Eight Phases of EMDR: More Than Just Eye Movements

In our prior blog, we looked at the basics of EMDR and a general idea of what it is. Now, you may still be wondering - what does EMDR look like? What is the format of EMDR therapy or even a single session? What can I expect during my time with an EMDR clinician? If you’re asking these questions, you’ve come to the right place.

I know you may have heard that you can see success in as little as just a few sessions. That is true of the sessions that use bilateral stimulation (eye movements, tapping, or tones). The answer to the question of “how long does EMDR therapy last?” is: it depends. You are an individual and no two people are going to travel the same journey. Working to establish good coping skills and evaluate what needs to be targeted before diving into bilateral stimulation are highly recommended. A typical single session, though, usually ranges between 55-90 minutes.

Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference in a much shorter time span. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes; the brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.

Much like how your physical wounds’ healing rates differs from person to person, so does your brain! This is why it is important to realize that EMDR Therapy is more than just those eye movements.

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EMDR Therapy is an 8 Phase Treatment Approach.

Prior to engaging in the bilateral stimulation, time should be spent in sessions just like any other form of therapy where you're gathering history, building coping skills and resources, and increasing one's window of tolerance.

When engaging in the bilateral stimulation phases of EMDR, it looks a little different than your typical psychotherapy session. As you travel through your difficult life experiences, you maintain a dual awareness (one foot in the past and one foot in the present). This means you are in the driver’s seat and in full control while being safely supported by your therapist. Many people who have been in talk therapy for years find that EMDR provides a significant decrease in emotional reactivity after just a few sessions. You'll be asked to give very brief feedback about what you're noticing which differs from a typical session where you're doing a lot of talking. We often use the analogy that compares what happens to either watching a movie or being on a train; just watching/observing and being asked about what you notice or what things pop up for you.

So what are these actual Phases?

• In the first phase, the individual seeking therapy and clinician cover the client’s history and identify the presenting problem plus why they’re seeking therapy. This should include going over the client’s history and identifying any needed skills in order to develop more adaptive responses to current and future life demands or stressors.

• In the second phase, the individual and the therapist consider what coping skills the client has utilized and skill-building in stress reduction techniques is used. Expectations of the process are discussed and the mechanics of EMDR are established.

• In the third phase, baseline measurements are taken in a safe, structured manner and client and clinician work to access the target memory as its currently stored so that it can be successfully processed.

Through the fourth through sixth phases, the client and clinician work through the tough stuff by picturing a traumatic event, distressing image, or focusing on a negative core belief and pairing the bilateral stimulation.

• In the fourth phase, bilateral stimulation is used in order to process through desensitization where the target memory and associated experiences are reprocessed to an adaptive state.

• In the fifth phase, still using bilateral stimulation, the client and clinician work to strengthen the linkage of the new Positive Cognition to the processed memory and ensure that the positive belief accurately reflects the client’s experience of self.

• In the sixth phase, continuing to use bilateral stimulation, a Body Scan is used to check for any residual body sensation associated with the target memory that needs reprocessing and ensures that the body is congruent with the processed memory and the associated (new) positive cognition.

• In the seventh phase, we bring closure to the memory work by focusing on the “here and now” to ensure the client’s stability and to educate the client on what may happen between sessions. The individual keeps a log to track their experiences during the week.

• Finally, in the eighth phase, the client-clinician pair summarize the reprocessing that’s occurred together, bringing attention to the changes the client is experiences as a result and reflecting on the skills the individual has developed. The initial target memory is evaluated and any remaining issues or targets are identified for continued processing.

After session, there is generally no assigned “homework”, which differs from the traditional psychotherapy session. If you’re wondering if EMDR will be effective for you without homework, fear not: a study funded by the National Institute of Mental Health that was conducted by a well-known exposure therapy researcher (Rothbaum et al., 2005) found that “E.M.D.R. seemed to do equally well in the main despite less exposure and no homework.” Whew! You will be asked to bring some mindfulness to your experiences throughout the week, between sessions, paying attention to any triggers, images, cognitions (beliefs), emotions, or sensations that come up for the client.

A “ninth phase,” called Future Template, would be done with any great EMDR therapist. Here, the client and clinician will work to optimize the client’s capacity to respond well to future related issues and to develop and strengthen specific coping skills, behaviors, and emotional responses to prepare for related challenging situations. Together, they address any anticipation anxiety that may come up.

Alright - now you’re familiar with what a single session looks like, what the phases look like, and if you’ll have homework. Stay Tuned to learn more about what you’re doing in those Phases 4-7! What that whole bilateral stimulation or “eye movement” thing is all about!