What Happens in an EMDR Therapy Session?

If you are considering EMDR therapy, it is reasonable to want to know what will happen before you begin. The early sessions focus on understanding your history, preparing you for the process and making sure the pace is appropriate for you.

EMDR is commonly described as an eight-phase therapy. Those phases are not the same as eight appointments. Some phases may take more than one session, some may overlap, and a therapist may return to an earlier phase when more preparation is needed.

What usually happens in the first EMDR appointment?

The first appointment is usually focused on informed consent, history-taking and developing a collaborative treatment plan. This is similar to the beginning of many forms of therapy. Active reprocessing does not normally begin before the therapist understands what you are experiencing and whether EMDR is an appropriate approach at that time.

History-taking may include discussion of:

• Family background, culture and important relationships
• Attachment and interpersonal patterns
• Mental-health diagnoses, medication and general health
• Current stress, supports and safety concerns
• Traumatic or overwhelming experiences, including events you may not previously have thought of as trauma.

This history can help identify whether the concerns involve a single event, experiences beginning in childhood, or multiple experiences over time. It can also help clarify whether the event a client first identifies is the most useful place to begin.

How does a therapist assess readiness for EMDR?

Readiness is not simply a matter of wanting to feel better. The therapist also considers your ability to remain present, tolerate distress and use strategies that help you regulate when difficult emotions or body sensations arise.

As part of this assessment, I may ask a client to complete a questionnaire about dissociation. Everyday experiences such as daydreaming or briefly tuning out are common, but it is important to understand a client’s particular pattern of disconnection or loss of awareness before beginning reprocessing. The results contribute to clinical assessment and treatment planning.

What happens before active reprocessing begins?

Preparation lays the foundation for later EMDR work. Depending on the client, this may happen in the second appointment or may take longer. The main goals are usually to identify a possible target, establish a baseline for its current impact and develop a self-regulation strategy.

How is the target memory chosen?

The target is the memory or experience selected for reprocessing. One approach I may use to help identify it is called a floatback. We begin with a recent situation that triggered a strong reaction and notice the body sensations connected with it. While staying aware of those sensations, earlier memories or images may come to mind. These can help us identify a relevant target memory.

The target assessment may include:

• The image or part of the memory that feels most disturbing
• The negative belief connected with the memory
• The more adaptive or positive belief the client would like to hold
• The current level of distress
• How true the preferred belief feels at that point.

The distress level and strength of the preferred belief are rated using standard numeric scales. These ratings create a baseline that can be revisited as treatment continues.

What is a CALM place?

The self-regulation strategy I use most often is called CALM place. A client visualizes a place associated with calm and safety, then practises returning to that image and the sensations connected with it. We may strengthen the exercise using bilateral stimulation.

This gives the client an opportunity to experience the rhythm of bilateral stimulation while focusing on something comforting. It also provides a strategy that may be used to help settle the nervous system when distress rises.

What are bilateral eye movements, tapping or sounds?

Bilateral stimulation is alternating sensory input from left to right. Depending on the client and the setting, it may involve guided side-to-side eye movements, tapping the knees, holding pulsers or listening to alternating sounds.

During reprocessing, bilateral stimulation is usually delivered in short sets. At the end of each set, I ask the client to pause, take a breath and briefly report what they noticed, such as a thought, image, emotion or body sensation. Different clients may find different forms of bilateral stimulation more comfortable or effective for maintaining attention.

Bilateral stimulation is a standard part of EMDR therapy. Research continues to examine exactly how it contributes to processing traumatic memories.

You remain awake, aware and in control throughout the session. EMDR is not hypnosis.

What happens during active reprocessing?

Once preparation is in place and the client is ready, active reprocessing can begin. In my typical sequence, this may be around the third session, but it may begin earlier or later.

The client is asked to bring the target memory to mind along with the associated belief, emotion and body sensations. Physical reactions may include a faster heartbeat, pressure in the chest, shallow breathing or muscle tension. The therapist then guides the client through sets of bilateral stimulation and checks in between sets.

What does the client focus on during reprocessing?

The starting point is the target memory. After that, the client notices where their mind goes rather than trying to force a particular thought or outcome. A new thought, image, feeling or sensation that appears after one set may become the starting point for the next.

Clients sometimes tell me that the hardest part is observing without analyzing or trying to control the process. This can take time, especially for people whose minds have learned to stay busy or alert in response to trauma.

How does the therapist monitor distress?

The goal is not to create the highest possible level of distress. The therapist aims to keep the client within a tolerable range, often called the window of tolerance, while paying attention to changes in breathing, movement, muscle tension, attention, facial expression and connection with body sensations.

If the client becomes too activated, we may pause and use CALM place, intentional breathing or another agreed self-regulation strategy. If the client begins to feel disconnected, shut down or unable to stay present, we may pause and use grounding through the five senses. The pace can be adjusted at any time.

How does an EMDR session end?

A target does not have to be fully processed by the end of every appointment. The closing part of the session focuses on helping the client feel stable enough to leave and return to the rest of their day. This may include grounding, paced breathing or another self-regulation exercise.

The next session usually begins by reviewing what the client noticed since the previous appointment and reassessing the target. That information helps determine whether to continue, slow down, return to preparation or adjust the treatment plan.

What might someone notice between EMDR sessions?

Responses between sessions vary. Some clients feel settled when they leave and notice emotions or body sensations later. Some feel irritable or tired. Others report little or no distress between appointments. Memories, thoughts or details connected with the target may also continue to emerge.

What happens between sessions helps guide the pace of treatment. I begin each appointment by asking what the client has noticed since the previous session. Clients should also follow the between-session plan discussed with their therapist and contact them if distress becomes difficult to manage.

Can EMDR therapy be done online?

EMDR can be provided online for some clients, but online treatment is not the right fit for everyone. In-person sessions make certain physical and attentional changes easier for the therapist to observe. Suitability depends on the client’s needs, safety, ability to stay present and access to a private, stable environment. This is assessed individually before active reprocessing begins.

How do I know whether EMDR may be right for me?

A consultation can help you understand whether EMDR fits what you are experiencing and what preparation may be needed before reprocessing. You do not need to know which memory to target or arrive ready to discuss every detail. The first step is a conversation about your concerns, history and goals.

If you are considering EMDR therapy in North West Calgary, learn more about EMDR Therapy in Calgary or book a free 20-minute consultation to ask questions and discuss what an appropriate first step could look like.

About Dr. Shelley Skelton

Dr. Shelley Skelton is a registered psychologist who has supported clients as a psychologist since 2015. She provides EMDR therapy for adults in North West Calgary and takes an individualized approach to assessment, preparation and treatment pacing.

This article provides general information and is not a substitute for individualized medical or psychological advice.

Helpful resources

EMDR International Association: The Eight Phases of EMDR Therapy

American Psychological Association: Eye Movement Desensitization and Reprocessing (EMDR) Therapy

This article provides general information and is not a substitute for individualized medical or psychological advice.