EMDR
Eye Movement Desensitization and Reprocessing (EMDR) is a therapeutic approach designed to help individuals process traumatic memories and distressing experiences. EMDR involves bilateral stimulation (BLS). There are a variety of ways to incorporate BLS into your session. Your therapist may move their hand back and forth. Some therapists have you hold buzzers. The client can actually do the tapping on their knees or cross their arms. Light bars are used as you follow the ball across the bar. In telehealth, the client watches the ball go back and forth across the screen. There is even auditory versions. At Reilly Counseling, we have buzzers for in person sessions or client using telehealth click and follow the ball across the screen. The eight phases of EMDR are as follows:
History and Treatment Planning: In this phase, the therapist takes a detailed history of the client’s background, including identifying past traumatic memories that need to be processed. A treatment plan is created. Then the client prioritizing memories and targeting specific issues. Keep in mind, EMDR uses a three prong approach - looking at the past, examining the present stressors and preparing for future stressors.
Preparation: The therapist explains the EMDR process to the client, addressing any concerns and ensuring they feel comfortable and safe. The therapist also teaches coping mechanisms to manage emotional distress, such as grounding techniques or relaxation exercises. Two resources introduced include a container (imaginary container to store the memories) and safe/calm place. There are plenty of other resources to utilize.
Assessment: Together the client and therapist identifies a specific target memory to process. They also determine the negative belief associated with the memory (e.g., "I am powerless") and the desired positive belief (e.g., "I am in control"). The client rates their level of distress (SUDS - Subjective Units of Disturbance Scale) and their belief in the positive statement (VOC - Validity of Cognition). The SUD scale is zero (no distress) to 10 (highest distress). The VOC is on a scale of 1 (completely false) to 7 (complete true). The idea is for the SUD rating to decrease while the VOC increases.
Desensitization: In this phase, the client focuses on the target memory while engaging in bilateral stimulation (typically eye movements) to help reprocess the traumatic memory. The therapist encourages the client to notice any shifts in their thoughts, feelings, or physical sensations. The goal is to reduce the emotional charge of the memory. There are several sets of BLS after each one the client takes a deep breath and then another set of BLS resumes. There is no real time frame on this starge. It could take multiple sessions. As the client becomes more comfortable with EMDR and targets are completed, you may notice some targets are processed in one session.
Installation: Once the SUD is reported to be a zero. The next phase begins. This phase focuses on reinforcing the positive belief the client identified earlier (e.g., "I am in control"). The therapist uses bilateral stimulation to strengthen the connection between the memory and the new, positive belief, helping the client integrate it more fully. BLS is used with shorter sets.
Body Scan: The therapist asks the client to mentally scan their body for any remaining tension or discomfort linked to the traumatic memory. If any negative sensations are present, the therapist uses bilateral stimulation to help process and release these feelings.
Closure: In this phase, the therapist ensures that the client feels stable and calm before ending the session. If the target memory has not been fully processed, the therapist may use techniques to return the client to a state of emotional equilibrium and prepare them for the next session. The container may be used to “hold” the memories until the next session. Typically, the therapist is assessing how the client is after a session. Utilizing calm place or breathing techniques may be used to have the client end the session. Clients are encouraged to use their resources if needed and track any emotions, cognitions and behaviors they experience after an EMDR session. A few clients report sleeping well after an EMDR session.
Reevaluation: During subsequent sessions, the therapist revisits previously processed memories to ensure that the gains made are stable and the client’s emotional distress remains low. The therapist checks whether any new issues have emerged or whether further processing is needed. Then the client and therapist will proceed to the next identified target. EMDR can be used for a single incident trauma or a series of traumatic events.
These eight phases work together to help individuals reprocess traumatic memories in a safe, structured way, reducing their emotional impact and facilitating healing. In my experience, there are clients who seek me out for EMDR and other clients I am introducing it to them. We spend a lot of time discussing the approach. I remind the clients they are in control. I have clients who have no interest in EMDR and others who use it regularly. We may do EMDR for one session and then next week return to traditional talk therapy.
Melissa Zawisza, LCSW-S is EMDR Certified and is a Consultant in Training (CIT) to assist other therapists in their EMDR learning process.
