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This is by far the most frequently asked question I get asked by potential clients. It’s hard to find information on what the process of EMDR is actually like to go through. I see a lot of overly technical discussion and also vague stories of the “magic” that is the result of EMDR. I’m hoping to break it down a bit for you in this article in an easy-to-understand format.
Eye Movement Desensitization Reprocessing (EMDR) has been used for the past 30 years to treat single, traumatic incidents like a sexual assault or helping someone heal after years of abuse & neglect. Most recently it is being used to treat broad conditions like depression and anxiety too. I’m going to focus on how EMDR works in healing after trauma.
Let me walk you through the process by using an example of a client we will call “Casey”. (Casey is not a real client but a blending of real clients’ stories to help illustrate a typical course of EMDR treatment.)
Casey enters therapy because she experienced a sexual assault two years ago. She’s tried lots of different forms of therapy and interventions like meditation & yoga to help her feel like herself again. Most of these things have been helpful but her nightmares, anxiety, and inability to have sex with her partners continues to be an issue for her.
Here’s how I might work with Casey:
We start with an assessment phase where Casey shares everything she thinks I should know about her. I ask her a ton of questions about her history, current life, and eventually we create a list together of all of the bad things that have happened to her.
Casey’s list:
- Bit by a dog when she was 5 years old
- Had a seizure (cause never found) when she was 7
- Grandmother dies when she is 13
- When she was 15 she had a creepy incident on a bus involving a stranger – she’s not quite sure how to label this experience.
- At 21 she goes through the sexual assault she is hoping to process now.
Right now, Casey’s life is pretty good. She has a few emotionally & physically intimate relationships that feel healthy. Her partners are very supportive of her. She’s working in a job she enjoys. She has financial stability and resources to help her engage in self-care activities as needed.
I name all of the factors above because that is a part of our assessment for whether now is the appropriate time for Casey to engage in the hard, stressful work of EMDR. Life doesn’t have to be going perfectly (and often it isn’t which is why people reach out for help) but if you are struggling with addiction, current abuse, suicidality, or other acute conditions/environmental factors we may need to work through those issues first before tackling the work of processing traumatic material. However, don’t let this be a barrier for reaching out! It just means that we may focus our initial sessions on how to make life a little better for you right now so that you are safe and feel able to do this work.
Back to our example — let’s say Casey seems to be in a good place to do some trauma work and so we discuss using a treatment like EMDR to process through the experience. We both agree it’s the right time and right circumstances for her.
Here’s how we might start:
I would take Casey through a “test run”. This means Casey will use a non-traumatic event while doing EMDR for the first time so she can learn the process in a relatively low-stress way. If all goes well, we then start to go through the bad things on her list starting from the earliest memory to the most recent.
We always start with the earliest memories because oftentimes a more recent trauma will remind our brains of the previous bad events in our lives. This means it can be difficult for the brain to fully process a recent memory that was actually a retraumatization without first processing the original events our brain was reminded of.
When we process a memory, we start by identifying the memory we are going to work with. We identify an image that represents the worst part of the memory. Then I walk the client through a series of questions to identify what the feelings were at the time of the incident, the beliefs developed about the self or world from this experience, how the body responds when remembering the event, and getting a number (from 0-10, with 0 = no bad feeling at all and 10 = the worst possible feeling) on how bad the feeling is right now as the person thinks about the memory.
Let’s see what this might look like for Casey using the first memory on her list.
Memory: Being bit by a dog when she was 5 years old.
Image that represents the worst part: Dog approaching her growling.
Belief: I am never safe.
Preferred belief (this is what Casey would prefer to believe when thinking about the incident): I can be safe.
Emotion: fear
How it’s felt in the body: clenching of the stomach
How bad it feels right now on the 0-10 scale: 7
Next, I will ask Casey to get the image in her mind, the belief she can’t be safe, the fear, and where she feels it in her body and ask her to follow my fingers (or a wand I use) with her eyes while I move my fingers/wand back and forth fairly quickly from left to right in front of her. At different intervals we will stop and I will check in with her on what’s coming up while she is concentrating on the memory.
This part of the process can take 15 minutes or 10 sessions depending on how difficult or complicated the memory is for Casey’s brain to process. We continue going until Casey consistently reports that the memory is a “0” on the 0 (no bad feeling) – 10 (worst possible feeling) scale.
During EMDR people can feel rather intense emotions and sometimes a surprising (to them) lack of emotion. It’s all “normal”. As the memory starts to feel less and less intense and eventually becomes a 0 people have described to me feeling:
“it’s like it’s really far away now and I have a hard time picturing it”
“it doesn’t really feel like it happened to me anymore even though I know it did”
“I’ve lost some of the details… it’s like it’s fading”
“It feels like I am seeing the sun for the first time after a really long night”
“It feels really over now”
People do not:
– Forget about it
– Say “it’s ok that happened to me”
– Automatically forgive a person who harmed them
– Feel happy they had the experience (in some cases it may happen that the person feels gratitude for the lessons learned from the event but this is not necessary to healing)
For Casey, when we finish the dog memory, we keep moving along to the other memories on her list until each one feels like a “0” (no bad feeling). As the trauma processing phase winds down Casey may experience a sense of grief over what life could have been like if she hadn’t experienced these events. We may spend some time after processing all of the memories working through her grief together. Some people also like to spend time at the end of processing to make meaning of their experiences or acknowledge the ways the events impacted their lives. During this time Casey and I will work together through whatever is coming up for her after processing. We then might anticipate future events that might be stressful or acknowledge ways of avoiding potentially traumatic things.
I will ask Casey to let me know if she experiences any traumatic responses (panic attack, nightmares, intrusive thoughts, etc.) so we can assess if there are any memories we may have left out. I always keep my door open to folks and ask them to come back if they experience anything disturbing or continued symptoms.
This process can take anywhere from 3 months to a few years depending on life factors and the number of bad experiences on the list.
EMDR is an incredibly effective tool for healing trauma. And it is also not the only tool in the bag. Stay tuned for my upcoming article on how Progressive Counting (PC) works!
