What to Expect During an EMDR Therapy Session: A Guide for Clients
What to Expect During an EMDR Therapy Session: A Guide for Clients
Author: Alex Penrod, MS, LPC, LCDC
Eye Movement Desensitization and Reprocessing (EMDR) therapy is a powerful and effective treatment for trauma and PTSD. If you’re considering EMDR therapy, it’s natural to feel curious or even a bit apprehensive about what to expect. This guide will walk you through the typical structure of an EMDR session, helping you feel prepared and confident as you begin your journey to healing.
What is EMDR Therapy?
EMDR therapy involves recalling distressing experiences while simultaneously engaging in bilateral stimulation, such as side-to-side eye movements, to help reprocess and integrate traumatic memories. This method aims to reduce the emotional impact of the memories and facilitate healthier responses. For more information on the neuroscience behind EMDR, check out my blog that goes into greater detail here.
Before Your First Session
Before starting EMDR, I will conduct an initial assessment to understand your history, symptoms, and specific needs. This helps tailor the therapy to your unique situation and ensures a safe and effective treatment process. For complex trauma, phase 2 of EMDR, described below, may extend for weeks or even months prior to moving into the memory activation phases of the protocol. This is to ensure that you can remain in your window of tolerance for memory processing. Moving too fast is contraindicated for complex trauma. Rest assured, I will guide you and ensure both you and I feel confident you are ready.
The Phases of EMDR Therapy
EMDR therapy is structured in eight phases, each playing a crucial role in the healing process.
Phase 1: History Taking
Objective: To gather comprehensive information about your background and the issues you're facing.
What to Expect: I will ask about your personal history, traumatic experiences, and current symptoms. This helps create a tailored treatment plan.
Phase 2: Preparation
Objective: To build trust, ensure you have coping mechanisms in place to stay in your window of tolerance, and ensure that all parts of your internal system are in agreement with moving forward.
What to Expect: I will explain the EMDR process, answer any questions, and teach you techniques to regulate your nervous system and manage distressing emotions. I may recommend we do ego state therapy or IFS-Informed therapy to help stabilize and prepare you to move into memory processing. This phase ensures you feel safe and supported.
Phase 3: Assessment
Objective: To identify the specific memory and negative belief to target, and activate that memory system.
What to Expect: I will work with you to select a traumatic memory and associated negative thoughts, emotions, and physical sensations. You’ll give a rating from 0-10 on how disturbing the memory feels to you. You’ll also identify a positive belief you’d like to adopt and give a rating from 0-7 on how true this belief currently feels to you. We will then activate the memory to begin processing.
Phase 4: Desensitization
Objective: To reduce the emotional charge of traumatic memories and integrate them into the adaptive information processing (AIP) system. For more info on the fascinating way EMDR facilitates memory reconsolidation in the hippocampus, once again, check out my blog on the neuroscience of EMDR here.
What to Expect: While recalling the chosen memory, I’ll guide you in sets of eye movements or other bilateral stimulation methods while monitoring your response and adjusting accordingly. I have many tools I can use to help contain your distress, help you move through a sticking point, or shift you back into the present moment if needed. During this phase, there is generally a spike in emotional intensity but if you can ride through it, it will hit a peak and then fall back down as the emotional content is released and digested. It helps to picture yourself going through a tunnel, the quickest way to the light at the end is to keep moving and just notice what’s happening. You will continue in this phase until you have two consecutive sets where the disturbance rating feels like 0 out of 10 to you, or as low as you feel is possible.
Phase 5: Installation
Objective: To associate the newly desensitized and reprocessed memory with a new positive belief that contradicts your old negative belief.
What to Expect: I will guide you to focus on the positive belief identified in Phase 3 along with the target memory while continuing bilateral stimulation. We will continue doing sets of bilateral stimulation until you feel the new belief is as true as it can be. This phase is my favorite because I get to watch you experiencing your nervous system reorient to feeling empowered. What could be cooler than that?
Phase 6: Body Scan
Objective: To identify and address residual physical tension and ensure your body is in alignment with your new belief.
What to Expect: I’ll ask you to mentally scan your body for any lingering tension or discomfort. If any is found, I will guide you through processing it with bilateral stimulation until it feels clear and neutral.
Phase 7: Closure
Objective: To ensure emotional stability at the end of each session.
What to Expect: I will help you return to a state of calm using containment strategies if necessary, and provide self-care techniques to manage emotions between sessions.
Phase 8: Reevaluation
Objective: To review progress and plan further treatment.
What to Expect: At the start of each subsequent session, I will assess the effectiveness of previous sessions and determine the next steps. Not every target memory will be completed in one session. That’s normal and ok. We will contain any residual distress at the end of session and resume processing during the next session.
What You Might Experience
Emotional Intensity: It’s common to experience strong emotions during EMDR as you confront and process traumatic memories. I will support you through these moments and encourage you, but you are always in control and can use your stop signal at any time.
Physical Sensations: You may notice physical sensations such as tingling, release of tension, tremors or jerking motions. Sometime these sensations travel around the body in interesting ways before dissipating. The body remembers things in ways that can feel strange, but there is a rhyme and reason to it. Some people yawn and get sleepy if they experienced hypoarousal during the original event, we will stop to ensure you aren’t dissociating before continuing. These are normal experiences and part of the body’s response to processing trauma.
Gradual Change: Many clients begin to notice changes in their emotional responses and thought patterns after a few sessions. This often occurs without consciously trying to make it happen. These shifts are what I refer to as the “neuro nuance” that leads to hope that change is just around the corner.
After the Session
After an EMDR session, you might feel tired or emotionally drained. It’s essential to practice self-care and use the coping techniques we’ve worked on in previous sessions. You may experience vivid dreams and the resurfacing of additional memories between sessions. This is normal and can often guide us on where to go next. Journaling, engaging in calming activities, using your coping skills learned in session, and reaching out to your support network can all be helpful.
Conclusion
Understanding what to expect in an EMDR therapy session is essential to help alleviate any apprehension and prepare you for the transformative journey ahead. By working through the structured phases of EMDR with me, you can reprocess your past and move towards a healthier, more balanced future.
Alex Penrod, MS, LPC, LCDC
August 5th, 2024
