In the post Trapped in Trauma: Perspectives from EMDR Therapy, psychologist Carlos Sanz Andrea, a former student of ISEP’s Master’s Degree in Clinical Psychology, explained the foundations of EMDR (Eye Movement Desensitization and Reprocessing) and its contributions to helping patients overcome trauma and associated issues. It is important to emphasize that, as with other therapeutic approaches, the patient does most of the work; we are merely guides. Furthermore, it is also important to highlight that what EMDR seeks is not to make the patient “leave behind” what has happened to them, but rather to help them reintegrate it into their life and continue living despite having suffered in the past. That is why I consider it important to work on it within a specific therapeutic context and supported by other approaches, such as mindfulness or acceptance and commitment therapy (ACT). When included within therapy, it can be especially useful for working with traumatic memories.
The goal of this approach is to work with traumatic memories that are still significantly impacting the patient’s life. It is interesting to note that it works with the memory itself, and not with the symptoms it is generating.
And how exactly is EMDR used in therapy? EMDR comprises 8 phases, which we will analyze to better understand how it is put into practice.
Phase 1: Patient History
This phase is similar to what we would do in other therapeutic approaches, including family history, symptomatology, antecedents, consequents, etc. Additionally, we will emphasize the timeline, with all those moments that have been important for the patient. It is important to mention that the traumatic situation can be reflected in this phase and that it can involve several events, which we call treatment target/s and resources, which will be used: problems, symptomatology, the trigger, the core memory are identified, and the fundamental event is also pinpointed. “Memory files” are also identified—everything that has not been processed—and clusters, meaning if we can group memories by themes.
To find these situations, the floatback technique is very useful, in which, according to the timeline (from today backward) and significant events, the patient’s negative beliefs about themselves, the most disturbing emotions and physical sensations, similar situations, the last time what they fear happened, and the first time they felt that way, begin to emerge.
This phase, as in other types of therapy, is carried out over several sessions, as time is required to gather all the information.
Phase 2: Preparation and Safe Place
In this phase, the objective is to prepare the patient for reprocessing and dual attention (attention to the memory and to bilateral stimulation). This phase is supported by the therapeutic alliance, involves informed consent, and includes a space for psychoeducation. Emphasis is placed on the patient’s availability, any important medical considerations that might obstruct processing, and any indications of dissociative disorder symptoms.
Regarding the safe place, the patient is asked to imagine and describe in detail a place (real or imagined) where they feel safe and protected, a place that generates only pleasant sensations, as it will be the place to which they can return in their imagination when feeling overwhelmed by emotion or discomfort. Its other objective is to teach bilateral stimulations, which can be of three types: visual (eye movements), auditory (sounds alternating from one ear to the other), or tactile (small taps on hands or legs).
This phase can take one or two sessions.
Phase 3: Assessment
Once we have gathered the most relevant patient information, we will proceed to assess the main elements of the memory (with the intensity of the disturbance and associated beliefs). The target elements will be analyzed according to image, cognition, emotion, and physical sensations:
Image
– The most representative or the most disturbing.
– If there is no image, we will focus on physical sensations.
Cognition
– Negative Cognition: what they negatively thought about themselves at the time, generalized, and which they still believe to be real.
– Positive Cognition: what they would have liked to have thought about themselves, and we will measure to what extent they believe it can be true, on a scale of 0 to 7.
– These cognitions can be opposite, but this is not always the case.
Emotion
– Emotions associated with the event.
– Level of disturbance (measured using Subjective Units of Distress, SUD, from 0 to 10).
Physical sensations
– Body localization and type of sensation
Phase 4: Desensitization
This is the phase in which we perform bilateral stimulation (according to what the patient has chosen) and our objective is to access the target and stimulate the memory network:
– Sets of bilateral stimulation are performed while the patient maintains attention on their memory and what is happening, and feedback is given after each set.
– Stimulations are performed until the SUD is 0, meaning there is no disturbance.
– Changes that may occur in image, thoughts, emotion, physical sensations, and localization are observed and recorded.
– At the end, return to the original target and ask what they are noticing. They should not notice any discomfort.
Phase 5: Installation
Once the sets of bilateral stimulation have been completed, the memory should be integrated and reprocessed, which is why the validity of their positive belief (what the patient wished they had thought about themselves at the time the trauma occurred) is verified. This is done through bilateral stimulations until the validity is 7 and it integrates with the target memory.
Let’s look at an example. This is a patient who suffered a car accident, in which they were trapped and felt that no one could help them. From then on, they feel useless and that they will always have to depend on others, presenting anxious and depressive symptomatology. Their negative cognition could be “I am useless” and the positive one could be “I am useful” or “I am capable.” At the end of the bilateral stimulations, it is expected that the belief “I am useless” will be minimal and the positive belief (which the patient chooses) will be 6 or 7, integrating with the target. The goal is that when the patient remembers that moment, they manage to associate it with a feeling of capability and not uselessness, as they had been doing.
Phase 6: Body Scan
The previous phases usually involve a lot of emotional and disturbing load, so in this phase, the aim is to verify that there are no negative sensations associated with the procedure or the memory, and that the patient can leave the session. If the patient reports positive sensations, bilateral stimulations are performed to reinforce them, and if they report something negative, it is reprocessed until it disappears.
Phase 7: Closure
In this phase, we seek to verify changes in the patient’s state and complete the processing. If a session remains incomplete (i.e., SUD is greater than 0 and the validity of the cognition is less than 7), relaxation is performed with the safe place, and it continues in the next session.
Phases 3 to 7 are carried out in the same session.
Phase 8: Reevaluation
The last phase, which is done in the following session, aims to evaluate whether there are residual disturbances, and whether both the SUD and the validity of the cognition were maintained. Additionally, it verifies whether new processing channels have opened, meaning any new memory that needs to be reprocessed.
As we can see, it is a structured tool that seeks to thoroughly analyze the beliefs and emotions that the patient has associated with the trauma they have experienced. The goal is then for them to reintegrate it into their life and be able to move forward.
While EMDR requires specific training, ISEP’s Master’s Degree in Third-Generation Therapies will give you the necessary tools to learn more about this therapeutic approach, which is very useful for cases of trauma.