EMDR therapy, initially for PTSD, arose serendipitously through Dr. Shapiro’s observations; it’s now a structured approach utilizing eight distinct phases for comprehensive treatment.
What is EMDR?
EMDR (Eye Movement Desensitization and Reprocessing) therapy is a structured psychotherapy approach designed to alleviate the distress associated with traumatic memories. It doesn’t involve extensive talking about the trauma itself, but rather focuses on processing the disturbing experiences through bilateral stimulation – typically eye movements, but also tactile or auditory stimulation.
This process aims to reduce the vividness and emotional charge of the memory, allowing individuals to reprocess it in a more adaptive way. Originally developed to treat Post-Traumatic Stress Disorder (PTSD), EMDR is now recognized as effective for a range of mental health conditions. The therapy operates on the premise that traumatic memories are “stuck” in the brain and prevent normal processing.
Through the eight phases of EMDR, therapists guide clients to access these memories safely and facilitate their natural healing capacity. It’s a goal-oriented therapy, meaning it focuses on specific targets related to past experiences.
Historical Context of EMDR
EMDR’s origins trace back to 1987, when Dr. Francine Shapiro noticed that rapid eye movements seemed to diminish the intensity of disturbing thoughts. This accidental discovery sparked her research, leading to the development of the therapy. Initially, the process wasn’t fully understood, but Shapiro hypothesized that eye movements facilitated the processing of traumatic memories, similar to what occurs during REM sleep.
Early research focused on validating these observations, and by the early 1990s, EMDR began gaining recognition as a potentially effective treatment for PTSD. However, it wasn’t without controversy, with some skepticism surrounding the mechanism of action.
Over time, rigorous research studies have supported EMDR’s efficacy, leading to its acceptance by major mental health organizations. The therapy has evolved from its initial focus on eye movements to incorporate other forms of bilateral stimulation, solidifying its place as a valuable therapeutic tool.
EMDR for Trauma and PTSD
EMDR (Eye Movement Desensitization and Reprocessing) therapy is widely recognized as a highly effective treatment for Trauma and Post-Traumatic Stress Disorder (PTSD). It addresses the underlying mechanisms of traumatic memories, which often become “stuck” in the brain, causing distressing symptoms like flashbacks, nightmares, and anxiety.
Unlike traditional talk therapies that focus on cognitive processing, EMDR directly targets the emotional impact of trauma. By utilizing bilateral stimulation – typically eye movements – the therapy facilitates the brain’s natural processing abilities, allowing traumatic memories to be reprocessed and integrated in a healthier way.
EMDR isn’t limited to combat PTSD; it’s also effective for processing trauma resulting from accidents, natural disasters, abuse, and other distressing life events. Its structured eight-phase approach provides a safe and controlled environment for individuals to confront and resolve traumatic experiences.
The Eight Phases of EMDR: A Comprehensive Overview
EMDR therapy follows a structured eight-phase protocol, encompassing history taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation for optimal results.
Phase 1: History Taking & Treatment Planning
Phase one of EMDR therapy is dedicated to a thorough client history, establishing a strong therapeutic alliance, and collaboratively developing a comprehensive treatment plan. The therapist gathers detailed information about the client’s past experiences, focusing on both traumatic events and positive life experiences.
This phase isn’t simply about recounting trauma; it’s about understanding the client’s overall functioning, coping mechanisms, and resources. Identifying potential target memories is crucial, alongside exploring any existing diagnoses or co-occurring conditions.
The treatment plan outlines specific goals, target memories to be addressed, and the anticipated sequence of processing. A key aspect is ensuring the client has adequate coping skills and resources to manage potential distress during subsequent phases. This foundational stage sets the stage for safe and effective EMDR processing.
Phase 2: Preparation
Phase two in EMDR therapy focuses on preparing the client for the processing of traumatic memories. This involves educating the client about the EMDR process, explaining the eight phases, and addressing any questions or concerns they may have. Establishing a sense of safety and control is paramount.
The therapist works with the client to develop coping skills and relaxation techniques to manage potential distress that may arise during processing. This might include imagery techniques, deep breathing exercises, or grounding methods.
Building a strong therapeutic relationship and ensuring the client feels empowered throughout the process are vital. The goal is to create a safe container where the client can explore difficult memories without feeling overwhelmed. This preparatory stage is essential for successful EMDR treatment.
Phase 3: Assessment
Assessment involves pinpointing specific target memories, gauging their disturbance using the SUD scale, and validating associated beliefs with the VOC scale.
Identifying Target Memories
Identifying target memories is a crucial step within the EMDR assessment phase. This process doesn’t immediately focus on the worst memory, but rather on memories that are readily accessible and representative of the broader trauma network. Therapists guide clients to pinpoint specific images, negative cognitions (beliefs about themselves), emotions, and bodily sensations linked to distressing events.
The goal is to select memories that, when processed, will have a ripple effect, reducing overall disturbance. Clients are encouraged to “float back and forth” between different aspects of the event, noticing what stands out most vividly. These initial targets are often chosen based on their current level of disturbance, as indicated by the Subjective Units of Disturbance (SUD) scale. The therapist assists in breaking down complex traumas into manageable components, ensuring the selected memory is specific and well-defined for effective processing during subsequent phases.
Establishing a Validity of Cognition (VOC) Scale
The Validity of Cognition (VOC) scale is a key component of EMDR therapy’s assessment phase, used to measure the client’s belief in a positive cognition. This scale ranges from 1 to 7, where 1 indicates complete disbelief and 7 signifies complete belief. It’s applied after a negative cognition related to a target memory has been identified.
The therapist and client collaboratively identify a positive cognition that ideally represents how the client would like to believe about themselves in relation to the trauma. For example, if the negative cognition is “I am helpless,” the positive cognition might be “I am capable.” The VOC scale then assesses how true this positive statement feels to the client right now.
This measurement provides a baseline and tracks progress as EMDR processing strengthens the client’s belief in the positive cognition, ultimately shifting their perspective and reducing distress.
Subjective Units of Disturbance (SUD) Scale
The Subjective Units of Disturbance (SUD) scale is a crucial element within EMDR therapy’s assessment phase, quantifying the level of distress associated with a specific target memory. This scale ranges from 0 to 10, with 0 representing complete calm and 10 indicating the highest possible level of disturbance. Clients rate their distress based on the intensity of the negative emotions, physical sensations, and images connected to the memory.
Before initiating EMDR processing, the therapist asks the client to focus on the target memory and then rate their current level of disturbance using the SUD scale. This provides a baseline measurement. Throughout the desensitization phase, the SUD is repeatedly assessed after each set of bilateral stimulation (BLS) to track reductions in distress.
A significant decrease in SUD levels indicates successful processing of the traumatic memory.
Phase 4: Desensitization
Desensitization employs bilateral stimulation (BLS) – eye movements, tactile, or auditory input – while the client focuses on the target memory, reducing its emotional impact.
Bilateral Stimulation (BLS) Techniques
Bilateral Stimulation (BLS) is a core component of EMDR therapy’s desensitization phase, crucial for processing traumatic memories. It involves alternating stimulation of both sides of the body, believed to mimic the rapid eye movements occurring during REM sleep – a phase linked to memory consolidation and emotional regulation.
The most commonly recognized BLS technique is eye movements, where the therapist guides the client’s focus between two points moving horizontally. However, tactile stimulation, such as alternating taps on the hands or shoulders, and auditory stimulation, using alternating tones in headphones, are also effective alternatives.
The choice of BLS technique is individualized, based on client preference and suitability. The stimulation isn’t directed at the memory itself, but rather serves as a conduit to unlock the brain’s natural processing capabilities, allowing the memory to be reprocessed and integrated adaptively. BLS helps reduce the vividness and emotional charge associated with distressing experiences.
Eye Movements in Desensitization
Eye Movement Desensitization and Reprocessing (EMDR) utilizes specific eye movements as a primary form of Bilateral Stimulation (BLS) during the desensitization phase. The therapist guides the client’s gaze horizontally, back and forth, typically with a finger or a light bar. These aren’t random movements; the pace and pattern are carefully adjusted to suit the individual’s processing speed.
The theory suggests these rhythmic eye movements activate the brain’s information processing system, similar to what occurs during REM sleep. This facilitates the adaptive resolution of traumatic memories, reducing their emotional intensity and vividness. Clients are encouraged to simply notice their internal experience – thoughts, feelings, sensations – while following the therapist’s guidance.
The eye movements aren’t focused on the trauma itself, but rather serve as a dual-attention stimulus, allowing the brain to reprocess the memory without becoming overwhelmed. This process helps to break down the memory’s rigid neural connections, leading to more adaptive cognitive structures.
Tactile and Auditory BLS
While eye movements are the most recognized form of Bilateral Stimulation (BLS) in EMDR therapy, tactile and auditory stimulation offer valuable alternatives, particularly for clients who find eye movements distressing or ineffective. Tactile BLS involves alternating gentle taps on the client’s hands, shoulders, or knees. This provides a grounding sensation and can be especially helpful for individuals with a history of trauma.
Auditory BLS utilizes alternating tones presented through headphones, one to each ear. The pace and volume are adjusted to the client’s comfort level. Both tactile and auditory stimulation share the same neurological principle as eye movements – creating a dual-attention stimulus that facilitates information processing.
The choice of BLS modality is individualized, based on client preference and clinical presentation. Therapists often explore different options to determine what best supports the client’s reprocessing work, ensuring a safe and effective therapeutic experience.
Phase 5: Installation
Installation strengthens newly formed positive cognitions, replacing negative beliefs with empowering affirmations; this phase aims to solidify the client’s adaptive mindset.
Strengthening Positive Cognitions
During the installation phase of EMDR therapy, the focus shifts towards reinforcing a positive cognition that the client has identified as a desired belief. This isn’t simply about thinking a positive thought, but about deeply instilling it as a genuine and believable truth. The therapist guides the client to fully associate with this positive cognition while simultaneously engaging in bilateral stimulation (BLS).
The goal is to increase the “validity of cognition” (VOC) score – a subjective measure of how true the positive belief feels to the client. BLS helps to process the positive cognition, allowing it to become more firmly rooted in the client’s neural pathways. The therapist will repeatedly ask the client to focus on the positive cognition and assess its validity, continuing BLS until a high VOC score is consistently reported. This ensures the positive belief isn’t just intellectually understood, but emotionally experienced and integrated.
Using Positive Affirmations
Positive affirmations play a crucial role within the installation phase of EMDR therapy, working in tandem with strengthening positive cognitions. These aren’t merely repeated phrases, but carefully chosen statements that directly counter the negative beliefs associated with the target memory. The therapist collaborates with the client to craft affirmations that feel authentic and personally meaningful, fostering a sense of empowerment.
While the client focuses on the affirmation and engages in BLS, the brain processes the new information, reducing the power of the original negative belief; The affirmation should be present-tense and stated positively – for example, “I am worthy of love” instead of “I am not unworthy.” Repeated assessment of the “validity of cognition” (VOC) scale ensures the affirmation is becoming increasingly believable. This process aims to create a lasting, positive internal shift.
Phase 6: Body Scan
EMDR’s body scan assesses lingering physical sensations linked to the processed memory, identifying any residual tension needing further attention during continued therapeutic work.
Assessing Residual Tension
During the body scan phase of EMDR therapy, the client is guided to internally focus on the target memory and then systematically scan their body for any remaining physical sensations. This isn’t about creating sensations, but rather noticing what is already present. The therapist asks the client to observe if there are any areas of tension, tightness, heat, or other physical feelings associated with the memory.
This assessment is crucial because trauma is often “stored” in the body, manifesting as physical discomfort. Identifying these residual sensations helps determine if the desensitization process was fully effective. If tension remains, it indicates that the memory still holds a physiological charge and requires further processing. The client is encouraged to describe these sensations without judgment, simply noting their location and intensity.
The goal isn’t to eliminate all physical sensation – that’s unrealistic – but to reduce the intensity and distress associated with them, allowing the client to experience the memory with less reactivity.
Addressing Physical Sensations
If residual tension is identified during the body scan, EMDR therapy proceeds to directly address these physical sensations. The therapist guides the client to focus on the identified areas of discomfort, encouraging them to observe the sensations without attempting to change or suppress them. This mindful awareness is key.
Further bilateral stimulation (BLS) may be employed, specifically targeting the physical sensations. The client is asked what they notice in their body during the BLS sets, and how the sensations shift or change. The focus shifts from the cognitive aspects of the memory to the somatic experience.
The therapist may also utilize resourcing techniques – accessing calming images or safe places – to help the client regulate their nervous system and tolerate any discomfort. The aim is to help the client process the physical component of the trauma, allowing the body to release the stored energy and move towards a state of equilibrium.
Phase 7: Closure
Closure ensures the patient leaves each session stable, even if processing isn’t complete; self-soothing techniques are taught to manage distress between EMDR sessions.
Ensuring Patient Stability
Patient stability is paramount during the Closure phase, recognizing that full processing of traumatic memories often extends beyond a single session. Therapists proactively equip clients with strategies to self-regulate and manage any potential distress that may arise between appointments. This involves reinforcing coping mechanisms previously established during the Preparation phase, such as deep breathing exercises, grounding techniques, or visualization of safe places.
The goal isn’t to eliminate all discomfort, but to ensure the client feels empowered to handle any emergent emotional or physical sensations. Therapists may also provide a “safe place” exercise, guiding the client to vividly imagine a location where they feel completely secure and calm, to which they can mentally retreat if needed. Crucially, clients are reminded that experiencing unsettling feelings is a normal part of the EMDR process and doesn’t signify failure or regression.
Furthermore, therapists emphasize the importance of self-care activities – engaging in enjoyable hobbies, maintaining social connections, and prioritizing physical health – to bolster overall well-being and resilience throughout treatment.
Self-Soothing Techniques
Self-soothing techniques are integral to EMDR therapy, particularly during the Closure phase, empowering clients to manage residual distress independently. These strategies aim to activate the parasympathetic nervous system, promoting a sense of calm and safety. Common techniques include deep, diaphragmatic breathing exercises, focusing on slow, deliberate inhales and exhales to regulate heart rate and reduce anxiety.
Grounding exercises, such as the “5-4-3-2-1” method – identifying five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste – help anchor individuals in the present moment, diminishing overwhelming emotional sensations. Visualization of a peaceful and secure location, a “safe place,” provides a mental refuge.
Progressive muscle relaxation, gentle stretching, or engaging in enjoyable activities like listening to calming music or spending time in nature can also be highly effective. Clients are encouraged to experiment and identify techniques that resonate most effectively with their individual needs.
Phase 8: Reevaluation
Reevaluation assesses EMDR treatment’s progress, identifies remaining disturbances, and plans future sessions to address unresolved issues for complete healing.
Assessing Treatment Progress
During reevaluation, a thorough assessment of the client’s progress is paramount. This involves revisiting the initial target memories and associated disturbances to gauge the reduction in Subjective Units of Disturbance (SUD) scores. Therapists meticulously compare current SUD levels with those recorded during the initial assessment phase, documenting any significant changes.
Furthermore, the Validity of Cognition (VOC) scale is revisited to determine the strength of the positive cognition established during the installation phase. An increase in the VOC score indicates a stronger belief in the positive cognition, signifying successful reprocessing. The therapist also explores whether the client experiences any lingering negative emotions or physical sensations when recalling the target memory.
This phase isn’t merely about numerical scores; it’s a holistic evaluation of the client’s overall well-being and functional improvements. The therapist actively solicits feedback from the client regarding their experiences and perceived changes since the previous session, ensuring a collaborative approach to treatment monitoring.
Identifying Remaining Issues
Reevaluation extends beyond simply measuring progress; it’s crucial to pinpoint any residual unprocessed components or newly surfaced memories. Clients may report fragments of the original trauma or uncover related distressing experiences that require attention. The therapist actively explores these emerging issues, assessing their potential impact on the client’s overall well-being.
This involves a careful review of the client’s narrative, looking for inconsistencies or areas where emotional reactivity persists. Sometimes, seemingly unrelated memories become linked during reprocessing, revealing previously hidden connections to the initial trauma. Identifying these connections is vital for comprehensive treatment.
The therapist and client collaboratively determine if further processing is needed, potentially establishing new target memories for subsequent EMDR sessions. This ensures that all relevant aspects of the trauma are addressed, promoting lasting healing and resolution.
Future EMDR Sessions
Following reevaluation, the therapist and client collaboratively plan any necessary future EMDR sessions. This isn’t always a linear progression; sometimes, a client may require additional processing of previously targeted memories, or new targets may emerge during the ongoing work. The treatment plan remains flexible and responsive to the client’s evolving needs.
The number of future sessions depends on the complexity of the trauma and the individual’s processing speed. Some clients may benefit from a few additional sessions, while others may require more extensive treatment. The focus remains on achieving adaptive resolution, reducing distress, and enhancing the client’s coping mechanisms.
Continued monitoring of symptoms and regular assessments are essential to track progress and adjust the treatment approach as needed, ensuring optimal outcomes and lasting positive change.