What is an actual EMDR session like?
Eye Movement Desensitization and Reprocessing (EMDR) is an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches. To date, EMDR therapy has helped millions of people of all ages relieve many types of psychological stress. Below is a Brief Description of EMDR Therapy.
8 Phases of Treatment
The amount of time the complete treatment will take depends upon the history of the client. Complete treatment involves a three-pronged protocol (1-past memories, 2-present disturbance, 3-future actions), and all are needed to alleviate the symptoms and address the complete clinical picture. 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 be able to guide you in positive ways in the future. The inappropriate or harmful 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.
Phase 1: History and Treatment Planning
Phase 1 generally takes 1-2 sessions at the beginning of therapy, and can
continue throughout the therapy, especially if new problems are revealed.
In the first phase of EMDR treatment I will take a thorough history, and we will
develop a treatment plan. This phase will include a discussion of the specific
problem that has brought you into therapy, any behaviors stemming
from that problem, and your current symptoms. With this information, we will
develop a treatment plan that defines the specific targets on which to use EMDR. These targets include the event(s) from the past that created the
problem, the present situations that cause distress, and the key skills or behaviors you need to learn for your future well-being. One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of their disturbing memories in detail. So while some individuals are comfortable, and even prefer, giving specifics, other people may present more of a general picture or outline. When I ask, for example, "What event do you remember that made you feel worthless and useless?" you may say, "It was something my brother did to me." That is all the information I need to target the event using EMDR.
Phase 2: Preparation
For most clients this will take only 1-4 sessions. For others, with a very traumatized background, or with certain diagnoses, a longer time may be necessary. Basically, I will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you are generally able to proceed to the next phase. One of the primary goals of the preparation phase is to establish a relationship of trust between you and I; if you're not able to feel comfortable and safe while we are talking, it will be difficult for this process to work. While you do not have to go into great detail about your disturbing memories, without trust you may not accurately report what you feel, and what changes you are (or aren't) experiencing during the eye movements. If you're just trying to please me and say you feel better when you don't, no therapy in the world will resolve your trauma. In any form of therapy, it is best to look at the clinician as a facilitator, or guide, who needs to hear of any hurt, need, or disappointments in order to help achieve the common goal. EMDR is a great deal more than just eye movements, and I need to know when to employ any of the needed procedures to keep the processing going. During the Preparation Phase, I will explain the theory of EMDR, how it is done, and what you can expect during and after treatment. Finally, I will teach you a variety of relaxation techniques for calming yourself in the face of any emotional disturbance that may arise during or after a session.
Learning these tools is an important aid for anyone. The happiest people on the planet have ways of relaxing themselves and decompressing from life's inevitable, and often unsuspected, stress. One goal of EMDR therapy is to make sure that you can take care of yourself.
Phase 3: Assessment
Assessments are used to access each target memory in a controlled and standardized way so it can be effectively processed. I will help you identify the aspects of the target to be processed. The first step is for you to select a specific picture or scene from the target event (which was identified during Phase One) that best represents the memory. Then you will choose a statement that expresses a negative self-belief associated with the event. Even if you intellectually know that the statement is false, it is important that you focus on it. These negative beliefs are actually verbalizations of the disturbing emotions that still exist.
Common negative cognitions include statements such as ...
"I am helpless,"
"I am worthless,"
"I am unlovable,"
"I am dirty,"
"I am bad," etc.
You then pick a positive statement that you would rather believe. This statement should incorporate an internal sense of control, such as ...
"I am worthwhile/lovable/a good person/in control"
"I can succeed"
Sometimes, when the primary emotion is fear, such as in the aftermath of a natural disaster, the negative cognition can be, "I am in danger" and the positive cognition can be, "I am safe now." "I am in danger" can be considered a negative cognition, because the fear is inappropriate -- it is locked in the nervous system, but the danger has actually passed. The positive cognition should reflect what is actually appropriate in the present.
1 -- 2 -- 3 -- 4 -- 5 -- 6 -- 7
At this point, I will ask you to estimate how true you feel your positive belief is using the 1-to-7 Validity of Cognition (VOC) scale. "1" equals "completely false," and "7" equals "completely true." It is important to give a score that reflects how you "feel," not what you "think." We may logically "know" that something is wrong, but we are most driven by how it "feels." Also, during the Assessment Phase, you identify the negative emotions (such as fear or anger) and physical sensations (such as tightness in the stomach or cold hands) which you associate with the target memory. You also rate the disturbance using the 0 (no disturbance)-to-10 (the worst feeling you’ve ever had) Subjective Units of Disturbance (SUD) scale.
Phase 4: Desensitization
For a single trauma, reprocessing is generally accomplished within 3 sessions of this stage. If it takes longer, you should see at least some improvement within that amount of time. Phases One through Three have laid the groundwork for the comprehensive treatment and reprocessing of the specific targeted events. Although the eye movements (or taps) are used during this and the following two phases, they are only one component of a complex therapy. The use of the step-by-step eight-phase approach allows the experienced, trained EMDR clinician to maximize the treatment effects for the client in a logical and standardized fashion. It also allows both the client and the clinician to monitor the progress during every treatment session.
This phase focuses on your disturbing emotions and sensations as they are measured by the SUDs rating. This phase deals with all of your responses (including other memories, insights and associations that may arise) as the targeted event changes and its disturbing elements are resolved. This phase gives the opportunity to identify and resolve similar events that may have occurred and are associated with the target. That way, you can actually surpass your initial goals and heal beyond your expectations. During desensitization, I will lead you in sets of eye movements (or other forms of bilateral stimulation, such as tapping alternately on your knees) with appropriate shifts and changes of focus until your SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). Starting with the main target, the different associations to the memory are followed. For instance, a person may start with a horrific event and soon have other associations to it. I will guide you to a complete resolution of the target.
Phase 5: Installation
The goal is to concentrate on and increase the strength of the positive belief that you have identified to replace your original negative belief. For example, a
client might begin with a mental image of being beaten
up by his father and a negative belief of "I am powerless." During the Desensitization Phase he will have reprocessed the terror of that childhood event and fully realized that as an adult he now has strength and choices he didn't have when he was young. During this fifth phase of treatment, his positive cognition, "I am now in control," will be strengthened and installed. How deeply the person believes his positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal of EMDR is for you to accept the full truth of your positive self-statement at
a level of 7 (completely true). Fortunately, just as EMDR
cannot make anyone shed appropriate negative feelings, it cannot make you believe anything positive that is not appropriate either. So if the client in this example is aware that he actually needs to learn some new skill, such as self-defense training, in order to be truly in control of the situation, the validity of his positive belief will rise only to the corresponding level, such as a 5 or 6 on the VOC scale.
Phase 6: Body Scan
After the positive cognition has been strengthened and installed, I will ask you to bring the original target event to mind and see if you notice any residual tension in your body. If so, these physical sensations are then targeted for reprocessing. Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in motoric (or body systems) memory, rather than narrative memory, and retains the negative emotions and physical sensations of the original event. When that information is processed, however, it can then move to narrative (or verbalizable) memory, and the body sensations and negative feelings associated with it disappear.
Therefore, EMDR treatment is not considered successful until you can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.
Phase 7: Closure
The Closure phase ensures that you leave at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, I will assist you in using a variety of self-calming techniques in order to regain a sense of equilibrium. Throughout the EMDR session, you are always in control (for instance, you are instructed that it is okay to raise your hand in the "stop" gesture at any time during our session), and it is important that you continue to feel in control outside my office. You will also be briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and which techniques you might use on your own to help you feel more calm.
Phase 8: Reevaluation
At the beginning of subsequent sessions, I will check to make sure that the positive results (low SUDs, high VOC, no body tension) have been maintained, identify any new areas that need treatment, and continue reprocessing the additional targets. The Reevaluation Phase guides me through the treatment plans that are needed in order to effectively address your problems. As with any form of good therapy, the Reevaluation Phase is vital in order to determine the success of the treatment over time. Although you may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment as it is to complete an entire course of treatment with antibiotics.
Past, Present and Future
Although EMDR may produce results more rapidly than previous forms of therapy, speed is not the issue and it is important to remember that every client has different needs. For instance, one client may take weeks to establish sufficient feelings of trust (Phase Two), while another may proceed quickly through the first six phases of treatment only to reveal, then, something even more important that needs to be processed. Also, treatment is not complete until EMDR therapy has focused on the past memories that are contributing to the problem, the present situations that are disturbing, and what skills the client may need for the future.