What EMDR In My Practice Looks Like?
Eye Movement Desensitization Reprocessing (EMDR) is a trauma focused therapy that targets disturbing memories spanning from childhood to adulthood and works towards eliminating feelings of distress. In the midst of experiencing trauma, you don’t have time to process and make sense of what happened to you. In order to survive, we tend to push forward despite our readiness to do so. Consequently, we store negative beliefs about ourselves surrounding the trauma in our neuro-networks.
Trauma comes in all forms. “Big” traumas can comprise natural disasters, the pandemic, births, death, marriage and divorce. “Small” traumas can consist of repeated verbal abuse, financial worries, interpersonal conflicts and non-life-threatening injuries. As the small traumas pile on throughout life, the negative belief (e.g., “I’m not good enough”) strengthens.
When clients make the decision to start therapy, the symptoms they typically want to address encompass crying spells, anger outbursts, anxiety, panic attacks, fear, obsessions, compulsions, and shock and disbelief. If you are repeatedly taught to scream and cry as a child to get attention then that is how a client will respond to not being heard as an adult with others without intervention. Through the process of EMDR we go back to the first time you experienced the negative belief (e.g., I’m not good enough) and work on making new connections about the experience looking back from the present day.
How does the process work?
EMDR is a more structured modality than standard psychotherapy. One constant aspect is that I use a personalized approach with all of my clients. This means that during our first session we will discuss what the presenting problem is and what the clients’ expectations of themselves look like once they are healed.
Phase 1: History Taking and Treatment Planning
My approach to history taking includes a genogram (in depth family tree), a developmental timeline and several questionnaires. The information that comes from history taking gives background to the client’s past, present and future challenges. With this information, we are able to formulate ‘targets’ which are disturbing memories that we want to address through EMDR.
Phase 2: Prep, Prep and Prep Some More
This is arguably one of the most important phases of EMDR. Further, preparation will begin from the start of therapy. During this stage, clients will be given resources to help them cope with stressors in daily life and incomplete sessions. Imagery and grounding techniques will be used in the beginning and end of sessions. Together the client and I will explore and reflect on their likes and dislikes of the different forms of preparation. During this time, I continue to walk my clients through the stages of EMDR to foster client empowerment.
(Feel free to click on my “resources” tab to hear several exercises used in actual sessions)
Phases 3-6: Assessment, Desensitization, Installation and Body Scan
During this phase, the target is chosen. The memory, image or feeling that is associated with the target is identified. The negative thoughts and body sensations they currently have about themselves when they think of this distressing event are brought to the surface. In addition, clients are asked to identify a positive belief they would like to believe about themselves when they think of this distressing event.
The client is then instructed to focus on the image, the negative belief and where they feel their body sensations. Simultaneously, the client in some form of bilateral stimulation such as eye movements or tapping. The form of bilateral stimulation will be chosen and agreed upon between the psychotherapist and client. Furthermore, the length of sets will be dependent on each clients’ needs. After each set of bilateral stimulation, the client will be asked to notice what happens. If the client becomes distressed at any point during processing, we will use different interventions at my discretion to help the client get back on track.
When we get to the point where the client reports no distress when thinking of the disturbing memory, the client will be asked to recall their positive belief they want to believe about themselves and whether that belief still fits or if there is a stronger positive belief that fits. This positive belief will be strengthened during the installation phase.
During the body scan, the client will be instructed to bring up the disturbing event and the positive belief. The client will then be instructed to scan their entire body to notice anything good or bad. Depending on the type of sensation the clients will engage in bilateral stimulation to either strengthen the positive or address the negative ones.
Phase 7: Closure
The target is cooked! I encourage my clients to notice if there are any new insights, thoughts, memories or dreams. If they do, I ask my clients to keep a written or mental log to report back.
Phase 8: Re-evaluation
Sometimes the target cannot be closed over the course of one session and therefore is incomplete. Fortunately, there is a procedure to close down an incomplete session which includes utilizing our resources from phases 1-3 including imagery and grounding techniques. I will never let a client leave a session without feeling stabilized or neutralized.
What is the commitment?
Due to the intensity of EMDR there is a stricter commitment to sessions. All clients are expected to meet for weekly sessions for 60-to-90-minute sessions. The longer length of sessions allows for time to incorporate 1 to 2 therapeutic resources at the start and end of session. Due to the intensity of treatment gains it is important to check in more frequently with your therapist with weekly sessions to interpret any information the client has processed outside of sessions.
Why do we use eye movements, tapping and/or sounds?
EMDR seeks to recreate the REM sleep phase while we are fully awake and present. While my clients track a visual stimulus (e.g., my fingers), listen to auditory sounds and or tap; they are stimulating the left and right sides of their body. At the same time, clients are encouraged to concentrate on their disturbing memory. This process allows us to work out distressing material in a controlled, safe environment while conscious.
There are four stages of sleep, the first three being “Non-Rapid Eye Movement” (NREM) stages whereas “Rapid Eye Movement” (REM) is the final stage. Stages one through three revolve around the transition from wakefulness to a deep sleep (stage 3). Non-REM sleep encompasses our body temperatures, heart rate, blood pressure and breathing rate decreasing as well as our muscles relaxing. The fourth stage, REM sleep, leads to our brain becoming more active, our bodies relaxing and becoming immobilized, dreams are occurring and our eyes begin to move rapidly, side to side.
If you’ve ever heard of and or have taken the advice to “sleep on it” then you are aware of its merit. You get some rest, have dreams, and wake up. You wake up and remember your dream. Then you think about why you had the dream. You realize the dream may have to do with something related to your past, present or future. Perhaps your dream has to do with a pattern or theme that you wouldn’t have become aware of otherwise. This movement is believed to play an important role in our brains ability to process information.
Is EMDR right for you?
EMDR is right for you if you have heard every reason why you should “get over” your distressing event and none have stuck with you. Sometimes we need more intensive treatments than talk therapy. Sometimes hearing logic, itself isn’t as meaningful as coming up with the facts ourselves. While EMDR will never let you forget your past, the trauma will no longer define who you are today.
Are you ready to confront your past, present and future? If you’re ready to take action you can reach me via email at firstname.lastname@example.org, phone: 973-314-2464 and or click the “Request appointment” tab at the top of this page to schedule your free 15-minute phone consultation.
Please email me questions, comments or blog post ideas at email@example.com