What is the EMDR therapy process?
Understanding EMDR: An Overview
Eye Movement Desensitization and Reprocessing therapy represents a structured, evidence-based approach to treating trauma and various psychological difficulties. Developed in the late 1980s, EMDR has since become recognised globally as an effective treatment for PTSD and other conditions stemming from distressing life experiences. The therapy works by helping your brain reprocess traumatic memories that have become "stuck," allowing them to be stored in a more adaptive way that no longer causes overwhelming distress.
Unlike traditional talk therapy, EMDR doesn't require you to discuss your trauma in extensive detail. Instead, the process uses bilateral stimulation—typically through guided eye movements, though tactile or auditory stimulation can also be used—to activate your brain's natural healing mechanisms. This approach allows your mind to process information about traumatic experiences more effectively, similar to how your brain processes ordinary memories during REM sleep.
The EMDR protocol consists of eight distinct phases, each designed to ensure safe, effective, and thorough treatment. These phases guide both the therapist and client through a comprehensive journey from initial assessment through to the completion of reprocessing work. Understanding these phases helps demystify what might otherwise seem like an unusual or mysterious therapeutic approach, allowing you to engage more fully and confidently in your healing process.
What makes EMDR particularly effective is its ability to access memories at multiple levels—the images, thoughts, emotions, and physical sensations associated with traumatic experiences. By engaging all these elements simultaneously during reprocessing, the therapy facilitates comprehensive change rather than simply helping you manage symptoms. Many clients report that after successful EMDR treatment, they can recall traumatic events without experiencing the intense emotional and physical reactions that previously accompanied those memories.
Phase One: History Taking and Treatment Planning
The first phase of EMDR therapy involves comprehensive history taking and the development of a tailored treatment plan. During initial sessions, your therapist will gather detailed information about your background, current difficulties, and the experiences that have brought you to therapy. This isn't simply about collecting facts; it's about understanding how trauma has impacted your life and identifying the specific memories and issues that need to be addressed through the reprocessing work.
Your therapist will ask about your symptoms, when they began, and what situations or triggers make them worse or better. They'll explore your personal history, including significant relationships, major life events, and any previous experiences of trauma. This comprehensive assessment allows the therapist to understand the full context of your difficulties and to identify patterns or connections between different experiences that may need attention during treatment.
A crucial part of this phase involves identifying target memories for reprocessing. These targets typically include the earliest memory related to your current difficulties, recent instances where you've experienced distress, and situations where you anticipate future challenges. This three-pronged approach—addressing past events, present triggers, and future concerns—ensures comprehensive treatment that doesn't just resolve historical trauma but also equips you to handle life moving forward.
Your therapist will also assess your current stability, coping resources, and any factors that might affect your ability to engage safely in trauma processing. If there are concerns about your readiness—perhaps you're in crisis, experiencing severe dissociation, or lack adequate support systems—your therapist may recommend preparatory work before beginning the reprocessing phases. This careful assessment ensures that EMDR treatment proceeds in a way that's appropriately paced and safe for your particular circumstances.
During this phase, you'll also discuss what you hope to achieve through therapy. Setting clear, realistic goals helps guide the treatment process and provides markers for measuring progress. Your therapist will explain how EMDR works, what you can expect during sessions, and answer any questions you have about the process. This collaborative approach to treatment planning establishes a foundation of trust and understanding that supports all subsequent work.
Phase Two: Preparation and Resource Development
The preparation phase is essential for ensuring you have adequate resources to handle the intensity of processing traumatic memories. During this phase, your therapist will teach you various techniques for managing distress, grounding yourself when feeling overwhelmed, and maintaining emotional stability between sessions. These aren't optional extras; they're fundamental tools that enable safe, effective reprocessing work.
One key technique taught during preparation is the "calm place" or "safe place" exercise. This involves identifying and developing a detailed mental image of a place—real or imagined—where you feel completely safe, peaceful, and relaxed. Your therapist will guide you through enhancing this image with all your senses and pairing it with bilateral stimulation to strengthen its calming effect. This resource becomes something you can access during processing sessions if you need a break, or between sessions if you're experiencing distress.
You'll also learn the "container" technique, which involves imagining a secure container where you can temporarily store distressing thoughts, feelings, or memories. This skill is particularly useful for managing material that surfaces between sessions or during times when you need to focus on daily life rather than processing trauma. The container doesn't make anything disappear permanently; rather, it gives you control over when and where you engage with difficult material.
Your therapist may introduce other resource development techniques tailored to your specific needs. These might include identifying positive memories or experiences that can serve as resources, developing imagery that enhances feelings of strength or safety, or practising grounding techniques that help you stay present and connected to your current reality rather than feeling trapped in the past. The time spent developing these resources varies depending on your existing coping skills and the complexity of your trauma.
Some clients feel impatient during the preparation phase, eager to "get on with" the reprocessing work. However, the resources developed during this phase directly impact how smoothly and effectively the later phases proceed. Clients who've thoroughly integrated these preparation techniques typically process traumatic material more efficiently and with less destabilisation between sessions. Your therapist will ensure you're adequately prepared before moving forward, as rushing into reprocessing without proper preparation can be counterproductive and potentially harmful.
Phase Three: Assessment and Target Selection
Once preparation is complete, the assessment phase begins each time a new memory or target is addressed. This phase involves identifying the specific components of the traumatic memory that will be targeted during reprocessing. Your therapist will guide you through a structured process of connecting with different aspects of the experience, including the visual image, negative beliefs, emotions, and physical sensations associated with the memory.
The assessment phase begins by identifying a specific image that represents the worst part of the traumatic memory. This doesn't need to be an actual visual memory—some people experience trauma more through physical sensations or emotions than through clear images—but the therapist will help you identify what aspect best captures the essence of the disturbing experience. This image serves as an entry point into the memory network that needs reprocessing.
Next, you'll identify the negative belief about yourself that connects to this memory. These beliefs often take the form of statements like "I'm not safe," "I'm powerless," "I'm worthless," or "I'm bad." The negative cognition captures how the traumatic experience has shaped your sense of self and your understanding of the world. Identifying this belief clearly allows the reprocessing to address not just the memory itself, but also the maladaptive conclusions you drew from the experience.
You'll then identify a positive belief—how you'd prefer to think about yourself in relation to this experience. This might be something like "I'm safe now," "I have control," or "I'm worthy of love." You'll rate how true this positive belief feels currently using the Validity of Cognition (VOC) scale, where 1 means it feels completely false and 7 means it feels completely true. Most traumatised individuals rate their positive cognition quite low initially, which is expected; the goal of treatment is to strengthen this adaptive belief through the reprocessing work.
The assessment phase also involves identifying the emotions connected to the memory and rating the intensity of your distress using the Subjective Units of Disturbance (SUD) scale, where 0 represents no disturbance and 10 represents the worst disturbance imaginable. Finally, you'll notice where in your body you feel the distress associated with this memory. This comprehensive assessment ensures that all aspects of the traumatic experience—cognitive, emotional, and somatic—are engaged during the reprocessing phase that follows.
Phase Four: Desensitisation Through Bilateral Stimulation
The desensitisation phase is where the actual reprocessing of traumatic memories occurs. During this phase, you'll focus on the target memory whilst simultaneously engaging in bilateral stimulation—typically following your therapist's fingers with your eyes as they move them back and forth across your field of vision. This dual attention—holding the memory in mind whilst engaging in eye movements—facilitates the brain's information processing and allows the memory to be integrated more adaptively.
The bilateral stimulation used in EMDR can take various forms. Whilst eye movements are most common and were the original method discovered, therapists may also use alternating tactile stimulation (such as tapping on your hands or knees) or auditory tones delivered through headphones. The specific method used matters less than finding what works effectively for you. Some clients respond better to one form of stimulation than another, and your therapist will work with you to identify the most effective approach.
During each set of bilateral stimulation—typically lasting 30 seconds to a minute—your brain begins processing the traumatic material. Between sets, your therapist will ask you to take a breath and report briefly what you're noticing. You might notice changes in the image, different thoughts or memories emerging, shifts in emotions, or changes in physical sensations. These changes indicate that processing is occurring, and your therapist will guide you to simply notice whatever arises without trying to control or direct the process.
The reprocessing doesn't follow a predictable path. Sometimes distress intensifies briefly before it decreases. New memories or associations might emerge. Physical sensations might shift or move through your body. Emotions might change or cycle through different states. All of this represents your brain working through the traumatic material, forming new connections, and integrating the experience into your broader memory networks. Your therapist monitors this process carefully, ensuring it continues moving toward resolution.
Desensitisation continues until the distress level associated with the target memory decreases significantly—ideally to 0 or 1 on the SUD scale. For some memories, this happens within a single session. For others, particularly complex or intense traumatic experiences, it may take multiple sessions of desensitisation work. Your therapist will track the progress and determine when sufficient desensitisation has occurred to move forward to the next phase.
Throughout desensitisation, you remain conscious and in control. You're not in a trance or hypnotic state; rather, you're actively engaged in a process that allows your brain to work through material that has been "stuck" in a maladaptive form. The bilateral stimulation appears to facilitate the kind of processing that would naturally occur during REM sleep, allowing traumatic memories to be integrated in a way that reduces their distressing power whilst preserving the important information they contain.
Phase Five: Installation of Positive Cognition
Once the distress associated with the target memory has been adequately reduced, the installation phase strengthens the positive belief you identified during assessment. This phase recognises that it's not enough simply to reduce distress; true healing involves replacing maladaptive beliefs with adaptive ones. Installation helps consolidate more helpful ways of thinking about yourself in relation to the traumatic experience.
During installation, you'll bring to mind the original target memory—which should now feel much less disturbing than it did initially—along with the positive cognition. Your therapist will guide you to hold these together whilst engaging in additional sets of bilateral stimulation. This process strengthens the connection between the memory and the adaptive belief, essentially helping your brain fully integrate the new understanding into its memory networks.
You'll periodically rate the validity of the positive cognition using the VOC scale. The goal is to achieve a rating of 6 or 7, indicating that the positive belief now feels genuinely true to you. For example, if your positive cognition was "I'm safe now," by the end of installation, this statement should feel authentically true rather than merely being something you'd like to believe. This shift from intellectual understanding to felt sense represents the deeper integration that EMDR facilitates.
Sometimes the positive cognition needs adjustment during installation. As processing has occurred, you may find that a different positive belief feels more accurate or meaningful. Your therapist will work flexibly with you to ensure the positive cognition truly resonates and captures your adaptive understanding. The goal isn't to force a predetermined belief, but rather to identify and strengthen whatever adaptive understanding has emerged through the reprocessing work.
Installation typically proceeds more quickly than desensitisation. Since the heavy lifting of processing the traumatic material has already occurred, strengthening the positive belief is usually relatively straightforward. However, if the positive cognition doesn't strengthen adequately, this may indicate that additional desensitisation work is needed, as residual distress can block the full integration of adaptive beliefs.
Phase Six and Seven: Body Scan and Closure
The body scan phase acknowledges that trauma is stored not just in thoughts and emotions, but also in physical sensations. After installation, your therapist will ask you to bring to mind the original target memory and the positive cognition, then scan through your body from head to toe, noticing any sensations. Ideally, you should feel neutral or positive sensations. If any uncomfortable sensations or tension remain, these become targets for additional processing using bilateral stimulation.
This attention to the somatic dimension of trauma is crucial. Many trauma survivors carry tension, pain, or other uncomfortable physical sensations that are connected to their traumatic experiences. The body scan ensures these somatic aspects are fully addressed, as leaving them unprocessed can maintain vulnerability to triggers even after cognitive and emotional processing has occurred. Your therapist will continue bilateral stimulation to process any residual physical distress until your body feels clear and comfortable.
The closure phase occurs at the end of each processing session, whether or not the reprocessing of a particular target is complete. Your therapist will guide you back to a state of equilibrium, using the calming techniques developed during preparation if necessary. They'll explain what you might expect between sessions—processing often continues after you leave the therapy room—and remind you of strategies for managing any distress that arises.
Your therapist will also ask you to keep a brief log between sessions, noting any dreams, memories, thoughts, or situations that trigger distress. This information helps track the ongoing processing and provides material for discussion at your next appointment. The log isn't meant to be burdensome or detailed; rather, it's a simple tool for maintaining awareness of your experience between sessions.
Proper closure is essential, particularly if processing of a target isn't complete within a single session. You shouldn't leave a session feeling highly activated or distressed. Your therapist will ensure you're sufficiently grounded and stable before ending the appointment, and will provide clear guidance about how to manage if difficulties arise before your next session. This care in closure prevents destabilisation and maintains safety throughout the treatment process.
Phase Eight: Re-evaluation and Continued Progress
The re-evaluation phase occurs at the beginning of each subsequent session after reprocessing work has begun. Your therapist will check in about how the previously processed material has settled since your last appointment. Has the distress remained low? Have new associations or memories emerged? Are there changes in how triggers affect you? This ongoing evaluation ensures that processing has been stable and identifies any additional material requiring attention.
Re-evaluation serves multiple purposes in the EMDR protocol. It confirms that the gains achieved in previous sessions have held and haven't regressed between appointments. It identifies any remaining aspects of targets that need further work. It brings awareness to new memories or triggers that have surfaced as a result of earlier processing. And it helps track overall progress toward your treatment goals, allowing both you and your therapist to see how far you've come.
Sometimes re-evaluation reveals that while one aspect of a memory has been fully processed, related memories or different aspects of the same experience need attention. This is normal and expected, particularly with complex trauma. The re-evaluation process helps ensure nothing is overlooked and that treatment addresses your difficulties comprehensively rather than simply focusing on isolated incidents.
As treatment progresses and multiple targets are reprocessed, re-evaluation helps identify patterns and connections between different traumatic experiences. You might notice that processing one memory has led to improvement in reactions to other situations without those situations being directly targeted. This generalisation effect is one of the powerful aspects of EMDR—processing key memories can create shifts that ripple through related experiences and current difficulties.
The re-evaluation phase continues throughout treatment and even after you've processed all initially identified targets. Your therapist will check that improvements are maintained over time and will address any new issues that arise. This ongoing assessment ensures that EMDR treatment is thorough and that you're equipped to handle future challenges without the burden of unprocessed trauma limiting your capacity to live fully and freely
