How EMDR Therapy Works: A Step-by-Step Guide for Beginners
Whether you’re just hearing about Eye Movement Desensitizing and Reprocessing (EMDR), are starting EMDR, or have been doing EMDR with a therapist, it can be helpful to have an in-depth overview and guide of the process.
You’re probably here because you’re wanting to feel better. That could be noticing and experiencing unexpected triggered discomfort, anxiety, depression, disconnection from self, low self-esteem, PTSD, or all kinds of other struggles. EMDR is an effective, efficient, and widely used tool to help with these struggles. Initially created to process past trauma, notably for PTSD clients, it has expanded its use as well as shown wonderful results with the other things (e.g. anxiety) mentioned above.
If you’re curious about EMDR or considering it as a treatment option, this EMDR guide will help you understand more about the process so you can be better informed and prepared. We’ll talk about an overview of EMDR, the setup prior to EMDR, as well as breaking down each phase of therapy.
What is EMDR Therapy?
Before talking about the phases of EMDR, let’s give a quick overview. Initially developed in the 80s by Francine Shapiro to treat trauma and PTSD, it’s been more and more widely used by therapists all over the world. Unlike traditional talk therapy, EMDR utilizes bilateral stimulation (BLS) to desensitize, or reduce the discomfort or distress, and reprocess, change the belief and somatic responses, the trauma.
The underlying theory is that we experience all kinds of events throughout life, most of which go well. However, at times those events or situations can be traumatic. Normally what our brains and systems do is process through that situation and store it away appropriately. However, sometimes that doesn’t happen for reasons we don’t always remember or understand. When that trauma gets ‘stuck’ it can be triggered. When that happens and that triggered ‘feeling state’ comes out it gives similar thoughts, somatic or physical reactions, and emotional reactions as the original trauma. What our systems also do is create avoidance to keep things from getting triggered, as well as coping when something does get triggered.
For example, when going through childhood physical abuse, a child can internalize the stuck trauma and triggered feeling state of “I am worthless” along with a sinking feeling, depressed mood, and shameful reaction. In present day this can get triggered in a situation where there is subtle criticism that wouldn’t feel great to most people, but due to the triggered feeling state it’s an 8/10 instead of 3/10. To avoid having this triggered this person might avoid situations where any feedback or criticism can happen, as well as cope if it doesn’t happen for example with drinking.
To process through this, EMDR would utilize the BLS to desensitize the charge, reprocess the worthlessness and associated somatic and emotional response, and instill a positive belief.
Prior to the EMDR process itself, most therapists offer a phone consultation to get to know them and give you an opportunity to ask some questions. Along with that therapists have some paperwork to fill out ahead of time.
Now, let’s go through the EMDR process step by step.
Phase 1: History Taking and Assessment
The initial step of EMDR is all about learning more about you, the client, as well as rapport (or connection) building. For learning more about you, we take a dive in to your history. The therapist will gather information about your life, both past and present. This can include relationships, family, past trauma, work, family dynamics, and whatever else feels important to you. We also establish hopes and goals for therapy and EMDR. All of this helps both the client and therapist build a comprehensive picture of who you are as a person and have a better understanding of how to move forward.
Part of this step is identifying the specific ‘target memories’ that we will want to work on with EMDR. The hallmark of these memories are ones that are still currently bringing up discomfort or distress in your system when you think of them. The therapist doesn’t need much information, only an approximate age, a 0-10 rating of how strong the reaction is present day, and ideally a description of the triggered feeling state – the belief (e.g. I am worthless), somatic response (e.g. sinking feeling), and emotional response (e.g. shame). For example, from the physically abused client from above, it could be a memory of being hit by a parent when they were 6 that still feels like a 5 (out of 10) present day. To be clear, we don’t need much information on the specific trauma. Although it can be helpful, for some clients it can be too much to talk about so we’re able to avoid that with EMDR if needed.
During the history-taking phase, you and the therapist will also discuss what is and isn’t working for you in life as well as with coping. This can also cover social supports to utilize during or after EMDR sessions.
Phase 2: Preparation
The next phase of EMDR therapy is Preparation. During this phase, the therapist will help you prepare or get ready for the actual reprocessing of trauma. This is helpful because EMDR can temporarily bring up discomfort while working on the memories. This can be emotions, somatic responses, thoughts, all of which can come in strongly. Although this is where the healing happens, it’s important to be prepared for this potential. We want you to feel safe enough and comfortable enough to push through anything that comes up and allow your system to heal.
Part of this step is your therapist explaining how EMDR works as well as what to expect during sessions. They will also go over some anxiety, overwhelm, and distress management options. This can include mindfulness, deep breathing, grounding, and other central nervous system de-escalation techniques. These tools are important to help during EMDR if you need a pause, as well as after session if some of the processing continues.
One of the other pieces of preparation is a specific coping visualization exercise called the “safe place” exercise. This involves internal resourcing that allows you to have a safe, or calm, visualization exercise to use to de-escalate. This can be a time or place in your that you’ve felt particularly calm or safe and you will practice with your therapist getting in touch with the imagery, somatic, and emotional safety and calmness with that memory. This can provide a nice anchor or escape from distress that can come up.
Phase 3: Assessment of Target Memory
Once we’re both feeling good enough about moving forward, we want to take a deeper dive in to the initial or target memory we’re going to start EMDR with. You and the therapist will go over a few key pieces of the memory to get a clear picture of it.
The image: What specific image or visual comes to mind when you think of the memory? Although the therapist doesn’t need a deep description of this, it’s helpful for at least you, the client, to have this.
The negative belief: What negative belief do you hold about yourself, the world, or others? For example, you might believe "I am powerless," or "I am not safe."
The positive belief: What would you prefer to believe instead? For example, you might want to replace the negative belief with "I am strong," or "I am safe now."
Body, physical, or somatic sensations: You and the therapist check-in with where the memory activates your body. This can be things like chest tightness, a knot in the stomach, a sinking feeling, increased heart rate, or a lot of other reactions.
Finally, you will rate the intensity of the distress using a scale called the SUDS (Subjective Units of Distress). This scale ranges from 0 (no distress) to 10 (extreme distress). This rating helps to monitor your progress as you move through the therapy. You will also rate the Validity of [Positive] Cognition (VOC) on a scale of 0-7. For most clients memories tend to start with a SUD of 3 to 10 and a VOC usually around 0 to 2.
Phase 4: Desensitization and Reprocessing
The fourth phase is the meat and potatoes of EMDR. This is where you and the therapist start the active healing process.
Sessions usually start with a quick check in to see how things have been since the last session, but ideally this is usually pretty short. We want to give as much time for EMDR processing as we can while still honoring the check in process.
To begin the reprocessing, you will be asked to bring up the target memory and the triggered feeling state that comes with it (cognition, image, somatic/body response, and emotional response). While holding that in your conscious awareness the therapist will start BLS. This was originally following the therapist’s hand back and forth which moved the client’s eyes back and forth, but today we also use headphones that play a tone back and forth, tappers that buzz or vibrate, or digital programs with a light or motion to move the eyes back and forth. After a short period of time, the client allows their mind to ‘go where it wants to go’ and your brain will begin the reprocessing.
During this, new memories, emotions, sensations, images, and whatever else may come up. There’s not a right or wrong way for your brain to do this, we’re simply looking for movement – is something happening internally. Often the reprocessing starts with the highest intensity and most irrational belief/thoughts and de-escalates as we reprocess and moves towards more rational thought patterns.
As the session wraps up the therapist may encourage some resourcing or coping techniques to try to get back to a baseline prior to leaving. They usually get a new distress (SUD) scaling between 0-10. Sometimes the memory has changed on the scale, sometimes not – but regardless reprocessing has happened and over time it will drop. Some memories can get to 0 within one session, some can take several.
Phase 5: Installation of Positive Belief
Once the distress from the target memory gets to a 0 (or close to it and progress has stopped), the next step is to install the positive belief and get the Validity of [Positive] Cognition (VOC) to a 7. For example, if the original belief was “I am worthless”, we’ll likely be working towards feeling 7/7 for “I am worthwhile” or “I am valuable”.
To do this the therapist will ask you to focus on the positive belief and the target memory and continue BLS. The aim is to get this belief fully believes, integrated, and felt in both your mind and body. Usually, we get some positive movement on the VOC during Phase 4, but to get it all the way to 7 is important in this step.
Phase 6: Body Scan
The next step is the Body Scan. During this step the therapist will check in on any somatic/body responses to the target memory. Since trauma is just as much in the body as the mind it’s important to attend to both, which is part of what makes EMDR a somatic therapy. This can also be helpful to reduce or root out some of the chronic physical manifestations of this like tension or pain.
The therapist will ask you to check in with how your body is feeling and get a baseline, then ask you to bring up the target memory. Notice any shifts that occur in your body. With those shifts, we can do some specific reprocessing to target those and ideally release whatever is still there.
Phase 7: Closure
At the end of each session we want to help you get back to a safe and grounded place to be able to transition back to everyday life. This step can occur after Phase 4 if we aren’t able to get to phase 5 or 6 in a session.
This can involve a de-escalation exercise like the “Safe Place”, deep breathing, or other options. Clients don’t always return to baseline and a complete calm place, which is ok since the reprocessing can continue to do work, but we want to make sure things are ok enough to proceed.
Phase 8: Reevaluation
The last phase of EMDR is re-evaluation. This happens at the beginning of each session where the therapist checks in to see how things have been with the EMDR/target memory/triggers since the last session and if anything new has come up. This can inform the upcoming session goals and direction.
Why EMDR Can Be Life-Changing
Hopefully this has been helpful in giving an overview of the process and the Eight (8) Phases of EMDR. This can be a wonderfully effective approach especially when used well like the therapists at EMDR Therapy Nashville. It can help work on past trauma as well as depression, anxiety, self-esteem, self-worth, self-compassion, relationships, and more.
The shift from internalized core beliefs like “I am worthless” or “I am in danger” to healthy and actually true ones like “I am worthwhile” and “I am safe” has been profound for a lot of our clients.
Regardless of the process, we appreciate the courage you show when you reach out and start EMDR. We know it can be a big step for people to tackle the past trauma that is ever-present, but we’ve seen the benefit and hope you are open to starting the process.