I’ll try to describe what an average traumatic memory reprocessing session using EMDR looks like. During the first few minutes of the session we select the specific memory that the client will initially focus on. I ask the client about thoughts and emotions that she feels when holding this memory (most of the time the thoughts relate to safety and the emotions are a mix of fear, anger, or sadness). I ask how distressing this memory is to hold on a 0 to 10 scale. For 90% of sessions, the distress level is between 8 and 10. In an average session, the client will hold a “tapper” in each hand that provides the left-right vibration. The tappers quickly vibrate left and then right and are controlled by a device that I hold. This left-right stimulation is central to EMDR and in other sessions they will use headphones that beep or use left and right eye movements.
I ask the client what she is noticing in her body in response to us setting up the target memory. The targeted memory is often very “hot,” so talking about it usually causes a bodily response. About 60% of the time, it’s a pressure somewhere in her chest. About 25% of the time, it’s a tight stomach. The remainder are split between tension in the shoulders, neck, and areas between stomach and chest. As we start reprocessing, I ask her to do two things simultaneously: play the memory (or a part of the memory) and notice that sensation in her body. There is very little talking in EMDR. After about 20-30 seconds of noticing (end of the first “set”), we stop and take a deep breath together. I ask her what she is noticing. During the first few sets of noticing (first few minutes of reprocessing), she probably will not notice much movement or change in the bodily sensation (other than it will likely become more intense as more parts of the memory come into awareness). After the first few sets, things usually start to change and move around.
This is how most of the remainder of the session goes. In 20-40 second spans of silence, the client is noticing what comes up in response to holding a memory. The client is aware that this noticing can occur on one of five channels: body sensations (the channel we started on); body memory (the memory of a previous body state); thoughts; emotions; or memory. Things come into awareness as the client notices and I simply ask her to notice then. About 75% of the noticing that my clients do tends to occur on the body sensation or memory channels. For some clients, most of their noticing is on the body sensation channel. Other clients notice very strong and frequent changes in emotion and others have many thoughts to notice. Clients reprocess differently. Most of my clients will notice that their body sensations move and shift. A sensation that starts in the chest might slowly move down into the stomach, then up into the shoulders, then back down into the chest, as though it is following a path through the body. Patterns of sensations do often emerge in a single client across multiple sessions. Likewise, the speed of reprocessing is different between clients. A few of my clients can fully reprocess lava-hot memories in 25 minutes or less. Many will take a whole session. Some may take several sessions.
As the session progresses, other related memories often come in and I ask clients to notice what comes up as they hold or play that new memory. During the course of the session, the level of distress associated with the initial targeted memory starts to decrease (as well as the distress associated with the connecting memories that have come in). When the level of distress gets to 0 out of 10, then that specific memory or memory cluster has lost its “heat” and the client is very likely to be able to recall that memory in 20 years with very little emotional or bodily response. There are other elements that go into successfully closing down a session. During most of my sessions (about 70% of the time), the client’s level of reported distress will be 0 or 1 by the end. For the remainder, the distress is often in the 3-5 range and we are often able to return to that memory in later sessions and it will usually “cool” to a 0 or 1 within 15 or 20 minutes of additional reprocessing.
In an average EMDR session that I do with clients, there is a lot of:
- Noticing without judgment to whatever comes up on any of the five channels (memory, body memory, body sensation, thought, and emotion).
- Noticing fairly intense emotions or sensations.
- Taking a deep breath before I ask, “What are you noticing?” This helps the client manage intensity (and helps me discharge some of the intensity that comes at me vicariously).
- Therapist encouraging client to continue noticing what is coming up or directing the client to notice something in a certain way.
- Intense bodily releases as memories are reprocessed and clients get resolution. Clients often report that they feel more relaxed at the end of sessions than they have felt in months or years.
- By the end, noticing immediate improvement in self-esteem. Clients appear to recover instantly the self-esteem that the targeted traumatic memory took from them.
There is astonishingly little that is reminiscent of traditional talk therapy (talking, reflecting, questioning, scrutinizing, instructing, psychoeducation, etc). Prior to being trained in EMDR, I did a lot of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with clients. TF-CBT often requires a lot of talking. It causes a similar emotional release in the body while talking about a traumatic memory. However, I never saw a traumatic memory go to a 0/10 level of distress in a single session using TF-CBT. My clients were nearly never relaxed when leaving my office (they often carried all of that distress out the door with them). I frequently wondered if I was causing more harm than good. EMDR has changed all of that. The vast majority of my clients are getting objectively “better,” even those who have been in counseling nearly their whole lives. They get better each session. It’s beautiful to see.