What Happens During EMDR Therapy?

If you’ve been considering EMDR therapy, you may be wondering what actually happens during a session. How do you choose which memories to work on? Do you have to describe everything that happened? What are you supposed to think about while your eyes are following the ball across the screen?

EMDR, or Eye Movement Desensitization and Reprocessing, is an evidence-based treatment for PTSD. It uses a structured process to work with traumatic memories, the emotions and physical sensations connected to them, and beliefs about yourself that may have developed from those experiences. 

Treatment is individualized, and memory processing is one part of the larger EMDR process.

Preparing for EMDR

Before beginning memory processing, we’ll spend time understanding your history, current symptoms, and what you hope will be different as a result of therapy.

Part of this process involves identifying experiences that continue to affect you today and the beliefs that became connected to them. For example, someone who experienced abuse may have developed beliefs such as “I’m not safe,” “Something is wrong with me,” or “I can’t trust anyone.”

I also screen for dissociation before beginning EMDR processing. Dissociation can include experiences such as feeling disconnected from yourself, feeling as though your surroundings aren’t quite real, losing periods of time, or having difficulty staying connected to the present. Dissociative experiences are common in people with trauma histories, although they vary considerably from person to person. 

I use the Dissociative Experiences Scale (DES-II) as one part of this assessment, along with your history and what you tell me about your experiences. If someone is currently experiencing a high level of dissociation or has difficulty staying present when distressed, moving directly into trauma processing may not be a good idea. We may spend more time on preparation, grounding, and helping you remain connected to the present before beginning that part of EMDR. 

Preparation also includes developing ways to manage distress during and between sessions. This may involve grounding, visualization, noticing what helps you stay connected to the present, and practicing strategies we can use if a memory becomes overwhelming.

What Happens During an EMDR Session?

When it’s time to begin processing, we’ll identify a specific memory and some of the pieces connected to it. This typically includes an image or part of the memory, a negative belief about yourself, the emotions that come up, and where you notice distress in your body.

Then we begin bilateral stimulation (BLS).

Bilateral stimulation involves alternating attention from one side to the other while bringing aspects of the traumatic memory to mind. There are different ways this can be done in EMDR, including eye movements, alternating sounds, lights, handheld devices, or tapping. 

Because my practice is virtual, I typically use a ball moving from side to side across your screen, alternating tones that you hear from one side to the other, or guided alternating tapping. We can determine which option works best for you.

What Am I Supposed to Notice While the Ball Is Moving?

This is often the part people have the most questions about.

You don’t need to deliberately analyze the memory or figure out what you’re “supposed” to think about. You begin with the memory and notice what happens while the ball is moving, the tones are playing, or you’re tapping.

What comes up can vary quite a bit. You might notice another part of the memory, a different memory, an emotion, a thought, an image, or a physical sensation. Sometimes people notice a new connection or perspective they hadn’t considered before.

You might notice your chest tightening. You might remember something someone said years ago. You might suddenly feel angry or sad. You might realize how young you were when something happened. A thought such as “I really couldn’t have stopped that” might come up.

Sometimes you may notice very little during a particular set.

After a short set of bilateral stimulation, we pause and I’ll ask what you noticed. You give me a brief description, and what came up helps guide where we go next. EMDR commonly uses repeated short periods of bilateral stimulation followed by checking in about what the person experienced. 

You generally don’t have to tell me the entire story in detail. I need enough information to understand what you’re experiencing and guide the process, but you don’t have to give a detailed verbal account of everything that happened.

As processing continues, you may notice that the memory feels different, your distress changes, physical sensations shift, or different thoughts and perspectives come up.

What If I Get Overwhelmed?

You remain actively involved throughout the process. You can tell me to stop, slow down, or take a break at any point.

If distress becomes too intense or you begin feeling disconnected from the present, we can stop processing and use grounding or other strategies we’ve practiced beforehand.

How quickly we move through EMDR depends on your history, current symptoms, ability to stay present, and how you respond during treatment.

When Might EMDR Processing Need to Wait?

There are times when beginning trauma processing right away may not be the best clinical choice.

Someone who is highly dissociated or having significant difficulty staying connected to the present may need additional preparation first. The same may be true during periods of significant instability or crisis, when someone is currently living in an unsafe environment, or when other mental or physical health concerns need to be addressed as part of treatment planning.

These situations are considered individually. Sometimes the next step is spending more time building grounding skills and stability. In other situations, another treatment approach or additional support may make more sense before beginning EMDR processing.

Ending an EMDR Session

EMDR processing doesn’t always reach a natural stopping point at exactly the same time the appointment needs to end. We’ll leave time at the end of the session to help you transition out of processing and back into the rest of your day.

We’ll check in with what you’re noticing emotionally and physically and use grounding or other strategies when needed.

Some people continue noticing thoughts, memories, dreams, emotions, or new connections between sessions. If that happens, you can make note of what you notice so we can talk about it when we meet again.

How Many EMDR Sessions Will I Need?

There isn’t a set number of EMDR sessions that applies to everyone. The length of treatment depends on what you’re working on, your history, your current symptoms, and how different experiences are connected.

Someone working through a single traumatic experience may have a different course of treatment than someone with years of repeated trauma and several related experiences.

We’ll regularly look at what is changing, what is still causing distress, and where treatment needs to go next.

Taking the Next Step

If you’re interested in EMDR, we’ll start by talking about what you’re experiencing, your history, and what you’d like help with. From there, we can determine whether EMDR is appropriate and what preparation may be helpful before beginning memory processing.

At Sol Recovery, EMDR is provided virtually to adults in New Mexico, Texas, Arizona, and Florida. If you’d like to learn more about virtual EMDR therapy through Sol Recovery, contact me to schedule a free 15-minute consultation.