What to Expect After EMDR

What Is EMDR?

EMDR is a type of trauma-focused therapy that combines bilateral stimulation with the reprocessing of traumatic and distressing memories and negative beliefs. EMDR works to link memories of traumatic events with adaptive, helpful thoughts and resources in order to lessen distress and trauma symptoms when the person thinks of the event. So, while nothing can take away the fact that the traumatic event happened, EMDR changes the client’s response to it.¹

EMDR can be done online or in person, and it is important to note that EMDR is an entire therapeutic modality, and not just the bilateral stimulation and reprocessing as many assume.² Although EMDR is trauma-focused, it has been found effective for a wide range of concerns, including PTSD, anxiety, depression and more.

How Does EMDR Work?

EMDR works by helping people reprocess traumatic past experiences and negative beliefs. EMDR follows a standard protocol that includes eight phases and utilizes both fast and slow bilateral stimulation. Options for bilateral stimulation include watching a light move across a bar, watching the therapist’s hand movements or another side-to-side movement, holding tappers that pulse on alternating sides, or even self-tapping.

“Through processing, clients are able to establish a better internal understanding/response of their trauma and thus, demonstrate an improved outward presentation. They will experience a decrease in or elimination of anxiety attacks, outbursts, withdrawal, etc.” – Ayesha Davenport, LPC

What to Expect During Your First Session

In the first session, the therapist and client will get to know each other and start identifying themes and topics for treatment. This is when the therapist will start to gather history, help the client identify traumatic memories, and explore the client’s negative beliefs. The therapist and client will go over any intake paperwork including policies, procedures, and payment. The therapist will also ask about coping skills and begin teaching the client tools to help them stay calm and present during the treatment.

Getting to Know Your Therapist

The first session allows both therapist and client a chance to meet, get to know each other, and answer any questions the client may have. The therapist and client will mutually determine if it is a good fit. It is important that the therapist and client develop a good rapport, and that the client feels comfortable. The first session will give the client a sense of the therapist’s personality and treatment style, as well as an idea of what to expect in future sessions.

Talking About Your Childhood

EMDR is based on the idea that the way we experience trauma is tied to earlier distressing life events. The therapist will ask about the client’s childhood and family of origin to start to get an idea of their background and any potential distressing early events that may be related to the presenting problem. These events will become the targets for treatment.

Discussion of Negative Beliefs

The therapist will help the client uncover the negative beliefs they have about themselves relating to the traumatic memories, such as, “I am not safe” or “I am unlovable.” Part of what makes EMDR work is identifying and reprocessing these negative beliefs.

Discussion of Distress

The therapist will help the client identify how the distress is showing up for them in the present, which could be in the form of memories, images, thoughts, emotions, or body sensations. The therapist will have the client rate their distress on a scale of 0-10, with 0 being none at all and 10 being the worst the client can imagine.

What to Expect From Your First Desensitization Session

Once the therapist has gathered all of the necessary background information, the traumatic memories have been identified, and the client has tools and resources to help them regulate their nervous system, reprocessing can begin. It’s important that the client has tools to help them stay in the “window of tolerance,” meaning the traumatic memories aren’t so intense that the client can’t handle them. It can be a delicate balance to find the sweet spot where the memory is intense enough to reprocess, but not unmanageable.

Revisit Traumatic Events

The therapist will go back to the list of identified memories, and may ask the client a question like “which of these is the most emotionally charged for you right now?” The therapist will then help the client identify the images, thoughts, emotions, and body sensations that come up related to that memory. The therapist will then ask the client to rate the current distress level on a scale of 0-10, a scale known as SUDS, or subjective units of distress.

Receive Bilateral Stimulus

EMDR was originally developed with eye movement, but there are now several different options for bilateral stimulation. The therapist may have the client watch a moving light, hold tappers that pulse on alternating sides, tap on the client’s knees or have the client tap on themselves. There are also tools available for doing EMDR online.³

Talk About How You Feel

The therapist will stop the bilateral stimulation at regular intervals and ask the client a question like, “what are you noticing?” or, “what’s coming up for you?” The client’s role at that point is to simply notice what is coming up, without judgment or filtering. For the most part, the therapist will stay out of the client’s way, administer the bilateral stimulation, and encourage the client to notice without much other talking.

Results to Expect After EMDR

It can be anxiety-producing to try something new, especially something that might feel different or unusual like EMDR. Many clients feel better about starting a new process when they know what to expect. Although every client, situation, and therapist is different and unique, many clients have similar experiences after EMDR treatment.

“The goal of EMDR,” Davenport adds, “is to reconcile emotions and, in most cases, thoughts associated with significant trauma. When EMDR is completed, clients have reported feelings of relief, confidence, and self-assuredness with regard to whatever the identified challenge was.”

After the First Session

If EMDR is working, a person should feel relieved after just a couple of sessions. The traumatic memory will start to be desensitized and will at the very least be less emotionally distressing. However, EMDR opens up the memory networks in the brain and many clients may notice new memories, additional details, or dreams after the first session. This is normal and is the brain’s way of continuing to process the material. The therapist will make sure the client has coping skills and resources to help them deal with anything that comes up after each session, especially the first one.

Davenport ecplains that, “EMDR is often preferred because it is believed to be effective within a shorter time frame than other therapeutic approaches. In some cases, just one or two sessions (after initial intake) can be enough depending upon what the client is processing.”

After 2-4 Sessions

By this point, it is reasonable to expect that the initial target memory is much less distressing, and possibly even completely cleared. Having a clear target does not mean that the client doesn’t remember the traumatic event, or even that they are ok with the fact that it happened. It simply means that it no longer feels like it’s happening today. Most people find that they are less easily triggered and that they feel less distress in their bodies at this point.

After Treatment Is Complete

Once EMDR therapy is finished, most people can expect to feel a great deal of relief. Even though the traumatic memory may still come up, it won’t have as much emotional charge. A person may feel more of a sense of calm and acceptance when thinking about the event. Moments of overwhelm, or feeling like the event is happening again, are very rare, if not non-existent at this point.

While remembering a traumatic event may of course still bring up grief or sadness, EMDR helps clients leave it in the past so it no longer causes intrusive images, negative thoughts, overwhelming emotions, or body sensations.

Side Effects

EMDR is generally regarded as a safe and effective treatment for a range of mental health concerns and symptoms.⁴ However, as with any treatment method, some side effects of EMDR are possible. These include a resurfacing of additional traumatic memories, feeling emotionally exhausted after sessions, and the discomfort of revisiting the memories during reprocessing. One study found that EMDR may interfere with the accuracy of memories.⁵ 

Overall, it is important to remember that part of EMDR therapy is making sure that the client has plenty of coping skills, supports, and resources to help them deal with any difficult experiences or side effects that come up. If you start “feeling weird” or even depressed after EMDR, those are important points to bring up with your therapist at your next session.

How To Find an EMDR Therapist

There are many resources available to help in the search for an EMDR therapist. It is important to make sure the therapist has been fully trained in EMDR through EMDRIA, the accredited body for EMDR training. Finding the right therapist can be tricky, so don’t be discouraged if the first person you meet with isn’t the best fit. Make sure you find the right therapist who meets your needs and you have a good rapport with. A great way to start your search is through an online therapist directory, where you can filter by expertise and insurance coverage.

Final Thoughts on What to Expect After EMDR

EMDR can be a safe and effective treatment, and knowing what to expect in your first session is a great way to get the most out of it.