What Happens in an EMDR Session?

So if you’ve read my last blog post, you have a general idea of what EMDR is and how it can be helpful. Now you may be wondering what happens during an EMDR counseling session. Even with all the information out there on the web to include videos and reviews for just about everything you can think of, you probably won’t see a video that shows what happens in an actual EMDR session. At least, you shouldn’t – because counseling is confidential! But since many people have some apprehension when it comes to counseling and specifically EMDR, I want to talk about the 8 Phases of EMDR and what it looks like in the counseling session. I would like to note that prior to formally starting the 8 Phase process, your therapist should have spent some time building rapport with you and establishing a safe therapeutic environment. In other words, don’t expect to start Phase 1 in your very first therapy session. 

Phase 1: History Taking

In the first phase of EMDR, your therapist will obtain a history of your experiences that may be contributing to emotional distress; You will rate each experience on a scale of 0-10, where 10 represents the strongest emotional distress you can imagine, and 0 represents no emotional distress (or neutral). Sometimes these experiences will have already been reprocessed and don’t need any attention, while other times you may acknowledge a potential target but choose not to address it during the course of counseling. The therapist will also ask you some additional questions about how you have overcome difficult times in the past, and what you identify as positive times in both your childhood and adulthood.  Most of the time, this phase takes a full therapeutic hour to complete. 

Phase 2: Resource Building

In the second phase, your therapist will work on some specific coping skills that will help you manage intense emotions that may occur during EMDR. Probably the most common exercise is the “Calm/Safe Place.” Your therapist will use guided imagery along with very slow bi-lateral stimulation to help you feel calm and relaxed. If there are any potential barriers or concerns that either you or your therapist feel may impede your EMDR work, these concerns are addressed in Phase 2 as well. Depending on your specific circumstances, Phase 2 could take one or more sessions to complete before moving on to the next phases.

Phases 3 – 7: 

These next phases of EMDR can take place in one session, or over multiple sessions. During Phase 3 your therapist will ask you to identify a memory to target, and follow up with additional questions to create a starting point. You will also identify a negative thought you have about yourself that relates to the memory, a positive thought you would prefer to think instead, and then rate how much emotional distress you feel when you think about the memory. Phase 4 is when the therapist uses bi-lateral stimulation to target the memory and the associated emotion and negative thoughts until the emotional distress is resolved. During Phase 5 your therapist will check how your desired positive thought feels at this point, and Phase 6 consists of mentally scanning how your body feels to make sure there are no lingering emotional traces. Your therapist will use EMDR therapy to continue the reprocessing of any sensations in each of these phases until you no longer feel emotional distress related to your targeted memory. Phase 7 is a debriefing of the work you have done during the session. Because it may take a few sessions before all the emotion is completely reprocessed, you may stay in Phase 4 for a few sessions. If that is the case, your therapist will let you know when the session is ending and will go through the debriefing process (which is part of Phase 7) in order to make sure you are emotionally grounded before you leave. At your next session the reprocessing will continue, starting again at Phase 4. Just a note here: While most of the time it takes a few sessions to complete the reprocessing, Phases 3-7 can also take place during just one session. There is no hard and fast expectation.

Phase 8: 

Phase 8 always takes place at the beginning of your next session. Your therapist will ask you questions related to what you worked on previously, and if you are still working on a particular memory you will transition back to Phase 4 and proceed with bi-lateral stimulation until the emotion is fully reprocessed. If you have completed the reprocessing, then during Phase 8 your therapist will check in to make sure that no additional issues have surfaced since the last session. If there are no issues, then you start again at Phase 3 with a different target memory, and continue working through the phases for different targets until you have worked through all your indicated memories. 

After you have worked through an identified target, your EMDR Certified Therapist will shift focus to work on positive ways to adapt and respond to future situations. For example, if you have been working on your fear of public speaking and have an upcoming presentation to give, your therapist can use EMDR to target a future situation and apply the positive adaptive responses you have worked on to better manage that situation. Once you have worked through all your identified experiences, your therapist will then go back and have you re-assess each one to make sure that there are no remaining adverse emotions that need attention. 

I hope this breakdown has been helpful in preparing you for your first EMDR session. If you are interested in scheduling an appointment for EMDR, please contact me or search for EMDR Certified Therapists in your local area on the EMDRIA website. Next week, I will be focusing on potential barriers to EMDR, as well as reasons EMDR might not be the right intervention for you. Make sure you stay connected for future posts!