EMDR

1. Though it has a broad range of applications, it is primarily a trauma treatment. The theoretical underpinnings of the practice include a premise that some traumatic events or prolonged exposure to traumatic environments are not received by the brain and body in a way that helps a person know how to cope or respond to future challenges. EMDR language would say that we have an “intrinsic system” for responding to difficulties, but sometimes trauma disrupts this and information is stored in a “maladaptive state.” In other words, trauma puts the brain’s danger system on high alert and perceives danger or exaggerated danger when it doesn’t need to work so hard. EMDR’s job is to help sort that stuff out so that there is a moderated and more “adaptive” response to challenges, a response that can better recognize real danger and respond proportionally to the threat.

2. EMDR is a positive, optimistic form of treatment that believes in a person’s natural ability to heal. Though early phases of EMDR feel very much like the warm, relational approach to counseling that we are used to, the middle and end phases heavily rely upon this optimism for the brain and body to heal itself. The therapist facilitates the eye movements, monitors responses, and shapes the session, but largely stays out of the way of the work your brain and body are doing.

3. The “EM” in EMDR stands for eye movements. Yep. Here’s where it gets a little bit weird and very, very cool. The therapist will likely use some sort of technique to guide the person in moving her eyes rapidly from side to side. I use my arm and hold up two fingers for a person to watch as I move it out and back from my body. Other therapists might use a light bar with flashing lights on either side. There are YouTube videos with dots like this one: https://www.youtube.com/watch?v=Uul1tXDgCy4 .  And some therapists use other form of “dual action stimulus” such as tapping or headphones with sounds alternating in each ear. This is only one part of EMDR, your therapist is not likely to start waving her arms around on the first session.

4. The “D” stands for desensitization. This is the idea that with a careful and guided revisitation of the traumas while using eye movements, the traumas won’t sting so much. There will be a desensitization to them, a smaller response.

5. The “R” stands for reprocessing. At the conclusion of EMDR, those traumatic events are sorted out in the brain in a way that helps a person respond better to stress, triggers, and challenges. A heartbreakingly familiar example of a trauma response is a military veteran who hears fireworks but perceives gunshots. The booming sounds from exposure to combat cause some service people’s brains to activate a danger response and they may feel the same terror as they did in the field when their lives were endangered and they saw lives lost. With EMDR, the goal would be to help the person reprocess that sound and have increased agency in the response rather than activating the fight/flight/freeze response.

6. There’s a lot of wacky language and scaling in EMDR. This form of treatment has been studied and tested rigorously for decades. Time and time again, the outcomes are correlated with how closely the therapist follows the protocol and uses the vocabulary. So we do. You can expect to rate your distress on a scale from 0 to 10. You can expect to rate your beliefs about yourself on a scale from 1 to 7. You will hear “notice that” and “go with that” a lot. Just…go with it. We therapists go with it because we are warm fuzzy people who still want the research to tell us what helps, and the research tells us that this protocol is effective.

7. There are eight phases to EMDR, but they don’t always go in order.

   1. Phase 1: History taking—The therapist will listen to get to know you better, start to identify some of the things from the past that are causing problems in the present, and catch things that might not make EMDR right for you or right for you right now. If you are taking a lot of benzodiazepines or struggling with substance use, frequently dissociate (your body stays but your mind goes somewhere else), if you are pregnant, have a seizure disorder, or don’t feel comfortable with EMDR, it’s probably not right for you. At least not right now. And that’s okay—there are other ways to heal.

   2. Phase 2: Preparation—You would never climb up a mountain without the proper gear, and you would not want to go back to the hardest things in your life without some tools to help you cope. In this phase, you’ll learn some practical skills to help you calm yourself, and you’ll be exposed to small stressors to help train your brain and body to go from stress to calm. It’s a lot like stretching before the climb and filling your pack with things that can help you if you encounter added difficulties. No bear spray or crampons in EMDR, though.

   3. Phase 3: Assessment—You and the therapist will select a traumatic situation to address. You’ll identify some of your thoughts at the time and you’ll choose thoughts that will serve you better today.

   4. Phase 4: Desensitization—This is the eye movement part. Your therapist won’t say much, but will be right there with you.

   5. Phase 5: Installation—At this part of therapy, you have told your therapist that you aren’t having significant reactions when you think about the traumatic memories (you’re desensitized!). Your therapist will then use eye movements to help get your brain thinking positive, adaptive thoughts.

   6. Phase 6: Body Scan—Your therapist will help you check in with yourself and make sure your whole body is feeling okay. Ever felt queasy when you’re worried? Ever had a headache when you had too much going on? Ever felt blue when you were fighting a cold? Our brains and bodies are roommates, so it’s important to check in with the whole self.

   7. Phase 7: Closure—It’s common to need a few sessions for each trauma target. Sometimes you finish, sometimes you don’t. The closure phase helps make sure that you’re okay before you head out the door (or log off your computer).

   8. Phase 8: Reevaluation—This is the check-in that helps you and your therapist review how you responded and what needs to happen next. Ideally, you’ll be keeping a log of what you notice changing throughout the week

8. Your therapist must be trained by an EMDRIA-approved trainer (EMDR International Association) to say that they provide EMDR. The minimum standards include a master or doctoral degree, 40 hours of EMDR training, and 10 hours of case consultation. EMDR therapists must be independently licensed therapists or associates working under supervision.

9. The length of time in EMDR therapy varies. Some studies show significant improvement in just a few sessions, others prefer a longer, more gradual approach. You and your therapist can make a plan together that’s best for you.

10. It’s wonderful, but not magical. EMDR doesn’t erase memories, it doesn’t erase your story. It doesn’t mean you’ll never hurt again. EMDR takes the edge off your reactivity, loosens the grip of trauma on your day-to-day functioning, helps increase your ability to regulate yourself when you’re triggered, and gives you hope and confidence in your ability to live with increased peace.

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References: 

A Guide to the Standard EMDR Therapy Protocols for Clinicians, Supervisors, and Consultants by Andrew M. Leeds (2nd Ed. 2016)

Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures by Francine Shapiro (3rd. Ed. 2017)

Personal Transformation Institute