What to Expect from EMDR Therapy

When I have new clients interested in EMDR (eye movement desensitization and reprocessing), they often report feeling unsure what to expect. Some have been told by a therapist, friend, or someone else to try EMDR therapy, but still are unsure what it even is. As a therapist, I want you to feel empowered in all your choices regarding your treatment, especially when engaging in a specific model of therapy, such as EMDR. I want to explain what EMDR is and how EMDR sessions look on a regular basis, as well as how therapy overall looks with my EMDR clients.

Your first session with any EMDR therapist will likely look the same as any initial therapy session you have with any other therapist. You come in and we get to know one another. The therapist will typically complete some sort of an assessment to understand what is bringing you to therapy, your history with mental health, any physical health issues that could be a factor, your living situation, and the quality of your relationships. The first session of therapy can be a bit more difficult than ones in the future, because you are asked to disclose quite a bit to a stranger in that first session. While this is uncomfortable for some people, it helps the therapist to determine if they are qualified to work with the issues you need help with and if you are a good fit for EMDR. When we talk about a “good fit” for EMDR, that refers to if you have the coping skills to manage stress in between sessions and if you are in a place where you are emotionally ready to engage in EMDR, because it can be very triggering work. If you are not a good fit at that time, many EMDR therapists will still work with you in helping you to build up the skills that you need to engage in EMDR.

After the initial session, the several following sessions can look different depending on the therapist, but I like to take a few weeks to get to know my clients and help them feel comfortable with me. I have an exercise that helps us to identify your defense mechanisms that I often like to complete with clients early on, because it tends to feel lighthearted, but helps transition us to talking about some deeper things. Usually during these next sessions I try to assess a client’s coping skills to understand what they do well and where they may need some additional support to help manage difficult situations and moments. Remember that EMDR therapy can cause you to feel like your back in the moment of your trauma, so having good coping skills is important so that you are able to ground yourself in between sessions. My clients and I often talk about walking, meditation, yoga, and journaling during these sessions, as these are behaviors I encourage throughout therapy. We will often talk about your support network too, so you can identify people you trust to speak to about these things if you need additional support. These sessions typically last about 4-6 weeks, but this varies greatly depending on the client, their history in therapy, the extent of their trauma, if they are/have been suicidal or engaging in self-harm, and their current level of coping.

When we are ready to start EMDR, the client will be lead through several questions to identify target memories. To identify these targets, we first identify a presenting problem, which can be anything broad or precise. I have had presenting problems as general as “anxiety” and as specific as a certain memory that causes distress. From this presenting problem, we identify a negative statement and from that statement we find the targets; every memory you can think of associated with the words “I’m worthless” or whatever your statement may be. It is important to remember that the questions I ask during this session are intended to fire up your limbic system, thus making you upset. I am an attachment-based EMDR therapist, which means that I will start reprocessing with your youngest, or touchstone, memory and work towards your more recent stressors. Some clients do find this confusing and even frustrating – if you are coming in because of a recent car accident, what does that have to do with your childhood? That is a valid question! The theory is that your reaction to the car accident is based on past behaviors. Maybe there was another time in your life where you felt extreme pain, similar to your accident, but were ignored or rejected by a caregiver or medical professional – that experience can directly effect how you are reacting to your pain now. Sometimes the connections between the memories are not as obvious in the beginning, but are uncovered as we move throughout the process. This can often be a heavy and emotional session for clients, which is why it is important we work on coping skills prior to this.

After we have identified all the target memories, we start reprocessing them using bilateral stimulation (BLS), beginning with the earliest memory identified. BLS can be done several different ways. In my office, I have a few different options for this: First, I have a lightbar for visual, where the client moves their eyes side-to-side while keeping their head straight. I also have headphones for audio where you would just leave the headphones on, and a sound would occur in one ear and then the other. Lastly, I have pulsators which vibrate one at a time. Clients can use just one form of BLS or combine some or all the methods. Each method I have is able to be adjusted for speed, intensity, and even color on the lightbar, so that each client can create their most optimal experience. There are also ways to do BLS and all of EMDR on telehealth, if that is more convenient for you at this time. Getting through a particular memory can take only one session, but typically it takes several. Heavier memories, such as abuse or military combat, tend to take several sessions – I have seen some memories take over 6 weeks to work through. Less traumatic memories, such as a memory of rejection or maybe a hurtful comment, tend to take 1-2 sessions on average, though this can vary greatly depending on a variety of circumstances.

At the end of each session, I offer a stabilization exercise to my clients, which is most commonly a meditation or breathing exercise to help re-ground them to the room, so that they are not leaving my office too dysregulated. When reprocessing difficult memories, sometimes the week in between sessions can be difficult, which is again why it is so important that we focus on coping and calming skills early before starting EMDR. Typically, for less traumatic memories, most of my clients report feeling tired and maybe a bit more emotional (shorter temper, more teary than usual) for a couple of days and then don’t really think about the session after that. We continue to reprocess all the identified memories until they are all complete and then EMDR is over. Sometimes we go right into another presenting problem that may have come up, but usually people are feeling good and want to take a break from therapy before starting something new. It is not required, nor is it common, that we will only do EMDR sessions once the process has started. Oftentimes clients will have stressors occur in between sessions that they want to verbally process and that is completely fine. EMDR is a great resource for most presenting problems in therapy and I really hope that this gives you a better understanding of the process. Please do keep in mind that this is how I tend to manage my sessions, but other therapists may differ in some ways and that is ok – we all have our own styles that we become accustomed to.