When clients come to me looking for EMDR therapy, a part of them is eager to jump right into reprocessing the disturbing memories that they’ve been working so hard to submerge and avoid. Oftentimes clients don’t realize that EMDR therapy has a structured process that includes eight specific phases that help the client and clinician understand what has happened in the past, what is happening now, and how the client would like things to be in the future. This step-by-step process also allows the client and therapist to build a relationship and a sense of relative safety before jumping into trauma work together. At Prosper Counseling we are trained therapists in the use and application of EMDR. Read on to learn more about the EMDR process.
The 8 Phases of EMDR Therapy
- History Taking
- Preparation
- Assessment
- Desensitization
- Installation
- Body Scan
- Closure
- Reevaluation
Phase 1 in EMDR therapy: History Taking
After the free consultation and agreeing to work together, clients are sent several forms before the initial intake appointment. Clients are sent a questionnaire to get more detailed information on current symptoms, prior work with other therapists, and hopes for our work together.
They are also sent a set of screening tools to get a baseline measurement of depression and anxiety symptoms. At our practice, we use the Patient Health Questionnaire and General Anxiety Disorder. (PHQ-9 and GAD-7). In addition, we use the Adverse Childhood Experiences (ACE) measure to assess childhood abuse, neglect, and other adverse experiences. Generally speaking, as your ACE score increases, so does the potential risk of medical and psychological problems.
Understanding Your Past
During our intake appointment, I will also ask about where you grew up and who was in your household. Common questions that I ask to gain a better understanding of you and your relationship with your household members in the past are:
- “If you had to use adjectives to describe this person, what would they be? What stories come to mind that is connected with those adjectives?”
- “How would you describe yourself as a child, teenager, adult?”
- “Who was important to you growing up? Were there any helpers or adult mentors that you remember?”
Understanding Your Present
An important part of the intake appointment is also gathering information about your present. I want to understand your top three problems and have you rate them on a scale of 0-10 as a baseline. We will reassess these top three problems weekly, or at the beginning, middle, and end of our EMDR intensive. I also want to understand:
- who is important to you now,
- what do you do, or what have you done in the past, that helps you feel better,
- what are your strengths,
- what do you envision the future to look like after our work together
Oftentimes my clients who have experienced traumatic events or relationships have isolated themselves in order to keep themselves safe. For good reason, people can feel dangerous. It can be a struggle to name any close relationships. I want to encourage you to consider pets, objects such as plants, or aspects of nature that feel nurturing and grounding. These are important resources.
Phase 2 in EMDR therapy: Preparation
Throughout our work together, my intention is that clients feel safe and stay within their “window of tolerance” or “window of resilience”. In order to do that, we will talk about what the window is and what it typically looks like for the client. We will also introduce and practice different tools and exercises to help your nervous system stay regulated. Two standard exercises are the Peaceful Place or Calm Place and the Container as part of the preparation phase.
The Train Ride
A common metaphor for EMDR phases 4-7 is a train ride in which the client is able to maintain dual attention – one foot in the present, and one foot in the past. When we move into reprocessing trauma, we want the client to feel safe and present inside the train car with me sitting beside them, watching the images from the past move along outside the window. When a client feels like there is no window and they are in the past, they are most likely outside the window of tolerance.
In order to shift back into the window, we can shift our attention back to the present with grounding exercises and/or using the tools mentioned above. In the preparation phase, we will commonly reprocess a “sample” EMDR target with a low disturbance to get familiar with the process.
Phase 3 in EMDR therapy: Assessment
During this phase, my clients and I agree on the disturbing events that we want to reprocess together, also known as the Treatment Plan, or list of targets.
Listing Traumatic Events
In addition to the information I’ve gathered from the intake, I will ask my clients to list the traumatic events that they have experienced – not going in-depth, but just giving it a title. An example might be “Car accident, age 5”. We’re just lightly touching on the event, but trying not to open up or access the memory during this assessment phase.
After we have our list, I also ask the client to rate how disturbing that event feels on a scale of 0-10, with 0 being no disturbance or neutral and 10 being the highest level of disturbance. This will help inform our treatment plan.
Initial Caregiver Trauma
Oftentimes my clients have trauma connected to their initial caregivers. For relationship trauma, where there are too many traumatic experiences to name, we can process a cluster of targets – starting with the first memory, the worst memory, and the last memory. We won’t need to target every single event related to the person. The beautiful thing about EMDR is that there is a “generalizing effect.” When we desensitize the cluster of memories, other similar memories also fade into the past and feel neutral.
After we have our list of targets or clusters, we take each memory and set up the target for phases 4-7.
With each target we want to know:
- The worst part about that memory: an image, a sound, a feeling
- The body sensations associated with the memory
- The emotions associated with the memory
- The Negative Cognition (NC) about yourself connected with this memory (ex: I’m in danger)
- The Subjective Units of Disturbance (SUD) – the level of disturbance on a scale of 0-10
- The Positive Cognition (PC) that you would rather believe about yourself when you think about this memory (ex: It’s over. I’m safe now)
- The Validity of Cognition (VOC) – how much do you believe the PC on a scale of 1-7, 1 meaning it doesn’t feel true at all, and 7 meaning it feels completely true.
Phase 4 in EMDR Therapy: Desensitization
During this phase, we take the information for the target memory and ask the client to focus on the memory while adding bilateral stimulation (BLS).
What is Bilateral Stimulation?
Bilateral stimulation can be eye movements following a therapist’s finger back and forth, or with the use of a light bar. For online EMDR therapy, bilateral stimulation can entail using an app with a ball that moves across the screen from right to left, or clients can use their hands and tap on their shoulders or knees repeatedly. All of these forms of BLS work to desensitize memory.
Bilateral stimulation is usually done for about 30 seconds. During this time, the client is asked to just notice what comes up for them as the train is moving and they observe the scenery outside the window of the train. Sometimes it will be a sensation, parts of the memory, an emotion, or nothing at all.
After each set of BLS, there is a brief pause where the therapist will ask the client what they are noticing. The client will briefly share, and then the therapist will say “go with that” and BLS continues. BLS continues until the memory is no longer disturbing or has a SUD of 0 out of 10.
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Phase 5 in EMDR Therapy: Installation
Once the SUD is down to 0 and the memory no longer feels triggering, we move to install the positive cognition (PC) in connection with the memory. We use bilateral stimulation during this phase to strengthen the positive belief to a 7 out of 7. Similar to phase 4, we ask the client to hold the PC and the memory while adding BLS. After about 30 seconds, there is a brief pause and the therapist will ask something along the lines of “Is that feeling more true, the same, or less true?” We want to strengthen the positive belief as much as possible.
Phase 6 in EMDR Therapy: Body Scan
Once the target memory has a SUD of 0 and a VOC of 7, we will want to check in specifically with the body and clear any distress that the body is still holding. The client is asked to hold the memory and the positive cognition together and scan their body from the top of their head down to their toes, noticing any sensations. Any lingering disturbance held in the body is processed with BLS until there is a clear body scan.
Phase 7 in EMDR Therapy: Closure
The closure is an important part of the process if the target memory is not fully reprocessed during the session. We want to use the end of the session to contain the memory until the next session and ensure that the client is grounded and calm before leaving the appointment.
One of the benefits of EMDR intensives is the potential to reprocess targets to completion in one intensive session. I love working with clients in this way, however, it’s not for everyone. Working weekly or intensively will get you the same results, it’s just a matter of how long it will take to get those results.
Phase 8 in EMDR Therapy: Reevaluation
At the beginning of each new session, clients are asked what they are noticing in general and in relation to the target that was worked on or reprocessed. Clients may choose to keep a written log of things that they notice in between sessions. This could include new memories coming up and/or helpful shifts in their thoughts, emotions, or relationships. During this phase, there is an agreement on what to work on during the present session.
Closing Thoughts
If you are curious about how EMDR might help you, please reach out for a free consultation. We offer EMDR therapy intensives and weekly EMDR therapy to residents of Pennsylvania and New Jersey. If you live in Philadelphia or are willing to travel to Center City Philadelphia, we can do in-person intensives. Otherwise, we are available to work with you for online EMDR therapy.
Start EMDR Therapy in Pennsylvania and New Jersey
EMDR Therapy is proven to be highly successful in processing and healing past trauma. If you are struggling to live your best life because you are stuck in the cycle of reliving past trauma, we can help. At Prosper Counseling our therapists are here to guide you on your journey to healing. Follow the steps below to get started.
- Get to know more about me here.
- Use the convenient online contact form to set up a consultation.
- Set up your first appointment and begin healing!
Other Mental Health Services at Prosper Counseling
Our in-person and online therapists in Pennsylvania specialize in EMDR treatment modalities. We offer EMDR Intensives, EMDR Therapy, and online counseling in addition to EMDR Therapy services. We understand that life can be full of challenges that make self-care difficult if not impossible. Allow us to help you reconnect with yourself and live the life you want full of confidence and free of regret.