The therapeutic
process in
EMDR Therapy

EMDR employs an eight phase model of treatment to address the full range of personal problems caused or exacerbated by prior negative experiences. The eight phases of EMDR provide a systematic way to explore and process the negative experiences that are contributing to dysfunction, and the positive experiences that are needed to bring a client to full health.

The overall goal of EMDR is to achieve the most profound and comprehensive treatment effects possible. Therefore, it is important for the therapist to co-partner with you and explore your life story in order to understand the bigger picture of the problems you are experiencing.

During the first phase your therapist will use a history taking questionnaire and/or other tools:

• to obtain the necessary background information to better understand you and your specific problem/s
• to identify past events that have contributed to the current problem/s and needs further processing
• to identify specific aspects of current situations that trigger negative responses
• to identify future needs
• to discern whether EMDR treatment is suitable for you and
• to identify clear targets (from both positive and negative events in you life) that can be used in the process of helping you effectively overcome the problem/s. These targets include the event(s) from the past that created the problem, the present situations that cause distress, and the key skills or behaviors you need to learn for your future  well-being
• to develop an appropriate treatment plan to achieve the targets with EMDR

One of the unusual features of EMDR is that you do not have to discuss any of his disturbing memories in detail. So 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?” you 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 most clients this will take only 1-4 sessions. For others, with very traumatized backgrounds more time may be necessary.

Your therapist will emphasize that you need to actively participate in the process of healing. Therefore he/she will help you to understand the whole picture, i.e., what EMDR is and how it works, what you can expect during and after treatment, where your problem/s came from (including the panic attacks), what is reinforcing them in the present, what the choices might be, what the therapy can achieve… and the importance of actively engaging in the treatment by identifying memories and triggers.

To actively participate in the process, you must learn to trust your therapist. It is only when you trust him/her that you will be able to accurately report what you feel and what changes you are (or are not) experiencing during the eye movements. If you just want to please the clinician and say you feel better when you don’t, no therapy in the world will resolve your trauma. And in this phase you need to learn to trust your therapist and give honest feedback.

If you do not have sufficient positive experiences and counter-examples stored in your memory networks, the therapist will help you to establish positive experiences through the therapeutic relationship, and resource work that includes the incorporation of mastery experiences – before attempting comprehensive processing.

The therapist will also teach you specific techniques so you can rapidly deal with any emotional disturbance that may arise –

Finally, the therapist will teach you a variety of relaxation techniques for calming yourself and dealing with any emotional disturbance that may arise during or after a session – empowering you to actively participate in the process.. 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 unexpected, stress. One goal of EMDR therapy is to make sure that you can take care of himself.

One example is the Safe Place technique, in which you will learn to bring back (at will) a feeling of safety, calm, or courage. This will repeatedly help you to control feelings of helplessness or hopelessness that emerge from unprocessed memories… and continue the process of healing.

During this phase you will work with a specific stressful event (called the target event) – one that was earlier identified e.g., the physical abuse you suffered as a child, a violent crime against you, etc.  Your therapist will guide you through a process to delineate (or assess) all aspects of the experience you will be working with in a controlled fashion. In the process attention will be given to different aspects of the experience:

• a specific picture or scene from the event that best represents the memory;
• negative self-beliefs/cognitions (like “I am helpless,” ” I am worthless,” ” I am unlovable,” ” I am dirty,” ” I am bad,” etc.) associated with the event
• positive self-statements/cognitions that you would rather believe
• scoring the “how you feel” about positive self-beliefs;
• negative emotions (fear, anger) associated with the event
• physical sensations(tightness in the stomach, cold hands) associated with the event
• rating the disturbance level of the event

Phases One through Three lay the groundwork for the comprehensive treatment and reprocessing of the specific targeted event.

During this phase your therapist will focus on your disturbing emotions and sensations related to the event you started to explore in the previous phase. He/she will help you to deal with all your responses to the event – including memories, insights and associations that may arise as the targeted event changes during the process and its disturbing elements are resolved. You will (at the same time) be given the opportunity to identify and resolve similar events that may have occurred and are associated with the target event. That way, you can actually surpass your initial goals and heal beyond your expectations.

This process is called desensitization. During desensitization, your therapist will lead you in sets of eye movement (or other forms of bilateral stimulation) with appropriate shifts and changes of focus until the distress level of the event is as low as possible (a complete resolution of the target event is attained). He/she will use structured procedures that engage the adaptive mechanisms of the brain. The result will be that you will gain new sights, new memories will surface, negative emotions will be replaced with positive ones, and the entire memory will becomes adaptively assimilated within the larger memory networks of your brain.

This is the way it will work:

You will be asked initially to concentrate on the target memory (image, negative belief, sensation) while simultaneously attending to the bilateral stimulation. At the end of each set of stimulation you will be asked to report any new associations that may have emerged. Depending upon the response, your therapist may direct you to concentrate on the new information that has arisen, or return to the target. The various aspects of the target event are addressed in this manner until you can return to the targeted experience with no distress.

While many forms of therapy depend on the therapist to suggest alternative perspectives, direct action, or reframing the interpretation of an inherent belief, EMDR uses procedures that allow you to reshape the targeted experience yourself. Therefore EMDR clinicians are trained to stay out of the way as much as possible, since he/she does not know what the best unconscious connections are that need to be made.

If a memory has been successfully processed, it has been transformed in meaning and affect. As a result your experience and management of your life (your automatic reactions and behaviors) should also change e.g. in your relationships. Your therapist will therefore always try to determine whether you have processed the stressful experiences properly, increased positive reactions and behaviors and have been able to overcome previous deficits. Regardless of within-session observations, this can only be ascertained with progress reports after real world experiences.

For example, you might begin with a mental image of being beaten up by your father and a negative belief of “I am powerless.” During the Desensitization Phase the therapist will have helped you to reprocess the terror of that childhood event and to fully realize that as an adult you now have strength and choices you didn’t have when you were young. During this fifth phase of treatment, the positive belief, “I am now in control,” will be installed and strengthened. How deeply you believe this positive cognition is then repeatedly measured during the process. The goal is for you to accept the full truth of your positive self-statement at the highest possible level as true.

Evaluations of thousands of EMDR sessions indicate that there is a physical response connected to unresolved thoughts. This means that information about a traumatic event is stored in the motoric (or body systems) memory – rather than in the narrative (or verbalizable) memory. It is in this part of your memory that the negative emotions and physical sensations of the original event are retained. And it is this part of the body memory that creates the tension/stress in your body when something triggers the recollection of the target original event.

When that information is properly processed, however, the recollection of the event moves to the narrative 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 event without feeling any body tension.

After the positive cognition has been strengthened and installed, the therapist will therefore ask you to bring the original target event to mind and see if you notice any residual tension anywhere in your body. If so, these physical sensations are then targeted and processed in consecutive sets until the sensation dissipates.

This phase is completed when you have a “clean” body scan, devoid of any negative sensation.

Closure is the last part of every treatment session. It ensures that you leave 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 you in using a variety of self-calming (guided imagery)techniques in order to regain a sense of equilibrium. He will also brief you 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 you might use on your own to help you feel more calm.

During this phase of treatment you will be reminded to use your TICES Log. The TICES Log is a journal used to identify and record positive or negative experiences related to your problem between therapy sessions. It means that you will record these experiences by writing down the trigger, image, self belief, emotion and bodily sensation you experienced. This is then used to give an accurate report of your experiences to your therapist at the next session.

If a memory has been successfully processed, it has been transformed in meaning and affect. As a result your experience and management of your life (your automatic reactions and behaviors) should also change e.g. in your relationships. Your therapist will therefore always try to determine whether you have processed the stressful experiences properly, increased positive reactions and behaviors and have been able to overcome previous deficits. Regardless of within-session observations, this can only be ascertained with progress reports after real world experiences.

Consequently your therapist will (at the beginning of subsequent sessions) check to make sure that the positive results from previous sessions have been maintained, to identify any new related areas that surfaced and need treatment, and to continue reprocessing the additional targets.

As with any form of good therapy, the Re-evaluation Phase is vital in order to determine the success of the treatment over time. Although you 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.