8 Phases of EMDR Therapy
EMDR. You may or may not have heard these letters tossed around before. You tell a friend that you are looking for a new therapist and the friend says “have you tried EMDR?” Next, the algorithm starts showing you posts about EMDR therapy. And then you type EMDR into a search engine to find out, what exactly is EMDR. In this blog post, I’ll break down those letters, the approach, the 8 phases of this type of therapy, and how to prepare for EMDR therapy.
What is EMDR and how can it help you?
EMDR stands for Eye Movement Desensitization and Reprocessing. EMDR was discovered in the 1980s by Francine Shapiro. The premise for her discovery was that while she was taking a walk, she was moving her eyes back and forth, while thinking about a life stressor. She found that she felt better and started testing out the theory: moving your eyes back and forth while thinking of something that is causing distress can lead to feeling better.
Since then hundreds of hours have been spent researching the outcomes of EMDR. Through research, the model has been expanded to include different types of bilateral stimulation beyond moving eyes back and forth. This can include tapping or audio tones. The standard protocol of EMDR has also been expanded to include protocols for recent events, anticipated future events, and diagnoses other than PTSD. EMDR has been shown to be effective in reducing and eliminating symptoms associated with PTSD, trauma, pre-verbal trauma, anxiety, depression, grief and loss, phobias, substance use, etc.
Having some sense of understanding of EMDR can help you feel more confident in the treatment you are getting, provide you with a sense of direction in your therapy journey, and help you feel prepared for what to expect.
EMDR is rooted in the theoretical model of Adaptive Information Processing or AIP. This model asserts that the brain is wired to adaptively process information and that memories are stored in networks. However, when something distressing or traumatic happens, the brain may not optimally be able to process and therefore the memory gets stuck. This is where EMDR and the use of bilateral stimulation comes in and can help support the brain in reprocessing the memory in an adaptive way.
EMDR is a 3 pronged approach. What does this mean? It means that everything is interconnected. It can be hard to imagine a positive future, if there are memories from your past that contribute to feeling unwell. In EMDR, we take an approach of addressing first the past, then the present, and then the future. Typically, once memories from the past are reprocessed, the present gets a little bit easier, and then imagining a positive future becomes much easier.
8 Phases of EMDR Therapy
Within the 3 prongs, EMDR has 8 phases of treatment. Some of these phases will feel like traditional talk therapy. Take a look below to find out just what will be happening during EMDR treatment and how it all flows together!
1st Phase: History Taking
The number one predictor of success in therapy is the relationship that you have with your therapist. So, the first phase is meeting your therapist, building trust, and sharing who you are. Each therapist has a different style of doing this. Some might have a series of questions, others will let you take the lead. The important thing is to come prepared to share what brings you in, present day concerns, and provide history about important aspects of your life.
As your therapist gets to know you, the presenting problem, and your history; the therapist will be able to notice pain points, parts that need care, and develop some ideas for memories to target in later stages of EMDR.
2nd Phase: Preparation
The next phase of EMDR is preparation. During this phase your therapist will start to prep you for a desensitization session. Think of this stage as preparation appointments prior to surgery (like maybe you need to pick up medication or have x-rays done.) Your therapist will provide education about EMDR and answer any questions or concerns.
You and your therapist will also identify or build resources that can help ground you and help you cope with distress. Some examples of these skills include creating a before and aftercare plan about how you will take care of yourself between sessions, creating peaceful imagery that you can focus on, creating an imaginary container that you can put away distressing emotions/thoughts/sensations, or reminding yourself of memories where you felt confident/strong/capable/ etc.
3rd Phase: Assessment
The third phase is assessment. During this phase, your therapist and you will determine what memory you are wanting to target for phase 4. Your therapist and you may have already identified pain points and memories during phase 1.
During phase 3, your therapist will ask you specifics about the memory including the image, belief, emotions, and physical sensation. These targeted questions can help bring the memory into greater focus. You will also start to determine what you would prefer to believe (something positive) about yourself when thinking about the memory.
4th Phase: Desensitization
The fourth phase of EMDR is desensitization. This is the phase where your therapist will guide you to move your eyes back and forth, or your preferred bilateral stimulation, while you think about the memory that is causing stress. The bilateral stimulation (BLS) allows both sides of the brain to be activated, which results in more efficient processing. During this phase, your therapist will stop every minute or so and ask you take a breath and then you will be asked to briefly share what you were noticing.
Once you say what you were noticing, your therapist will ask you to go with what you were just noticing and return to bilateral stimulation. Your therapist will help guide you if things seem stuck. You will continue to do sets of BLS until there are no new associations with the memory and the level of distress has decreased. Sometimes this takes one session and sometimes it takes many.
5th Phase: Installation
The fifth phase is to install the positive belief (from phase 3 or you may pick a new positive belief) with the memory. Your therapist will guide you to notice the positive belief in conjunction with the memory that was just desensitized. This will be enhanced with BLS.
6th Phase: Body Scan
The sixth phase is to do a head to toe body scan, while holding the target memory and positive belief, and notice any sensation that comes up. If there is any sensation that has a negative charge to it, your therapist will have you notice that while doing BLS.
7th Phase: Closure
The seventh phase is closure. This phase will occur at the end of the session regardless of if you complete phases 4-6. During this phase your therapist will guide you to the present moment and bring in resources that you established during phase 2.
8th Phase: Reevaluation
The eighth phase occurs at the beginning of the next session and you and your therapist will check in on recently desensitized memories to ensure that they are still neutral and that the positive belief is still strong. If you have not completed desensitization of a memory, your therapist will go back to phase 3, ask you to check in with the memory and notice what comes up. From there your therapist will guide you to re-enter phase 4.
You will repeat this process until memories from the past and present concerns have been reprocessed. Once that is completed, your therapist will guide you to notice any future situations.
If there is any level of distress that appears dysfunctional, you will go back to reprocessing. If there is no distress, your therapist will guide you to visualize a future situation in which the outcome is positive. For example, if you reprocessed a bad break up, you may want to install positive beliefs and visualize a scene where you successfully go on a date with someone new.
Tips to Help you Prepare for EMDR Therapy:
The most supportive thing you can do when engaging in therapy is take care of you.
Do your best to:
stay hydrated
eat nutrient dense foods
practice sleep hygiene
avoid substances
get some movement or exercise in
It can be helpful to have a routine when it comes to EMDR therapy. Potentially scheduling time before and after the session; which will allow you to prepare and reflect. This can help you to know what you want to discuss or share and afterwards help to integrate any new insights, emotions, or body sensations.