EMDR Explained: From Start to Finish in 8 Phases

EMDR (Eye‑Movement Desensitization and Reprocessing) is an evidence‑based psychotherapy originally developed for PTSD. It helps people process and reduce the emotional intensity of traumatic memories by guiding them through distressing scenes while using structured techniques to support healing and adaptive integration.

Unlike traditional talk therapy—which relies on verbal exploration, insight, and dialogue—EMDR integrates bilateral sensory input alongside memory recall.

Rather than extensive discussion or exposing clients to prolonged recollection, EMDR pairs targeted trauma activation with rhythmic stimulation to facilitate processing.

Bilateral stimulation (BLS)—such as side‑to‑side eye movements, alternating tapping, or auditory tones—activates both brain hemispheres and supports reprocessing of distressing memories.

Though its precise mechanism isn’t fully understood, BLS is thought to reduce emotional vividness and aid memory integration.

This article is for informational and educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, therapist, or other qualified health provider with any questions you may have regarding a medical or mental health condition. Never disregard professional advice or delay in seeking it because of something you have read on this site.

The eight phases of EMDR therapy

EMDR therapy follows an eight-phase protocol that guides the client from initial assessment to follow-up evaluation (phases may overlap across sessions).

1. History-taking & Treatment Planning – Therapists gather background, build rapport, and plan trauma targets.
2. Preparation – Clients learn coping strategies and are introduced to bilateral stimulation.
3. Assessment – The specific memory is identified, along with associated thoughts, emotions, and measures like SUD and VOC scales.
4. Desensitization – Clients engage with the memory while bilateral stimulation (e.g., eye movements, tapping, sounds) is used to reduce distress.
5. Installation – Positive beliefs are strengthened to replace negative ones.
6. Body Scan – The client checks for residual physical tension linked to the memory.
7. Closure – The session is wrapped up with grounding to ensure the client returns to emotional equilibrium.
8. Reevaluation – Beginning in subsequent sessions, progress is assessed and treatment adjusted if needed.

Therapist Yunetta Spring Smith, LPC, MHSP:

“If it’s coming up, it needs to come out…[EMDR] is a beautiful approach to facilitating that process.”
She also emphasizes the importance of clients being open with their feelings throughout therapy, noting there’s “no wrong way or wrong answer.”

According to Megan Boardman, LCSW, author of The EMDR Workbook for Trauma and PTSD:

“The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes.”

What clients typically experience in a session

In a typical EMDR session, lasting 60–90 minutes, the therapist and client usually begin with a brief check-in.

The client is then guided to focus on a memory while the therapist administers repeated sets of bilateral stimulation—such as eye movements, auditory tones, or tapping.

After each set, the client is invited to observe any emerging thoughts, emotions, or sensations. They retain full control and can pause the process whenever they choose.

Common questions about session length and structure

• How long are sessions?
  Typically 60 to 90 minutes per session.
• How many sessions are needed?
  Processing a single disturbing event usually requires 3–6 sessions, while more complex or multiple traumas may require 8–12 or more.
• Does everyone move through phases uniformly?
  No—preparation may take longer for some, and phases may be revisited as needed. The therapy pace is adapted to the client’s emotional readiness.

Coping Strategies

Stress-reduction techniques help clients manage emotions during and between EMDR sessions. These include resourcing, where individuals practice skills to handle difficult thoughts, feelings, or sensations. Clients can choose whichever resource feels most helpful:

• Butterfly Hug – Cross arms over the chest, lightly tapping hands in an alternating rhythm (like wings flapping) while breathing slowly and noticing thoughts or sensations without judgment.
• Safe/Calm Place – Imagine a safe, peaceful setting while focusing on pleasant sensations; therapists may use bilateral stimulation to strengthen this calming association.
• Container – Visualize a secure container to hold upsetting thoughts or images. Memories can be “stored” here temporarily, helping reduce distress until they’re ready to be processed.
• Coherent Breathing – Breathe with the diaphragm at a slow, steady rhythm (about six breaths per minute) to promote relaxation and balance.
• Mindfulness – Stay present by noticing thoughts, emotions, and body sensations with acceptance, rather than judgment.

These strategies provide grounding tools clients can return to during or outside of sessions to maintain emotional stability.

Benefits of EMDR

People consider EMDR therapy for several reasons. While it may not work for everyone, research and client experiences highlight some key benefits:

• Reducing negative thinking – EMDR helps reframe distressing memories and replace harmful beliefs (e.g., “It was all my fault”) with healthier, more balanced perspectives. Insights come less from therapist interpretation and more from the client’s own processing.
• Rapid results – Many report improvement within a few sessions. Because EMDR works directly with traumatic memories rather than only their emotional aftereffects, it may bring faster relief than traditional talk therapy.
• Minimal talking – Clients don’t need to describe every detail of their trauma. This makes EMDR especially helpful for those who struggle to verbalize painful experiences.
• Increased self-worth – By reshaping negative self-beliefs (e.g., feeling weak or powerless), EMDR can strengthen confidence and promote a more positive sense of self.

“It has been an awakening of parts of myself and emotions I did not have before. These parts are the good emotions, no longer the bad ones.”

“I have been going to therapy for 20 years and never have I had a breakthrough like this.”

What can EMDR therapy help with?

PTSD and trauma-related conditions

EMDR is often used for treating PTSD and trauma-related symptoms.

A review found moderate-quality evidence that EMDR reduces PTSD symptoms and may lead to complete loss of PTSD diagnosis.

Systematic analyses also show that EMDR is as effective as trauma-focused CBT (TF‑CBT) for adult PTSD.

Francine Shapiro, who developed EMDR, states in her book, EMDR: The Breakthrough Therapy for Overcoming Anxiety:

“Research has shown that about five hours of EMDR treatment eliminates PTSD in 84 to 100 percent of civilians with a single trauma experience, including rape, accident, or disaster.”

Anxiety, phobias, and depression

EMDR has demonstrated efficacy in treating various anxiety disorders.

Systematic reviews show significant reductions in anxiety, panic, phobia, and psychosomatic symptoms across multiple RCTs.

Reports also mention its potential in helping with performance-related anxieties like public speaking and test anxiety.

Regarding depression, observational studies have found high remission rates, with 74% of participants remaining relapse‑free after 12 months.

Childhood trauma and complex PTSD

Although research on EMDR’s specific role in treating complex PTSD (cPTSD) is still emerging, preliminary findings suggest that trauma-focused treatments—including EMDR—yield comparable symptom improvement in cPTSD as they do in standard PTSD.

Other potential uses (grief, stress, performance blocks)

EMDR has been explored for broader applications beyond trauma. Research points to benefits in treating grief, substance misuse, and even chronic pain, though evidence is still limited.

Popular media accounts, such as a recent profile of Miley Cyrus, describe EMDR’s effectiveness for performance anxiety and stage fright—highlighting its capacity to reduce emotional grip by reprocessing underlying memories.

Are there any downsides to EMDR therapy?

Potential dangers and side effects

EMDR is generally safe but can produce short‑term side effects. Clients may experience emotional distress, vivid or unusual dreams, fatigue, physical sensations like headaches, nausea, or intense emotional shifts—especially if the therapy progresses too quickly.

In rare cases, hallucinations or exacerbation of symptoms have been reported, though evidence remains limited.

Who may not be a good fit for EMDR?

EMDR may not be appropriate in certain circumstances:

• Individuals in ongoing trauma or active abusive situations may lack the safety or emotional stability needed to process intense memories.
• Those with severe mental health conditions, such as active psychosis, schizophrenia, severe personality disorders, or uncontrolled dissociation, may not benefit—and could be destabilized—without prior stabilization.

Considerations

• Therapist training matters: EMDR should only be administered by properly trained and licensed clinicians. Poorly administered EMDR may deepen distress or derail progress.
• Mechanisms remain theoretical: While effective, the specific role of bilateral stimulation (like eye movements) is debated; some research suggests its benefits may stem mostly from exposure-based or cognitive-behavioral mechanisms.
• Not a cure-all: EMDR is generally effective for trauma-related conditions, but it’s less useful for issues stemming from physiological causes (e.g. brain injury or neurodevelopmental disorders).
• Client readiness is key: Ensuring that individuals have sufficient emotional coping resources and support systems in place is essential before beginning EMDR.

How to Find an EMDR Therapist

• Check qualifications: Look for a licensed mental health professional (psychologist, counselor, social worker) who has completed accredited EMDR training, ideally through EMDRIA or EMDR Europe.
• Use official directories: The EMDR International Association (EMDRIA) and EMDR Europe both offer searchable databases of trained practitioners.
• Ask about experience: Inquire how much EMDR training they have, whether they’re certified, and what kinds of issues they’ve worked with.
• Consider practical factors: Session costs range widely and insurance coverage varies, so confirm fees and payment options. Many therapists also offer EMDR online via secure telehealth platforms.

How Was EMDR Developed?

• Origin: Psychologist Francine Shapiro discovered in 1987 that moving her eyes side to side while recalling distressing thoughts reduced their emotional intensity.
• Introduction: By 1989, she formally presented EMDR as a treatment for traumatic memories.
• Growth: Once considered experimental, EMDR is now widely used for PTSD, phobias, panic, and other anxiety-related conditions.
• Guiding Model: EMDR is based on the Adaptive Information Processing (AIP) model, which suggests symptoms arise when traumatic memories remain “unprocessed.”
• Core Idea: These unprocessed memories carry the emotions, beliefs, and sensations from the original event, leading to ongoing distress until they are effectively reprocessed.

Further Information

• Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Perez, V., & Amann, B. L. (2017). EMDR beyond PTSD: A systematic literature review. Frontiers in psychology, 8, 1668.
• Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71.
• Shapiro, F. (1995). Eye movement desensitization and reprocessing.

References

Altmeyer, S., Wollersheim, L., Behnke, A., Hofmann, A., & Tumani, V. (2022). Effectiveness of treating depression with eye movement desensitization and reprocessing among inpatients–A follow-up study over 12 months. Frontiers in Psychology, 13, 937204. https://doi.org/10.3389/fpsyg.2022.937204

Forman-Hoffman, V., Middleton, J. C., Feltner, C., Gaynes, B. N., Weber, R. P., Bann, C., … & Green, J. (2018). Psychological and pharmacological treatments for adults with posttraumatic stress disorder: A systematic review update.

Jongh, A. D., & S. Hafkemeijer, L. C. (2024). Trauma-focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy. Journal of Clinical Psychology, 80(4), 824-835. https://doi.org/10.1002/jclp.23521

Scelles, C., & Bulnes, L. C. (2021). EMDR as Treatment Option for Conditions Other Than PTSD: A Systematic Review. Frontiers in Psychology, 12, 644369. https://doi.org/10.3389/fpsyg.2021.644369

Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Perez, V., & Amann, B. L. (2017). EMDR beyond PTSD: A systematic literature review. Frontiers in psychology, 8, 1668. https://doi.org/10.3389/fpsyg.2017.01668

Watts, B. V., Schnurr, P. P., Mayo, L., Young-Xu, Y., Weeks, W. B., & Friedman, M. J. (2013). Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. The Journal of clinical psychiatry, 74(6), 11710.