What to Expect in EMDR Therapy
In part one of this two-part series, I explained in depth what EMDR Therapy was, what the therapist’s goals are, and how it works. Click here to read part one if you missed it.
Now that you’ve learned about EMDR Therapy, the brain, and what therapists may be looking for, let’s explore what therapy looks like once an appointment is scheduled and the client arrives. Keep in mind that there are various approaches to EMDR, and each therapist may have a different method. The therapeutic relationship is crucial for recovery, so it’s important to work with a therapist who is supportive and empathetic, providing a safe space for exploration and reprocessing of memories.
EMDR Therapy Explained
During phase one, the history and treatment planning phase, the focus is on accurately selecting EMDR target memories. This portion is where the therapist is filling out a biopsychosocial assessment of the client, which provides the therapist with a comprehensive understanding of the client’s well-being by examining the interplay of biological, psychological, and social factors. This phase can take anywhere from one session to many sessions, but is crucial to the therapist’s understanding of the problem. The therapist will work to create a safe environment and, once the client is ready and treatment planning is complete, the next phases will begin.
Phase two of EMDR is about preparation. Depending on the client, the response to EMDR may vary. Due to the nature of trauma, some clients may experience distress, dissociation, or exhaustion from the process. The varied responses to treatment is why preparation is a necessary step. Common preparation includes the client and therapist discussing the client’s window of emotional tolerance, coping strategies, mental exercises, and support systems in the client’s life. The therapist may include mental exercises that can happen in the therapy room, if the client becomes overwhelmed during the bilateral phase of EMDR. A common example of this is creating a peaceful place the client can imagine when they are pushed outside of their window of tolerance.
Client Experience in EMDR Therapy
You can read more in depth about the rest of the phases in part one of this blog post, but I would like to focus here on what the client’s experience will be in the next phase. Once phase three (the desensitization) phase begins, therapists may use a variety of techniques to accomplish dual attention and bilateral stimulation. Bilateral stimulation can be auditory (using headphones with bilateral music or tapping noises), tactile (using devices that vibrate back and forth in the client’s hands), or visual (guiding the client's eye movements using hands, a wand, a screen, or a machine). Bilateral stimulation sessions can last from 5 seconds to several minutes, depending on the EMDR method used.
Therapists will periodically pause to check in with the client about any changes in their thoughts, feelings, or physical sensations. Clients are encouraged to focus on the distressing memory while the bilateral stimulation continues, with minimal talking during this phase. The client remains comfortable, engaging in dual attention, while the therapist observes and notes responses. The therapist may take measurements before and after sessions and help the client regulate before leaving. This process may span several sessions, with occasional verbal processing sessions in between. Clients should feel comfortable asking their therapist for clarification or more information about the process.
At the end of every session, and/or once the client has successfully completed desensitization of a memory, the therapist will help the client install a more positive neural network connected to the memory, check for any leftover negative physical sensations associated with the memory (which would then be desensitized), and feel safe enough to return back to their life.
Commonly Asked Questions about EMDR Therapy in Utah
Because EMDR can look so different compared to each client, each targeted trauma, and each therapist, I will answer some commonly asked questions here:
What can I expect after an EMDR session?
Everyone’s reaction is different after an EMDR session, which is why we prepare coping skills and mental techniques to help with adverse reactions. The most common report I hear from client’s after EMDR is a day or two of mental or emotional exhaustion, or a feeling of emotional rawness. My EMDR trainer said that 40 minutes of EMDR is equal to 4 hours of talk therapy, so it makes sense that your brain would be tired and need rest. I often encourage my client’s to schedule time to rest and for self-care after a session. It is also common for additional memories, thoughts, or physical sensations to pop up for a day or two after treatment.
A more extreme reaction would be an increase in anxiety or depressive symptoms, or a feeling of being unable to cope with the memories, thoughts, or sensations coming up. If this is happening, contact your therapist, and plan to do additional preparation before another EMDR session, and likely have shorter and slower sessions.
What pain points will be potentially solved?
EMDR has the potential to heal three different kinds of trauma. There are three slightly different kinds of EMDR to help with each one, that can be used together or switched between. To illustrate this idea, I use the example of a car crash. Say a client recently got into a traumatic car accident that they would like to resolve. EMD (Eye Movement Desensitization) can heal a moment of time that is disturbing. This would be a moment during the car crash that the client remembers vividly, such as the moment they were hit or the sound of the cars colliding. This type of treatment focuses only on the desenitization of a single moment in time, and can be helpful for repeated nightmares or flashbacks of moments in time.
EMDr (Eye Movement Desentization and some Reprocessing) can also heal an entire traumatic event. This would be the entire day of the car accident, starting with the client waking up, getting in their car, the crash, hospital, and going home after. This treatment can be helpful for a single traumatic incident that the client would like to recover from, but not connect to an entire neural network or other childhood memories.
EMDR would still be treating the car accident, but would be discovering why a client’s brain categorized the trauma into a neural network, and finding other memories on that neural network that contribute to it’s strength. This may look like the client discovering that they felt a lack of control during the car accident, and allowing EMDR to treat other times in their life that they have felt out of control.
How will I know if EMDR Therapy is working or if something has changed?
Your therapist will be taking measurements during the EMDR process. The measurements focus on how disturbing the memories are, and how true the negative and positive neural networks attached to the memory feel to you. You will know something has changed when those numbers have changed, or when you think of the memory and it doesn’t feel quite as disturbing. Trauma can always feel disturbing, but the goal of EMDR is to turn trauma into an uncomfortable memory, instead of a memory that controls your nervous system, sending it back into fight or flight when that memory is recalled.
Will I need more EMDR in the future?
Our brains are large and complex places. If EMDR has been helpful for you in the past, it can likely be helpful for you in the future. EMDR can work on traumatic memories, such as a car accident, or on a negative self-belief that is holding you back, such as needing to be perfect or feeling not good enough.
Will there be talk therapy involved?
This question depends a little more on your therapist. I can only answer with my personal experience, but if a client has a memory come up during processing that they would like to discuss, I allow them to lead the session into a conversation. I also ask client’s at the end of an EMDR session if they would like to continue the EMDR protocol next time, or if they would like to verbally process their experiences in the next session.
Do I have to lay down or is this the same as a normal therapy session, but with different techniques?
I encourage clients to get as comfortable as possible. For many clients that is sitting up with their eyes closed, but I have had clients choose to lay down, sit on the floor, take off their shoes, use a blanket, and more.
Can EMDR create false memories?
Probably, but it doesn’t really matter to me. When clients ask this question, I use the example of a small child reporting to police that a werewolf came into their house and hurt a family member. There was no werewolf, there was just a human hurting someone the child loved. The child’s brain used the image of werewolf to cope therefore creating a false memory. However, the werewolf memory is disturbing and traumatic so it would be treated anyway.
Can EMDR bring up repressed memories?
Yes, our brains hold a lot more than we consciously remember. It is not a rare occurrence for a client to remember something that they didn’t previously remember while in an EMDR session.
Where to Find an EMDR Therapist in Utah
At Wasatch Family therapy, we have a team of compassionate and highly qualified therapists who offer EMDR therapy. Our Utah Therapy clinic would be honored to support you on your journey to healing. Contact us to schedule your initial visit by texting or calling 801.944.4555 or by filling out this form.
For a more in depth explanation of EMDR therapy and helpful definitions used in this article, refer to part one of this series found here.
