More Than Just Eye Movements: The Eight Phases of EMDR

August 9, 2010
By Sarah Jenkins, MC, LPC, EMDR Topic Expert Contributor

He called me, as most new clients do, to inquire about me, my practice, and my approach to helping. What made this call unusual was that I had to educate him about Eye Movement Desensitization and Reprocessing (EMDR), not because he was unaware of the treatment, but because what he had heard about it from his current therapist was inaccurate. Unfortunately this happens a lot with all kinds of therapy.

As I tell many folks, finding a therapist is like finding the right pair shoes. Some shoes look good, but they don’t fit. Some don’t appear to be a good fit or style, but they are. Just as many of the choices you make as a consumer are aided by research and experience, becoming an educated therapy consumer is a necessary part of your healing journey. When you contact a new therapist, the therapist, too, will wonder whether he or she is the right therapist for you, whether the type of therapy used will be in your best interest, and whether the therapist can offer the expertise that you seek.

With the potential new client on the phone, I found myself in a bind. On the one hand, I wanted to be respectful of the relationship he had with his therapist, but on the other hand, what he had been told about EMDR was not accurate and could possibly hurt him. I elected to educate him and tell him the truth about it, even though it was different what he had heard from his provider. With this information, he was able to better identify what he needed from a counselor and to determine when or whether to pursue EMDR.

EMDR Is Not a Quick Fix

We often look for a quick fix in this culture. Certainly, EMDR’s way of processing traumatic material can be rapid, intense, and highly effective, but it is no guaranteed quick fix, as the client on the phone had been told. Generally, when I first meet with a client to talk about EMDR, this is one of the first misunderstandings that comes up. EMDR is like a specialized surgery procedure, a laser beam of sorts that hones in on the material that is stuck in the nervous system causing distressing symptoms. I wouldn’t ask my surgeon to rush, nor would you. In fact, rushing may mean missing out on completing the eight phases.

More than Just Eye Movements

The name Eye Movement Desensitization and Reprocessing suggested to the client that the treatment involved little more than eye movements. This is a common misconception. If your EMDR therapist is talking only about eye movements and nothing else, it’s not EMDR. EMDR consists of eight distinct phases, which I will illustrate for you. If you are currently using EMDR therapy, you may already know where you are in the process. If not, I hope to reveal some of the mystery behind the treatment. Though the phases are intended to be completed in a particular order, transitioning between them, in a circular fashion, is not uncommon. We can go back to a phase at any time.

The Eight Phases of EMDR

History Taking

In this stage, your therapist will learn about you and your history and might conduct the standard assessments that he or she uses. This is the time when you share your story, get to know your therapist’s style, and set up initial treatment goals. The therapist should also be creating a target sequence plan, an overview of what affects you from your past and a template for your future. In this phase you are likely to discuss touchstone events, previous experiences that contribute to your current symptoms. You may be surprised to know that how you think and feel in this moment is linked directly to your past. As you review these events with your therapist, you may be asked to rate how disturbing things are to you on a scale of 0-10.
Preparation

The next three phases are like a traffic light, and phase two is like the red light. At this point, you are learning more about EMDR, as well as identifying and ensuring your readiness to move further through the phases. You may be learning additional grounding skills, stress reduction skills, or state change skills, and your therapist will help create a safe-place image for you. You will also be asked to complete a brief assessment to identify if you experience dissociation. You will learn about bilateral stimulation (BLS), the back-and-forth eye movements, sounds, or tactile sensations that help the right and left hemispheres to process the traumatic material and activate the brain’s Adaptive Information Processing (AIP) system. In this phase, you may also hear your therapist talk about resourcing and using the BLS to help you access more positive experiences, thoughts, and images before moving on through the remaining EMDR phases.
Assessment

This phase is like the yellow light on a traffic signal. In the assessment phase, you and your therapist will look at what you want to target when you move into the processing phase. Your therapist will ask you for an image, a negative cognition, and a positive cognition, and to rate how true your positive cognition feels on a scale of 1-7 and how disturbing the target is on a scale of 0-10, and to describe what you experience in your body.
Desensitization

This phase is the green in our traffic light analogy. This is where the BLS really comes into play. Those who have used EMDR know that this is where what you are working on comes up. All of your senses become involved as you process the disturbance you are targeting. You won’t talk to your therapist during this process; you’ll have a brief check in, and then go back to moving your eyes back and forth, hearing the tones, or feeling the taps. This is where AIP comes into play, and your brain will recycle the material for your nervous system to release it as it did not get to at the time. In between sets of BLS, your therapist may also throw some things in for you to think about; these are called cognitive interweaves. The same 0-10 scale from the assessment phase will be used here to assess your level of disturbance. When the level of disturbance is rated at zero and the target truly feels neutral and not distressing, we move on to phase five.
Installation

Next, we will install the positive cognition that you chose with the BLS, but before we do, we recheck to see if the positive cognition has changed at all. It often does because you have moved further on in your healing. We will also check to see how true that positive cognition feels to you, using the same 1-7 scale from phase three. We then keep using the BLS to see if anything is getting in the way. When you get to a 7, completely true, we move to phase six.
Body Scan

Just as the name suggests, you will be asked to mentally scan your body to find any sensations or tensions that signal that something is still stuck regarding the target. If there are any lingering sensations, your therapist will continue with the BLS.
Closure

This will look and sound different depending on if your session was complete or incomplete. You will close down the material and do a final check. You will also use various methods, including imagery, to contain the material that is still not processed. This may include returning to your safe place or creating a container to hold anything that may become to distressing in between sessions.
Reevaluation

Though it looks like the last step, the reevaluation phase spirals back as if it were the beginning. Your EMDR therapist will do a check in at the beginning of your next session that will include reevaluating your disturbance level regarding the target from the last session. This helps to determine if your disturbance is still neutral and if your positive cognition still rings true. If the previous EMDR session was incomplete, the cycle begins again at phase four.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org.