EMDR Guide

Clients often have a lot of questions about Eye Movement Desensitization and Reprocessing (EMDR). My hope is to address common questions about EMDR so you can a) determine if EMDR is right for you and b) know what to expect from treatment.

• What is EMDR?

  EMDR is a somatic, or body-based, therapy developed in 1987 by Dr. Francine Shapiro. The first clinical trial on EMDR’s efficacy was conducted with veterans experiencing PTSD in the 90’s, which found a 77% reduction in PTSD symptoms after 12 EMDR sessions (Carlson et al., 1998). Now, EMDR is one of two treatments recommended for PTSD by the World Health Organization, and has also been found effective for a variety of other presentations, including: anxiety, depression, OCD, chronic pain, and addiction (EMDRIA, 2026).

• How does EMDR work?

  When we experience something traumatic, our brain starts behaving differently, including our hippocampus, which is in charge of memory. You may have heard of people who’ve experienced a traumatic incident not remembering anything that happened, remembering things out of order, or remembering every little detail. This is because their hippocampus was behaving differently than it normally does–it was storing memories differently, not having processed them the way we process them when we feel safe. These memories can get “stuck,” leading to things like flashbacks, intense physical and emotional reactions to trauma reminders or “triggers,” pervasive unpleasant emotions, limiting beliefs about ourselves, and a host of other symptoms.

  EMDR helps these memories get “un-stuck,” and reprocesses them so they get filed away correctly in our brains, reducing symptoms. EMDR does this with bilateral stimulation, drawing on the bilateral eye movements we experience during Rapid Eye Movement (REM) sleep to help us store traumatic memories correctly. We don’t know exactly why it’s helpful, just that it is helpful.

  During EMDR processing, we identify a negative belief associated with the traumatic incident, as well as the belief that would be more helpful to believe instead. For example, someone may believe that they’re unlovable due to being physically abused by their parents, leading them to avoid intimate relationships and push people away in adulthood. They may identify a more adaptive belief that they’d like to hold about themselves, something like: I am worthy and deserving of love. During EMDR, we not only work on desensitizing and reprocessing the traumatic memories, but we also pair them with the more adaptive belief, zipping them together so that you can view these past memories from a more helpful perspective. To return to the aforementioned example, this client may come to realize that they were always worthy and deserving of love, and that their parents’ abuse was about their parents’ lack of emotional regulation skills, not about them being lovable.

  Once we’ve processed past memories, we move on to present and future situations that are related to the negative and adaptive beliefs, continuing to pair the adaptive belief with these situations. This allows your brain to continue filing the situations and adaptive belief together in your brain, helping reduce and prevent symptoms.

• Why choose EMDR over other types of therapy?

  Besides EMDR being a frontline treatment for PTSD, some people prefer EMDR because it does not require a retelling of your traumatic memories. All that your therapist needs is a “chapter title” of your memories or different parts of a specific memory. There is very little talking about the content of your memories in EMDR.

  Some clients also find EMDR useful in bridging the gap between their logical mind and emotional mind. Some clients may intellectually understand something (e.g. that they’re worthy of love), but not feel that way emotionally or “in their bones.” EMDR can help bridge that gap, making what we can understand to be true actually feel true.

• What happens during an EMDR session?

  EMDR is broken down into 8 phases, so it depends on the phase you’re in.

  Phase 1: History-taking and treatment planning.

  • Your therapist will collect information about your main concerns/symptoms, beliefs contributing to your concerns, and memories that led to those beliefs. Your therapist will also assess your resources–your coping skills, support system, and the accessibility of positive emotions.

  Phase 2: Preparation

  • Your therapist will teach you coping skills, “strengthen” memories related to your adaptive belief, provide expectations for EMDR, and answer any questions.

  Phase 3: Access and Activate

  • This is where we really start to get into it. You and your therapist will pick a memory to focus on for reprocessing. The therapist will then help you connect with that memory, as well as the most distressing belief, emotions, and physical sensations related to that memory. The therapist will also help you identify the adaptive belief you’d like to believe instead, and how true that feels to you now. From this phase on, your therapist will ask you to keep your talking to a minimum. This is in order to help keep you “in it,” because too much talking can take you “out of it,” making EMDR ineffective.

  Phase 4: Desensitization

  • Here, we start bilateral stimulation. This may look like eye movements, tapping, holding buzzers, pumping your arms back and forth–you and your therapist will figure out what works best for you. In this phase, your therapist will lead you through sets of bilateral stimulation, typically 15-30 seconds, while you let your mind make connections and heal. 

  • Your mind may do a number of things during this time–it looks different for everyone. For some, it is very visual, perhaps experiencing several memories racing by like they’re on a train, watching their memories zoom by out the window. Or they stay in one memory, but the visuals of it change–their perspective, what’s happening. Some folks have a more embodied experience, noticing changes in their physical sensations or emotions. Others may notice changes in their thoughts. Often, people are surprised by which other memories show up–this is normal. 

  • There is no wrong way to do this. Your job is to let your brain do its thing, to heal. Your therapist is there to help you access your brain’s natural healing mechanism in a safe way.

  • This phase ends when your level of emotional disturbance is reduced to 0 or 1 (if appropriate), on a scale of 10, with 10 being the most disturbed you’ve ever felt and 0 being not at all.

  Phase 5: Installation

  • Here, we link the adaptive belief to the memory, “installing” it by using short sets (5-10 seconds) of bilateral stimulation. We do this until the belief reaches a 7 on a scale of 1-7, 7 being totally true and 1 being not at all.

  Phase 6: Body Scan

  • In this phase, you hold the memory and adaptive belief together in your mind and scan your body. If you notice any uncomfortable or painful sensations, we do short sets of bilateral stimulation until those sensations subside, leaving you with calm or neutral sensations.

  Phase 7: Closure

  • If your level of disturbance is above 0, your therapist will help reduce your level of disturbance before ending the session by leading you through using your grounding and relaxation skills. This is also the time to debrief anything that came up during bilateral stimulation that you feel you need to talk about before closing out the session.

  Phase 8: Reevaluation

  • At the start of each EMDR session, your therapist will ask you if anything came up related to the EMDR themes you’ve been working on since last session. If anything that came up needs to be processed using EMDR, this can become your next EMDR target. Once all the important memories related to your symptoms have been processed and distress remains at a 0, we will process present and future scenarios related to the negative and adaptive beliefs as part of Phase 8.

• How many sessions does it take?

  It varies. The number of sessions is so dependent on you, your history, how resourced you are coming into therapy, what’s happening in your life. Some clients stay longer in Phase 2 than others. Some clients have more memories to process, or need to move through them more slowly. Some clients start EMDR and then have a bunch of other things happen in their life, and want to use part or all of their therapy time to address those new concerns. I never give a timeline for EMDR or therapy in general, because we just don’t know what will happen.

• How will I feel after?

  After a session:

  • After an EMDR session, you may feel tender. I recommend you be intentional about the timing of EMDR sessions, trying to pick a time in your schedule where you will have the space and capacity after sessions to tend to your emotions, move more slowly, and be gentle. As opposed to, let’s say, jumping into a very high-stakes work meeting, or immediately running off to high-energy social plans. You may feel a little tired, more emotionally spent than normal. This may last the rest of the day, maybe a little into the next day. However, at no point should you be feeling unable to move about your daily life after EMDR sessions. If you’re finding it hard to function after EMDR sessions, please talk to your therapist.

  After treatment:

  • After treatment is over, the adaptive belief(s) you’ve been working towards should feel believable “in your bones.” Not just something you can logically wrap your head around–they should feel real to you. The memories may still be upsetting, but they should be far less upsetting than they were before. The symptoms you experienced related to your negative belief should also be greatly reduced.

• What if I want to stop EMDR before we’ve finished?

  If you want to stop EMDR before you’ve gone through the entirety of treatment, talk to your therapist. Your therapist can help you determine if something about EMDR needs to be tweaked to better suit you, or if another therapeutic modality would be more effective. Sometimes people ask if there is danger to stopping EMDR part-way through treatment–there is no danger, except that your symptoms may persist.

If you’re interested in starting EMDR, please reach out to schedule a session.

About the Author

Rachel Mintz is a Licensed Clinical Social Worker (LCSW), Certified Sex Therapist (CST), and Perinatal Mental Health-Certified (PMH-C) therapist based in Chicago, and she’s the founder of Connection Psychotherapy. Rachel helps clients heal from trauma, address dissatisfaction with their sex lives, navigate pregnancy and postpartum struggles, reduce anxiety, and stop engaging in obsessive-compulsive behaviors. Rachel uses various evidence-based modalities, including CBT, ACT, EMDR, ERP, and Mindfulness.