EMDR - What happens?

EMDR (Eye movement desensitisation and reprocessing) seems to provoke a reaction in people - one of curiosity. As the therapeutic approach gains a wider audience and becomes more accessible, a demystification process is underway with discussions on Instagram and TikTok, videos on Youtube and hundreds of Reddit threads. More and more people are sharing their experience of EMDR and what to anticipate. This blog aims to add to those discussions from the perspective of myself as therapist (and client).

What is EMDR?

Memories or events become effectively ‘stuck’ in our neural network without having reached a satisfactory place to be filed safely. These memories often have emotional potency or a bodily sensation that goes alongside them. The purpose of EMDR is to allow these memories, sensations, images to reach their intended destination before it was interrupted and for the emotional intensity to be reduced. It doesn’t remove or erase a memory but it alters our reaction to a response.

I use the analogy of a blocked train line - the train has a destination but is unable to reach it due to the line being blocked. We find ways to unblock the line so the train can continue to its destination. We do this by activating the memory neural network and jumping into it. I know that all sounds a little like ‘Innerspace’ (1987) yet what we find it when we follow the images, feelings and sensations that are attached to a memory or image we uncover insight and awareness that our unconscious mind had kept hidden. We know the body keeps the score, the brain knows the score - it just doesn’t tell the mind. So by utilising mind, brain and body we can create a whole picture to what can often be a fragmented picture of understanding. This can then lead to shifts in our way of being - to ourselves and our inner dialogues, personal and professional relationships. It frees up more capacity to consider who we are in the world and who we wish to become.

So what is EMDR? It’s using eye movements to desensitise a person to the memory or image stored inside their mind. The hypothesis is that using eye movements, a person enters into a state that is similar to REM sleep - the sleep we need for rest and restoration. Our mind then effectively ‘free associates’, it pulls together similar feelings, emotions and sensations we’ve experienced as a way to clear the blocked line. We can then see the interrelation of some of the symptoms a person may present with. Working with the frame of ‘one foot in the past and one foot in the present’, we begin to teach the mind and body that you’re OK in the present day.

Will EMDR work for me?

Part of the approach in EMDR, as with most therapies, is to undertake an assessment in the history taking phase. This isn’t a test. There isn’t any right or wrong. The assessment is to understand suitability for EMDR, as my job is to ensure a successful experience for you so I prefer to see it as a readiness review. And by suitability, amongst other things I’m looking to whether your home environment is safe for you to return to, whether you’ve chosen to come to therapy or been sent, what your attachment style is, how resourced you are, single incident or multiple traumas - as these will impact your ability to be immersed in the processing phase. I can’t determine if EMDR will ‘work’ for you specifically until an assessment is completed yet I can outline which symptoms have an evidence base to support the use of EMDR:

Trauma, PTSD and Complex PTSD (Recent trauma journal, and proposals for future research can be found here)

Anxiety (Research journal here) and here)

OCD and phobias (Research journal for OCD can be found here and phobias here

Grief and loss

Long Covid (Research journal can be found here)

Why is EMDR so exhausting? Can EMDR cause migraines?

Your body stores aspects of your trauma or memory, as a way of creatively adjusting to things that are unspeakable or frightening. As we activate the memory neural pathway, emotions and sensations rise to the foreground to be processed. Remember, the aim of EMDR isn’t to eradicate the triggering memory (that’s simply not possible) but to reduce the emotional reactivity or potency attached to it. So if in the future there is a trigger of some kind, your body can respond to it rather than react. We’re teaching the body and mind that you’re OK.

As we’re processing the memory (including any sensations, images, feelings or thoughts), it can be exhausting as you’re in a stage of releasing what you’ve had to hold onto in order to survive the world. After the session, it’s no wonder your body needs to rest as it’s had to carry a lot. With regards to migraines, if you have a predisposition for them then they may occur and your therapist should be aware if this in instances of visual disturbances and the risk of driving home afterwards.

Does EMDR wear off?

Successful EMDR has been shown to have lasting effects in terms of a person’s emotional reactivity to triggers. Further reading can be found here.

How long do EMDR sessions last?

Session length can vary from therapist to therapist and even within the same group practice. On average, it’s recommended that a client has space for 40 minutes of processing time and then sufficient time to ground themselves before leaving the room - which is why EMDR sessions with myself are 60 minutes long. Additionally, some therapists may do their initial assessments within a 60 minute period but I personally find that a 90 minute initial assessment allows us to gather together required information and begin to establish our therapeutic relationship. Ultimately, if the relationship between the client and therapist isn’t co-created to be a holding space then this will sidetrack the EMDR process as it’s the relationship you’ll return to when processing your emotions, memories and somatic experiences.

What happens after EMDR sessions?

After any session, not only may you feel tired (some people feel quite energised too!) you may begin to experience more vivid dreams, recall certain events or find shifts in your mood and concentration. All of which are perfectly natural and is your mind and body processing aspects of the ‘blocked train line.’ With dreams and images, it can be useful to write them down in a journal and to bring them to your next session for reflection or to use as a focus for the work. Personally, I ask clients of any upcoming important dates or events as these can also prompt further unfolding of the memoryscape and it’s also OK to contact your therapist in-between sessions if you’re concerned.

I hope this answers a couple of the most common questions and gives you some insight into what EMDR is and what to expect. I’ll go into deeper depth of the different phases and the theory underpinning EMDR in future blog posts.