One highly evidenced-based practice known to heal a variety of mental health issues, especially trauma, is a modality known as Eye Movement Desensitization & Reprocessing (EMDR) Therapy. Created by American Psychologist Francine Shapiro (1948-2019) in the late 1980s, it has become one of the most popular and effective treatments in modern psychotherapy. EMDR can be used with children and adults of all ages. In addition to treating trauma, mental health clinicians utilize EMDR therapy to address a variety of presenting issues including anxiety, panic attacks, grief, and sleep disturbance (EMDRIA, 2022). I am trained in S.A.F.E (Somatic and Attachment Focused) EMDR, which is a specific form of EMDR created by Deb Kennard. It’s both a passion of mine and an honor to be able to utilize this modality with my clients. Lastly, this article is by no means an all-encompassing article on EMDR, but will briefly break down the very basics of this therapeutic modality.
Question 1: What is the process like?
EMDR is broken down into eight phases and is very different compared to traditional talk therapy modalities. Its primary difference involves the use of bilateral stimulation, often in the form of eye movements or tactile stimulation such as vibrating buzzers in each hand, while the client recalls the traumatic memory (during phases 3-7). Secondly, when gathering the history of memories to process, the client does not have to verbalize every detail of each memory. A brief explanation of the memory is all that is needed in the history-taking phase. Lastly, phases 3-7 of EMDR do not involve much talking at all in comparison to other modalities. The client is asked to report in brief statements what is going on in their mind as the therapist guides them through the phases.
Phase 1 is known as the history-taking & treatment-planning phase. In this phase, the therapist and the client gather a timeline of the traumatic events that a client would like to process via EMDR (EMDRIA, 2021).
Phase 2 is known as the preparation phase. During this phase, the therapist helps the client prepare for processing by providing further psychoeducation around EMDR. This phase also involves the strengthening of the therapeutic relationship between the therapist and the client. Lastly, the therapist helps the client develop and expand upon healthy coping skills to cope with the emotional disturbance that arises at various points of completing EMDR therapy (EMDRIA, 2021).
Phase 3 is known as the assessment phase. It is at this time that the therapist and client move toward a specific memory to process. This includes identifying the images, beliefs, feelings, and sensations associated with the memory. Before phase 4 takes place, a baseline measure of how disturbing the memory is (known as a SUD- subjective unit of disturbance) and a baseline measure of the authenticity of the positive cognition associated with the memory are recorded (EMDRIA, 2021).
Phase 4 is known as the desensitization phase. The bilateral stimulation begins while the client focuses on the traumatic event. At this point in EMDR, the focus is on decreasing the client’s subjective unit of disturbance until it reaches a zero (or 1 if appropriate) while allowing new cognitions, sensations, and emotions to arise (EMDRIA, 2021).
Phase 5 is known as the installation phase. While undergoing bilateral stimulation, a positive cognition that the client wants to associate with the memory is processed alongside the memory until the positive cognition feels authentic. Once this occurs, the therapist and client move to phase 6 (EMDRIA, 2021).
Phase 6 is known as the body scan phase. At this time, the client is asked to hold the target memory in their mind alongside the positive cognition while scanning the body. The therapist guides the client through processing any bodily disturbance that comes up while the client continues to undergo bilateral stimulation. Once this is complete, the therapist guides the client toward phase 7 (EMDRIA, 2021).
Phase 7 is known as the closure phase. At this point, the therapist assists the client in returning to a calm state, regardless of if the processing is fully complete. (EMDRIA, 2021). Phases 1 & 2 of EMDR often take multiple sessions. In addition to that, it is not uncommon for one memory to take more than one session to fully process. This means that a therapist may guide a client from phase 4 (desensitization) to phase 7 (closure) to “pause” processing and come back to it at a later date if the therapist and client are running out of time.
Lastly, Phase 8 is known as the reevaluation phase. This occurs at the beginning of each session following the completion of a processed memory. The therapist and the client make sure that the processed memory’s subjective unit of disturbance is still low and that the positive cognition still feels authentic. From here, the next target (if applicable) is determined (EMDRIA, 2021)
Question 2: Is EMDR effective and is this modality supported by professional organizations?
Since Francine Shapiro’s creation of EMDR in the late 1980s, a plethora of research has been completed that supports the efficacy of EMDR. One recent meta-analysis on the effectiveness of EMDR & TF-CBT (Trauma-Focused Cognitive Behavioral Therapy) in reducing trauma symptoms and externalizing behavior problems in adolescents conducted by Hoogsteder et al. (2022) found that both of these modalities had a large overall effect (d= 0.909) on reducing trauma symptoms and externalizing behaviors.
Lastly, EMDR has been endorsed by several organizations, including The World Health Organization, The American Psychiatric Association, and the United States Department of Veterans Affairs (EMDRIA, 2022). For more information on EMDR, please visit www.emdria.org.