Unlike a traditional psychotherapy session, you don’t need to recount the details of the memory to your therapist when you’re doing EMDR. When you do EMDR, you are not giving the therapist the details of the memory; you’re targeting the pieces of it. You just need to find an image, a feeling about yourself that goes along with it, the emotion that it elicits and what part of your body it resides in. Thereafter, most processing takes place without you realising it as you follow a series of eye movements or taps.
That’s the part that is hard for people to believe. Talk therapy has made us all believe that healing means telling the story, so the notion that you can heal without clarifying the story seems to be avoiding the story. It’s more similar to the opposite: EMDR accesses the memory more easily and more quickly than talking would, without the need to have to tell it to somebody else.
The Things People Really Say While Speaking During a Session
Your therapist will have you recall the worst picture in the memory—the one with the highest charge. You don’t describe the scene. It’s only a confirmation that you have it. Next, there are four anchors. When you hold that image (I’m not safe, it was my fault), what you want to believe is what emotion arises, and physically where it is located: chest, throat or stomach. Both of you rate the disturbance from 0-10 and have a number to follow for the rest of the session.
Then, it’s generally quiet. Your therapist begins bilateral stimulation (typically guided eye movements, alternating taps or sounds via headphones) in sequences of approximately 20-30 seconds. In between sets, they ask one question: What do you notice now? They say a sentence or two, sometimes just a word; you say, “go with that,” and they move on to the next set.
That one question is working everyone up to the task. You’re telling about what you think, not what you did. All that people normally do is switch from the original image to a totally different memory, sensation or thought about someone in their life at present, and the therapist does not take the lead.
Why People Choose to Skip the Narrative Isn’t a Sign of Work Skipping
Skipping the narrative doesn’t mean they are skipping the work. The principle of EMDR is that traumatic memories are stored differently than normal memories and are stored in raw sensory information rather than being assimilated with all other information in the mind. It’s why a smell or a car door slamming will result in a full-body reaction, and the actual memory will feel frozen and unchanged by time. The material is not missing, but stuck.
Bilateral stimulation seems to open a window in which it can be updated. There is no consensus on how, with the strongest contenders being that working memory loads as the memory is being used, or that it resembles the memory consolidation that occurs during REM sleep. The results of the outcome are less controversial. Trials indicate that EMDR has effects similar to trauma-focused cognitive behavioural therapy, and is recommended in treatment guidelines by the World Health Organisation and the Department of Veterans Affairs for PTSD.
It does make a difference to people who can’t handle exposure methods. Prolonged exposure involves telling the story of the traumatic experience repeatedly, sometimes in writing, and sometimes being read to you and heard in between sessions. This is fine for some and intolerable for others, and dropouts are a serious issue in trauma treatment in general. If you’re afraid that you can’t use the words, you don’t have to here.
The 8 Phases, The Cost And The Timeline
There is a standard protocol for EMDR consisting of eight phases, and processing begins on day 1. The first two involve history taking and preparation and usually take 1–3 sessions, sometimes longer if there is complex or childhood trauma. Preparation involves teaching you resourcing techniques, which are usually a calm place exercise and a container exercise to put material on the shelf between sessions.
Sessions are 60 to 90 minutes in length after processing has started, and the length of the format is for a reason. The last 10-15 minutes are used for closing down, and stopping mid-set with the disturbance still elevated is the last goal of the therapists.
The estimated 6-12 sessions for stable adults who have experienced a single-incident trauma is the standard. Chronic or developmental trauma is a whole other project, and can take months, or even years, to work through, as there are typically dozens of associated memories around a single core belief. Anyone who gives a definite figure is just guessing.
Cost: the average cost of any specialist therapy in the region, typically $150 – $300 per session per individual (private sessions), and the 90-minute format can be slightly more expensive. Typically, EMDR is utilised in psychotherapy codes and not as a separate service, but this may be the case with increased session length, which can make it difficult to be reimbursed for EMDR by insurance.
Carefully evaluate credentials. In addition to having a clinical license, there are three components of EMDR training, plus consultation hours, that must be completed to become fully certified, and additional practice hours and supervision are needed. When shortlisting clinicians trained in EMDR, ask directly whether they have completed both training weekends and how many clients they have taken through full protocol. Basic training alone is a legitimate starting point, but you want to know which you are getting.
What it feels like and who it is good for
Most people say that the sets are “easy,” “fun,” or “weirdly easy. You’re not trying to think about anything; the teaching is really to let whatever happens happen. The emotions can surge up in the blink of an eye, and then just as quickly plummet, making it difficult to understand what is happening the first time, and possibly ever.
Common physical reactions include yawning, crying, feeling hot or heavy, or nausea. They may feel exhausted for a day or two afterwards, and dreams can be vivid for a week or so. Typically, therapists will request that you take a short note on what comes up between sessions but that it not be too much of an analysis of the meeting.
The most common outcome of what people have reported is not forgetting. The memory stays. What changes is that it no longer elicits the physical alarm response, and it begins to feel like it’s a thing that happened, not a thing that is happening. Its beliefs change, as does the “I should have stopped it” that turns to something more like “I did what I could at nine years old.
EMDR is more helpful in certain situations than others. It has the best documentation in history for discrete traumatic events involving assault, accident, medical trauma and combat exposure. It can also be used for phobias, grief, performance anxiety and with reasonable success. It’s not a great first step if you are actively in crisis, not safe or using substances to an extreme, or experiencing a high level of dissociation, which tends to require stabilisation work first. These are for preparing, and a competent therapist won’t skip them.
When considering it, the question that might be useful to ask in a consultation is ‘how will we know if this is working for me’ rather than ‘does EMDR work’. A good EMDR therapist will respond with concrete detail: a decrease in the disturbance rating across sessions, the vividness of the target image, and the increased difficulty of maintaining the negative belief. Numbers to watch and a memory to which there was no narration.
Leave feedback about this