What an EMDR Session Looks Like

There are 8 phases in EMDR treatment. The phase you are in determines what the session will look like. The first two phases are in preparation for processing. Phases 3 though 6 are where the actual processing takes place. The final two phases consist of closing out a session and reopening the next.

There are a few terms that are helpful to know. Bilateral stimulation means crossing the body back and forth in a rhythmic pattern. This gets the left (logical) brain and right (emotional) brain communicating with each other to facilitate processing. Bilateral stimulation could include following an object with your eyes left to right, listening to a quick sound first in one ear and then the other, or tapping one knee and then the other. The limbic system is the part of the brain responsible for emotional and behavioral responses, especially those behaviors associated with survival. You can think of unprocessed disturbing memories as being stuck here, causing you to feel and act “triggered”.

Phase 1: History Taking

The therapist works to understand your symptoms, what experiences triggered their development, and collaborates with you on a treatment plan. Your treatment plan consists of the disturbing memories you want to target, your desired future outcomes, and how your sessions will be structured (hourly or intensive). This phase may take several sessions depending on your needs.

Phase 2: Resourcing

The therapist works with you to ensure you have adequate internal and external resources for maintaining emotional balance during and between sessions. Resources can include breathing or tapping techniques to calm the nervous system, imagery techniques, or loved ones who are supportive of your treatment. As some of the target memories can be very disturbing to revisit, it is extremely important you are well resourced so that you are able to stay within your window of tolerance for negative emotions. Processing cannot occur when we are outside of our window of tolerance. An example of being outside of your window of tolerance is dissociating.

Phase 3: Assessment

This phase is often referred to as the activation phase and sets the conditions for processing. A specific memory is selected for the session from your treatment plan. You are asked 7 questions about the memory which help you to activate the limbic system where the memory is stuck. Once activated, the therapist will immediately move into phase 4.

Phase 4: Desensitization

This is when the actual processing happens. The the therapist begins bilateral stimulation and will periodically stop to ask you “What do you notice?” You will very briefly describe what thought, emotion, body sensation, or additional memory comes to mind. The therapist will then say “Go with that” and restart bilateral stimulation, signaling you to continue. This is repeated until there is no longer any change to report and the memory has been processed. This phase can take a little as 15 minutes or as long as several hours depending on a number of factors (nature of the disturbance, blocking beliefs that may pop up, or intensity of your reaction to the memory, etc,.). Talking by you or the therapist is kept minimal, allowing you to stay in the limbic system, where the memory is stuck (language and communication are in a different part of the brain).

Phase 5: Installation

During phase 3, you were asked 7 questions about the target memory. One of those questions relates to how you prefer to feel or react to the memory when you think about it. The installation phase solidifies and strengthens your preferred positive feelings or alternate reaction to the memory using a few more sets of bilateral stimulation. You will retain your original opinion of the event ( i.e., that person was abusive and what they did was wrong) but you should feel significantly less upset, or not upset at all, when thinking about it.

Phase 6: Body Scan

Because the body stores trauma, you are asked to hold the original memory and the new positive beliefs in mind while scanning your body for any lingering disturbance or discomfort in your body. If there are any lingering disturbances, they are addressed with additional sets of bilateral stimulation.

If you are doing intensive sessions (several hours in a day), you will restart the process with the next target memory. When you are at the end of your session time, whether one-hour or intensive, the session is formally closed out in phase 7.

Phase 7: Closure

The session ends with the therapist helping you to return to a state of calm in the present moment. Some people are already calm as the memory has been processed and they are no longer upset by it. If the memory isn’t completely processed but it is time for the session to end, we use the resources learned in phase 2 to help you return to a calm state.

Phase 8: Reevaluation

This is how every session starts once processing of memories has begun. The clinician will evaluate your symptoms since last session, any new memories that surfaced, changes in mood or behavior, etc,. You and the clinician will briefly discuss the treatment plan to make any changes to it and identify the next target for processing, or resume processing the incomplete memory from the last session. The process starts again at phase 3. Each targeted memory will be processed through these phases.