EMDR Therapy Protocol & Procedure
How Does EMDR Therapy work?
Eye Movement Desensitization and Reprocessing (EMDR) is explained by the Adaptive Information Processing (AIP) model that is developed by Dr. Francine Shapiro** in 1987. AIP Model states that human beings are innately equipped to assimilate new high aroused negative experiences and move to adaptive resolution; that is, human beings can make use of the negative experiences and be integrated into positive emotional and cognitive structure. However, when the level of arousal is overwhelming and traumatic to the individual, the AIP progression is interrupted and an imbalance occurs in the nervous system, subsequently, healthy processing does not continue. What happens is that the traumatic event is stored in the memory with all the sensations and perceptions that the individual experienced at the time of the event. Therefore, a variety of internal or external stimuli can easily trigger the original distressing memory and people will show signs of Posttraumatic Stress Disorder (PTSD), such as, nightmares, flashbacks, high arousal, and intrusive thoughts.
The role of the EMDR therapist is to use alternating bilateral stimulation BLS (eye movement, tapping, or auditory pulses) while the client is asked to bring forth the traumatic image with the associated beliefs, emotions, and physical responses. The bilateral stimulation (BLS) seems to activate the information-processing system and accelerates the processing of the traumatic memory until it is transformed into adaptive learning experiences.
What is the Three-Pronged EMDR Protocol?
In EMDR therapy, attention is directed to three-time periods: (1) the past, where the disturbing memories have occurred, (2) the present, where the daily or current disturbing triggers or situations reside, and (3) the future, where templates are formed for desired future behaviors.
What are the 8 phases of EMDR Therapy?
EMDR therapy uses an eight-phase treatment approach:
Phase 1: History Taking and Treatment Planning
The therapist seeks first to establish rapport with the client and to assess his/her readiness and suitability for EMDR treatment. A detailed history is taken related to clients’ major life events, physical health, medication intake, social support, past negative events or experiences that are still causing emotional distress, current emotional and cognitive states, daily stressors and disturbing situations, and desired future goals. A treatment plan is developed and the therapist and client work on targeting traumatic memories with EMDR in order to reach an adaptive resolution.
Phase 2: Preparation
The therapist prepares the client for the reprocessing of disturbing memories. The therapist explains EMDR theory and its components and steps. The client is informed that there are 3 types of bilateral stimulations (BLS), the most effective of which is the “eye movement”. If “eye movement” is not feasible to be used, then tapping or auditory pulses can be the alternative. The therapist also teaches him/her how to use a number of relaxation techniques, such as abdomen breathing, light-stream, and safe place. The aim of the preparation is to help the client feel in control and balance within and outside of the therapy session.
Phase 3: Assessment
Assessment is a very important phase where the therapist and the client identify the target disturbing memory to work on. Then the therapist establishes baseline measures of the client’s emotional, cognitive, and bodily reactions.
Phase 4: Desensitization
This phase involves accelerated processing of information by using the bilateral stimulation (BLS) with the most disturbing image, negative self-belief, and body sensations. The client notices any changes or shifts in images, thoughts, feelings, bodily sensations and reports them to the therapist after each set of BLS. This phase ends when the client reports that the image is no longer disturbing him/her.
Phase 5: Installation
In this phase, the therapist guides the client to integrate the desired positive self-belief by associating it with the original disturbing image. The therapist uses bilateral stimulation (BLS) to strengthen the positive self-belief, therefore, improving the client’s self-esteem and enhancing his/her ego-strength.
Phase 6: Body Scan
To check for any residue of body tension or tightness, the therapist asks the client to mentally scan his/her body while bringing to mind the originally disturbing image with the positive self-belief. If there are unusual bodily tensions, the therapist will do sets of BLS until these sensations disappear.
Phase 7: Closure
This phase is the end of each treatment session where the therapist makes sure that the client leaves the clinic feeling better. If the reprocessing work of the traumatic memory is not complete, the therapist will guide the client by using self-relaxation techniques to regain a sense of emotional balance. The client gets debriefed on what to expect between sessions and on how to use a journal to record any memories, dreams, thoughts, and sensations. He is reminded to use the self-relaxation techniques at home or at work whenever he feels tense or uncomfortable.
Phase 8: Re-Evaluation
Every new session begins with a re-evaluation. The client reports what he/she experienced between sessions; the therapist checks the earlier targeted memory to see if the client fully reprocessed it or if it needs further work. This phase is very important for it serves as an indicator to the progress of the treatment plan and the success of the treatment itself.
**Shapiro, Francine (2018). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. 3rd ed. New York: The Guilford Press.