What is EMDR Therapy?
EMDR Therapy is a very unique and powerful approach to resolving painful memories and negative beliefs that was originally developed over 30 years ago for treating post-traumatic stress disorder (PTSD), following significant traumatic events.
We know from decades of extensive research that EMDR Therapy has far-reaching applications beyond large or obvious traumas (e.g. life threatening traumas).
EMDR Therapy is very useful to consider whenever memories of past events are causing us significant disturbance and/or a negative view of ourselves.
- EMDR Therapy was developed over 30 years ago by psychologist Francine Shapiro, and is now backed by decades of research.
- In 2013, EMDR Therapy was recognized by the World Health Organization as a first-choice treatment for trauma.
- In 2018, the Australian Psychological Society included EMDR therapy as a Level I evidence-based psychological intervention for posttraumatic stress disorder in adults.
- In 2020 EMDR Therapy was included by Australia’s Medicare Better Access Scheme as being the only one of two other therapies deemed an ‘acceptable strategy’. This important because it is the first time any therapy has ever been added to this list by Medicare (in the entire 10+ years history of the Better Access Scheme).
Why Choose EMDR Therapy?
In practice, ‘trauma’ is not about the event itself. It is about what happens inside us in response to an event. A traumatic response is essentially an unfinished set of reactions to something. In other words, this is any haunting or destructive material that is left inside us (emotionally, in our minds and / or in our bodies) following a disturbing event. This can be caused by any event that we experience as emotionally distressing – not just life-threatening events.
While the formal diagnostic criteria for Post-Traumatic Stress Disorder (PTSD) lists large, obvious, single-incident events that are typically life-threatening, this is actually misleading because many people are also affected by other adversities that do not meet any formal diagnostic criteria. These experiences commonly include interpersonal injuries such as: Betrayal, the loss of a significant relationship, Attachment wounds, Emotional Abuse (gas lighting, bullying or harassment), and any other experience that can result in extreme humiliation/shame, fear, or a loss of control or feelings of insignificance.
Left untreated, adverse events experienced as traumatic can leave a huge and long-lasting negative impact on our mind, body and emotions that can leave us vulnerable to present-day stress and future triggers. Moreover, the effects of untreated trauma can also be passed on inter-generationally. In addition to the emotional and physical effects, the long-term cumulative effects of unresolved traumas can trigger a complex reorganization of the brain and body that can make us more prone to serious mental health and medical/physical complications.
In children, we now know that the cumulative effects of unresolved adverse childhood experiences and painful attachment experiences can have a negative impact on general brain development. This can affect a child’s emotional and cognitive development and can negatively impact on resilience (i.e., our ability to handle stress, to regulate our emotions, and to bounce back from significant setbacks).
We now know that the risk of developing mental and physical health problems increases with the number of untreated adverse events we experience. This is because the accumulation of painful experiences over time can have a significant, long-lasting negative impact on how our brains develop and function (particularly if these events repeatedly happened during childhood). This has far-reaching implications for how we store and recall existing information, and how we interpret and respond to new information, which ultimately affects how we act and feel about ourselves (and others).
This partly explains why two adults who may experience the same traumatic event may handle it very differently. One person may ‘bounce back’ and ultimately be unaffected in the longer-term, whereas for the other person (if they have vulnerabilities due to having a history of many similar unresolved traumas), the event may be experienced as debilitating and may either ‘confirm’ beliefs they hold about their world which may continue to affect them for years to come. Thankfully (as will be discussed) with EMDR Therapy it need not be this way.
Resolve the Memory, Resolve the Problem
The theory underpinning EMDR Therapy views the majority of emotional, psychological, and behavioural problems as being related to ‘stuck’ (unprocessed) memories. It follows that by identifying and reprocessing these memories safely, a person’s emotional, psychological and behavioural diffisulties will also resolve. This is exactly what we observe following EMDR Therapy. Here is a brief summary of key points about this therapy:
- Over the past 30 years, EMDR Therapy has been extensively researched and validated as a very effective approach for BOTH single-incident (life-threatening) and also repeated (non-life-threatening) interpersonal traumatic experiences.
- There is also strong research support that EMDR Therapy is useful for a wide range of behavioural and psychological difficulties including: Depressive disorders, all forms of Anxiety (Panic, Phobias, Social Anxiety, PTSD, OCD etc), Addictive and Compulsive behaviours, Eating Disorders, Chronic Pain, and Complex Trauma (c-PTSD).
- EMDR Therapy is also useful to for non-diagnostic difficulties, such as attachment-related wounds, intense shame and self-criticism (which is often related to having a painful attachment history).
- There is also emerging research demonstrating that EMDR Therapy is effective with helping people manage Chronic Pain and also medically-unexplainable physical sensations (also known as ‘somatoform disorders’).
Benefits: Results without ‘talking’
Although we cannot erase a memory, we now know from over 30 years of research that memory processing done via EMDR Therapy results in a complete elimination of the disturbance associated with the memory. Moreover, we know that with this change, comes positive associations (positive, adaptive self-beliefs). In addition, these changes become the new normal – a new foundation that all new learning and subsequent experiences are encoded.
Unlike most talking therapies, the processing of memories via EMDR Therapy involves very little talking. Early on, the therapy involves taking a history, and also determining your window of tolerance (for your safety).
Preparation for memory processing involves teaching you the skills you need to stay within your window of tolerance (this may take several sessions depending on your needs). Following this, you will be well resourced for the memory processing phase of treatment (which often can happen very quickly – in as little as a single session).
Your therapist will then develop with you an EMDR Treatment Plan, which identifies patterns and orders your past experiences related to different themes in terms of Past Events (Memories related to that theme), Present Triggers (i.e., “Every Time ‘X’ happens, I still get triggered”), and Future Templates (What you ultimately would like to achieve as a result of processing memories within that Theme – how you would like to be able to respond to the Present Triggers). This process will help you and your therapist identify which experiences most significantly relate to the Theme in question, and which memories you will likely need to Target.
With EMDR Therapy, you get to decide which Theme you would like to work on and which memories you would like to Target and resolve. You may choose to start to work on processing the earliest memories, the most disturbing memories, or a recent memory / trigger.
Memory processing involves recalling certain features of the target experience and noticing with your therapist: what you feel in your body, what emotions you may be experiencing, and any beliefs about yourself that you may have. This happens in the presence of 10-20 seconds of bi-lateral stimulation provided by your therapist (which most commonly takes the form of eye-movements, but it can also include tapping, or auditory bi-lateral stimulation).
Overall, there is very little talking that occurs. Your therapist will periodically check in with you to ensure that you are on track to resolve the memory (taking cues from the things that you report that you are ‘noticing’ after each set of bi-lateral stimulation).
We know that the processing of a memory is complete when bringing up the original image actually no longer disturbs you. Instead, you will feel calm and will have new positive associations / beliefs about yourself. People are often very surprised to find that this can happen in as little as 1-2 sessions, even for very old and painful memories
How EMDR Therapy Works:
Freeing ‘Stuck’ Memory Networks
When we experience a painful event, it can often become ‘stuck’ in our mind in the form of a painful unprocessed memory (which may have imagery, sounds, smells, emotions, bodily sensations and/or beliefs associated with it). Depending on the severity of the painful event, these memories may not resolve on their own. This can create ‘fragments’.
We know this has happened whenever the memory of an event still causes us disturbance, or when we are triggered by similarities in present-day experiences that in someway relate to a previous event – even if it happened years before and we may not often think about that link consciously. Healing past pain and removing any ongoing vulnerability is precisely what EMDR Therapy can us to resolve.
How? Normally, events from each day are processed by our hippocampus (short-term memory storage) and integrated into to our cortex (where longer-term links are made) during sleep. However, the content from disturbing memories is ‘stuck’ and becomes held in a raw or unprocessed state in the limbic system (which is essentially our Threat System). This keeps the distressing elements of the memories ‘alive’. When a new experience triggers any of the related elements of the memory, the event may feel like it is happening again, NOW. This can become very debilitating.
During a memory-processing session (which does not happen without a thorough assessment and skills building, which may take several sessions), you asked to recall specific components of the problem memory as directed by your therapist – this may include its image, the negative self-belief, and/or the disturbing emotions and associated body sensations. This will happen while simultaneously engaging in bilateral stimulation (i.e., stimulation involving both sides of the body) such as left-to-right eye movements (self-administered ‘tapping’, sounds alternating between each ear, or flashing lights). Eye movements are the most common bilateral stimulation used and these are believed to mimic the eye movements of REM sleep (the stage of sleep responsible for memory processing and learning). These eye-movements may be repeated quickly, in sets of 20-30 (several times), until processing has completed.
In this way, the EMDR Therapist systematically treats each of the stuck components of an unprocessed memory (described above) using bilateral stimulation to help your brain store this information in new ways. In doing so, the information that was once held in a ‘stuck’ memory network is reconnected to more functional memory networks, where a person can make better sense of what has happened. This leaves a person feeling resolved (vs ‘stuck’) about the corresponding memory and its components.
A Simple Metaphor: Disk Defragmentation
A simple analogy is that our brains can become a lot like a mechanical computer Hard Disk requiring a regular disk defragmentation to perform optimally. Without a regular disk defragmentation, a Hard Disk can become slower and can experience processing errors due to the information it holds becoming ‘fragmented’.
Inadequately stored (or incomplete processing of) past information can create dysfunction in our Brain’s Memory Networks and this results in inefficiencies in how our brains process and store new information (leading us to become ‘triggered’). EMDR Therapy is like performing a Disk Defragmentation on our Brains, for past experiences that did not get fully metabolized. EMDR Therapy helps our brains de-fragment, integrate, and store the past in a more helpful and efficient way.
Although we cannot get rid of a memory, it is possible with EMDR Therapy to remove the distress and disturbance that was once associated with this memory. We know that processing is complete because we find that the original memory no longer causes any disturbance. In other words, after processing a memory using EMDR Therapy, bringing up this memory or any of its components will still be possible, but doing so will no longer bother you anymore (processed memories become resolved). For example, a painful experience may still be ‘awful’ or ‘sad’, but after EMDR Therapy, bringing up the memory that you have about this event will no longer cause you any disturbance. Instead, you will feel calm and will have new positive associations / beliefs about yourself.
Returning to our analogy of a computer– Like defragmenting a Hard Drive helps a computer run better, EMDR Therapy helps the brain to metabolise previously ‘stuck’ memory networks (which can contain previously intrusive Imagery, Sensations, Emotions and Self-beliefs) so that it can operate more efficiently. Like defragmentation, this information is not ‘erased’. Rather it is reorganised to become (and is transformed into) adaptive material where you can recall the past, but it doesn’t affect you anymore and healing, letting go, and/or positive changes can occur.
In other words, when a previously dysfunctional ‘memory network’ has been processed with EMDR Therapy, the information becomes ‘adaptive’. When this happens, many positive changes occur alongside this process: Emotions associated with the past event become ‘clean’ vs the ways they used to seem disproportionate (eg instead of fear, you will feel safe and calm; you will be able to experience appropriate sadness without this emotion overwhelming you or it feeling ‘unsafe’; when thinking about a failure or a setback you will be able to feel ‘clean disappointment’ without the setback ‘saying something’ negative about your deeper worth as a human being; or, instead of anger feeling consuming or toxic, you may still feel anger if it is justified but will feel an appropriate amount of emotion where you are not overwhelmed and can choose your next response without reactivity). People are often very surprised to find that even when a particular memory is very old and/or painful, that this change can happen in as little as 1-2 sessions.
Before EMDR Therapy:
- When we experience an intense adverse experience that is too overwhelming for our Brains to make sense of, this information forms a ‘stuck’ or dysfunctional Memory Network (with associated feelings, sensations, sounds, smells, and beliefs about ourselves).
- Experiences that are ‘stuck’ have not been fully processed – they carry an emotional ‘sting’ or can cause us pain when we remember them.
- Because we draw on our Memory Networks to make sense of the world, we remain forever vulnerable to being triggered by any present events where there is enough similarity.
- This may cause us disturbance, may pull us into the past, or may leave us open to being reactive.
- Dysfunctional Memory Networks often relate to one or more negative self-referencing beliefs (eg ‘I am bad’ / ‘I’m unlovable’ / ‘I am in danger’ / ‘It’s my fault’ – and other self-referencing negative cognitions that typically cluster around themes of Guilt, Shame, Vulnerability, Control, or Belonging).
After EMDR Therapy:
- We are free to choose to recall a painful event and doing so does not disturb us.
- We feel resolved about a previously negative situation (‘it happened, it is in the past, I am SAFE now’), and the memory of it does not affect our view of ourselves.
- Things that used to trigger us no longer do – we become free to choose how we want to respond
- We can connect with a more positive view of Self (eg ‘I am loveable’ / ‘I did the best that I could’ / ‘I am safe now it is over’ and other positive self-referencing cognitions).
- We are free to have new experiences which strengthen the memory processing done in EMDR.
- This then becomes an adaptive lens through which all new events are viewed.
Before and after EMDR Therapy
EMDR Therapy & Sleep
Bi-lateral stimulation is unique aspect of EMDR Therapy. This is believed to relate to how the brain processes memories while we are a sleep. One of the most important stages of sleep in terms of learning and memory is called ‘rapid eye movement’ (REM) Sleep. REM sleep is where we consolidate learning and memories from the previous day. A key component of REM sleep is bi-lateral eye movements (our eyes flicker left-to-right). You may have seen someone’s eyes doing this when they are sleeping – chances are that they were in REM sleep and were processing memories.
Therefore, EMDR Therapy makes use of this process by mimicking the eye-movements of REM sleep to stimulate the brain’s natural way of storing memories. This can be done by using bi-lateral stimulation (i.e., using both sides of the body) such as left-to-right eye movements (or sounds, flashing lights, or ‘tapping’).
Interestingly, regarding sleep – we know that people who do not sleep well do not learn well. For example, studies investigating the benefit of sleep for learning a new task have found that people who learn a complex task before bedtime do better in the morning than participants who were taught the same task in the morning but were tested in the afternoon. Studies deliberately interfering with REM sleep (using alcohol – a substance known to interfere with REM sleep) have also demonstrated that a disturbance to REM sleep directly affects memory consolidation and learning.
Clearly, sleep is important for learning and memory. We know that people do not experience good quality sleep when they are distressed. Distressing dreams are common to people who have experienced significant stress or trauma. We also know that REM sleep is important for storing memories and processing emotions. When REM sleep is disturbed, emotional distress may accumulate. People who have experienced trauma or significant emotional distress often report that they are haunted by persistent and intrusive imagery, thoughts, and memories (e.g., rumination, intrusive thoughts, and flashbacks). As previously discussed, many of these are in fact components of unprocessed memories. This indicates a relationship between unprocessed memories and poor REM sleep.
Again, EMDR Therapy identifies a stuck memory (and its components) and carefully stimulates this information, while pairing it with the bilateral eye movements observed in REM sleep. This in turn allows the brain to process the memory. By mimicking the eye-movements of REM sleep, or by using other forms of bi-lateral stimulation (i.e., using both sides of the body) such as sounds, flashing lights, or ‘tapping’, EMDR Therapy facilitates the brain’s natural way of processing a memory that was previously ‘stuck’. This results in an elimination of distress associated with the memory – and with this, comes a resolution of the related emotional, psychological and behavioural problems people were originally experiencing!
Getting past your past: What’s the Catch ?
EMDR Therapy is very different to all other talking therapies. During the memory-processing phase, talking is kept to a minimum. In fact, while a memory is being processed using the bi-lateral stimulation (e.g., left-to-right eye-movements) very little talking occurs at all (!).
The only talking that does occur is simply for the sake of a brief check-in, so that the therapist can check in with you to ensure that you are still processing the memory.
Therapist: “OK – take a breath. What do you notice?”
Client: “I feel something in my chest and shoulders”
Therapist: “Ok – Notice that…” (Bi-lateral stimulation continues until memory is processed…)
Notice that in the above example, unlike typical ‘talk’ therapies, in EMDR Therapy the therapist does not ask the client about what their sensation might relate to, what their sensation ‘might’ mean, or why they think they are experiencing their sensation.
Instead, there therapist is simply checking to make sure that memory processing is still occurring.
This is very different to regular talking therapy.
Worse Before Better
Sometimes during the processing of a painful memory, your distress may increase. This is normal – and it is OK if you have the skills to calm, ground, and soothe yourself, so that processing can continue. Without calming, grounding and soothing skills, processing a painful memory could become very difficult. If you have not done this necessary preparation work with your therapist, you may find this very emotionally challenging.
Often, therapists who are overly eager to get to processing memories with their clients may rush through this preparation stage. However, processing a memory without adequate preparation is insensitive to you and your needs, and this could become unsafe for you – it could even make things worse.
Although this preparation work may take several sessions, it is important to do this thoroughly. Preparation will typically involve exploring your Window of Tolerance and your triggers, and teaching you numerous ways to calm, ground and soothe yourself (for example, by using soothing breathing, mindfulness, and calming imagery). These skills are also helpful to use in-between therapy sessions – even if you are not yet at the memory processing stage of EMDR Therapy.
Without this preparation work – I do not recommend processing memories via EMDR Therapy. If you are reading this and your therapist has not prepared you for memory processing, please give them the following article to read: Understanding your Window of Tolerance.
It Can Work Fast, but….
Processing a memory can happen very quickly. Often, a previously disturbing painful memory can be reprocessed and relieved, within 1-2 sessions (!). Although this may sound impossible, it is actually quite commonplace (remember, EMDR Therapy is supported by over 30 years of research). However, there are some important considerations to be aware of:
For more complex issues, there may be a network of multiple thematically-related memories that need to be processed before a full relief from disturbance is achieved. This is often the case with complex trauma (for instance).
Essentially, preparation for memory processing involves numerous steps: Taking a History, mapping out how your memories cluster into themes, determining your Present Triggers and Future Goals, establishing your Window of Tolerance (see the image below), and building skills so that you can handle any difficult emotions that may show up as when you bring up the memories that are affecting you.
Although EMDR Therapy can produce results very quickly, some people require several preparation sessions before they are ready to process memories. In essence, this preparation phase is focused on helping you to manage your symptoms skillfully, to a level where you are able to tolerate bringing up the memories that are affecting you. These skills will ensure reprocessing past memories with EMDR Therapy is comfortable and safe. After all, the last thing anyone wants is to create further negative associations with painful memories. Some people may need time to work on these skills.
*Again, click here to read more about your Window of Tolerance.
The Three Stages of EMDR Therapy
EMDR Therapy is often wrongly referred to as ‘EMDR’ (which connotes it is a ‘technique’). In other words, people often falsely assume that ‘EMDR is just the eye movements’. However, ‘EMDR Therapy’ is a comprehensive approach to helping alleviate human suffering that encompasses many elements of other therapies (the depth of which is determined by the skills / experience that the therapist brings).
Although the ‘eye movements’ are commonly mistaken as the ‘EMDR’ part of the therapy, in actual fact there are 3 distinct Stages of EMDR Therapy. As you will see, these Stages make it a highly nuanced and comprehensive Therapy (vs ‘just a technique’).
- Assessment Stage
- Preparation Stage
- Treatment Stage
Assessment Stage: Assessment is common to ALL therapies. The assessment Stage includes taking a detailed history, trying to understand your goals for seeking treatment (i.e., including understanding why you happen to be seeking help now at this point in your life specifically?), identifying the maintaining factors (that keep your problem continuing), identifying your skill set and any relevant risk factors, identifying potential clashes in the therapeutic relationship or challenges in terms of your expectations regarding what can be achieved in therapy (vs the work / effort you’re willing to invest), and trying to arrive at a conceptualization that helps explain how past events relate to the present difficulties you may be having so as to determine what will be most helpful. (You can read more about what to expect in therapy and how to get the most out of these early sessions here.)
If the Assessment Stage is skipped and you jump straight to any treatment, important information may be missed and this could mean that you are not given the most appropriate treatment for your issues or goals.
Although the Assessment Stage is presented above as a distinct entity, in practice a good Clinical Psychologist is ostensibly always in ‘assessment mode’. They may be monitoring your understanding, assessing how a skill or treatment is fitting with you, assessing for any signs that indicate a change in your Window of Tolerance, or determining the approach being taken is ultimately what you need. In other words, there are often several reasons behind why a Clinical Psychologist asks you the questions they do and makes the recommendations that they make – and if you are curious you should ask what their reasoning is and they should be able to tell you.
Preparation Stage: This Stage of therapy involves teaching you skills that will make doing the work of therapy (the Treatment Stage) SAFE for you. This Stage shares overlaps with the Assessment Stage and may include: determining your physiological Window of Tolerance, your capacity to self-soothe / self-regulate, determining what activities you needs and which you respond best to (and you prefer). This stage can incorporate skills from ANY therapy – anything that is helpful is useful at this stage (eg, ACT, CFT, IFS – any therapy that can be tailored to your unique situations / needs). The duration of this stage of therapy is informed by information from your assessment, and also from your response to these activities. Sometimes people may need to spend several months working at Preparation. A related area in Preparation is the development of an EMDR Treatment Planner – which is essentially a live document designed in collaboration with you that organizes into Themes your TRIGGERS (and the underlying historical experiences that likely feed into those triggers) and your GOALS.
Because EMDR Therapy is very specific and probably unlike anything you have ever experienced before, it is common for therapists to take you through an example of what happens in an EMDR Therapy session using a recent trigger you have experienced that is only moderately difficult. That way, you will be able ‘see’ what a typical re-processing sessions of EMDR Therapy entails. By picking something ‘easy’ to do this with, you will be able to have your attention ‘in’ the experience of re-processing, while also able to ask questions about what is happening. It is kind of like playing an ‘open-handed card game’ until you understand what is required to get the most out of EMDR Therapy. Only then will you be well-informed and ready to apply EMDR Therapy to more significant and challenging material.
If the Preparation Stage is skipped, negative outcomes can occur. You may find the work highly triggering or you may not have adequate skills to settle and soothe yourself in-between sessions.
Poorly trained therapists often skip or rush the Preparation Stage to get to the Treatment Stage. This does a MASSIVE disservice to the public who may then be at risk of being triggered by EMDR Therapy and who may otherwise discontinue receiving a treatment from which they could have greatly benefited. Sadly, I have met many individuals who have had negative experiences with previous therapists, who needed my help to heal from prior therapy.
Treatment Stage. This is where EMDR Therapy differs THE MOST from other therapies, because the amount of ‘talking’ that happens in most other therapies stops in EMDR Therapy. As is discussed in the remainder of this article – the application of bi-lateral stimulation to each of the specific components of unprocessed emotional experiences (the image, the negative view of your Self, the emotion/s and your somatic experience), is what makes EMDR Therapy very different to other therapies.
A common misconception is that because EMDR Therapy uses eye-movements, it is “a form of ‘hypnosis’”. This is completely inaccurate – Although hypnosis may use eye-movements (or other forms of stimulation / sounds), hypnosis uses the ‘power of suggestion’ in the hope that you feel different. ON the other hand, EMDR Therapy works with how past experiences are represented in your mind, body, and emotional experience, and it helps your brain re-process this material so that it can be stored in more helpful ways. There is no ‘power of suggestion’, rather, your brain ‘re-processes’ the past and then files away this information where it belongs – in the past (in your long term memory), and as a result you are no longer triggered in the present. You can read more about the differences between hypnosis and EMDR Therapy in the ‘MYTHS & MISCONCEPTIONS’ section at this bottom of this page).
Imagery Rescripting & EMDR Therapy
Once you feel comfortable with reprocessing an experience with EMDR Therapy, more advanced options are available. One of these involves combining Imagery Rescripting within the framework of EMDR Therapy. Imagery Rescripting is an evidenced-based way to help people creatively resolve either upsetting memories, nightmares, and/or upsetting imaginings of the future.
Rescripting may involve considering how you would like the image to be different, what you would like to do to the image to make it less threatening or for you to feel safer, or what you are needing in the image and finding ways to rewrite the story to meet that need.
A common misconception becomes obvious when clients say ‘but I can’t change the past’. YES – This is 100% correct: We cannot change the past and that is not our aim. Rather, with imagery Rescripting we are working with the way your brain has stored / is representing the past. Imagery Rescripting in conjunction with EMDR Therapy is particularly helpful for healing attachment wounds and resolving other adverse experiences from early childhood. This can also be helpful for future events.
However, combining EMDR Therapy with Imagery Rescripting requires that the Assessment and Preparation Stages to have been completed. It is also helpful to be well-resourced in self-regulation and grounding skills and to be familiar with the standard way of doing EMDR Therapy if you are interested in adding this additional deeply healing component.
EMDR Therapy Animations:
The following brief animations explain how EMDR Therapy works. As you watch, remember that although EMDR Therapy was originally developed for large and obvious single-incident traumas, it has since been found to be highly effective for healing from all sorts of Adverse Events that can otherwise continue cause us psychological, emotional, or physical harm. This is because that when left untreated, the pains from our past combine and accumulate, resulting in ongoing vulnerabilities for us to be triggered by the present. Unless we resolve the past, we will continue to be affected by it past indefinitely and this is what can often fuel psychological and behavioural problems ranging from from anxieties, relationship issues, low moods, and addictions.
Thankfully it need not be this way. Although we cannot erase the past, by safely re-processing the pains of the past using EMDR Therapy, we can heal our brains, and the past will no longer affect us the way it once did. By using bi-lateral stimulation (vs talking), EMDR Therapists work with how your brain represents the past to achieve a resolution safely and quickly (with very little need to talk about what happened).
Do I have to process every memory I’ve ever experienced ?
Thankfully NO, because this would take a long time. Due to what is known as the ‘Generalization Effect’, often processing an event or memory may also help reduce the disturbance you experience in response to similar memories.
The Generalization Effect works in the following way – imagine you were going to cut back a huge, thorny rose bush: You could start at the most recent flower and trim the bush backwards to the most recent leaf, then work backwards to the nearest branch (etc…). Alternatively, you could start much lower down, and with one or two ‘snips’ you could remove large sections of the bush because everything stems from the earlier, more established branches. On the other hand, if you wanted to remove the entire bush, you could do so by going directly to the oldest part of the bush (the trunk). However, the thorns from the branches may make that difficult, so (luckily) you have the above options.
Because of the Generalization Effect, processing memories with EMDR Therapy is similar to the above Rose bush metaphor – you could start at the most recent memory, the earliest memory, or the most painful memory. There are pros / cons to each. However, most of the time, resolving an earlier memory has the biggest flow on effect for all subsequent memories. It is like trimming the rose bush low down at its trunk (all other branches will thus be affected).
Determining where to start is up to you. However, before memory processing can begin, an important phase of treatment involves working with your therapist to formulate a Treatment Plan. This is often written up into a table, which clusters the memories that disturb you and bought you to EMDR Therapy, into ‘Themes’.
The EMDR Treatment Plan orders your experiences related to each Theme in terms of Past Events (Memories related to that theme), Present Triggers (i.e., “Every Time ‘X’ happens, I get triggered”), and Future Templates (What you ultimately would like to achieve as a result of processing memories within that Theme – how you would like to be able to respond to the Present Triggers). This process will help you and your therapist identify which experiences most significantly relate to the Theme in question, and which memories you will likely need to Target.
With EMDR Therapy, you get to decide which Theme you would like to work on and which memories you would like to Target. You may choose to start to work on processing the earliest memory, the most disturbing memory, or a recent memory / trigger. Your therapist can assist you to learn skills to help support you through the memory processing safely, so that you can remain within your Window of Tolerance whilst processing a memory / experience.
Thanks to the Generalisation Effect, you do not need to process every experience or memory related to that theme that you have ever had.
What if I Can’t Remember the Past?
There are many reasons why we have ‘foggy’, incomplete, or even very little recollection of the past. Sometimes people ‘know’ that an event happened, but they cannot remember the experience. Other times, people report that there is no specific event that they can remember, because the same painful experience happened over, and over again (or happened many times throughout long periods of their development).
However, with EMDR Therapy, it is not necessarily important that you remember the ‘facts’ of an event.
Why? Because EMDR Therapy works on how a memory is encoded (stored). The ‘facts’ are not necessarily what is most important. Rather, how your brain ‘represents’ the past is what we are working with in EMDR Therapy.
Sometimes, you can literally create a scene in your mind that captures an event or a period of your life, and your therapist can work with you and that scene to extract the significant material that captures what has been left by that experience. This is because just as a memory has specific components, a scene that you have created in your mind will also have these components. Any of the components in that scene can be used as a Target for memory processing.
Again, EMDR Therapy is working with what has been left in your brain by the past (i.e., how the past is being represented in your mind). This frees you up from having to remember ‘everything’ from your past.
Is EMDR the Same as Hypnosis?
No – In hypnosis, you are guided by a therapist to enter an altered, trance-like ‘hypnotic state’, which is thought to bypass the conscious, analytical mind. This is thought to make a person more open to accepting positive suggestions. Therefore, in Hypnosis, you are encouraged to act or feel differently by the therapist’s ‘use of positive suggestion’ about a pre-determined goal or behaviour.
In contrast, the tasks of EMDR Therapy are driven by what we know about how memories are perceived, stored and retrieved. In an EMDR session, a person does not go into a trance-like state of consciousness, because this would actually be counter-productive to processing a memory. This is why steps are taken by the EMDR Therapist to pre-determine your Window of Tolerance (because memory processing cannot happen if you are not mentally ‘present’).
Therefore, in EMDR, active attempts are made towards repeatedly grounding a person in the present moment, by asking them to remain highly focused on specific things (like eye-movements, physical tapping or other forms of bilateral stimulation), while checking-in with their current feelings and body sensations. In EMDR, the therapist is deliberately doing this to prevent you from drifting away from reality, because memories cannot be processed if you are not consciously present.
In EMDR Therapy, we are working with your memories until you have processed them, and you remain in control at all times.
Will EMDR Erase Memories?
No – EMDR Therapy cannot not get rid of a memory. EMDR Therapy also cannot change that fact that past negative experiences happened to you. That is not the goal. You will still have the memory, but it will not disturb or bother you any longer.
You will still be able to retrieve the memory, but it will not disturb or bother you any longer.
Can I do EMDR Myself (or to someone else)?
NO – A common question clients have is whether they can simply “move their eyes left-to-right” while thinking of a painful memory and process that memory themselves. This is not advised (and is potentially unsafe) for several reasons:
Firstly, an EMDR Therapist must undergo a minimum of 50 hours training comprising of: 20 hours of didactic training, 20 hours of skills training and 10 hours of consultation with an EMDRAA Accredited Consultant. Part of this training encompasses understanding the numerous components of an unprocessed memory and how they interact (images, sounds, smells, bodily sensations and negative views of Self), what decisions to make whilst processing memories (EMDR Therapists do not just ask you to move your eyes back and forward – at each stage of processing, they are actually looking for specific cues from you that the individual components of the memory are being successfully processed, before they move onto the next memory component), and how to determine that a memory has indeed been successfully (and safely) processed.
As you can see, each of these components is complex and cannot be executed by one’s self, on one’s self. Similarly, before memory processing can commence, an extensive history must be taken by the therapist to determine the themes, patterns, and cautions that need to be kept in mind when doing memory processing. These skills require professional objectivity, extensive university training, and clinical experience. You cannot do these things yourself.
Secondly, it is not possible to take one’s self through the steps of memory processing because they are so complex that it would not be possible to fully stay ‘in a memory’ whilst self-monitoring. This means you cannot be processing a memory AND be consciously maintaining awareness of (and fidelity to) the EMDR Treatment Protocol (the decision-making steps based on responses made after each set of eye-movements). In other words, even if you knew what the steps were to processing a memory, you would not actually be sufficiently ‘present’ and engaged in your memory – if you were simultaneously mentally taking yourself through these steps – to derive any benefit from doing any EMDR to yourself. EMDR Therapy may appear simple, but unfortunately, it is not something you can do, yourself.
Third, often processing a memory may bring you to the edge of your Window of Tolerance. An EMDR Therapist is trained to help you recognise the cues that this may be happening, and is trained to work with you to ensure that you can keep processing memories, safely. This is not possible (and may be harmful) if you try to perform EMDR with yourself (or anyone else). You may even cause a negative emotional reaction that you cannot manage, and this could put you (or another person) at risk of re-traumatization, dissociation, or self-harm. If this happens, chances are that is not something that you have skills or training to manage.
Think about it this way – Therapists who know how to do EMDR Therapy very well STILL go and seek the help of an EMDR therapist when they have memories that need to be processed. So, what does that tell you?
Does EMDR Therapy Work Online (via Telehealth) ?
YES – it does, and we can say this with a high degree of confidence. In fact, below is a list of peer-reviewed research publications attesting to the effectiveness of EMDR Therapy delivered online. Recommendations for online EMDR Therapy are simply that a) you use a device that is hands-free that b) has a screen large enough for your eyes to move left-to-right when you follow the visual stimulus (a requirement for bi-lateral processing in EMDR Therapy). Also, it may go without saying, but for memory processing sessions via Telehealth you will need to location that is quiet and private (where you will not be disturbed by people, pets, or alerts from any devices).
Similarities & Differences Between Other Approaches
Cognitive-Behaviour Therapy (CBT): We all can have negative thoughts and negative Self Beliefs. However, whereas CBT focuses on homework exercises designed to help you challenge all negative thoughts with the expectation that emotional changes come from helping you ‘think differently’, EMDR Therapy has no homework and does not require you to ‘think differently’.
Rather, one of the many positive side-effects of having successfully reprocessed a difficult emotional experience using EMDR Therapy is that people spontaneously report that their negative Self-Belief has in fact been replaced with a more positive Self-Belief. In other words, one indication that an event has been successfully ‘resolved’ with EMDR Therapy is that a person endorses a more positive view. This happens every time an experience is reprocessed in the Treatment Stage of EMDR Therapy, WITHOUT the typical rationalizing or homework exercises characteristic of CBT.
Mindfulness: Mindfulness is a way of attending to experience (i.e., our internal and the outer world) from the perspective of a non-judgmental Observer. Although Mindfulness is not a treatment in itself, it is a hugely important skillset that can increase your capacity for self-awareness, for insights, and for tolerate strong emotions and challenging internal experiences. Unsurprisingly, the capacity to attend to one’s experience in this way is a hugely useful asset to bring to (or develop in) any therapy. (You can read more about Mindfulness in articles I have written: here and here.)
In the Resourcing Stage of EMDR Therapy, clients are often taught brief Mindfulness skills that can help increase self-awareness and objectivity which can be essential in helping people attend to their experience in ways that are helpful (vs harmful). In the Treatment Stage of EMDR Therapy (which incorporates bi-lateral stimulation) individuals are specifically asked to make use of Mindfulness to mindfully attend to all of their experience (thoughts, feelings, imagery, emotions, sensations in the body, and any other associations their mind may be making) and to objectively report their experience and observations which helps the therapist to understand what aspects of a reprocessing a past experience remain and to determine when it is time to move onto the next Stage of the Treatment.
Acceptance & Commitment Therapy (ACT): ACT is about helping you clarify meaningful and pragmatic (tangible) goals that are deeply connected to your values, and it aims to teach you Mindfulness and distress-tolerance skills so that you can be freer to take more workable actions in directions that serve you (even if discomfort is present). ACT is an ‘experiential therapy’ (the insights you gain come not from talking, but from the insights you gain via participating in ACT experiential practices).
Equally, EMDR Therapy (particularly in the Resourcing and Treatment Stages) make extensive use of Mindfulness and distress-tolerance skills. For example, in the Resourcing Stage, EMDR therapists trained in ACT may draw upon experiential exercises from ACT (to help increase your Window of Tolerance in preparation for the Treatment Stage). Equally, Treatment Stage in EMDR Therapy is also highly experiential and makes use of mindfulness and distress tolerance-skills commonly taught in ACT. In this way, EMDR Therapy can make use of ACT skills and is consistent with ACT: EMDR Therapy aims to help free you from your past, so that you can be free to choose how you respond and can live a freer and more valued-life.
However, whereas ACT focuses on increasing your distress tolerance so that you can ‘take action’ in important areas of your life that you were previously avoiding, with EMDR Therapy once you have re-processed the material underlying your difficulty it is often the case that there is no ‘distress’/’disturbance’ left to apply any skills to. This is a significant different between the approaches (i.e., ACT prepares you to handle distress as an end point, whereas EMDR Therapy aims to removes).
Compassion-Focused Therapy (CFT): Both EMDR Therapy and CFT make extensive use of soothing Imagery and Imagery Rescripting to change how you respond to internal experiences and life’s challenges. Both EMDR Therapy and CFT also result increased self-awareness and (most importantly) an increased capacity for individuals to respond to prior difficulties with a deep sense of Self-Compassion. (I have written articles about the benefits of Self-Compassion and common resistances people have to developing a self-compassionate stance, here.)
Psychodynamic Therapies: Psychodynamic Therapies (there are many variants) and comprehensive EMDR Therapy can focus on elements of the unconscious mind (including unresolved conflicts and repressed emotions) and past experiences as a way to help individuals understand and resolve their current psychological problems. Ideally (provided that your EMDR Therapist is highly skilled), EMDR Therapy can serve as a ‘complete treatment’ (vs just a ‘technique’); one that focuses on Early Childhood, Attachment, and Unmet Needs at all Stages (Assessment, Preparation, & Treatment Stages) to help you better understand the patterns that give rise to your current emotional difficulties (to which the EMDR Therapy is then applied).
In Psychodynamic Therapies and in in EMDR Therapy (and many modern contextual and behavioural therapies such as ACT and CFT) the relationship between yourself and your therapist is understood to serve as a possible window into the problematic relationship patterns in your life. Although historically this was a ‘defining characteristic of Psychodynamic Therapy’, nowadays most Psychologists are also trained to attend to the nature of the dynamic between you and this is certainly a focus in other therapies including ACT, and CFT discussed above. However, whereas in Psychodynamic Therapies the focus on this dynamic is often central to the ‘treatment’, in EMDR Therapy this element features most commonly in the Assessment, and Preparation Stages (i.e., in EMDR Therapy the Treatment Stage is focused on helping your brain heal itself).
Like Psychodynamic Therapies, the Treatment Stage of EMDR Therapy makes use of free association and this can extend to working with symbolic experiences (including memories, imagery and dreams). In addition, both therapies (provided EMDR Therapy is conducted by a highly skilled therapist) share a focus on exploring the nature of your relationships with others, including family members and Attachment figures, and how these relationships may have influenced your current psychological state.
However, a major difference is that: Whereas Psychodynamic Therapy is a purely ‘talking-therapy’ (the success of which is in-part determined by the accuracy of the interpretations of your therapist, combined with your capacity to develop insight based on these interpretations), in the Treatment Stage of EMDR Therapy there is very little talking done at all. Rather, it is via the systematic (i.e., focused) eliciting of the specific components we know from the decades of research to underlie each element of an unprocessed emotional experience in conjunction with bi-lateral stimulation and free association. This can be combined with Imagery Rescripting, to help you work with your brain’s representation of the earliest developmental experiences.
Peer Reviewed Articles about Online EMDR Therapy
Bates, A., Rushbrook, S., Shapiro, E., Grocott, M., & Cusack, R. (2020). CovEMERALD: Assessing the feasibility and preliminary effectiveness of remotely delivered eye movement desensitisation and reprocessing following Covid-19 related critical illness: A structured summary of a study protocol for a randomized controlled trial. BioMedCentral, 21: 929. Open Access: https://doi.org/10.1186/s13063-020-04805-1
Bongaerts, H. Voorendonk, E. M., van Minnen, A., & de Jongh, A. (2021). Safety and effectiveness of intensive treatment for complex PTSD delivered via home-based telehealth. European Journal of Psychotraumatology, 12(1), 1860346. Open access: http://dx.doi.org/10.1080/20008198.2020.1860346
Bursnall, M., Thomas, B. D., Berntsson, H., Strong, E., Brayne, M. & Hind, D. (2022). Clinician and patient experience of internet-mediated eye movement desensitisation and reprocessing therapy. Journal of Psychosocial Rehabilitation and Mental Health, 28. Open access: https://doi.org/10.1007/s40737-022-00260-0
Fisher, N. (2021). Using EMDR therapy to treat clients remotely. Journal of EMDR Practice and Research, 15(1), 73-84. http://dx.doi.org/10.1891/EMDR-D-20-00041
Lazzaroni, E., Invenizzi, R., Fogliato, E., Pagani, M., & Maslovaric, G. (2021). Coronavirus disease 2019 emergency and remote eye movement desensitization and reprocessing group therapy with adolescents and young adults: Overcoming lockdown with the butterfly hug. Frontiers in Psychology, Psychology for Clinical Settings, 701381. Open access: https://doi.org/10.3389/fpsyg.2021.701381
Lenferink, L. I. M., Meyerbroker, K., & Boelen, P. A. (2020). PTSD treatment in times of COVID-19: A systematic review of the effects of online EMDR. Psychiatry Research, 293:113438. Open access: https://doi.org/10.1016/j.psychres.2020.113438
Liou, H., Lane, C., Huang, C., Mookadam, M., Joseph, M., & Hecker DuVal, J. (2022). Eye movement desensitization and reprocessing in a primary care setting: Assessing utility and comparing efficacy of virtual versus in-person methods. Telemedicine and e-Health, Ahead of Print. https://doi.org/10.1089/tmj.2021.0454
Marotta-Walters, S.A., Jain, K., DeNardo, J., Kaur, P., & Kaligounder, S. (2018). A review of mobile applications for facilitating EMDR treatment of complex trauma and its comorbidities. Journal of EMDR Practice and Research, 12(1), 2-15. Open access: http://dx.doi.org/10.1891/1933-3220.127.116.11
Maxfield, L. (2021). Low-intensity interventions and EMDR therapy. Journal of EMDR Practice & Research, 15(2). http://dx.doi.org/10.1891/EMDR-D-21-00009
McGowan, I. W., Fisher, N., Havens, J., & Proudlock, S. (2021). An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid-19 pandemic. BMC Psychiatry, 21, 560. Open access: https://doi.org/10.1186/s12888-021-03571-x
Mischler, C., Hofmann, A., Behnke, A., Matits, L., Lehnung, M., Varadarajan, S., Rojas, R., Kolassa, I-T., & Tumani, V. (2021). Therapists’ experiences with the effectiveness and feasibility of videoconference-based eye movement desensitization and reprocessing. Frontiers in Psychology: Psychology for Clinical Settings, 748712. Open access: https://doi.org/10.3389/fpsyg.2021.748712
Moench, J., & Billsten, O. (2021). Randomized controlled trial: Self-care traumatic episode protocol (STEP), computerized EMDR treatment of COVID-19 related stress. Journal of EMDR Practice & Research, 15(2), 99-113. http://dx.doi.org/10.1891/EMDR-D-20-00047
Perri, R. L., Castelli, P., La Rosa, C., Zucchi, T., & Onofri, A. (2021). COVID-19, isolation, quarantine: on the efficacy of internet-based eye movement desensitization and reprocessing (EMDR) and cognitive-behavioral therapy (CBT) for ongoing trauma. Brain Sciences, 11(5), 579. Open access: https://doi.org/10.3390/brainsci11050579
Perez, M. C., Estevez, M. E., Becker, Y., Osorio, A., Jarero, I., & Givaudan, M. (2020). Multisite randomized controlled trial on the provision of the EMDR integrative group treatment protocol for ongoing traumatic stress remote to healthcare professionals working in hospitals during the Covid-19 pandemic. Psychology and Behavioral Science, 15(4), 555920. DOI: 10.19080/PBSIJ.2020.15.555920. Open access: https://juniperpublishers.com/pbsij/PBSIJ.MS.ID.555920.php
Spence, J., Titov, N., Johnson, L., Dear, B. F., Wootton, B., Terides, M., & Zou, J. (2013). Internet-delivered eye movement desensitization and reprocessing (iEMDR): An open trial [version 2; peer review: 2 approved]. F1000Research, 2:79. Open access: https://doi.org/10.12688/f1000research.2-79.v2
Tarquinio, C., Brennstuhl, M., Rydberg, J. A., Bassan, F., Peter, L., Tarquinio, C. L., & . . . Tarquinio, P. (2020). EMDR in telemental health counseling for healthcare workers caring for COVID-19 patients: A pilot study. Issues in Mental Health Nursing, published online. Open access: https://doi.org/10.1080/01612840.2020.1818014
Todder, D., & Kaplan, Z. (2007). Rapid eye movements for acute stress disorder using video conference communication. Telemedicine and e-Health, (13)4, 461-464. http://doi.org/10.1089/tmj.2006.0058
Winkler, O., Dhaliwal, R., Greenwhaw, A., O’Shea, K., Abba-Aji, A., Chima, C., Purdon, S. E., & Burback, L. (2021). Web-based eye movement desensitization and reprocessing for adults with suicidal ideation: Protocol for a randomized controlled trial. JMIR Research Protocols, 10(11): e30711. Open access: https://doi.org/10.2196/30711
If you have further questions about how EMDR Therapy can help you to get past your past, please contact me below. I am PhD Clinical Psychologist with over 15 years experience. I am an Accredited EMDR Practitioner. Alternatively, for further information please visit the EMDR International Association (EMDRIA) (external website): https://www.emdr.com/frequent-questions/
- EMDR Therapy is a very unique and powerful approach to resolving painful memories that was originally developed to treat trauma, over 30 years ago
- EMDR Therapy has far-reaching applications beyond large or obvious traumas and is essentially useful to consider whenever the past is causing an individual significant disturbance and/or a negative view of themselves.
- Present day stress and triggers exist because of unprocessed memories from our past.
- Early painful attachment experiences and Adverse Childhood Experiences (ACEs) are examples of developmental experiences that may leave a lingering effect on an individual, and these may be useful to work on using EMDR Therapy.
- In EMDR Therapy, the therapist takes each of the stuck components of an unprocessed memory and uses the bilateral stimulation to help the brain store this information in new ways. In doing so, the information from the memory is transferred from the limbic system to the pre-frontal cortex where a person can make better sense of what has happened. This leaves a person feeling resolved (vs ‘stuck’) about the corresponding memory and its components.
- Preparation involves: Taking a History, determining your Present Triggers and Future Goals, mapping your memories into themes, establishing your Window of Tolerance, and building skills so that you can handle any difficult emotions that may show up as when you bring up the memories that are affecting you.
- During a memory-processing session, a client is asked to recall specific components of the problem memory as directed by their therapist – this may include its image, the negative self-belief, and/or the disturbing emotions and associated body sensations. This happens while simultaneously engaging in bilateral stimulation (i.e., stimulation involving both sides of the body) such as left-to-right eye movements (or bi-lateral sounds, flashing lights, or ‘tapping’).
- Eye movements are the most common bilateral stimulation used and these are believed to mimic the eye movements of REM sleep (the stage of sleep responsible for memory processing and learning).
- These eye-movements may be repeated quickly, in sets of 20-30 (several times), until processing has completed.
- EMDR Therapy is very different to regular ‘talking therapy’ – During processing a memory, there is very little talking (other than a brief ‘check in’) in between the bilateral stimulation
- Processing a memory can happen very quickly (in as little as a single session)
- Due to the Generalisation Effect, you do not need to process every single memory – processing one event or memory may also help reduce the disturbance you experience in response to similar memories.
- EMDR Therapy can be highly effective when delivered online, but working with trauma requires extensive and advanced supervised training to ensure that it is a safe and comfortable experience. Therefore, you should not attempt to perform EMDR Therapy (on yourself or anyone else) because this could become highly unsafe.
- How your early experiences of caregiver attachment affect your relationships (and your relationship with yourself)
- How Adverse Childhood Experiences (ACEs) impact on attachment, brain development and later lifestyle and health risk factors
- Emotion Regulation skills: Understanding your Window of Tolerance
- Your Brain’s 3 Emotion Regulation Systems
- How you can get the most out of therapy
- A list of all articles that I have written
Dr Andreas Comninos, PhD Clinical Psychologist
I am a PhD Clinical Psychologist and EMDR Accredited Practitioner with over 15 years of psychotherapy experience. Whether you are seeking an assessment and diagnosis, or are searching for integrative research-backed ways to help you heal past wounds, break reactive-patterns and achieve long-lasting change, my aim is to provide a safe space for you to feel seen, understood, and empowered so you can make meaningful progress on your healing journey.
To learn more and to get in touch, please:
I endeavor to reply to all enquiries within 24 hrs.
Dr Andreas Comninos, PhD Clinical Psychologist
I am a PhD Clinical Psychologist and EMDR Accredited Practitioner with over 15 years of psychotherapy experience. Whether you are seeking an assessment and diagnosis, or are searching for integrative research-backed ways to help you heal past wounds, break reactive-patterns and achieve long-lasting change, my aim is to provide a safe space for you to feel seen, understood, and empowered so you can make meaningful progress on your healing journey.
To learn more and to get in touch, please:
I endeavor to reply to all enquiries within 24 hrs.