What Happens During an EMDR Session?

If you are considering Eye Movement Desensitization and Reprocessing (EMDR) therapy, you may wonder exactly what happens once you sit down with your therapist. Does EMDR involve talking about a traumatic event? Is it hypnosis? And how are you supposed to feel during and after EMDR?

What happens during an EMDR session depends partly on where you are in treatment. EMDR is a structured psychotherapy with eight phases that you gradually move through. Early sessions may focus on your history, goals, coping resources, and readiness. Later sessions may involve focusing briefly on a distressing memory while engaging in bilateral stimulation, such as guided eye movements, alternating sounds, or tapping.

EMDR stands for Eye Movement Desensitization and Reprocessing. It is a structured psychotherapy approach developed to address distress associated with difficult or traumatic experiences.

During the reprocessing portions of EMDR, you may briefly focus on aspects of a distressing memory while simultaneously paying attention to alternating stimulation. This is known as bilateral stimulation, or BLS.

Bilateral stimulation may involve:

• Following the therapist’s hand or another visual target from side to side
• Alternating taps
• Alternating sounds or tones

A typical EMDR session may look quite different depending on how far you have progressed in treatment.

Your first appointment, for example, generally will not involve immediately choosing your most upsetting experience and beginning eye movements. Your therapist first needs to understand why you are seeking treatment, relevant aspects of your history, your symptoms and goals, and whether you are ready for reprocessing.

During a later reprocessing session, you and your therapist may identify a particular memory or experience to work on. You may be asked to notice an image associated with the memory, the negative belief connected to it, your emotions, and sensations in your body.

I like to tell my clients that your brain knows how to process things, we just have to help guide it to accessing the proper neural networks used for reprocessing. The bilateral stimulation helps to do this. Once the bilateral stimulation begins, you will be encouraged to witness the thoughts that naturally come up and every so often share what you are noticing. During this time, the therapist is monitoring for specific things that indicate the memory is effectively getting reprocessed.

Once a memory is fully reprocessed it should feel more “neutral”. — This is typically when someone may ask “How will I know when I feel neutral about the memory?”

To answer this question, I pose a metaphor:

Let’s say you’re on a playground as a kid and you fall and get a deep cut on your hand. It doesn’t get fully clean and then heals incorrectly. For a long time, anytime something brushes up against it, it’s pressed on or poked at, it becomes inflamed and activated for a while. With EMDR we are essentially going in, cleaning out the cut, and healing it into a scar. You can still remember how badly it hurt when you got the cut, you can remember how you got it, but when you poke at it or examine it, it doesn’t hurt present day.  

EMDR aids in decreasing how “triggering” or distressing a memory is to you in the present.

EMDR therapy follows eight phases. These phases provide structure, but they should not be interpreted as eight appointments. Several phases can occur within one session, while other phases may require multiple appointments.

The amount of time devoted to each phase varies considerably between people.

1. History and Treatment Planning

EMDR begins with understanding you and what brought you to therapy.

Your therapist may ask about your current concerns, symptoms, important experiences, treatment goals, strengths, support system, and relevant personal history.

You do not necessarily have to give an exhaustive account of every difficult experience. The therapist is gathering enough information to develop an appropriate treatment plan and identify possible treatment targets.

A “target” in EMDR is an experience or memory selected for reprocessing. Treatment can also consider current triggers and future situations that you want to handle differently.

Your therapist will also consider your resources and readiness before beginning reprocessing.

2. Preparation

Preparation is an important part of EMDR.

Your therapist will explain how EMDR works, what you may experience, how bilateral stimulation will be used, and how you can communicate if you need to slow down or stop.

You may also practice strategies for managing emotional distress and returning your attention to the present.

Preparation may include techniques involving breathing, mindfulness, guided imagery, or a “safe/calm place” exercise. The exact approach depends on your needs and your therapist’s clinical judgment.

Some people move through preparation relatively quickly. Others need more time before beginning memory reprocessing.

There is no benefit to rushing simply because you believe you are “supposed” to reach the eye-movement portion quickly.

3. Assessment

Once you and your therapist decide you are ready to work on a target, the assessment phase helps define what you will focus on.

Your therapist may ask you to identify:

• A particular memory or experience
• An image representing the most distressing part
• A negative belief connected with the experience
• A preferred positive belief
• Emotions associated with the memory
• Physical sensations you notice
• Your current level of distress

4. Desensitization

This is the phase many people associate most strongly with EMDR.

You bring the target experience to mind while engaging in bilateral stimulation. Depending on the method your therapist uses, this might mean following something from side to side with your eyes, hearing alternating tones, or experiencing alternating taps.

Your therapist typically pauses between sets and asks what you notice.

There is not necessarily a “correct” response.

You might notice:

• A new thought
• Another memory
• A change in emotion
• An image
• A physical sensation
• A shift in perspective
• A decrease or increase in distress
• Very little change at first

You generally do not need to analyze everything while it is happening. The therapist helps guide the process while monitoring your responses and level of distress.

The aim is for the target memory to become less disturbing, rather than to erase it.

5. Installation

As distress related to a target decreases, attention shifts toward a more adaptive or positive belief.

For example, a distressing experience might be connected with a belief involving helplessness or danger. The person and therapist identify a preferred belief that better fits the person’s current circumstances.

6. Body Scan

Trauma-related reactions are not always experienced only as thoughts or emotions. People may also notice bodily responses when recalling a difficult event.

During the body scan phase, your therapist may ask you to bring the target memory and preferred positive belief to mind and then notice sensations throughout your body.

You might notice tension, heaviness, tightness, discomfort, or another sensation.

If disturbance remains, your therapist may continue working with it using EMDR procedures.

7. Closure

An EMDR session does not have to completely resolve a memory before the appointment ends.

Closure is designed to help you shift attention back to the present and finish the session appropriately, including when reprocessing is incomplete.

8. Reevaluation

At a subsequent session, your therapist will check what has happened since you last worked on the target.

They may ask:

• How does the memory feel now?
• Has your level of distress changed?
• Have new thoughts or memories appeared?
• Have your reactions to triggers changed?
• Does the preferred positive belief still feel accurate?
• Is additional work on this target needed?

Your answers help determine whether to continue with the same target or move to another part of the treatment plan.

Not necessarily.

One feature that may distinguish the experience of EMDR from some other trauma-focused therapies is that you generally do not need to provide a lengthy verbal description of every detail of the traumatic experience.

However, this does not mean no communication is involved. As an EMDR therapist, it is important to have some understanding around what you are experiencing during the phases of reprocessing, that being said, the information necessary is typically minimal. This can appeal to many individuals who feel uncomfortable with the thought of going into detail around trauma.

There is no single emotional experience that everyone has during EMDR.

Because reprocessing involves intentionally bringing distressing memories to mind, uncomfortable emotions or physical sensations can arise. I like to say, it often feels as though you’re thinking deeply about the memory we are targeting or past events, but it should not feel like a flashback or as though you’re re-living it.

You may also notice thoughts, images, sensations, or memories shifting as the session continues.

Some people experience a noticeable reduction in distress during a session. Others need more time and multiple sessions.

If you are worried about becoming overwhelmed, discuss this before reprocessing begins. Assessing readiness and developing ways to manage emotional disturbance are part of EMDR’s preparation phase.

EMDR can be used for so many things. Most commonly, EMDR is used for PTSD, CPTSD, Traumatic Loss or prolonged grief, phobias, anxiety, distressing beliefs about oneself or the way the world works.

It can also be used to aid in treatment of many other conditions. Sometimes EMDR is not the entire treatment, but rather a piece of it. One common example of this can be the use of EMDR in eating disorder treatment or OCD treatment. EMDR will not fully resolve symptoms related to an eating disorder or OCD, but it can greatly reduce the intensity of triggers and beliefs related to these conditions.

Lastly, I often get asked- “I don’t have trauma, can EMDR still be applied?”. If a memory causes distress or a belief about yourself causes distress, these are appropriate EMDR targets. If it’s something that’s bothering you or on your mind, there’s a high likelihood that it is appropriate to reprocess through EMDR.

There is no universal number of EMDR sessions.

The length of treatment can depend on factors such as:

• Your treatment goals
• The nature and number of experiences being addressed
• Current symptoms
• Readiness for reprocessing
• Co-occurring mental health concerns
• Your response to treatment
• Whether EMDR is part of a broader treatment plan

Before beginning EMDR, it may be helpful to tell your therapist about your treatment goals, current symptoms, concerns about the process, previous therapy experiences, and anything that could affect your ability to participate comfortably.

Ask questions if you do not understand why a particular target or technique is being used.

You can also ask about the therapist’s EMDR training and experience, how they determine readiness for reprocessing, what they do if a client becomes highly distressed, and how they handle concerns that arise between sessions.

EMDR is collaborative. Understanding the process and feeling able to communicate with your therapist are important parts of treatment.

A first EMDR session commonly focuses on history, current symptoms, treatment goals, and planning. Your therapist may explain EMDR and assess whether it is appropriate for you. Reprocessing with bilateral stimulation does not necessarily begin during the first appointment.

Not necessarily. If eye movements are being used for bilateral stimulation, you will generally keep your eyes open so you can follow the visual target. Other methods of bilateral stimulation, such as tapping or alternating sounds, can also be used. I often ask clients what they are most comfortable with and go with that.

You need to provide enough information for your therapist to assess your needs and safely guide treatment, but EMDR does not necessarily require a detailed verbal retelling of every aspect of a traumatic experience. Many individuals find it to be more approachable than talk therapy if they have struggled with talking about traumatic events in past therapy sessions.

You can communicate with your therapist and ask to pause or stop. It is important that you feel in control of how sessions can look and you are absolutely able to stop an EMDR session if it becomes overwhelming.

Typical EMDR sessions last around 60 minutes, however, this depends greatly on the client and what is being processed.

EMDR is most commonly used for PTSD and CPTSD, although it also has strong evidence supporting its use for distressing beliefs, distressing memories, traumatic losses and grief, relationship struggles, phobias and anxiety.

If you’re interested in EMDR or want to inquire more about it to decide if it’s right for you, reach out SF Counseling & Wellness to schedule your free consultation today.

At SF Counseling & Wellness PLLC, we specialize in trauma informed therapy, EMDR, Relationship counseling and Couples counseling. We focus on being informed and approach each client with a relational approach.