In previous posts, we've talked about EMDR therapy (Eye Movement Desensitization and Reprocessing) and the benefits that EMDR can bring to your life. We've also discussed how EMDR works by using a process called bilateral stimulation. If you need a refresher, you can access that post here.
Today, we're going to walk through the 8 stages of EMDR to provide a more detailed understanding of what to expect from doing EMDR with a therapist.
Phase 1: History Taking, Case Conceptualization, & Treatment Planning
During this phase, your therapist is going to take quite a few sessions getting to know you and building rapport. We'll talk about what initially brought you to counseling, but we'll also dive a bit deeper into your family history and childhood trauma during this phase. We'll assess for any trauma exposure, developmental trauma, attachment, trauma symptoms, and/or dissociation. At Root Counseling, we believe the therapeutic relationship is one of the most powerful aspects of therapy, and our therapists are committed to ensuring we have a strong therapeutic relationship with our clients before conducting EMDR.
Think about it like this: we don't usually talk to a random stranger about our trauma. Our heavy stories are saved for those who we've built enough trust with to bear the weight. The same is true in therapy. Therapists have to prove to clients that they can be trusted. This can take time, but it's time well spent. The importance of that in this phase is almost indescribable! After building rapport and obtaining information related to your history, we'll assess client readiness. This just means that we make sure conducting EMDR on you is a safe option.
After client readiness has been assessed, we'll start to dive in on identifying the target you'd like to reprocess. We'll ask you specific questions related to your presenting complaint, and we'll also ask you to identify any disturbing past incidents related to your presenting complaint. While doing this, we're listening for the negative cognition you have about yourself. We'll talk about your first or worst event, present triggers, future concerns, future desired treatment outcome, and the positive cognition you would like to believe about yourself.
Phase 2: Client Preparation
This phase is one of my favorites because as therapists, we get to completely nerd out on some psychoeducation about how this works. This phase is all about preparing you, the client, to have a basic understanding about how EMDR works, as well as teach you resourcing skills.
We'll discuss how the amygdala plays a key role in holding on to trauma, what happens when the left brain and right brain can't communicate, and how bilateral stimulation helps them communicate again to reprocess the trauma. We'll dive into different types of bilateral stimulation (tapping, hand buzzers, music, etc), and you can pick what type of bilateral stimulation you enjoy. Each therapist has their own creative way to explain how EMDR works, but the main purpose is that we give you an informed understanding of EMDR and what to expect during this phase.
To prepare for reprocessing, we'll have you come up with a stop signal to signify to us when you need to stop. You have the power in our sessions, and when you need to take a break, this stop signal is a physical indicator that it's time to pause.
As mentioned above, teaching resourcing is a key part of this phase. What this means is that we'll teach you specific techniques that can help you enter into a state of regulation. This part of the phase is pretty creative on the part of the client, because you get to decide if you'd like an aroma to be what grounds you, create a safe space in your mind that you love to visit, or if breathing techniques are what work best for you. Regardless of what you choose, the goal is for you to have something, someone, or somewhere you can tap into to regulate your nervous system during reprocessing. We'll use bilateral stimulation during this part to get you familiar with it and to also lock in your safety net.
Because we might not finish processing through everything we need to, you'll work with your therapist to create a container to hold any of the extra heaviness between sessions. Like the other resource you created, your container can be creative, too! You get to pick what you want your container to look like and where you want to keep it.
Phases 3-7: Assessment, Desensitization, Installation, Body Scan, & Closure
Phases 3-7 all happen during one therapy session. This is the session where you'll reprocess the trauma you've chosen with your therapist. It sounds like a lot (and it is), so let's walk through it together:
Phase 3: Assessment - Specific target memory to access is selected from the treatment plan created with your therapist. You can keep your eyes opened or closed during this part while the therapist asks you to bring up the incident in your mind, a picture that represents the worst part of that incident, the negative cognition and positive cognition identified in the treatment plan, assessing the validity of the positive cognition, naming the emotion, assessing the subjective units of disturbance (SUDS), and noticing where you feel that disturbance in your body.
Phase 4: Desensitization - This is where bilateral stimulation plays a huge part! We'll encourage you to allow whatever comes up in your mind to come up, and we'll start doing bilateral stimulation (tapping, buzzing, listening to bilateral music, whichever method you chose). Once we stop the bilateral stimulation, we'll ask you what the last image, thought, words, or sensations that you had were, and then we'll encourage you to go with that while we resume the bilateral stimulation. We'll do this a lot during this stage, so once there's no new disturbing material coming up for you, we'll reevaluate the target, ensure your SUDS is low, and then we'll move on to the next phase.
Phase 5: Installation Phase - During this phase, we'll install the positive cognition you created and assess the validity of that positive cognition. We'll have you hold the picture of the original incident and the positive cognition while doing bilateral stimulation.
Phase 6: Body Scan - EMDR helps the the body release the trauma it's been holding on to. We'll have you focus on the original incident and your positive cognition and scan for where you feel anything in your body. We'll use bilateral stimulation during this phase.
Phase 7: Closure - This is where the container you created comes in handy. We'll ask you if there's anything disturbing you think you need to put into your container. You'll imagine putting 100% of whatever work is left into that container, and we'll also tap into the safe space, aroma, or person you came up with in phase 2.
Phase 8: Re-Evaluation
At the following session, we'll re-evaluate the initial target. If disturbing material still comes up, we'll work through phases 3-7 again. After the SUDS is assessed there's no distress, we'll go back to the treatment plan to find the next target. Once all targets that were identified in your treatment plan have been worked through, you're an official graduate of EMDR! But that doesn't mean you can't decide to process something else. As life moves forward and we continue to heal, stuff comes up. You can always resume EMDR at any time with your therapist.
Things to Know
EMDR is an incredible treatment modality, and we're huge advocates for this method. There are a few things we want you to take away with you about EMDR:
You'll feel very tired after an EMDR session. Make sure you give yourself time to rest.
Because we're tapping into unaccessed trauma, things will continue to process days after your EMDR sessions. Basically, what we've done is we've taken something that was frozen in time, locked in your nervous system the way it originally happened, and that's why you've continued to cycle through it because your brain has been trying to heal. Whatever comes up between sessions, make sure you write it down. You can also put anything in your container, too.
EMDR is not allowed to be conducted by therapists without training and/or certification. Therefore, not all therapists can do EMDR. If you're wanting EMDR, make sure you find a therapist who is trained and/or certified in it.
At Root Counseling, all of our therapists are trained in EMDR. If you're interested in scheduling an appointment, you can visit our therapists here.