A comprehensive resource for therapists on EMDR therapy: understanding the theory, 8-phase protocol, bilateral stimulation, and practical applications in trauma treatment.
Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychotherapy approach developed by Francine Shapiro in the late 1980s. Originally designed to treat trauma and PTSD, EMDR has since been adapted for a wide range of conditions.
EMDR is based on the Adaptive Information Processing (AIP) model, which posits that trauma and other adverse experiences can overwhelm the brain's natural information processing system, causing memories to be stored dysfunctionally with their original emotions, physical sensations, and beliefs intact.
Through bilateral stimulation (eye movements, taps, or sounds) while the client focuses on traumatic memories, EMDR helps the brain reprocess these memories, allowing them to be stored adaptively with reduced emotional charge.
The AIP model suggests that the brain has an innate capacity to process and integrate experiences adaptively. When this system is overwhelmed (as in trauma), memories remain unprocessed and can be triggered by current events.
Bilateral stimulation (eye movements, taps, or sounds) appears to activate the brain's information processing system, allowing traumatic memories to be reprocessed and integrated adaptively.
Clients maintain dual attention: focusing on the traumatic memory while simultaneously engaging in bilateral stimulation. This dual focus appears to facilitate processing.
Unlike talk therapy, EMDR doesn't require extensive discussion of trauma details. The client's own brain does the healing work, with the therapist as a guide.
Therapist gathers comprehensive history, identifies targets for processing (past events, current triggers, future templates), and develops a treatment plan. This phase includes assessing client readiness and stability.
Therapist explains EMDR, establishes rapport, and teaches stabilization and self-control techniques. Key elements include:
For each target memory, therapist identifies:
Client focuses on the target memory while engaging in bilateral stimulation (sets of eye movements, taps, or sounds). After each set, client reports what comes up. Processing continues until SUD reaches 0 or 1 (or as low as possible). This phase allows the memory to be processed and desensitized.
The positive cognition is strengthened and "installed" using bilateral stimulation until the VOC reaches 7 (completely true). This phase links the positive belief with the processed memory.
Client scans their body for any residual tension or disturbance while holding the target memory and positive cognition. Any remaining sensations are processed with additional bilateral stimulation.
Session ends with stabilization techniques. If processing is incomplete, therapist uses container or safe place to help client return to a stable state. Client is debriefed and given instructions for between-session self-care.
At the start of each new session, therapist checks on the previously processed target. SUD and VOC are re-assessed, and any new material that has emerged is addressed. This ensures processing is complete and stable.
The original and most common method. Therapist moves fingers or a light bar horizontally while client follows with their eyes. Typically 20-30 movements per set.
Alternating taps on client's hands, knees, or using handheld buzzers. Useful when eye movements are difficult or for clients who prefer tactile stimulation.
Alternating sounds through headphones. Less commonly used but effective for clients who cannot use eye movements or tapping.
EMDR has strong research support and is recognized as an effective treatment for:
PTSD, Trauma, Acute Stress Disorder, Complex Trauma, Childhood Trauma, Single-incident trauma
Anxiety disorders, Depression, Phobias, Panic disorder, Grief and loss, Performance anxiety, Addictions
Research shows EMDR is as effective as trauma-focused CBT for PTSD, often with fewer sessions. It's recognized by the World Health Organization, American Psychiatric Association, and Department of Veterans Affairs as an effective treatment for trauma and PTSD.
Proper Training: EMDR requires specialized training from an EMDRIA-approved trainer. Basic training is typically 20 hours plus 10 hours of consultation. Advanced training is available for complex cases.
Client Preparation: Ensure clients have adequate stabilization and coping skills before processing trauma. Use Phase 2 extensively with complex trauma clients.
Target Development: Develop a comprehensive target sequence plan addressing past events, current triggers, and future templates. Process past events before current triggers.
Following the Protocol: Adhere to the 8-phase protocol. While adaptations exist, the standard protocol should be followed unless there's a clear clinical rationale for modification.
Safety and Stabilization: Always ensure proper closure. If processing is incomplete, use stabilization techniques. Monitor client's window of tolerance throughout.
EMDR requires specialized training. The EMDR International Association (EMDRIA) sets training standards. Training typically includes:
Certification is available through EMDRIA. Ongoing consultation and adherence to the protocol are essential for effective and ethical EMDR practice.
EMDR has specific requirements and considerations:
PracFlow provides specialized tools for EMDR practice: protocol phase tracking, SUD/VOC monitoring, target identification, and trauma-informed documentation.