The following article provides an overview of the Eye Movement Desensitization Reprocessing (EMDR) process and integrates a simple case study to illuminate the positive benefits of the protocol. By providing a step-by-step approach, the general public will be more aware of what EMDR is, how it works, and its effectiveness.
Potential clients interested in EMDR will best experience the method when hearts and minds are open to new possibilities. If a client is resistant, the protocol may not be effective.
EMDR is a safe and effective protocol for clients carrying “small t” trauma, otherwise known as the bothersome daily grind that builds up over time if issues are left unresolved or “large t” trauma, such as PTSD or major earth-shattering life events like witnessing a death of a loved one.
These memories can replay within the mind as if the client is encountering the issue for the first time. The client’s body may experience a profound emotional impact as the loop persists with varying sensations and discomfort. The EMDR process is bilateral brain stimulation that allows the traumatic event to be processed so the client can recall the memory safely and neutrally.
The Cleveland Clinic describes the process as follows:
When you undergo EMDR, you access memories of a traumatic event in very specific ways. Combined with eye movements and guided instructions, accessing those memories helps you reprocess what you remember from the negative event. That reprocessing helps “repair” the mental injury from that memory. Remembering what happened to you will no longer feel like reliving it, and the related feelings will be much more manageable.
Clients do not need to prepare for their first EMDR session except for an event to be processed. The therapist administrating the protocol should ensure the client can use the stop signal with the hand if the traumatic experience becomes too overwhelming.
The following template outlines the activities that unfold during a typical EMDR session. The template is borrowed from the Manchester College of Coaching and Hypnotherapy and amended for the article. While the College has its specific style, there are various ways to approach the process with the same goal of neutralizing trauma.
Trauma Event To Be Processed
As we move through the EMDR template and method, a case study presenting a traumatic event demonstrates the clinical approach, allowing us to understand how the process unfolds.
The initial stages of an EMDR therapy session entail information gathering between the therapist and the client. The therapist must have already built a relationship with the client rather than jumping into an EMDR session on day one. Establishing mutual trust is a powerful support to ensure the client’s safety and comfort with the protocol.
The following case study is loosely based on actual events and is protected under therapist-client confidentiality. Names are fictionalized.
What image or symbol represents the worst aspect of the event? When you think of “X,” what comes to mind? Here, therapists may ask the client if they are looking at the traumatic event through their own eyes or observing their image from a distance — such as a person watching the world go by from the window of a train. If the scenario is the latter, moving to the ‘dissociate’ state in time can be helpful, although reducing the emotions in both states is essential.
Jamie, the client, replays the image of a recent fight with her significant other. She observes herself directly in the fight at a critical point when she feels the lowest.
2. Negative Belief
The therapist will ask the client what words are associated with the image or symbol in the ‘here and now.’ For example: “I am not safe” or “I am stupid”.
Jamie identifies her negative beliefs as:
- I am not worthy
- I am not enough
- I hold no value
What emotion do you feel when you bring up that image right now? The therapist will want the client to use statements starting with “I feel…” such as “I feel wobbly” or “I feel frozen.”
Jamie responds with:
- I feel disappointed
- I feel longing
- I feel frustration
4. Positive Belief
What would you like to believe about yourself now when you think about that image? For example: “I feel safe” or “I feel empowered.”
After a brief pause, Jamie confirms her desire to feel the opposite of the negative belief statements:
- I am worth fighting for
- I am safe
- I am valuable
When asked which statement Jamie feels the most resonance, she confirms, “I am worth fighting for.”
5. Feeling Scale
Consider a scale between 1 and 10, 10 being the worst and 0 being neutral. The therapist will ask the client where, on that scale, they would describe how disturbing the event feels now.
Jamie considers the question and lands on a heightened response of 8/10, given the traumatic event that occurred the night prior and feels fresh.
6. Locating Body Sensations
As you focus on that incident, where in your body do you feel the disturbance or uncomfortable feeling? This may include size, depth/surface, color, and shape.
At the onset of the question, Jamie struggles to locate where in her body the trauma provides the greatest sensations. She is encouraged to close her eyes and perform a body scan. Jamie feels tension at the back of her neck, shoulders, and above her heart. The therapist inquires which area feels the most significant impact, and Jamie confirms her heart.
7. Testing Positive Statement
On a scale between 0 and 7, 7 being entirely true and 0 being completely false, how true do the words seem or feel when you repeat the words (positive belief), and simultaneously, are you thinking of that incident now? For example, ‘I am safe’. (This is sometimes referred to as VOC — validity of cognition)
Jamie confirms her positive statements, mainly “I am worth fighting for,” is a 3/7. While she wants to believe the positive statement from an intellectual perspective, her body has not yet caught up to the new belief system.
8. Encourage Breath
Therapists should remind their clients to breathe during the protocol. Some people may hold their breath due to extreme focus on the task, and promoting relaxation is vital to a successful outcome.
With the information-gathering portion complete, the method or practice of EMDR comes into play. The technique entails processing the negative and positive emotions to decrease or desensitize the trauma, thus reducing the heightened emotional response.
1. Process Image and use the Emotion Scale
Bring up the image/symbol and negative words/beliefs. Next, the therapist will ask the client to notice where the sensation is felt in the body. The client will follow the therapist’s fingers with their eyes, keeping their head still. Again, remind the client to breathe. Continue for about 20–25 sweeps of the hand. The therapist completes the sweeps and exhales loudly as their hand comes down.
Note — there are a few aids a therapist can utilize to help a client process the negative emotions. All methods stimulate the left and right sides of the brain.
- Electronic Paddles — vibrating hand-held paddles that pulse from left to right. Paddles are used in person.
- Hand Sweeps — hand sweeps in a figure-eight motion across a computer screen or in person.
- YouTube Video Dot Movement — a video with a dot traversing from left to right at a controlled pace. It is best used with video calls.
When a therapist assists a client in processing negative emotions, the swiping, pulsing, or dot movement is set at a more rapid pace. For example, the YouTube video playback speed is best placed at 1.75.
Let’s return to Jamie. She experiences three sets of 30-second video clips using the YouTube Dot Movement technique. With each interval, the negative image of the fight with her significant other shifts, and the original image gradually diminishes.
Example: YouTube Dot Movement:
2. Gearing: Helping the Client To Reach a Positive Status
Next, the therapist requests the client to recall the original traumatic image and repeat the positive statement. Encourage the client to gently tap or smooth the affected area in the body and continue to do so during the bilateral brain stimulation of the pulsing paddle, hand swipe, or YouTube video. For video use, ensure the setting slows the playback speed to .75.
With each 30-second interval (or however long), the therapist pauses and checks in with the client to confirm their emotional response in the present moment. Has the original emotional response stayed the same, increased, or decreased? The goal is the latter: to reduce the emotional sensations.
There are a couple of ways to perform the positive emotional response technique. A client can recall the original image and keep the positive belief system in their mind, or the therapist can verbally say different variations of the positive statements aloud in a soothing voice so that the client can focus on the bilateral stimulation. I have found the second situation more effective.
Continue the technique until the client feels they have reduced the anxiety sufficiently. Ideally, they will have moved down to a 1 or 2. Next, a therapist will check the client’s belief system or VOC once the ideal positive statement is achieved.
Returning to Jamie, the therapist speaks variations of the positive belief statements in a slow, soothing voice as the client watches the YouTube video with the cascading dot. The therapist gently instructs Jamie to place her hands crisscrossed across the top of her heart and tap as the client soaks up the positive words.
- I am worth fighting for (more attention is paid to this statement)
- I am safe
- I am valuable
3. Process Body Sensation
The therapist asks the client to close their eyes and think about the original memory and the positive belief. The client will be asked to scan their body for uncomfortable physical sensations. Continue to circulate or swipe fingers until suitably reduced. Combine with positive statements.
Please note: it is not necessary to eliminate all negativity as the brain will continue to process the positive emotions after the session. More than one session may be required for the same traumatic image or variations of it, depending on the emotional intensity.
Jamie feels the pain in her heart reduced; however, she continues to feel dull sadness. She continues one more set of the EMDR positive process until the emotional response subsides to a 2/10.
4. Close Session
While there are many different ways to conclude an EMDR session, depending on the therapist’s style and training, one effective way may be to end with the therapist providing a meditation or positive words of affirmation. An example of a relaxation script will be provided in a later post.
Jamie feels satisfied with the reduced emotional response and appears calm and relaxed. The client’s stability reassures the therapist their session is complete.
The article provides a simple step-by-step overview of the EMDR process from a clinical perspective integrated with a case study of how the client, Jamie, experiences the protocol. By understanding how EMDR works, the general public will become better acquainted with EMDR and the benefits of reducing traumatic events, such as enabling greater personal freedom.
If you live in Ontario, Canada, and wish to try EMDR, please get in touch with me through my website, lisabradburn.com, or message me here on Medium to set up a free introductory call.