Why EMDR?

The therapist takes a thorough history of the client and develops a treatment plan, including a discussion of the specific problem that has brought the person to therapy, and the behaviors and symptoms stemming from that problem. The therapist then develops a treatment plan that identifies specific trauma memories — called ‘targets’ — that will be reprocessed. Targets include past events, present triggers, and future experiences related to the presenting problem.

One of the primary goals of this phase is to establish a strong, trusting relationship between the client and therapist. During this time, the therapist teaches various emotional regulation and, if necessary, grounding techniques. The client also learns and practices bilateral stimulation in preparation for reprocessing of trauma memories.

In this initial phase of EMDR reprocessing, the client focuses on a previously identified memory and is guided to explore the following aspects to activate the target memory:

• Disturbing image: identify the image that represents the worst part of the memory.
• Negative cognition: determine a negative self-belief associated with the event, such as “I am powerless”, “I am unlovable”, or “I am not safe”.
• Positive cognition: formulate a preferred positive self-statement, such as “I have choice and control”, “I am lovable”, or “I am safe now”.
• Validity of Cognition (VOC): rate the truth of the positive cognition on a scale of 1 to 7, where 1 means completely false, and 7 completely true.
• Current emotions: identify the negative emotions felt while focusing on the memory and the negative self-belief.
• Subjective Units of Disturbance (SUD): rate the disturbance level of the memory on a scale of 0 to 10, where 0 means neutral and 10 means the highest disturbance.
• Physical sensations: note any physical sensations experienced when focusing on the memory.

Directly following the assessment phase, reprocessing continues with the desensitization phase. In this stage, the client focuses on the memory while simultaneously engaging in bilateral eye movements, taps, or audio tones.

During each set of bilateral stimulation, the client observes changing aspects of the memory, gaining insights and making associations. The goal of phase four is to reach an adaptive resolution, indicated by a Subjective Units of Disturbance (SUD) rating of zero and no felt disturbance when recalling the memory. If the client encounters difficulty during this process, the EMDR therapist intervenes to help maintain the client’s natural healing trajectory.

The goal of the installation phase is to extend the benefits of reprocessing by having the client focus on the memory while simultaneously concentrating on the desired positive belief, thus replacing the original negative one. During this phase, the positive cognition is strengthened through additional sets of bilateral eye movements, taps, or audio tones.

The installation phase concludes when the client feels the positive belief to be completely true, as indicated by a Validity of Cognition (VOC) of seven.

The final stage of EMDR reprocessing aims to ensure that no residual disturbance related to the memory remains in the body. The client is guided to focus on the original experience while holding the positive cognition in mind, scanning their body for any negative physical sensations.

Residual physical disturbances are resolved with additional sets of bilateral eye movements, taps, or audio tones. If the body scan reveals positive sensations, these can also be enhanced through further bilateral work.

Each EMDR reprocessing session concludes with the closure phase to ensure client stability prior to leaving therapy. If reprocessing of a memory is not completed in a single session, the therapist guides the client through various calming techniques to help restore a sense of equilibrium.

The client is also reminded that reprocessing may continue after the session. They are encouraged to record any insights or new information in their therapy log for review in the next session.

Each session begins with a re-evaluation to address any ongoing issues and ensure long-term treatment success. While the client may feel relief almost immediately with EMDR, it is crucial to complete all eight phases of treatment to maintain stability and lasting effects of therapy.