EMDR (Eye Movement Desensitizationand Reprocessing), as with most therapyapproaches, focuses on the individual’spresent concerns. The EMDR approachbelieves past emotionally-chargedexperiences are overly influencing yourpresent emotions, sensations, andthoughts about yourself. As anexample: “Do you ever feel worthlessalthough you know you are aworthwhile person?”EMDR processing helps you breakthrough the emotional blocks that arekeeping you from living an adaptive,emotionally healthy life.EMDR uses rapid sets of eyemovements to help you updatedisturbing experiences, much like whatoccurs when we sleep. During sleep,we alternate between regular sleep andREM (rapid eye movement). This sleeppattern helps you process things thatare troubling you.EMDR replicates this sleep pattern byalternating between sets of eyemovements and brief reports aboutwhat you are noticing. This alternatingprocess helps you update your memories to a healthier presentperspective.

EMDR therapy does not require talking in detail about the distressing issue or completing homework between sessions. EMDR therapy, rather than focusing on changing the emotions, thoughts, or behaviors resulting from the distressing issue, allows the brain to resume its natural healing process.

EMDR therapy is designed to resolve unprocessed traumatic memories in the brain. For many clients, EMDR therapy can be completed in fewer sessions than other psychotherapies.

EMDR consists of eight phases. The number of sessions devoted to each phase vary greatly from person to person.

‍Phase 1 - History taking and assessment

• Rapport building and establishing goals for therapy (client needs a clear rationale for engaging in trauma/adverse memories work)
• History taking and assessment
• Assessing client suitability and readiness for EMDR therapy
• Treatment planning
• Mapping targets for reprocessing eg. establishing a trauma timeline

Phase 2 - Preparation and resourcing

• Establishing trust in the therapeutic relationship 
• Explanation of the theory and procedures of EDMR therapy
• Building coping strategies and resources that can be drawn upon both during and in between sessions eg. emotion regulation skills, calm place etc. 
• Setting up for an EMDR desentization session by establishing comfortable distance for bilateral stimulation, a cue word for calm place, and a stop signal

Phase 3 - Target assessment

• Establishing a target image or target trigger - ideally starting with the most distressing memory or trigger as other memories will lead back to this one
• Establishing a negative cognition (negative thought) about oneself strongly associated with the target eg. “I’m not enough”
• Establishing a positive cognition (positive thought) related to the negative cognition that the client would like to believe about themselves eg. “I’m enough”
• VoC (Validity Of positive Cognition) - rating the believability of the position cognition on a scale of 1 (feels completely untrue) to 7 (feels completely true). It is important to note that it is not about whether the cognition is intelellectually believable but whether it feels true to the individual
• SUD (Subjective Units of Distress) - rating how distressing the target is to the individual on a scale of 0 (not at all disturbing) to 10 (highest disturbance possible)
• Location of body sensations

Phase 4 - Desensitization

• Repeated sets of bilateral stimulation (with appropriate variations to reduce habituation) until the client’s SUD level is genuinely reduced to 0 or 1. This may span across many sessions
• Unblocking techniques utilised when processing gets stuck

Phase 5 - Installation

• Pairing the desensitised memory with an adaptive positive cognition eg. I did my best
• Sets of bilateral stimulation with the client simultaneously focusing on the desentised memory and the positive cognition, to achieve the greatest possible strengthening of the cognition (aiming for the positive cognition to feel true at a rating of 6 or 7 on the scale of 1-7)

Phase 6 - Body scan

• Mentally scanning the body whilst holding in mind the target memory and the positive cognition (not a typical body scan exercise)
• Further sets of bilateral stimulation to reprocess any residual distress and strengthen positive sensations

Phase 7 - Closure

• Occurs at the end of every session
• Debriefing the session
• If necessary, stabilising the client
• Providing information about what to expect in between sessions (if phase 4 desensitization occurred during the session, ongoing reprocessing is expected to occur for the following 24-48 hours in the form of thoughts, feelings, or body sensations popping up)
• Reiterating affect regulation skills

Phase 8 - Re-evaluation

• Occurs at the beginning of every session
• Re-accessing of previously reprocessed targets 
• Reviewing whether treatment gains have been maintained
• Assessing whether further reprocessing is required 

Why does EMDR work?

The Adaptive Information Processing (AIP) Model is the underlying explanatory model of EMDR therapy. The AIP posits that:

• The brain has an innate capacity to adaptively process information and integrate internal and external experiences
• Trauma can cause a disruption to the brain’s adaptive information processing system
• When this occurs, traumatic memories are maladaptively stored in isolated memory networks
• This can lead to mental illness and distress

It is thought that EMDR removes the ‘blockages’ that have been caused by trauma, allowing the brains natural healing process to resume. An example used to explain the AIP Model is the natural ability of the human finger to heal after a cut. However, if there is a splinter in the finger, the natural healing process is blocked. EMDR aims to remove the splinter (metaphorically) so that the normal healing processes of the brain can continue.

EMDR considers a distressing event successfully reprocessed if:

• The memory is recalled as a distant event (distancing)
• The memory no longer evokes significant distress (densenitization) 
• The meaning and beliefs linked to the memory shift to become more adaptive (reprocessing) 

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