What to expect during EMDR Therapy
EMDR is an 8 phase treatment but for ease of explanation; the phases are consolidated into three phrases: Beginning, Middle and End. Each phase will be described as what you might expect during your course of treatment but keeping in mind that this is a guideline and may slightly differ depending based on individual needs of each client.
Beginning phase of treatment: History Taking and Stabilization
All EMDR sessions are scheduled for the standard 55-minute sessions as many insurances do not cover extended sessions. Extended sessions for EMDR are available but will be considered an out-of-pocket expense.
During this part of the EMDR therapy process, we will be working on building rapport, gathering historical data about presenting issue(s), assessing for appropriateness and readiness to EMDR Therapy, identifying goals and target(s), and learning about the EMDR therapeutic model and the rationale for EMDR Therapy.
The targets that we identify will be the cornerstone of what we will be working on in sessions. Targets are typically based from presenting issues, and historical data gathered -including specific traumatic events, intrusive thoughts or memories -which might be contributing to the presenting issues.
Stabilization and Resourcing
We will spend a great deal of time getting prepared for the reprocessing and desensitization of traumatic event(s) or memories through what is referred as Resource Development and Installation or RDI’s. RDI’s include identifying and strengthening internal and external resources; learning new coping and relaxing skills; and stabilizing any negative thoughts, feelings or emotions that may feel “too overwhelming handle” during reprocessing.
Resourcing Development and Installation (RDI’s) also include utilizing guided visualizations to create a relaxing place as well as a container to put distressing emotions, thoughts or images in. Depending on the amount of internal and external resources that are needed, it may be necessary to create additional “internal allies” such as nurturing parent, protective figures or inner wise adults -just to name a few.
During the preparation stage, we will also be exploring potential barriers to treatment; identify and strengthen positive states based on passed and current experiences; learn new grounding techniques; and increase body awareness through somatic activities such as progressive relaxation techniques, light stream, body scan, and calming breath exercises -just to name a few. All of these resources that are develop and strengthened will be used during EMDR Therapy sessions as well in-between sessions.
You will also be introduced to bilateral stimulation or BLS – typically it will be with light bar or vibrating hand pulsers -to determine preferred BLS. We will also create signals that can be used should you become overwhelmed and need to pause during the reprocessing phase.
Rationale for Stabilization and Resourcing
The beginning phase of treatment is crucial to ensure that you are well-resourced and equipped to cope with any distress that might occur during the desensitization and reprocessing phase of treatment -the middle phase of treatment. It is important to keep in mind that even though we may not have begun to process the traumatic event(s) or intrusive memories, we are still utilizing EMDR techniques to prepare you for next phase of treatment. In short, we begin EMDR Therapy as soon as we determine that EMDR is an appropriate modality for you.
Length of Time for Stabilization
The amount of time and sessions needed to prepare for trauma processing will vary depending on the complexity and severity of presenting issues. Often times, clients who present with more complex or traumatic histories may need to spend a longer period of time in this phase before moving forward with to the middle phase of treatment. We will discuss this in greater details during your sessions. We will not move to the next phase until we both have assessed that you are ready.
Middle phase of treatment : Trauma Processing
Once it has been determined that you are sufficiently prepared and resourced, you will transition to the middle phase of treatment -reprocessing and desensitization of a target; and installation and integration of positive experiences/beliefs. We will always decide together the pacing of this phase of treatment.
Reprocessing and Desensitization of a Target
We will begin the session(s) with an identified target and bring up an image that bests summarizes that target. Then we will identify the negative thoughts, feelings, beliefs, and body sensations with that image. We will explore if there is a past or earlier event that is connected the target through what is called a float back. If there is an earlier event identified through the float back, we will use that as the identified target and begin the reprocessing and desensitization through the use of bilateral stimulation (BLS). The BLS is typically done in increments of 30-120 seconds. At the end of each set, we will pause the BLS and you will be asked to briefly share what you noticed during the BLS such as thoughts, images, emotions and body sensations. This will continue until the identified target has been fully reprocessed and desensitized and is no longer distressing. Often times due to time restraints in sessions, it may take several sessions to complete the reprocessing and desensitization of a target. There are also times that new targets may arise during reprocessing and desensitization and may need to be processed at separate sessions.
We will discuss how we will handle incomplete targets at the end of sessions as well as review necessary skills to utilize in-between the sessions.
Installation and Integration
Once the reprocessing and desensitization of the target is complete, we will work on installation and integrations of new thoughts, feelings, beliefs, and perceptions about self surrounding the target using guided imagery techniques and bilateral stimulation. In other words, this part of the therapy involves integrates the knowing part of the brain and the feeling part of together. We will also identify any potential “bumps in the road” to determine what may be needed to handle those obstacles. Once the identified target has been determined to be fully processed and integrated, we will determine if we need to continue to process other targets.
Length of Trauma Processing
The length of treatment will vary depending on the complexity and severity of the presenting issues; how long it takes to reprocess and desensitize the target; and the successful integration of new beliefs and perceptions about the target(s).
End phase of treatment: Future planning
This phase of treatment is where we will review overall progress made with EMDR therapy and identify the next course of action. Typically it will include the re-assessment of symptoms and impact on current functioning, re-assess coping skills, and begin to plan for other future “bumps in the road” that may not have been addressed earlier.
If you are ready to start EMDR Therapy, you can request a consultation.
Other links: Helpful ResourcesRequest Consultation