John Nielsen, MFT, LPC

While you can research EMDR exhaustively, you don’t have to fully understand the process to successfully address past trauma; However, it is important for you to be clear about which past memories you know you need to address (the earlier the better) and how they continue to impact you in your life. 

When we experience trauma, we often walk away with a belief about ourselves or the world around us such as “I will never be strong enough” or “I will never be safe”. EMDR includes the body in Therapy as we often feel anxiety in our belly, rejection or hurt in our gut, anger in our chest, shame in our throat, and heaviness in our shoulders. 

Memories are created through our senses. 

You SMELLED the fresh cut grass. 

You HEARD church bells in the distance. 

You SAW the sunlight pouring through the leaves. 

You TASTED your favorite coffee. 

And from this sensory input you BELIEVED in the order of all things. 

And you held a FEELING of peace deep in your chest. 

This describes a positive memory, but memories that threaten our safety can continue to dwell in our body and the smell of fresh cut grass can trigger feelings of fear and the belief that “I will never be strong enough”.

EMDR is a way of drawing out these traumatic memories and helps you take away their power. 

I have listed the Eight Stages of EMDR from EMDRIA where I received my training in EMDR.

https://www.emdria.org/page/120

There are eight phases of EMDR

Phase 1: History and Treatment Planning.

Phase 2: Preparation.

Phase 3: Assessment.

Phase 4: Desensitization.

Phase 5: Installation.

Phase 6: Body scan.

Phase 7: Closure.

Phase 8: Reevaluation.

Phase 1: History and Treatment Planning

This phase generally takes 1-2 sessions at the beginning of therapy, and can continue throughout the therapy, especially if new problems are revealed. In the first phase of EMDR treatment, the therapist takes a thorough history of the client and develops a treatment plan. This phase will include a discussion of the specific problem that has brought him or her into therapy, the behaviors and symptoms stemming from that problem. With this information, the therapist will develop a treatment plan that defines the specific targets on which to use EMDR. These targets include the event(s) from the past that created the problem, the present situations that cause distress, and the key skills or behaviors the client needs to learn for his future well-being. One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of his or her disturbing memories in detail. So while some individuals are comfortable, and even prefer, giving specifics, other people may present more of a general picture or outline. When the therapist asks, for example, “What event do you remember that made you feel worthless and useless?” the person may say, “It was something my brother did to me.” That is all the information the therapist needs to identify and target the event with EMDR.

Phase 2: Preparation

For most clients this phase will take between 1-4 sessions. For others, with a very traumatized background, or with certain diagnoses, a longer time may be necessary. In this phase, the therapist will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you are generally able to proceed to the next phase. One of the primary goals of the preparation phase is to establish a relationship of trust between the client and the therapist. While the person does not have to go into great detail about his disturbing memories, if the EMDR client does not trust his or her therapist, he or she may not accurately report what is felt and what changes he or she is (or isn’t) experiencing during the eye movements. If the client just wants to please the therapist and says they feel better when they don’t, no therapy in the world will resolve that client’s trauma. In any form of therapy it is best to look at the therapist as a facilitator, or guide, who needs to hear of any hurt, need, or disappointments in order to help achieve the common goal. EMDR therapy is a great deal more than just eye movements, and the therapist needs to know when to employ any of the needed procedures to keep the processing going. During the Preparation Phase, the therapist will explain the theory of EMDR, how it is done, and what the person can expect during and after treatment. Finally, the therapist will teach the client a variety of relaxation techniques for calming him or herself in the face of any emotional disturbance that may arise during or after a session. Learning these tools is an important aid for anyone. The happiest people on the planet have ways of relaxing themselves and decompressing from life’s inevitable, and often unsuspected, stress. One goal of EMDR therapy is to make sure that the client can take care of him or herself.

Phase 3: Assessment

In this phase, the client will be prompted to access each target in a controlled and standardized way so it can be effectively processed.

Processing does not mean talking about it. See the Reprocessing sections below. The EMDR therapist identifies different parts of the target to be processed. The first step is for the client to select a specific image or mental picture from the target event (which was identified during Phase One) that best represents the memory. Then he or she chooses a statement that expresses a negative self-belief associated with the event. Even if the client intellectually knows that the statement is false, it is important that he or she focus on it. These negative beliefs are actually verbalizations of the disturbing emotions that still exist. Common negative cognitions include statements such as “I am helpless,” ” I am worthless,” ” I am unlovable,” ” I am dirty,” ” I am bad,” etc. The client then picks a positive self-statement that he would rather believe. This statement should incorporate an internal sense of control such as “I am worthwhile/lovable/a good person/in control” or “I can succeed.” Sometimes, when the primary emotion is fear, such as in the aftermath of a natural disaster, the negative cognition can be, “I am in danger” and the positive cognition can be, “I am safe now.” “I am in danger” can be considered a negative cognition, because the fear is inappropriate — it is locked in the nervous system, but the danger is actually past. The positive cognition should reflect what is actually appropriate in the present. At this point, the therapist will ask the person to estimate how true a positive belief feels using the 1-to-7 Validity of Cognition (VOC) scale. “1” equals “completely false,” and ” 7″ equals “completely true.” It is important to give a score that reflects how the person “feels,” not ” thinks.” We may logically “know” that something is wrong, but we are most driven by how it ” feels.” Also, during the Assessment Phase, the person identifies the negative emotions (fear, anger) and physical sensations (tightness in the stomach, cold hands) he or she associates with the target. The client also rates the negative belief, but uses a different scale called the Subjective Units of Disturbance (SUD) scale. This scale rates the feeling from 0 (no disturbance) to 10 (worst) and is used to assess the disturbance that the client feels. The goal of EMDR treatment, in the following phases, is for SUD scores of disturbance to decrease while the VOC scores of positive belief increase.

Reprocessing. For a single trauma reprocessing is generally accomplished within 3 sessions. If it takes longer, you should see some improvement within that amount of time. Phases One through Three lay the groundwork for the comprehensive treatment and reprocessing of the specific targeted events. Although the eye movements (or taps, or tones) are used during the following three phases, they are only one component of a complex therapy. The use of the step-by-step eight-phase approach allows the experienced, trained EMDR therapist to maximize the treatment effects for the client in a logical and standardized fashion. It also allows both the client and the therapist to monitor the progress during every treatment session.

Phase 4: Desensitization

This phase focuses on the client’s disturbing emotions and sensations as they are measured by the SUDs rating. This phase deals with all of the person’s responses (including other memories, insights and associations that may arise) as the targeted event changes and its disturbing elements are resolved. This phase gives the opportunity to identify and resolve similar events that may have occurred and are associated with the target. That way, a client can actually surpass his or her initial goals and heal beyond his or her expectations. During desensitization, the therapist leads the person in sets of eye movements, sounds, or taps with appropriate shifts and changes of focus until his or her SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). Starting with the main target, the different associations to the memory are followed. For instance, a person may start with a horrific event and soon have other associations to it. The therapist will guide the client to a complete resolution of the target.

Phase 5: Installation

The goal is to concentrate on and increase the strength of the positive belief that the client has identified to replace his or her original negative belief. For example, the client might begin with a mental image of being beaten up by his or her father and a negative belief of “I am powerless.” During the Desensitization Phase that client will have reprocessed the terror of that childhood event and fully realized that as an adult he or she now has strength and choices that were not there when he or she was young. During this fifth phase of treatment, that person’s positive cognition, “I am now in control,” will be strengthened and installed. How deeply the person believes that positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal is for the person to accept the full truth of his or her positive self-statement at a level of 7 (completely true). Fortunately, just as EMDR cannot make anyone shed appropriate negative feelings, it cannot make the person believe anything positive that is not appropriate either. So if the person is aware that he or she actually needs to learn some new skill, such as self-defense training, in order to be truly in control of the situation, the validity of that positive belief will rise only to the corresponding level, such as a 5 or 6 on the VOC scale.

Phase 6: Body scan

After the positive cognition has been strengthened and installed, the therapist will ask the person to bring the original target event to mind and see if any residual tension is noticed in the body. If so, these physical sensations are then targeted for reprocessing. Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in body memory (motoric memory), rather than narrative memory, and retains the negative emotions and physical sensations of the original event. When that information is processed, however, it can then move to narrative (or verbalizable) memory and the body sensations and negative feelings associated with it disappear. Therefore, an EMDR session is not considered successful until the client can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.

Phase 7: Closure

Ends every treatment session. Closure ensures that the person leaves at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the client in using a variety of self-calming techniques in order to regain a sense of equilibrium. Throughout the EMDR session, the client has been in control (for instance, the client is instructed that it is okay to raise a hand in the “stop” gesture at anytime) and it is important that the client continue to feel in control outside the therapist’s office. He or she is also briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and what calming techniques could be used to self-soothe in the client’s life outside of the therapy session.

Phase 8: Reevaluation

Opens every new session. At the beginning of subsequent sessions, the therapist checks to make sure that the positive results (low SUDs, high VOC, no body tension) have been maintained, identifies any new areas that need treatment, and continues reprocessing the additional targets. The Reevaluation Phase guides the therapist through the treatment plans that are needed in order to deal with the client’s problems. As with any form of good therapy, the Reevaluation Phase is vital in order to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment, as it is to complete an entire course of treatment with antibiotics.

The role of Past, Present, and Future Templates 

EMDR therapy is not complete until attention has been brought to the past memories that are contributing to the problem, the present situations that are disturbing, and what skills the client may need for the future.