Eye Movement Desensitisation and Reprocessing (EMDR) therapy is a NICE guideline recommended therapy that has gained recognition as a powerful tool for addressing trauma and other distressing experiences. Developed by psychologist Francine Shapiro in the late 1980s, EMDR has been extensively researched and validated, becoming a staple in trauma therapy. But what exactly does EMDR involve, and what can clients expect from the process? This blog aims to explain the process of EMDR therapy, providing a comprehensive overview of its principles, stages, and outcomes.
The Foundation of EMDR Therapy
EMDR therapy is grounded in the Adaptive Information Processing (AIP) model, which posits that our brains have a natural ability to process and integrate traumatic memories. However, when a person experiences overwhelming stress or trauma, this processing can be disrupted, leading to memories being stored in a fragmented, maladaptive way. These unprocessed memories, along with their associated thoughts, emotions, and physical sensations, can intrude into a person’s present life, causing distress and dysfunction.
EMDR therapy aims to reprocess these traumatic memories, allowing them to be integrated into the individual’s broader life narrative in a healthy way. This reprocessing involves the use of bilateral stimulation—typically eye movements, but sometimes taps or tones—which is believed to facilitate the brain's natural healing processes.
The Eight Phases of EMDR Therapy
EMDR therapy is structured around eight distinct phases, each serving a specific purpose in the therapeutic journey.
Phase 1: History Taking and Treatment Planning
The initial phase involves a thorough assessment of the client’s history and current concerns. The therapist gathers information about the client’s traumatic experiences, symptoms, and overall mental health. This comprehensive understanding allows the therapist to develop a tailored treatment plan. During this phase, the client and therapist also establish trust and rapport, which are crucial for the success of the therapy.
Phase 2: Preparation
In the preparation phase, the therapist educates the client about the EMDR process, setting realistic expectations and addressing any concerns. This phase also involves teaching the client various self-soothing techniques and coping strategies to manage any distress that may arise during or between sessions. Techniques such as deep breathing, mindfulness, and visualisation can be particularly helpful.
Phase 3: Assessment
The assessment phase focuses on identifying the specific memories and associated components that will be targeted during reprocessing. The therapist helps the client select a particular traumatic memory to work on and assesses the vividness of the image, the negative belief about oneself associated with the memory, the desired positive belief, and the level of emotional distress linked to the memory. This phase provides a structured framework for the reprocessing work that follows.
Phase 4: Desensitisation
Desensitisation is the core of EMDR therapy, where bilateral stimulation is used to reprocess the targeted traumatic memory. The client is asked to focus on the distressing memory while simultaneously following the therapist’s hand movements, listening to alternating tones, or experiencing other forms of bilateral stimulation. This process continues until the memory becomes less distressing and more adaptive beliefs begin to emerge.
Phase 5: Installation
In the installation phase, the focus shifts to strengthening the positive belief that the client identified earlier. The therapist uses bilateral stimulation to help the client integrate this positive belief deeply, reinforcing a healthier self-perception. This phase aims to replace the negative, maladaptive belief associated with the trauma with a positive, empowering one.
Phase 6: Body Scan
Traumatic memories often leave a residue in the body, manifesting as physical sensations. During the body scan phase, the client is asked to focus on the traumatic memory and notice any residual tension or discomfort in their body. Bilateral stimulation is used to process and release these physical sensations, promoting holistic healing that encompasses both mind and body.
Phase 7: Closure
Each EMDR session concludes with the closure phase, ensuring that the client feels stable and safe before leaving. The therapist reviews the progress made during the session, discusses any insights or changes in feelings, and reinforces the use of self-soothing techniques. If the memory has not been fully reprocessed, the therapist ensures that the client can safely contain any remaining distress until the next session.
Phase 8: Re-evaluation
At the beginning of each new session, the therapist conducts a re-evaluation to assess the client’s current state and review the progress made. This phase helps determine whether further work on the same memory is needed or if the client is ready to move on to other targets. re-evaluation ensures that the therapeutic process is dynamic and responsive to the client’s evolving needs.
What Clients Can Expect During EMDR Therapy
Emotional Intensity
Reprocessing traumatic memories can bring up intense emotions. Clients may experience sadness, anger, fear, or even physical sensations related to the trauma. While this can be challenging, it is a normal part of the healing process. The therapist is trained to support the client through these emotions, providing a safe space for them to be expressed and processed.
Vivid Memories and Imagery
Clients often report vivid recollections of traumatic events during EMDR sessions. This heightened recall is facilitated by the bilateral stimulation and the focused attention on the memory. Over time, these memories typically lose their emotional charge and become less intrusive.
Cognitive Shifts
As EMDR therapy progresses, clients often experience significant cognitive shifts. Negative beliefs about oneself, such as “I am powerless” or “I am unlovable,” begin to transform into positive, adaptive beliefs like “I am in control” or “I am worthy of love.” These shifts can lead to profound changes in self-perception and overall mental health.
Physical Sensations
The reprocessing of traumatic memories can also evoke physical sensations, such as tightness in the chest, tingling, or a sense of heaviness. These sensations are remnants of the body’s response to the trauma and typically diminish as the memory is processed. The therapist may use additional bilateral stimulation to help release these physical manifestations.
Increased Awareness
Many clients report an increased awareness of their thoughts, emotions, and physical sensations during and after EMDR sessions. This heightened awareness can lead to greater self-understanding and insight into how past traumas have influenced current behaviour and emotional responses.
The Benefits of EMDR Therapy
EMDR therapy has been shown to offer numerous benefits for individuals struggling with trauma and related conditions. For instance, EMDR is particularly effective in reducing symptoms of Post-Traumatic Stress Disorder (PTSD), including flashbacks, nightmares, and intrusive thoughts. Studies have demonstrated that EMDR can significantly decrease the severity of these symptoms, often in fewer sessions than other therapeutic approaches. Likewise, as negative beliefs are replaced with positive ones, clients often experience a boost in self-esteem and self-worth. This improvement in self-perception can have far-reaching effects on various aspects of a person’s life, including relationships, career, and overall well-being.
By processing traumatic memories, clients gain better control over their emotional responses. This enhanced emotional regulation can reduce the intensity and frequency of emotional outbursts, anxiety, and depression, leading to a more balanced and stable emotional life. Physical symptoms, such as chronic pain, headaches, and gastrointestinal issues are frequently resolved as EMDR addresses the underlying traumatic memories linked to those physical sensations. Consequently, by addressing the traumatic material, the physiological tension held within the body is also addressed.
EMDR therapy not only helps clients heal from past traumas but also equips them with coping strategies and a stronger sense of self. This increased resilience can make it easier to handle future stressors and challenges.
Potential Challenges and Considerations
The initial stages of EMDR therapy can be uncomfortable as clients confront distressing memories and emotions. However, this discomfort is typically temporary and diminishes as the therapy progresses. Likewise, although there is strong evidence showing the effectiveness of this type of therapy, individuals can respond differently to EMDR therapy. Some may experience rapid improvements, while others may require more time and sessions to achieve the desired outcomes. Patience and commitment to the process are crucial.
In some cases, clients may experience a temporary relapse of symptoms between sessions, especially if the traumatic memory has not been fully processed. Ongoing communication with the therapist and the use of self-soothing techniques can help manage these episodes.
Summary
EMDR therapy offers a promising path for individuals seeking to heal from trauma and related conditions. By understanding the phases of EMDR, what to expect during sessions, and the potential benefits and challenges, clients can approach the therapy with a sense of preparedness and openness. The journey through EMDR therapy may be intense and challenging, but the potential for profound healing and transformation makes it a worthwhile endeavour.
If you or someone you know is struggling with the aftermath of trauma, consider exploring EMDR therapy as a viable option. With the guidance of a skilled therapist, EMDR can help unlock the brain’s natural healing capabilities, paving the way for a brighter, more resilient future.
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