Phases 3 & 4
Answering the “what”, “why” and “how” of each phase of EMDR.
Phase 3: Assessment
What is the purpose of this phase?:
At this point, you and your therapist have already developed a treatment plan and have chosen a target to start reprocessing. You should have also had space to discuss and prepare to manage any concerns or fears with your therapist before starting the reprocessing phases.
When starting a 'new target' your therapist will ask you a series of 7 questions to bring to mind the memory to be reprocessed. When a target is considered 'incomplete' your therapist will use a shorter variation of those 7 original questions to reengage the memory. (New target: A memory that is being reprocessed for the first time) (Incomplete target: Most memories tend to take more than one reprocessing session-in this case it is considered 'incomplete')
Why do we need to go through phase 3?:
In order to begin reprocessing a memory, we must bring the past into focus in the present. The goal here is not to retraumatize you, but instead access the memory safely in the present with your therapist while maintaining dual awareness.
Essentially, we want one foot in the past and one foot in the present.
Phase 3 is always done leading directly into Phase 4. Your therapist wont begin this phase unless there is plenty of time in the session to reprocess as well as contain/ground in the present before the session ends.
How can I expect this phase to look and feel?:
7 questions: Lighting up both the left and right hemispheres preparing the memory to be reprocessed.
Image: What image represents the worst part of the memory?
Negative Cognition (NC): What is the belief that you have about yourself when you think of this image?
Positive Cognition (PC): What would you prefer to belief about yourself?
Validity Of Cognition (VOC): On a scale of 1-7, how true do the words (PC) feel to you now as you think of the memory?
Emotion: What emotion(s) are you noticing right now?
Subjective Units of Disturbance (SUD): On a scale of 0-10, how disturbing does the memory feel to you now?
Body: Where do you notice it in your body? (tension, tightness, discomfort?)
This is a relatively quick phase that leads directly into phase 4...
Phase 4: Desensitization
What does desensitization mean?:
Up to this point the Bilateral Stimulation (BLS) that you have become familiar with is slow and short sets (used in Phase 2). The difference in BLS used in Phase 4 that you will experience is that the sets are both longer and faster.
It's important to have realistic expectations around speed of reprocessing memories. In most cases, it may take more than one session to fully clear out or bring a memory down to a Subjective Unit of Disturbance (SUD) of 0 with a clear Body Scan.
EMDR can’t take a “bad experience” and turn it into a “good experience”. The goal of reprocessing is to help your brain store the traumatic memory in a way where it is no longer hijacking your nervous system (and causing intense reactions) when it is brought to mind.
The goal of reprocessing is to reduce the level of disturbance and reduce symptoms (including behavioral, emotional and somatic)
The reality of reprocessing is that: "Sometimes it gets worse before it gets better". Trust the process and know that in some cases the level of disturbance (SUD) may increase before decreasing.
Why does it work?:
The speed and length of BLS used in Phase 4 mimics what happens in our brains during REM sleep. (If you've ever watched someone's eye lids when they're sleeping you may have noticed their eyes moving left and right- this is exactly what BLS does). The length and speed of BLS is what promotes the reprocessing of the traumatic memory.
Desensitization of a memory helps promote the 'digestion of experience(s)'. New adaptive information that we may not have recognized or acknowledged may come up. A reduction of maladaptive information/thoughts may occur as well. Basically, what happens here is once all the information about an experience is brought to the surface your brain has the opportunity and ability to keep what is helpful and get rid of what is not helpful.
Some common shifts people experience during Phase 4 may include:
Increased compassion for self and others
New insights/awareness
New core beliefs and shedding of old maladaptive beliefs
Continuity/consistency of sessions important at this stage of treatment. Your therapist may even recommend a longer session at this point to help speed up the processing of the traumatic memory.
How can I expect this part of EMDR to feel?:
When EMDR was first developed the bilateral-stimulation that speeds up the reprocessing was done using eye movements. Originally this was your therapist moving their fingers horizontally left and right for you to follow. As time went on other forms of BLS were identified such as tapping (using the butterfly-hug, tapping the tops of your knees, or using buzzers-if working in person). There is audio-bilateral stimulation as well which plays a sound in one ear and then in the opposing ear back and forth- mimicking the same pattern of eye-movements or tapping. (P.S.- Reprocessing is equally as effective both virtually and in person!)
Depending on what works best for you, your therapist may decide to use a combination of bilateral-stimulation such as eye-movements paired with tapping, or tapping paired with audio BLS.
Up to this point, there may have been a blend of talk-therapy happening in your work. During the reprocessing phases you'll notice limited engagement in dialogue between you and your therapist. Your brain knows what it needs to process in order to feel more peace (and we don't want to get in the way of that!)- we are giving it the tools and the space to do the work it can and will do.
Noticing what comes up without judgement is one of the most important factors here. During reprocessing the thoughts, images, insights, sensations may appear unrelated or unimportant- but trust the process and know that you just need to notice right now- and not judge or make sense of what is coming up. What you notice between sets is unique and individual- your brain knows what to do and how to get there so lean back and just trust the process.
Your therapist will be looking out for any additional memories that are unrelated to the memory-network being worked on. If (or when) this happens, containment strategies will be integrated to honor what is coming up- but temporarily set it aside so it doesn't impact the processing occurring at the moment.
You may notice between reprocessing sessions:
Shifts in insight or thoughts
Dreams
Triggers (new or old)
Symptoms (increase or decrease)
Physical sensations
This is why it is important between reprocessing sessions to practice your tools and coping skills acquired through Phase 2. It is helpful to keep a log (such as the TICES log (Trigger, Image, Cognition, Emotion, Sensation) found in The EMDR Therapy Progress Journal by Dana Carretta-Stein) of any shifts/changes experiences between sessions.
If you missed Part 1- EMDR: Breaking Down the 8 Phases of this series - Check it out!
Annabella Lipson is a Mental Health Counselor at Peaceful Living Mental Health Counseling.
She enjoys working with young adults & adults who are dealing with stress, anxiety, grief, trauma, PTSD and other challenges.
Annabella helps clients develop healthy communication skills, learn to tolerate and manage uncomfortable emotions and develop insightful decision-making skills.