Eye Movement Desensitization and Reprocessing
(EMDR) Therapy:

How does EMDR therapy work?

At the time of a traumatic event, strong emotions interfere with our ability to completely process the experience and one moment becomes “frozen in time.”  Recalling the traumatic event may feel as though the person is reliving the event all over again because the images, smells, sounds, and feelings are still there and can be triggered in the present.  When activated, these memories cause a negative impact on our daily functioning and interfere with the way we see ourselves, our world and how we relate to others.  EMDR therapy appears to directly effect the brain, allowing the individual to resume normal functioning while no longer reliving the images, sounds, and feelings associated with the trauma.  The memory is still there, but it is less upsetting.

Unlike many forms of talk therapy, an EMDR therapist helps trauma survivors by linking what was seen, felt, heard and believed at the time of the trauma with a unique, additional element: a pattern of rapid directional eye movements induced by the therapist waving one or two fingers back and forth in front of the client’s eyes.  Typically this is done at a distance of 12” or more.  There are other forms of dual processing, such as tactile sensations or audio processing.  The client is gently guided to just notice what comes up without trying to control the content while processing the information until it is less and less disturbing.  Overtime the disturbing memory and associated beliefs, feelings, sensations become “digested” or worked through until it is associated with a positive belief about the self.  For example, “I am a failure” becomes “I can succeed.”

Similar to many forms of psychotherapy, the exact mechanism for the effectiveness of EMDR is yet unknown.  It appears that using rapid eye movements relieves the anxiety associated with the trauma so that the original event can be examined from a more detached perspective, somewhat like watching a movie of what happened. Some experts have noted that the eye movements involved in EMDR might be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep.  It may be thought of as a physiologically based therapy that allows a person to see material in a new and less distressing way.  Others believe it reactivates parts of the brain that were “shut down” as a coping mechanism. In this way cognitive reorganizing takes place, allowing the negative, painful emotions to give way to more resolved, empowered feelings.

Steps of an EMDR therapy session

EMDR Step #1: History and treatment planning

If you choose to try EMDR therapy, your first session will likely involve the therapist taking an initial client history. The therapist will probably ask you about the problems, behaviors, and fears that have provoked you to try therapy. However, one difference between EMDR and many other therapies is that you don’t need to discuss traumatic events in detail. The emotions and physical sensations surrounding the event are what’s important, not the details about the event itself. Once the therapist has developed a treatment plan for you based on this initial assessment, the process of EMDR can begin.

EMDR Step #2: Preparation

The preparation stage involves the therapist teaching you some self-care techniques, so that you can handle strong emotions that may arise during or between sessions. EMDR places a strong emphasis on self-care. This stage is also important for developing a sense of trust with the therapist. He or she will explain the theory of EMDR in more detail, and talk about what you can expect in the following sessions.

EMDR Step #3: Assessment

In the next few sessions, the therapist will ask you to identify three things:

• A target - the visual image of a traumatic memory and the associated emotions and bodily sensations. You probably will have already discussed your target in your first session, but at this point you will clarify the visual "scene" or "picture" related to the trauma you experienced. You'll also be asked to rate the intensity of the sensations you feel when you focus on this target.
• A negative belief about yourself related to the memory, which you will rate depending on how true you feel this belief to be
• A preferred positive belief about yourself.

EMDR Steps #4 & 5: Reprocessing, Desensitization and Installation

Once you’ve identified the target, negative belief, and preferred positive belief, the therapist will help you recall the target image while leading you through a series of rapid eye movements (or audio or tactile processing and or a combination there of). This is known as dual processing, which enables you to access positive ways of reframing the original trauma (reprocessing), and to release the body’s stored negative emotional charges around it (desensitization). The goal is that you’ll then be able to recall the traumatic event without the anxiety or sadness you once experienced, thereby “digesting” the trauma until it no longer holds a “negative charge.”

After each set of rapid eye movements, the therapist will check in with you and will later assess your level of disturbance regarding the target image.  During this process, you will continue to “digest” or process the feelings, images and beliefs that occurred in relation to the trauma target.  You’ll be asked again, to rate the negative and later positive self-beliefs surrounding your trauma target which gives the therapist concrete measures of how you are progressing.

What is unique about EMDR is how rapidly new beliefs about the self and interpretations of the trauma replace old beliefs. New possibilities emerge that were never before considered. These new insights are used as the starting points for the next set of eye movements, continually helping you to process the trauma in a healthier, more manageable ways. EMDR therapists also monitor their clients’ reports on the intensity of their symptoms between sessions to ensure that progress is being made and maintained.

EMDR Step 6: Body scan

After being able to replace your negative beliefs surrounding the trauma with the preferred positive belief, the next step is to focus on any physical sensations in the body that may have emerged. The therapist will ask you to think of your original target and concentrate on your body, noticing any tension or other sensations that may occur. Once the trauma has been worked through, you may notice positive bodily sensations that replace the negative ones originally noted when the session began.  EMDR practitioners believe that there is a “physical response to unresolved thoughts”. In other words, emotional pain can manifest itself as physical pain and by changing our beliefs we may also change the way our body reacts to our thoughts.

In order for EMDR therapy to be successful, the goal is for you to be able to think or talk about the original target without feeling any body tension. According to the EMDR Network, “positive self-beliefs are important, but they have to be believed on more than just an intellectual level.”

EMDR Steps #7: Closure

One of the goals of an EMDR session is for you to leave feeling better than you did before you got there. There may be times the self-care and calming techniques taught in the preparation phase may be used in session and will be recommended between sessions.  In EMDR, the client is the one in control and using techniques such as journaling or imagery helps to provide a sense of mastery between sessions.

EMDR Step 8: Reevaluation

At the onset of the next session, your therapist will assess the positive belief and or level of disturbance regarding the initial target to insure consistency with the final processing of the last session.  This is initiated to assure that positive results have been maintained, and to note if any additional processing has occurred, or to determine if there is a need for additional reprocessing. 

EMDR often leads people to feel better very quickly, but it is important to experience the entire 8-phase process with a qualified EMDR therapist to ensure the most beneficial results.

Reported benefits and drawbacks of EMDR

EMDR therapy is relatively new – it was developed 20 years ago in 1987, and as a result, the scientific community continues to examine the long-term results of EMDR. While there are differing ideas on how effective this treatment really is, the main benefit of EMDR is the speed at which deep-seated problems can be resolved. Single sessions of EMDR have been shown to produce results, and Dr. Francine Shapiro reported an average treatment time of five sessions to comprehensively treat people with post traumatic stress disorder (Shapiro, 1989 199-223).

The following is a list of reported benefits and drawbacks, to help you make your own decisions regarding EMDR.

Potential Benefits

Potential Drawbacks

EMDR does not require the client to go into detail about the distressing events of the past. Unlike many “talk” therapies, there is no need to analyze the trauma for long periods of time. EMDR is a multi-faceted approach.The fact that it simultaneously works on mind, body, and emotions may account for its success in taking mere intellectual understanding of the origins of a problem (e.g. “I know I have guilt over killing in the war”) to a resolution where post-traumatic symptoms such as intrusive thoughts, nightmares, and anger outbursts clear up. The trauma that must be re-experienced during treatment is relatively short-lived. Cognitive reprocessing occurs simultaneously with memory recall.

EMDR was created for use as a trauma therapy and as such focuses on intensely stressful subjects. Pregnant women, or those with heart conditions or eye problems, should consult their health care practitioners before beginning EMDR therapy. EMDR has not been proven effective in studies on phobias, panic disorder or stress related disorders, only on PTSD. EMDR is a relatively new therapy and as such the verdict is still out as to its long-term effectiveness.

Research on EMDR

There is a divergence of opinion within the scientific community regarding the efficacy of EMDR compared to other specific forms of therapy.  Those on either side of the debate are passionate about their claims, and present plenty of food for thought. However, the number of studies performed is prolific and makes a statement about EMDR’s impact. According to Gary Peterson, M.D.  EMDR has had “more double-blind, placebo-controlled studies published in peer-reviewed journals than any other psychotherapy method” for the treatment of PTSD. Based on the encouraging results of these studies, in 1999, both the American Psychological Association and the International Society of Traumatic Stress Studies approved EMDR as a valid therapy for post-traumatic stress disorder.

Finding an EMDR therapist

EMDR is a highly specialized therapy that needs to be conducted by a licensed mental health professional who has taken specific training in this complex approach. Due to the relative newness of this therapy, some clinicians may not have received appropriate training. Also, they may be inexperienced in the actual practice of EMDR, or be out-of-date with the latest developments in the therapy.

The EMDR Network suggests asking any prospective EMDR clinician the following questions, to ensure you will receive proper care:

The two most widely respected professional organizations for EMDR are the EMDR International Association and the EMDR Institute. Both organizations list certified and trained therapists on their websites who have met the necessary requirements to provide EMDR therapy in your area.  Please refer to the references and resources below to find learn more about EMDR.

Related links for EMDR therapy

General information on EMDR therapy

EMDR Frequently Asked Questions – A gateway to thorough descriptions of EMDR therapy, synopses of research studies on EMDR’s effectiveness, clinician training information, and information on finding a therapist in your state. (EMDR Institute)

Francine Shapiro on EMDR – An interview with the originator of EMDR. (New Therapist Magazine) 

About EMDR and EMDR & PTSD – Brief, easy-to-understand articles (Carol Corcoran, LCMFT, LMFT and EMDRIA Certified Therapist) 

Finding an EMDR therapist

EMDRIA – Find a Therapist – A searchable directory of EMDR International Association certified professionals. (EMDR International Association)

Choosing an EMDR Clinician – Allows you to search by city and state; offers criteria for selecting a therapist. (EMDR Institute)

EMDR Articles

EMDR: Taking a closer look – Presents a more skeptical view of EMDR, comparing it to other traditional therapies (Scientific American)

Pro and Con: EMDR for Traumatized Children – A point-counterpoint discussion on the use of EMDR on children. (Child Survivor News)

Innovative therapy helps people move beyond the disturbing effects of trauma – Article concerning EMDR and post-traumatic stress disorder (PTSD), especially for those in the military. (Amherst Bulletin)

Suzanne Bartson wrote this article with editing by Carol Corcoran, LCMFT, LMFT,  an  EMDRIA Certified Therapist.. Last modified on: 1/23/08