The image shows two queer people playing together after successful EMDR therapy for PTSD treatment.

EMDR therapy: The ultimate guide

 

There is a lot of hype around EMDR therapy when it comes to trauma therapy. While it is an efficient option for PTSD treatment, it is often hard to find in-depth information. If you are curious about EMDR or consider EMDR as an option, you have come to the right place. This blog post delves into what EMDR therapy is and how it works. You will also learn what EMDR therapy should look like and what to expect in an EMDR session. I hope this guide helps you gain insights about EMDR therapy. Let’s dive in!

What is EMDR Therapy?

When we talk about EMDR therapy, it is often only used in the context of integrating a traumatic experience. In general, memory integration belongs to the second stage of PTSD treatment. The first stage of trauma treatment is related to stabilization and safety and is a vital component of trauma recovery. I emphasize this because the first stage prepares a client for memory integration. EMDR therapy is a complete trauma treatment modality that integrates the different stages of trauma recovery. In the context of this blog post, I use EMDR therapy to refer to the treatment modality and EMDR memory reprocessing for the part where clients process traumatic memories.

EMDR is a specialized trauma treatment modality that requires additional training for the counsellor or the therapist. EMDR training is usually available by EMDRIA-approved institutes. EMDRIA stands for EMDR International Association. For example, I have been trained in EMDR by the Trauma Institute in the U.S.

In this article, I mainly explain EMDR Therapy. However, please keep in mind that best practices in trauma treatment require an integrative approach that combines more than one trauma treatment modality.

The History of EMDR therapy

Dr. Francine Shapiro developed EMDR therapy in 1987. Due to its unique approach to reprocessing trauma, it transformed the approach to PTSD treatment and healing trauma.

Over the last decades, several international PTSD treatment guidelines have recommended EMDR therapy. Here are some examples: in 2004, the American Psychiatric Association recommended EMDR therapy as an effective treatment for trauma. The World Health Organization endorsed EMDR as a treatment for adults with PTSD in 2013. The Practice Guidelines of the Department of Defence/ Department of Veterans Affairs favour EMDR for all trauma populations at all times. Additionally, the Dutch National Steering Committee Guidelines Mental Health Care consider EMDR as the treatment of choice for PTSD.

Initially, EMDR therapy mainly focused on treating PTSD. However, its use now expands to other trauma-associated symptoms, such as complicated grief, anxiety, disordered eating, or dissociative disorders.

How does EMDR memory reprocessing work?

EMDR is a structured therapy that encourages the client to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements). The bilateral stimulation is an integral part of the memory reprocessing with EMDR. Each mental health professional uses different tools for this stimulation. In my practice, I primarily use my fingers, i.e. I move my fingers from left to right and ask the client to follow them for the bilateral stimulation. However, I can also use sounds or other visual support if needed.

How does this relate to trauma?

Adaptive Information Processing (AIP) theory provided the theoretical framework for EMDR therapy. The theory suggests that we can naturally heal from emotional wounds by integrating upsetting memories step by step through talking, thinking, feeling or dreaming. Since a traumatic experience is overwhelming, our system is in shock. Therefore, the natural healing process is blocked. As a result, we can not properly digest the painful experience, and the experience is stuck in our system. The goal of EMDR memory reprocessing is to support the individual to digest and integrate traumatic experiences. This is also an essential step for PTSD treatment.

How does bilateral stimulation affect PTSD treatment?

There are a couple of theories on how bilateral stimulation works; however, it is not yet fully understood. One theory is that the eye movements of EMDR mirror a REM-like state that occurs during dreaming. The REM-like state allows individuals to access their brains’ natural healing capacity.

Another theory states that eye movements serve as an anchor. As a result, the client’s capacity to stay in the present while accessing the traumatic memory increases. Therefore, the risk of becoming flooded by emotions decreases while processing the traumatic experience. The breaking down of the memory processing in sets of eye moments may also prevent the client from being flooded. As Bessel van der Kolk stated, the challenge in recovering from trauma is to learn to tolerate feeling what you feel and knowing what you know without becoming overwhelmed. Overall, I would say that EMDR increases the capacity to stay present and creates a sense of dual awareness.

Trauma often disconnects our right and left brains, with traumatic memories stuck in the right brain. One assumption is that bilateral stimulation activates both parts of our brain, the right and left. Therefore, it aids in integrating those memories. Additionally, the bilateral eye movements activate the neural network, allowing the integration of the stuck memories.

Bilateral stimulation allows people to resolve traumatic experiences and associated stress, can help reduce stress and anxiety, and can improve individuals’ focus and cognitive functioning.

What to expect in your first EMDR therapy session

First of all, many people feel nervous or scared when they have their first EMDR therapy session. However, the first EMDR therapy session is not about memory reprocessing. I consider it a warning sign if an EMDR therapist immediately jumps into the memory-processing aspects of EMDR therapy for PTSD treatment. Overall, the first EMDR therapy session is similar to any first trauma counselling session.

Here are some of the elements that you can expect in your first EMDR session:

Assessment and preparation

I usually do an initial assessment with my clients in the first session. During the assessment, I gather information about my client’s presenting concerns, history, and treatment goals during this period. I also explore where they are in their recovery journey, such as their capacity to be in their tolerance window or other skills they have learned before working with me. Furthermore, I determine with the client whether we need further assessments, such as exploring dissociative experiences. Additionally, I will provide more details about what the EMDR therapy process looks like, and we will explore the integrative treatment approach. Assessment is an ongoing process in collaboration with the client.

Psychoeducation and orientation

In addition to the assessment, I often provide psychoeducation about trauma, memory processing, the underlying principles of EMDR therapy, and the differences between EMDR and other trauma counselling strategies. Clients usually feel more empowered if they understand the therapeutic environment and the tools and techniques used for trauma recovery. Since EMDR has different treatment options, I integrate the bilateral stimulation early in the collaboration so the client can better grasp it.

Generally, I allow clients to ask questions to address their concerns in the first few sessions and throughout the process. I have noticed that this component is beneficial during memory reprocessing with EMDR since some people may doubt whether they are “doing it right.”

Collaborative treatment planning

During the first EMDR session, I will collaborate with the client to create a treatment plan tailored to their unique needs and goals. At this stage, we may identify specific traumatic memories or distressing experiences to target during EMDR processing. Additionally, we may discuss any additional therapeutic interventions or strategies that may be beneficial. We will establish clear objectives for treatment and outline the steps involved in achieving them. It is perfectly ok to adjust these goals throughout the collaboration depending on what’s going on in your life. This collaborative approach empowers you to participate actively in your healing journey. Furthermore, it ensures that treatment aligns with your preferences and priorities.

What to expect in an EMDR memory reprocessing session

If a client feels prepared enough, we have our first EMDR memory processing session.

Choosing the target memory

The first step is to choose a target memory. There are different approaches to selecting the target memory, and each depends on the client’s story. One option is to go for the “intense memory.” This choice is beneficial for people who have trauma due to a single event and were highly functional before the event.

This approach may be too overwhelming for some clients and has the risk that the client experiences a backlash since working with the memory might be upsetting and doesn’t improve the client’s well-being at first. If working with a later memory, there’s a risk that the client touches on unresolved prior traumatic memories and suddenly feels a high emotional intensity due to the unprocessed prior memory. Memory reprocessing may also get “stuck” if the client doesn’t resolve prior traumatic memories. In general, the client will likely resolve an identified later memory more smoothly, if they integrate earlier traumatic memories first.

Options for choosing the target memories

Another option is to choose by going in order, i.e., each traumatic memory is addressed chronologically, starting with the earliest. By using this option, the client is unlikely to touch on unprocessed prior memories. When working with later memories, the prior traumatic memories are already processed, so the client will not feel the intense emotions associated with them.

Another option is to go in order depending on a certain theme in the client’s story. This usually entails that the client doesn’t work with the memory that holds the highest emotional intensity for the theme but with an earlier memory associated with the intense memory. This approach reduces the risk of working with intense traumatic memories; however, it has a similar risk of touching on unprocessed prior traumatic memories.

Suppose these memories have a high emotional intensity. In that case, it is often helpful to choose a less distressing traumatic memory first so that the client has an idea about the process that can happen and feels confident in managing the process. This approach helps clients to learn to trust the process. These experiences can be recent memories with a small traumatic impact or a recent intense nightmare. Additionally, it can be separate traumatic memories unrelated to more challenging memories. For example, if an individual has a theme of loss in their life, it would not be a memory of the losses but a memory of a car accident.

Increasing client’s safety

Before starting the memory reprocessing, I usually explore with the client the strengths and resources that they would need to work with the memory. The client creates these resources in stage 1 of trauma recovery. Typical examples are connecting with a safe place or visualizing a loving friend, a guardian angel, or a comforting blanket. It can be reconnecting with their goals or prior achievements for other clients. Furthermore, I explore the client’s boundaries and explain how to stop the EMDR process.

Assessing the target memory

In this phase, the client and I will assess the target memory. We explore the worst part of the memory, what made the client believe about themselves (negative belief), and what they would prefer to think about themselves (positive belief). Additionally, I ask the client how true the positive belief feels when thinking about the memory. Furthermore, I ask them what emotions come up when thinking about the memory and how intense it is. To address the body, I also ask the client whether they notice any physical sensations associated with the memory.

Sets of EMDR eye movements

After the assessment phase, we move into the desensitization and installation phase.

At this stage, I ask the client to concentrate on the target, which includes the image, the negative belief and the body sensation. When the client is ready, I ask them to continue focusing on the memory and follow my fingers with their eyes. During the eye movement, I don’t talk and give the client space to process. An eye movement set usually takes about 20 to 30 sec. After that, I asked the client to take a deep breath and asked them what came up. Clients can choose what they want to share. It’s usually a word or a couple of sentences. After this short debrief, I again asked the client to “go with it,” as we continued with another EMDR set.

We follow this process until the client doesn’t notice a change for two consecutive EMDR sets. It is important to note that change doesn’t mean less intensity of complicated feelings; while it is surprising for some client, it can also mean more positive feelings. Recovery from trauma does not only mean to reduce painful emotion; it also can mean to increase positive ones. If the client has no change for two consecutive sets and the emotional intensity is at zero, one of the channels is processed. At this stage, we return to the original memory and explore the client’s emotional intensity on a scale of zero to 10. If there is still an emotional charge, we continue with the eye movements and clear out a different channel. We repeat this process until the client has integrated the memory fully, i.e. all channels are at no charge and zero emotional intensity.

Installing the positive belief

After the memory reprocessing, I collaborate with the client to install the positive belief. Therefore, I ask the client to focus on the positive belief while thinking about the memory. Sometimes, clients change their original positive beliefs, which is perfectly fine. We then do eye movements with this belief until it feels completely true for the client.

Body scan

The final step is to explore whether the client has any remaining body sensations associated with the memory. If so, the client and I do eye movement sets until the body sensations have dissolved.

Overall EMDR process

While EMDR is an efficient way to resolve traumatic memories, the duration of memory reprocessing cannot be predicted. Therefore, a memory can be left incomplete at the end of one session. In that case, I usually invite the client to put the memory into an imaginary container and debrief the experience with the client. I will explain some other approaches to using EMDR therapy in the second part of this guide.

The benefits of EMDR Therapy

Here are some benefits people can experience when choosing EMDR therapy.

Effective trauma and PTSD treatment

Extensive research proofs that EMDR therapy is highly effective in treating trauma-related disorders, such as post-traumatic stress disorder (PTSD). Additionally, it helps individuals process and integrate distressing memories and associated emotions. Please note that there is a difference between research and applying EMDR in trauma recovery. Each person is different and it doesn’t mean that there is something wrong with you if EMDR did not work for you.

Fast reduction of symptoms

EMDR therapy is known for its potential to rapidly reduce symptoms associated with trauma, anxiety, and other psychological disorders. Compared to traditional talk therapy approaches, clients often report significant improvements in distressing symptoms after just a few sessions.

Lasting Results

Research suggests that EMDR therapy’s benefits are often long-lasting, with many individuals experiencing sustained relief from symptoms even after completing a relatively short course of treatment. EMDR facilitates a deep reprocessing and resolution of traumatic memories that integrate the body and the rational and emotional aspects of us.

Empowerment

EMDR therapy empowers clients by providing them with tools to process and cope with distressing memories and emotions. EMDR also allows clients to gain unique insights about their story and make connections between different events in their life story. Through the therapeutic process, clients often develop a sense of mastery and self-efficacy as they work through challenging experiences and learn to regulate their emotions more effectively. Furthermore, clients don’t have to retell their stories and can choose how much they want to share with a therapist.

Versatility and Adaptability

I usually adapt EMDR therapy to suit the needs of a diverse client base and a wide range of psychological issues beyond trauma, including anxiety disorders, depression, phobias, and grief. I like integrating it with various therapeutic techniques and approaches to addressing individual client needs effectively.

Limitations of EMDR therapy

As with any PTSD treatment modality, EMDR therapy has its limitations as a stand-alone practice, especially for complex trauma such as ongoing domestic violence, childhood abuse or systemic trauma. Each person’s experience is unique, so I adapt the therapy process to the needs to the individual.

Take away

EMDR therapy is a powerful therapy for healing from trauma and PTSD treatment. Major health organizations recognize it and EMDR can bring about quick, lasting relief from distressing symptoms. The therapy involves:

  • Careful preparation.
  • Processing traumatic memories through structured sessions.
  • Reinforcing positive beliefs, all while ensuring the client’s safety and readiness.

This guide aims to help you understand what to expect and how EMDR therapy might help you in your healing journey by breaking down the process and benefits. Sign up for our newsletter and stay tuned for further information about EMDR therapy and trauma counselling.

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