From the broadest view, EMDR allows stuck memories to connect with and assimilate into adaptive information. This is done by activating the stuck memory, noticing whatever comes up, while receiving one of several forms of bilateral stimulation. Noticing is an essential component to this type of healing. It’s the bright yellow line in the center of the path. Lose that and you quickly get lost.
Clients with trauma will likely have problems noticing without specific guidance. Part of this difficulty may be grounded in our shared cultural baggage that values forms of dissociation over embodiment. People with trauma make an art of not noticing. It’s a survival strategy. I expect this. When I first mention noticing anything (body sensations, breath, or current awareness), the look is frequently one of terror. Many clients would rather do anything else. A few, I’m sure, would rather I set them ablaze. Since many trauma clients come to the idea of noticing with either a decided bias or a pronounced deficit, I describe all initial noticing interventions as an invitation to “dip your toe into noticing” in preparation for the kind of extended noticing that is required during EMDR reprocessing (see: “Deep Breathing Doesn’t Work for Me”).
During reprocessing, clients primarily notice on one of four “channels:” body sensation, memory, thought, and emotion. Some clients may also notice on other channels: some see colors or textures as a central part of their reprocessing; others spontaneously “see” trauma-based enactments that are not based in memory (like when a client sees her adult self assault a childhood abuser in revenge); or when certain sensory channels “blur” together. The vast majority of clients do most of their reprocessing in a mixture of the body sensation, memory, thought, and emotion channels.
Part of the goal of this piece is to educate therapists about the range experiences clients might have while noticing, problems some clients have with noticing, and ways to quickly redirect clients who temporarily lose the bright yellow line of noticing. It’s also important to note that these channels often blur together and interact. For instance, the emotional channel is nearly always reflected in the body sensation channel (as is memory, particularly when the memory is trauma).
Items in bold are helpful to share with the client as part of psychoeducation prior to reprocessing. The remainder (the vast majority of them) are to help assist you, so you can assist the client as needed.
Assorted Notes on the Body Sensation Channel
- It’s helpful to educate the client prior to reprocessing to try to notice body sensations without trying to explain their presence or to nudge them one way or another. “Simply notice that you are having a sensation in your body, without pushing or pulling it. When you notice it for a while, it will often move or shift or change on its own.”
- Body sensations may or may not be a function of an emotion that the client can identify (or is even experiencing right now). In EMDR, body sensations may be their own thing and may move, shift, or change without something else changing on another channel. Don’t ask me to explain this in any detail, but good movement or shifts of bodily sensations is one way to know that reprocessing is occurring. Movement or shifts on any channel are often the only way that you’ll know that reprocessing is occurring.
- Shifts in body sensations may travel smoothly and seamlessly from one region of the body to another (more common). Or, body sensations may quickly extinguish in one region and “jump” to another region (less common). Some clients experience sensations in different regions like waves that quickly peak and then quickly diminish.
- Many clients may be aware (from a distance) that things are happening in the body, but are not actively noticing what is actually happening. If reprocessing has stalled and I suspect a deficit in noticing, I may ask the client to notice the edges of the sensation or to notice the shape of the boundary of the sensation. This usually allows the client to notice the sensation in ways that allow some reprocessing to occur.
- Body sensations may be difficult for clients to notice because of the distress of the sensations themselves and/or because of what those somatic sensations connect to related to the trauma. In short, body sensations have associations. Those associations often really suck. Normalize this and support noticing.
- The sensations that the client experiences in a reprocessing session may or may not mirror sensations that occurred during the traumatic event. It is fine if this occurs. It is fine if it does not. A client who is burned during a trauma may feel a burning sensation in the area of the injury. Or, that same client may not.
- Many (if not most) clients will have periods where they notice multiple sensations at once. It’s usually best to ask the client to notice the most distressing sensation first. If that sensation is “stuck” after several sets, you can ask the client to notice the other sensation (if it’s still there). Some clients will report a positive and a negative sensation in different parts of their bodies. Unless you’re winding down a session, always ask the client to notice the negative sensation first (the positive stuff takes care of itself, but the distress is a part that has yet to be metabolized).
- Sensations may be layered and each layer may correspond to a specific emotion or part of the trauma. I have several clients who do a lot of reprocessing using layers of different sensations in their stomachs and they usually have to notice each layer as a discrete element for reprocessing to progress.
- Many clients will suddenly notice nothing. In many cases, they have simply arrived at the end of the content for the last channel they were following. It’s okay to ask the client to notice nothing for several sets. If the client still notices nothing, take a SUDS. If the client gives you a number above a one, you can ask “Where is that [four] sitting?” Which will immediately give the client something to notice. Or, you can simply ask the client to check back in with the target memory and see if anything else wants to come on any channel.
- Near the end of reprocessing a difficult target (about 90% through the session), some clients new to EMDR report feeling dizzy. Sometimes this disorientation is caused by the client having her eyes closed (while using the tappers or headset). Ask the client to keep her eyes open on the next set. This usually resolves dizziness or disorientation for the remainder of the session.
- Near the end of sessions, some clients new to EMDR will report that the relaxation or “lightness” that they feel is scary or triggering. Normalizing this usually helps.
Assorted Notes on the Memory Channel
- For clients with complex trauma, it’s helpful to allow the client flexibility in how he approaches the memory. Standard protocol places the entryway at the worst image/part, but Shapiro also offers the VCR metaphor that allows the client to approach the memory with options. The client can fast forward, rewind, play, or stop the progression of the memory. However, the memory is not considered fully reprocessed until the client can “play” all parts of the memory without distress.
- For clients with severe and complex trauma, we rarely start reprocessing with the client’s most unspeakable traumas. We usually start with something the client can handle with language. This approach is well tolerated. My clients nearly always return after the first reprocessing sessions.
- When clients notice “nothing” in the first few sets, this is often because the client is trying to find a workable way into the targeted memory network. A good first approach is to simply direct the client back to target and give longer sets (more suggestions at When Reprocessing Starts but “Fizzles” in the First Few Sets).
- For clients with severe and deeply entangled traumas, there is a heightened risk in the initial reprocessing sessions that a large number of memories will flood into awareness. When many memories flood in faster than the client is able to notice his responses to them, this can be overwhelming to the point that reprocessing stops. It is helpful to educate clients on the possibility that this may occur and that it is better to let memories come in at a more measured pace that allows client to notice responses to them individually.
- In the last 15 minutes of a session where the target will remain open, it is a good idea to inform the client that it is time to start winding down the session. At this time, it may helpful to ask the client to “turn off/turn down the memory channel.” This helps prevent the emergence of new memories/material while the client is noticing existing body sensations or the client is preparing to go to a closing resource.
Assorted Notes on the Thought Channel
- A lot of blocks are revealed by checking the thought channel. If you detect a block and suspect that it may do with thoughts, ask: “Have you been noticing anything on the thought channel the past few sets?” Thoughts related to blame and responsibility are common blocks.
- It is often a block to reprocessing when clients actively pursue “why” questions: Why did all this bad stuff happen to me? Why did my [abuser] do it to me? Why did God allow this to happen to me? EMDR may not assist clients in answering existential or “why” questions, particularly not when the client is actively seeking an answer. If a client is blocked because of active pursuit of a question that the client is unable to unlock, I may provide some information: “EMDR seems to work best when you allow things to come to you, instead of trying to track down a specific answer to a specific problem.” I may validate the motivations behind seeing these answers, but redirect the client back to target memory and simply ask the client to notice what comes up.
- Be suspicious of adaptive information when it comes too soon in a reprocessing session. Some clients will purposefully recruit adaptive thoughts very early in the reprocessing session in an attempt to avoid the distress or boredom of noticing. If the client reports a lot of adaptive thoughts on the thought channel in the first few minutes of a reprocessing session (before the client has even fully “loaded up” the memory), I’m likely to address this as a potential problem.
- When a client reports related but conflicting thoughts (maybe one that is adaptive and one that is likely maladaptive), it is fine to have the client to notice one thought on one hand and the other thought on the other hand and to notice what comes up as she toggles between then. If you feel the need to ask the client to notice one thought or another, focus on the negative thought (again, the adaptive stuff takes care of itself).
Assorted Notes on the Emotion Channel
- Most noticing of emotion occurs on the body sensation level. But again, not every bodily sensation in EMDR will track directly back to an identifiable emotion.
- When the client reports a sudden change in emotion, Shapiro recommends that you ask the client “Where in your body do you notice that [emotion]?” This is a consistently helpful piece of advice. Immediately after changes in emotions, clients often are not sure what to notice. The nudge toward the body connects these two channels in ways that seem to allow the client to move back into reprocessing.
- Guilt, shame, blame, and regret are common emotions in trauma survivors. They’re also likely points of blockage during reprocessing, if the client can’t find his way around them. I let my clients know that these emotions and their connecting cognitions are common blocks to reprocessing and to let me know if he should become stuck in one of them. There are many ways to help the client with these blocks and some of these may need to be done inside a reprocessing session. These emotions have a strong body sensation component, a strong cognitive component, and a strong memory component. One way to help a client resolve a block involving these emotions is to ask the client to explore the block by noticing on one of the other channels (a channel other than the one the client is experiencing the block on). For a client who is stuck in the belief that she is responsible for being sexually abused when she was seven years old, Shapiro might ask the client to notice the thought that a seven year old can be responsible for the actions of an adult. Shapiro might ask the client to perspective-take: “Imagine it’s your daughter and that she is responsible for what an adult does to her.” Shapiro is clear that reprocessing will not occur where the client lacks the necessary adaptive information for the maladaptive information to metabolize into. EMDR requires that you get out of the way when the client is reprocessing, but that you assist the client back into a reprocessing channel if the client gets lost or gets caught in a loop.