The therapist's guide to EMDR

In the late 1990s, Francine Shapiro, PhD, developed a form of psychotherapy called eye movement desensitization reprocessing (EMDR). Listed as a “best practice” for treating veterans with PTSD by the US Department of Veterans Affairs and Department of Defense, EMDR has proven its value in a number of clinical trials in the years since its inception.^[]

Mental health professionals who use EMDR can best serve their patients by creating a supportive therapeutic relationship through patient-specific accommodations.

Adaptive information processing model

If you’re new to EMDR, the first thing to know is that this form of therapy is based on an adaptive information processing (AIP) model.

According to a 2021 article published by Frontiers in Psychology, the AIP model centers the brain’s tendency to heal when harmed—much like how the body immediately responds to a papercut.^[]

But when adverse life experiences overwhelm the brain’s information-processing system, it struggles to reach a resolution, causing the memory of the negative experience to maladaptively encode. The undesirable symptoms of this failure to process are what HCPs focus on in EMDR therapy.

8 phases of EMDR therapy

An article published by the Cleveland Clinic states that EMDR is composed of eight phases:^[]

1. Patient history and information gathering. This initial phase enables you to learn and document information on your patient and their past. With the patient, you’ll determine whether EMDR is right for them. If it is, you can delve into disturbing memories that could serve as the basis for treatment. This is also a good time to set goals with the patient.

2. Preparation and education. Phase two is when you talk through the EMDR process with patients. Let them know what they can expect throughout the course of treatment, and provide them with a set of tools for managing emotions as they surface.

3. Assessment. This phase is dedicated to parsing through specific memories to identify recurring themes. Help your patient notice the negative cognition associated with the memory, and identify the positive cognition they’d like to reach through treatment.

4. Desensitization and reprocessing. Phase four entails walking your patient through their memory and asking them to identify any bodily sensations that arise as the imagery becomes clear. You’ll also guide your patient to new insights about the memory that could help them reprocess it.

5. Installation. This is the phase in which you implement the patient’s positive cognition or belief from phase three into the reprocessing of a memory.

6. Body scan. In this phase, you check in with your patient’s bodily sensations. Any negative side effects or emotions that come up should decrease with each treatment until they dissolve (or get as small as possible). This is how you know you’ve finished processing.

7. Closure and stabilization. This phase serves as the “bridge” between sessions. Here, you teach your patients about what might surface, as well as how to self-stabilize. Ask them to document what comes up for the next session.

8. Reevaluation and continuing care. In the final phase, you summarize your patient’s progress, and determine if they will need additional treatment. You may also give them tips on how to handle emotional hardships in the future with their new self-knowledge.

Protocols for best practices

Throughout the phases of EMDR, mental health professionals can enhance treatment by tending to their therapeutic relationship with patients.

As noted in Frontiers in Psychology, the therapeutic relationship is just as significant as the treatment itself.

As such, therapists and mental health professionals can accommodate their patients as needed.

When you establish cultural, racial, religious, and spiritual accommodations for patients, there is a greater likelihood of a positive outcome, according to the research.

It’s also important that therapists who facilitate EMDR remain aware of their patients’ experience during sessions. Pay close attention to their nonverbal gestures and help them co-regulate as needed. You can achieve this through eye contact and maintaining a mindful presence as the session unfolds.