Eye Movement Desensitization and Reprocessing (EMDR) is a short-term therapy that has been extensively researched and empirically validated. It is widely considered to be one of the best evidence-based treatments for trauma.

Trauma can be defined as any negative event you experienced, which you felt you had no control over, that you still think about a lot.

EMDR uses bilateral stimulation (BLS) of the left and right sides of the brain, similar to what occurs during REM sleep. Types of BLS include either eye movements back and forth (e.g., while following the therapist’s fingers or a light bar) or providing sensations that alternate between the left and right side of the body (e.g., holding buzzers in each hand, listening to beeps via headphones, the tapping of your knees, heels, or arms).

Traditional EMDR involves engaging clients in multiple rounds of BLS while being guided to think about various aspects of their trauma. This allows the memory to be moved from short- to long-term memory storage.

Typically, short-term memories (e.g., events of the day) are transferred to long-term memory storage via Rapid Eye Movement (REM) sleep. However, when we experience traumatic events, our fight, flight, freeze, or fawn response on the emotional/right side of the brain becomes over-activated. This makes it difficult for the logical/left side of the brain to realize that the danger has passed. So the emotional/right side remains on high-alert, the fight, flight, freeze, or fawn response continues to be re-activated when presented with reminders of the traumatic event, and the memory is never fully processed or moved to long-term memory storage.

A secondary purpose of BLS is to distract you/ground your focus in the present moment so that your emotional/right side of the brain doesn’t become overly-engrossed in the traumatic memory, which could trigger the fight, flight, freeze, or fawn response. This distraction gives the brain the time it needs to process and move the memory to long-term memory storage via BLS. Once there, it will no longer hold the same negative emotional charge, and you will be able to access those memories objectively and without becoming overwhelmed like you may have in the past.

I also utilize an EMDR technique called, “Flash,” which is an even gentler approach. Flash involves focusing on a positive memory, rather than a negative one, while doing bilateral stimulation and very briefly flashing back to the negative memory every so often.

Evidence-based treatments (EBTs) are those that have been proven, via clinical trials, to be effective and result in better outcomes.

EBTs are time-limited and goal-oriented.

When using EBTs, progress is evaluated continually in order to deliver effective and individualized psychological care.

While the length of treatment will vary from person to person, overall, EBTs tend to be shorter in duration than other psychological treatments.

Unlike traditional talk therapy, EMDR doesn’t require clients to change any emotions, thoughts, or behaviors that resulted from their trauma. While those will likely improve with EMDR, it isn’t something that’s forced. It is simply observed and documented.

EMDR doesn’t require the challenging of negative beliefs, completion of homework between sessions, extended exposure to traumatic memories, or the provision of in-depth detail of the traumatic events.

Now, some clients prefer and do better when allowed to process things out loud and explore the finer details of their experiences, and that is perfectly fine as well.

During the clinical trials, between 77-100% of clients experienced a reduction in symptoms that was clinically significant enough to no longer meet diagnostic criteria for PTSD.

Clients’ symptoms tend to continue improving even after treatment ends. The negative beliefs and distressing symptoms don’t typically return once properly processed via therapy. The positive beliefs instilled (e.g., It’s safe to show my emotions) tend to generalize to future events as well, which can help prevent future experiences from being interpreted and internalized as traumatic.

I like to start off by meeting on a weekly basis. However, this can be more or less frequent, as needed. At minimum, I recommend that sessions not be any less frequent than biweekly. Otherwise, gains and skills learned may become hard to maintain between sessions.

The optimal length for EMDR sessions is 60-90 minutes, 1-2 times per week. However, this is flexible and can be adjusted based on needs and preferences.

This will vary from client to client and depend on several factors, including the following:

• The complexity and severity of symptoms

• The nature and number of therapy goals

• The duration and frequency of sessions

The typical timeline is as follows:

• 1-3 sessions for the completion of the intake and the administration and discussion of the results of any additional assessments needed

• 1-2 sessions for the EMDR-specific assessment of what is causing/maintaining clients’ symptoms. In EMDR, these are referred to as, “targets.”

• 1-4 sessions for the identification and development of emotion-regulation skills

• An average of 3 sessions per target, spent on processing and resolving those

• Plus however many additional sessions may be needed to address any crises or new concerns that arise

The average number of sessions is typically higher for individuals with more-complex concerns and/or symptoms.

I start by conducting an intake, which involves obtaining medical, developmental, educational, family, and mental health histories.

I then assess for clients’ compatibility/appropriateness for EMDR treatment. If I believe it would be a good fit, we proceed with EMDR. If not, clients are referred out so that they can receive a more appropriate treatment.

Next, I administer any additional assessments needed for anxiety, depression, trauma, etc. This will allow us to compare clients’ pre- and post-treatment scores.

Clients’ levels of distress are closely monitored to prevent them from becoming overwhelmed during sessions. EMDR utilizes 3 different levels of intensity, which are flexible and can always be adapted to fit clients’ needs. The level of intensity used during any given session is based on the client’s ability to remain calm while accessing traumatic memories. So the next phase involves preparing clients for such distress by teaching them how to remain and return to a state of calm. This is done by assisting clients with identifying and further-developing both current and new coping skills and self-soothing techniques.

Next, I conduct an EMDR-specific assessment of past, present, and possible future traumas, as well as any negative beliefs and/or distressing body sensations tied to those. This information is then used to create a list of treatment, “targets.”

Clients’ baseline distress scores (aka Subjective Units of Distress) are then obtained for each target. Those scores are then monitored for improvements and/or regressions over the course of treatment. These self-reported scores help us determine which targets still require more processing.

Next, I utilize bilateral stimulation (BLS) to guide clients through the processing of target memories.

Once all of the targets have been processed and the client is satisfied with their remaining levels of distress around each target, EMDR treatment is complete.

It’s not always possible to alleviate all distress surrounding a given target. In some situations, some residual distress is to be expected. Some examples of this might include a client who has no choice but to continue living with their former abuser or a client who lives in a truly unsafe neighborhood. In those cases, the goal would be to alleviate as much distress as possible, rather than to eliminate it completely.