EMDR - Part 2: The Nitty Gritty Deets
In the last EMDR post, I wrote about what EMDR is effective in treating or addressing, and why you might want to try it. In this post, I’ll share the details of what exactly the process of EMDR might look like for you.
First off, EMDR therapy involves eight* phases:
1. History and treatment planning: Gathering detailed history of life experiences, taking note of overwhelming experiences as well as themes and patterns, and developing a treatment plan around the main concerns identified between you and your therapist
2. Preparation: Identify and/or develop resources and skills to ensure you are ready for and can manage processing; Your therapist might introduce other skills, such as Dialectical Behavioral Therapy, to help you manage stressors and negative memories.
3. Assessment: Identify a memory to work on, and identify images, emotions, body sensations and beliefs that come up with that memory in order to develop a “target”:
- Determine a negative, or what therapists in the world of psychology would call "maladaptive," beliefs related to the memory. Then you would rate the level of distress for the memory or belief
- Determine a desired healthier, "adaptive" belief, and then you also rate that belief, this time how strongly you believe it.
4. Desensitization: Begin the work of re-processing memories/beliefs while bilateral stimulation (BLS) is applied (more on that later).
5. Installation: Work on increasing the strength of the healthier, adaptive belief.
6. Body scan: Scan your whole body for any remaining physical sensations.
7. Closure: Your therapist checks in, remind you of resources, and guides you back to the present focus
8. Re-evaluation: Reviewing shifts, identifying and processing additional targets, and continuing the process as needed. * Note that EMDR is not always a linear process and may not always follow this exact progression.
So, that's good to know, but what do we actually do in EMDR sessions?
Great question. With EMDR, instead of asking you to verbally recount your experiences, your therapist helps you to re-process your experiences and memories through emotions and body sensations. With this process, the intensity of your memory discomfort can decrease without the potential of feeling re-triggered by re-telling your trauma verbatim.
Essentially, we’re giving the brain the opportunity to reopen memories, and more appropriately process and store these memories and experiences. This allows the old, unhelpful emotions, beliefs, sensations and responses to be discarded and to shift to healthier, more helpful ones.
To do this, EMDR uses something called bilateral stimulation, or what we like to call: "BLS." BLS involves using alternating stimulation to activate the brain and to allow the two sides (the rational and the emotion-based) to communicate with each other.
This allows healthier connections to form in the brain, and allows it to more adaptively and accurately “file away” experiences.
BLS is administered through three methods:
1. With visual BLS, you may be asked to simply watch the therapist’s hand as it passes back and forth in front of your eyes, or asked to visually track lights that move back and forth on a light bar. 2. Tactile stimulation is done by using small vibrating devices that gently alternate from hand to hand while holding them.
3. Auditory stimulation is applied using headphones where alternating sounds occur in the ears.
Each of these modes of stimulation can be used independently or in combination.
To begin the process, your therapist asks you to pay attention to both the target experience/memory and the BLS being applied. While the BLS is applied, you're encouraged to let your mind wander, as the brain guides you where it needs to in order to heal. The BLS is applied for a brief period of time (generally between 10 and 30 seconds), then there is a break when you're asked to share what you're noticing - thoughts, feelings, physical sensations, etc. The process is continued until the emotional charge of the experience or memory has been reduced or eliminated. Sometimes the re-processing occurs all in one session, but often we continue working on the same, or a related target, during subsequent sessions to achieve full dissipation of the intensity of the memory or emotions.
Since EMDR aims to desensitize feelings and thoughts, and reduce their intensity, people often don’t notice huge, tangible changes immediately, but DO notice the absence of certain symptoms.
You may begin to notice that you're no longer triggered in the same way you once were, or that you feel comfortable talking about things you couldn’t before. You might notice that you no longer experience nightmares, or panic attacks, or that you're less likely to experience anger, fear, or guilt in response to certain situations. With EMDR, the power of the old, improperly stored memories and beliefs is taken away and replaced with healthier beliefs, and more adaptive responses.
You may experience a shift from a belief of: "I'm not good enough" or “I’m not in control” to a more adaptive belief such as: “I am more than enough,” “I am strong and capable,” or “I am worthy of good things.” Which is a pretty powerful thing.
To hear about EMDR from a client’s perspective you can read more here.
Stay tuned for a future post on what trauma is, how it’s processed and stored in the brain and body, and why EMDR is a helpful treatment for this.
Until next time, Paula
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[This article does not create a client-counselor relationship. This article is general counseling information and is not to be considered legal or medical advice. Please consult with your mental health professional before you rely on this information.]
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