What is EMDR and How Does it Work?

8/22/2024

by Cindy Zabinski, LMHC, CRC, ACS, EMDRIA Approved Consultant

EMDR has received a great deal of recognition in the world of pop culture and social media, with celebrities endorsing it’s effectiveness and the way it has helped them make positive changes in their life. The way that it is often portrayed in movies and television shows do not show much more than the concept that eyes move back and forth in the process. When many new clients call regarding EMDR, they are unsure as to what the process will be like. Here, I will try to share more detail about the background of EMDR and the phases that occur when doing EMDR with an EMDR clinician.

Part 1 - What is EMDR?

EMDR (Eye Movement Desensitization & Reprocessing Therapy) was developed by Francine Shapiro in the 1990s. She began to develop the idea for EMDR on a walk one day outside in a park. She recognized, as she was walking, that the process of a walk helped immensely in clearing her head and helping her to think more clearly about her response to a current life concern. She noticed the bilateral movements that occurred in her body as she stepped left-right-left-right and looked from side to side at the nature around her.

From this, she began to develop EMDR. EMDR is based on the Adaptive Information Processing (AIP) model. The model goes like this: our brain is built and designed to naturally work towards resolution and healing. However, when there are past experiences that have negatively impacted this process (often classified as “Traumas” or “traumas”), that impacts the healing process of experiences moving forward. Here is an illustration: Have you ever, with 20/20 eyesight, tried on the glasses of a friend that has a strong prescription? Think of how clearly you see before putting on their glasses - this is the way in which our brain naturally heals and grows through experiences. When an experience negatively impacts this process, it is like putting on that friend’s glasses. Then, moving forward, we see the world and our experiences (and often ourself) in this distorted way.

The process of EMDR is meant to help one to take off that distorted lens, so that the brain can resume the natural healing process that is meant to occur. I wish I could say that we are able to throw away those painful glasses and fully forget painful memories, but that is not entirely true. A person who has successfully gone through EMDR still remembers the past event, however it does not impact them in the same way emotionally. They may no longer recall details of the event or the event may appear “blurry” compared to prior to treatment.

EMDR focuses on a three-pronged approach, meaning that the clinician and client will first focus on reprocessing past events, going back to the “touchstone event”, the event that started the distorted lens in the first place. The client and clinician will then move into processing present-day experiences that have been impacted by the negative lens, and finally focus on future use of the new healthy lens that has been developed.

EMDR is considered “evidence-based” for Post Traumatic Stress Disorder (PTSD). This means that, through many years and funding of research, the medical community has seen the positive and significant impact that it has for those diagnosed with PTSD. There has also been much research done for those who have struggled with negative/difficult/traumatic experiences and may have a different diagnosis or concern (for example, depression, anxiety, chronic pain, grief, substance use, eating disorders, performance anxiety).

Part 2 - What are the Steps of EMDR?

EMDR consists of 8 phases. One of the common misconceptions that I hear from new clients is that EMDR is 8 sessions long since there are 8 phases. This is not true. As an EMDR therapist, I often address more than one phase in each session and each phase may take more than one session to complete. The client’s comfort level is a big part of the decision making process regarding when a new phase is entered.

Here I will discuss each of the phases to provide further clarity about the process:

Phase I - History Gathering
The first phase of EMDR is much like that of traditional psychotherapy/talk therapy. The clinician will work with you to gather information about your current concerns and history. The clinician may focus on creating a timeline of events, both positive and negative, that have occurred throughout your life. They may also ask about relationships with others throughout the course of your life. They will do this at a pace that feels comfortable and safe enough for you. During this phase, rapport is also focused on. It is important, before engaging in working through painful memories, to feel comfortable and safe enough with your clinician.

Phase II - Preparation
The second phase of EMDR is focused on preparing for the reprocessing of traumatic memories. Each client will spend a different amount of time in this phase, depending on their specific situation. The clinician, during this phase, will help you to build the tools needed to tolerate the movement of work that occurs during EMDR reprocessing. Stabilization may be focused on, if needed, to make sure that you remain feeling safe throughout the process. Coping and grounding skills will be taught and practiced. Bilateral stimulation will be explored and utilized starting in this phase. Bilateral stimulation can occur in the original method of eye movements, in which your clinician will assist you in moving your eyes back and forth using their hand, a light bar, or a tool via telehealth on your computer screen. It can also occur in a tactile manner, which can be by buzzers that are held in each hand, your clinician tapping on your knees, or self-tapping that will be taught by your clinician. A third method includes auditory bilateral stimulation, which would include wearing headphones in which music or beeps are played alternating in each ear.

The preparation phase allows you and your clinician to create a “game plan” for the work moving forward. Spending some time doing this can help to expedite the work done in upcoming phases. It can help to prevent confusion and promote further feeling like you and your therapist are on a team together working on this.

Phase III - Target Assessment
In the third phase of EMDR, the clinician will work with the client to identify the events and experiences that are likely impacting the present-day concerns, or that have formed the negative “lens” through which the client currently views the world. It may be difficult to choose one event. The clinician will most likely use the history gathering phase as a tool to assist with choosing an initial target.

In considering EMDR as a “bottom-up approach”, the goal is to find the “touchstone event” or earliest event that caused the start of the negative belief that exists today, to reprocess in Phase IV. For some clients, it is ideal to start with this event as the target assessment. For others, if starting with that memory feels overwhelming, other targets may be a better option to begin the process of EMDR.

Your clinician will guide you through a Target Assessment by asking you several questions to depict the memory, the negative belief that it brings up for you, the feelings it brings up within you, and the positive or neutral goal belief you would prefer to believe. This Target Assessment will be used by you and your therapist as you enter Phase IV.

Phase IV - Reprocessing
The fourth phase of EMDR is the phase that is typically represented in movies and on TV. In this phase, there is often silence between the client and clinician, as silent reprocessing of the event is done while the clinician assists with bilateral stimulation. During this phase, the clinician will assist the client in bringing up the target that was outlined in the target assessment. They will then allow the client’s brain to work towards healing silently as they lead the client in bilateral stimulation. The clinician will pause bilateral stimulation periodically to check in with the client. The purpose of this check-in is to make sure that the process is moving forward and that the client is safe and present. In EMDR, we never want the client to feel as if they are back in the past experiencing their memory. We want to make sure that they are in the present looking at the memory, as if it is a movie playing on a screen in front of them, with the ability to press pause and play as needed.

Reprocessing can occur at different paces. The theory behind this phase is that the clinician is meant to stay “out of the way” to allow the brain to utilize the preparation and present-day knowledge that the client has to “digest” the memory in a different, healthier way. Sometimes, reprocessing occurs quickly, with the client noticing images, thoughts, feelings, and body sensations occurring at fast rates. Other times, it can slow down or even feel like it is on a loop. The clinician is there to assist in those moments with a variety of tools.

One of the most common questions I am asked by clients during their first session of Phase IV is “Am I doing it right?”. It is important to keep in mind that the process of healing is different for everyone. By allowing thoughts, feelings, and body sensations to flow and come up as they do, the process is occurring.

Phase V - Installation
The fifth phase of EMDR occurs after reprocessing of a target image is complete. Likely, the negative belief that was identified in the target assessment no longer feels connected to that image, however a neutral or positive belief will feel true. The clinician will assist the client in installing this positive belief using bilateral stimulation.
If you are reading this blog prior to experiencing EMDR, you may think that the second sentence of the previous paragraph is crazy or impossible. Many clients have laughed at me when I explain this phase prior to them completing Phase IV for a target image. If you don’t believe it, I am not going to try to convince you here. Give it a try, and then get back to me ;-)

Phase VI - Body Scan
The sixth phase of EMDR occurs after reprocessing of a target is done and installation of a more neutral or positive rational belief is installed. Because our emotions are held within the body, the process of scanning the body is necessary to see if there is any leftover “stuff” that did not come up or out in Phase IV or V. Sometimes our feelings occur as body sensations, such as a jabbing pain in your side or a slight throbbing in your leg. Rather than leave these feelings unrecognized and unprocessed, the clinician will assist, using bilateral stimulation, to work through these feelings as body sensations. Once the body scan is complete, Phase VII can occur.

Phase VII - Closure
The seventh phase of EMDR occurs either: A) after Phase VI is complete, otherwise known as a complete session; or B) at the end of session time before Phase VI is complete, otherwise known as an incomplete session. The clinician will check in with you to see how you are feeling, and assist you in using your grounding skills to be fully present in the room prior to ending the session. Sometimes, especially in the case of incomplete sessions, the clinician will help you to “leave the work at the office” through use of a Container Exercise.

Phase VIII - Re-Evaluation
The final phase of EMDR occurs at the session following a complete session. In this Phase, the clinician will bring up the target image that was worked on to check in regarding feelings and the positive/neutral belief that was installed in Phase V. If it is seen that there remains something to work through, then Phase IV will be re-entered in session. If not, then the target is considered complete and the clinician and client will move forward in their work, such as choosing a new target to work through.

EMDR is a powerful and effective therapy. I hope that the above information is helpful in answering your questions about EMDR and it's process. I fear that some people may avoid trying EMDR because it is different from traditional therapy. My goal is to provide insight that may help others decide if further exploring EMDR is right for them!

Read more about EMDR as one of the services provided at Healing & Growth Counseling by clicking here.

Author

Cindy Zabinski, LMHC, CRC, ACS, is an EMDRIA Certified Therapist and an EMDRIA Approved Consultant. Upon being trained in EMDR in 2016 she fell in love with EMDR as a treatment modality, finding that it helps clients to overcome past traumas and change negative self beliefs quickly and effectively. She was Certified in EMDR in July 2017 and focuses her clinical practice on using EMDR to help people overcome past trauma and find peace in their present. She focuses as an EMDRIA Approved Consultant in helping trained clinicians become proficient in using EMDR with their clients. Cindy is the owner and founder of Healing & Growth Counseling, a group practice that focuses on providing trauma-informed counseling to clients across the state of New York, both in person and online. Read more about Cindy here.

Working with a Mental Health Counselor (MHC) Intern

8/4/2024

by Kat Pearl, EdM, MA, MHC Intern

If you're considering starting therapy and have come across the opportunity to work with an intern at a therapeutic clinic or practice, you might be wondering what exactly that entails. As a Mental Health Counselor (MHC) intern, I am here to clear up any confusion around this and encourage you or someone you know to give it a try.

Affordability and Accessibility
One of the biggest advantages of working with an intern is the reduced cost of their therapy sessions. Therapy sessions with interns are generally more affordable than with fully licensed professionals, which makes mental health services accessible to a broader population. The lower fees encourage more clients to seek therapy, providing interns with a diverse range of clinical experiences. The lower fees may also be beneficial for clients who are finding it difficult to find a provider who is in-network with their insurance plan and are also unable to afford the costs of out-of-network benefits. While the cost is lower, it’s important to note that the quality of our care remains high due to the rigorous supervision and oversight provided by licensed, well-vetted supervisors.

Flexible Scheduling
Interns often offer more flexible scheduling options as they build their client base and gain experience. In our post-pandemic world, finding therapists who are both available and affordable can be challenging. Interns are eager to fill their hours and do not keep as large of a caseload as many licensed clinicians, helping to solve availability issues. This flexibility can be especially beneficial for clients with busy schedules, those who need appointments outside of typical office hours, or those who have rotating schedules preventing them from keeping the same appointment time each week.

Up-to-Date Knowledge and Fresh Perspectives
Interns are immersed in the latest research, techniques, and trends in mental health due to their recent or ongoing education and training. We are often open to trying new or innovative therapeutic techniques and approaches, which can be beneficial for clients who are looking to explore fresh perspectives. Our passion and enthusiasm for our work drive us to apply our skills and knowledge diligently. This can bring a dynamic energy to therapy sessions, fostering a creative and open-minded environment for exploring mental health concerns.

Diverse Backgrounds and Unique Perspectives
Many interns have years of related work experience in various roles, such as rehabilitation counselors, school counselors, school psychologists, vocational counselors, or other positions that provide a broad understanding of mental health care. These diverse experiences allow us to bring unique perspectives to our internship sites, enhancing our ability to connect with and support clients. Our varied backgrounds enable us to draw on a wide range of skills and insights, making our therapeutic approaches well-rounded and adaptable to different client needs.

Comprehensive Supervision
As an intern, I am supervised by experienced, licensed professionals who provide regular guidance and oversight. This means clients working with interns benefit from the expertise of both the intern and their supervisors. This meticulous training process often includes weekly supervision meetings, case discussions, collaborative problem-solving, group consultation, and ongoing professional development opportunities. Close supervision ensures that interns adhere strongly to ethical standards, resulting in high levels of professionalism and care. Clients can feel confident that they are receiving quality care, as all intern activities are closely monitored and guided by seasoned professionals.

Personal Growth and Development
Working with an intern can be a collaborative and growth-oriented experience. Clients play a significant role in the professional development of interns, creating a rewarding therapeutic relationship. Interns are dedicated and committed to their professional growth, ensuring they are well-prepared to become effective, compassionate, and knowledgeable mental health counselors. This mutual growth fosters a unique and empowering dynamic in the therapeutic relationship, where both client and intern learn and evolve together.

Incorporating Coping Skills and Exercises
As an MHC intern, I am also enthusiastic about integrating practical coping skills and exercises into our sessions. Here are a few techniques you might encounter:

Mindfulness and Meditation: Techniques to help you stay grounded, present in the moment, and reduce anxiety.
Cognitive Behavioral Techniques (CBT): Strategies to challenge and change unhelpful thinking patterns.
Relaxation Exercises: Progressive muscle relaxation or guided imagery exercises to reduce stress.
Journaling: Encouraging self-reflection and tracking progress.
Breathing Exercises: Simple practices to manage stress and improve emotional regulation.

Ultimately, MHC interns bring fresh ideas and enthusiasm while working diligently to support their clients' well-being. Benjamin Franklin once said: "Tell me and I forget, teach me and I may remember, involve me and I learn." I believe that this quote perfectly captures the essence of the therapeutic process with an intern. By involving clients in their journey, both the intern and the client learn and grow together. If you're looking for affordable, flexible, and high-quality mental health care, working with an intern like myself might be the perfect fit. Let's embark on this journey together and explore your potential for growth and healing.

Author

This blog article was written by Kat Pearl, EdM, MA, MHC Intern, a Mental Health Counseling Intern at Healing & Growth Counseling. Kat has many years of experience as a certified school psychologist, and decided to go back to school to become a Mental Health Counselor so that she could work with people outside of the school setting to help them achieve their goals and heal from their past. Kat is an active yogi and long distance runner who engages in her own daily practice of meditation and mindfulness. She incorporates a variety of techniques into her routine, including breathwork, guided visualization, and mindful movement, in order to stay grounded and centered. Kat currently has openings for new clients for online therapy and offers evening and weekend options for appointments. If you’d like to read more about Kat’s style and philosophy regarding therapy, check out her bio page here:

Learn more about Kat

If you are interested in scheduling an appointment with Kat, send us a Contact Form here:

Schedule an Appointment

What is EMDR and How Does it Work?

by Cindy Zabinski, LMHC, CRC, ACS, EMDRIA Approved Consultant

Part 1 - What is EMDR?

Part 2 - What are the Steps of EMDR?

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Working with a Mental Health Counselor (MHC) Intern

by Kat Pearl, EdM, MA, MHC Intern

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