In this blog post, I will present the eight steps of EMDR therapy. I will refer to these steps in my future writings when describing therapy work. Eye movement therapy always uses a specific, precisely defined protocol, i.e., a treatment practice that proceeds in stages. There are different protocols for different mental disorders, but they are always based on a basic protocol. The use of the eye movement therapy should always be based on case-by-case consideration, in which is considered the appropriate creation of a therapeutical relationship, the examination of the conditions for using the method, the defining of the client's assets and resources, and the composing of a treatment plan.
Eye movement therapy focuses on processing disturbing memories and the cognitions connected to them, meaning beliefs and thoughts about the self, as well as emotions and bodily sensations. This takes place while the client is given bilateral stimulation that supports information processing. This helps the memory material begin to reorganise in the person’s brain during treatment in a way that supports adaptation. A typical treatment session lasts 60 minutes and, when the basic protocol is used, proceeds through the following stages:[i]:
- History of the client and treatment planning.
- Preparation phase: the client is introduced to the mechanisms and procedures of eye movement therapy, and their psychological resources are strengthened.
- Subjective assessment of the event to be processed, which proceeds step by step as follows: the client selects the target memory to be processed and the image connected to it that best represents the disturbance associated with the target memory. Together with the therapist, the client identifies a negative thought about the self that fits the image and expresses a negative, irrational belief about the self in relation to the event, for example, “I am bad.” The client then identifies a positive thought about the self that fits the image and reflects a more realistic experience of the self in the present moment, while still relating to the event, for example, “I am good enough.” The client rates how true the positive cognition feels emotionally in relation to the image on a scale from 1 to 7, where 1 = does not feel true at all and 7 = feels completely true. The client identifies the emotions evoked by the target memory. The client also rates the intensity of the disturbance associated with the event using the Subjective Units of Disturbance scale (SUD) from 0 to 10, where 10 = the highest possible level of disturbance and 0 = neutral. This measurement provides a basis for evaluating change during processing. In addition, the client indicates where in the body they notice the disturbance, for example, “there is pressure in my chest.”
- Desensitisation: while the client simultaneously holds the image of the event in mind, the identified disturbance is desensitised through sets of bilateral stimulation (BLS) until the disturbance associated with the image has decreased to zero or to a level of 1–2.
- Installation: the client’s positive thought about the self is installed into the memory being processed by holding the target memory and the positive cognition in mind at the same time, while bilateral stimulation is given until the positive thought feels completely true in relation to the event on a scale from 1 to 7.
- Body Scan: the client is asked to hold the target memory and the positive thought about the self in mind, and to mentally scan their body to check whether any tension remains in the form of bodily sensations. Any remaining bodily sensations are processed with eye movements.
- Closure: The therapy session is terminated, the client and the therapist discuss the session (e.g., what was achieved with it), and the client is instructed to identify and deal with any follow-up.
- Reevaluation: evaluation of the treatment’s results, when the client's overall progress, the changes achieved as a result of the re-treatment and permanence of the results of the treatment are assessed.
With the help of eye movement therapy, the memory that disturbs the client is combined into a larger memory network that promotes adaptation. The effects of therapy are both neurobiological and psychological: the treatment changes the memory experienced as disturbing to emotionally neutral and at the same time binds a positive belief about the person to it. The client often describes the experience in such a way that the image drifts away, goes farther, or shrinks, and he or she no longer gets a grip on it. The duration of treatment varies from case to case. Neutralization of a specific target memory that is difficult for a client can be achieved with a single 60-minute therapy session. However, the first appointment with the therapist is always used to map the client’s condition and make a treatment plan. Only in very acute crisis situations can eye movement therapy be used at the first treatment session to stabilize the client's condition.
Various effectiveness studies have demonstrated the efficacy of eye movement therapy, particularly in the treatment of trauma, and have shown that, compared with other forms of therapy, treatment outcomes are achieved significantly faster with eye movement therapy. Its range of use is broad, however, and in practice almost any memory or even thought that feels negative can be neutralised using the method. It is evident that eye movement therapy enables a deeper processing of emotions than traditional talk therapy. The prerequisites for successful treatment are therefore the ability and willingness to work through the emotions connected to the target memory. The treatment results are lasting.
See a more detailed presentation of the phases of EMDR therapy in the article. How does EMDR treatment proceed? The eight phases of the process.
Useful links
- EMDR Association Finland: emdr.fi
- EMDR Europe: emdr-europe.org
- EMDR Institute (USA): emdr.com
- EMDRIA: emdria.org
[i] The article (in Finnish) ”Silmänliiketerapian käyttö läheisen menetyksestä aiheutuneen komplisoituneen surun hoitoon” can be downloaded from here: https://www.duodecimlehti.fi/xmedia/duo/duo15751.pdf
