EMDR

What is EMDR and what does an EMDR Therapy session look like?

Francine Shapiro developed Eye Movement Desensitisation and Reprocessing (EMDR) in 1987, in order to successfully treat Post-Traumatic Stress Disorder (PTSD). Since then, EMDR has been used to effectively address a wide range of issues.

Most of the time our bodies routinely manage new information and experiences without us being aware of it. However, when something out of the ordinary occurs and we are traumatized by an overwhelming event (for example, a car accident) or by being repeatedly subjected to distress (for example, childhood neglect), our natural coping mechanisms can become overloaded. This overloading can result in disturbing experiences remaining frozen in our brains or being ‘unprocessed’. 

Unprocessed memories are stored in a ‘raw’ and sensory form (as smells, sounds, physical sensations or images), rather than as a verbal ‘story’ or thought. This means that they can be continually triggered when things happen that are similar to the difficult experiences we have been through. Almost like Groundhog Day, we can feel stuck in time. As if we are repeatedly going through the disturbing experience.

Our ability to live in the present and learn from new experiences can therefore become challenging. EMDR helps to create connections in our brain’s memory networks, enabling us to process disturbing memories. EMDR uses the natural healing ability of the body. 

EMDR helps reconcile the brain/body disconnection that can happen where part of your body freezes. Your brain may be up to the task of recognizing “hey I’m safe now” but your body still responds with a heightened state of psychological ‘arousal’ (not to be confused with sexual arousal). EMDR helps integrate these discordant pieces to facilitate healing. 

The REM or dream phase of sleep is the body’s way of processing information naturally and ‘filing’ it away. EMDR is thought to mimic this process.

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Basics of EMDR

If you’re not familiar with what EMDR is in general, I invite you to read about it here: https://www.emdr.com/what-is-emdr/  

This is a fantastic guide to the whole treatment scope: https://positivepsychology.com/emdr-therapy/#:~:text=EMDR%20is%20very%20similar%20to,gathered%20during%20a%20traumatic%20event  

I encourage anyone interested in trauma treatment or EMDR to read Francine Shapiro’s book, Getting Past Your Past.  It’s a great supplement to the work that I do with patients, and helps reinforce and strengthen our work.  

Does EMDR work via telehealth? 

Some people have the misconception that EMDR must be completed in-person, and cannot be completed via telehealth successfully. This belief is incorrect. 

Especially since the advent of work-from-home technology advancements with the era of COVID-19, online administration of EMDR has increased a lot. Now there are lots of EMDR therapists who practice via telehealth, some of whom exclusively provide EMDR online. 

Research suggests that EMDR is just as effective online. As one research article summarizes: “…Intensive, trauma-focused treatment of severe or Complex PTSD delivered via home-based telehealth is feasible, safe and effective, and can be a viable alternative to face-to-face delivered intensive trauma-focused treatment.”   

Read more here: https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1860346 

More literature regarding online EMDR can be explored here: https://www.emdria.org/publications-resources/practice-resources/online-emdr-therapy-resources/

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Session Overview

The first session of EMDR treatment involves simply getting to know each other and attuning our nervous systems to the treatment space. We will not start to get into the details of your trauma until at a minimum the 2nd session unless we are doing an Intensive. The first hour of treatment is all about measuring your symptoms, providing informed consent, giving information about how EMDR works, and making sure EMDR is an appropriate treatment for you. 

The next several sessions typically center around developing ‘Resources’ – ways in which to self soothe or look after yourself.  We will typically establish the following Resources: 

• A Calm Safe Place
• A Container 
• 2-3 resources referencing ‘The Answer’ (specific resources addressing emotional challenges we collaboratively identify) 

We may also practice somatic EMDR strategies for emotional regulation, a Light Stream exercise, identifying an Inner Protector or Higher Power, and more. 

It is only once trust is established successfully between yourself and your therapist that we can safely embark upon doing ‘processing’ work, aka discussing in detail the traumatic events that have happened in your life. 

A standard processing EMDR processing session looks something like this:

• A disturbing memory or ‘target’ is chosen
• You are asked to think of the worst part of the memory and bring up an image of it.
• You are asked to think about the words that best describe the negative belief that you hold about yourself now while thinking of the memory. For example: ‘I’m in danger’ or ‘I’m bad’
• You are then asked what you would prefer to believe about yourself. For example: ‘I’m safe’ or ‘I’m OK’. This belief is then scored on a scale of 1 to 7.
• You will be asked to think of the image, say the negative words (‘I’m in danger’) to yourself and notice how you feel as you do that. For example: ‘scared’
• You are then asked how disturbed you feel while you think of the memory on a scale of 0 to 10 where 10 is the most disturbed.
• Finally, you will be asked where you feel this in your body. For example: ‘in the chest’

(Don’t worry if this sounds a lot. You can’t do it wrong. Your therapist will guide you and it’s OK to say I don’t know. If you can’t see an image or you can’t think of a belief, that’s completely fine. Your therapist will help you).

The processing then begins. This can be done by using eye movements (following a dot on a screen), holding tappers which vibrate gently in each hand or by using headphones which make a sound alternately in each ear. Or a combination of one or more of these. You will be asked to simply notice without judging or analysing what is happening in your internal world. What thoughts, sensations, physical responses are happening. It sounds as if a lot is going on and it is! However, you will be guided by your therapist at all times.

After each phase of processing, there is a pause. You are then asked what you are noticing at that moment.

This can be a thought or a sensation or an emotion. Or it can be ‘nothing really’. The therapist will then say OK, just notice that and the processing resumes or the therapist may ask a question or make a comment if they feel processing has become stuck. 

You are merely asked to be an observer of your inner world while processing.

The goal is for you to be able to recall the memory/target without any feelings of disturbance and have updated your belief system to recognise the ‘preferred’ belief. For example, I am now safe and that what happened was in the past. The above process is repeated until this has been achieved. The therapist may check at intervals on how disturbing the memory feels to ensure this is shifting.

FAQ’s

How do I prepare for this?

One concrete thing you can do to be prepared for your EMDR session is to reflect on your triggers and complete a TICES Log. Check it out here: TICES LOG.  It doesn’t have to be comprehensive, if we start with 4-5 triggers listed on the log before your session, that’s a fantastic starting place! It’s not required however. We can talk through setting up the TICES log during your first intensive session as well. 

What if I do it wrong?

There is no way of doing EMDR wrong. Whatever comes up is relevant and has come up for a reason. Even if it seems completely random. The therapist is not expecting any particular feedback and it is absolutely OK to say I’m not noticing anything at the moment or ‘I don’t know’ or I don’t really want to say. The therapist may ask you a question if they think processing has stalled.

What if I want to stop?

You can stop processing at any time. Just agree on a signal with your therapist at the beginning. For example: you can just hold up your hand or simply say you want to stop. 

What if I dissociate while we are doing the processing?

EMDR involves some element of ‘controlled’ dissociation. The experience of being in the trance state can feel like dissociation, or like you’re in danger of dissociating completely. The goal is to maintain a sense of being present in the here and now, and also feel like you’re going a little bit into a trance state where you’re going back to the past. 

If it feels like you’re going in too deep, losing contact with the present moment, then that might be a time to stop the processing. However, sometimes going in what feels like ‘too deep’ is actually useful. Getting past that discomfort might be where you need to go to actually heal. Being open and curious about what’s happening in your brain is crucial to the process. But what’s most important is maintaining your sense of safety. It’s a delicate dance, and your therapist will help you maintain your connection to reality.