Eye Movement Desensitization and Reprocessing (EMDR) is a specialized therapy approach, involving 8 Phases, that first requires screening and an assessment process to evaluate appropriateness and readiness before beginning the 8 Phase process. This is determined by a protocol that is mandated by EMDR International Association, which governs the standards and ethics of EMDR practice. The screening and assessment process can take up to 2-4 sessions, just as any other therapy approach, to formulate a diagnosis and treatment recommendations. Afterwards we can determine whether to proceed with EMDR, using the 8 Phase protocol. Note that the protocol and pacing can vary depending on the person and the needs that arise both in and out of sessions.
THE EIGHT PHASES OF EMDR THERAPY ACCORDING TO FRANCINE SHAPIRO
In the first sessions, your history and an overall treatment plan are discussed. During this process I will help identify and clarify potential targets for EMDR. Target refers to a disturbing issue, event, feeling, or memory for use as an initial focus for EMDR. Maladaptive beliefs are also identified (e.g., ʺI canʹt trust peopleʺ or ʺI canʹt protect myself.ʺ)
Before beginning EMDR for the first time, it is recommended that we identify and create a ʺsafe place,” an image or memory that elicits comfortable feelings and a positive sense of self. This safe place can be used later to bring closure to an incomplete session or to help with being able to tolerate a particularly upsetting session.
In developing a target for EMDR, prior to beginning the eye movement, a snapshot image is identified that represents the target and the disturbance associated with it. Using that image is a way to help you focus on the target. A negative cognition (NC) is identified, a negative statement about the self that feels especially true when you focus on the target image. A positive cognition (PC) is also identified, a positive self‐statement that is preferable to the negative cognition.
I will then ask you to focus simultaneously on the image, the negative cognition, and the disturbing emotion or body sensation. At this point I will typically guide you to follow two fingers with your eyes; my hand will move alternately from side to side so that your eyes also move back and forth. After a set of eye movements, you’ll be asked to report briefly on what has come up; this may be a thought, a feeling, a physical sensation, an image, a memory, or a change in any one of the above. In the initial instructions, I’ll ask you to focus on this thought, and begin a new set of eye movements. Under certain conditions, however, I may direct you to focus on the original target memory or on some other image, thought, feeling, fantasy, physical sensation, or memory. From time to time I may query about your current level of distress. The desensitization phase ends when the SUDS (Subjective Units of Disturbance Scale) has reached 0 or 1.
Installation: I’ll ask you about the positive cognition, and if it is still valid. After Phase 4, the view you may have had on the event/the initial snapshot image may have changed dramatically. Another PC may be needed. Then you’ll be asked to ʺhold togetherʺ the snapshot and the (new) PC. I will ask, ʺHow valid does the PC feel, on a scale from 1 to 7?ʺ New sets of eye movement are issued.
Body scan: I’ll then ask if anywhere in your body there is any pain, stress or discomfort. If so, you’ll be asked to concentrate on the disturbance or whatever may arise and new sets are issued.
Debriefing: I will give appropriate info and support.
Re‐evaluation: At the beginning of the next session, you will review the week, discussing any new sensations or experiences. The level of disturbance arising from the experiences targeted in the previous session is assessed. An objective of this phase is to ensure the processing of all relevant historical events.