What is EMDR Therapy? Just the Basics: Part 1
As an EMDR Therapist in Los Angeles, I often get questions like: what is EMDR Therapy, how does EMDR therapy work, and what do sessions look like? I struggled to find an online article to refer people to that is informative enough while not being too technical, so I decided to write my own.
I included what happens in each of the 8-phases, as I understand that surprises can be anxiety-producing for many.
It didn’t take long to realize my “quick little guide” would become a blog series. There are many more frequently asked questions that I’d like to address. I think it’s essential to remove the “mysteries” of EMDR, so they don’t become barriers to accessing a therapy that can be so effective and life-changing. For information on: does EMDR work, is EMDR Evidence-Based, and EMDR vs Talk Therapy click here.
What does EMDR stand for?
EMDR stands for Eye Movement Desensitization and Reprocessing. A mouthful, I know! That’s why you seldom hear it, and most will just say “EMDR!” Don’t worry; what the letters mean WILL BE addressed below.
What does EMDR treat?
While there is extensive research demonstrating EMDR to be effective in treating Post-Traumatic Stress Disorder (PTSD), both in cases of single incident traumas and complex traumas, EMDR is quite versatile. A significant trauma does not need to have occurred for EMDR to be effectively used. EMDR also treats depression, anxiety and panic disorders, OCD, low self-esteem and confidence, substance abuse, eating disorders, and is even used for performance enhancement in sports and the creative arts.
What is EMDR Therapy? What does EMDR Therapy Look Like?
EMDR is a brain-based therapy that works to decrease the impact of disturbing memories and negative thoughts one has about themselves. It is an 8-phase model designed by Francine Shapiro over 30 years ago. While 8 phases may sound like a lot, EMDR can accelerate treatment progress compared to a more traditional talk therapy approach.
The 8 phases consist of:
History taking - Phase 1. An EMDR therapist will want to know what difficult life experiences you’ve had, how you have coped with them, and how they impact your daily functioning. While EMDR is efficient and effective, facing disturbing events from the past can be emotionally draining, so assessing client readiness is an important consideration.
Self-Regulation/ Preparation - Phase 2. The therapist will ensure you have self-calming and coping strategies to use when interacting with negative memories. You will also identify positive feelings and memories to use as “resources” during trauma processing, should distressing feelings become too intense. Like history taking, this phase is all about addressing client readiness.
Phases 3-7. This is when the upsetting memories, feelings, and beliefs are actively targeted, and all the letters of EMDR come into play! While there are several steps, some are done relatively quickly and in combination with the others. During these phases, you and your therapist will:
Identify a “target” memory or negative experience to the process.
Explore what negative thought about yourself is attached to the memory. For example, someone bullied or mistreated as a child may conclude “there’s something wrong with me” or “I’m unlovable.” You’ll want to discover the negative thought that best fits how you interpret the “target memory” and what it makes you think about yourself today.
Determine what image represents the most distressing part of the “target.” So, if you were playing the incident over in your head like a video, you’d take a snapshot in your mind of the part that is the most disturbing, as the image of the “worst” part is what you’ll want to desensitize (the “D” in EMDR) yourself to.
Once you’ve paired the negative thought and image with the “target,” you’ll be asked to check in with yourself and identify what emotions and physical sensations come up for you. When doing this, you are not to try and remember what you felt back when the incident occurred, but rather what emotions and physical sensations come up during the session. This process of bringing up the negative thought, image, feelings, and body sensations all together helps bring the dysfunctionally stored, or “stuck,” long-term memory to the short-term memory where your brain can access and process it.
You will also identify what neutral or positive thought you’d like to have when reflecting on the distressing memory. For example, in the earlier example of being bullied, one might want to transition from “I’m unlovable” to “I’m lovable,” or move from “there’s something wrong with me” to “I am okay as I am” or “I was just a kid and did the best I could.”
You’ll temporarily set aside the neutral/positive thought and focus on the negative thought with its associated image, emotions, and body sensations. You will rate the level of distress you are experiencing from 0 to 10 before processing begins.
You and your therapist will use bilateral stimulation, like eye movements (the “EM” in EMDR), tapping, handheld buzzers, or sounds (with headphones) to activate the brain to start processing and “digesting” the target memory and negative core belief. The therapist will pause intermittently to check in with what you are noticing and feeling, as you may not stay on the initial target memory for very long. The brain may move to other incidents or memories related to the negative thought, which you will also process. The goal is for your brain to sort through, untangle, and process all memories associated with that negative belief.
You’ll be asked periodically to share your current level of distress. You may see the distress level go up initially as you face difficult memories. As you continue to work on the target, you will notice the distress level going down. This is because of the reprocessing occurring (the “R” in EMDR). Reprocessing means that your brain is getting the chance to process the yucky thoughts, images, feelings, and body sensations that it didn’t effectively process at the time of the event. Your level of distress decreasing also indicates that you are becoming desensitized (the “D” in EMDR) to the disturbing memory and that the intensity of the feelings (both emotional and physical) are diminishing.
The goal is to continue to process the target until the level of distress gets to “0.” This often doesn’t happen in one session, which means your therapy session may end with you still having uncomfortable thoughts and feelings about the target incident. There’s no need to fret, as you may have decreased your level of disturbance to lower than when you got to the session. But, just in case, your therapist will do a closing exercise to help you gather up those negative thoughts and feelings and set them aside until the next session.
Since you worked so hard to bring that “stuck” long-term memory to the short-term, your brain may continue to process outside the session. Continued processing might come through vivid dreams related to the target incident or new memories, feelings, or body sensations. You’ll be asked to note if any of these occur and discuss them with your therapist at the next session. Should your distress level elevate, you can use your self-regulation strategies to manage the discomfort or call your therapist if needed.
Once your disturbance level has gone down to 0, you will reflect on the positive thought you had identified and see if it still fits the situation. You will create a new positive or neutral thought if it does not. Either way, once you have ironed out the associated positive thought, you will rate how true it feels on a 1 to 7 scale. The therapist will use bilateral stimulation (eye movements etc.) to help reinforce or “install” the associated positive statement with the original distressing image.
When you get that up to a seven, you will say the positive statement in your mind while scanning your body from head to toe. You will see if the statement feels like it can travel through your whole body or if it gets “stuck” somewhere. If it doesn’t feel like your mind/body can fully digest the positive statement yet, you’ll be asked to notice where it feels stuck in the body while the therapist resumes bilateral stimulation. Once the statement passes through the body, you can consider it successfully installed.
Your therapist will do the closing phase to remind you that dreams may occur and that even a fully processed target may become elevated through the week as the brain continues to process and heal.
Re-evaluation - Phase 8: When you return for your next session, the therapist will follow up with the target by asking you to pull up the image and negative thought in your mind and see if the distress level is still at 0. If it has increased, you will follow the steps to get it back to 0.
After one target has been completed, many clients choose to continue EMDR work to target more distressing thoughts and memories that are getting in their way. You’ll just repeat the process for phases 3-8 until you feel like you have sufficiently addressed the desired targets. For some, the entire process will take less than a few months, while others may need more time to get through multiple targets because of a more intense or traumatic history. Whether it takes weeks or months, EMDR is typically more efficient (and therefore more cost-effective due to fewer sessions being needed) than many other therapies.
I work intensively with clients in 2–3-hour sessions (sometimes with multiple sessions a week!) to help them access several weeks of therapy in a short period. This works well for those that feel like they need quicker progress and relief than weekly sessions can provide.
Can EMDR be done Virtually?
Yes, EMDR can be done successfully online. Before the pandemic, several therapists with online practices used EMDR to serve their clients. During the COVID-19 pandemic and “shutdowns,” even more therapists gained familiarity and comfort with using EMDR in an online format by adapting how they use eye movements, tapping, buzzers, or tones/sounds to accommodate the different format.
There are, of course, both therapists and clients that prefer EMDR in an in-person setting which is fine too. This highly effective treatment model has plenty of room for flexibility in personal preferences.
Are you in California and curious about Online Intensive EMDR Therapy?
Contact me for a free consult by clicking on the button below. To get more information about the services I provide, click here and see if EMDR Intensive Therapy is the right fit for you.