Phase 1: History-Taking and Treatment Planning
This initial phase is crucial for building a strong therapeutic relationship and establishing a clear understanding of your history and current challenges. Your therapist will:
- Gather your history: This includes discussing past and present experiences, focusing on the specific events that are causing distress.
- Identify target memories: Together, you'll pinpoint the traumatic or distressing memories that will be the focus of EMDR processing.
- Assess your readiness: Your therapist will evaluate your stability and coping mechanisms to ensure you are prepared for the processing phases.
- Develop a treatment plan: This outlines the specific targets, processing strategies, and anticipated timeline for your therapy.
Phase 2: Preparation
In this phase, your therapist will help you develop the resources and skills needed to navigate the more intense processing stages. This involves:
- Explaining the EMDR process in detail: You'll gain a thorough understanding of what to expect during bilateral stimulation and the overall goals of therapy.
- Teaching coping mechanisms: Your therapist will equip you with techniques for managing any emotional distress that may arise during or after processing sessions. These might include relaxation exercises, visualization, or grounding techniques.
- Establishing a "safe place": You'll work with your therapist to identify a mental image or feeling of safety and calm that you can access whenever needed.
Phase 3: Assessment
This phase involves activating a target memory that has been identified in Phase 1. Your therapist will ask you to focus on different aspects of the memory, including:
- The visual image: What do you see when you recall the event?
- The negative cognition: What negative belief about yourself is associated with the memory (e.g., "I am not safe," "It was my fault")?
- The positive cognition: What positive belief would you prefer to have about yourself in relation to the memory (e.g., "I am safe now," "I did the best I could")?
- The associated emotions: What feelings arise when you focus on the memory?
- The level of disturbance: You'll be asked to rate the intensity of your distress related to the memory using a Subjective Units of Disturbance (SUD) scale (typically 0-10).
Phase 4: Desensitization
This is the core processing phase of EMDR therapy. While focusing on the target memory and the associated negative cognition, emotions, and body sensations, your therapist will guide you through sets of bilateral stimulation (BLS). This can involve:
- Eye movements: Following the therapist's finger moving back and forth across your field of vision.
- Tapping: Alternating taps on your hands or knees.
- Auditory tones: Alternating sounds presented through headphones.
After each set of BLS, your therapist will ask you to take a deep breath and notice whatever thoughts, feelings, images, or sensations come to mind. There is no right or wrong response. The goal is to allow your brain to naturally process the memory without judgment or conscious control. This phase continues until the distress associated with the target memory significantly decreases (low SUD score).
Phase 5: Installation
Once the disturbance related to the target memory has reduced, the focus shifts to strengthening the positive cognition identified in Phase 3. Through continued sets of BLS, the aim is to help you internalize and believe the positive belief on a deeper level. You may be asked to rate the validity of the positive cognition using a Validity of Cognition (VOC) scale (typically 1-7). The goal is to achieve a high VOC score, indicating a strong belief in the positive statement.
Phase 6: Body Scan
After the positive cognition has been strengthened, your therapist will ask you to bring the target memory to mind once more and scan your body for any remaining physical sensations. If any tension or discomfort is present, further processing may be needed using BLS until these sensations subside. This phase aims to ensure that the memory is not only emotionally resolved but also somatically integrated.
Phase 7: Closure
Every EMDR therapy session ends with closure to ensure you leave feeling stable and grounded. Your therapist will:
- Review the processing that occurred during the session.
- Reinforce any coping mechanisms or grounding techniques used.
- Provide instructions for self-care between sessions.
- Address any questions or concerns you may have.
It's important to understand that processing can sometimes continue between sessions. Your therapist will prepare you for this possibility and provide strategies for managing any lingering thoughts or feelings.
Phase 8: Re-evaluation
This phase takes place at the beginning of subsequent EMDR sessions. Your therapist will:
- Assess your progress since the previous session.
- Revisit the target memory and its associated disturbance and positive cognition.
- Determine if further processing is needed on the initial target or if new targets should be addressed.
Re-evaluation ensures that the therapeutic process remains on track and that you continue to make progress towards your healing goals.
