Eye Movement Desensitization and Reprocessing (EMDR)is used for individuals who have experienced severe shock or trauma that remains unresolved. When a traumatic or distressing experience occurs, it may overwhelm our normal coping mechanisms. The result is the memory and associated sensations stays with us long after the trauma has passed.
EMDR therapy processes these distressing memories and feelings, clear their lingering effects – allowing clients to develop more adaptive coping mechanisms. This is done in an eight-phase approach that includes having clients recall distressing images while receiving one of several types of bilateral sensory input, including side to side eye movements.
The use of EMDR was originally developed to treat adults suffering from PTSD; however, it is also now incredibly successfully used to treat other trauma conditions. EMDR works well with children also.
EMDR therapy consists of eight phases and each phase has its precise intentions:
Phase I – History and Treatment Planning
The therapist will conduct an initial evaluation of the client’s history and develop a general plan for treatment. This includes the problems which are the primary complaint of the client and a history of distressing memories which will become the targets for reprocessing.
Phase II – Preparation
The therapist helps the client develop ways to cope with distressing emotions so that they are able to calm down and help themselves in between therapy sessions. Commonly this is done with guided imagery or other relaxation techniques.
Phase III – Assessment
The therapist asks the client to visualize an image that represents the disturbing event. Along with it, the client will describe a thought or negative cognition (NC) associated with the image. The client will be asked to develop a positive cognition (PC) to be associated with the same image that is desired in place of the negative one. The client is asked how strongly he or she believes the PCs to be true using a 1-7 scale (completely false to completely true) called the Validity of Cognition (VOC) scale. The client is also asked to identify what emotions he or she feels. The client is then asked to rate his or her level of distress on a scale from 0-10, with 0 being no distress and 10 being the most distress they can imagine. This is the same as a Subjective Units of Distress scale (SUD) that is commonly used in cognitive behavioral therapy (CBT). Finally the client is asked to identify where in the body he or she is sensing the feelings.
Phase IV – Desensitization
During the reprocessing phases of EMDR therapy, the client focuses on the disturbing memory in multiple brief sets of about 15–30 seconds. Simultaneously, the client focuses on the dual attention stimulus, which consists of focusing on the trauma while the clinician initiates lateral eye movement or another stimulus such as a pulsing light held in each hand, or tapping on the knees. Following each set, the client is asked what associative information was elicited during the procedure. This new material usually becomes the focus of the next set or another aspect of the memory may be guided by the clinician. This process of personal association is repeated many times during the session. This process continues until the client no longer feels as distressed when thinking of the target memory.
Phase V – Installation
The therapist asks the client to focus on the event along with the PC developed in phase III. The client is asked to hold in mind the memory with the positive thought as the therapist continues with the bilateral stimulation. When the client feels he or she is certain the PC is fully believed and that belief is as strong as possible, the installation phase is complete.
Phase VI – Body Scan
At this phase the goal of the therapist is to identify any uncomfortable sensations that could be lingering in the body when the client is thinking about the target memory and the PC. While thinking about the event and the positive belief the client is asked to scan over his or her body entirely, searching for tension, tightness or other unusual physical sensation. Any negative sensations are targeted and then diminished, using the same bilateral stimulation technique from phases IV and V. The PCs should be incorporated emotionally as well as intellectually. Phase VI is complete when the client is able to think and speak about the event along with the PC without feeling any physical or emotional discomfort.
Phase VII – Closure
Not all traumatic events will be resolved completely within one session. If the client is significantly distressed the therapist will guide the client through relaxation techniques that are designed to bring about emotional stability and tranquility. The client will also be asked to use these same techniques for experiences that might arise between sessions such as strong emotions, unwanted imagery, and negative thoughts. The client may be encouraged to keep a brief log of these experiences, allowing for easy recall and processing during the next session.
Phase VIII – Reevaluation
With every new session, the therapist will reevaluate the work done in the prior session. The therapist will also assess how well the client managed on his or her own in between visits. At this point, the therapist will decide whether it is best to continue working on previous targets or continue to newer ones.