What is EMDR?

What is EMDR?

Eye Movement Desensitisation and Reprocessing (EMDR for short) is an evidence-based psychological therapy that works to alleviate the impact of traumatic memories for the individual. EMDR is an effective treatment for a wide variety of conditions which may be caused by a range of different traumatic experiences.

EMDR is somewhat different to traditional modes of therapy in that it does not require the client to talk extensively and analyse the past events within their lives. In traditional forms of therapy, individuals are often encouraged to process traumatic events by exploring the event in detail. EMDR has been demonstrated to be more effective in alleviating distress from traumatic events and has been shown to do so in a shorter amount of time compared with trauma-focused cognitive behaviour therapy.

Throughout the process of EMDR therapy, there are many stages which are completed in order to ensure the individual is able to process the event. The initial phases of EMDR encompass taking a full clinical history and understanding the whole picture of the client. This involves looking over a detailed view of all of the client's most difficult memories and past patterns of behaviour. We explore this thoroughly in order to assist the individual to be able to be aware of the impact of their past events on their present experience in everyday life.

How EMDR differs is that the process of EMDR involves asking the individual to focus on the target memory whilst following the therapist moving their index finger from left to right. This is known as bilateral stimulation and works to help the individual process the memory. This experience may seem strange or unusual when compared to more conventional forms of therapy (such as CBT).

The EMDR approach takes the view that traumatic memories from our past can often tend to remain unresolved and that they continue to impact upon us in the present moment. It is this present impact that affects our daily lives and is often triggered by everyday events that can seem quite unrelated. For example, people who have been involved in a vehicle accident or violent assault will often experience severe distress around reminders of the event such as similar places, images, sounds, or smells.

EMDR allows a person to resolve the unprocessed memory which allows the individual to overcome the distress associated with those past incidents and events. Moreover, it has been demonstrated to be effective in treating those with single incident trauma (i.e. vehicle accident, home invasion, etc.) and complex trauma (i.e. childhood trauma).

How does EMDR work?

EMDR works by asking individuals to focus on the target memory that is causing them distress whilst engaging in bilateral stimulation (BLS). The left-to-right movement of the eyes is similar to that of when we are engaging in REM (rapid eye movement) sleep. During REM sleep, our eyes are moving rapidly from left to right and consolidating a number of memories from the present day and from the past. When this process occurs, we tend to experience this mechanism through the sensation of dreams.

In a similar manner, when this process takes place it engages the same memory sensory mechanisms that are involved as when the original event took place. Often all of the five (5) senses are involved and we can feel like we are back there again, experiencing the event just as it was when we first experienced it.

In cases of post-traumatic stress (e.g. PTSD, complex trauma, etc.), we tend to experience what we call ‘intrusions’ or ‘flashbacks’ of the traumatic memory. When this occurs, we experience the sights, the sounds, the emotions, the sensations and even smells and tastes as though the event is happening all over again. Often times, this is quite distressing for the individual experiencing the trauma and occurs in many facets of everyday life.

The impact of this can usually result in people avoiding situations related to the trauma, feeling ‘on guard’ or ‘on edge’ almost all of the time, and being severely impacted by intrusions such as flashbacks and nightmares. We often understand nightmares to be the experience of our brain attempting to process the memory but being unable to do so due to the experience being so profound and so traumatic that we are often left outside of our window of tolerance.

Our clinic has used the process of EMDR therapy to help treat patients for a variety of conditions and we’re here to help you as well.

It has often been our experience that individuals will often request EMDR therapy when they have trialled previous therapies and therapists that have not been able to resolve their symptoms. The most common reaction that individuals have when engaging in EMDR therapy is that their memories which have caused them so much distress in the past, now feel just like any other memory.

What are the phases of treatment in EMDR?

Phase 1: History Taking and Treatment Planning

The first phase of EMDR commences with the therapist and client discussing what the presenting concerns are and what has brought them to therapy. In this phase, a detailed history of the client's presenting concerns, past events and goals for therapy are all discussed and a treatment plan developed.

Phase 2: Preparation

The second phase of EMDR therapy involves the therapist preparing the client for the process of working with the selected memories. This involves deepening the working relationship with the client and developing a range of internal resources that the client can utilise for the following phases of treatment. This stage enables clients to have the skills and resources to be able to 'hit the brakes' and ground themselves back in the present after they have begun processing a target memory.

Phase 3: Assessment

The third phase of EMDR therapy involves focusing in on a specific target memory to commence the next phase with. During this stage, the client will be asked to identify the images, emotions, sensations, sounds, and underlying beliefs that underpin the selected target memory. The therapist will also ask about the two scales that are used measuring the Subjective Units of Distress (SUDs; 0 to 10) and the Validity of Cognition (VoC; 1 to 7).

Phase 4: Desensitisation

The fourth phase of EMDR involves the commencement of bilateral stimulation (BLS). During BLS, clients are asked to focus on the target memory whilst following the therapists index finger moving from side to side. This is the phase of the treatment where the therapy derives its name. In addition to side to side eye movements, other forms of BLS used can also include shoulder tapping and the use of handheld paddles. This process continues until the client's SUDs reach a score of zero (no distress). Occasionally, there may still be some level of distress at this stage.

Phase 5: Installation

The fifth phase of EMDR involves the installation of a new, more positive belief about the target memory. During this phase, the client is able to 'install' a more positive association with the event. A 'positive cognition' is paired with the target memory.

Phase 6: Body Scan

The sixth phase of EMDR involves the therapist guiding the client through a complete scan of their body from head to toe whilst keeping the target memory in their mind. Clients are asked to notice if there is any disturbance in their bodies in relation to the target memory. Any disturbance in the body is then reprocessed as in phase 4.

Phase 7: Closure

The seventh phase of EMDR is commenced once the reprocessing phases have been completed. In this phase, the therapist assists the client to return back to a state of safety and calm. Usually, this will involve reverting back to resources installed in phase 2. Slow BLS movements are continued until the client is feeling calm and safe again in the present.

Phase 8: Reevaluation

During the final phase of EMDR, a reevaluation process takes place with the therapist. This is usually at the commencement of the session following the reprocessing component of the treatment. At this stage, the therapist and client discuss any recent memories and evaluate if there is any accompanying distress. The future direction of treatment and (if needed) future target memories are identified. The process is then repeated from phase 3 for subsequent target memories.

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