*Adapted from F. Shapiro (2001) Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd edition) New York: Guilford Press.
The 8 Phases of EMDR Therapy
In the first sessions, the client’s history and an overall treatment plan are discussed. During this process the therapist identifies and clarifies potential targets for EMDR. Target refers to a disturbing issue, event, feeling, or memory for use as an initial focus for EMDR. Maladaptive beliefs are also identified (e.g., ʺI canʹt trust peopleʺ or ʺI canʹt protect myself.ʺ) During the initial sessions the therapist is creating a safe and welcoming environment for the client to tell their story.
Before beginning EMDR for the first time, it is recommended that the client identify a ʺsafe placeʺ‑‑an image or memory that elicits comfortable feelings and a positive sense of self. Besides a safe, calm soothing place many clients will also identify a loving person (real or imagined). This safe place and loving person can be used later to bring closure to an incomplete session or to help a client tolerate a particularly upsetting session.
In developing a target for EMDR, prior to beginning the eye movement, a snapshot image is identified that represents the target and the disturbance associated with it. Using that image is a way to help the client focus on the target, a negative cognition (NC) is identified –a negative statement about the self that feels especially true when the client focuses on the target image. A positive cognition (PC) is also identified –a positive self statement that is preferable to the negative cognition.
The therapist asks the patient to focus simultaneously on the image, the negative cognition, and the disturbing emotion or body sensation. Then the therapist usually asks the client to follow a moving object (a hand held wand or watch a light bar with alternating lights) with his or her eyes; the object moves alternately from side to side so that the clientʹs eyes also move back and forth. Another form of bilateral stimulation is a hand held “tapping device” which can be a alternative to eye movements and is sometimes used with clients. After a set of eye movements, the client is asked to report briefly on what has come up; this may be a thought, a feeling, a physical sensation, an image, a memory, or a change in any one of the above. In the initial instructions to the client, the therapist asks him or her to focus on this thought, and begins a new set of eye movements. Under certain conditions, however, the therapist directs the client to focus on the original target memory or on some other image, thought, feeling, physical sensation, or memory. From time to time the therapist will ask the client about her or his current level of distress. The desensitization phase ends when the SUDS (Subjective Units of Disturbance Scale) has reached 0 or 1.
The ʺInstallation Phaseʺ: the therapist asks the client about the positive cognition, if itʹs still valid. After Phase IV, the view of the client on the event/ the initial snapshot image may have changed dramatically. Another PC may be needed. Then the client is asked to ʺhold togetherʺ the snapshot and the (new) PC. Also the therapist asks, ʺHow valid does the PC feel, on a scale from 1 to 7?ʺ New sets of eye movement are issued.
The body scan: the therapist asks the client to scan their body for any pain, stress or discomfort. If any distress is identified, the client is asked to concentrate on the discomfort in the body and new sets are issued.
Debriefing: the therapist gives appropriate information about what to expect after a EMDR session and support as needed.
Re‑evaluation: At the beginning of the next session, the client reviews the week, discussing any new sensations or experiences. The level of disturbance arising from the experiences targeted in the previous session is assessed.