EMDR Therapy: The Eight Phases in Clinical practice

A Quick Guide

EMDR therapy, an empirically supported therapy, focuses on treating distressing symptoms of mental disorders. Overall, it involves an emphasis on processing childhood memories, traumatic memories, or other negative experiences and gives them an adaptive meaning. Such that negative images, emotions, thoughts, and beliefs associated with these no longer affect the person’s present.

The Phases of EMDR Therapy

EMDR therapy undergoes eight different phases. The clinician may dedicate a different number of sessions to each phase depending on an individual’s needs. Even though each phase focuses on different aspects of the entire treatment. But overall their main effect includes the following:

• Increased individual self-efficacy
• Reduced negative affect
• Desensitization to the distressing memory
• Enhanced insight
• Reduced discomforting bodily sensations
• Cognitive restructuring i.e. changing one’s negative thought patterns

Phase 1: Taking Client History and Treatment Planning

This phase includes choosing clients suitable for undergoing EMDR therapy. Particularly those who can withstand high disturbance triggered by processing distressing information, who are personally stable, and who have reduced life stressors/constraints. After this, the clinician takes a detailed history including the person’s symptoms, behaviors, and personal aspects that need addressing. Next, the clinician and client jointly discuss and decide on targets for processing. For example,

• past events underlying their pathology
• present triggers of symptoms
• positive behaviors or beliefs to adopt in the future.

Phase 2: Preparation

In this phase, the clinician focuses on building rapport and educating the client about the theory & process of EMDR therapy, its possible consequences, and its effects. Moreover, he addresses the client’s underlying concerns, builds realistic expectations, and devises a safety strategies/toolkit to deal with emotional disturbance in and after the session. For instance, this can include relaxation exercises, guided imagery, deep breathing exercises, etc. He teaches these to the client to build his capacity to deal with the distress of facing traumatic memories.

Phase 3: Assessment

In this phase, target components are set. For example, image, negative cognition, positive cognition, emotion & rating, physical sensations, and stimulation strategy. Furthermore, the client and clinician establish a baseline for all EMDR therapy components to track the progress made in sessions.

Phase 4: Desensitization

In this phase, the processing begins including the bilateral stimulation activity. e.g. lateral eye movement, tapping on the chest, etc. Here, the focus is on reducing negative affect, its SUD, and building new insights.

Phase 5: Installation

This phase focuses on replacing the earlier negative cognition with the desired positive cognition after the negative emotions/affect have reduced. The client also rates how strongly he believes in his new cognition. This rating gives an idea of how much more work is required. Till he can believe the new cognition with appropriate affect.

Phase 6: Body Scan

The client revisits the memory after adopting the new cognition. Then, he focuses on the image, and the positive effect and scans his body. The purpose is to identify any residual distress in the form of physical sensations. If there is, relaxation exercises are done to address it. Here, it is also possible to uncover new unprocessed information. Thus, it again becomes a target to process and resolves.

Phase 7: Closure

At the end of an EMDR therapy session, the client goes back to an equilibrium state. The clinician instructs the client to keep a log of emotions, thoughts, dreams, situations, and other memory triggers that occur outside the session. So that they can target these in the next session. The clinician also informs the client what to expect outside the session and how to deal with it.

Phase 8: Reevaluation

The final phase or reevaluation is done at the start of a new session. The clinician and client review previous targets and processing. The client discusses whether treatment effects were maintained or still need addressing. Accordingly, old or new targets are focused on in the next session.

If you want to find out what EMDR therapy phases look like in clinical practice, check out this helpful youtube guide.