Folks, this is a big question–how does EMDR work?–and a really great one because EMDR is so different than any other form of therapy I’ve ever heard about. If you are coming to me (or another EMDR provider) to heal your trauma, I believe you deserve to know what’s going on so you can make choices about what makes most sense for you clinically. This is essential because one of the hallmarks of trauma is the denial of choice: a horrendous thing happened to you and it’s highly likely your choices were taken away. For many people, not having choices is what turns a terrible situation into a traumatic one.
I’m going to do my best to give you an overview without writing a masters thesis and without using therapy jargon. If there is something that doesn’t make sense, shoot me an email, or leave a comment and I’ll come back to edit it.
Eye Movement Desensitization and Reprocessing
the premise is that traumatic memories cause us distress because they have been ineffectively processed in our brains so the goal of EMDR is to manually reprocess this material and simultaneously desensitize our brains to the traumatic material–eliminating flashbacks, nightmares, and other responses to triggers.
EMDR has changed many many lives
by healing old wounds and
making space for joy and light once again.
The process ought not to be a secret.
It happens through a very non-linear 8-phase process.**
Here’s how it goes:
1: History and Treatment Planning
Generally takes a few sessions at the beginning of therapy, and can continue throughout the therapy, especially if new problems are revealed. Unless the client is coming to see me to clear up one very specific traumatic event, I like to spend a good month on this phase to be sure I have a solid conceptualization of the issues at hand.
In the first phase of EMDR treatment, the therapist takes a thorough history of the client and develops an EMDR-specific treatment plan. This phase will include a discussion of the specific problem that has brought the person into therapy, the behaviors stemming from that problem, and the symptoms the person would like resolved. With this information, I can develop a treatment plan that defines the specific targets on which to use EMDR. These targets include the event(s) from the past that created the problem, the present situations that cause distress, the key skills or behaviors the client needs to learn for his future well-being, and beliefs that block the entrance to the trauma.
One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of their disturbing memories in detail. That’s the part I love the most. It has never made sense to me that healing can only happen if a person tells and retells to story of the most awful thing that has ever happened to them. to me, that sounds much more like torture than therapy. While some individuals are comfortable, and even prefer, giving specifics, other people may present more of a general picture or outline. When the therapist asks, for example, “What event do you remember that made you feel worthless and useless?” the person may say, “It was something my brother did to me.” That is all the information the therapist needs to identify and target the event with EMDR.
For some clients this will take only 1-4 sessions. For others, with a more complex background or trauma, or more difficulty with regulating their emotions, a longer time may be necessary. Basically, your clinician will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you are generally able to proceed to the next phase. One of the primary goals of the preparation phase is to establish a relationship of trust between the client and the therapist. While the person does not have to go into great detail about his disturbing memories, if the EMDR client does not trust his clinician, he may not accurately report what he feels and what changes he is (or isn’t) experiencing during the eye movements. If he just wants to please the clinician and says he feels better when he doesn’t, no therapy in the world will resolve his trauma. In any form of therapy it is best to look at the clinician as a facilitator, or guide, who needs to hear of any hurt, need, or disappointments in order to help achieve the common goal. EMDR is a great deal more than just eye movements, and the clinician needs to know when to employ any of the needed procedures to keep the processing going. During the Preparation Phase, the clinician will explain the theory of EMDR, how it is done, and what the person can expect during and after treatment. Finally, the clinician will teach the client a variety of relaxation techniques for calming himself in the face of any emotional disturbance that may arise during or after a session. Learning these tools is an important aid for anyone. The happiest people on the planet have ways of relaxing themselves and decompressing from life’s inevitable, and often unsuspected, stress. One goal of EMDR therapy is to make sure that the client can take care of himself.
Used to access each target in a controlled and standardized way so it can be effectively processed. Processing does not mean talking about it. See the Reprocessing sections below. The clinician identifies the aspects of the target to be processed. The first step is for the person to select a specific picture or scene from the target event (which was identified during Phase One) that best represents the memory. Then he chooses a statement that expresses a negative self-belief associated with the event. Even if he intellectually knows that the statement is false, it is important that he focus on it. These negative beliefs are actually verbalizations of the disturbing emotions that still exist. Common negative cognitions include statements such as “I am helpless,” ” I am worthless,” ” I am unlovable,” ” I am dirty,” ” I am bad,” etc. The client then picks a positive self-statement that he would rather believe. This statement should incorporate an internal sense of control such as “I am worthwhile/ lovable/ a good person/ in control” or “I can succeed.” Sometimes, when the primary emotion is fear, such as in the aftermath of a natural disaster, the negative cognition can be, “I am in danger” and the positive cognition can be, “I am safe now.” “I am in danger” can be considered a negative cognition, because the fear is inappropriate — it is locked in the nervous system, but the danger is actually past. The positive cognition should reflect what is actually appropriate in the present. At this point, the therapist will ask the person to estimate how true he feels his positive belief is using the 1-to-7 Validity of Cognition (VOC) scale. “1” equals “completely false,” and “7” equals “completely true.” It is important to give a score that reflects how the person “feels,” not ” thinks.” We may logically ” know” that something is wrong, but we are most driven by how it ” feels.” Also, during the Assessment Phase, the person identifies the negative emotions (fear, anger) and physical sensations (tightness in the stomach, cold hands) he associates with the target. The client also rates the disturbance using the 0 (no disturbance)-to-10 (the worst feeling you’ve ever had) Subjective Units of Disturbance (SUD) scale. Reprocessing For a single trauma reprocessing is generally accomplished within 3 sessions. If it takes longer, you should see some improvement within that amount of time. Phases One through Three lay the groundwork for the comprehensive treatment and reprocessing of the specific targeted events. Although the eye movements (or taps, or tones) are used during the following three phases, they are only one component of a complex therapy. The use of the step-by-step eight-phase approach allows the experienced, trained EMDR clinician to maximize the treatment effects for the client in a logical and standardized fashion. It also allows both the client and the clinician to monitor the progress during every treatment session.
This phase focuses on the client’s disturbing emotions and sensations as they are measured by the SUDs rating. This phase deals with all of the person’s responses (including other memories, insights and associations that may arise) as the targeted event changes and its disturbing elements are resolved. This phase gives the opportunity to identify and resolve similar events that may have occurred and are associated with the target. That way, a client can actually surpass her initial goals and heal beyond her expectations. During desensitization, the therapist leads the person in sets of eye movement (or other forms of stimulation) with appropriate shifts and changes of focus until his SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). Starting with the main target, the different associations to the memory are followed. For instance, a person may start with a horrific event and soon have other associations to it. The clinician will guide the client to a complete resolution of the target. Examples of sessions and a three-session transcript of a complete treatment can be found in F. Shapiro & M.S. Forrest (2004) EMDR. New York: BasicBooks. http://www.perseusbooksgroup.com/perseus-cgi-bin/display/0-465-04301-1
The goal is to concentrate on and increase the strength of the positive belief that the person has identified to replace his original negative belief. For example, the client might begin with a mental image of being beaten up by his father and a negative belief of “I am powerless.” During the Desensitization Phase he will have reprocessed the terror of that childhood event and fully realized that as an adult he now has strength and choices he didn’t have when he was young. During this fifth phase of treatment, his positive cognition, “I am now in control,” will be strengthened and installed. How deeply the person believes his positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal is for the person to accept the full truth of his positive self-statement at a level of 7 (completely true). Fortunately, just as EMDR cannot make anyone shed appropriate negative feelings, it cannot make the person believe anything positive that is not appropriate either. So if the person is aware that he actually needs to learn some new skill, such as self-defense training, in order to be truly in control of the situation, the validity of his positive belief will rise only to the corresponding level, such as a 5 or 6 on the VOC scale.
6: Body scan
After the positive cognition has been strengthened and installed, the therapist will ask the person to bring the original target event to mind and see if he notices any residual tension in his body. If so, these physical sensations are then targeted for reprocessing. Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in motoric (or body systems) memory, rather than narrative memory, and retains the negative emotions and physical sensations of the original event. When that information is processed, however, it can then move to narrative (or verbalizable) memory and the body sensations and negative feelings associated with it disappear. Therefore, an EMDR session is not considered successful until the client can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.
Ends every treatment session The Closure ensures that the person leaves at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the person in using a variety of self-calming techniques in order to regain a sense of equilibrium. Throughout the EMDR session, the client has been in control (for instance, he is instructed that it is okay to raise his hand in the “stop” gesture at anytime) and it is important that the client continue to feel in control outside the therapist’s office. He is also briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and which techniques he might use on his own to help him feel more calm.
Opens every new session At the beginning of subsequent sessions, the therapist checks to make sure that the positive results (low SUDs, high VOC, no body tension) have been maintained, identifies any new areas that need treatment, and continues reprocessing the additional targets. The Reevaluation Phase guides the clinician through the treatment plans that are needed in order to deal with the client’s problems. As with any form of good therapy, the Reevaluation Phase is vital in order to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment, as it is to complete an entire course of treatment with antibiotics.
**information regarding the 8 phases of EMDR therapy has been adapted from EMDRIA.org
You will find lots of information on the internet about EMDR.
Read it and talk to me (or your therapist) about it.
Some will tell you EMDR is quick and painless–
especially relative to other forms of trauma therapy.
For some, this is accurate, but it is not a promise.
More often than not, EMDR stirs up emotions
and for a few weeks life may feel harder than before.
As a therapist, it is my job to know you well enough to know how much we can push without hurting your capacity to live your life. Whether you choose to do trauma therapy with EMDR or another model, please ask your therapist lost of questions about it and come up with a plan for how to handle the discomfort that will arise, maybe more intensely, outside of session.
As a neuroscientist-therapist, I love that EMDR’s success can be measured scientifically–through brain scans–as well as through typical forms of evaluation used in psychotherapy research. To learn more, visit: the Francine Shapiro library on EMDR