Naturally, the amount of time to complete EMDR therapy depends on the client and their history. Treatment involves a three-pronged protocol including (1) past memories or experiences, (2) present disturbance or distress, and (3) future actions.
The goal of EMDR therapy is to process completely the experiences that are causing problems and to include new ones that are needed for full health. “Processing” does not mean talking about it. “Processing” means setting up a learning state that will allow experiences that are causing problems to be “digested” and stored appropriately in your brain. That means that what is useful to you from an experience will be learned and stored with appropriate emotions in your brain and then be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded. Negative emotions, feelings, and behaviors are generally caused by unresolved earlier experiences that are pushing you in the wrong directions. The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.
- History Taking
In this stage, your therapist will learn about you and your history and might conduct the standard assessments that he or she uses. This is the time when you share your story, get to know your therapist’s style, and set up initial treatment goals. The therapist should also be creating a target sequence plan, an overview of what affects you from your past and a template for your future. In this phase, you are likely to discuss touchstone events, previous experiences that contribute to your current symptoms. You may be surprised to know that how you think and feel in this moment is linked directly to your past. As you review these events with your therapist, you may be asked to rate how disturbing things are to you on a scale of 0-10.
The next three phases are like a traffic light, and phase two is like the red light. At this point, you are learning more about EMDR, as well as identifying and ensuring your readiness to move further through the phases. You may be learning additional grounding skills, stress reduction skills, or state-change skills, and your therapist will help create a “safe place” image for you. You will also be asked to complete a brief assessment to identify if you experience dissociation. You will learn about dual attention stimulus (DAS); e.g., the back-and-forth eye movements, sounds, or tactile sensations that help the right and left brain hemispheres to process the traumatic material and activate the brain’s Adaptive Information Processing (AIP) system. In this phase, you may also hear your therapist talk about resourcing and using the DAS to help you access more positive experiences, thoughts, and images before moving on through the remaining EMDR phases.
This phase is like the yellow light on a traffic signal. In the assessment phase, you and your therapist will look at what you want to target when you move into the processing phase. Your therapist will ask you for an image, a negative cognition, and a positive cognition, and to rate how true your positive cognition feels on a scale of 1-7 and how disturbing the target is on a scale of 0-10, and to describe what you experience in your body.
This phase is the green in our traffic light analogy. This is where the DAS really comes into play. Those who have used EMDR know that this is where what you are working on comes up. All of your senses become involved as you process the disturbance you are targeting. You won’t talk to your therapist during this process; you’ll have a brief check-in, and then go back to moving your eyes back and forth, hearing the tones, or feeling the taps. This is where AIP comes into play, and your brain will recycle the material for your nervous system to release it as it did not get to at the time. In between sets of DAS, your therapist may also add things in for you to think about; these are called cognitive interweaves. The same 0-10 scale from the assessment phase will be used here to assess your level of disturbance. When the level of disturbance is rated at zero and the target truly feels neutral and not distressing, we move on to phase five.
Next, we will install the positive cognition that you chose with the DAS, but before we do, we recheck to see if the positive cognition has changed at all. It often does because you have moved further on in your healing. We will also check to see how true that positive cognition feels to you, using the same 1-7 scale from phase three. We then keep using the DAS to see if anything is getting in the way. When you get to a 7, completely true, we move to phase six.
- Body Scan
Just as the name suggests, you will be asked to mentally scan your body to find any sensations or tensions that signal that something is still stuck regarding the target. If there are any lingering sensations, your therapist will continue with the DAS.
This will look and sound different depending on if your session was complete or incomplete. You will close down the material and do a final check. You will also use various methods, including imagery, to contain the material that is still not processed. This may include returning to your safe place or creating a container to hold anything that may become too distressing in between sessions.
Though it looks like the last step, the reevaluation phase spirals back as if it were the beginning. Your EMDR therapist will do a check in at the beginning of your next session that will include reevaluating your disturbance level regarding the target from the last session. This helps to determine if your disturbance is still neutral and if your positive cognition still rings true. If the previous EMDR session was incomplete, the cycle begins again at phase four.
For an alternative description and brief review of research, please see Therapy Advisor funded by NIMH. This website promotes scientifically based psychotherapy: http://www.therapyadvisor.com/LocalContent/adult/consumer-shapiro-EMDR-PTSD.PDF.