What is EMDR therapy, and what happens in a session?

If you have heard of EMDR, you may have heard it described as the therapy involving eye movements. That is part of it, but there is a lot more going on. EMDR is a carefully structured approach, and knowing how it works can make it feel much less mysterious if you are thinking of trying it.

This article explains what EMDR is, the eight phases a course of therapy usually moves through, and what tends to happen during a typical session. It is general information, so if you are wondering whether EMDR is right for you, it is worth talking it through with your GP or a registered therapist.

What EMDR stands for

EMDR stands for Eye Movement Desensitisation and Reprocessing. It was developed in the late 1980s and has since become one of the better-known therapies for trauma.

In the UK, NICE (the body that gives guidance on health treatments) recommends EMDR as one of the treatment options for adults with post-traumatic stress disorder (PTSD). Therapists also use it for other difficulties linked to distressing experiences, such as some forms of anxiety, phobias or painful memories that keep resurfacing. As with any therapy, it does not work the same way for everyone, and a good therapist will talk with you about whether it suits your situation.

The idea behind EMDR

Most of the time, our brains make sense of difficult experiences without us noticing. A bad day becomes a memory we can look back on without feeling it all over again.

Sometimes, though, an experience is so overwhelming that it does not get processed in the usual way. It can stay stored with the original images, sounds, body sensations and beliefs still attached. Later, something small, like a smell or a tone of voice, can bring it flooding back as if it were happening now.

EMDR is based on the idea that the brain has a natural ability to process and heal, and that this can be helped along. During EMDR, you briefly hold a memory in mind while also paying attention to something that moves from side to side. This is called bilateral stimulation. It might be:

• following a moving point with your eyes
• feeling gentle taps on alternate sides of your body
• hearing sounds that switch between your left and right ear

Researchers are still exploring exactly why this helps. One common explanation is that keeping part of your attention on the present moment makes it easier to stay with a memory without being swept away by it. Many people find that, over time, the memory feels less vivid, less upsetting, and more like something that happened in the past.

The eight phases of EMDR

EMDR follows a standard structure made up of eight phases. These are not the same as eight sessions. Some phases take a few minutes, while others may stretch over several weeks.

1. History taking and planning. Your therapist gets to know you, what has brought you to therapy, and what you would like to change. Together you start to identify which memories or issues you might work on.
2. Preparation. Your therapist explains how EMDR works and helps you build ways of calming yourself if feelings become strong. This phase matters a great deal, and for some people it takes longer than others.
3. Assessment. You choose a specific memory to work on and describe its key parts: an image, a negative belief about yourself, the emotions and the body sensations that go with it.
4. Desensitisation. This is the part most people picture when they think of EMDR. You hold the memory in mind while doing sets of bilateral stimulation.
5. Installation. Once the memory feels less distressing, your therapist helps strengthen a more positive, balanced belief about yourself.
6. Body scan. You bring the memory to mind again and notice whether any tension or discomfort remains in your body. If it does, this is processed too.
7. Closure. At the end of every session, your therapist helps you settle and feel steady before you leave, whether or not the memory has been fully processed.
8. Re-evaluation. At the start of the next session, you look back at what was worked on and check how it feels now.

What happens in a typical processing session

Once the earlier groundwork is in place, a processing session often follows a fairly predictable pattern. Sessions are commonly around 60 to 90 minutes, though this varies between therapists.

Checking in

Your therapist will usually ask how you have been since last time, and whether anything has come up, such as dreams, new memories or changes in how you feel. This is part of the re-evaluation phase.

Setting up the memory

If you are starting a new memory, your therapist will ask you a few questions to focus it. For example, they might ask you to pick the image that represents the worst part, the belief about yourself that goes with it, such as 'I am not safe' or 'It was my fault', and the belief you would prefer to hold instead.

They will often ask you to rate how upsetting the memory feels on a scale from 0 to 10, where 0 is no distress and 10 is the most you can imagine. They may also ask how true the positive belief feels on a scale from 1 to 7. These numbers are simply a way of tracking change, not a test you can pass or fail.

Sets of bilateral stimulation

Your therapist then guides you through short sets of bilateral stimulation while you bring the memory to mind. After each set, they will ask something simple like 'What are you noticing now?' You do not need to give a long answer. A word, an image or a body sensation is enough.

Then they will usually say something like 'Go with that' and start another set. Thoughts may shift in unexpected directions, and that is normal. You do not have to force anything or get it right.

Staying in control

You are in charge throughout. You can agree a stop signal with your therapist, such as raising a hand, and pause at any point. If feelings become too strong, your therapist can slow things down or help you use the calming skills you practised earlier.

Closing the session

Towards the end, your therapist will make sure you feel grounded before you go. They may guide you through a calming exercise and talk about what you might notice in the days ahead.

How you might feel between sessions

Processing can continue after a session ends. Some people feel lighter or relieved. Others feel tired, emotional or notice memories and dreams more than usual for a day or two. This is something to mention to your therapist at your next appointment, and it can help to plan a gentle, unhurried time after each session.

If you notice anything that worries you, such as feeling much worse, let your therapist know rather than waiting.

How many sessions does EMDR take?

There is no fixed number. Someone working on one distressing event may need fewer sessions than someone with several difficult experiences, or experiences that began in childhood. The preparation phase alone can take longer when there is a lot to hold. Your therapist should review progress with you regularly and be open about how things are going.

Finding a trained EMDR therapist

EMDR should be carried out by a therapist who has completed specific EMDR training as well as being a qualified, registered practitioner. It is reasonable to ask a therapist about their training and experience before you start.

EMDR can be offered face to face or by video. On WebcamTherapy, you can book a private video session with a registered therapist, and therapists who offer EMDR can use on-screen bilateral stimulation during the session.

Online therapy is not an emergency service. If you are in crisis, feel unsafe or are thinking about harming yourself, please call 999 in an emergency, call NHS 111, or contact Samaritans free on 116 123, at any time of day or night.