This form of psychotherapy, which incorporates principles from cognitive-behavioral therapy and other types of behavioral therapy, uses lateral eye movement techniques to connect the individual’s consciousness to memories of past traumatic events. The client is asked to recall a specific event that evokes strong negative or somatic reactions, and as the memory resurfaces, the client fixes his or her gaze on the therapist’s hand motions as the therapist’s hand moves back and forth, guiding the client’s eyes within the client’s visual periphery. The main goal of EMDR therapy is to understand the client’s history as it relates to the client’s current adaptation to the world. EMDR consists of eight main phases, which are as follows:
Phase I: Documentation of the client’s history and background
As the therapist learns more about the client’s history and background, they identify specific memories and current situations to be addressed in therapy. Specified targets may start with traumatic events from childhood rather than events that took place in adulthood, or they may include distressing memories related to past events. The client is asked to identify an image or picture that represents the most salient part of the target memory. Then the client is asked to verbalize the negative self-belief associated with the event, even if the client intellectually knows it to be false. This illuminates for the clinician the underlying emotions that continue to undermine the client’s self-esteem. The length of treatment varies as it depends on the number of traumatic events and the age of the client at the onset of trauma. In Phase I, the therapist helps clients develop essential skills and behaviors that will help them cope with similar situations in the future. As clients recall and process their memories with the therapist, their emotional distress begins to dissolve, thereby resulting in changed behavior as well.
Phase II – Treatment preparation
During Phase II, the client learns various stress-relieving relaxation techniques such as breathing, guided imagery and mindful meditation after the therapist explains EMDR therapy and establishes some expectations and goals for treatment. The therapist will explain to the client his or her symptomology and train the client in using recommended techniques to maintain stability during and between therapy sessions. Clients with PTSD tend to exhibit emotional avoidance through dissociative behaviors such as substance abuse. Dissociation may be conscious or subconscious, whereby the clients are disconnected from their identity, memory, and awareness of self and surroundings. Exercises such as mindful meditation help individuals reconnect with their sense of self as they learn to deal with uncomfortable emotions instead of avoiding them.
Phase III – Assessment
In the Assessment Phase, the therapist and client work closely together to identify a particularly salient memory as the target for the session. The client expresses negative cognitions associated with the imagery such as, “This experience made me feel worthless because…” The clinician notes the maladaptive self-assessments and introduces positive cognitions that challenge the client’s current feelings about the event. The client is also asked to identify where he or she feels physical sensations in the body stimulated by the memory as the client focuses on the event. The clinician uses the validity of cognition scale (VOC) and subjective units of disturbance scale (SUDS) as baseline measures to assess the level of distress associated with the memory and how much the client holds the positive cognition to be true for the target memory. Phase III can be lengthy as it may extend over numerous sessions during which the therapist helps the client actively complete the processing of the memory.
Phase IV – Desensitization
The focus of Phase IV is to reduce the client’s levels of distress as indicated on the Subjective Units of Disturbance (SUD) scale. On the SUD scale, negative emotions are rated on a scale of 0-to-10 (0 = calm or emotionally neutral, 10 = highest level of disturbance). During Phase IV, the therapist repeats the sets of reprocessing (essentially Phases One through Three) until the client’s SUD levels are reduced to zero or one. Phase IV gives clients the opportunity to identify and resolve events similar to the target memory as new memories and associations might arise in relation to the target. For example, if a client had an abusive past with a toxic mother or emotionally distant father that affects the client’s current relationships with romantic partners, the therapist will focus on reprocessing the client’s maladaptive emotions associated with certain traumatic events related to the unhealthy dynamic of the client’s parental relationships. The clinician will help the client identify and process the subliminal messages (negative cognitions) internalized by the client, who then gains insight about the memory, which enables him or her to accept and embrace new positive cognitions introduced by the clinician.
Phase V – Installation
The therapist continues to help the client reprocess memories and make new associations between positive beliefs and target memories. Phase V focuses on empowering the client and reinforcing the positive cognitions which will help the client handle current situations more effectively. The positive cognition is “strengthened” and “installed,” bringing about an adaptive resolution for the client’s problem-solving skills. Old negative cognitions (e.g., “I have no choice”) are replaced with positive reinforcements (e.g., “I have choices now that I didn’t have then when I was younger”); the new cognitions that change the client’s perceptions about old target memories give the client greater control over current and future events.
On the Validity of Cognition (VOC) scale, a client’s belief about a positive cognition is measured on a scale of 1 to 7 (1 = completely false, 7 = completely true). The goal of Phase V is to bring the client’s VOC level to 7, signifying that the client has fully accepted the positive statement to be true. The acceptance of a new cognition is not blindly accepting it at face value; if the client realizes that he or she needs to learn a new skill to fully bring the new cognition to a reality, the client will take those steps to meet personal development goals. The crucial step is changing the client’s perception about something that will bring about a positive change in behavior, thus reinforcing the new cognition introduced by the therapist.
Phase VI -Body Scanning
Following the installation of positive cognition, the therapist will ask the client to recall the original target event and identify any residual somatic tension that may arise in response to the memory recall. If the client reports any somatic response, the therapist will continue to target these physical sensations until the memories are reprocessed. This is based on the premise that information about the traumatic event is stored in the body, and the body remembers the negative emotions and somatic sensations associated with the event. An EMDR therapy session is considered successful when, after the information is processed, it moves from motoric memory to narrative memory; the somatic responses and negative emotions disappear, and the client is able to verbalize the event without feeling physical tension.
Phase VII – Closure
At the end of every treatment session, the therapist brings it to a closure to ensure that the client feels better by the end of the session. If the processing of the target event is not completed in a single session, the therapist gives instructions to the client on what to do between sessions. This may include what to expect, how to record disturbances that may arise, and how to apply self-calming techniques that will help the client maintain a sense of equilibrium.
Phase VIII – Re-evaluation
At the beginning of every subsequent session, the therapist evaluates the client’s current psychological state to determine the effectiveness of treatment by assessing levels of disturbances, positive cognitions, and physical tension. If treatment has been successful, the therapist works with the client to identify and process additional memories or disturbances that may have surfaced since the last session.