8 Phases of EMDR Therapy
Curious about starting EMDR Therapy to help you love the life you live? But you first want to understand what EMDR therapy actually looks like?
Here, I’ll walk you through it.
As an EMDR Therapist many people come to me eager to address past trauma, tired of being in pain and looking for relief. Sound familiar? Here’s the thing: with any trauma informed care, building a supportive therapeutic relationship in addition to other preparation, is crucial for treatment to be successful. There are important steps prior to jumping into deeper trauma work which is why EMDR actually has 8 phases of treatment. That’s right, EMDR is more than reprocessing overwhelming experiences. Here I will walk you through each phase of EMDR therapy, and share some additional information and guidance to consider:
Phase 1 in EMDR Therapy: History Taking and Treatment Planning
Understanding the past
*The initial sessions focus on getting to know the client and understanding their past, specifically related to the overwhelming experiences that they come interested in working on.
*I also want to know more about how past experiences have impacted them, what barriers they’re experiencing to living a satisfied life.
*I provide information about EMDR treatment and the treatment process, and answer any questions. It’s so important that client’s feel informed and clear about what treatment will look like.
As a somatic and trauma informed therapist, I gather information at the pace that feels right to the individual. I always guide small breaks between sharing history, and encourage really checking in throughout the session, looking for any signs of overwhelm that may show up as we talk about tough things. Most of us are used to overriding signals that something is ‘too much’, out of a sense of pressure or expectation. Client’s often share with me that in the past they attended talk therapy and described frequent experiences of feeling overwhelmed and agitated after sessions. This can be the result of talking through painful histories without giving enough attention to how activated we feel while we talk. I guide a slower pace to observe and make sure we aren’t starting our work together from an overwhelmed place.
We will have all the time we need to build the treatment plan and gather related history, no matter the pace we take to get there. And your body will thank you for respecting the pace it needs to prevent overwhelm.
Treatment planning and identifying desired changes
*I typically ask, “what do you want things to look like when we get done with our work together? How will you know treatment is complete - what will you feel like and what will your life look like?”. I help client’s visualize details about what life may look like after recovering from the negative impacts of their past. Being able to visualize what we want, is one of the initial healing components of trauma work. I often guide body awareness and connection to the felt sense of this new visualization, and expand seeing & experiencing oneself in a healthier and happier state. From here we get clear about the treatment plan and which overwhelming experiences will be targeted with EMDR.
Identifying resources
*I want to know what a client does, or has done in the past, to feel better? Who and what is important to them now? And we will look at resources they have access to - people, places, practices, things that are naturally nourishing and comforting.
Oftentimes people with trauma in their pasts have limited “safe” relationships because they’ve needed to protect themselves and view others as dangerous - this is very common, and I encourage those that have a difficult time identifying people in their life that feel comforting to them, to look at a wide variety of emotional resources that also include pets, animals, comforting and cozy environments, nature, music, stories, spirituality, and art.
Reminders:
* Be open and honest about your experiences and feelings, paying attention to what feels available to share, don’t push it. You’ll have time.
* Ask questions and seek clarification if you don't understand something. Almost everyone I’ve worked with at one point in treatment has been worried about whether they are “doing it right?”. It’s an unfamiliar process and subtle at times. Ask questions when they arise.
Phase 2 in EMDR Therapy: Preparation
Building skills and awareness to dive into deeper processing
* Focus is on learning and practicing skills and techniques for coping with difficult emotions and for dropping into relaxation. I will help clients build resources for additional emotional and physical support and help build capacity for working within uncomfortable states.
* I take the time to educate about nervous system regulation and how traumatic and overwhelming experiences can impact the brain, nervous system and body responses. With this understanding and information I then focus on helping the client build skills and techniques to support their nervous system stay regulated. This helps manage discomfort and builds capacity for deeper trauma processing to prevent any additional overwhelm. For most of us, we’ve experienced enough overwhelm in our life, that we certainly don’t need any more of it when trying to heal, am I right?
A Commonly Used Metaphor for EMDR Reprocessing Stages
While working through deeper layers of trauma it’s crucial to maintain some connection to the present. Trauma can often make us feel like we are still experiencing the extreme sense of danger and unsafe feelings. In order to process in a safe and present way, grounding skills are used to help anchor oneself to the present, while reviewing past experiences. This concept is often described with the metaphor of being on a train. When we are reprocessing the trauma, we want to maintain connection with the present, as if the client and I are sitting in the train car together, safe and present, while watching the images of the past moving along outside the train windows. The profound difference is that they aren’t fully in the past, they are instead an observer of the past.
Phase 3 in EMDR Therapy: Assessment
*In order to prepare for the next phases of EMDR I gather more details about the targeted memory/image/physical experience. The client explores what story got stuck as a result of the traumatic experience - we often find this is a belief we carry about oneself and/or the world. We also identify a more adaptive belief that is a more helpful perspective and ultimately would ease pain if it’s how we viewed the situation.
*Many people I work with have overwhelming experiences that start with infancy and early childhood with their caregivers. Relational trauma typically carries with it so many memories that it can feel overwhelm to identify specific target memories. The incredible thing about EMDR is that there is a “generalizing effect”. This means that when we start the desensitization work, when we target a thread of memories, similar memories that are related also become less charged and ultimately feel more neutral overall. Meaning, we don’t have to go into every memory that exists in order to make a meaningful change.
Details we review for the targeted memory/image/physiological response
*The worst part about the memory: an image, sound, or feeling
*Emotions connected with the memory
*The negative cognition (NC) about yourself connected with this memory. This is the belief and story that got stuck and reinforced since the experience (ex: I’m unlovable, I’m in danger, I’m not good enough, I should have done something).
*The positive cognition (PC) that you would rather believe about yourself when you think about the memory (ex. I did the best I could)
*Measurements of distress that surfaces when we think about the memory - this is measured on a scale of 0-10. I always ask clients to think less about the number and really check in with their internal experience to discover what charge the memory holds at the time.
Phase 4 in EMDR Therapy: Desensitization
* This is the part of treatment where I will help the client focus on the memory or image they have identified, and then use bilateral stimulation (BLS) to help the client process the memory.
*Minimal dialogue will occur between myself and the client, the emphasis is on the reprocessing with brief pauses to support regulation, prevent overwhelm, and maintain guidance when appropriate.
* The general focus of this phase is reducing the level of disturbance felt about the experience (SUD level) and allowing new thoughts, images, feelings and sensations to emerge.
Types of bilateral stimulation
* The type of BLS really depends on personal preference. The original form was provided by a client following the therapist’s fingers as they moved from left to right, allowing the eyes to follow back and forth. Another option is the use of tappers that are handheld and pulse bilaterally in the client’s hands which can also include an auditory tone through headphones. Alternatively, if provided virtually, clients can tap their body at a specific pace. All of these methods allow for reprocessing to occur.
Reminders:
* Try to focus on the memory or image, maintaining an observing perspective such as watching scenes from the experience as if you were watching a movie on a screen or scenes out the window on a train, as the train passes by.
* During this phase, pay attention to your body and how it is feeling with the BLS. Remember you can stop at any time. I pay close attention to the signals of the body and look out for physiological signs of distress, and when appropriate I guide longer breaks between cycles to help treatment maintain a manageable pace, which actually leads to more meaningful change.
Phase 5 in EMDR Therapy: Installation
* Once the overwhelming memory no longer feels triggering and the disturbance level is as low as it will realistically go, we work on supporting the new, more adaptive beliefs and emotions associated with the memory.
Reminders:
* Pay attention to how you feel during the installation phase, and try to hold onto those feelings. The therapist may support you in learning methods to reinforce positive changes and strengthen the adaptive belief between sessions.
Phase 6 in EMDR Therapy: Body Scan
* At this point we want to check in with the body directly and clear any lingering distress responses associated with the memory or image. The client will be asked to hold in mind the memory and the adaptive belief while scanning their body from their head to their toes. Bilateral stimulation will continue through this stage, helping to process and release any areas of tension or discomfort.
Phase 7 in EMDR Therapy: Closure
* Closure is a very important part of EMDR treatment, whether or not the desensitization phase is completed. This phase is dedicated to helping the client contain the memory and comfortably transition from the therapeutic work. I guide somatic practices and grounding skills to really support ease in transitioning from the session, and returning to a present and calm state.
As a somatic therapist I offer extended sessions of EMDR alongside of somatic movement and therapeutic yoga. These extended sessions promote integration of insight from the EMDR treatment, as well as assists with establishing relaxation, security and empowerment in the present. The movement practices can really help some individuals feel they are intentionally closing out the deep therapeutic work of the session, which contributes to a sense of confidence and ease in returning for more reprocessing work when they are ready.
Reminders:
* If closure is happening because it’s the end of a session, but not that the desensitization phase is complete, you may need additional support with transitioning. Often times people mention feeling a little light headed after a session. Try to intentionally transition out of the session by walking slowly, allowing some body shakes, mindful steps, and consider playing a song you enjoy or some other way to provide a nourishing transition out of the session back into your day.
* Be patient with yourself and remember that it's okay to still have some negative emotions or thoughts.
Phase 8 in EMDR Therapy: Re-evaluation
* At each returning session the client is supported with re-evaluating their progress. We typically consider if any new memories emerged between sessions, and if they noticed any helpful changes in thoughts, feelings, and/or behaviors. Evaluating progress helps determine if they are ready to move on to the next phase of therapy.
Reminders:
* Be honest with yourself and the therapist about your progress and any areas where you still need support or guidance.
* Consider keeping a written journal or a way to track changes in thoughts/feelings/behaviors related to the targeted memory, between sessions so you can share.
In Closing
It’s important to mention that it is rare to accomplish all 8 phases in one session. Often times you spend many sessions in phase 4 desensitization before being ready to move on to the next phases. I hope this outline helps you understand the 8 phases of EMDR therapy. Remember to always be patient and kind to yourself throughout the process, and that treatment should happen at a pace that is right for you and your unique nervous system. And that engaging in self-care and self-compassion is a necessary part of trauma treatment.
Start EMDR Therapy in North Carolina:
EMDR Therapy is a powerful evidenced based treatment for healing from past trauma. If you are struggling from overwhelming childhood experiences and feel it contributes to you feeling stuck and afraid of being your true self, I can help. If you are interested in learning more about what EMDR Therapy looks like with a somatic therapist, check out more information on my practice and offerings here. Or Contact me directly here.