EMDR begins with a discussion between the client and therapist about the reasons they are seeking therapy. The therapist will explain how EMDR might be used to help address their issues. The therapist takes a patient history so they can develop an effective treatment plan that is sensitive to the client’s needs. During phase one, the therapist will also assess the client’s internal and external resources.

During preparation, the therapist explains everything about the EMDR process, including terms they might use. This is also the time to set expectations. The client may ask any questions they have about EMDR.

The client and therapist collaborate to plan specific coping techniques in case the therapy causes emotional disturbance. Phases one and two may move slowly, but it is important the client feels confident in the EMDR process before moving to phase three.

In this phase, the client and therapist work to identify what is referred to as the “target event.” The client will share any feelings, images, beliefs, or other sensations they associated with this event. The therapist uses the Subjective Units of Disturbance scale (SUD) and the Validity of Cognition scale (VOC) to create a baseline measurement that is used to assess improvement as therapy progresses.

Phases four, five, and six are referred to as “reprocessing” phases and involve a technique known as bilateral stimulation, which may include sounds, taps, eye movements, or other techniques intended to activate the client’s information processing system while keeping them grounded and aware in the present moment.

During desensitization, the therapist begins bilateral stimulation as the client focuses on the target event. Bilateral stimulation continues until the client registers zero on the SUD.  New sensations, feelings, beliefs, and images may emerge at this time.

Installation begins once the desensitization process is complete. During desensitization, the client attaches positive beliefs to the target event until those positive beliefs feel true.

For example, a client’s original belief about a traumatic event might be something like “That happened because I am unlovable and deserve to be mistreated.” The new belief being installed might be “I deserve to be loved and treated with respect.”

Body scanning refers to the client simultaneously holding the target event in their mind, holding the newly installed positive belief in their mind, and mentally scanning their body from head to toe to detect any lingering physical disturbance or discomfort.

Physical sensations help to indicate how fully the triggering event has been reprocessed. The VOC scale is used to measure the results of a body scan. A patient who feels absolutely no uncomfortable sensations would measure VOC=0.

Every EMDR session ends with closure, during which the therapist helps the client return to a calm state of mind. Closure is performed even if the reprocessing is not complete.

It may take several sessions to fully reprocess a triggering event (meaning their feelings about the event are neutral and their body is clear of disturbance). However, closure after each session is important to help the client process the events of a single EMDR session and regain emotional balance before leaving the therapist’s office.

Each new session begins with reevaluation. During this process, the therapist and client discuss the previous EMDR session and processed memories. The goal is to ensure that distress levels have remained low and the positive installation continues. 

EMDR therapy is not a straight line. In some cases, new beliefs or sensations about the targeting event will arise between sessions and the positive installation will weaken. It may be necessary to repeat the steps of reprocessing several times before the event is fully reprocessed and the new positive belief remains firmly installed.