Many people come to me specifically for Eye Movement Desensitization and Reprocessing (EMDR). Most people who find me for EMDR were referred by another provider due to trauma. Or, you may have found me by Googling New York EMDR therapists after seeing a portrayal of EMDR in Grey’s Anatomy or The Affair. EMDR is a therapy that Francine Shapiro developed to treat PTSD. When someone is seeking EMDR, the first thing I will share with you is that a fair amount of therapy happens on the way to the bilateral stimulation phase. EMDR is an 8-phase modality and we will not begin bilateral stimulation (BLS) until phase 4. Before we can get there, I will support you with maintaining a sense of control and emotional regulation. Below is an overview of what to expect in EMDR therapy with me.
What To Expect In Each Phase of EMDR
EMDR Phase 1: History Taking & Treatment Planning
History taking begins after our consultation call. I will send you my consent forms and intake paperwork to complete prior to our first session. Sometimes the paperwork is overwhelming; there is no expectation that it has to be completed before we meet. The intake assessment offers insight into your family history, important early attachment experiences, mental health history, current concerns, and strengths and supports. As we meet, you will notice that I reflect what I’m hearing and noticing. I’ll start to integrate some “EMDR speak,” such as identifying negative self beliefs (“negative cognitions”) and support you with focusing inward on your somatic experience. We’ll identify earlier times you remember thinking or feeling similar things. This is how we start gently identifying an EMDR treatment plan. I find that when I structure your early treatment this way, you have a better idea of what to expect in EMDR before jumping into the intervention.
While resourcing occurs in a separate phase, I integrate some resourcing throughout phase one. For example, if you mention a time you felt particularly proud of yourself or comforted, I will help you install this experience so that it can be easily accessed as we proceed with treatment. Additionally, if you start to feel overwhelmed, dissociated, or activated while we are completing history taking, I’ll offer resources to help you return to your window of tolerance.
EMDR Phase 2: Preparation & Resourcing
During phase two, our goal is to prepare for EMDR. This is where we start to make the shift into the nitty gritty of the intervention. We will identify which method of bilateral stimulation (BLS) you prefer and will try auditory, visual eye movements, and tapping. Next, we identify metaphors that help you maintain dual focus between the thoughts, memories, and sensations that arise during reprocessing and the therapy space. Many of my clients like the idea of the material being a movie that they have control to pause, rewind, fast forward, or mute. I will offer you a few different metaphors and you will pick the one that most resonates. We will always agree on a stop signal so that you can easily indicate to me if you need me to halt the BLS. These expectations are important to bring a sense of safety to your nervous system in the EMDR therapy room.
Once we have reviewed this, we move into resourcing. This phase activates the adaptive information processing system that is inherent to our brain function. You have had adaptive experiences outside of whatever shame or trauma you are meeting with me to address. I will support you with identifying times you felt calm, strong, capable, or loved (for example) and fleshing out those experiences in ways that you can feel in your body. Sometimes, we might install the feeling of connection you are experiencing in the therapy space with me. Therapy may be the first experience you have of feeling fully seen and still valued by another person. I’m honored to be in this space with you and to help you connect with those beliefs and feelings positively. We will install this by pairing the image, words, and somatic sensations with a few sets of slow taps so that you can feel those positive sensations and beliefs grow and feel more true.
EMDR Phase 3: Assessment
The assessment phase is where we will begin targeting specific experiences. In phase one, we identified a sequence of memories or experiences to process. Typically, we are identifying experiences from your present, past and that translate into future concerns. Clusters may connect by the associated sensations, negative beliefs, or type of experience based on setting, behavior, or people involved.
A target assessment incorporates the following material:
- Memory
- Snapshot (“What image represents the worst part of this experience for you now?”)
- Negative cognition (“When you bring up this image, what words represent your inner critic or deepest fears about yourself?”) (Kennedy, 2014)
- Positive cognition (“When you bring up that picture (or feeling state), what would your compassionate self say about the idea, remembering to use a supportive tone of voice toward yourself?”) (Kennedy, 2014)
- When you bring up that image, how strongly do you feel the positive cognition in your body? (This is called “Validity of the Positive Cognition” or “VOC”)
- When you bring up that image and the negative cognition, what emotions and sensations do you notice?
- How disturbing does that feel on a scale of 1 – 10? (Subjective Units of Distress, or SUDs)
Pairing the negative belief you hold about yourself with the disturbing memory activates the sensations and emotions that make this experience disturbing to you. In phase four, the first goal is to desensitize, or make this memory feel less disturbing. Identifying the positive cognition supports with identifying the adaptive information you are moving towards in the reprocessing phase.
EMDR Phase 4: Desensitization & Reprocessing
EMDR is a very different experience compared to other therapy interventions and it’s important that you know what to expect. Phase four begins with bringing up the target and activating the sensations and beliefs associated with the memory. Then, you will begin BLS via your preferred method. I will prepare you when I am pausing the light bar or the ball on your screen (if we meet virtually) or ask you to pause if you are tapping on your own body. I’ll remind you to take a breath and then ask, “What do you notice?” This is an invitation to share whatever came up, whether it’s another memory, a thought about the memory we’re reprocessing, a body sensation, or something else. You’ll notice this phase feels repetitive, as I will say little beyond indicating it’s time to pause BLS, asking you what came up, and directing you to “go with that.”
In the first few sessions, it is incredibly common for you to wonder if you’re “doing this right.” Whenever I hear this, I will remind you, “Whatever is coming up is connected – even that thought.” Sometimes I will prompt you with questions to support desensitization or reprocessing. EMDR has a set protocol, but there is also flexibility for therapists to integrate other interventions to best support your healing. When you know what to expect in EMDR, you will worry less about whether you’re “doing it right” and you’ll notice how organically the process continues. We are just tapping into your brain’s natural ability to adaptively process memories.
EMDR Phase 5: Installation
Installation is the process of expanding your connection to the positive cognition. Once SUDs reach 0, we will assess how strongly you believe the PC now. We’ll do slow, short sets of BLS and I’ll check in with you to ask what you’re noticing. Common questions I will ask are whether there’s something getting in the way of that belief growing and where you notice that belief in your body. I might encourage you to imagine that feeling growing and how you would know if it felt 100% true. Often, you will spontaneously remember times that you embodied the PC. This is your adaptive information processing system at work, connecting to experiences that reinforce your positive attributes. We’ll continue slow, short sets until that belief feels close to 100% true for you.
EMDR Phase 6: Body Scan
We use the body scan to reveal any blockages to desensitization and reprocessing. I will guide you through a scan from the top of your head, through your neck, core, and pelvis all the way down to your toes. Is there anywhere that the initial target still feels stuck in your body? Is there anywhere that doesn’t fully feel the PC? If so, we will continue BLS until desensitization and reprocessing are complete.
EMDR Phase 7: Closure
I will leave time to close a session whether or not you have reached SUDs = 0. Some targets take more than one session to fully reprocess a target while others take just one session. If you closed the loop on a target, you will feel good at the end of your session. Closure offers an opportunity to reflect on how your thoughts on the target and level of activation have changed. Often, there is a new distance between yourself and the memory. One client offered perfect words to summarize this transformation: “It’s disturbing that this happened, but it doesn’t feel disturbing in my body anymore. It’s just a memory.”
When a target is not fully reprocessed, we close a session moving from phase four to phase seven. We will close with a debrief and regulating your nervous system using your resources. We’ll use imagery to contain the target and other material that arose during phase four, followed by other resources we developed in phase two. My go-to resources are calm space imagery and/or progressive muscle relaxation to help you move from disturbance into a calmer state of mind and body.
Phase 8: Reevaluation
Reevaluation occurs at the start of the next session. We will check in on anything that continued to disturb you between sessions, including nightmares and new experiences. Next, I’ll bring up the target we worked on and check how disturbing it currently feels in your body. If we have already completed installation and nothing has changed since last session, we will decide on our next steps together. If the memory is still causing disturbance or you don’t fully believe the positive cognition, we will return to phases four and five and proceed through the phases.
Next Steps
It is important that you understand EMDR before we start working together. Once you know what to expect in EMDR therapy, you can determine whether the pace and process aligns with what you want. Contact me if you have general questions about EMDR.