EMDR (Eye Movement Desensitization and Reprocessing therapy) is a form of psychotherapy that utilizes numerous principles and techniques from Cognitive Behavioral Therapy and behavioral therapy, and incorporates them with lateral eye movements, where the eye moves back and forth (left to right and then right to left horizontally). The developer of the EMDR technique, Dr. Francine Shapiro, believes that lateral eye movements in conjunction with psychotherapeutic techniques can reduce stress, heal trauma, and address numerous conditions.
During the delivery of certain aspects of therapy, the client is instructed to follow the therapist’s hand with their eyes as they move their hand back and forth in the client’s visual field. Proponents of EMDR believe that this adds to the effectiveness of the other techniques they use and have very complicated neuroanatomical explanations as to why this is so. However, there is significant controversy regarding the use of the lateral eye movement component of EMDR and if this component actually adds anything to the already established psychological principles and techniques that come from other sources.
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EMDR practitioners will typically follow a standard procedure that consists of eight steps or phases of treatment. The experience of being in a session depends on which stage of treatment the client is in. For ease, we can view three general categories that comprise the eight phases of treatment as similar in their experiences. This allows for simplicity in understanding what EMDR sessions are like from the viewpoint of the client.
- Assessment: EMDR phases or steps 1-2
- Treatment: EMDR phases or steps 3-6
- Termination: EMDR phases or steps 7-8
We can conceptualize the three categories of treatment as:
During the first two phases of treatment, the therapist must understand the client, learn why the client has come to treatment, and fully develop a profile of the client, including understanding the person’s beliefs, needs, relationships, history, etc. The first two appointments are devoted to information gathering and developing the therapeutic alliance (the relationship between the client and the therapist).
The goal in the assessment stage is to get as complete a picture of the individual as possible in order to develop an individualized treatment plan for the person. Clients in this phase get quite a bit of interview-type questions, and there is substantial question-and-answer interplay during the early stages of treatment. Therapists should take copious notes, ask for clarification, and review what they believe their understanding of the client’s situation and history is with the client in order to ensure accuracy. The therapist also discusses the limits of confidentiality with the client in the initial session (see below).
As the assessment progresses, the therapist begins to explain the overall treatment philosophy of EMDR to the client so they know what to expect from the therapy. Early in the treatment, the therapist may also provide the client with some quick tools that the client can immediately use, such as learning progressive muscle relaxation, diaphragmatic breathing, and the use of mental imagery to deal with stress and tension. This helps the therapist in several ways, but it most importantly builds a working bond between the therapist and client (the therapeutic alliance) and also gives the client an opportunity to practice techniques that they will need to use in the treatment and to adjust them to fit their needs.
As the assessment process winds down (although good therapists continue to assess all aspects of their clients throughout the treatment), the therapist and client begin to develop specific therapeutic targets to address. These targets are the specific issues that the client and the therapist agree on that will be the major focus of treatment.
In the initial part of the treatment phase, the client and therapist begin to elaborate more on the targets they will address. They work together to identify how these targets affect the client in terms of negative emotions, dysfunction, etc. The identification of targets also helps the therapist and the client to develop the goals of the particular therapy. The specific targets are identified, the specific issues associated with the targets are identified, and how the therapy will address the targets and change them for the better are discussed. Therapists often help the client to develop a hierarchy of targets, starting with targets that produce the least amount of distress or dysfunction and then working toward targets that are far more stressful and produce significant dysfunction.
Once the targets are identified and goals have been outlined, the actual treatment begins. The client follows the therapist’s fingers as the therapist moves them back and forth in the client’s visual plane while the client discusses their feelings associated with the specific targets. During treatment, the therapist works with the client to restructure their beliefs and feelings regarding these stressful situations (targets). The client can use their relaxation training and stress management techniques to help them while discussing stressful or anxiety-provoking issues. This helps the client to get control of their feelings and better prepares them to change their feelings and behaviors. In addition to the work that occurs in the sessions, therapists often assign specific types of homework for the client, such as testing new beliefs, incorporating new behaviors, and continuing to use stress management techniques to deal with anxiety and other issues.
The treatment process also incorporates continual assessment of the client’s progress toward the goals of the therapy, allows both the client and therapist to return to earlier issues if needed, and helps them to move forward in addressing more stressful and dysfunctional issues as the initial issues become resolved.
Eventually, the majority of the issues that have been identified in the treatment plan are satisfactorily addressed, and the therapist begins to work with the client to end the treatment. This termination phase can be quite complicated. Sometimes clients do not have the confidence to leave therapy even if they have mastered all of their issues. However, the therapist remains understanding and works with the client to continue to address the issues, goes back to previous issues and makes sure that the client is satisfied with their progress, and reassesses the client to make sure that the goals of the therapy have been reached. Eventually, the client and therapist jointly agree when the therapy will terminate.
Because EMDR is a time-limited therapy, meaning that it simply addresses the issues identified in the treatment plan and then is discontinued, the therapy is eventually terminated. However, clients are encouraged to return if they feel they need additional help, and the therapist welcomes periodic check-ins from the client to assess any progress the client has made, discuss any new issues they need to work on, etc.
Concentrations and Confidentiality
EMDR is heavily influenced by behavioral and cognitive-behavioral principles of therapy. The focus is on the therapeutic alliance, restructuring an individual’s belief system to make it more realistic, and the reduction of anxiety and stress that are associated with dysfunctional behaviors. Numerous other techniques may be involved during treatment that are taken from cognitive-behavioral therapeutic principles.
The main focus is to develop a strong working agreement between the client and therapist, which has been shown by research studies to be an important factor in positive outcomes that occur in all forms of psychotherapy. A positive therapeutic alliance instills a strong working bond, mutual trust, and mutual respect, and it facilitates the development of positive growth in both the therapy sessions and in the client’s functioning outside of the therapy.
The practitioners of EMDR believe that using the eye-movement component in conjunction with the treatment facilitates the process; however, as mentioned above, the independent research investigating this does not support this belief.
EMDR is as effective as most cognitive-behavioral interventions in treating issues due to its use of cognitive-behavioral techniques.
Clients in EMDR sessions develop a strong collaborative relationship with their therapist, and this relationship results in them becoming more confident in their ability to change and being able to be honest with the therapist and discuss very intimate issues with them. It also increases their efficiency at reaching their goals in therapy.
The bond between the client and therapist also includes the issue of confidentiality in therapy. The issues discussed in therapy, the progress of therapy, and any other incidents that happen in the therapy sessions are held strictly confidential by the therapist unless in rare situations that require the therapist to discuss these issues with authorities. For example, if the therapist discovers there is any type of ongoing child abuse that involves the client, or the client is judged by the therapist to be an immediate danger to another individual or in danger of immediate self-harm, they must notify authorities. The therapist must have evidence that immediate harm is feared before they break confidentiality.
By maintaining an environment where there is trust, confidentiality, and collaborative movement toward change, the therapist and the client can work together to address the issues that the client brings to the therapeutic situation in an effective manner.