EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy for trauma resolution that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experience. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.
EMDR therapy is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which trauma memory to target first, the therapist asks the client to hold different aspects of that event or thought in mind and use their eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. It is believed to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep. Internal associations arise and the clients begin to process the memory and disturbing feelings.
How It Works
In successful EMDR therapy, the meaning of painful trauma events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.” Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes. The net effect is that clients conclude EMDR therapy feeling empowered by the very traumatic experiences that once debased them.
As a natural outcome of the EMDR phases, the client’s thoughts, feelings, and behavior are all indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.
The EMDR Phases
EMDR therapy involves attention to three time periods: the past, present, and future. Focus is given to past disturbing memories and related events. Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions. With EMDR therapy, these items are addressed using an eight-phase treatment approach. During EMDR treatment, the client will focus on a traumatic memory while their eyes track the therapist’s hand movements. This bilateral stimulation is related to Rapid Eye Movement (REM) sleep functions and helps the client process their memories. In contrast to standard PTSD treatments, EMDR not only closes mental wounds, but it also transforms them into personal empowerment.
The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan. 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.
Initial EMDR processing may be directed to childhood events rather than to adult-onset stressors or the identified critical incident if the client had a problematic childhood. Clients generally gain insight into their situations, the emotional distress resolves and they start to change their behaviors. The length of treatment depends upon the number of traumas and the age of PTSD onset. Generally, those with single event adult onset trauma can be successfully treated in under 5 hours. Multiple trauma victims may require a longer treatment time.
During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. This stage is also used to foster trust between the therapist and client. The therapist will explain the EMDR process in great detail so the client will be informed, relaxed, and confident during treatment. The goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.
In phases three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying 3 things:
- The vivid visual image related to the memory
- A negative belief about self
- Related emotions and body sensations
In addition, the client identifies a positive belief. 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 image, negative thoughts, 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 are different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneously happens.
After each set of stimulation, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client’s report, the clinician will choose the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.
When the client reports no distress related to the targeted memory, they are 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 until it feels true for them.
In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses. If the client has multiple traumas, this phase will identify those areas and the process will begin again with a new target trauma. After successful treatment with EMDR therapy, patients will achieve physiological reconciliation, relieved distress, and the ability to reformulate negative beliefs.