What is the actual EMDR session like?
The amount of time the complete treatment will take depends upon the complexity and intensity of your history. Complete treatment of the disturbing memories (targets) involves a four-part protocol:
1. Identify present disturbance and the memory it is associated with (target)
2. Build regulation capacity to respond to intense emotional states, should they arise
3. Processing past memories,
4. Install adaptive future thoughts/feelings/actions
8 Phases of Treatment
Phase 1: History and Treatment Planning
In the first session, Sara takes a thorough history by inviting you to share specific problems, behaviors and symptoms. A treatment plan is formulated, which identifies the event(s) from the past that created the problem (the target), the present situations that cause distress, and the key skills or behaviors the you need to learn for your future well-being. One of the unusual features of EMDR is that you do not have to discuss any of your disturbing memories in detail.
Phase 2: Preparation
For most clients this will take only 1-4 sessions, unless there is a deep traumatized background. You will learn the theory and procedure of EMDR, plus specific techniques to rapidly deal with emotional disturbance that may arise during or after the work. Once you are solid with containing strong emotions, you are generally able to proceed to the next phase. During preparation it is crucial to establish a relationship of trust with the therapist, so that you feel able to accurately report the content of the “sets” once the work begins.
Phase 3: Assessment
A standard set of questions is used to access each target in a controlled and standardized way so it can be effectively processed. This protocol involves the following steps:
1. Choose the target and describe a specific picture or scene that best represents the memory.
2. Choose a statement that expresses a negative self-belief associated with the event, which is a verbalization of the disturbing emotion that still exists. Common negative cognitions include statements such as “I am helpless,” ” I am worthless,” ” I am unlovable,” ” I am dirty,” ” I am bad,” etc.
3. Choose a positive self-statement that you would rather believe. This statement should incorporate an internal sense of control such as “I am worthwhile/ lovable/ a good person/ in control” or “I can succeed.” Sometimes, when the primary emotion is fear, such as in the aftermath of a natural disaster, the negative cognition can be, “I am in danger” and the positive cognition can be, “I am safe now.” “I am in danger” can be considered a negative cognition, because the fear is inappropriate — it is locked in the nervous system, but the danger is actually past. The positive cognition should reflect what is actually appropriate in the present.
4. At this point, the therapist will ask you to estimate how true your positive belief is on the Validity of Cognition (VOC) scale. It is important to give a score that reflects how you “feel,” not ” think.” We may logically ” know” that something is wrong, but we are most driven by how it “feels.”
5. Identify the difficult emotions (fear, anger) that you are experiencing in the moment, remembering the target.
6. Identify and Rate the physical sensations (tightness in the stomach, cold hands) you are experiencing as you rembember the target.
Phase 4: Desensitization
Now that the groundwork and container are firmly established, it is time to begin reprocessing, using these elements:
1. A form of bi-phasic stimulation (Sara typically uses auditory tones and pulses or taps to the hands),
2. Sharp focus of attention on past, then present, then past as Sara moves you in and out of the reprocessing.
3. Sharing what arose during the set with Sara, so that the traumatic experience you endured (likely very much on your own) is finally received in connection.
You begin with a focus on the targets you initially identified, but because the brain is a matrix of associations, as shifts and body-brain integration occur in the primary target, other similar memories and incidents tend to resolve as well, such that healing may extend delightfully beyond your expectations. During desensitization, Sara remains raptly attuned to your breath, facial and body expressions skin colour, spontaneous saccadic eye movements, and many other signs which signal where you are in processing. Based on these indications, she leads you through reprocessing sets, either deepening or shallowing the internal states to remain within your Window of Tolerance. If she senses an arrest in integration, she may assist with simple instructions to maximize your brains capacity to re-evaluate the experience. She regularly checks your SUD-scale levels until they are reduced to 0-2.
Phase 5: Installation
The goal is to concentrate on and increase the strength of the positive belief that you identified to replace your original negative belief. An example, the client might begin with a mental image of being bullied at school and a negative belief of “I am powerless.” During the Desensitization Phase he will have reprocessed the terror of that childhood event and fully realized that as an adult he now has strength and choices he didn’t have when he was young. During this fifth phase of treatment, his positive cognition, “I am now in control,” will be strengthened and installed. Installed refers to being in touch, mentally, physically, and emotionally with new capacity, and doing sets to establish and deepen the neural pathway that carries that new state. This leads to quicker access of this state as new situations arise in the future, thus leading to new outcomes based on current reality rather than old memory.
Phase 6: Body scan
After the positive cognition has been strengthened and installed, Sara offers you the opportunity to bring the original target event to mind and see if there is any residual tension in your body. If so, these physical sensations are then targeted for reprocessing, as EMDR research indicates that our bodies carry the burden of any unresolved thoughts. Studies show that energy from the traumatic event is stored in motoric (or body systems) memory, rather than narrative (language) memory, and retains the negative emotions and physical sensations of the original event. Successful reprocessing leaves the body free of impacts and allows the incident to be carried in narrative (or verbalizable) memory. A target is not considered successful until you can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.
Phase 7: Closure
It is important to leave the session clearer than you started. If the processing of the traumatic target event is not complete in a single session, Sara will guide you through the self-calming techniques learned in an earlier stage, in order to regain a sense of equilibrium. Throughout the EMDR session, the client has been in control (for instance, he is instructed that it is okay to raise his hand in the “stop” gesture at anytime) and it is important that the client continue to feel in control outside the therapist’s office. You will be briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and engage in a review of the techniques you can use to calm as necessary.
Phase 8: Reevaluation
At the beginning of subsequent sessions, Sara will check with you to make sure that the positive results (low SUDs, high VOC, no body tension) have been maintained, celebrate new capacities emerging as a result of the work, and identify any new areas that need treatment, and continue reprocessing the additional targets. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment, as it is to complete an entire course of treatment with antibiotics.