by Cindy Zabinski, LMHC, CRC, ACS, EMDRIA Approved ConsultantEMDR 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. AuthorCindy 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.
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PurposeBlog posts are meant to bring mental health awareness and education to anyone who visits our site. Please know that although reading blogs may be extremely helpful, they may not substitute the work that can be done in therapy. Archives
December 2024
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