What Can I Expect From EMDR Therapy? A Session to Session Guide

Read the first blog in this series:
What is EMDR? Is it as powerful as they say?

Although EMDR has been around, and researched for decades, it still receives a lot of skepticism. In this article, we will outline what EMDR should look like, if administered by a qualified and trained professional. It is a systematic process that shouldn’t be rushed through.

Phase 1: History Taking and Treatment Planning

As with any therapy, it must start with a comprehensive intake. It is imperative for the therapist to have a solid understanding of the client’s past, current situation and stressors, and goals for the future. In EMDR, we effect change by processing through troublesome memories from the past. During this phase, in collaboration with the client, the therapist will help identify what life experiences are contributing to the symptoms of today. In some cases with significant trauma, it can take some time to plan this out. In more clear-cut cases it can be done fairly quickly. This document is then called a ‘target sequence plan’. It organizes all the memories from the past, triggers in the present, and hopes for the future, guiding future sessions.

Another important element is to evaluate the client’s level of dissociation. Dissociation is a natural and normal process for all humans. When you take the same route home from work, your brain doesn’t remember all the details of the drive. While watching TV or reading a book, we sometimes need to go back because we weren’t focused. For people that have experienced trauma, the level of dissociation is often higher. The ability to disconnect from your body and the circumstances is a useful skill in self-preservation. For EMDR, however, it can add a speed bump. This doesn’t mean EMDR is not possible, it means we will take a little longer in Phase 2 to learn new coping and self-regulation skills.

Phase 1 can be done fairly quickly, or may take several sessions to complete. It’s more important to be thorough than to be quick. When done with intention it will make the following phase move much quicker and bring faster relief.

Phase 2: Preparation

Once we have completed a thorough intake, have a well thought out target sequence plan, and assessed for dissociation, we move into preparation phase. As the name suggests, we are preparing for EMDR processing here. The therapist will work with the client to understand their ‘Window of Tolerance’. Essentially, this refers to how well the client is able to regulate their emotions.

During Phase 2, your therapist will also introduce the Bilateral Stimulation (BLS). These include eye movements, self-tapping, audio tones or mechanical tappers. Together, you will try different options to see what’s optimal for you. You will then put the BLS into use by creating an imaginary place that feels calm and peaceful for you. The BLS is added to help you better connect to your imaged place. This new coping skill can be used in and out of the session to help you stay regulated and within your optimal zone. They may use a few other techniques as well to help you contain and stay balanced. All of these activities are just as effective when done in person or virtually.

Phase 2 is often 2-3 sessions. If you struggle with your own emotional regulation, or have a history of dissociation, this phase will take much longer. Again, moving too quickly will result in hyper or hypoarousal down the road and require you to come back to phase 2 for more work.

Phase 3: Assessment of the Target Memory

When your therapist identifies that you are ready for memory processing, they will review the target sequence plan with you. Often they will start with either the first memory in the sequence, or the one that is the most emotional. This is intentional. The earlier the memory is, the more foundational it is, and the greater the impact of the memory. Alternatively, the most activating memory will also provide the greatest relief.

Your therapist will ask a series of very particular questions about how you experience the memory now. The purpose is to make this memory very vivid for you – the image of the memory, a negative belief you have about yourself, the emotions evoked by this memory and where you feel it in your body (sense of tension or discomfort). I think of this as laser focusing your brain and body into what we want it to process. At this phase, we expect intense emotions to arise, even if it feels like a very small or insignificant memory. This is why we do the groundwork in Phase 2, should we need to use those skills here.

Phase 4: Desensitization

This phase is the one most often depicted in TV and film, the therapist is moving their fingers back and forth in front of the client. While desensitizing, we will use fast BLS, this allows the emotional center of the brain to connect with the logical center of the brain. This linking, that allows for information transfer, was blocked previously, as the emotions were too high. As you experience the intense emotions (sadness, fear, guilt), your brain also reminds you that it is over, that someone was there to help you or that there weren’t any other viable options available for you.

This phase ends when you can recall the memory without feeling disturbance. It’s often described as just another thing that happened, a distant memory or that it seems far away. Sometimes we are able to get all the way through phase 4 in one session, other times it takes more. This doesn’t mean that you or your therapist are doing EMDR wrong. It means that this memory is complicated (even if it doesn’t feel like an important one) and takes longer to unravel. Your therapist is responsible for making sure that you are able to return to a calm state before the session ends. This is where some of our work in Phase 2 comes in handy.

Phase 5: Installation

Installation phase comes next. At this point, we are confident that all of the emotions and disturbance of the memory were worked through in Phase 4. We check on the beliefs that we had identified in Phase 3, focusing on the positive belief. Some examples would be ‘I am enough’, ‘I am safe’, ‘I am worthy’. We anticipate that these statements are now true, as the disturbing part of the memory is gone. We are now able to fully engage our logical/thinking brain. Your therapist will continue with the fast BLS to strengthen your connection to your positive statement. Sometimes we will find a little piece of the experience that wasn’t quite cleared out, and will return to Phase 4 to continue processing.

Phase 6: Body Scan

The body is last element to work through the trauma, and is checked last. Your therapist will ask you to think of the memory, along with the positive statement we installed in the previous phase. If it’s fully processed, you wouldn’t find any stress or tension in your body. If something does show up, we will continue processing it until it gets resolved. Sometimes this means returning to Phase 4 Reprocessing.

Phase 7: Closure

After every processing your therapist will remind you of a few things. Your brain will continue to digest and process, even after the BLS has stopped. As a result, you may be a little irritable, have memories resurface or have unusual dreams. This is all normal. If it becomes disruptive of your work, home life or sense of safety, try using some of the skills you used in Phase 2. If that doesn’t help, contact your therapist for support.

You will also be advised to you a TICES log. This is a worksheet that helps you track anything new that comes up after processing. It stands for Trigger, Image, Cognition (thought), Emotion and Sensation (Body)/SUD. Bringing this in to your therapist gives insight into any additional support you may need, as well as memories to add to the target sequence plan.

Phase 8: Re-evaluation

After every session that we use fast BLS we need to follow up and check on the memory. This TICES log mentioned in Phase 7 is helpful here. We also want to check on the memory itself. As the brain continues to work after session, it may find a new piece of disturbing material that was missed, or what was left there for next session resolves itself on it’s own. If the memory continues to be activating, we will pick up in Phase 4 and resume processing. If the memory remains neutral, that memory is complete and we’ll move onto the next one in the target sequence plan.

How do I Find a Qualified EMDR Therapist?

When looking for a qualified EMDR therapist, the first place to look is on the EMDRIA website. The EMDR International Association is the body that regulates both how EMDR is trained, and the therapists that wish to move up the credentialing process. There are companies that offer EMDR trainings, however they do not hold the same rigorous expectations, including supervised practice. Make sure your therapist has EMDRIA approval before moving forward.

There are several levels of EMDR therapists:

• EMDR in training: Currently participating in the 50 hours of training. This includes lecture, video and live demonstrations of key principles, and practicing with another trainee while an experienced EMDR therapist observes and gives live feed-back. They are also participating in 10 hours of group sessions, where they share their use of EMDR, review lecture material and learn from their peers’ experiences.
• EMDR trained: Completed the 50 hours or training, the 10 hours of group and a post-test demonstrating their knowledge. No further actions are necessary to keep this status.
• EMDR certified: After becoming EMDR trained, these therapist continue their learning by taking at least 12 hours of advanced trainings, have an additional 20 hours of oversight with a higher level EMDR therapist (including audio tapes of actual sessions), and have completed a minimum number of processing sessions. Certification must be renewed every 2 years, an additional 12 hours of advanced trainings is required at each renewal.
• EMDR Consultant in Training (CIT): After becoming certified, they continue to learn by taking another 12 hours of advanced training and have more processing sessions completed. They are also required to have a minimum of 20 hours of oversight from an Approved Consultant (the next levelup). The Approved Consultant will evaluate the CIT’s ability to correctly guide and support newly trained therapists in their use of EMDR with their clients. The audio/video used here will be of the CIT offering consultation to the therapist that is either in training or trained.
• EMDR Approved Consultant: Once all the above requirements are met, the therapist will now have the title of Approved Consultant. This credential requires 12 hours of advanced training and renewal every two years.
• EMDR Trainer: This is the highest level of credentialing for an EMDR therapist. There are believed to be less than 250 trainers in the United States. In addition to being an Approved Consultant, the trainer has to go through a rigorous screening process. The curriculum has to meet very specific criteria about content and length of time spent on topics, the in training practicum experiences, even how the learning management system works. They are also required to answer a series of questions around how they handle certain situations, learner engagement, and being culturally sensitive and aware. Trainer status is renewed every 2 years by answering the training specific short essay questions.

If you have further questions about EMDR, either as a therapist or as a potential client, please reach out to Heather Dunn, EMDRIA Approved trainer, at heather@bluehorizoncounseling.com.

Summary

There is a lot more to EMDR, it requires a minimum or 60 hours in supervised training to be credentialed. This overview is designed to help you feel more prepared before starting EMDR for yourself. Admittedly, it does seem odd that experiencing BLS could have such a significant effect. It has been tested over and over again for 40 years, with strong results supporting this therapy.

Each phase is just as important as the next and need to be done thoroughly and in order. The most common mistakes that new or inexperienced EMDR therapists make is not doing the groundwork. Phases 1 and 2 are imperative to ensure the processing is emotionally safe and tolerable for the client. Unfortunately these phases are often rushed through. Additionally, you want to make sure your therapist is intentional about which memory to start processing through. Starting with an intense trauma, especially if the client is ill prepared, can have significant long-term impacts. It’s often advised to start with a smaller memory as the client gets comfortable with the process, and the therapist can evaluate their ability to stay regulated.

Read more about EMDR:
How is EMDR Different From Talk Therapy?
How Effective is EMDR with Anxiety and Depression?
How Effective is EMDR with Adolescents?
How Effective is EMDR with Children?
How Effective is EMDR with Physiological Diagnosis, such as Bipolar, Neurodivergence and Schizophrenia?
How Effective is EMDR with a Trauma Based Diagnosis – PTSD and Borderline Personality Disorder?

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At Blue Horizon Counseling we have several therapists that are passionate and qualified in EMDR therapy. We also offer consultation for EMDR therapists that are looking for additional support as they continue to learn and grow.

You’re Not Alone. Our Therapists are here to help, in Pearland, TX.

Hang in there. This won’t last forever, even if some days feel like it might. You’re planting the seeds for future blossoms. All our therapists at Blue Horizon Counseling offer sessions both in person and via telehealth.  Find the right therapist for you. We accept most major insurance plans.

Written by Heather Dunn, Licensed Professional Counselor Supervisor and Licensed Marriage and Family Therapist Supervisor, specializing in trauma, dissociation and EMDR. Heather has been practicing for over 20 years and enjoys sharing her knowledge and helpful tips.

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