Your Guide to EMDR Therapy: What to Expect & How It Helps

As an Eye Movement Desensitization and Reprocessing (EMDR) therapist and former scientist, I have yet to come across a thorough, yet accessible, explanation of EMDR that would properly prepare clients who are considering this treatment. 

In 2018, I completed my Master’s level thesis on EMDR, and later used my knowledge to convince my employer to send me to a training so I can help our highly traumatized and underserved population that only had access to brief therapy. Because the clients could only receive short-term therapy, the only treatment that could address their trauma was EMDR.

As part of the training, we underwent EMDR ourselves. An EMDR exercise that had me visualize a calm place, then attach the positive sensations to a cue word I chose, was so effective that I could only describe it as feeling my stress *melt* away when I thought of my word: “resolution.”

Read about the changes I experienced after three EMDR therapy sessions here.

My chemist brain was quite bothered that I had no scientific explanation for the clients. But, there are many things that we use that we don’t have concrete scientific explanations for, such as psychiatric medications like Prozac. Yet we still use them. 

Regardless, I still wanted to give the best explanation I could. After considering many sources since then, this is my attempt to provide an explanation that answers the frequently asked questions from my clients who are interested in EMDR.

Sources include: EMDR International Association, EMDR Professional Training, evidence-based research, creator of EMDR Francine Shapiro’s Getting Past Your Past, leading trauma expert Bessel van der Kolk’s The Body Keeps The Score, and 3 years of EMDR practice.

This article was also reviewed by Senior EMDR Trainer Deborah Silveria, PhD. 

What is EMDR and How Does it Work?

EMDR is a short-term trauma therapy (it can be effective within a few sessions) that differs from typical treatments because it is not talk-based. Extensively talking about trauma can be re-traumatizing. So, a different method like EMDR can be better. 

Talk therapy can also be limited in its effectiveness because trauma is hardly a clear idea in our minds. It is a collection of loosely associated memories, images, and sensations – not a clear story we can narrate, or even make sense of consciously. This is why trying to talk through or rationalize memories can be ineffective, or, as mentioned earlier, re-traumatizing. 

Instead of retelling the trauma narrative, in EMDR, the client focuses on one traumatic memory at a time while engaging in a rhythmic activity (known as bilateral stimulation). This helps eliminate the feelings of distress and cultivate positive beliefs. The client is in control of how much they share. Doing this enough times can lead to the ultimate goal: Rather than re-experiencing the distress we feel when we are reminded of our trauma, we think of the trauma as a coherent, and finished, event in the past.

What Constitutes a Traumatic Memory in EMDR Therapy?

First, we are broadening our description of trauma to mean anything that is perpetually distressing or disruptive to our lives. That could be due to childhood abuse, neglect, a vehicle collision, or an embarrassing incident. It could also be a fear of something in the past, or in the future. EMDR can help with all of these.

Today, we consider a traumatic – or distressing – memory to be one that evokes a disturbance in the body that is physical (e.g., fast heartbeat, anxiety, tension). A memory that does that has not been successfully processed by the brain, because processed memories are neutral – they do not evoke a disturbing, physical reaction.

For example, a processed memory might be what you ate for breakfast yesterday – it’s neutral. (Assuming you didn’t get food poisoning.) 

The second point is that traumatic memories can leave us with a negative belief about ourselves or the world, such as, “I’m not good enough,” “I’m in danger,” or “I’m worthless.” EMDR will help reprocess these negative beliefs and turn them into something neutral or positive. 

EMDR’s purpose is to process these distressing memories so you no longer experience that strong negative reaction or have that negative belief. Instead, it’s as neutral as the Quaker oatmeal you had for breakfast. 

Acronym: Eye Movement Desensitization and Reprocessing

The best way to explain EMDR is to break it down by the letters:

EM stands for Eye Movements

Originally, EMDR involved moving your eyes back and forth, in the same way as when we walk or dream (think of Rapid Eye Movement, AKA REM sleep!). This rhythmic activity, also known as bilateral stimulation, inherently reduces distress. It also gives the brain the capability to process the traumatic memory while offering something to focus on that can be soothing. 

• One important note: eye movements are just one form of bilateral stimulation. They can be replaced by alternating tapping, sounds, vibrating pulses, etc. 

D stands for Desensitization

Traumatic memories often bring us back to a dark time, evoking negative mental, emotional, and physical reactions. EMDR’s first goal is to desensitize you to that memory so it no longer affects you in the same way.

R stands for Reprocessing

Traumatic memories can instill a related negative belief about ourselves (e.g. “I’m worthless”). After desensitizing, EMDR helps change these negative beliefs into something positive or neutral. 

For example:

• “I’m worthless” becomes “I am worthy.”
• “I’m in danger” becomes “I can protect myself.”
• “I’m not good enough” becomes “I am good enough.”

The last part of EMDR is completing a body scan to help remove any trauma or distress that is stored in your body. It’s quite important, even though it didn’t make it into the acronym in time.

Fun fact: Francine Shapiro wished she called EMDR “Reprocessing Theory,” but there are a few reasons she stuck with it. (Author’s Note: While a brand’s a brand, it certainly doesn’t help that no one can remember the acronym. Once, someone referred to it as “EDM Therapy.” Is there a world where techno music heals trauma? I’ll defer that to another dance enthusiast.)

What is the Science Behind EMDR?

First and foremost, there’s no fully established scientific explanation – just theories. We really don’t know how EMDR works.

There is a model known as Adaptive Information Processing (AIP Model). EMDR International Association explains it wonderfully and here is a snippet from their full explanation of the AIP model:

“The AIP model helps us understand EMDR therapy. It recognizes that both positive and negative experiences influence a person’s current perceptions, feelings, thoughts, and behaviors: “The past is present.” Experiences from the past become the “glasses” that we wear when we see the present. Disturbing experiences appeared “stuck” and linked to other disturbing ones. EMDR therapy helps us to get unstuck so those old feelings, thoughts, and body sensations do not keep affecting our lives today.” 

A fundamental part of this theory is that the brain will heal itself if given the space to do so, much like how a finger heals itself when cut. That’s why EMDR is not talk therapy – the brain will take care of the processing. 

As mentioned above, our eyes move back and forth while walking and during REM sleep – two circumstances that facilitate processing of emotions and memories. Will moving our eyes back and forth during EMDR do the same thing? It’s really hard to prove – especially since there are other types of bilateral stimulation, like alternating tapping. 

The rhythmic activity (bilateral stimulation) is quite calming for many people, which I personally have observed playing a significant role in the following process:

It seems that during EMDR, the brain is able to freely associate during the rhythmic activity (bilateral stimulation) of eye movements, tapping, etc. And letting your brain freely associate while engaging in rhythmic activity allows the brain to begin processing the memory on its own, as well as the other underlying memories, sensations, and images. 

The ultimate goal is that the traumatic memories will no longer negatively affect you when you think of them.

What Are Typical Reactions to EMDR Therapy Sessions?

I’ve witnessed many different reactions. After EMDR, some people feel like their distress just “melts away.” Others feel “healed.” Many feel a level of relief akin to no longer carrying a heavy burden. 

But during EMDR, people can experience intense emotions, and some people will become tearful, distressed, and ask to stop the session. Some elect to return to EMDR in a later session, while others have declined to continue because they do not want to experience the psychological arousal associated with recalling the disturbing experiences to mind. Some clients will work on further developing coping and self-soothing strategies with the therapist before trying EMDR again.

This is why the following is so important:

Experiencing intense emotions is frequently part of the EMDR process. The goal is for the client to experience some level of arousal to allow the reprocessing – but too much (hyperarousal), or too little (hypoarousal), makes EMDR ineffective. Therapists have ways to help clients stay in what is called the Window of Tolerance so they can tolerate some distress without needing to stop the session.

It’s also important that we prepare our clients for the possibility of distress during informed consent, and teach clients how to manage distress in the initial sessions.

• Note: EMDR therapists will also dedicate a portion of the session to closure, so the client does not feel unsafe leaving the session. We are usually also available outside of the session in some capacity if needed.

What Does an EMDR Therapy Session Involve?

In short, EMDR consists of you focusing on a specific event, using bilateral stimulation, with the therapist providing you directions and feedback. But, that’s just the Desensitization phase! There is an 8-phase process that includes preparing for EMDR beforehand, reprocessing your negative belief, targeting trauma stored in the body through a body scan, and more. EMDRIA explains the 8 phases of experiencing EMDR therapy really well, so if you want a deep dive into EMDR from start to finish, that’d be a great place to look.

How Many Sessions of EMDR are Required?

Based on numerous research studies, it is expected that reprocessing is generally accomplished within three 90-minute sessions for a single trauma. However, the amount of sessions could vary on a number of factors, including complexity of trauma, how long it takes to prepare you for EMDR, or life circumstances. 

Once, I witnessed a transformation in one session that left me wondering, “Is this real?” as the person went from crying out in pain to shedding tears of joy because they found relief from a gruesome memory that had disturbed them for decades. 

Potential Risks of EMDR Therapy & How to Prepare

EMDR can bring up intense emotions that have been frozen in the past. This means the client can experience distress during the session, and possibly outside of it.

That’s why, before starting EMDR, it’s important to have strong coping skills, self-soothing techniques, and a plan of action that includes resources, people, places, activities, and out-of-office support that will help calm you. 

Again, the therapist will work to keep the client in the Window of Tolerance. The therapist will also leave enough time at the end of the session for closure and also be available in some capacity between EMDR sessions.

Other things to note:

• Individuals with substance use challenges would benefit from a relapse prevention plan while commencing EMDR.
• Memory can be fallible, so we don’t always know whether a memory is accurate.
• Anyone involved in legal matters may need special consideration.

EMDR Therapy for Crisis & Disaster Response

This can prompt people to ask: what about the use of EMDR in the wake of a disaster like an earthquake or shooting? This is something that can be done, but is not within my scope of knowledge. 

It’s necessary to consult with a clinician who is familiar with EMDR Early Interventions. To start, here is an article from EMDRIA: https://www.emdria.org/blog/using-emdr-therapy-in-disaster-response/

Why is a Trained Therapist Essential for EMDR Therapy?

This sounds like something you could potentially do on your own, right? And some websites will help you do EMDR on yourself for a price, though this is not recommended due to the potentially triggering or destabilizing nature of remembering disturbing memories. 

However, the therapist is very important. The therapist is not only present to assist with monitoring for adverse reactions and safety; the therapist also facilitates the processing by pausing the EMDR when appropriate, providing guidance on what memories to stay with and how to interpret them, and assessing when to stop and move to other phases. 

In addition, due to the potential risks of EMDR, it is important to have a trained professional available in some capacity outside of session in case of an urgent situation.

When is EMDR Therapy Not Recommended?

While it’s likely difficult to tell if it will or will not work without talking to your therapist, it does not help when the client:

• Uses mind-altering drugs (including marijuana) or certain medications (such as benzodiazepines). This is because they can inhibit the ability to experience emotion.

Sometimes clients are unable to use techniques to reduce distress when they experience psychological arousal during and after the EMDR process – even with the therapist’s help. That doesn’t mean they can never do EMDR; the therapist may just return to the preparation phase of building coping strategies and addressing any barriers to reducing the feelings of distress. 

EMDR may not be appropriate with some individuals who have organic issues (such as traumatic brain injuries). Be sure to always consult with your therapist!

Online EMDR Therapy: Is Telehealth Effective?

Yes. Research has indicated that it can be equally effective as in-person sessions. The person could even be in their car or sitting on the ground in a shelter. However, some people feel it’s more effective in-person, and it is important to find a space where you can concentrate via telehealth. 

EMDR Therapy Homework: What to Expect Between Sessions

EMDR does not require homework. In between sessions, some people experience continued processing – dreams (that can be good, bad, or really weird), or strong urges to journal or reflect. That’s why EMDR doesn’t require homework – your brain is doing the homework on its own.

Beyond Trauma: Other Uses for EMDR Therapy

EMDR can also help:

• Memories that cause distress, anxiety, or embarrassment
• Symptoms including anxiety, panic attacks, and depression 
• Fears or phobias (including flight anxiety and public speaking anxiety)
• Grief
• Performance anxiety
• Planning for future situations that induce distress (for example, addressing a fear of flying)
• An uncomfortable “ick” with someone, such as a family member or coworker

Final Thoughts on EMDR Therapy & Next Steps

I discussed the pros and cons of EMDR therapy. I explained the risks and benefits of EMDR. And I shared that not everyone will have the same experience with EMDR therapy.

Regardless, I have helped many people through EMDR, and there is extensive scientific research to support the claims. EMDR can also help with more than just trauma.

The uses of EMDR are expanding every day. I’m continuously seeking training from experts. I also seek consultations from them to further my specialization.

Find a Qualified EMDR Therapist in California

With research-informed, clinical, and personal experience, I offer high-quality, efficient EMDR therapy to help with issues including:

• • Imposter Syndrome

• • Substance use (both abstinence and harm reduction)

• • Severe mental illnesses, including depression, anxiety, bipolar disorder, schizophrenia, and psychosis
    
    
  • Trauma for healthcare professionals

To schedule an appointment or a free 15-minute consultation with me, contact me here.

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