What does an EMDR session look like?
You’re ready to address your trauma. You’ve heard about EMDR. You have a therapist in mind. You’re intrigued. What would this process actually entail? What does a typical session look like, and how long does treatment take? Below you will find a description of the 8 phases of EMDR and a general outline for the number of sessions to expect for each one. Let’s walk through it.
1: History and Treatment Planning (1 or 2 sessions)
The very first phase of EMDR is History and Treatment Planning. During these initial appointments, your therapist’s goal is to get a clear picture of the issue and associated symptoms you’re wanting to address. Once they understand your goals, they will create a treatment plan to facilitate your healing. If you’re coming in with one acute trauma, like a car accident, this phase will usually take one or two sessions. If you’re coming in with a more complex experience, like a history of abuse by a loved one, this may take longer or need to be revisited as more memories or elements are uncovered.
2: Preparation (1+ sessions)
During phase two, your therapist will introduce various coping strategies aimed to help you achieve a calm, mindful mental state. This phase can take anywhere from one session to 10 sessions or more. If that seems like a wide range, you’re absolutely right. Time spent here will vary from client to client based on things like trauma history and mental health needs. As you can imagine, talking about traumatic incidents can lead any of us to experience a wide array of emotions: agitation, overwhelm, sadness, anger, betrayal, grief, etc. These emotions are welcome during your sessions. If they become large enough that you are finding difficulty staying present, then you may need to implement one of the practiced coping skills in order to effectively continue session. It is common for clients to use their emotional regulation skills outside of session, too. Once you and your therapist feel confident that you have enough self-awareness into your emotional state and adequate skills to help you regulate after an intense emotion or sensation, you will be ready for the next phase.
3: Assessment (1-2 sessions)
During this phase you will be guided to identify a single image or moment from your traumatic incident. You will also work to articulate a negative belief associated with that image. Some common beliefs include “I’m not good enough” and “I’m unlovable.” You’ll then establish an adaptive belief, or, in other words, something you’d rather think instead. Examples of these beliefs are “I’m enough as I am” or “I welcome and receive love.” It’s normal for these to feel far fetched at first. Just do your best to express your desired belief, and trust the process. You’ll then identify how much you believe this new belief using a specific scale your therapist will provide. After that you’ll be prompted to again consider the image and negative belief that represents your traumatic incident. You’ll consider any emotions and physical sensations that arise, and share those with your therapist. You’ll then be asked to rate the level of distress you are currently experiencing on another scale your therapist will describe to you. This phase can generally be completed in one session and may be broken up into two in order to achieve ideal timing for phase four.
4: Desensitization (1+ sessions)
The fourth phase is usually what people refer to when they talk about EMDR therapy. It is during this phase the bilateral stimulation (BLS) takes place through eye movements, auditory prompts, or physical sensations (tapping, buzzers, etc.). You will be invited to reflect on the elements identified in the previous stage—mental image, emotions, physical sensations, negative belief, and level of distress—while completing your first set of BLS for roughly 30-60 seconds. It is expected that different associations will come to mind, and that is normal. The therapist’s role is to help navigate the memories, emotions, and sensations that arise. Their verbal contribution simple and repetitive and may sound something like, “Pause, and take a breath. You’re doing great. What are you noticing?” After sharing the most prominent element of your reflection, your therapist will encourage you to continue with your chosen method of BLS. This type of exchange will continue for the duration of session, until you or your clinician determine a break is appropriate, or until you achieve a neutral reaction to your traumatic event. (Note: neutral is not the same as numb.) This phase can be completed in as little as 1 session or take 10 or more sessions. Here again, there are many factors at play that determine the time needed for effective, long-lasting resolution.
5: Instillation (1-2 sessions)
The adaptive belief will be strengthened in this phase. Now that the negative belief has been dissolved, or substantially minimized, the goal is to increase confidence in the new belief. Specifically, using the specific measuring strategy referenced earlier, the goal is for this new belief to feel “completely true.” BLS is used to aide in this effort as well. This phase is usually completed in one or two sessions.
6: Body Scan (<1 session)
After achieving a neutral reaction to your traumatic experience and full confidence in the new, adaptive belief, you will be prompted to reconsider the initial mental image identified in phase one. With this image in mind, you’ll consider your body sensations from head to toe. If your scan reveals a body that is calm and at ease, that suggests a thorough, successful progression through the identified trauma. In this case, the present phase will be quick. Do you have any tension in your shoulders or jaw? Are you experiencing a heaviness in your chest? Do you notice tears forming or a tightness in your throat? If you do notice any of these types of sensations, that is a clue more reprocessing (phase four) needs to be done.
7: Closure (<1 session)
This phase is completed at the conclusion of every EMDR session regardless of the level of progress made during the current session. The purpose of this phase is to ensure you end session feeling as calm, capable, and in control as possible. Strategies rehearsed in phase two are often incorporated here.
8: Reevaluation (1 session)
The final stage occurs the session after you complete your targeted traumatic incident. This is where you and your therapist will discuss improvements and shifts you noticed outside of session. Has your progress sustained the time between sessions? Have your symptoms continued to be reduced or nonexistent? This is also an opportunity to revisit any of the previous phases if needed. As this phase is primarily used to evaluate processes and progress, some version of it should take place at the beginning of every EMDR session.
Some clinicians offer EMDR intensives that allow you to go through this process in a day or two. If that sounds like something you’d like to explore, visit our colleague’s page here.
