The Eight Stages of EMDR

If you’re reading this, chances are you’re interested in pursuing EMDR therapy. Maybe you’re in the early stages of your exploration, or maybe you’ve already heard about the eight stages of EMDR. Either way, this post will help clarify each stage of EMDR, giving you more confidence to decide if EMDR is right for you.

Just in case you need a refresher on what EMDR is, you can read my post “Three Types of Trauma Therapy.” There’s a section that gives an overview of EMDR and will help you understand the content in this post.

Phase 1: History and Treatment Planning

The first step in EMDR is getting a good client history and creating a treatment plan. This means the therapist learns about the client’s past, assesses the client’s symptoms, and works with the client to establish their goals.

The therapist should also provide the client with an overview of EMDR and allow them to ask any questions they may have. Additionally, it’s crucial that the client and therapist begin forming a strong alliance with each other. Depending on the client’s history, this phase could last a few sessions or take several months.

Phase 2: Preparation

EMDR can be an intense process. As such, it’s important that clients have an abundance of resources they can use to manage their distress.

Phase 2 is devoted to helping clients develop these resources. Mindfulness techniques, DBT skills, and breathing exercises are all common techniques that therapists teach clients during this stage.

There are also skills developed specifically for EMDR. Therapists commonly call these skills “resourcing” because they are designed to increase the positive resources clients have to manage their distress.

Some common EMDR resourcing techniques are developing an imaginative calm/safe place, creating a mental “container” to “hold” one’s distress, and developing protective/nurturing figures who will help clients on their healing journey.

One hallmark of EMDR resourcing is applying slow bilateral stimulation (BLS) to “strengthen” these resources. You can check out this video of an EMDR therapist creating a calm place with a client to get a clearer picture of what this looks like.

Once the client and therapist agree that the client has sufficient resources, it’s time to begin Phase 3.

Phase 3: Assessment

EMDR works when unprocessed memories are brought into the present to be processed. It’s not enough to simply think about a distressing memory – it needs to be alive and active for EMDR to move it into long-term memory.

Phase 3 helps bring memories into the present. In EMDR, there is a standard list of questions therapists ask to “activate” the memory. These questions are:

• What is the worst part of the memory?

• What is a negative belief you have about yourself when thinking about this memory?

• What would you prefer to believe about yourself instead?

• On a 1-7 scale, with 1 being completely false and 7 being completely true, how true does this positive belief feel to you?

• What emotions are you feeling?

• On a 0-10 scale, with 0 being no distress and 10 being the worst distress you can imagine, how distressing is this memory?

• Where do you feel this memory in your body?

Remember, these questions bring the memory into the present. Therapists are concerned with how clients experience the memory currently, not when the event actually happened.

Once the memory is activated, it’s time to immediately move into Phase 4.

Phase 4: Reprocessing

Reprocessing is where most of the EMDR magic happens. As the client continues to think about the distressing memory, the therapist will begin to apply BLS. Each application of BLS is called a “set.” Some sets will be longer or shorter depending on what the client is experiencing.

There are several ways to apply BLS. Originally, the therapist moved their hand quickly back-and-forth across the client’s field of vision while the client tracked this movement with their eyes. Now, many therapists utilize paddles that gently buzz in the client’s hands.

During a set, the client will likely notice a change in their thoughts, feelings, or levels of distress. The mental picture of their distressing memory may also change. Their job is simply to notice what is happening.

One metaphor therapists often use is watching the landscape move while riding on a train. Similar to being a train passenger watching the scenery change, the client’s job is to sit back and allow their brain to work – they just have to notice it happening.

Phase 4 continues until the memory is no longer distressing and the client can confidently rate it as a “0 out of 10.”

Phase 5: Installation

After the memory is no longer disturbing, it’s time to begin the Installation phase. Remember when the therapist asked, “What would you prefer to believe about yourself instead?” in Phase 3? This positive belief is “installed” in Phase 5.

As they think about the same memory from Phase 4, clients also repeat this positive belief to themselves as the therapist applies BLS. Sets are repeated until this positive belief feels completely true.

Phase 6: Body Scan

Trauma can be stored in our bodies, meaning we may experience physical reactions and sensations when disturbing memories are triggered. Phase 6 is about making sure the client’s body is no longer storing any trauma from the memory they are processing.

At the start of this phase, the therapist will invite the client to think about the memory and mentally scan their body, starting at the top of their head and slowly working their way down to the bottom of their feet.

If the client notices any tension, anxiety, or unusual sensations, the therapist will apply BLS while the client focuses on the sensation. This continues until the client’s body feels free of any distress.

Phase 7: Closure

Phase 7 occurs at the end of every EMDR session. The therapist and client review the client’s takeaways from processing, focusing on what the client learned and how he or she experiences the memory differently after processing.

If the client is experiencing any distress, the therapist will encourage them to utilize coping skills they learned in Phase 2 to manage their distress.

The therapist should create a plan for the client’s next session and have safeguards in place should the client experience any distress between sessions.

Phase 8: Reevaluation

At the start of every EMDR session, the therapist and client will reevaluate the memory the client processed in their last session. If the memory is still distressing, they will resume processing it. If the memory is no longer distressing, they can select a new memory to begin processing and begin at Phase 3.

This cycle continues until the client is no longer experiencing symptoms and their therapy goals have been achieved.

Some Final Thoughts

EMDR is an amazing therapy tool, but it’s not something to be taken lightly. If you’re considering EMDR, it’s important to find a therapist who has good, reputable training. I was trained by the EMDR Institute, Inc., the organization founded by the creator of EMDR, Dr. Francine Shapiro.

If you’re a therapist who’s getting trained in EMDR, you can download a handy Eight Stages of EMDR guide I created to help you as you’re learning.

If you’re interested in starting EMDR, you can contact me to learn more about how I can help you take the first step.