What is EMDR therapy?
EMDR stands for Eye Movement Desensitisation and Reprocessing. It was developed by an American psychologist named Dr Francine Shapiro in 1980s. From her own experiences, Dr Shapiro had observed that using eye movements could help to process difficult experiences. It was thought eye movements can replicate the memory processing that occurs in rapid-eye-movement (REM) sleep. Initially Dr Shapiro’s discoveries were met with scepticism, but over time EMDR has been found to be effective in many research studies.
What does EMDR involve?
EMDR involves identifying experiences from the past that may not have been fully processed. When these unprocessed memories are triggered by situations in the here-and-now, this can bring up difficult feelings. We may or may not be consciously aware that this is happening. When difficult feelings from the past are very tiggered and are very intense, this can lead to a number of responses. This might include withdrawing, shutting down, or dissociating. These are a way of coping with the difficult feeling but may have inadvertent consequences for us.
If EMDR is appropriate for you we will begin a structured EMDR process. This involves a specific assessment phase and a step-by-step protocol. Most clients will require some preparation before starting the EMDR assessment and process.
When proceeding with EMDR we will go through a process of identifying specific memories from the past that are still problematic. We will then begin to process these memories using eye movements or tapping. When there is more than one memory to process, we will agree a plan for which order to tackle these in. This will take into account clinical judgement and your preferences.
Although the process is very structured, each EMDR session is different for each person. I will ask you just to notice and observe what is coming up for you in the sessions. We take the view that your mind knows what it needs to do to heal, and that we are facilitating this process by using the eye movements or tapping.
For most people difficult emotions will come up during processing, which is natural and to be expected. You might experience ‘lightbulb’ moments in sessions or in between sessions. Alternatively you might experience a sense of things changing or shifting gradually.
What kinds of difficulties is EMDR used for?
EMDR can be used to treat psychological responses to difficult and traumatic events. It is also helpful to treat a range of anxiety disorders. I have also used EMDR effectively with many clients who experience difficulties with self esteem or difficulties with mood.
What kinds of traumatic experiences can EMDR help to process?
EMDR can be used for any type of trauma. When most people think of trauma, they imagine situations like accidents, injuries or terrorist events. These situations are clearly traumatic, but experiences that cause trauma responses are much broader than this.
Traumatic experiences that I often work with include many childhood experiences that have been difficult. This might include a parent that was dismissive, invalidating, punishing or unpredictable.
Difficult early experiences can include your specific characteristics not being a good ‘fit’ for your environment in some way. Being creative and introverted in a high achieving family is an example of this. Being from a working-class background in a top school can be another.
Situations in early adulthood can also be important; a critical boss or bullying when you were early in your career, or an early romantic relationship that turned out to be controlling and toxic.
Adult experiences of trauma can include anything that has been particularly difficult. Common experiences I work with include physical health events that have been sudden and unexpected. Experiences of becoming unwell very quickly can be very frightening. As can being diagnosed with cancer or losing a loved one. EMDR can be effective for trauma responses following these situations.
When I use EMDR with difficulties related to self-esteem, it is common to target childhood experiences or experiences from early adulthood.
Usually when clients seek EMDR to process experiences in adulthood, they will be experiencing classic trauma symptoms. This usually includes feeling emotionally triggered by reminders, and/or experiencing intrusive memories. Most people will feel anxious but sometimes people feel emotionally numb. Usually you will not feel comfortable thinking or talking about the experience, or you will talk about it in a detached way, as if you are reading from a script.
What research evidence is there that EMDR is effective?
In 2018 a meta-analysis looked at different psychological therapies for post trauma symptoms and found that EMDR was effective. A meta-analysis is considered to be strong evidence of effectiveness, because the method involves summarising the results of many other studies. This provides confidence that EMDR is effective with different types of clients and in different settings.
EMDR is also recommended in the NICE guidance for post-traumatic stress disorder. These guidelines are based on a thorough review of the research evidence on therapy effectiveness.
Research is ongoing and there is emerging evidence that EMDR can be helpful for a range of anxiety disorders. This includes a 2022 meta-analysis which found that EMDR can be effective for anxiety, panic disorder and phobias.
When is EMDR not suitable?
EMDR should not be used with clients who have epilepsy. It is important that a client’s mental health is stable prior to proceeding with EMDR. You need to be coping as well as you can be prior to revisiting difficult memories from the past. If this is not the case, we will go through a period of ‘stabilisation’. This often means putting in place day to day coping strategies and helping you to understand and deal with situations when you are triggered more effectively.
Your life situation should be as settled as possible when proceeding with EMDR. When there are ongoing stressors we will discuss this in some detail before deciding whether to proceed.
What kinds of changes do clients see when having EMDR?
Sometimes clients will experience ‘lightbulb’ moments during processing sessions. Other times there is a gradual sense of things feeling different. This is a bit like if you have ever taken medication or had physiotherapy for a physical problem. As time goes on you notice that you can make movements you previously couldn’t, or you can do something that would have previously been a struggle with more ease.
Many clients notice this gradual shift. They might be faced with a trigger that they previously found hard to deal with, and they might notice themselves handle it better. They might still feel triggered but because the feelings are less intense, they are able to ‘take a step back’ rather than to respond automatically. This is a gradual process over a number of weeks and months.
Towards the end of processing clients often feel a sense of closure on the experiences we have worked on. Many often describe a sense of feeling ‘lighter’ somehow.
Most clients who finish EMDR sessions will have made good progress towards their initial therapy goals. The things that predict a good outcome are it being the ‘right time’ for clients to have therapy, them being committed to the process, and us building trust and working as a team.
Do I have to ‘believe’ in EMDR for it to work?
This is a question that clients sometimes ask. I’m aware that the process of EMDR can sound very strange and it is difficult to understand exactly how it works. In response to the question, clients do have to be open to the process and possibility that it will be effective. You don’t need to ‘believe’ that it will work but you will need to be willing to ‘give it a go’ and to put the work in. This is the case with any type of therapy.
How many sessions will I need?
Clients will vary significantly in how many sessions they need. For clients who have experienced a single trauma in adulthood, the guidance suggests 8 to 12 sessions are usually necessary. This will be significantly more if we are working on multiple traumas and trauma from childhood. My clinical experience is that people seem to process at different speeds. It is important not to rush the process and so I would usually only advise proceeding with EMDR if we are confident that we have sufficient sessions funded to cover this.
I hope has helped you to consider whether EMDR might be right for you. Please contact me if you would like to book in.