EMDR is an eight-step process. The number of sessions devoted to each step varies on an individual basis.
Step 1: The therapist takes a complete history of the client and a treatment plan is designed.
Step 2: Clients are taught relaxation and self-calming techniques.
Step 3: The client is asked to describe a disturbing memory. He/she is instructed to bring up the visual image of the memory as well as the associated feelings, body sensations and negative thoughts, such as "I'm a failure." The client is then asked to identify a desired positive thought, such as "I really can succeed." This positive thought is a goal of the treatment session. The client then is asked to combine the visual image of the trauma with the negative belief, feelings and body sensations, which are then rated on the Subjective Unit of Disturbance (SUD) scale. While focusing on the combination of the traumatic image and negative thought, the patient watches the therapist move his/her hand back and forth, in a bilateral direction. Hand tapping and auditory tones may be used instead of eye movements. The purpose of the eye movements, tapping or auditory tones is to induce a state of "dual awareness" which means that the client is thinking of a past experience while remaining grounded in the present. After each set of bilateral stimulation the patient will be asked to clear his/her mind and relax and describe what they are noticing. This will be repeated numerous times during a session.
Step 4: This step involves desensitization to the negative thoughts and images. The client is instructed to focus on the visual image of the trauma, the negative belief he/she has of him/herself, and the bodily sensations and emotions evoked by the memory, while at the same time following the therapist's moving finger with his/her eyes (or other bilateral stimulation). The client is asked to relax again and report what comes up (or what he/she notices). These new images, thoughts, or sensations are the focus for the next eye movement set. This is continued until the patient can think of the original trauma without significant distress.
Step 5: This step focuses on cognitive restructuring, or learning new ways to think. Once the original memory is desensitized (the SUDS level is down to "0"), the client is asked to think about the trauma and a positive thought about him/herself (e.g., "I can succeed"), while completing another couple of eye movement sets. The point of this step is to bring the client to link the positive statement about him/herself to the original memory.
Step 6: The client focuses on the traumatic image and the positive thought, and is once again asked to report any bodily sensations. The sensations are then targeted with another set of eye movements. The theory behind this is that improperly stored memories are experienced through bodily sensation. EMDR is not considered complete until the client can think of the traumatic event without experiencing any negative bodily sensations.
Step 7: The therapist determines whether the memory has been adequately processed. If it hasn't been, the relaxation techniques learned in Step 2 are employed. Memory processing is thought to continue even after the session has concluded, so clients are asked to keep a journal and record dreams, intrusive thoughts, memories and emotions.
Step 8: This is a reevaluation step and is repeated at the beginning of each EMDR session after the initial session. The client is asked to review the progress made in the previous session and the journal is reviewed for areas that may need further work.
The eight steps may be completed in a few sessions, or over a period of months, depending on the needs of the client. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important and new cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures.
