Lisabeth Wotherspoon, LICSW
In a nutshell, EMDR works by activating the
information-processing part of the brain to help it recover more quickly than with many
traditional forms of therapy. The name comes from the use of eye movements and other lateral
stimulation (like sound and tapping) to tweak the brain's information processing system. It is
one of the most thoroughly researched methods ever used in the treatment of
Eye Movement Desensitization and Reprocessing
(EMDR)1 is a comprehensive, integrative psychotherapy approach. It
contains elements of many effective psychotherapies in structured protocols that are
designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal,
experiential, and body-centered therapies2.
EMDR psychotherapy is an information processing
therapy and uses an eight phase approach to address the experiential
contributors of a wide range of pathologies. It attends to the past experiences that have
set the groundwork for pain, the current situations that trigger dysfunctional emotions,
beliefs and sensations, and the positive experience needed to enhance future adaptive
behaviors and mental health.
During treatment various procedures and protocols are used to address the
entire clinical picture. One of the procedural elements is "dual stimulation" using
either bilateral eye movements, tones or taps. During the reprocessing phases the client
attends momentarily to past memories, present triggers, or anticipated future experiences
while simultaneously focusing on a set of external stimulus. During that time, clients
generally experience the emergence of insight, changes in memories, or new associations.
The clinician assists the client to focus on appropriate material before initiation of
each subsequent set.
Eight Phases of Treatment
The first phase is a history taking session during which the therapist
assesses the client's readiness for EMDR and develops a treatment plan. Client and
therapist identify possible targets for EMDR processing. These include recent distressing
events, current situations that elicit emotional disturbance, related historical
incidents, and the development of specific skills and behaviors that will be needed by
the client in future situations.
During the second phase of treatment, the therapist ensures that the client
has adequate methods of handling emotional distress and good coping skills, and that the
client is in a relatively stable state. If further stabilization is required, or if
additional skills are needed, therapy focuses on providing these. The client is then able
to use stress reducing techniques whenever necessary, during or between sessions.
However, one goal is not to need these techniques once therapy is complete.
In phase three through six, a target is identified and processed using EMDR
procedures. These involve the client identifying the most vivid visual image related to
the memory (if available), a negative belief about self, related emotions and body
sensations. The client also identifies a preferred positive belief. The validity of the
positive belief is rated, as is the intensity of the negative emotions.
After this, the client is instructed to focus on the image, negative
thought, and body sensations while simultaneously moving his/her eyes back and forth
following the therapist's fingers as they move across his/her field of vision for 20-30
seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use
auditory tones, tapping, or other types of tactile stimulation. The kind of dual
attention and the length of each set is customized to the need of the client. The client
is instructed to just notice whatever happens. After this, the clinician instructs the
client to let his/her mind go blank and to notice whatever thought, feeling, image,
memory, or sensation comes to mind. Depending upon the client's report the clinician will
facilitate the next focus of attention. In most cases a client-directed association
process is encouraged. This is repeated numerous times throughout the session. If the
client becomes distressed or has difficulty with the process, the therapist follows
established procedures to help the client resume processing. When the client reports no
distress related to the targeted memory, the clinician asks him/her to think of the
preferred positive belief that was identified at the beginning of the session, or a
better one if it has emerged, and to focus on the incident, while simultaneously engaging
in the eye movements. After several sets, clients generally report increased confidence
in this positive belief. The therapist checks with the client regarding body sensations.
If there are negative sensations, these are processed as above. If there are positive
sensations, they are further enhanced.
In phase seven, closure, the therapist asks the client to keep a journal
during the week to document any related material that may arise and reminds the client of
the self-calming activities that were mastered in phase two.
The next session begins with phase eight, re-evaluation of the previous
work, and of progress since the previous session. EMDR treatment ensures processing of
all related historical events, current incidents that elicit distress, and future
scenarios that will require different responses. The overall goal is produce the most
comprehensive and profound treatment effects in the shortest period of time, while
simultaneously maintaining a stable client within a balanced system.
After EMDR processing, clients generally report that the emotional distress
related to the memory has been eliminated, or greatly decreased, and that they have
gained important cognitive insights. Importantly, these emotional and cognitive changes
usually result in spontaneous behavioral and personal change, which are further enhanced
with standard EMDR procedures.
(2001). Eye Movement Desensitization and Reprocessing: Basic
Principles, Protocols and Procedures (2nd ed.). New York: Guilford
2Shapiro, F. (2002). EMDR as an Integrative Psychotherapy
Approach: Experts of Diverse Orientations Explore the Paradigm Prism. Washington, DC:
American Psychological Association Books.