What is EMDR Therapy?
What is EMDR?
Eye -movement desensitization and reprocessing (EMDR) is an experiential, non-talk therapy that has been around since the late 1980’s, developed by Francine Shapiro. EMDR is typically known for its use in treating trauma, including post-traumatic stress disorder (PTSD). It is also commonly used for other things that people seek therapy for, like anxiety, depression, or phobias.
How does EMDR work?
In a nut-shell, EMDR therapists following a structured 8-phase protocol and use different types of bilateral stimulation to help clients process distressing memories. The science of how the change mechanism/process works is still emerging, but it is generally understood that the combination of eye movements, bilateral stimulation, and auditory tones can help the brain process the distress that clients feel in their nervous systems and reprocess memories so that they feel less intense.
I did my EMDR training in April 2022, so I have been using it in treatment with my clients for almost 2 years now. I did my training through EMDR Consulting and what I loved about their specific approach is that they teach a processing continuum. What does that mean? Having a processing continuum means that the therapist can adapt the 8-phase protocol to the client’s needs, readiness, and emotional capacity so that the process is helpful and not overwhelming. Gold-standard EMDR protocol focuses on having clients target their first/worst experiences of a distressing memory or negative belief. What I’ve found in my practice is that first/worst isn’t always the most helpful (or safest) place to start. Sometimes it’s helpful to start with something smaller (a distressing memory but perhaps not your MOST distressing memory) and to work through the process so you can get a feel for how your body and emotions respond to the process. Starting with a lower level or day-to-day anxiety trigger can be a helpful way place to start.
Preparing for EMDR work
Before we ever do any processing, a few things need to be in place: building the therapeutic relationship, learning and practicing regulation tools, and target sequence planning.
Building the relationship & learning regulation tools
First, I focus on developing a strong relationship with my clients. We need to know each other well, and you need to feel safe within the therapeutic relationship to be able to get into processing work, which can be intense or emotionally overwhelming. We do a lot of work to ensure you have the regulation skills you need to handle the experience of connecting with the strong emotions and memories that you want to process. This looks like spending time learning and practicing different tools to help cope with strong emotions – often using breathing techniques and some visualization scripts, including visualizing a peaceful place and practicing containing distressing emotions/thoughts/experiences. We might discuss safe and protective figures that could be helpful to imagine as we’re doing the processing work. We often spend one or two sessions just learning and practicing tools, and clients get the homework of practicing them outside of session so they can see how they work with real emotions in real time. We also work on creating a STOP signal (usually saying “stop” or gesturing stop with their hands) so that clients can communicate at any time that they need to stop the process or take a break. As with any therapy, clients are always in the driver’s seat of therapy, including during process, and need to feel empowered to end the process or part of the process at any time.
Target sequence planning
Once you feel comfortable and successful using emotional regulation tools, we move into planning the specific targets you want to process – these are the images, memories and experiences that cause you to experiences stress and that you want to change your responses to. Sometimes I use the analogy of having a bookshelf and the distressing memories we will target are books on the shelves. We spend time naming them and thinking about how to categorize them according to what they’ve taught us about ourselves or how they’ve made us feel. By doing this, we are able to identify a negative belief or perception which is associated with the distressing memory or experiences. Books that fall into the same genre (having the same negative beliefs) are thought to belong together and we will typically process them together. Negative beliefs can be things like, “I’m not good enough”, “I’m not safe”, “I’m not in control”. They are often related to themes like safety, security, and responsibility, and can be tied to early experiences in life. We spend time planning what negative belief best describes the image you want to process, so that we can make things that trigger those negative beliefs feel less powerful. We also identify a positive or adaptive belief that we want your nervous system to identify as true e.g. “I am enough”, “I can control what I can”, “I’m safe now”, as a way of increasing your resilience and adaptive coping skills in the present. Once we have planned all these out, it’s time to get into processing.
Processing using bilateral stimulation
During processing, we follow a script where I’ll ask you to recall distressing memories and then have you focus on bilateral stimulation, which does the desensitization and reprocessing. In my practice, I use a combination of low-tech and high-tech tools – it’s all based on what a client is comfortable with and what works for your body and preferences. I have a light bar available – many clients choose to follow the light with their eyes. I also have headphones which play alternating tones in sync with the light movements, and theratappers, which you hold in each hand and they vibrate in sync with the sounds and lights. Often people like the combination of these three tools together, while some prefer only one or two modalities. Other clients prefer to use tapping on their body (e.g. on their arms or legs) or might ask for me to tap their legs if that feels safe and comfortable. Others might like to do what I call the old school way of using eye movements where I move my hand back and forth and they follow it with their eyes.
What do you notice? Go with that
After several passes back and forth (using between 15-30 seconds) of the bilateral stimulation, I check in with the client, asking them to take a breath, let it go, and tell me what they notice. Sometimes clients may experience vivid memories, while others will have thoughts or emotional experiences come up, or notice sensations in their bodies (e.g. tightness in their chest, rising emotions like anger, etc). There’s no right or wrong way of doing the processing – clients simply need to tune into what they’re noticing, and then I’ll let them know to “go with that” or “notice that” and we’ll continue on with the BLS.
The goal is to reduce the physical and emotional distress associated with the target image we want to process so that the negative belief feels less true, the associated felt-sense of distress in the body decreases, and a more adaptive or positive belief increases. To measure distress levels and how they are changing over time (the goal is to decrease them), we take a measurement of how distressing the experience feels. This is called a SUD; it’s a scale between 0, no disturbance, and 10, highest disturbance possible, and we measure it before we start processing. I often check in throughout the processing session to see if the SUD has changed. For some folks, depending on what we’re processing, the SUD can move quickly. For folks processing a lot of memories attached to the same negative belief (e.g. processing childhood trauma), if may take several sessions to see noticeable change or decrease in the SUD scale. We move at the pace of your individual nervous system and approach this work in a way that helps you to feel decreased distress over time - changes will happen at the pace that your body feels comfortable with.
Increasing adaptive beliefs
As I mentioned earlier, EMDR also involves in increasing adaptive or positive beliefs. Once the distress is processed down to a manageable level (as close to a SUD of 0 as possible), we typically shift to installing the adaptive belief. We also use a rating scale to measure it, which ranges from 1 (not very true) to 7 (the truest possible). We try to get the client to experience a VoC of 7 or as close to 7 as possible.
Ending a processing session
Once the SUD is as close to 0 as possible, and the VoC is as close to 7 as possible, we end the session with a body scan. This is a way of checking to see if there are any lingering emotions or sensations associated with the negative belief or image that we processed in session. If there client notices anything, we typically circle back to addressing it with a little more processing. We may end with grounding techniques, containing any parts of the target that we were not fully processed, or spending time visualizing peaceful images and places.
What happens if you don’t finish processing in one session?
If we don’t completely process a target in session (which is often the case), then we use different strategies to ensure that the client feels like we’ve wrapped up todays work and feels safe and grounded before leaving the session. I always focus on ensuring that clients feel as well regulated as possible after processing, especially when we’ve been working with really intense or overwhelming memories and experiences. This is one of the reasons that we focus on developing tools and resources before processing - we can use these at any point in session if things start to feel overwhelming and we need to stop and focus on grounding.
After-care
Processing doesn’t end when the therapy session ends - your nervous system continues to work behind the scenes to reprocess the memories we targeted in session. This can mean feeling exhausted or increase emotionality outside of session, especially after processing intense emotions. I often tell clients to treat themselves gently as though they have the flu - be gentle with yourself, get lots of rest, eat nutrient dense foods, hydrate, and spend time with loved ones, pets, or doing preferred activities. It’s not uncommon to have new memories, insights, or dreams come up after processing, and these are things we review together in our next session as we figure out what steps to take next with EMDR.