The 8 Phases of EMDR

Written by: Jennifer Acker, M.A.

EMDR or Eye Movement Desensitization and Reprocessing is an Evidenced-Based psychotherapy treatment used to treat Post-Traumatic Stress Disorder and other mental health conditions. It works by using Bilateral Stimulation, primarily eye movements, to access a person’s traumatic memory and brings it to an adaptive resolution. EMDR differs from traditional talk therapy, in that during the reprocessing phases the therapist and clinician say very little so as not to distract from the neural connections being reformed.

EMDR Treatment consists of eight phases: History Taking, Preparation, Assessment, Desensitization, Installation, Body Scan, Closure, and Reevaluation. It is important to note that Phases one and two take several sessions and so one should not expect to begin eye movements right away.

Phase One: History Taking

In this phase you can expect the therapist to take a thorough history much like other psychosocial/intake assessments. In this phase the therapist and client are establishing a therapeutic relationship and establishing trust. Also, in this phase the therapist is assessing current symptoms of trauma and overall functioning. In these first two phases that therapist and client are also formulating a treatment plan identifying traumatic memories to later reprocess.

Phase Two: Preparation

The goal of phase two is safety and stability. In this phase the therapist is preparing the client’s nervous system for the future phases by teaching coping skills, often referred to as “resources”. This can take several sessions as therapists need to be sure the client can self-regulate and connect with others in a healthy way outside of the therapy office.

Also in this phase the therapist is working with the client to identify the most appropriate forms of Bilateral Stimulation to use with the client and reviewing the Mechanics of later reprocessing. Forms of Bilateral Stimulation include Eye Movements using the therapist’s fingers, light bar, or computer application, physically tapping ones body either at the knees to self-guided butterfly taps, as well as, audio tones, and buzzers.

Phases three through six blend together seamlessly. These phases are what one thinks of when they think of EMDR. It is here that EMDR deviates from typical talk psychotherapy as therapist now use scripts and verbal processing is limited.

Phase Three: Assessment

In this phase the “target” memory is identified as well as images, negative beliefs, feelings, and body sensations associated with the target memory. Ther therapist will take initial baseline measurements of distress using the Subjective Units of Distress (SUD) scale. The clients Positive Cognition related to the memory is identified and a baseline of how true a client beliefs this positive cognition is taken using the Validity of Cognition (VOC) scale.

Phase Four: Desensitization

Immediately after identifying the target memory, SUD, and VOC, the therapist and client move into Phase Four and begin Bilateral Stimulation while focusing on the target memory until the client reports a SUD of 1 or 0. During this phase new thoughts, images, and body sensations may occur. The client is instructed to “notice that” and continue reprocessing.

Phase Five: Installation
Once a client reports a SUD of 1 or 0 and changes have stalled, installation begins. In this phase the client now focusses on the Positive Cognition to associate with the target memory. Ther therapist continues Bilateral Stimulation until the new positive belief is installed and feels completely true using the VOC scale.

Phase Six: Body Scan

Following the installation of the Positive Cognition, the client is instructed to complete a body scan for any lingering disturbances that need to be reprocessed. If any are identified the therapist facilitates Bilateral Stimulation until they are cleared.

Phases Seven and Eight focus on ensuring safety at the end of the current sessions and the beginning of the next session.

Phase Seven: Closure

Every session ends with phase seven: Closure whether or not reprocessing in complete. In this phase the therapist helps the client regulate to a state of calm and safety.

Phase Eight: Reevaluation

At the beginning of the next session the therapist and client reevaluate the reprocessing ensuring the distress is still low and the positive cognition is still strong before moving onto a new target.