“The speed at which change occurs during EMDR contradicts the traditional notion of time as essential for psychological healing” – Bessel A. van der Kolk, MD Professor of Psychiatry, Boston University School of Medicine
For many clients it is sufficient to know that research (or often positive experiences from friends or family members) shows that EMDR is effective and efficient, and will leave the nitty gritty details for the professional to worry about, as it is the professional’s job. For other clients, being in control of their treatment makes them feel more comfortable, and knowing about the treatment modality being utilized is important. If the latter sounds like you, here is an outline of what to expect during the 8 phases of EMDR treatment:
Phase 1: Treatment Planning
This is where I will get to know you and what brought you to therapy. I will gather information about your current symptoms, briefly the significant past events in your life that have led to these current symptoms, and how you would like to think, feel and behave differently in the future. I’ll utilize clinical assessments to more effectively guide your treatment specifically to your needs. For example, if you are highly dissociative, we will most likely have to approach our preparation for reprocessing differently, and it may take longer to prepare. Together, we will develop a treatment and targeting plan that includes clear intentions around the changes you would like to make in your life. Many clients begin to immediately see positive changes in their lives once they have worked with a trained professional on setting clear and achievable intentions for their lives.
Phase 2: Preparation
In preparation phase we will develop resources, tools and skills to increase your ability to regulate your emotions and tolerate emotional distress. These positive resources will depend on your presenting concerns and specific needs. Most clients will begin to see positive results from therapy in this phase as they begin to apply these skills in their everyday lives. The development of these skills also makes for a smoother, faster, easier reprocessing phase.
Phase 3: Assessment
After re-evaluating the targeting plan from phase 1, we will determine which past experiences to reprocess. We will assess the first target by identifying an image of the target event, how distressing it is to bring up right now, the negative cognition associated with the image, the preferred associated belief and how true it feels right now, and the associated emotions and body sensations.
Phase 4: Reprocessing or Desensitization
At this point, I will briefly have you bring up the identified parts of the assessed target, and notice, almost in a meditative way, what comes up for you in the present. I liken “bringing up” the assessed components of the target to being on a train and simply noticing the scenery outside the window (assessed components of target) pass by from inside the safety of the train (the present). Another helpful metaphor is when you see a film in a theatre, let’s say about World War II, you are aware of the title and the general gist of the film, and notice from the safe distance of your seat in the audience (the present) the scenes and what happens next in the story with non-judgmental curiosity. You are not in the screen, participating in World War II. World War II has already come and gone, you are just an objective observer.
While you are bringing up the assessed components of the target, I will guide you to follow side-to-side eye movements for a set(or another form of bilateral stimulation, if necessary). As this happens, for reasons believed by Harvard researchers to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and your brain will begin to reprocess the memory and disturbing feelings. After the set is finished, I will ask you the most prominent thing you notice right now in the present moment. There is no right or wrong answer to this question. There are no “supposed to’s” in this process. It may be an emotion that comes up, a thought, a memory, a change in the image, a body sensation, or nothing at all. Your only job is to give as accurate feedback as possible as to what is going on within you without judging or over-thinking it. EMDR operates under the assumption that the body naturally moves towards healing. If your arm has a cut, your body will naturally work to close it, unless, for example, a splinter obstructs the healing process. The impact of traumatic events can act as that splinter or obstruction, that emotional wound festers and causes suffering. Using the detailed protocols, reprocessing removes the block and allows the healing to resume.
Phase 5: Installation
In installation I will ask you to hold together the target image with your chosen positive cognition you prefer to believe about yourself in regards to the event until the validity to you is fully strengthened.
Phase 6: Body Scan
During body scan we will identify and clear out any last lingering body sensations associated with the target.
Phase 7: Closure
We close every treatment session to ensure you are calm and feeling grounded, especially if we are ending a session with an unfinished target. We will most likely utilize skills and resources developed during preparation phase. I will also brief you on what to expect between sessions: just because our session has ended does not mean your brain will stop processing. Thoughts/emotions/sensations/dreams may come up, and if they do that is perfectly normal, just notice them. You can log them if you’d like, without getting into too much detail. Otherwise simply observe, use your skills, and we will check in regarding what comes up during re-evaluation phase at the beginning of the next session.
Phase 8: Re-evaluation
At the beginning of every session I will check in with you regarding any new insights or connections since our last session. We will also check in to assess where the target is before continuing reprocessing phase if the target was not completed last session. A completed target has moved through assessment, reprocessing, installation and body scan phases. In addition, after a target is completed and before moving on to a new target we will re-assess your targeting plan. It is typical for a “generalization effect” to occur, where distress goes down in targets in the same associative pathway of our brains. Once past targets are completed, we will move to any current targets that persist, and then “future template” where the same procedures are conducted with a future scenario that you would like to respond to more adaptively.
Helen’s Notes of Importance on the 8 Phases:
- Therapy is set at your pace.
- The phases of EMDR therapy are not linear. They are fluid based on your needs. For example if we are not finding movement during reprocessing phase, skills can always be enhanced (preparation phase) to ease the process.
- EMDR is not about “reliving” or even describing past events in detail. I have worked with individuals who preferred not to share virtually any details about events they had experienced, and were still able reprocess and heal from these distressing events.
- It is important to note that all eight phases of treatment are EMDR, not solely the reprocessing phase, and a client can experience improvements during all phases of EMDR.
- In EMDR you are not just “in treatment” indefinitely. You will know at any one time where you are in the process.