What is EMDR?

If you live in Spokane, Washington, and have been thinking about going to therapy, I’m glad you're here! You may have heard of EMDR. It is a therapy that was discovered in the 80s and is known to treat PTSD, but EMDR can treat more than just trauma*! Also known as eye movement desensitization and reprocessing, EMDR has an 8-phase protocol. Below, I will outline what each phase looks like so you know what to expect when you get on the couch (or on the trail).

Phase 1: History Taking

This and phase two are going to feel the most like traditional talk therapy, because it's all about getting your story and understanding who you are.

At Seeds of Sage Counseling, we start out with a 2-hour holistic assessment. We explore your history in depth and identify the goals that you have related to your mental health and well-being. These goals guide us to the challenges you are facing and help us identify the memories that capture the essence of this problem, a pattern throughout life. While the assessment often gives us an understanding of what we will be working with, it may take several sessions to compile a complete "target list" of memories* that we will work with using the EMDR process. Because this process takes time and I am of the belief that therapy happens as much outside of the office as it does inside, I often will invite you to explore different ways of being outside of session to address present-day challenges you may be having. This practice is also a part of your preparation for engaging in reprocessing.

Phase 2: Preparation and Stabilization 

Phase 2 is all about developing positive coping strategies that work for you. Some of the strategies I use are pulled directly from the EMDR manual, but this is where I use creativity to meet you where you are and use an integrative approach to invite you to experiment outside of session with practices that may be familiar to you, and some that may not be.

Part of the goal of this is to support you in finding ways to regulate your nervous system. In EMDR, we are going back to difficult memories, often times some of the worst experiences in your life. It is important that we prepare you for this and enhance your ability to shift from working in the past, back into the present, whether you are at home, on the trail, or in my office.

This is the point where many types of therapy often stop. You are given skills to support you in managing your nervous system, and don't get me wrong, this is really important. In EMDR, we use these skills to support you in confronting the things from your past that make you feel stuck. You can stop just coping and start feeling fundamentally different, dare I say, healed.

Phase 3: Activating the Memory

Remember that list of target memories we created at the beginning? This list becomes our guide for reprocessing. It establishes the path we take through the past, present, and into the future to support you in achieving your goals.

This list captures the essence of the problem you are facing and often highlights a pattern that contributes to core beliefs about yourself that are holding you back. We go back to the beginning and follow this list chronologically*, sometimes going as far back as when you were in your mother's womb, depending on your history. We do this because the initial event or "touchstone" is where the seeds of these beliefs are planted. Working with the earliest memories supports the unraveling of this belief as we make our way through each memory and into the present.

Once we have a thorough history, are adequately prepared, and have identified our touchstone memory, we "activate" it, inviting the images, emotions, sensations, and beliefs that accompany this memory to the surface of our awareness. This process is often uncomfortable, and it helps us get in touch with the lingering pieces of the memory that would benefit from reprocessing. As soon as the memory is activated, we move directly to phase 4.

Phase 4: Reprocessing

This is where the bilateral stimulation (BLS) begins. At Seeds of Sage Counseling, we offer you BLS with the most modern and the most ancient technologies available. But what is it?

What is BLS?

BLS is stimulating one side of the body, then the other. Think left, right, left, right. This can be done with your eyes, with a sound in one ear and then the other, or with somatic stimulation on one side of your body, and then, you guessed it, the other. Our office is equipped with wireless audio, visual, and somatic BLS equipment. We have headphones with a wide range of sounds, a light bar with adjustable colors, and wireless "tappers" or buzzers with adjustable intensity. All of our equipment has adjustable tempos to tailor the BLS to your preference and the stage of EMDR treatment you are in.

At Seeds of Sage Counseling, we are also passionate about using nature-informed therapy to enhance your therapeutic process and support you in staying grounded in the present while engaged in reprocessing. Our wireless equipment gives us the flexibility to bring the traditional EMDR technology outdoors. If you find yourself more restless or uncomfortable with sessions seated in an office or at a picnic bench, we can use our bodies to engage in BLS and ditch the tech. Every step you take stimulates one side of your body, and then the other. At Seeds of Sage Counseling, our favorite sessions are done on the trail using walking as the source of BLS for reprocessing. Okay, so now you know what your options are for BLS... But what is reprocessing?

What is Reprocessing?

I went off on a bit of a tangent, but do you remember when we activated that memory back in phase three? That is where we left off in the process.

The memory is at the forefront of your awareness. During reprocessing, I invite you to just notice whatever comes up without judgment. You might notice different parts of the memory; other memories may come to the surface, you might notice things in your body, or you might notice yourself thinking about the groceries you are going to get after the session. There is no right or wrong in this process. Your job is just to notice what comes to mind while engaged in your preferred form of BLS. You do this for about a minute until I invite you to pause.

During this break, you clue me in on what is happening for you. This gives you an opportunity to shift briefly from working in the past to the present. After you share a bit about what is happening in the process with me, I invite you to continue noticing what surfaces as you do another "set" of BLS for about a minute. This continues, alternating between sets and pauses until the end of the session or until you no longer find the memory disturbing and are ready to move into phase five.

I know what you’re thinking, there’s no way it’s that easy. I can’t ever possibly find that memory to NOT be disturbing. And I get it, I was totally skeptical too, but I wouldn’t be offering this therapy if I didn’t believe in it. It has a success rate reported across various studies ranging from 77%-100% effectiveness in treating PTSD. It is the leading evidence-based trauma treatment protocol. I've seen the results in my own life and the impact it has on my clients every day. Don't knock it till ya try it.

Phase 5: Installing the Positive Belief

Like installing Chrome on my PC? Yeah… kinda?

We spend a large part of our time working with the existing negative belief that was seeded with the memory. This belief is often untrue, and I like to think of it as a weed that has been planted in the garden of your mind. In phase 4, we pulled the weed out by the roots. In phase 5, you get to decide what to plant in its place. Oftentimes, this positive belief ends up being the opposite of the negative. If the belief was "I am weak", it transforms into something along the lines of:

I am strong.

I am resilient.

I can learn to be powerful.

Sometimes in this phase, there is some lingering resistance; part of you knows the positive statement is true, but, for whatever reason, it doesn't feel true. Reprocessing with BLS continues in this phase, noticing and confronting the resistance that prevents this statement from being completely true. When there is no longer resistance, we move into phase 6.

Phase 6: Body Scan

One of the things I love about EMR is that it is so holistic. Not only does it have the capacity to address the past, present, and future, but it also allows you to work with so many forms of experience, including the experiences you have in the body.

I personally experience my emotions very somatically. When my own therapist asks me how I feel, I first describe the sensations in my body before I can find the emotional word to capture it. Oftentimes in phase 4, you will experience an array of sensations. In phase 6, we work directly with the body, which, as we know, keeps score. We take time to work with any lingering sensation so that you can not only think and believe differently, but so that you can feel differently.

Phase 7: Closure

After you complete phase 6, the memory is considered "complete". This can feel final and intimidating. I remind everyone that just because you "complete" a memory does not mean it does not matter or was not painful, but it does not have to control you any longer.

Whether we complete a body scan or end the session in the middle of reprocessing, having time at the end of the session to debrief your process is so important. It allows you to notice the patterns and integrate the wisdom that arises from each set. This time also allows space for you to come back into the present moment. Oftentimes, I will guide you to one of the coping strategies identified during our work in phase 2, or I will provide a brief guided meditation to support you in feeling grounded before our session is over. Because of the time that it takes to enter and exit the EMDR process, experts recommend 90-minute sessions.*

In between sessions, reprocessing often continues with your mind visiting thoughts, dreams, and sensations related to the memories. Between sessions, tracking these can be helpful when you return the following week.

Phase 8: Reevaluation 

When you come to therapy, we don't just immediately dive in. Just as we ease out of the process in phase 7, we ease in as we circle around in phase 8.

At the beginning of each session, after you have begun reprocessing, we take time to go over what you have noticed across the week in relation to the memory or address any more pressing present-day concerns. When we decide to return to a memory we have already been working with, we again conjure up the memory so you can get in touch with how it impacts you when you think about it. We work with whatever arises following the process until you feel it is complete.

In phase 8, following a completed memory, we also revisit the list of memories that you created at the beginning of your journey and decide where to go next. We follow this through your past and into the present to work directly with the things that are difficult for you now. After we complete working with something that is challenging for you in the present, we work with future scenarios to support you in identifying how you want to feel and integrating it so that you can show up as your best self as you walk out of therapy and into the rest of your life.

*Additional notes:

1. While EMDR has been identified as a trauma treatment, the limited scope of trauma represented by the Diagnostic and Statistical Manual of Mental Disorders (DSM) (the big book used by mental health professionals to tell you what you "have") does clients a disservice. Trauma is not just about almost dying from violence. As humans is is vital to our survival to connect with others, and when we are shamed, judged, bullied, verbally abused, and neglected, our bodies do not feel safe, and our minds do their best to make sense of it. Trauma ends up looking like generalized anxiety, depression, social anxiety, specific phobias, personality disorders, and more. EMDR is effective at treating symptoms with diagnostic presentations outside of the standard trauma diagnoses like PTSD and ASD. While I believe in EMDR's effectiveness wholeheartedly, there are some cases where it is not advised or should be practiced with caution, including in cases of dissociative identity disorder or with active psychosis.

2. I use the term memory because the majority of work done with EMDR is in relation to memory. I have used EMDR to work directly with symptoms like panic attacks and nightmares. I have also used EMDR to work directly with clients who experience opposing "parts" of themselves to reduce the sense of friction clients experience within themselves. I have also used EMDR to address preverbal experiences like adoption.

3. The standard procedure for EMDR is to work from the earliest memory forward; however, in some instances, particularly in the case of complex trauma where you have experienced ongoing abuse for months, years, or decades, working with the first, worst, and last often supports reprocessing more effectively and more quickly than trying to unearth every memory or abuse. The process and your mind often guide us to where we need to go, and while chronologically is the standard, it is not in stone.