What happens during an EMDR therapy session?

In my therapy practice in Chicago, a fair number of my clients express interest in Eye Movement Desensitization Reprocessing, or E.M.D.R. for short. They may have heard about this therapy technique, which specifically targets traumatic experiences. Although counseling can also help clients resolve trauma, EMDR is more systematic in its’ approach. If you’d like to read more about what EMDR is, you might want to check out the page on my website dedicated to this subject. I also include links to the EMDR Institute’s page, for even more information.

Knowing that EMDR could be a useful technique, and actually picturing what it’s like in a session are two different things, though, so I thought it would be useful to give a description here.

IDENTIFYING EMDR TARGETS
Prior to beginning EMDR, we will discuss whether EMDR is right for you, and I may give you some assignments to work on at home. A common assignment I give is to identify a list of approximately 10 situations or struggles that you would like to target in a specific way. This list should then be rank-ordered from most to least upsetting to you in the present. As I discuss below, when identifying traumas, a trauma can be a single incident (e.g. sexual assault) or it could be a chronic condition (e.g. “my mother drank a lot when I was little and didn’t pay attention to me.”)

PREPARATION FOR EMDR COUNSELING
Before actually using EMDR in a session, I like to introduce the equipment I use for this technique. This can make the process a lot less intimidating. As you may have read, EMDR works by stimulating both sides of the body, thereby stimulating both halves of your brain. I use equipment that produces a back-and-forth stimulation through small tappers you hold in your hands, or through headphones that you wear. The volume, speed and intensity can be adjusted. It looks a little like an old Walkman. We will also practice a relaxation exercise using the equipment, and this can be especially helpful both in getting you used to the process, and in finding healthy ways to relax even during times of stress. Finding healthy ways to cope with stress is important during any therapy process, because bringing up unpleasant memories and beliefs can generate stress in and of itself. We will want to make sure that you have enough support to get through the week between sessions, and of course it is always okay to call your therapist between sessions if you need to touch base.

You can see my equipment, as well as a picture of me demonstrating and discussing EMDR here.

USING EMDR DURING A THERAPY SESSION
Once we begin EMDR, a typical session will go like this: First we will identify the topic or event that we will be targeting that day. This may be a continuation from a previous session, if we ran out of time. I may gather some information from you as I ask you about various aspects of these memories, such as determining how upsetting it is to you to recall them, or how you may have “internalized” these events (more on that in a moment).

Once we have identified a target, I will help you walk through various aspects of this event. This is what I like most about EMDR, as it truly helps my clients identify and address all the aspects of a trauma, in 365 degrees. These different aspects include a visual memory, negative thoughts you associate with the target, a more adaptive or positive thought you would like to believe, how your body feels, and any emotions that come up for you. When I refer to a negative thought or belief, this is what I mean by “internalizing.” We all experience unpleasant or even frightening things in our lives from time-to-time. Ideally, we can make sense of this experience without it impacting our sense of self or our relationship with the world or with others overly. In other words, we can have bad things happen to us but still feel fundamentally okay. But for some people, these events become crystallized into a negative belief about the self or your experience of the world (e.g. “I’m never good enough,” “Bad things always happen to me,” “I’m unattractive,” etc.). EMDR doesn’t work when you make a general statement about the event, such as “getting raped was scary.” It makes sense that an event like that would be terrifying, but how is it still impacting you today? EMDR helps you re-process these beliefs, and identify more positive beliefs to replace them with.

In identifying more adaptive or positive beliefs, please keep in mind that you may not actually believe them at the beginning of treatment. Of course not! Your mind has been traumatized, and it’s tough to see or believe them. I think it’s actually more effective when you don’t believe the positive statement, because it means we’ve really identified places in your life that you’ve gotten stuck. An example of positive beliefs may sound like “I’m surrounded by loving people who care about me,” “I have love and support in my life,” “I’m attractive,” “I did the best I could,” etc. I often refer to these statements as “I-statements” because EMDR works best when you identify a belief in the most personal way possible “I…..” Even if you don’t believe it, it’s important for now just to be able to name a thought you would like to have, and to make that thought as personal as possible.

Once I get a baseline in terms of identifying a target and how you think and feel about it, and cue into any bodily sensations you may be experiencing, I will ask you to think of your target image and I’ll turn on the EMDR equipment. You will already be familiar with the equipment from previous sessions. It’s important to just let your mind wander, making any connections or associations that you wish. Sometimes I’ve noticed that clients will get “stuck” in this phase, since I ask them to think about a specific target, they think they need to think about that one thing and nothing else. It’s actually better to let your mind wander, and not to try to control the process at all. There is no right or wrong way to do EMDR, so really let yourself go.

After a minute or two, I’ll stop the equipment and check in with you. I’ll make a brief note of where your mind wandered to, and this can be helpful for me in getting a sense of the kinds of connections you make in your own mind. For example, if I have a client who is targeting a painful recent break-up, perhaps the negative belief may be “no one ever sticks around.” During processing, she may spontaneously begin to think about her parents divorce, and how that separation and loss was painful for her in a similar way. This can be a valuable insight that can help her understand why her current break-up has been so very painful for her.

After checking in, I’ll turn the equipment back on and have you continue to free associate. Sometimes I might tell a client to keep going, sometimes I may make a suggestion to focus on a particular aspect of what we’re exploring. When I do that, it’s important to use that as a starting place, but continue to let yourself think whatever pops into your head spontaneously. A lot of an EMDR session flows like that- turning the equipment on, processing thoughts and feelings while being bi-laterally stimulated, and then taking short breaks to check in with your EMDR counselor.

Because we are targeting very painful memories and beliefs, powerful emotions can come to the surface during a session. Although it’s uncomfortable- I once had a client say she wanted to jump out of her seat and run away from the session (she didn’t ;)- this is a healthy and important part of the process. This is the “Desensitization” part of EMDR. Tolerating these powerful emotions, while simultaneously being aware that you are perfectly safe, choosing to target these memories with a safe person in the room and the ability to stop and take breaks allows this material to become less emotionally reactive over time. However if this gets too overwhelming, please know you can stop this process at any time. You are in control, and you can take the equipment off or ask to stop. That’s perfectly okay. EMDR isn’t like being hypnotized, you are in control the whole time.

Usually as EMDR progresses, you will make spontaneous new insights and begin to notice that you feel less overwhelmed recollecting aspects of our chosen target, or thinking about related memories that are painful or unpleasant. That’s great! Your mind is beginning to heal. It’s at this point that I will usually bring you back to the original target. It’s my goal at this point to trigger as much unpleasant associations as I can, so we can allow them to surface and for them to become desensitized. I may even make statements encouraging you to relate the target to other unpleasant life events, to see if there are connections between them. This is tough stuff!

If we don’t have enough time in one session to get to get all of the negative material to the surface, as is often the case, I will monitor the time and suggest switching gears to wind down the session. I’ll switch the processing to the relaxation exercise we established in the sessions before beginning EMDR, so that you won’t leave session feeling raw and exposed, but instead leave feeling as relaxed as possible. Don’t worry, we’ll pick back up where we left off next session.

Over the course of the session (or several sessions, if we run out of time), I may notice that the negative associations and feelings are slowing down significantly, or even stopping. When this happens, it’s time to move into the “Reprocessing” part of EMDR. I’ll remind you of the positive statement you identified before we began processing, and ask you if it still “fits” all the material we processed during the EMDR session. I’ll give you a chance to revise it, and often these statements do get tweaked at this point, since so many new insights have been made, you may want to find a statement that matches more perfectly the new insights you’ve generated. I’ll turn the equipment back on, usually at a much slower speed, and ask you to process this positive statement. This often feels great, as warm and positive feelings come to the surface and take hold. Sometimes we may also identify blocks to these beliefs, and we can target them so you can truly learn how to see yourself and your world in a new and more positive way.

After an EMDR session, you may continue to process old material in new ways. That’s terrific! Some people may notice their memory become stronger, or conversely it may become less reactive or fades after processing. Some insights you make may be unpleasant, or you may have bad dreams, so please make a note of these and bring them into the next session, or call your therapist in between sessions if it gets overwhelming. As an example, I once worked with a young man who had been molested, but never reported this experience to anyone. After processing, he felt ashamed that he hadn’t reported it, and wondered if any other boys had been harmed after him. This was an example of a spontaneous new insight he made, as this thought had never occurred to him before. We were able to target this the next session and get successful resolution around this, as he realized that he was traumatized and did the best he could as an innocent child who felt overwhelmed by being molested, and didn’t have enough family support to feel safe reporting his abuser. Other people report feeling lighter and more free, like a burden has been lifted. Often right after a session, you may feel a little drained. It’s probably not a good idea to schedule EMDR therapy on your lunch break, and then go straight back to work. Find a time when you can carve out time and space to relax. Be gentle with yourself! You’ve doing some great work. Go home, relax, and take good care of yourself for the rest of the day.

RESOLVING ISSUES USING EMDR
When I talk about “resolving” trauma, I mean a few different things. First, we should work together to get you to a place where you have an integrated and seamless life narrative, without leaving parts of your story out or avoiding parts of your own experience. Sadly, a lot of people feel so upset or ashamed of what they have gone through that they avoid certain topics or memories, not just in conversations with others, but even inside themselves. This kind of avoidance takes a huge toll. Secondly, you should get to a place where you can recall certain unpleasant parts of your life without as much emotional reactivity as in the past. It might be healthy and appropriate to still tear up from time-to-time, but there shouldn’t be a sense that remembering certain things is so overwhelming that you begin to break down. If trauma has caused a lot of other unpleasant side effects in its’ wake- low self-esteem, trouble building trusting relationships with others, high anxiety or worry all the time- good trauma therapy including EMDR should help you let go of these symptoms. You may also find that you think about what has happened to you in a new way, as you develop new insights and let go of negative beliefs or thought patterns.

WHAT DEFINES TRAUMA?
There are a few other points I would like to note. When we talk about “trauma,” we often think of the cause being a major traumatic incident that is potentially life-threatening. These events can often change a person’s life in an instant. Examples include a sexual assault or physical assault; witnessing a violent crime; being raised in a violent or neglectful home; being exposed to domestic violence, war or combat situation; or near-death experiences such as a major accident or illness. Sometimes being exposed to these kind of events leads to the development of Post-Traumatic Stress Disorder, or PTSD for short.

We also know that sometimes less than life-threatening situations can still be traumatic, especially if the situation is chronic. One common example that has gotten a lot of media attention lately has been the effects of bullying on LGBT teens, especially following the tragic suicides of several teens. In many of these cases, the teens in question weren’t necessarily exposed to life-threatening situations, but the chronic effects of being humiliated through teasing and bullying over time left the victim with major damage to their sense of self (identity), self-esteem, trust in others, and their sense of safety and security. This, in turn, can create or worsen anxiety and depression, creating a negative downward spiral. This is what I mean when I refer to “being traumatized”- all of the negative qualitative and cumulative effects that these kinds of incidents produce in a person’s life over time. Keep in mind also, that people who have lost trust in others or feel badly about themselves may begin to isolate themselves socially, or drink more heavily, or do any number of things that help them feel better or avoid pain for the short-term, but are likely to produce worse symptoms over time. Knowing more about trauma may help you find good targets for your EMDR sessions.

Targets for EMDR don’t necessarily need to involve trauma, either. EMDR can address other kinds of issues as well. Any negative self-talk that involves a negative belief system and unpleasant or overwhelming memories can be used. A few examples of issues I’ve helped clients work on using this technique include body image issues and a fear of relapsing into old compulsive behaviors (addiction). I can help you decide how to target these issues using EMDR.

EMDR WITH PEOPLE IN 12-STEP RECOVERY
A word about substance abuse: As a drug and alcohol abuse counselor, I have observed that many of my clients have also been traumatized during their using or drinking days. There can be tremendous shame around events that have happened during drug use or alcohol intoxication, especially if a person feels at least partially responsible for the choices that they made. Part of our counseling may need to focus on resolving these traumas. This can be tough to talk about, and sometimes processing traumas can feel like re-living them- very painful. That’s why it’s important that any person doing this work be stabilized in their recovery. It’s also important as a part of this process to remember that drug addiction and alcoholism is a disease that affects, first and foremost, the brain, which can truly impair the ability to make good choices. You are not responsible for your disease, but you are responsible for your recovery. You may want to discuss with your therapist the best way to integrate your 12-step work with your mental health counseling.

TALK THERAPY OR EMDR?
EMDR is not for everyone. For example, if you’re currently going through a crisis in your life, it might not be the best time to use a technique that encourages you to remember all the terrible aspects of traumatic things that have happened to you in the past. It might just be too much, and too overwhelming all at once. For clients that have been in talk therapy for a while, the transition from psychotherapy to switching to using EMDR may feel awkward at first, and some people don’t like it. Usually during EMDR sessions, there is far less direct interaction with your counselor, because a lot of processing happens internally rather than being processed out loud through conversation. This can feel to some people like they are more disconnected from their therapist than before.

Sometimes EMDR is used with terrific results in an inpatient chemical dependency setting or detox facility, but that doesn’t always mean that a person would be appropriate for continuing this work right after discharge on an outpatient basis with a therapist neccesarily. The reason for this is that an inpatient setting provides a lot of safety, especially around potential for relapse. If your therapist determines that it might be best to wait a month or two to establish a trusting relationship with a Sponsor, or perhaps work through a 4th step first, that is probably good advice.

Sometimes your coping skills in general need work before starting a EMDR process. If you’re drinking too much to cope, or engaging in other unhealthy behaviors, then a better starting place would be to help you find other ways to deal with stress before beginning EMDR.

Lastly, some people cope with excessive anxiety and stress by disassociating or numbing out / spacing out. Usually what that means to me as a therapist is that the stress has become so overwhelming that your system goes on shut-down. Usually in that case we would want to help you find better ways to cope and establish “grounding techniques” before beginning an EMDR process.

If you’d like to learn more about my practice, why don’t you start here. My psychotherapy practice in Chicago focuses on addictions, trauma, EMDR, anxiety, depression, relationship conflict, and LGBT issues. My therapy office is in the Lakeview /Uptown area (60613 zip code). I hope that you’ve found this post helpful in exploring whether or not EMDR might be right for you.