Preparing for EMDR therapy? Feel more confident going forward as a first-time client, knowing what to expect.
TL;DR: EMDR, or Eye Movement Desensitization and Reprocessing, is a multi-phase therapy that aims to reduce the intensity of distressing memories and associated symptoms through use of side-to-side eye movements. Unhelpful beliefs can get “stuck” in the brain, and EMDR may help to remove that block, allowing a person to connect with more adaptive, helpful ways of relating to the stressor or trauma.
If you’re curious about EMDR or your therapist suggested giving this type of therapy a try, it’s common to have a lot of questions about what it is and what to expect. This guide should hopefully answer a few of those questions and equip you with the information you need to explore EMDR further.
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What Is EMDR?
First developed by Francine Shapiro in 1987, EMDR is a type of therapy primarily used to treat trauma and PTSD, and research is showing it may be effective for other issues including addiction, anxiety, and depression. It stands for Eye Movement Desensitization and Reprocessing. Breaking that down:
Eye Movement: EMDR uses side-to-side eye movements (or an alternative type of bilateral stimulation like tapping) to facilitate processing.
Desensitization: EMDR can help individuals gradually approach distressing memories. With the use of eye movements and self-regulation techniques, the memories can feel less intense* and overwhelming as you progress in EMDR treatment. (*Note: Some people report more intensified distress after EMDR—more on that below.)
Reprocessing: With EMDR, the idea is to fully process unresolved memories that are maladaptively stored in the brain. In this state, the memories influence our perceptions, beliefs, and feelings—causing symptoms like reactivity, anxiety, panic, flashbacks, self-criticism, etc. When a memory is reprocessed, we gain new adaptive information that helps us connect to our natural strengths and a sense of safety.
In short, EMDR uses eye movements and relaxation techniques to help people fully process distressing memories so that symptom-causing triggers feel less overwhelming in daily life.
Because EMDR is a multi-phase treatment, it often takes several sessions to prepare, assess, and process. For some, it may be possible to achieve results within a short period of time, while others with more extensive or complex experiences of trauma may benefit from longer-term treatment.
EMDR clinicians undergo training and supervision to ensure they are providing safe, effective treatment. If you are interested in EMDR, look for licensed therapists who have completed EMDR Basic Training or are EMDRIA certified.
How Does EMDR Work?
When researching new treatment modalities, studies first seek to answer the question “Does this work, and how well?” For this reason, we don’t always know how something works—just that it does (or doesn’t). EMDR is an example of treatment that seems to work well for trauma, but it’s not yet clear why.
In her book, Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Shapiro describes a foundational theory for EMDR: Adaptive Information Processing, or AIP. According to this theory, the brain hangs onto information, especially in response to trauma. It has the capacity to store this information in adaptive ways—weaving it helpfully into a coherent story that makes sense and helps guide our actions.
But, sometimes, this information is stored maladaptively. Instead of integrating the memory in a helpful way, it’s fragmented in the brain, along with the sights, smells, emotions, and thoughts from the original event. This is why intrusive thoughts, flashbacks, nightmares, and reactivity trigger easily in our day-to-day.
In theory, EMDR jumpstarts the brain’s natural ability to process maladaptively stored information— “metabolizing” the fragments, so to speak. Studies have investigated the hypothesis that bilateral eye movements facilitate this process by taxing our working memory to reduce the intensity of the memories.
To summarize: EMDR works by using bilateral stimulation, like eye movements or taps, to help the brain reprocess traumatic memories, reducing their emotional impact and integrating them into healthier memory networks.
The 8 Stages of EMDR
EMDR treatment is composed of eight phases:
History Taking
Preparation
Assessment
Desensitization
Installation
Body Scan
Closure
Reevaluation
There is no prescriptive length for each phase, meaning treatment length can vary from person to person. It’s also not perfectly linear; sometimes, you’ll return to earlier phases to strengthen your self-regulation skills or process other memories.
Here’s a breakdown of what generally happens in each phase:
Phase 1: History Taking
History Taking is when your therapist collects information about you and your experiences to guide the therapy process. They may ask questions about your history, identity, relationships, goals, and other important aspects of your life. With EMDR, this is also when your therapist may introduce questionnaires to assess severity of different symptoms.
Phase 2: Preparation
In Preparation, your therapist will begin to explain EMDR, teach you self-regulation skills, and build resilience. The Preparation stage is intended to expand access to adaptive information in the brain, while also teaching you tools to reduce stress in the moment. This will serve as an important foundation for memory processing in later stages.
Phase 3: Assessment
Once you’re feeling solid with Preparation, you and your therapist will move onto Assessment. In this phase, your therapist will start to ask specific questions about a memory you’d like to target. The intention is to understand: how the memory affects you; how intensely it affects you; the negative belief tied to that memory; and the positive belief you wish you could hold.
Phase 4: Desensitization
After targeting a memory, your therapist will guide you through bilateral eye movements, allowing the brain to engage its natural processing capacity. Between each set of eye movements, your therapist will ask you to share what you noticed. You’ll briefly share any emotions, thoughts, sensations, images, or other information that emerged during the eye movements. There are no wrong answers here—whatever you noticed is a valid part of the brain’s process. This process will be repeated over and over as you observe gradual shifts and address anything that feels “stuck” with your therapist.
Phase 5: Installation
With Installation, we’re moving into the reprocessing step of EMDR. Once you’ve reduced the intensity of the memory, your therapist will guide you through the process of integrating the positive beliefs of self, others, and the world that you wish to believe. This, too, is done with the help of eye movements. When complete, you should feel that the memory is not only less distressing, but that you’re also able to think about it from a more helpful perspective.
Phase 6: Body Scan
Next, your therapist will prompt you to detect any lingering distress through a Body Scan. This is an exercise where we move our awareness from the top of the body to the bottom, noticing any sensations that may still be sticking around. These sensations are helpful signals to guide next steps, whether that’s identifying new material to process further or adding a few more sets of eye movements to allow fuller resolution of processing.
Phase 7: Closure
Each EMDR session should end with Closure, a time reserved toward the end of your appointment that helps you transition out of processing and into a calm, regulated state. We won’t always fully resolve memories each session, and that’s okay; Closure helps us set the work aside, knowing we can come back to it next time.
Phase 8: Reevaluation
With Reevaluation, you and your therapist will return to any unfinished processing from the previous session. If you completed processing a memory last session, this might instead be an opportunity to identify any additional memories or material you’d like to target next. Oftentimes, this phase will begin with your therapist asking what you noticed between appointments to help guide next steps.
Is EMDR Evidence Based?
EMDR is an evidence-based treatment for PTSD and other trauma/stress disorders. It is recognized as such by the World Health Organization (WHO), Department of Veterans Affairs & Department of Defense, American Psychological Association, Substance Abuse and Mental Health Services America (SAMHSA), American Psychiatric Association, and others.
The research base for EMDR spans over two decades, including over 20 randomized controlled trials (RCTs)—the gold standard for clinical trials seeking to establish cause-and-effect relationships between interventions and outcomes.
An exhaustive list of EMDR studies can be found here.
EMDR Side Effects
As the research shows, EMDR has the potential to catalyze healing for trauma survivors. But there are risks to consider alongside the benefits.
Intensification of symptoms: While EMDR is designed to reduce the intensity and vividness of memories over the course of treatment, some individuals do experience heightened distress after processing. This isn’t an uncommon experience—EMDR is an emotionally challenging process by nature. However, if you’re experiencing significant, debilitating discomfort after EMDR, let your therapist know right away. This may be a sign to slow down, strengthen self-regulation skills, and/or reserve more time for closure each session.
Medical side effects: Therapists should always screen for medical issues prior to beginning EMDR. Individuals with eye-related conditions, a history of seizures, or severe dissociative symptoms should be evaluated carefully. If you experience physical pain or discomfort during EMDR, let your therapist know. Adjustments may be made—such as switching from eye movements to tapping—to reduce discomfort.
Legal involvement: If you’re involved in legal proceedings in which you must testify to details of an incident, it’s important for your therapist to be aware of this before starting. Because EMDR can reduce the vividness of memories, this may have implications for your legal process. Consult with your therapist and lawyer to determine the best path forward.
Am I Ready for EMDR?
Your therapist should be able to help you evaluate your readiness for EMDR, as well as if it’s the right modality and/or timing for you.
There are specific considerations for individuals with medical issues, severe dissociative symptoms, or current legal involvement, so be sure to let your therapist know if any of these apply to you.
For many, the question “Am I ready for EMDR?” may really translate to something like “How do I know I can handle the difficult memories?”
Remember, there are several preparatory stages before memory processing to help you feel well-equipped to navigate the processing stages later on. When assessing readiness to move past Preparation into active memory processing, here are some questions to explore with your therapist:
Are my basic needs (food, housing, etc.) met?
Are there any safety issues currently present in my life?
Does the timing make sense to start EMDR, or are there upcoming events/transitions that may disrupt the process?
Am I able to tolerate emotions as they emerge?
When feeling stressed, overwhelmed, or numb, am I able to use coping tools to shift back into a state of calm, presence, and safety?
Am I able to describe my emotions, thoughts, and body sensations as they arise?
Do I have a trusting relationship with my therapist?
While EMDR as a process has much to offer, a vital part will always be the relationship you have with your therapist. With the right therapeutic fit, you may feel your readiness for EMDR grow alongside this relationship. Trust and comfort take time to cultivate. They are earned over a pattern of reliability, presence, and attunement that impart the unmistakable knowing that your therapist is there for you—a steady anchor through the shifting tides.
If you’re struggling with substance use, help is available. For immediate support and local resources, call SAMHSA’s National Helpline at 1-800-662-4357.
This article is written for the sole purpose of providing information on mental health topics. It is not medical or legal advice, nor a substitute for medical intervention or professional mental health counseling, diagnosis, or treatment. It should not replace or alter any treatment or care you are receiving without direct consultation from your mental health or medical providers. Any questions regarding your treatment should be brought directly to your professional and medical practitioners.
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