The 8 Stages of EMDR
1. History and Treatment Planning
The first step involves gathering information about the client’s clinical history through an initial interview. Treatment planning involves identifying distressing memories to target and establishing the order that these memories will be processed.
2. Preparation
This stage involves learning skills to manage distressing emotions before these emotions are processed. These skills can also be used in-between sessions to help clients manage difficult emotions. Examples of skills used during the preparation phase include: deep breathing, guided imagery, progressive muscle relaxation, etc.
3. Assessment
Clients are instructed to identify an image that best represents the distressing incident. Next, individuals are asked to identify a negative thought associated with the image (negative cognition), as well as a positive thought to associate with the image (positive cognition) that will be used to replace the negative one.
Clients rate how strongly they believe the positive thought to be true on a scale of 1 – 7, where 1 = completely false and 7 = completely true (called the validity of Cognition).
Feelings of Distress are also rated on a scale of 0 to 10, where 0 = no distress and 10 = maximum distress (known as a Subjective Unit of Distress scale rating).
4. Desensitization
The client is instructed to focus on the disturbing memory for brief sets of 15 – 30 seconds while the therapist initiates bilateral stimulation through side-to-side eye movements (i.e., the client follows the therapist’s index and middle finger as it is moved laterally over a 12 inch radius), bilateral auditory beeps (i.e., client wears a headset and hears alternating beeps in each ear) or bilateral tapping (i.e., the therapist alternates tapping the client’s knees).
After each set, the individual is asked what thoughts came to mind. Once this is identified, the client is asked to hold their final thought in memory and the next set continues from there. individual starts the next set from there.
This process is repeated many times during the session for approximately 20 – 30 minutes. This process is continued until feelings of distress have been eliminated or significantly minimized when the client thinks about the incident.
5. Installation
The client is asked to recall the disturbing incident and the positive thought they plan to associate to the incident. The client is instructed to hold the positive thought in mind, while the clinician continues with bilateral stimulation.
This stage continues until the positive thought is strongly associated to the incident.
6. Body Scan
Uncomfortable physical sensations are identified in the body when thinking about the distressing event and the positive thought associated to it.
Clients are instructed to think about the distressing event and the positive thought while they scan their body for tension. When tension is found, the client focuses on the tension, while the therapist uses bilateral stimulation.
This process continues until the client is able to think about the distressing memory and the positive without experiencing any physical discomfort in the body.
7. Closure
During this phase, relaxation techniques are used to help calm the body and mind if distressing images or emotions occur in-between sessions.
8. Re-evaluation
At the beginning of each new session, the progress during the previous session is evaluated. There is also a discussion about how well the client is coping in-between sessions. A decision is then made to either continue processing the distressing memory from the previous session or to begin work on processing a different distressing memory.