The Structure of EMDR
When trauma enters our lives, we become task-oriented to survive. There is no “one thing” that works in regards to treatment, and responses will look very different amongst us. Once triggered, you may feel like your entire life is out of their control. You become emotionally dysregulated, and it’s incredibly difficult to self-soothe as your capacity to help yourself and especially others declines. Furthermore, you may not even realize you are triggered or that what you’re experiencing is trauma in the first place. While varying in symptomatology, trauma is very common and will impact the entire body.
One of the most well-known and powerful psychotherapy treatment options for addressing trauma is EMDR, which stands for Eye Movement Desensitization and Reprocessing. It was initially developed by Francine Shapiro in 1987 to help combat PTSD (Posttraumatic Stress Disorder) and has since evolved over time. The EMDR framework is based on Shapiro’s “Adaptive Information Processing Model”, which posits that as our experiences unfold, the brain processes them as stored memories, eventually linking them with more adaptive information. We create meaning from these associations that will then inform how we learn, grow, and move forward. Due to this system, our memories are tied to the connecting thoughts, feelings and sensations that came with them at their inception.
When an experience is traumatic in nature, the negative emotions surrounding it override this information processing system, ultimately stopping it before its completion, never forging for us pathways to more adaptive knowledge.
The memory is stored, yet ultimately unprocessed, creating opportunities for an individual to be triggered by any event that brings forward similar feelings and/or physical sensations in them. In these instances one may feel like they are reliving the past - losing any awareness of the here and now and overwhelmingly distressed.
As mentioned above, trauma always ranges in severity. What is traumatic for one person may not be for another, and yet it is pivotal to note that all experiences are valid. EMDR is a structured type of therapy designed to help people heal as they move toward resolution. To do so, a client will temporarily be asked to go back to the traumatic memory, in an effort to close the processing gap and reformulate limiting beliefs. Simultaneously, they will engage in bilateral stimulation (BLS) of some sort, often audio tones, eye movement or hand tapping, while they process. This stimulation activates both the left and right brain, and allows one to focus on their pain as external to them. The hope is that their cognitive insight will shift as clients work directly through “the leftovers” of a disturbing event. EMDR is backed by a plethora of successful studies and research, and has now been an effective healing tool used by practitioners for decades. It contrasts from traditional talk or group therapy - also effective resources in combating trauma in their own right. It also requires clinicians to obtain additional training beyond standard licensing requirements, and for many, it has provided relief from years of suffering within just a small number of sessions.
EMDR is composed of eight phases and typically spans over 9-12 sessions, depending on the number of traumas to address and client bandwidth. They include:
Phase 1: History/Treatment Planning
In the first phase of treatment, a therapist will assess readiness and attempt to understand the full context of what is going on in an effort to identify key memories, triggers, and goals to target over the course of treatment.
Phase 2: Preparation
The therapist will then inform the client of: background information on trauma, how the EMDR method will work/all procedures, resources to help regulate emotional distress, and how to communicate boundaries and manage expectations throughout the duration of the process.
Phase 3: Assessment
In the assessment stage, the client and therapist will collaboratively choose and activate a targeted memory. To do so, the client will recall the emotions, sensations, physical image, and self-doubting beliefs attached to this experience. They will also be asked to call on positive beliefs they hold of themselves that may be at variance with those posited before. During this time, the therapist will be using cognition and disturbance scales to document a baseline and examine client progress.
Phases 4: Desensitization
Next, the client will be asked to focus on the same target while also engaging in BLS, encouraged to share any new thoughts that come forward. The therapist will then ask the client to focus on said new thought and pair it with more BLS. This pattern continues until the vividness and feelings surrounding the memory are reduced over time, eventually to nonexistence.
Phase 5: Installation
Here the therapist will aim their attention at strengthening these new positive cognitions within the client in the installation phase.
Phase 6: Body Scan
Then clients will be asked to somatically scan their body, noting where any lingering trauma is storing itself. If needed, further processing will take place.
Phase 7: Closure
This is the time when the therapist will guide the client on how to use the techniques learned between sessions, as well as on the importance of continually being aware of one’s triggers.
Phase 8: Reevaluation
In the final stage, the client and therapist will not only explore progress made thus far.
While everyone is the expert on their own life, sometimes you just need a little more support, and there is absolutely nothing wrong with that! For some, this looks like EMDR, for others, it’s sitting with others in a group who can understand what you’ve been through. No matter what works for you, the importance is that it works, and it’s for YOU.