EMDR 101

When people first hear about EMDR, there can be a lot of confusion about what it is and what it’s like to do EMDR therapy. I wrote this post to help explain some of the basics, and give you an idea of what you can expect if you’re interested in EMDR as a clinician or a client. 

Throughout the past five years, EMDR has become one of my go-to modalities with individual therapy clients. I believe in it so much that I’ve sought out additional training to become an Approved Consultant in EMDR, which means that I can provide consultation to folks who are training to become EMDR certified, or to become Approved Consultants themselves.

It truly is a life changing approach, and I hope that getting some clarity on how to think about this unique modality can help you in your healing or training journey. 
 

What is EMDR?

EMDR (eye-movement desensitization and reprocessing) is highly supported by clinical research for the treatment of single-incident traumas like an assault, the death of a loved one, or a car accident, but it is also effective in treating the complex trauma that results from Adverse Childhood Experiences, or ACEs. (ACEs can include experiences like neglect, physical abuse, witnessing substance abuse in the home, and more). In fact, EMDR is actually able to help remap the neural networks that inform our belief systems and ways of being.

The “eye-movement” part of the name is actually a bit of a misnomer. EMDR was first facilitated (and still is) by clinicians having their clients watch their fingers move back and forth across a visual plane. This eye-movement has the effect of creating bilateral stimulation (BLS) of the two sides of the brain. Bilateral stimulation is the key to the “magic” of EMDR, and we can activate BLS using tones or tactile stimulation as well as eye-movements.
 

How was EMDR developed?

EMDR was developed by Dr. Francine Shapiro throughout the late 1980s and 1990s. Dr. Shapiro essentially stumbled onto EMDR while taking a walk in the park and thinking about an issue that was distressing to her. She noticed that she felt better about the issue as her eyes scanned back and forth across her environment, and thought maybe there was something to that. She went on to experiment with eye movements using herself and her colleagues as subjects, and later expanded into more formal clinical research.

Dr. Shapiro found that thinking about a distressing event while tuning into eye movements had the effect of desensitizing the memory and causing it to be less disturbing. Because of this “desensitization” effect, EMDR was first known simply as EMD (eye-movement desensitization). As it was developed, it was discovered continuing with eye movements caused participants to associate the target memory with related past experiences, and helped those memories to be “reprocessed,” or stored in the brain in a different way that was more adaptive and empowering.

The Adaptive Information Processing (AIP) Model

EMDR is rooted in a theoretical framework called the Adaptive Information Processing model, or AIP. AIP forms the basis of everything we do in EMDR therapy.

AIP draws heavily on the concept of "memory networks." A memory network is a group of memories that are formed around a particular belief or idea. These memory networks are the basis of both psychological health and psychological dysfunction. Our memory networks come to be extremely important in the way we think about ourselves and our lives, and inform the schemas through which we see our experiences.

Every one of us possess “adaptive” memory networks, and “maladaptive” memory networks. Adaptive memory networks are oriented around beliefs and cognitions that are helpful to us, such as, “I am loved,” “I am safe,” or, “I have options.” Malaptative memory networks, on the other hand, are oriented around beliefs that do not serve us, such as “I’m worthless,” “It was my fault,” or “I can’t protect myself.” When we have new experiences, those memories are automatically added to our established memory networks. One of the goals of EMDR is to “reprocess” traumatic memories into adaptive memory networks, and to grow and strengthen those positive beliefs.

AIP suggests that our psychological systems, like our bodies, are naturally geared toward health (like a cut healing on its own). If we break a bone, a doctor will put a cast around the injury to help it heal, but it isn’t the cast that does the healing. Our bodies have an intuitive healing process that takes place naturally if it’s allowed to flow. The same is true for our nervous systems and our mental and emotional health. What happens with trauma is that this natural process gets stuck. EMDR helps to unstick those gears to allow healing to take its course, and bilateral stimulation is the key to that process. (I’ll talk more now about how that happens).

What makes EMDR effective?

Although we have ample evidence to support the fact that EMDR does work as a clinical approach, the “why” is really just theory right now. There are a few dominant theories on EMDR and why it works, and it’s likely that the answer is some combination of all of these. We do know that studies show that eye movements have an effect on memory retrieval, vividness of those memories, and emotional arousal.

Here are a couple of the theories that resonate the most for me:

What’s it like to do EMDR as a client?

If you’re at all familiar with EMDR, you probably think of it as just the part where the eye-movement happens. In fact, this is just one phase of the process, Phase 4: Reprocessing and Desensitization. Really “doing” EMDR is any therapeutic work that is based in AIP.

EMDR actually has eight phases in total. These are:

• Phase 1: History taking
• Phase 2: Preparation
• Phase 3: Assessment
• Phase 4: Reprocessing & Desensitization
• Phase 5: Installation
• Phase 6: Body Scan
• Phase 7: Closure
• Phase 8: Reevaluation

How soon you get into Phase 4 will depend on where the client is at, and the goals for therapy. For some clients, it could be appropriate to jump in within the second session, and for others, Phases 1-3 could take years. These phases can look like building coping tools, verbal narrative, and treatment planning, all with an AIP lens. All of this is still EMDR, just at a different pace.

Once it’s time for reprocessing and desensitization, there are a couple of routes to take. If there’s an obvious experience that you’re coming in to work with, that’s where you’ll start. From there, you’ll work with your therapist to identify the image that represents the worst part of the memory. 

Working from that image, you’ll identify the “negative cognition” that characterizes that memory for you, as well as the “positive cognition” that you’d like to grow. You’ll also name emotions and body sensations that come up when you tune in to all of that. On the other hand, for folks with a less identifiable single-incident trauma, you may start with a belief or schema that’s been dominant for you, and work backward to identify a foundational memory. This then serves as a starting point for Phase 4.

This process has the effect of lighting up the brain to get you ready to process. From there, you get the bilateral stimulation going as eye movements, tones, or tactile stimulation, and let the brain get to work. The client’s and therapist’s jobs are essentially to get out of your brain’s way and let it do its thing.

The brain will take you through the memory network that’s associated with that negative cognition through memories and feelings. You are likely to make connections between experiences that you had never considered before. As that process progresses, you’ll also get little lightbulbs connecting you to your positive cognition and the associated memory network.

In the end, the goal is that the original memory feels neutral, and the positive cognition that was identified at the beginning of the process feels 100% true. Phase 6 involves installing and strengthening that positive belief using bilateral stimulation, Phase 7 checks for any remaining disturbance in the body, and Phase 8 revisits the target in a future session to see if anything else has come up in the meantime and needs to be reprocessed.
 

Who is a good candidate for EMDR?

EMDR is a great fit for a wide array of candidates. It’s a excellent approach for single-incident traumas, and is also effective for working with any dominant beliefs that are having a negative effect on a person’s life and mental health.

Before moving into the reprocessing and desensitization phases of EMDR, it’s crucial for folks to be stable and have access to a strong set of coping tools to help them stay within their Window of Tolerance. But as I mentioned above, working in Phases 1-3 with an AIP lens is still important EMDR work. 
 

Questions?

EMDR can be an extremely powerful approach, but the details can be confusing, and it can feel completely different from other forms of therapy that you may be familiar with. I hope this blog helped to clear up some confusion and get you excited for the possibilites that EMDR can bring. 

If you’re interested to learn more, reach out to learn more about individual therapy or consultation.