A Brief Description of EMDR
Eve Movement Desensitization and Reprocessing
(EMDR)1 integrates elements of many effective psychotherapies in
structured protocols that are designed to maximize treatment effects. These
include psychodynamic, cognitive behavioral, interpersonal, experiential, and
body-centered therapies2. EMDR is an information processing therapy
and uses en eight-phase approach.
During EMDR1 the client attends to
past and present experiences in brief'-sequential doses while simultaneously
focusing on an external stimulus. Then the client is instructed to let new
material become the focus at the next set of dual attention. This sequence of
dual attention and personal association is repeated many times in the session.
Eight Phases of Treatment
The first phase is a history taking session
during which the therapist assesses the clients readiness for EMDR and develops
a treatment plan. Client and therapist identify possible targets for EMDR
processing. These include recent distressing events, current situations that
elicit emotional disturbance, related historical incidents, and the development
of specific skills and behaviors that will be needed by the client In future
During the second phase of treatment, the
therapist ensures that the client has adequate methods of handling emotional
distress and good coping skills, and that the client is in a relatively stable
state. If further stabilization is required, or if additional skills are
needed, therapy focuses on providing these. The client is then able to use
stress reducing techniques whenever necessary, during or between sessions.
However, one goal is not to need these techniques once therapy is complete.
In phase three through six, a target is
identified and processed using EMDR procedures. These involve the client
identifying the most vivid visual image related to the memory (if available), a
negative belief about self, related emotions and body sensations. The client
also identifies a preferred positive belief. The validity of the positive
belief is rated, as is the intensity of the negative emotions.
After this, the client is instructed to focus
on the image, negative thought, and body sensations while simultaneously moving
his/her eyes back and forth following the therapist's fingers as they move
across his/her field of vision for 20-30 seconds or more, depending upon the
need of the client. Although eye movements are the most commonly used external
stimulus, therapists often use auditory tones, tapping, or other types of
tactile stimulation. The kind of dual attention and the length of each set is
customized to the need of the client. The client is instructed to just notice
whatever happens. After this, the clinician instructs the client to let his/her
mind go blank and to notice whatever thought, feeling, image, memory, or
sensation comes to mind. Depending upon the client's report the clinician will
facilitate the next focus of attention. In most cases a client-directed
association process is encouraged. This is repeated numerous times throughout
the session. If the client becomes distressed or has difficulty with the
process, the therapist follows established procedures to help the client resume
processing. When the client reports no distress related to the targeted memory,
the clinician asks him/her to think of the preferred positive belief that was
identified at the beginning of the session, or a better one if it has emerged,
and to focus on the incident, while simultaneously engaging in the eye
movements. After several sets, clients generally report increased confidence in
this positive belief. The therapist checks with the client regarding body
sensations. If there are negative sensations, these are processed as above. If
there are positive sensations, they are further enhanced.
In phase seven, closure, the therapist asks
the client to keep a journal during the week to document any related material
that may arise and reminds the client of the self-calming activities that were
mastered in phase two.
The next session begins with phase eight,
re-evaluation of the previous work, and of progress since the previous session.
EMDR treatment ensures processing of all related historical events, current
incidents that elicit distress, and future scenarios that will require
different responses. The overall goal is to produce the most comprehensive and
profound treatment effects in the shortest period of time, while simultaneously
maintaining a stable client within a balanced system.
After EMDR processing, clients generally
report that the emotional distress related to the memory has been eliminated,
or greatly decreased, and that they have gained important cognitive insights.
Importantly, these emotional and cognitive changes usually result in
spontaneous behavioral and personal change, which are further enhanced with
standard EMDR procedures.
1. Shapiro, F, (2001), Eye
Movement Desensitization and Reprocessing: Basic Principles, Protocols and
Procedures (2nd ed.), New York: Guilford Press.
2. Shapiro, F.
(2002), EMDR as an Integrative Psychotherapy Approach: Experts of Diverse
Orientations Explore the Paradigm Prism. Washington, DC: American
Psychological Association Books..
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