The initial sessions of EMDR entail a thorough assessment, a discussion of memories that the client wants to target and improving the client's ability to manage things that they find stressful. When ready to move on to Phase 3-8 of EMDR therapy, the client will be asked to focus on a specific event. Attention will be given to an image that represents the worst part of that memory, a negative belief about themselves as they think about it and the emotions and body sensations the client is experiencing as they think about it. We also consider a preferred positive belief about themselves and moving towards believing that instead, indicating that the issue may have been resolved.
While the client focuses on the upsetting event, the therapist will begin sets of bilateral stimulation (BLS) which can entail eye movements, sounds or taps. Learn more about BLS here. The client will be guided to notice what came to mind after each set. They may experience shifts in insight or changes in images, feelings, body sensations or beliefs regarding the event being processed. The client has complete control to stop the processing at any point if needed. The sets of eye movements, sounds, or taps are repeated until the event becomes less disturbing. EMDR therapy may be used within a standard talking therapy, as adjunctive therapy with a separate therapist or as a stand alone treatment.
How Long Does EMDR Therapy Take?
A typical EMDR therapy session can last from 60 minutes to several hours. It could take one or several sessions to process one traumatic experience.
The goal of EMDR therapy is to completely process the traumatic experiences that are causing problems and to include new ones needed for full health. The amount of time it will take to complete EMDR treatment for traumatic experiences will depend upon the client's history. Complete treatment of a single EMDR trauma target involves a three-pronged protocol to alleviate the symptoms and address the complete clinical picture. The three prongs include:
past memories
present disturbance
future actions
Although EMDR therapy may produce results more rapidly than other forms of therapy, speed is not the goal of therapy, and it is essential to remember that every client has different needs. For instance, one client may take weeks to establish sufficient feelings of trust (Phase 2), while another may proceed quickly through the first six phases of treatment only to reveal something even more important that needs treatment.
"Processing" in EMDR Therapy
"Processing" does not mean talking about a traumatic experience. "Processing" means setting up a learning state that will allow experiences causing problems to be "digested" and stored more adaptively or appropriately in your brain. That means that what is useful to you from an experience will be learned and stored with appropriate emotions in your brain and can guide you positively in the future.
The maladaptive emotions, beliefs and body sensations will be discarded. Negative emotions, feelings and behaviours are generally caused by unresolved earlier experiences pushing you in the wrong direction. The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviours and interactions in the future.
Eight Phases of EMDR Therapy Treatment
There are eight phases to EMDR therapy: initial history discovery and treatment planning, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation.
Phase 1: History and Treatment Planning
This phase generally takes 1-2 sessions at the beginning of therapy and can continue throughout the therapy, especially if new problems are revealed. In the first phase of EMDR treatment, the therapist takes a thorough history of the client and develops a treatment plan. This phase will include a discussion of the specific problem that has brought him or her into therapy and the behaviours and symptoms stemming from that problem. With this information, the therapist will develop a treatment plan that defines the specific targets on which to use EMDR:
the event(s) from the past that created the problem
the present situations that cause distress
the key skills or behaviours the client needs to learn for his future well-being
One of the unusual or unique features of EMDR is that the client does not have to discuss disturbing memories in detail. So while some clients are comfortable and even prefer giving specifics, others may present more of a general picture or outline. When the therapist asks, for example, "What event do you remember that made you feel worthless and useless?" the person may say, "It was something my brother did to me." That is all the information the therapist needs to identify and target the event with EMDR.
Phase 2: Preparation
For most clients, this phase will take between 1-4 sessions. For others with a very traumatized background or with certain diagnoses, a longer time may be necessary. In this phase, your therapist will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you can generally proceed to the next phase.
One of the primary goals of the preparation phase is to establish a relationship of trust between the client and the therapist. While the person does not have to go into great detail about his disturbing memories, if the EMDR client does not trust their therapist, they may not accurately report what is felt and what changes they are or are not experiencing during the BLS. If the client just wants to please the therapist and say they feel better when they don't, no therapy in the world will resolve that client's trauma.
During the Preparation Phase, the therapist will explain the theory of EMDR, how it is done, and what the person can expect during and after treatment. Finally, the therapist will teach the client various relaxation techniques for calming him or herself in the face of any emotional disturbance that may arise during or after a session.
In any form of therapy, it is best to look at the therapist as a facilitator or guide who needs to hear of any hurt, need, or disappointments to help achieve the common goal. EMDR therapy is a great deal more than just eye movements, and the therapist needs to know when to employ any of the needed procedures to keep the processing going. Learning these tools is an important aid for anyone. The happiest people on the planet have ways of relaxing themselves and decompressing from life's inevitable and often unsuspected stress. One goal of EMDR therapy is to ensure that clients can take care of themselves
Phase 3: Assessment
In this phase, the client will be prompted to access each target in a controlled and standardized way to be effectively processed. Processing does not mean talking about it. (See the Reprocessing sections below.) The EMDR therapist identifies different parts of the target to be processed.
The first step is for the client to select a specific image or mental picture from the target event (identified during Phase One) that best represents the memory. Then he or she chooses a statement that expresses a negative self-belief associated with the event. Even if the client intellectually knows that the statement is false, they must focus on it in order to decrease the impact that the memory has. These negative beliefs are verbalizations of the disturbing emotions that still exist. Common negative cognitions include statements such as "I am helpless," "I am worthless," "I am unlovable," "I am dirty," "I am bad," etc.
The client then picks a positive self-statement that they would rather believe. This statement usually incorporates an internal sense of control, such as "I am worthwhile/lovable/a good person/in control" or "I can succeed." Sometimes, when the primary emotion is fear, such as in the aftermath of a natural disaster, the negative cognition can be, "I am in danger," and the positive cognition can be, "I am safe now." "I am in danger" can be considered a negative cognition because the fear is inappropriate -- it is locked in the nervous system, but the danger is past. Positive cognition should reflect what is appropriate in the present.
The therapist will then ask the person to estimate how true the positive belief feels using the 1-to-7 Validity of Cognition (VOC) scale. "1" equals "completely false," and " 7" equals "completely true." It is essential to give a score that reflects how the person "feels," not " thinks." We may logically "know" something is wrong, but we are most driven by how it "feels."
Also, during the Assessment Phase, the client identifies the negative emotions (fear, anger) and physical sensations (tightness in the stomach, cold hands) that they associate with the target. The client rates the negative belief but uses a different scale called the Subjective Units of Disturbance (SUD) scale. This scale rates the feeling from 0 (no disturbance) to 10 (worst) and assesses the client's feelings and body sensations.
The goal of EMDR treatment, in the following phases, is for SUD scores of disturbance to decrease while the VOC scores of positive belief increase.
Reprocessing. For a single trauma, reprocessing is generally accomplished within three sessions. If it takes longer, you should see some improvement within that time. Phases One through Three lay the groundwork for the comprehensive treatment and reprocessing of the specific targeted events. Although eye movements (or taps or tones) are used during the following three phases, they are only one component of a complex therapy. The step-by-step eight-phase approach allows the experienced, trained EMDR therapist to maximize the treatment effects for the client in a logical and standardized fashion. It also allows the client and the therapist to monitor the progress during every treatment session.
Phase 4: Desensitization
This phase focuses on the client's disturbing emotions and sensations as measured by the SUDs rating. This phase deals with the person's responses (including other memories, insights, and associations that may arise) as the targeted event changes and its disturbing elements are resolved. This phase gives the opportunity to identify and resolve similar events that may have occurred and are associated with the target. That way, a client can surpass their initial goals and heal beyond expectations.
During desensitization, the therapist leads the client in sets of eye movements, sounds, or taps with appropriate shifts and changes of focus until their SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). Starting with the main target, the different associations to the memory are followed. For instance, a person may start with a horrific event and soon have other associations to it. The therapist will guide the client to a complete resolution of the target.
Phase 5: Installation
The goal is to concentrate on and increase the strength of the positive belief that the client has identified to replace their original negative belief. For example, the client might begin with a mental image of being beaten up by their father and a negative belief of "I am powerless." During the Desensitization Phase, the client will have reprocessed the terror of that childhood event and fully realized that as an adult, they now has strength, capability and choices that were not there when they were young.
During this fifth phase of treatment, a client's positive cognition, "I am now in control," will be strengthened and installed. How deeply the person believes that positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal is for the person to accept the full truth of their preferred, positive self-statement at a level of 7 (completely true).
Fortunately, just as EMDR cannot make anyone shed appropriate negative feelings, it cannot make the person believe anything positive that is not appropriate either. So if the person is aware that they needs to learn some new skills, such as self-defense training, to be truly in control of the situation, the validity of that positive belief will rise only to the corresponding level, such as a 5 or 6 on the VOC scale.
Phase 6: Body Scan
After the positive cognition has been strengthened and installed, the therapist will ask the person to bring the original target event to mind and see if any residual tension is noticed in the body. If so, these physical sensations are then targeted for reprocessing.
Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in body memory (motoric memory), rather than narrative memory and retains the negative emotions and physical sensations of the original event. However, when that information is processed, it can then move to narrative (or verbalizable) memory, and the body sensations and negative feelings associated with it disappear. Therefore, an EMDR session is not considered successful until the client can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.
Phase 7: Closure
Closure ensures that the person leaves feeling better at the end of each session than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the client in using a variety of self-calming techniques in order to regain a sense of equilibrium. Throughout the EMDR session, the client has been in control (for instance, the client is instructed that it is okay to raise a hand in the "stop" gesture at any time) and it is essential that the client continue to feel in control outside the therapist's office. The client is also briefed on what to expect between sessions (i.e. some processing may continue, some new material may arise), how to use a journal to record these experiences and what calming techniques could be used to self-soothe in the client's life outside of therapy.
Phase 8: Reevaluation
Opens every new session. The Reevaluation Phase guides the therapist through the treatment plans needed to deal with the client's presenting challenges. As with any form of sound therapy, the Reevaluation Phase is vital to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as essential to complete the eight phases of treatment as it is to complete an entire course of treatment with antibiotics.
The Role of Past, Present and The Future
EMDR therapy is not complete until attention has been brought to the past memories contributing to the problem, the disturbing present situations, and what skills the client may need for the future.
If you have any questions about the phases of EMDR Therapy, please reach out to Sally-Anne at sallyanne@mentalblocks.net
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