EMDR takes place over the course of eight steps called “phases,” each of which are dedicated to specific part of the healing process. (It will help to remember that the phases are not strictly limited to a single therapy session.) This post will explain a little about what a patient undergoing EMDR can expect from the process.
Taking place during the first one or two sessions of therapy, Phase 1 will help to establish the patient’s history with trauma as well as identify why therapy was sought in the first place. Phase 1 will successfully identify targets for treatment. These targets will focus on the traumatic events from the past that are causing distress, the triggers in the present that are contributing to panic and anxiety, and the future behaviors that will help the patient overcome their trauma.
The second phase, which usually can take between one and four sessions (though sometimes longer with extensive traumatic history), allows the therapist to build trust in the patient. Without trust, it will be difficult for the patient to accurately report feelings in the later phases of treatment. Phase 2 is also when the therapist will explain the history and mechanics of EMDR. In addition, the patient will learn what to expect from treatment and outcome. This may be the most important phase because it is crucial that the patient understands how and why EMDR may be a helpful treatment option for them.
After targets have been identified and the patient has been prepped, the assessment phase may begin. This phase sees the patient and therapist working together to assess each of the targets so they can be processed. There is a standardized method to this that involves choosing and image from a traumatic event, focusing on a statement that expresses a negative belief (like “I am ashamed,” or “I deserved this”). Once that connection is established, the patient focuses on a positive statement they would like to believe, like “it’s not my fault.”
This is the phase from which EMDR takes its name. Having locked on certain images from the identified targets, the therapist leads the patient through a series of movements—usually side-to-side eye movements, but taps or other sounds that occur back and forth across the patient’s field of vision work, too—that are designed to help detach the memory from the negative feeling. Other insights and feelings may come up, too, and this information can be used to help the patient completely process their trauma.
Now that the traumatic memories and disturbing feelings associated with them have been processed through the desensitization phase, patients can now focus on the positive statements they identified, and “install” them. For example, the sexual abuse victim who previous felt powerless can now focus on their statement “I am powerful.” These positive statements are repeated and scored until the patient believes them to be true themselves. Now, a new association has been formed with the negative memories, allowing the patient to have a positive and healthy reaction to triggers.
This phase will help to establish whether any residual tension is present in the body when the newly-processed memory is brought to mind. EMDR research has shown that there is often dormant physical tension that needs to be further verbalized. Negative feelings can sometimes be stored in the body in the form of muscle memory, and a successful course of EMDR treatment will have converted all of it into verbal statements of positivity. The patient cannot move forward until all residual body tension is gone.
Every therapy session will end with closure, which helps to ensure that the patient leaves feeling better than they did when they arrived. There are self-calming techniques that the patient can use to regain a sense of order and control. The patient is also given information about how to keep progressing between sessions (through the use of journaling, for example) and how to prepare for the next session.
Re-evaluation begins at every new session and works for maintenance purposes. The therapist check to make sure that positive levels have remained up between sessions, and the therapist and patient work together to establish new goals. This helps the therapist to monitor progress over time. The most important thing is success for the patient, and though they may feel relief, they must work through all eight phases in order to have a complete run of EMDR.
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