What to Expect in Your EMDR Therapy Sessions
You’ve heard of EMDR therapy, and perhaps most recently have been hearing about EMDR therapy intensives. You’re curious and have done some research, but want to know more about what happens in an EMDR therapy session. In this article, I will explain the EMDR therapy framework step by step so you know what to expect when you go for EMDR therapy.
But first, what is EMDR therapy? I’ll make it brief…
EMDR stands for Eye Movement Desensitization and Reprocessing and was founded in 1987 by Dr. Francine Shapiro. Dr. Shapiro had been walking in the park when she noticed that her natural left to right eye movements decreased troubling feelings she was experiencing.
Since that time, EMDR therapy has been defined, evolved and been extensively researched. EMDR therapy is primarily known as treatment for trauma and PTSD, but is also used in treatment of many other mental health issues.
Ok, so what IS EMDR therapy? What can I expect?
EMDR is a mental health therapy that uses a specific framework, together with bilateral stimulation (BLS), to reprocess memories and experiences that your mind had been unable to fully adapt at the time they had occurred. This can happen when the experience that you went through was too overwhelming for your mind’s natural processing system to healthily adapt.
In essence, your mind’s natural healing system becomes disrupted by an overload of information (the overwhelming experience) causing it to, I’ll say, “glitch.” When your mind’s natural system is disrupted, the information becomes “stuck” in your mind and body. These stuck experiences can contribute to low self-esteem, anxiety, depression, PTSD, and other health and life functioning issues.
EMDR therapy incorporates a past, present and future perspective into an 8 phase protocol that serves as a roadmap for your treatment. Yikes, Carol. What did you just say? Yes, I understand that in and of itself, this can sound overwhelming. I mean, 8 phases?? I totally get it if that makes you feel apprehensive about EMDR therapy. Just hang in there with me, I’m going to explain each phase.
You mentioned bilateral stimulation (BLS), what is that?
Bilateral stimulation (BLS) is a stimulus that is applied in a manner that alternates on both of your left and right sides. This can be done through tapping, eye movements, sound or movement. The purpose of BLS is to facilitate the reprocessing by activating both hemispheres of the brain. In fact, if you’re walking you’re creating bilateral stimulation!
Although the precise workings of bilateral stimulation aren’t completely understood, it is believed that bilateral stimulation mimics REM sleep which is part of your mind's natural processing and healing system.
And what are these 8 phases of EMDR therapy?
Here I’m going to break down each phase of EMDR therapy and talk about what each phase can look like in treatment:
Phase 1: History Taking and Treatment Planning
In this phase your therapist will seek to learn more about you, your history and what you would like to work on. Your therapist can also explain about how EMDR is conducted, depending on whether you’re in person or online.
Part of this phase is to introduce you to the concept of how images, emotions and body sensations are interconnected and that collectively have created and contribute to the negative belief(s) (i.e. self-defeating thoughts/self-judgments) you have about yourself in the here and now. Your present day triggers and considering your vision for the future will also be explored.
Questions are encouraged! Your therapist wants you to understand your treatment.
Phase 1 is to lay the foundation for your treatment plan.
Phase 2: Resourcing
The resourcing phase seeks to identify your current and establish new skills to prepare you for managing any potential discomfort you feel during reprocessing. A resource can be “external,” meaning your resource relies on something or someone outside of yourself to be helpful (i.e. texting a friend), or “internal” where your resource does not rely on an outside factor (i.e. breathwork, self-talk).
Resources established using EMDR therapy may or may not use BLS. When BLS is applied, it is applied in sets where the pace is slow and the duration is short. Slow and short sets of BLS help with processing changes to your state of mind (i.e. from anxious to calm) without being activating.
What I explain to clients about using EMDR and BLS to establish resources is that in addition to gaining a new resource, using EMDR and BLS also helps to familiarize you with BLS and the ‘mechanics’ of EMDR therapy in a way that is focused on building positive feelings and relaxation. As a result, you will be acclimated to how EMDR is conducted prior to the reprocessing phase.
Phase 3: Assessment
In phase 3, your therapist will ask certain questions in order to determine the memory you want to focus on and prepare you for reprocessing in the next phase. Your therapist’s questions will look to identify:
an image that represents the experience as you think of it now (also known as a target)
a negative belief (or self-judgment) about yourself that goes best with the image as you think of it now
a positive belief you would prefer to believe about yourself instead
how your positive belief feels to you now on a scale (also known as a validity of cognition, or VOC)
what emotions are you feeling now as you think of the image and negative belief
how disturbing the memory feels to you now on a different scale (also known as a subjective unit of disturbance, or SUD)
the body sensations you’re feeling.
There are no right or wrong answers. You and your therapist will take the time needed to move through this phase. It is possible that you’re not able to identify a positive belief…yet. That’s ok! Personally, I have seen this phase take 5-10 minutes or 1-2 sessions to complete. However long it takes, it takes.
Once this information is identified, and you are ready to move forward, you will transition into phase 4.
Phase 4: Desensitization
This is the phase that most people associate with EMDR therapy. This is the phase where BLS is applied while you notice the information identified in phase 3 and let whatever happens, happen.
In phase 4, sets of BLS are faster paced and longer in duration but still comfortable for you. BLS sets that are faster paced and longer in duration facilitates reprocessing by assisting your natural healing system with completing your experience that it was unable to complete at the time it occurred.
Yes, phase 4 can bring up the upsetting emotions and physical sensations associated with such past memories and experiences. This is a normal part of the process. What is important to keep in mind is that EMDR is not about reliving the experience. You are reprocessing the experience as an observer.
You will feel those emotions and body sensations, and perhaps notice images, but with a sense of distance. It’s like a balance where one foot is in the here and now and one foot in the experience being reprocessed. Your therapist is trained to help you to maintain this balance, to support you during the process and help you to ground back in the present, if needed.
Reprocessing typically continues until a SUD of zero is reached. However, there are instances where reaching a zero may not occur. When this does occur, the non-zero SUD may be referred to as being “ecologically sound.” You and your therapist will make this determination and decide on next steps.
For our purposes here, we will assume you have reached a SUD of zero. If you report a zero SUD, your therapist will ask you to bring up the original image in your mind again and ask what you’re noticing now. Additional sets of BLS are then applied to strengthen your gains and solidify the zero SUD you’re feeling.
Once this is complete and your zero SUD feels solid, you will be integrating your new positive narrative in phase 5.
Phase 5: Installation
Remember in phase 3 you were asked to identify a positive belief? Well, now in phase 5, it is time to incorporate that belief into your narrative for what you just reprocessed. This is also known as “installation.”
In this phase 5, your therapist will refer to the positive belief from phase 3 (if one had been identified). Whether or not a positive belief has been identified, your therapist will ask you if you can identify one now, or if the one you identified from phase 3 still fits or if there is a positive belief that fits even better?
Once your best fit positive belief has been identified, this is where the VOC scale comes in. Your therapist will ask you to scale how true your positive belief feels when you now think of the memory that had been reprocessed. The VOC scale is a 1 - 7 scale where 1 is completely false and 7 is completely true.
If your VOC is less than a 7, BLS will again be applied as you hold in your mind the positive belief and the memory until your VOC reaches a 7. If your VOC is already a 7, you may be asked if that 7 feels like a solid 7. If it doesn’t quite feel locked in, your therapist will look to apply additional BLS. If it feels solid at the outset, you’re ready for phase 6.
There can be instances that after multiple sets of BLS, the VOC remains at a 6 or less. When this occurs, your therapist will explore further with you the appropriateness of the belief, meaning whether there are other beliefs that are blocking you from fully believing the positive belief you’ve identified. Possible next steps can be to rework the current positive belief to what does feel right for you, or to address the blocking beliefs further. You and your therapist will collaborate on next steps.
Phase 6: Body Scan
Once your VOC is a solid 7, you will be asked to close your eyes and scan your body from head to toe when thinking of the memory/experience and your positive belief. You will be requested to let your therapist know if you feel any tension, tightness or unusual sensation.
You will report to your therapist what you’re feeling, whether negative or positive. If you feel a negative sensation, BLS can be applied to decrease the discomfort. If you feel a positive or comforting sensation, BLS can be applied to enhance it.
If there are negative sensations that are not decreasing with added BLS, then possible blocking beliefs may be explored.
And that’s it! You have successfully reprocessed your memory and potentially other related experiences your mind has associated with this memory.
What about phases 7 and 8?
Phases 7 and 8 both occur within the framework of phases 1 - 6.
Phase 7: Closing a session
Whether you’re doing weekly EMDR therapy or an EMDR therapy intensive, sessions will end with a target having been reprocessed or in the midst of being reprocessed, but not complete. Phase 7 is about making sure that you are leaving the session feeling calm and grounded in the present moment. Your therapist will suggest certain exercises to assist as well as apply any of your preferred methods of resourcing.
Your therapist will also debrief your experience by stating that the processing that was done in the session may continue after the session. You may or may not notice new thoughts, insights, memories or dreams. It is encouraged to write down any if any of these occur, so they can be explored next session. You should also be offered the option to reach out to your therapist before the next session, if necessary.
Phase 8: Re-evaluation
Re-evaluation occurs at the start of each new session and is a debriefing with your therapist about the last session and taking note of any insights, thoughts, memories or dreams since the last session. If you’re in phase 4 and will continue with reprocessing an unfinished target, you will be asked what your SUD in relation to the target as you see it now (it’s possible it may have changed since last session), and what are the emotions and body sensations you’re feeling now before BLS is applied.
If you completed a target the session before, you will also debrief and be asked about any new insights, thoughts, memories or dreams. In addition, your therapist will check in to see whether you continue to feel calm and the positive belief still feels solid. Next steps for treatment and reprocessing additional memories may be explored.
Bonus: Future Template
The EMDR therapy model addresses the past, present and future. After reprocessing your past experience, the Future Template looks to help you prepare your mind to healthily adapt a similar situation if it were to occur. The Future Template consists of 3 steps:
You will be asked to identify a future situation that is similar to the past situation that had been reprocessed, a positive belief and a feeling of how the client would like to handle the situation (i.e. confidently, calmly).
You will next be asked to imagine a scene or image where you view yourself coping effectively with the situation as you notice your positive belief, emotions, thoughts and body sensations.
If what you notice is positive, then you will then be asked to run a movie of the experience where BLS may or may not be applied throughout.
If you report neutral or negative feelings during your imagined scene or running the movie, you and your therapist will explore further to address any difficulties you may be having.
EMDR therapy has evolved greatly over time and with its evolution many other specialized protocols have been developed. Also, each therapist is an individual and brings to your treatment their own approach and style. Many EMDR trained or certified therapists are also trained in other trauma therapies, and may apply aspects of these therapies to their work with you. What I described here is the “standard protocol,” and is the foundation of EMDR. Your therapist may apply a different form of this protocol because it is a better approach for you and your particular needs.
Learn more about the history of EMDR here.