced with something more functional.]
By identifying and exploring 'problematic symptoms' you and your therapist can find a window into the question: "What is it that my nervous system needs to handle this?". Exploring your symptoms from a frame of curiosity versus judgement will allow space for self compassion. In turn will promote the replacement of these maladaptive behaviors with more adaptive behaviors for coping.
Some common resources used include: Calm-State/Place, Container, Attachment-Figures, Nurturing-Figures, Protective-Figures, and so much more.
Depending on your unique needs you and your therapist will work together to identify and strengthen the specific resources that will be most helpful for you.
Your therapist may integrate other trauma-informed practices during Phase 2. Some commonly integrated practices may include (but are not limited to): Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Mindfulness, Polyvagal Exercises, Ego-state or IFS parts-work.
To build on the analogy previously used...
Phase 2 is like getting ready to get in the car for that cross-country road trip. We wouldn't start driving the car until our seat-belts are safely fastened, and everything that we need is packed in the car with us (our treatment plan and resources). Once we have all those components, THEN we can start driving (or moving into the reprocessing phases of EMDR.)
Annabella Lipson is a Mental Health Counselor at Peaceful Living Mental Health Counseling in Scarsdale, NY.
She enjoys working with young adults & adults who are dealing with stress, anxiety, grief, PTSD and other challenges.
Annabella incorporates a combination of Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), EMDR Therapy, Ego-state Interventions and Mindfulness practices with her clients
Are you curious about learning more about EMDR therapy and understanding how a treatment plan can get you on a path of healing your trauma?
Our own practice owner, Dana Carretta-Stein, authored The EMDR Therapy Progress Journal geared toward the client's perspective and to guide you to reach your goals with your therapist.
Available in E-Book, Paperback and Hardcover