EMDR (Eye Movement Reprocessing and Desensitization)

Eye Movement Desensitization and Reprocessing (EMDR) is a form of evidence-based mental health treatment created by Francine Shapiro, PhD in the 1980’s that was designed to alleviate the distress associated with traumatic experiences and memories. It was initially utilized and studied as a therapy to treat Post-Traumatic Stress Disorder and research has demonstrated its effectiveness in treating PTSD across all ages, cultures and gender. Subsequently, it has also been found to alleviate symptoms associated with Personality Disorders, eating disorders, addictions, phobias, pain disorders, dissociative disorders, complicated grief, panic attacks, and more.

EMDR is an integrating and comprehensive treatment that facilitates adaptive information processing. It is a thorough treatment method and is not considered complete until past memories have been processed, all present situations causing disturbance are processed, and the client embodies and visualizes skills needed for future situations that may be difficult. One of the hallmarks of EMDR is that it relies on the use of Bilateral Stimulation, which can be achieved in a number of ways, but traditionally this is accomplished by moving the patient’s eye focus from side to side by following the therapist’s finger. In addition to eye movement, many therapists use tappers, or small paddles, that are held in both hands and vibrate back and forth between hands. By stimulating the brain in this way while bringing one’s self into a disturbing memory or situation, new connections are able to be made in the brain that help to adaptively process the disturbing images, thoughts, and body sensations.

The following is a brief description of what EMDR therapy will look like from start to finish, though every patient will bring a different set of issues that may require modifications from the standard outlined below. An important thing to point out is that EMDR processing of traumatic material does not mean talking about it. The therapist assists the patient in getting into a mental and physical state that allows the brain and body to digest and integrate the traumatic material. Through the use of bilateral stimulation and the eight phases of treatment, new connections are created in the brain, which allow negative belief systems and uncomfortable body sensations to transform, and difficult memories to be stored appropriately. This means you will keep the parts of the memories that are useful to you, and the negative emotions, beliefs and body sensations will be discarded.

In the first phase of treatment, History and Treatment Planning, a thorough history is taken and a treatment plan is developed. The treatment plan will identify the specific targets to use in EMDR processing. A target is the memory or body sensation that is causing continued suffering and other negative symptoms. These include disturbing memories, current distressing situations, and important behaviors and skills the patient needs to learn for future well-being.

The next phase of treatment is Preparation, and the time spent in this phase varies depending on the current disturbance level associated with the trauma, as well as the existing external and internal resources the patient already possesses. This phase focuses on the patient learning quick and effective ways to move out of emotional disturbance. These resourcing and stabilization tools do not create lasting change in the underlying trauma, but are coping strategies to reduce intensity of difficult emotions or body sensations. This phase of treatment also centers on establishing trust within the counseling relationship. 

Assessment is the next phase of treatment. It is used to set up each target that will be processed by identifying different aspects of each target. First, an image will be chosen by the patient that best represents the memory. Then a negative belief, or cognition, is expressed that is associated with the memory. For example, “I am helpless,” “I am unsafe,” “I am worthless,” etc. Then, a positive self-statement that they would rather believe is chosen. For example, “I am loveable,” “I can succeed,” or “I did the best I could.” This positive cognition should reflect what is actually appropriate in the present to believe. The patient will then rate how true they believe the positive statement to be. This reflects what one feels, not what they think, as most people logically know that they are loveable but might not feel that they are. Also during the assessment phase, a patient will identify negative emotions and body sensations related to the memory, and rate the level of disturbance of the memory on a scale of 0 to 10.

Phase 4 is Desensitization. This phase focuses on the reprocessing of disturbing emotions, images and body sensations, rating them on a scale of disturbance level between sets of bilateral stimulation (BLS).  Between each set of BLS, the target memory will likely shift with changes to the image, movement into other related memories, and new insights will likely arise as the processing proceeds.  The therapist will check in between each set of BLS to assess how reprocessing is going and if shifts need to be made. When checking in, the patient does not need to discuss any traumatic material in detail; they only need to give the therapist a sense of how the target is changing. This phase continues until the memory is at a disturbance level of 0 (with some exceptions).

Installation is the next phase, and the focus here is to “install” the positive self-statement into the memory network that was just desensitized. The patient will be asked to notice both the target memory and the positive self-statement at one time and rate how true they believe the statement to be. For example, a person may have desensitized a memory of being taunted or ridiculed by a parent that was accompanied by the negative belief: “I am bad.” During installation, the person should hold the memory in mind and be able to fully and truly believe “I am good,” “I am loveable,” or another self-statement that is accurate for them.

Phase 6 is the Body Scan. Trauma is stored in the body and a memory cannot be considered “cleared” until this scan is successfully completed. The client will scan her body from head to toe for any negative or uncomfortable sensations or tension while thinking of the original target memory. Until all tension is gone, bilateral stimulation while scanning and thinking of the original memory will continue.

The Closure phase should end every treatment session. Every person should leave the session feeling better than they did at the beginning. If a target is incomplete at the end of the session, the therapist will often use tools learned in the Preparation phase such as visualizing a calm space, or putting traumatic material in a visualized “container” to assist the patient in feeling at ease after the session. The therapist will also brief the client on how new memories, insights or associations may come up between sessions related to the target and processing may passively continue throughout the week. Reminders will be given about calming activities that can be done between sessions.

The last phase is Reevaluation. This phase also reopens every session of unfinished processing. The therapist will check to see if the client’s positive results from the previous session (level of disturbance, less negative body sensation, etc.) have remained and explore any barriers have arisen that may necessitate a change in the treatment plan or processing method.

POTENTIAL EMDR THERAPY TOPICS:

  • Addiction
  • Anger
  • Anxiety
  • Car Accidents
  • Catastrophic Events
  • Childhood Trauma
  • Depression
  • Domestic Violence
  • Emotional Abuse
  • Grief
  • Guilt
  • Habits
  • Incest
  • Medical Issues
  • Perfectionism
  • Phobias
  • PTSD
  • Relationships
  • Self Esteem
  • Self Harm
  • Sexual Abuse
  • Sexual Assault
  • Shame
  • Social Anxiety
  • Stress
  • Suicidal Thoughts
  • Transitions
  • Trauma
  • Violence

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