In previous articles, we have explored what Eye Movement Desensitization and Reprocessing (EMDR) is and how it works. In this article, we are going to explore the what a typical EMDR session looks like and the course of treatment when EMDR is being used in therapy.
There are eight phases of EMDR therapy that will take place over multiple sessions depending on the client and the issue(s) being targeted. The first phase consists of history-taking session(s). The client and therapist identify possible targets for EMDR processing. These include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations. The therapist assesses the client’s readiness and develops a treatment plan.
During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress so they can manage their feelings between sessions. The therapist may teach the client a variety of imagery and stress reduction techniques. Since EMDR produces rapid change, it is important for the client to have a means of maintains equilibrium during and between sessions while adapting to their newfound feelings.
Phases three through six are active work phases. A disturbing target thought is identified and processed. These involve the client identifying three things:
1. The vivid visual image related to the memory,
2. A negative belief about self,
3. Related emotions and body sensations.
In addition, the client identifies a positive belief for future use in the session. The therapist helps the client rate the positive belief, as well as, the intensity of the negative emotions. After this, the client is instructed to focus on the disturbing visual image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones. The type and length of these sets is different for each client. At this point, the EMDR client is instructed to just notice whatever they spontaneously experience.
When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session. At this time, the client may adjust the positive belief if necessary, and then focus on it during the next set of distressing events.
The seventh phase is closure, where the client keeps a log during the week. The purpose of the log is to document any memory-related material that may arise. It serves to remind the client to use the self-calming activities that were mastered in phase two of treatment.
Lastly, phase eight consists of reviewing the progress made thus far. Therapist and client will go over the EMDR treatment processes, all related historical events, current incidents that elicit distress, and future events that will require different responses. Clients generally leave this session feeling empowered and accomplished, reporting a resolution of previous distressed and resumed functioning.
EMDR has a broad base of published case studies and controlled research that supports it as an empirically validated treatment. The research shows substantial and sustained reduction in symptoms in most patients. Studies include 3, 5, 15, and 18 month reviews with patients reporting sustained symptom reduction.
Now you know what EMDR is and how it works. In the next few blogs I will discuss what specific things EMDR can treat.