Ever wondered what EMDR looks like in a counselling session? EMDR – which stands for eye movement desensitization and processing, is a therapeutic approach with a wide range of applications. Research has demonstrated that EMDR is effective for working with experiences of trauma (and post-traumatic stress), anxiety, phobias, and addictions, to name just a few. To learn more about the components of EMDR, please read Part 1 by clicking here.
There are eight stages to the process of EMDR therapy. It begins as many therapies do: building rapport and getting a sense of what brings you in and your history. Knowing your story helps your Counsellor understand your needs in counselling, any troubling symptoms that need immediate attention, and also helps you both collaboratively create a treatment plan.
The next stage shifts into preparation, or resourcing. “Resourcing” is the common name for developing emotional coping skills. It involves developing the tools needed for emotion regulation. This phase involves learning to notice and move through strong, overwhelming emotions as they arise. It’s the part of therapy that works with treating the symptoms (the pounding heart sensation of anxiety, excessive worry cycles based on past experiences, sleep disturbance, etc.). In EMDR, we work with a rating scale called the Subjective Units of Distress Scale (SUDS for short). It’s a rating scale from 1 to 10, where 10 is the most distressed you’ve ever felt and 1 is no distress at all. The scale is a helpful way for therapists to attune to their clients, and also for clients to notice their own progress in a session.
Developing and strengthening emotional coping skills is important because moving into processing trauma too soon could cause a person to feel unsafe and emotionally flooded. With your Counsellor’s help, the intention is to learn to be present with emotion without being overpowered by it; learning to turn down the volume on some emotions as you need to, and ultimately helping you feel safe with the counselling process.
The experience of trauma can leave us feeling unsafe, that is why cultivating a sense of safety has to be a primary focus. Also, it’s okay to go slow and develop rapport with your Counsellor: you need to feel comfortable and understood (and dare I say, have a sense of trust) before you disclose all the tough stuff to someone. And, it is super important that you build the emotional coping skills to be okay after and between sessions. EMDR respects these important features of trauma work.
With the ability to regulate emotion and connect with a degree of internal safety developed, we can begin the next stages of EMDR: Desensitization. (Read more about this stage in Part 1 of this article.) Desensitization is where trauma processing begins. For those of you wondering what on earth this part of therapy looks like, let me demystify it for you.
During this trauma processing stage of EMDR, a session starts out with resourcing and then moves into target selection (which just means you choose what the session focus will be). Because I work with trauma, that often means we want to start out with the first traumatic memory or the worst traumatic memory. Wait! Please don’t slam your laptop shut and storm off – I know that can sound frightening, but you will be ready for this stage because of all your hard developing and practicing emotion coping skills during the preparation stage!
Once we’ve got that memory selected, we connect the negative belief that goes with it, the emotion it evokes, and where you feel it in your body (the sensation of the emotion).
Side Note: Why do we Need to Cultivate Awareness of the Felt Sense of Emotion?
Cultivating awareness of how we feel emotion in our body is super important. Trauma can often leave folks feeling disconnected from their body. They can get caught up in staying in their head (thoughts), because perhaps it feels safer. However, our body still carries all that tension. Maybe it gets experienced in the form of stomach aches or digestive problems, holding the breath/shallow breathing, muscle tension, or a clenched jaw. This disconnection from the felt sense can become so habitual, that many folks stop noticing it. But all that tension and unrecognized dis-ease can cause all kinds of health problems.
So, with the pairing of the trauma memory, with the negative belief, the emotion it evokes and how distressing it feels, and how you sense it in the body, we add BLS and start processing that old memory. Whatever your distress level was at the beginning of the session, your therapist’s goal is to guide you through the processing to get that number down so that you are anchored in a sense of internal safety when the session ends.
And here is the amazing part: as the BLS is repeated, the brain is processing the trauma to reconcile it as a past event. When your brain and your body can reconcile trauma as a past event, it means you can anchor into the present moment. You shift out of survival mode and can more accurate attest that you truly are safe now.
Emotional Activation (Feeling Triggered):
Have you ever noticed that when something in the present moment reminds you of a trauma you experienced, the emotion that arises feels completely raw and overly-excessive to the present situation you are in? That is what unprocessed trauma can feel like. There is an amazing little brain system we all have, called the limbic system. Its sole job is to keep us alive. Experiencing trauma can keep us popping into that limbic system survival mode way too frequently. Constant survival mode living can leave people feeling emotionally reactive (as though we are constantly in fight, flight, or freeze), and emotionally exhausted. The brain just doesn’t recognize that the trauma is over, and that you are safe now. That is why counselling is so important for your overall health and functioning.
During processing with BLS, emotion becomes less intense. One of the session goals is to keep reducing activation – getting your SUDS number going down so that you are shifting more and more out of distress.
As a result of all that emotional processing, you are able to connect with a positive belief, and we install it with BLS (the next stage in our 8 stage model). Instead of the negative belief a person started the session with, such as perhaps “I am not enough”, folks now get to decide what positive belief is more preferable, (such as “I am worthwhile”, or “I did the best I could”). We link the positive belief in with BLS so that when the client thinks about the past experience, he or she is no longer washed over with thoughts of being not enough – and in fact, that old negative belief feels distant. The past event really does feel over and anchored in the past, and linked with the positive belief. It may still evoke a degree of emotion (after all, we can not erase the past from having happened), but the sadness or fear that arises going forward when the memory is recalled, will be less intense and will fit the situation you are in.
Containment metaphors might be used at the end of a session, as well as a body scan. The body scan is a super useful tool to strengthen the positive sensations associated with the positive belief, and also for identifying any distress still present. The final stage of the session (but not yet the 8th stage of EMDR), is a debriefing of sorts, where we can review strategies for anchoring in the present moment, handling emotion as it comes up, and discussing what to expect after the session in terms of emotions percolating and taking care of self between sessions.
The subsequent session starts out with an exploration of anything that came up between sessions, and a re-evaluation of thoughts, beliefs, emotions, and sensations connected with the work from the previous session That’s the eight stage of EMDR, and then the process continues until folks feel as though they have worked through the pieces they entered into counselling to address.
I hope this summary of what EMDR in a therapy session looks like has been helpful. Remember, while we can not erase traumatic experiences from your memory, with EMDR the brain can reconcile them as a past events. We can lessen the intensity of the emotion the memory evokes, as well as the meaning attached to it. We learn to notice when we are shifting into the limbic system and either act to maintain safety or anchor back into the present moment acknowledging the memory as well as our present moment safety.
If you want to learn more about EMDR, please check out the EMDR International Association website or EMDR Canada. Both of those websites also list EMDR therapists by location, so you can even tap into those resources to find a practitioner close to you.