Eight Phases of EMDR

The eight phases of EMDR treatment start with the intake session to completion of treatment. This treatment can range from a few sessions (single-incident trauma) to several months/years of treatment (complex trauma). EMDR phases are not just for trauma. It is also effective with anxiety, depression, grief, panic disorders, and more.

Phase I – Client History and Treatment Planning

In this phase, rapport is built between client and therapist. Therapist assesses readiness for EMDR therapy based on safety factors, client’s interest, and client identifies target (past, present, future) based on clinician gathering thorough history.

Phase II – Preparation

Rapport continues to be built. EMDR therapy is explained, questions answered, and expectations set. Client selects form of Dual Action Stimulus (DAS). The DAS is a specific intervention that includes activating left-right brain hemispheres.  It may include eye movements, tapping, buzzers, sounds, etc. Therapist will guide client through Calm Place created and ensure client has ability to self-soothe and regulate if disturbing material arises. During this phase, any foundational therapy work will be done so that client is ready to proceed.

Phase III – Assessment

Target Formation: Client will choose each target to be reprocessed in a controlled and standardized way with support of the clinician. It is important to note that processing does not mean talking in detail about the incident. The EMDR client will identify parts of the target with support and direction from the clinician to be processed.

Step 1 – Client will select specific image or mental picture from the target memory that best represents the memory.

Step 2 – Client chooses a negative belief about self that is associated with the incident. Sometimes a person can know intellectually that the statement is false, yet this negative belief can still feel accurate when recalling the memory. These negative beliefs can negatively impact and are verbal indicators of disturbing emotions that still exist. Common negative cognitions include statements such as “I am unlovable,” “I am worthless,” “I am bad,” “I am stupid,” etc.

Step 3 – Client will choose a positive personal statement desired to believe. This will be determined with the help of clinician to create an effective and new positive belief. Examples include “I can succeed,” “I am safe now,” “I am worthy,” etc. A trained EMDR therapist will guide this process to ensure it is done correctly and explain the differences in cognitions should any questions arise.

Step 4 – Therapist will ask client to evaluate how true the positive belief about self on a Validity of Cognition (VOC) scale “1-completely false” and “7-completely true.”

Step 5 – Client will identify negative emotions (anger, fear, sadness, etc) and physical sensations (tightness in chest, stomach hurting, tightness in throat, etc) associated with the target.

Step 6 – Client will determine how strong the disturbance level is using a different scale 0 (no disturbance) to 10 (highest disturbance).  This scale is referred to as SUDS (Subjective Units of Disturbance).

Note – The goal of EMDR treatment is to have the disturbance level reduce (SUDS) while working to increase the validity of believing the new positive cognition (e.g. step 3 & 4, such as “I am worthy,” “I can succeed,” etc.)

Phase IV – Desensitization

The disturbing material is reprocessed by using Dual Action Stimulus (DAS) and following the EMDR appropriate steps. Again, the therapist will collaboratively work with the client to determine which DAS is recommended and appropriate.

This phase focuses on the client’s disturbing emotions and sensations, measuring them by the SUDS rating. This phase works with all responses (including other associations, memories, and thoughts that occur) as the targeted event changes and the disturbing pieces become resolved. This phase can also allow an individual to identify and resolve similar events that have occurred and could be associated with the target. The therapist will work with the client to resolve the initial target. Because of the associations and how the brain organizes information, often a client exceeds initial expectations and feels relief in multiple areas after completing EMDR sequences.

Phase V – Installation

The positive cognition and belief will be installed using the chosen DAS. The therapist will guide client to resolution of the target.  This positive belief will be strengthened through repetitive DAS, creating a new pathway in the brain and strengthening the positive new cognition.

Phase VI – Body Scan

Therapist will guide client through a body scan to identify any body disturbance and process with DAS. It’s typical to feel a lightness or positive change after working through the installation.

Phase VII – Closure

Therapist will go over what to expect between sessions, possible continued processing, and asked to keep a log of triggers if occur. For an incomplete session, client and therapist will wrap session up utilizing Container and Calm Place (without installation steps and no body scan done).

Phase VIII – Reevaluation

At start of next session, therapist will check on resolution of target material to see if continued processing is needed. Based on the client’s experiences, therapist and client will determine next steps in treatment plan of targets. Future templates may be considered for additional work. Client may be asked the following types of questions:

• Has the individual target been resolved?  (Therapist may again use the SUDS scale to have client rate level of current disturbance since last session.)

• Has associated material been activated that must be addressed?

• Have all the necessary targets been reprocessed to allow the client to feel at peace with the past, empowered in the present, and able to make choices for the future?

Additional possible outcomes:

• Clients may report positive integration of the EMDR therapy work in their cognitions, emotions, body sensations, relationships, energy level, spiritual connection.

• “Nothing or didn’t think about it at all.”

• “I feel lighter and have more energy.”

• Resistance or fear about the EMDR therapy that needs to be addressed. Note: It is important to talk honestly with therapist if this occurs.

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EMDR is a powerful tool to help client address more than just the past. The advantage of EMDR is that it can address all three areas in treatment – past, present, and future. It can give relief from past, deal with current symptoms, and work toward positive future change.  

Past, present, and future targets explained –Past: This includes using EMDR standard protocol to focus on past events that contribute to client’s present symptoms. EMDR can focus on adverse events that are distressing or activated without requiring the individual to talk in depth or go through negative details. This can be one incident or a cluster of memories to target.

Present: The second stage of work with EMDR focuses on present stimuli in the client’s life that trigger disturbing material or reactions. This may include relationship patterns.

Future: The final stage focuses on client’s ability to make new choices in the future, reducing anticipatory fear and strengthening a “positive template” of future behaviors and experiences.