How an Eye Movement Desensitization and Reprocessing Session is Conducted
Eye Movement Desensitization and Reprocessing, EMDR is a type of individual psychotherapy used to help people suffering from PTSD or other trauma to heal from the emotional scars and behavioral problems associated with the experience. Each session typically involves the therapist guiding their client to a specific memory associated with the trauma, holding that memory and experience (with guided help to destress the person while experiencing traumatic memories), and then focusing their eyes on the therapist’s hand, finger, or an object as it is moved back and forth across the client’s line of vision. This helps to reduce stress while focusing on the memory of the trauma. EMDR also uses some elements of Cognitive Behavioral Therapy to retrain behaviors in reaction to trauma, such as training the individual to avoid substance abuse.
The 8 Phases of EMDR Treatment
There are eight phases of EMDR treatment overall. Each phase may be part of an individual session, or they could be steps in a longer treatment plan.
Phases of the Process
- Body Scan
- History and Treatment Planning: The therapist will take their new client’s history in detail in order to develop a treatment plan. The person who will undergo EMDR treatment can work with the therapist to ensure they receive the treatment they want. While this phase is typically the initial 1-2 sessions, the care plan can be adjusted if new issues come up over the course of treatment. Once the plan is in place, it is not firmly cemented but instead offers guidelines for the clinician and client, so they both know how well EMDR is working.
- Preparation: This may occur at the beginning of each session, or a few sessions at the initial stages may be devoted to this work. EMDR may bring up intense memories or emotions from trauma, and the therapist will work with their client to manage stress, understand what is happening, and accept the feelings associated with the traumatic experiences. Part of EMDR, and any therapeutic treatment for trauma, is to understand the memories and their impact on behavior, and then to retrain reactions to these memories. By guiding the client through exercises, a therapist can help the person maintain emotional stability after the session is over. The client will also know when they need to seek emergency help to avoid substance abuse, self-harm, or other behaviors associated with traumatic memories.
- Assessment: During this part of a treatment session or plan, the client will identify their negative emotions and how behaviors bring up these emotions. For example, a person who has survived sexual trauma may feel afraid of physical touch, even if that touch is on the hand or shoulder, or another non-sexualized place. Assessment may occur during each session, or it may involve three sessions over the course of the whole treatment plan.
- Desensitization: This is one of the main phases of EMDR treatment. The person may bring up a memory they want to work on, or the therapist may guide the client through a memory. Once the memory is chosen, the therapist will guide the client to hold the memory, but focus on the therapist’s hand as it moves across the individual’s line of vision. Stress level is assessed using a specific rating scale at the beginning of the session, when the memory is first brought up, and at the end of the session. Ideally, stress level reduces to zero, indicating that trauma from the event is being healed.
- Installation: During the initial phases, negative self-beliefs are identified. During and after phase 4, these beliefs are reframed or replaced with positive beliefs. For example, “I am powerless,” is replaced with, “I am in control of myself.”
- Body Scan: After the installation of positive self-statements and images, the therapist will guide the person back to the memory and notice any remaining physical reactions or tension associated with the event. This is the final stage of processing information about the traumatic experience, so the event can move into narrative memory. It is still part of the person’s overall life experience, but it is not buried, and it brings up fewer instinctive behavioral reactions to self-soothe.
- Closure: This is the end of the session or the overall treatment plan. During this time, the therapist and their client will discuss the treatment to make sure the person feels better and calmer at the end of treatment than they did at the beginning. If they do not feel better, the treatment plan can be re-evaluated; if they do feel better, it is an indication that the plan is working appropriately, and psychological healing has begun.
- Re-Evaluation: This brings the end of the previous session into the beginning of the next session. The person discusses anything that came up between sessions, so those reactions can be acknowledged, helped as needed, and used as guidance in the overall treatment plan. The therapist will then use these benchmarks to guide the structure of the session.