8 Stages of EMDR

By John Soderlund

 

 1. Client history and treatment planning

 

The therapist develops a treatment plan and assesses the client's suitability for EMDR, helping the client to identify treatment goals and potential problem areas where the client might benefit from particular skills, eg. relaxation techniques.

 

2. Preparation for EMDR

 

The therapist prepares the client by educating him or her about the process and teaching self-control techniques and affect management skills. The client may be given self-study materials to better understand the process.

 

3. Assessment of the target

 

The client targets a specific memory and the most distressing visual image associated with it. The therapist encourages the client to outline the thoughts and feelings that are elicited by the visual image and to identify a current negative cognition about him or herself which is related to the target memory. By contrast, the therapist also gets the client to choose a positive cognition to juxtapose alongside the negative image. This positive image expresses a desired cognitive picture of the client. The client then rates the accuracy of this positive belief on the Validity of Cognition Scale (VoC), where 1 represents "completely false" and 7 represents a "completely true" statement. The client also identifies the emotions that are elicited when the visual image is combined with the negative belief. The attendant level of distress elicited by the memory of the disturbing event or negative cognition is rated from one to 10 on the Subjective Unit of Disturbance (SUD) scale, where 0 is calm and 10 is the most crippling distress.

 

4. Desensitisation & reprogramming

 

The client focuses on the visual image, the negative belief flowing from it and attendant emotions and bodily sensations while being exposed to bilateral stimulation in repeated, dosed exposures. In each of these bilateral stimulation episodes, the client holds all these elements in mind while simultaneously moving his eyes from side to side for 15 or more seconds, following the therapist's fingers or an alternate object as it is moved across the client's visual field. As alternatives to finger movements, hand-tapping or aural stimulation have been used. After each set of bilateral stimulation, the client is asked what material arose during the stimulation. This material is focused upon for the ensuing set of eye movements. This cycle of alternating focused exposure and client feedback, is repeated several times as the therapist looks for shifts in affect, physiological states, and cognitive insights.

If processing stalls, specialised interventions may facilitate processing. Processing can become stuck, for example, where cognitive distortions exist, and the client cannot identify the distortion without outside help. In an approach which Shapiro calls the "cognitive interweave", the therapist attempts to elucidate the cognitive distortion to the client. The therapist may ask a direct question about the distortion in a manner which allows the client a new perspective on it. The SUD level is reassessed once emotional, physical, and cognitive resolution becomes apparent. A SUD score of 0 or 1 indicates the end of this phase.

 

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