What to Expect in Your Initial EMDR Therapy Sessions

"EMDR is the most revolutionary, important method to emerge in psychotherapy in decades." - Herbert Fensterheim, Ph.D., Cornell University

If you're reading this, you're likely considering EMDR therapy, but want more info about how it works and its effectiveness, or still many have reservations about how it works, if it works well, how much it would cost, and the time commitment it would entail. After you and your EMDR therapist agree that EMDR therapy is a good fit for your presenting issues, in phase three, one to five sessions in, you will be asked to focus on a specific traumatic or distressing event.

Face child

Source: Gerd Altmann/Pixabay

Then, your therapist will ask you about the emotional and physical residue resulting from the event, specifically the negative image, self-referencing belief, and body feeling related to it, and then to a positive, self-referencing belief that would indicate the issue was resolved. This positive belief usually doesn't feel true viscerally before the EMDR session but will feel true after EMDR on this particular memory is complete. While you focus on the event, your EMDR therapist will begin sets of side-to-side eye movements, sounds, and/or taps. All of these can be done seamlessly online.

Pre-pandemic, EMDR online was fringe, and now it is increasingly common. You will then will be guided to notice what comes up in your body and mind after each round of dual-attention stimuli lasting 20-120 seconds. You will likely experience shifts in body sensations, insight, or changes in images, feelings, or belief(s) regarding the event being targeted with EMDR therapy.

As the client, your therapist will remind you that you have full control to stop, pause, slow down, or speed up the process at any point as needed. A useful metaphor is being on a train with your therapist: I would be in the seat next to you the entire time, the train is fully stocked, so we have what we need along the way, and we are in first class. Notice along the way if you are still in the train with me or if you’re in the scenery that you are noticing outside the window. You'd notice if the scenery is coming closer or if the train window (barrier) is gone.

Lastly, there is an emergency cord along the top of the train car. You can pull this at any time to stop the train. Because we would be in first class, you can even ask the conductor to slow the train down, go faster, or stop and take a break. If we are going through a tunnel, which may be scary and dark for a while, remember that there is always a light at the end. You may want to stop in the tunnel, or you may want to push to get through it. You would get to decide.

The sets of eye movements, sounds, or taps are repeated until the event becomes less disturbing, as indicated by the SUDs scale (subjective units of distress), where 10 is the highest disturbance possible, and 0 is neutral or no disturbance. Then, you will continue processing with the rhythmic movements (dual-attention stimuli or bilateral stimulation) mentioned above until the positive belief feels 100 percent true, and your body is totally calm when focusing on the event and its associated image.

A typical EMDR therapy session lasts from 60-90 minutes, give or take. EMDR therapy may be used within a standard talking therapy, as adjunctive therapy with a separate therapist, or as a treatment all by itself. There are eight phases to EMDR therapy: initial history discovery and treatment planning, preparation, assessment, desensitization, installation, body scan, closure, and then reevaluation. Healing these memories will help you manage and navigate your life from the wise, strong, and capable adult you are, instead of as the wounded child.

Pro tip: be prepared for mental and physical exhaustion after certain sessions. Have an "after therapy" plan, such as rest, hiking, Netflix, etc. I've had clients that have dealt with prolonged agitation, and seldom certain pains and aches (psychosomatic symptoms) that can linger for minutes, hours, and/or days after session. If you tend to have physical aches/pains, please inform your physician that you're planning on getting EMDR therapy. Keep your health professionals apprised of your symptoms you can use the TICES log to track symptoms. Keep in mind of these symptoms, if fully psychosomatic and not organic or medical by origin, will usually decrease and abate as therapy progresses.