EMDR Therapy: The 8 Phases Explained

EMDR Therapy: The 8 Phases Explained

Secrets lose their power once we share them with others, but what if the secret is a disturbing memory? What if instead of clearing space, speaking of it brings back intense flashbacks or panic attacks?

That’s where Eye Movement Desensitization and Reprocessing (EMDR) therapy comes in. Unlike talk-based therapies, EMDR utilizes eye movement to help us better compartmentalize traumatic memories. It plays out in eight stages.

1. History Taking

Whether through a pre-session questionnaire or first session conversation, your therapist will aim to understand your symptoms, prior therapy experience, current support network, and medical goals.

We may also screen you for Adverse Childhood Experiences (ACE), which are events that occurred during childhood increasing your likelihood for physical and mental stress responses as an adult (e.g. domestic violence).

2. Preparation

As therapists, we want you to have one foot in the past and one foot in the present. One goal of EMDR is to keep you out of a state of hyperarousal and in a “window of tolerance” so you can appropriately process memories.

Picture sitting on a train, watching memories through a window while you remain inside. If at any point you feel like you’re off the train and in the memory instead of watching it, you’re outside the window of tolerance. If this happens, your therapist lead you through grounding exercises to get you back to a place of safety.

3. Assessment

Once you’re ready for this phase, you and your therapist decide which events to process together by naming them. The goal isn’t to dig in, just lightly touch on them, making a list. As you think of each event, your therapist will ask you to describe:

• Body sensations
• Emotional reactions
• Negative cognitions (NC) you believe about yourself related to the event (e.g. “I’m stupid”)
• Subjective Units of Disturbance (SUD) — how disturbing it feels from 0-10
• Positive cognitions (PC) you would rather feel (e.g. “I’m good the way I am”)
• Validity of Cognition (VOC) — how much you actually believe the PC from a scale of 1-7

4. Desensitization

After going through assessments and targeting a memory, it’s time to focus on it while adding bilateral stimulation (BLS). This can look like following a light your therapist shines back and forth with your eyes or tapping on a part of your body repeatedly. We do this for about 30 seconds at a time, with the goal of you noticing what comes up as you observe the memory from the “train.” 

After 30 seconds, your therapist will ask you to briefly share any sensations or emotions that came up, rate them on a scale from 0-10 again, followed by more BLS until the memory becomes less disturbing.

5. Installation

Once the memory is at a SUD level of 0, we want to compartmentalize it into a more positive space by using BLS and positive cognitions (PC). An example of a PC might be “I am safe and in control of my life” while thinking of a memory where you felt unsafe and out of control.

6. Body Scan

There’s a saying in trauma work, “What the mind forgets, the body remembers.” Once you’re at a SUD level of 0 and a VOC of 7, your therapist will ask you to mentally scan your body head-to-toe for leftover signs of distress while holding onto the memory and the positive cognition.

7. Closure

Closure grounds you before leaving the session and it is especially important if we haven’t fully worked out the memory just yet. While many clients show success after one intensive session, the average is about six to twelve. Isolated memories tend to take less time, while complex ones (like traumatic relationships where many disturbing events took place) require more.

8. Reevaluation

You’ll begin the next appointment with anything new that came up for you about the target memory in between sessions. This can include mental shifts, new thoughts about it, relationship changes, emotions, etc.

Interested in trying EMDR therapy? Schedule your first appointment today.