What happens in an EMDR therapy session?

Perhaps you’ve heard of EMDR on a podcast or from a friend, but what actually happens in an EMDR therapy session?  As a provider of EMDR therapy for the last 10+ years, I’ve spent a lot of time explaining the process to clients.  EMDR follows an 8-phase protocol and much of the process looks and feels like traditional talk therapy.  

Let’s start with what EMDR is NOT 

EMDR is NOT hypnosis.  The client is always fully aware of what is happening and fully in control of whether the process proceeds.  EMDR is NOT any form of electric shock therapy and should never be intolerable or unbearable.  Your clinician may use “Tappers,”  small vibrating buttons that are neither painful or unpleasant.  They vibrate like your cell phone set to vibration.  

EMDR starts like all talk therapy

The initial phases of EMDR involve a thorough assessment of your history.  Your clinician will work to build rapport with you and will want you to have a sense of safety in therapy.  This assessment will likely be more involved than the average medical assessment in that a thorough history of your family life, past, and traumas will be essential components of making a plan to treat your symptoms.  During this time, your therapist is assessing your “resources” or skills and supports you have that will help you regulate emotions.  Your therapist is also developing a plan for treatment.  

Preparing for EMDR

Your EMDR therapist will spend some time on preparing you for EMDR.  Depending on your needs and your comfort level with the process, the therapist may need one or multiple sessions to prepare you.  This preparation includes education about the EMDR process, discussion of your concerns or questions, and development of some skills to help you manage emotional distress.  

Digging Deeper 

Next, your therapist will work with you to identify specific “targets” to reprocess.  Again, this is a talking and exploration process.  When identifying a specific memory to target, your therapist is looking for a memory that contributes to your present day symptoms.  The therapist will ask you questions about the image, level of distress, associated feelings, and a belief you have about yourself connected to the image.  The goal is to help you connect into the emotional experience of the image.  This process isn’t about detailed accuracy or perfection!  It is NOT necessary to recount in detail the traumatic memory.  

Desensitization 

At last, your therapist will begin the whole “eye movement” part of the EMDR process!  But you or your therapist may not use eye movements at all.  In fact, Francine Shapiro, the developer of EMDR expressed regret over the use of “eye movement” in the name of the therapy.  Any form of bilateral stimulation (left to right stimulation) can be used in the process.    

You will be asked to bring up the image while the eye movements, tapping, or other bilateral stimulation occurs.  Your therapist will direct you to “just notice” what comes up – new images, memories, thoughts, feelings or body sensations.  Your therapist will pause periodically to ask what you noticed and will determine next steps based on your response.  

The desensitization stage may last just moments or for several sessions.  Your specific timeframes are very personal to you.  Don’t be concerned if desensitization seems to take awhile.  The goals is to decrease your distress level to zero, but this can’t happen instantly!  Patience and curiosity are our friends here.  At any time during the phase, you can ask your therapist to stop.  You don’t need to recount in great detail EVERYTHING you noticed, but simple snippets of your experience are needed to determine next steps.  Throughout the process, your therapist will check in with your regarding your level of distress associated with the target memory.  

Installation 

When the target image or memory is no longer distressing, your clinician will work with you to “install” a new and more positive belief about yourself connected with that memory.  For instance, if you were in a car accident and your negative belief was “It’s my fault,” you may now be able to install the belief, “I did the best I could.”      

The Final Stages 

After a successful installation phase, your clinician can move you through the final phases.  These include a body scan for any remaining distress, a closure process, and a reevaluation of the original memory.   If any distress remains, the therapist may help you revisit earlier stages.  

Understanding the 8 Phases in Real Life

In an imaginary world, we could move through these eight phases swiftly in one therapy session.  However, that is almost never the case.  A skilled EMDR therapist will identify your needs and move back and forth between these phases with relative seamlessness.    You may need to do additional desensitization before installation occurs.  You may find that you are satisfied with reduced distress and may not enter installation phase right away.  As a client, you do not need to worry about managing the eight phases.  Your only responsibility is to communicate your needs to your therapist and to share any concerns, confusion, insights, or worries.  

Nicole Bolognini, LCSW, PMH-C has been providing EMDR therapy to clients since being trained in EMDR in 2011.  Nicole has provided EMDR therapy and trauma treatment to children and adults throughout the life course, including single incident traumas and pervasive developmental traumas.  If you are interested in learning more about how EMDR therapy can help you, please reach out today.   Nicole is happy to provide a free 15 minute phone consultation to discuss your needs and how treatment can be helpful to you.