"So, when are we going to start doing EMDR?"
I think I can speak for most EMDR therapists when I say: We get this question all the time.
The beauty in this question is that it speaks to the eagerness of clients. It says: “I am ready to work through this trauma that has kept me stuck for so long!”
The response I lend to clients is this: “We’ve been doing EMDR from the moment you walked into the office.” I usually receive a confused look, or a follow up question of: “Ok, when are the eye movements going to start though?”.
It’s helpful to understand what to expect when starting EMDR, and how it's not just about eye movements.
EMDR is an 8-phase process: This doesn’t mean that it takes 8 sessions only-this means that there are 8 stages in the treatment model.
Bilateral stimulation (BLS) or "eye-movements" are typically associated with (but not limited to) the desensitization phase: Phase 4.
Those who have experienced multiple trauma’s throughout their life (also known as Complex PTSD or C-PTSD) may need to spend more time in the history taking and preparation phases (Phases 1 & 2) before reprocessing traumatic event(s).
Let’s get a basic understanding of what each phase represents:
Phase 1: History Taking and Treatment Planning
This part of the EMDR process may feel similar to previous therapy sessions you have been in. In this phase we want to foster a comfortable relationship between the client and therapist. Your therapist will ask questions related to your history, present day symptoms, relationships with others, current resources/coping mechanisms, triggers, etc. Your therapist will collaboratively develop a treatment plan to help facilitate your goals.
Phase 2: Preparation
This phase is dedicated to resourcing, in other words: developing and strengthening coping skills. Trauma work can become intense and distressing, this is why we don't just dive right in.
I often use the analogy of getting on a roller coaster for this one: When you go to get on a rollercoaster, you sit in the seat, and the first thing you is buckle in. The rides mechanic comes over to each seat, checking and ensuring that each rider’s buckle and harness are tightly secured. They wouldn’t start the ride without checking - safety is essential!
Now, think of Phase 2 as the “buckling in” part of the process. We want to make sure that before we start the intense work of revisiting and reprocessing the trauma that you have the skills to regulate and ground yourself should it become overwhelming or dysregulating. You'll develop containment strategies to store any distressing material after and between sessions.
Your therapist may begin introducing BLS or eye movements during this phase with the intention of strengthening your ability to access these resources when you need them.
Phase 3: Assessment
This is where the reprocessing begins. During this phase your therapist will ask a series of questions to help you bring to mind the target memory including: the image, negative belief associated with the memory, body sensations, emotions, and level of disturbance that the memory feels in the present moment. These questions help activate the memory network to bring us into the next phase.
Phase 4: Desensitization
This phase is the one most people refer to when they think of EMDR. This is when the therapist begins to guide the client using eye movements or other forms of BLS (such as tapping, or auditory tones) as the client thinks about the traumatic event. During this phase, the goal is to reduce the level of disturbance as well as welcome more adaptive information (in the form of new thoughts, images, feelings, and sensations). It may take more than one session to fully reprocess a traumatic memory (it usually does). The reprocessing doesn't stop at the end of session. You may begin to notice shifts in thoughts, emotions, behaviors, dreams, etc. It's encouraged to keep a log between sessions to track any noticeable shifts to share with your therapist.
Phase 5: Installation
During this phase, the goal is to strengthen the positive belief the client prefers to associate with the memory until it feels completely true (or as true as possible). EMDR can't change a "bad" experience into a "good" one- but it can help shift the way we view and see ourselves more positively in relation to the memory.
Phase 6: Body Scan
Memories are not only stored cognitively-memories are stored on a somatic level as well. After Phases 4 and 5, when a memory is reportedly at a level of zero disturbance, and the positive belief we assign to the memory feels completely true, our body may tell a different story. Should any discomfort in the body be recognized, your therapist will help facilitate the reprocessing and clearing out of what is still stuck.
Phase 7: Closure
Every EMDR session should end with Phase 7. When reprocessing, we are essentially creating dual awareness-keeping one foot in the past and one foot in the present. The purpose of phase 7 is to ground in the present moment and regain a sense of calmness. Using the tools and skills acquired during Phase 2, your therapist will assist in containing any distressing material that came up during session as well as create a feeling of safety and comfort in the present moment.
Phase 8: Reevaluation
Each session will start with Phase 8. Your therapist will check in on the memory being processed- assessing the level of distress/disturbance, measuring the strength of the positive cognition, as well as checking for any residual physical sensations.
Once a target is complete, you and your therapist will evaluate for future targets and other treatment goals.
EMDR is not a race.
Each phase of EMDR holds great purpose- rushing through may cause blocking or looping which will keep you stuck in the reprocessing phases.
You may need more time with your therapist simply to create a comfortable and trusting setting.
You may find that you need time to develop new adaptive coping skills before working with the traumatic experience.
You may want to learn more about what to expect, and to unpack any concerns related to working on your trauma.
You may need to practice widening your window of tolerance or managing dissociative experiences.
Whatever it is, your therapist is on the ride along side to guide you appropriately.
Everyone has a different pace and that's okay! Trust the process, and you'll get there!
So remember, even if your not doing eye movements- you're still doing EMDR!
Annabella Lipson is a Mental Health Counselor.
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.
Want to know more about EMDR Therapy or start tracking your own progress?
Buy your copy of The EMDR Therapy Progress Journal today (written by our own Dana Carretta-Stein) and make more effective progress toward your goals with EMDR Therapy!