by: Jaclyn Rink, MSCP, LLP

Starting EMDR can sometimes feel like a daunting process, so let me ease your mind by shedding some light on what you’ll be doing in the therapy room.

Although it is tailored to the individual, EMDR follows a specific structure to ensure reliability and validity as an empirically supported treatment modality. It has 8 different phases, with some of them repeated based on patient goals and case complexity. It can be helpful to think of the EMDR phases as circular, as opposed to linear. Keep in mind, 8 phases do not equate to 8 sessions, as there are many things that impact a patient’s ability to complete a phase.

Here are the 8 phases, with a brief summary of what to expect:

1. Client History Taking & Target Planning
2. Preparation
3. Assessment
4. Desensitization
5. Installation
6. Body Scan
7. Closure
8. Re-evaluation

1. Client History Taking & Target Planning: In this beginning phase, your therapist will help to determine if EMDR is an appropriate treatment modality based on your symptom presentation and current functioning. In order to do this, they will conduct a clinical intake interview and assess current levels of personal stability and life circumstances. It is not uncommon in this phase for your therapist to ask you to fill out a few screeners regarding traumatic experiences to help them gain further insight and guide treatment planning. During this phase, your therapist will ask you to identify the issues/situations/challenges that you would like to address via EDMR. These are referred to as “targets” and will be broken down into very specific instances. For example: A patient may come in and say, “I am feeling a lot of resentment in my relationship.” EMDR takes that issue and attaches it to a tangible event for processing, “When I see my husband resting/sitting on the couch after dinner, and I am in the kitchen doing dishes by myself.” It can be helpful to identify past, current and future targets. For example, “When he walks out the door to go golfing next Sunday.” In EMDR, past events are seen as the root cause of current dysfunction, consequently triggering distress and maladaptive behaviors in the present. During this phase, you will begin discussing important past events or traumas. This is one of the longest phases of EMDR.

2. Preparation: This is one of the most important parts of EMDR. In this phase, the patient creates new ways to calm their nervous system when they are feeling triggered. These are different than so called “coping skills” taught in traditional therapies, as resources specifically target somatic symptoms, while utilizing bilateral stimulation to further strengthen positive associations. Generally, your EMDR therapist will help you to create several different resource options with the goal of practicing them outside of session. Only after you have trained your brain to regulate your body, can you move on to phase 3. Additionally, this is the phase where your therapist will provide you with some psychoeducation about trauma, how it is stored in the brain and body, and how it shows up maladaptively in day-to-day life. Your therapist will also offer you information on what EMDR is, how it works from a biological perspective, what to expect throughout therapy, and potential outcomes/effects.

3. Assessment: In this phase, you revisit your previously identified targets and select one for future processing. Once selected, you and your therapist will identify components of the target memory, including thoughts, feelings, sensations, images and validity of beliefs. You will also work on identifying what you think these traumatic or stressful scenarios negatively say about you, while identifying a more positive and adaptive belief. This is referred to as the “negative and positive cognition.” This can be a challenging phase for people, as EMDR begins to address uncomfortable situations by bringing up memories or current stressors in depth. Luckily, you have the resources you developed in phase two to help you through it!

4. Desensitization: This is the most talked about phase in EMDR. During this phase, your therapist will have you summon a stressful image in your mind while simultaneously remembering the negative cognition you previously identified. Once you are focused on these two elements, bilateral stimulation begins. Bilateral stimulation can be done in several different ways, but the most popular are horizontal eye moments, back and forth tapping across your chest or legs, or utilization of “buzzies” (two handheld objects that vibrate bilaterally). Everyone’s brain processes traumatic situations differently; some people see changes in images, some only see colors, and many experience shifts in physical sensations. Whatever it is, you “go with it”. This phase is considered complete once the patient identifies experiencing little to no discomfort when thinking about the target.

5. Installation: For the installation phase, you will identify a positive statement that reflects what you would rather think about yourself when you recall the traumatic picture. For example: instead of believing the negative cognition used in desensitization, “It was all my fault,” you attempt to install a more appropriate and adaptive thought such as, “I did what I could in the situation.” As you hold the event in mind, you will now “tap in” this positive cognition utilizing bilateral stimulation until it becomes something you truly believe (or is ecologically appropriate).

6. Body Scan: This is one of the final phases of processing, as the EMDR therapist will coach you through a body scan to identify any “stuck” feelings in your body. If nothing is there, you move on to the next phase. If you have any lingering sensations or uncomfortable feelings, this is addressed via another round of bilateral stimulation until those feelings significantly subside.

7. Closure: Before you leave the session, your therapist will walk you through a previously learned resource of your choosing to be sure your nervous system is fully regulated. They will often inquire about your experience during processing and provide you with a log to track thoughts, feelings, triggers and sensations between sessions.

8. Re-evaluation: This phase occurs at the beginning of your next session. The therapist will assess your overall functioning, symptoms, and triggers since you last met. They will re-measure your subjective discomfort when recalling the incident, in addition to how strongly you believe the positive cognition that was installed. Based on your answers, you will either re-process the initial target, pick a new one, or review any resourcing or psychoeducation that may seem beneficial.

If you think EMDR therapy may be right for you, please contact our office at 734-416-9098 to schedule an intake with our MFS EMDR therapist, Jaclyn Rink, MSCP, LLP.