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 the treatment of memories and cognitions (self-related beliefs and thoughts) that disturb a person, as well as emotions and bodily sensations, at the same time as the client is given a mutual, i.e., bilateral stimulus that promotes the processing of information. This causes the memory substance to begin to structure in the human brain during treatment in a manner that promotes his or her adaptation. Typically, one therapy session lasts 60 to 90 minutes and when using the basic protocol proceeds in the following steps[i]:
- History of the client and treatment planning.
- Preparation phase: the client is introduced to the mechanisms and procedures of eye movement therapy, and his or her mental resources are strengthened.
- 3. Subjective evaluation of the event to be processed, which proceeds in following stages: The customer selects the target memory to be processed and the associated image that best represents the disturbance associated with the target memory. Together with the therapist, the client looks for a negative cognition fit to the image that expresses a negative irrational belief in self in relation to that event (e.g., “I am bad”). The client looks for a positive cognition that fits the image, which is a more positive and realistic experience of themselves in the present, but in relation to that event (for example, “I am good enough”). The client evaluates the reality of the positive cognition at the affect level related to the image on a scale of 1 to 7, where 1 = not true at all and 7 = completely true. The customer recognizes the emotions evoked by the target memory. The customer evaluates the intensity of the disturbance sensation associated with the event on a subjective disturbance unit scale (SUD) of 0 to 10, where 0 = neutral and 10 = maximum disturbance (this measurement serves as a basis for evaluating the change during processing). In addition, the client tells where in his or her body he or she is sensing the disturbance (for example, “chest presses”).
- Desensitization: While the client keeps the image of the event, the negative cognition and the bodily sensations in his or her mind, the identified disorder is desensitized with bilateral stimulus sequences (BSS) until the disturbance of the image has been reduced to zero.
- Rooting: By keeping in mind the target memory and the positive cognition and providing bilateral stimulus, the client’s positive cognition is rooted in the memory being processed, until he or she feels the positive cognition in relation to the event as completely true on a scale of 1 to 7.
- Going through the body: the client is asked to keep in mind the target memory and the positive cognition and to go through their body in their mind to check if there is still tension left as body sensations in the body. Any remaining bodily sensations are processed with eye movements.
- Finishing: 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.
- Re-evaluation: 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 efficacy studies have shown the effectiveness of eye movement therapy, especially in the treatment of trauma, and that, compared to other therapies, the effectiveness of treatment is achieved significantly faster with eye movement therapy. It is obvious that eye movement therapy enables a deeper processing of emotions than traditional conversational therapy. The conditions for the effectiveness of treatment are the ability and desire to process emotions related to the target memory. The results of the treatment are permanent.
Links for further information:
EMDR Association Finland: https://emdr.fi/
EMDR Europe: http://emdr-europe.org/
EMDR Institute (USA): https://www.emdr.com/
[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