Phase In: The Eight Phases of EMDR
So how exactly does EMDR go about? Does your therapist just wave their fingers in front of your eyes, and suddenly you feel better? Not quite. EMDR is a complete treatment model with eight phases, and today I'll guide you through each one, so you'll know what to expect in therapy. This post will incorporate some EMDR-specific language, but don't worry. I'll include a brief glossary at the end!
Phase 1: History-taking
In phase 1, your therapist will take a closer look at your background, and how you experience things today.
Of course, your therapist needs to get to know you first! A detailed clinical assessment will happen in this phase, and EMDR will go a little deeper in asking about specific goals for treatment. Sometimes I imagine that trauma or adverse events live in a cardboard box in our brains with some of the contents leaking out, causing us symptoms like hypervigilance, avoidance, mood swings, nightmares, and anxiety. Opening that box needs to be very intentional. So in this phase, we complete an exercise called the floatback, where we identify memories associated with the symptoms or experiences we hope to decrease or resolve.
Now here's another metaphor: imagine a red string linking current events of your life to the past. Thoughts, feelings, and sensations from current difficulties link into memory networks that connect far into the past. EMDR seeks to find where the stuck points in those memory networks are, and this helps us identify a target memory for reprocessing. Sometimes the memories that become most relevant can be surprising, but in EMDR we trust the client's nervous system to tell us what their most important targets are.
Phase 2: Preparation
The preparation phase is exciting because we orient to the tools we use in EMDR. During reprocessing, a client is in a state called dual awareness, meaning that they are experiencing elements of the past while knowing and feeling themselves in the present.
In this phase, we identify resources that folks have in order to support them in reprocessing. Resources can be external (Having supportive people in our lives! Consistent exercise! Other coping skills that work for us!) and internal. EMDR has some special interventions which help strengthen internal resources.
In the preparation phase, we also orient to the process of using bilateral stimulation, the back and forth motion EMDR is famous for. You might be aware of tools like a light bar or small vibrating handheld "tappers," or your therapist may ask you to follow their fingers with your eyes. You'll also create a phrase or gesture to stop reprocessing if needed. Reprocessing always goes at your own pace.
Phase 3: Assessment
It sounds funny to have another phase about assessment when phase 1 was all about assessment, but phase 3 is different. In this phase, we assess all the elements of a chosen target memory, including sensory information. This phase will involve identifying the worst part of a target, the associated images, emotions, sensations, and negative thoughts that go with it, as well as the positive (or neutral!) thoughts you would hope have after reprocessing.
You'll use a scale called subjective units of distress (SUDs) to identify how disturbing a memory is, and validity of cognition (VOC) to identify how true a new positive thought feels.
For example, a difficult memory might make me believe "I'm worthless." We might then imagine a positive thought like "I am worthy," then rate it on a scale of 1-7, where 7 is completely true. Before reprocessing, I might rate that a 2/7.
Most likely, if you have several memories to reprocess, you'll come back to these questions frequently with your therapist.
Phase 4: Desensitization
The “butterfly hug,” where a client crosses their arms across their body and alternates tapping with their hands, is one way of doing bilateral stimulation.
Desensitization is the "meat and potatoes" of EMDR: what folks will generally refer to as the first phrase of "reprocessing." This is the part where using the bilateral stimulation, your therapist will guide you through the memory so that you can access new information about it. Even after a difficult event, we continue to live our lives, learn, and gather information, but unfortunately that difficult event stays frozen in the past, without the new adaptive information. So think of phase 4 like a system update for your computer: you're bringing the difficult memory up to date into the present. For a given memory, the desensitization phase might last for 1-3 hour-long sessions.
Phase 5: Installation
I've always thought "installation" sounds very futuristic--but in this phase, installation means we check in about the positive, adaptive thoughts we identified in phase 3, to see if they still make sense. If they do, then we use bilateral stimulation to ensure that we've fully embodied the healthier beliefs.
Oftentimes I find when clients get to this phase, they seem surprised about how much they believe a new thought, like "I am worthy" or "It wasn't my fault" when before phase 4, they didn't believe it at all.
Phase 6: Body scan
We always check in with the body during EMDR, and in phase 6, we have a chance to check our work. Your therapist will ask you to scan your body for any strange sensations, pleasant or unpleasant. If any remain, you'll do more BLS to either enhance pleasant sensations or decrease distress.
Phase 7: Closure
Remember that cardboard box I mentioned earlier? At the end of every reprocessing session, it is important to close it. Using resources developed in phase 2, ample opportunities to ground or calm the body will be provided.
Phase 8: Re-evaluation
In phase 8, you'll check in with your therapist about changes which have occurred between sessions. In phase 8, we get to celebrate successes! If reprocessing wasn't completed in the previous session, you'll dive back in to see if any new insights have developed, and choose next steps.
But what will it be like for me?
This all probably sounds very…intense. And EMDR can be intense, sure! But during session, you’ll find that all this happens really naturally. A well-trained EMDR therapist can guide you through the phases seamlessly, so that you can get to other other side of a difficult memory. Learn more about the difference between EMDR and the talk therapy you might be familiar with.
Your system is always moving toward healing.
And those are the eight phases! I recognize that all this is a lot of information, but in session, your therapist is there to guide you, and to help your nervous system through all this difficult content. Your goal during reprocessing is to not try to direct things. In EMDR, we say that your system wants to heal, and through the eight phases, you and your therapist will create the best possible circumstances for that to happen. If you're interested in seeing what EMDR could do for you, why not book a free consultation with me?
Below is a quick glossary of terms:
Key terms used in EMDR:
Adaptive: a term used to describe whether information is currently working for a client, versus making symptoms worse.
Bilateral Stimulation (BLS): the back and forth motion of the eyes, hands, or a BLS tool during various EMDR phases.
Dual awareness: A state of being in both the present and in the past at the same time
Floatback: an exercise done in EMDR to identify key memories for reprocessing
Installation: the process of enhancing new adaptive information during treatment
Memory Network: a series of connected memories associated through thoughts, feelings, and sensations
Subjective Units of Distress (SUDs): a 0-10 scale, with 10 most distressing, used to identify the degree of disturbance associated with a target
Target/Target Memory: the memory currently chosen for reprocessing
Validity of Cognition (VOC): a 1-7 scale, with 7 as completely true, to measure the degree of belief in new adaptive information
Arianna Iliff, LMFT (they/she) is a licensed therapist and the founder of Inspiration Point Therapy. On their blog, The Reroll, they share helpful information about ADHD, DBT, EMDR, and the wide world of mental health.