Phases of EMDR Therapy

I’ve written a lot about my journey of participating in EMDR (eye movement desensitization reprocessing) for trauma-based PTSD (post-traumatic stress disorder) and sleep disturbances and how it has helped me and changed a bit of my life.

In this article, I’ll go over some of the phases in detail and what happens in a session led by an EMDR specialist. Note: Not all therapists can do EMDR. They are specifically medically and scientifically trained to do this type of rigorous therapy. A LOT goes into EMDR.

The 8 phases of EMDR therapy

There are 8 phases to EMDR. “EMDR is an 8-phase treatment method: history taking, client preparation, assessment, desensitization, installation, body scan, closure, and reevaluation of treatment effect.”¹

Phase 1: History taking

In this phase of EMDR, the clinician asks the patient to talk about some of the traumas or anxieties that are preventing them from moving forward and finding closure with certain traumatic events. Although hard for the patient, the more details given by the patient about the history of behaviors, symptoms, and trauma, the more it can help build a suitable plan for the patient in collaboration with their clinician.¹

Phase 2: Preparation

In this phase, the client/patient and EMDR clinician build trust in order to get the most out of this type of therapy. This phase helps build expectations and the clinician helps “train” the patient with self-control techniques to close certain sessions that may not feel like there is closure, as they may be in the middle of a session and the time is physically up. In the preparation phase, the EMDR specialist helps the patient find safe words or signals that they may need to stop. The therapist explains certain symptoms and helps them acknowledge and understand this is a big part of actively processing traumas discussed.¹

Phase 3: Assessment

In this phase, there is a specific memory that is targeted for that particular session. The therapist asks the patient to think of the most noticeable and important enough to help draw out an image that will be focused on during this part of EMDR. The patient is asked how they feel and what beliefs they have about themselves that are actually negative and irrational thoughts, particularly about a specific event. Thoughts or negative beliefs such as “I am dirty” or “I am not loveable” are common. This helps the therapist and patient come up with positive beliefs rather than negative ones based on the image they are asked to conjure up.¹

Phase 4: Desensitization

In this phase, the patient’s trauma is evaluated in an attempt to “change the trauma-related sensory experiences.”¹ The patient will focus on a certain disturbing image that the patient came up with during the assessment phase. This is where the eye movement (bilateral stimulation) part of EMDR comes in. In addition to minimal check-ins with the patient, patients do breath work along with the therapist to clear their minds, so they are able to do the bilateral eye stimulation work. There are many forms of stimulation used: eyes following the clinician's finger, tapping of the shoulders, or using tappers in the patient’s hands that vibrate to rhythm and pattern. Depending on patient response, the therapist is in control of directing the patient, with the speed and length of the type of stimulation that is used for that patient.¹

Phase 5: Installation

In the fifth phase of EMDR, the patient and therapist work together to replace the negative beliefs brought up in the assessment phase with a positive belief. They work to increase the strength of the most positive beliefs. Instead of the negative belief that the patient worked on in the assessment phase, positive beliefs like “I am worthy,” or “I’m gaining my power back,” or “I am in control,” may be installed, depending on the patient’s thoughts, beliefs and feelings. Results in this stage may be evaluated using the VOC (Validity of Cognition) scale.¹

Phase 6: Body scan

After the positive beliefs have been fully installed, the patient is asked to mentally scan their body to see if there is tension or any signals that something is still “stuck” on. If that is the case, the therapist might continue the bilateral stimulation.¹

Phase 7: Closure

To feel calm and collected at the end of the session, the patient will be asked to “contain” images or other things they do not want a part of their daily lives. Some patients are told they can return to their safe place and “store the container” with anything that might be stressful to them in between sessions.²

Phase 8: Reevaluation

The final phase of EMDR is to check how the patient feels compared to how they felt at the beginning of the session. A reevaluation is then done again at the beginning of the next session to ensure the full treatment plan is working and see if the patient’s positive beliefs from Phase 3 still resonate with them.