If You’re Doing EMDR With Your Therapist, You Need to Read This
Having informed consent into your treatment is a crucial part of the therapy process. That’s why I wrote this article for clients who are engaged in Eye Movement Desensitization and Reprocessing (EMDR) therapy with me or any other clinician practicing EMDR.
Sometimes it’s difficult to provide psychoeducation to clients about what EMDR is and how it works in sessions, as describing EMDR could take up the whole therapy hour. I often send clients to the EMDR International Association website (EMDRIA), however I find that there’s too much information listed on the website, which can feel overwhelming.
In this article I’ll be describing in plain language what EMDR is and the 8 phases of EMDR therapy so that you know exactly what the treatment looks like and how EMDR can help you reach your goals.
Let’s start with a simple explanation of what we’re trying to accomplish in EMDR.
I conceptualize EMDR as having two overarching goals:
1) To reduce the “charge” of any situation/memory that is so distressing that it overwhelms a person’s ability to cope, live in the present, and problem-solve. The goal here is the be able to visit with a past or present situation without becoming flooded/overwhelmed.
2) Once we reduce the charge of a distressing situation/memory, we get you to hold that situation/memory while choosing how you prefer to respond to it. In this sense, EMDR is about taking control of your life. No matter how distressing a current or past situation has been, you get to decide and work on how you’d like to think about yourself in relationship to that situation.
When you experience something distressing, there is an automatic (and often unhelpful) way that your brain begins to see yourself. You may feel out of control, worthless, or overly responsible for those around you. In EMDR therapy, you get to choose if you’d prefer to feel:
like you’re good enough/worthy
like you have control of your life choices
only responsible for what is yours to be responsible for
more safe/secure
We accomplish these goals by going through the 8 phases of EMDR.
The 8 phases of EMDR
Did you know that EMDR is broken down into 8 phases? Most often, clinicians will have this framework in mind when working with clients, however, you have the right to know where you are within these 8 phases and to collaboratively decide what the best phase is to work in together with your clinician.
Here is what we’re aiming to accomplish in each phase of the treatment.
Phase 1: History and overall treatment plan
In this phase, we’re collecting information together about what it is that you’d like to accomplish in therapy.
What is the presenting concern that you’re coming with? Here are a few examples:
some folks come to therapy struggling with a specific situation/person/feeling that they find overwhelming and are looking for better ways to cope.
many adults come to therapy with traumatic histories, and they want to work through how their life experiences having influenced them in the present.
In this first phase of treatment, we want to:
develop a strong relationship between clinician and client - this is actually the basis upon which all therapy rests. Building rapport and developing trust in one another is a crucial step before moving forward with other phases.
figure out what you’d like in your life to be different. Do you want to feel more confident? Less anxious? More connected to your community? It’s really important not to skip this step, since your goals fundamentally guide your treatment.
collect life history that could be influencing current symptomology. If you’re an adult who struggles to relax, we’d collect a history of where this vigilance came from, and whether there may be past experiences that are “stuck” in the nervous system that are contributing to the current presentation.
Phase 2: Preparation
Phase 2 is where the skill-building part of therapy lies. The goal is to increase your tolerance to visiting with distress in your life so that we can have a sense of distanced observation from whatever situation/memory that you’d like to change your relationship to.
The EMDR world calls this process the building of “dual awareness”- the client can have the experience of visiting with a challenging memory/situation without feeling like it’s actually happening now.
We also want to learn to turn the level of distress down in the body so that we can avoid becoming overwehelemd and flooded. EMDR uses many tools to accomplish this, but I go over the “calm place” and “container” resources with all of my clients. The “calm place” exercise helps clients in the moment experience soothing comfort in bringing up the memory of a place they can find peace in, while the “container” exercise can teach clients how to compartmentalize or “put away” things that are distressing.
Phase 3: Assessment
Phase 3 is arguably the most “structured” phase of EMDR. In this part of EMDR, we take a specific memory/situation that is distressing and we “assess” how it is stored in the body. In essence, we “poke” at the distressing situation/memory and we bring it to life.
Let’s say we’ve decided to work on “assessing” how the memory of a critical boss is stored in the client’s body. We do this by asking the following questions:
what’s the worst part of having a critical boss, and what image comes to mind when you think of that?
how do you think about yourself when you think about the critical boss? (e.g. people can feel powerless, worthless, etc)
how would you PREFER to think about yourself when you think about the critical boss? (e.g. you get to CHOOSE if you’d prefer to feel more in control, good enough, even if you don’t believe it yet.)
how true does that positive way of thinking about yourself feel right now (1-7?)
when you bring up the situation, what emotions come up now?
how distressing does it feel to you now? (1-10)
where do you feel those sensations in your body?
As you can see, assessing how a disturbing situation/memory is stored in the body is not only cognitive. We ask about what images, emotions, and sensations come to mind. That’s because distress doesn’t reside in cognition, it resides in the body.
Phase 4: Desensitization
This is the part of EMDR that most people associate with being EMDR, as it includes bilateral stimulation. Bilateral Stimulation (BLS) includes the clinician guiding a client through either eye movements side-to-side, or self tapping side-to-side.
Right after we take an assessment of the situation/memory, the distress is stirred up, alive, and front-and-center in the client. This is the time when we apply bilateral stimulation so that we can let people work through whatever it is that comes up.
There’s a ton of research on why bilateral stimulation (e.g. eye movements/tapping) helps our brains and bodies process disturbing material (and I’m happy to write a blog post about this specifically!).
In this phase, we let your brain do it’s own processing around the situation, and eventually what we find is that the brain works through the material and changes your relationship to it.
Bilateral stimulation helps us reduce the distress around a situation, so that you can pick how you’d prefer to relate to it.
Phase 5: Installation:
Once we reduce the distress around a situation using eye movements, we re-pair that event with how you’d prefer to relate to it.
For example, if we’re working with how a critical boss causes a client distress, we can decide how you’d prefer to see yourself when you think of that boss.
In phase 5, we pair the “critical boss” with an adaptive belief of your choice. This can be “I’m good enough”, “I have control and choices”, or whatever else feels relevant and true for you.
Phase 6: Body Scan
In phase 6, we take the distressing memory and we continue to pair it with how you’d prefer to relate to it, but we add in the body - is the body holding any residual distress around having a critical boss? In this way, we ensure that the mind and body are connected as you (once again) choose how you’d prefer to relate the situation.
Phase 7: Closure
In phase 7, we wrap up our session together, see what insights/learnings came out it, and ensure that you’re stable and ready to move on with your day.
Phase 8:
In phase 8, we re-visit with the initial distressing situation/memory, and we check in to see what differences the EMDR process has yielded.
So there you have it - EMDR goals and the 8 phases, explained. I sincerely hope that you’ve found this article helpful, and that you get to experience the amazing potential that EMDR has to help you take control of your life, no matter what trauma you’ve been through.