What to Expect in EMDR Therapy
If you've been looking into trauma therapy, you've probably come across EMDR. Maybe a friend mentioned it, or a doctor suggested it. And maybe the descriptions you found online left you with more questions than answers. What actually happens? Do I have to relive the worst moments of my life? Can it really work over video?
These are fair questions. I want to break down what EMDR therapy is like, from the first session to the last.
What EMDR is
EMDR stands for Eye Movement Desensitization and Reprocessing. It's a structured therapy that helps the brain work through painful memories so they lose some of their charge. The memory doesn't disappear. It just stops hitting you the way it used to.
During parts of EMDR, you briefly bring a memory to mind while paying attention to something that goes back and forth, left and right. This is called bilateral stimulation. I know that might seem odd, but it may simply be following a moving target with your eyes, feeling gentle alternating taps in your hands, or hearing tones that switch from one ear to the other.
EMDR is well studied. The World Health Organization and the American Psychological Association both include it in their guidelines for treating PTSD.
A short overview of EMDR therapy from EMDRIA, the EMDR International Association.
The phases, in plain language
EMDR follows eight phases. You don't need to memorize them, but knowing the general shape can take some of the mystery out of it. This is a general look.
Getting ready. The first sessions are about getting to know you, your history and what you want to change. Then we build skills for calming your body and mind, so you have ways to settle yourself when things feel intense. With complex trauma, this part can take a while, and that's on purpose. We don't start working on hard memories until you have solid footing. In this phase we might practice HeartMath heart-focused breathing skills or use the Safe and Sound Protocol (SSP), which I discuss in a previous post, to help ready your nervous system for the reprocessing work.
Reprocessing. When you're ready, we choose a specific memory to work on. You notice the picture, the thought about yourself that goes with it (like "I'm not safe" or "It was my fault") and where you feel it in your body. Then come short sets of bilateral stimulation. After each set, I'll ask what you notice, and we keep going from there. Over time, the memory tends to feel less upsetting, and a more accurate belief, like "It's over" or "I did the best I could," starts to feel true.
Closing and checking in. Every session ends with time to settle, even if a memory isn't finished. At the next session, we check how things went in between and decide what comes next.
What it can feel like
People describe EMDR in different ways. Some notice feelings or body sensations coming up and then easing. Some find their mind jumping to related memories or images. Others feel very little during a set and notice the change later. When I experienced EMDR, it felt like the stress and anxiety I felt about the memory was flowing out of the top of my head.
A few things are worth knowing ahead of time:
You stay in control. You can stop at any point, and you never have to say more than you're comfortable sharing.
You don't have to tell every detail. EMDR doesn't require describing what happened out loud, step by step. Many people find that a relief. In fact, with some people, I never knew the details of what they were able to process.
It can stir things up. Dreams, memories or emotions may surface between sessions. That's usually part of the process, and it's something we plan for together.
Pacing matters. Good EMDR goes at a speed your nervous system can handle. Going slower is often what makes it work.
How EMDR works over telehealth
My practice is telehealth-only, so I do EMDR by secure video. Bilateral stimulation adapts well to the screen. You can follow a moving target with your eyes, use headphones for alternating tones, or tap your own shoulders or knees in a left-right rhythm, sometimes called the butterfly hug. With some clients, I have sent them buzzers to use during our sessions, which they return when we are finished.
Online EMDR became common during the pandemic, and early research suggests it can be an effective option. A good setup helps: a private room where you won't be interrupted, a stable internet connection, headphones, and a phone number where I can reach you if the video drops.
Many people find it easier to do this work from somewhere familiar. And you don't have to fight traffic on Highway 17 or 85 to get home afterward. Whether you're in Los Gatos, San Jose, Campbell or anywhere else in California, you can do EMDR from home.
Is EMDR right for you?
EMDR is often used for PTSD and trauma, including complex trauma that builds up over years. It can also help with anxiety, painful memories, and beliefs about yourself that seem stuck no matter how much you think about them.
It isn't the right first step for everyone. Sometimes it makes sense to start with stabilizing the nervous system, for example with the Safe and Sound Protocol, before moving into memory work. I'm an EMDRIA Certified EMDR clinician and an EMDRIA Approved Consultant, which means I also guide other therapists in their EMDR training. Part of my job is helping you figure out what order makes sense for you.
Taking the first step
If you're curious about EMDR but unsure, that's a fine place to start. I offer a free phone consultation where you can ask questions, share a little about what's going on and get a sense of whether EMDR, or something else, fits what you need. There's no pressure either way.
This article is for general information and isn't a substitute for professional care. If you're in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911.