In this blog post, I will discuss EMDR, one of the therapy modalities I use in my practice. I'll explain what EMDR is and how it works, covering the eight phases of an EMDR therapy course. I will also describe what it can feel like to undergo EMDR therapy, and finally, highlight some important considerations regarding EMDR treatment.
As EMDR is a form of trauma therapy, I will refer to trauma and PTSD (Post-Traumatic Stress Disorder) multiple times throughout this post. If you're interested in learning more about trauma in general, I have also written a dedicated blog post on the topic of trauma.
EMDR stands for Eye Movement Desensitisation and Reprocessing. It is an evidence-based therapy, meaning it has been thoroughly tested and scientifically proven to be effective. The Danish Health Authority (Sundhedsstyrelsen) recommends EMDR as one of the preferred methods for treating PTSD.
EMDR was developed by Francine Shapiro in the late 1980s. It is a therapy modality well-suited for working with traumatic experiences that continue to cause problems in the present. EMDR is effective in addressing both recent trauma and trauma from many years ago, including childhood trauma.
Below is a video that explains more about how EMDR can help you. The video is in English.
Experiencing a traumatic event can have profound and lasting consequences on one's life.
When we experience something extremely overwhelming, we may go into shock, making it difficult for the brain to process the memory as it normally would. This can result in the memory being stored in a different way than other experiences – often in a raw and unprocessed form, retaining the original thoughts, sensory impressions, and emotions present at the time of the event.
Consequently, when reminded of the experience later in life, it can resurface and feel very real, as if it's happening again.
When an experience is stored in memory in this unprocessed way, it can lead to various difficulties.
It's common for the experience to return as flashbacks or nightmares. Many people also struggle with intrusive thoughts about the event that they can't let go of. Developing negative self-beliefs, such as “it was my fault” or “why didn't I do anything?”, is also very common. These thoughts can lead to difficult feelings like shame and guilt.
Additionally, it's common to develop negative thoughts about other people, making it difficult to trust. Many individuals find themselves emotionally withdrawing from relationships. Anxiety symptoms and sleep difficulties are also very common consequences.
Fortunately, in most cases, it is possible to work through these challenges, even if the traumatic event happened many years ago.
In EMDR, we work by reactivating the uncomfortable experience, bringing it into your working memory. Through EMDR procedures, we can then help your brain process the experience so that it no longer remains raw and unprocessed. Think of it like an inflamed wound that needs to be cleansed so your body can then heal itself.
Below, I describe in more detail what happens during an EMDR therapy course and what the experience can be like.
Below, I have outlined the structure of a typical EMDR therapy course. EMDR therapy involves eight phases. The time spent in each phase varies for every individual. Click on the phases you wish to learn more about.
Phase 1: Initially, we will spend time exploring the difficulties you are currently experiencing and wish to address. Following this, we will review your trauma history. This means we will look together at the significant experiences you have been exposed to. We won't delve into every detail, but rather discuss them in broad strokes. The purpose is for me to understand your past experiences, as other trauma memories can sometimes emerge during processing. This isn't an issue, but it's easier to manage the process if we have prior knowledge of what might be present from your past. Next, we will select the specific experience you wish to process. Sometimes, clients intuitively know which event caused their current problems. Other times, it can be challenging to identify, especially if there are multiple traumatic experiences. A helpful approach can be to address either the most difficult memory or the earliest trauma you can recall. The idea is to target the root cause of your current difficulties. Processing the most significant or earliest trauma often has a positive ripple effect on other related traumas.
Phase 2: Once we have collaboratively developed a treatment plan and identified an experience you wish to process, we will dedicate time to learning techniques that help you connect with positive resources. We can use various exercises to strengthen positive experiences of, for example, safety and competence. Additionally, I will explain in more concrete terms how the processing itself will take place.
Phase 3: In this phase, we work to activate the specific event you have chosen to address. We will explore any negative thoughts you have about yourself when you recall the event, and identify any bodily sensations or symptoms you experience.
Phase 4: This phase involves the actual processing or desensitisation. During this time, your brain will work with the event while you receive bilateral stimulation (such as eye movements, tapping, buzzers, or auditory tones). Processing typically continues until you no longer experience discomfort when thinking about the event.
Phase 5: In this phase, we reinforce a positive thought you can have about yourself following the processing.
Phase 6: During this phase, we ensure that no residual physical discomfort remains when you think about the event.
Phase 7: In this phase, we ensure the session is concluded effectively and safely. It's important that you feel secure leaving and that we have discussed your experiences during the processing.
Phase 8: This phase typically occurs at the beginning of the following session. I will ask about your experiences related to the processing since our last meeting, and how you feel about the event today. The purpose is to evaluate the long-term effectiveness of the treatment.
If you have previously seen a psychologist or received other psychotherapeutic treatment, EMDR may feel somewhat different. During the actual trauma processing (Phases 3-6), I use an EMDR light bar where you watch a moving light dot, which guides the eye movements used in the processing.
During the processing itself (Phases 3-6), we will not engage in a typical conversation as you might be used to in other forms of psychotherapy. It will largely be an internal process happening within you. I will periodically ask you what you are noticing, and I will simply ask for a brief answer without us discussing it. We avoid conversation at this point, as it could disrupt your internal processing.
You don't need to do anything specific during the processing. Your role is to remain open and allow your brain to do the work naturally. A helpful metaphor is to imagine yourself as a passenger on a train, looking out the window and simply noticing what passes by. You don't need to hold onto anything or try to force a particular outcome.
You will not experience being under hypnosis or anything similar. You remain fully conscious throughout the entire process and can stop at any time. We will agree on a stop signal beforehand. During processing, you may come into contact with strong emotions or experience an anxiety reaction. This is completely normal and not dangerous. If you feel it becomes too intense, I will help you pause the process, and we can then discuss how to adjust the intensity.
After the processing, we will return to our usual seating (Phase 7). We will then, of course, discuss what you experienced during the processing.
After an EMDR session, it's common to feel tired. It can be a good idea to bring something to drink or eat, such as some juice or a muesli bar. Feeling a bit dizzy is also normal. You may wish to wait 5-10 minutes before driving. You are welcome to sit in the waiting area.
In the first few days after a processing session, it's common to experience a slight increase in symptoms. You might have more dreams or find yourself thinking more about the event we worked on. This is completely normal and indicates that your brain is continuing to process. If these experiences persist after several sessions, or if they don't lessen between sessions, we will discuss it.
When engaging in trauma processing, I recommend booking a 90-minute session. This isn't always necessary for the initial sessions, but once we begin the actual processing, it provides a sense of security to know there's ample time to activate the event, complete the processing, and properly conclude the session. Therefore, I often recommend double sessions for processing phases.
Many clients have described that the mental images of the event become much less intrusive. Several have reported that the images become blurry or faded. I've also heard clients say that after EMDR, they are no longer angry with themselves or feel shame, but instead have developed self-compassion. Many have expressed something along the lines of, 'it was a shame it happened, but it was a long time ago, and I am in a different place in my life today.'
Most people can benefit from EMDR therapy. However, there are some situations where extra caution is needed. For example, if you do not feel safe in your current life situation, it is more appropriate to address these immediate concerns before conducting EMDR for past trauma. If you are in an abusive relationship, for instance, it's crucial to work on stopping the abuse or safely leaving the relationship before processing the episodes of violence.
Another important consideration is that if you are taking sedating medication, such as benzodiazepines, it may reduce the effectiveness of the treatment.
Finally, if you are experiencing suicidal thoughts or dangerous self-harm, I would typically suggest addressing these issues first, for example, with the help of DBT (Dialectical Behavior Therapy).
If you wish to read more about EMDR, I recommend visiting EMDR Denmark.
If you believe EMDR might be helpful for you, please feel welcome to book an appointment.
