The Phases of EMDR by APA

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The Phases of EMDR

History-taking and Treatment Planning

In addition to getting a full history and conducting appropriate assessment, the therapist and client work together to identify targets for treatment. Targets include past memories, current triggers and future goals.  

Preparation

The therapist offers an explanation for the treatment, and introduces the client to the procedures, practicing the eye movement and/or other BLS components.  The therapist ensures that the client has adequate resources for affect management, leading the client through the Safe/Calm Place exercise. 

Assessment

The third phase of EMDR, assessment, activates the memory that is being targeted in the session, by identifying and assessing each of the memory components: image, cognition, affect and body sensation.Two measures are used during EMDR therapy sessions to evaluate changes in emotion and cognition: the Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale. Both measures are used again during the treatment process, in accordance with the standardized procedures: 

Validity of Cognition (VOC) scale 

The clinician asks, “When you think of the incident, how true do those words (repeat the positive cognition) feel to you now on a scale of 1-7, where 1 feels completely false and 7 feels totally true?”
Completely false	1	2	3	4	5	6	7	Completely true

Subjective Units of Disturbance (SUD) scale 

After the client has named the emotion he or she is feeling, the clinician asks, “On a scale of 0-10, where 0 is no disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does it feel now?”
No disturbance	0	1	2	3	4	5	6	7	8	9	10	Worst possible

Desensitization

During this phase, the client focuses on the memory, while engaging in eye movements or other BLS. Then the client reports whatever new thoughts have emerged. The therapist determines the focus of each set of BLS using standardized procedures. Usually the associated material becomes the focus of the next set of brief BLS. This process continues until the client reports that the memory is no longer distressing.  

Installation

The fifth phase of EMDR is installation, which strengthens the preferred positive cognition.  

Body Scan

The sixth phase of EMDR is the body scan, in which clients are asked to observe their physical response while thinking of the incident and the positive cognition, and identify any residual somatic distress. If the client reports any disturbance, standardized procedures involving the BLS are used to process it. 

Closure

Closure is used to end the session. If the targeted memory was not fully processed in the session, specific instructions and techniques are used to provide containment and ensure safety until the next session. 

Re-evaluation

The next session starts with phase eight, re-evaluation, during which the therapist evaluates the client’s current psychological state, whether treatment effects have maintained, what memories may have emerged since the last session, and works with the client to identify targets for the current session. 

Special thanks to Louise Maxfield, PhD, and Roger M. Solomon, PhD, for their contributions to this description.

CASE EXAMPLE

Mike, a 32-year-old Iraq War veteran

Mike was a 32-year-old flight medic who had completed two tours in Iraq. He had been discharged from the Army due to his posttraumatic stress disorder (PTSD) and was divorced with a 2-year-old son. The Army psychologist referred Mike for treatment of his PTSD with Eye Movement Desensitization and Reprocessing therapy.

CASE EXAMPLE

Phillips, K.M., Freund, B., Fordiani, J., Kuhn, R., & Ironson, G. (2009). EMDR treatment of past domestic violence: A clinical vignette. Journal of EMDR Practice and Research, 3(3), 192-197.

CASE EXAMPLE

Kullack, C., & Laugharne, J.. (2016). Standard EMDR protocol for alcohol and substance dependence comorbid with posttraumatic stress disorder: Four cases with 12-month follow-Up.  Journal of EMDR Practice and Research, 10(1), 33-46.

CASE EXAMPLE

Aranda, B. D. E., Ronquillo, N. M., & Calvillo, M. E. N.. (2015). Neuropsychological and physiological outcomes pre- and post-EMDR therapy for a woman with PTSD: A case study. Journal of EMDR Practice and Research, 9(4), 174-187.

CASE EXAMPLE

Buydens, S. L., Wilensky, M., & Hensley, B. J. (2014). Effects of the EMDR protocol for recent traumatic events on acute stress disorder: A case series. Journal of EMDR Practice and Research, 8(1), 102-112.

CASE EXAMPLE

Pagani, M., Di Lorenzo, G., Monaco, L., Niolu, C., Siracusano, A., Verardo, A.R.,…Ammaniti, M. (2011). Pretreatment, intratreatment, and posttreatment EEG imaging of EMDR: Methodology and preliminary results from a single case. Journal of EMDR Practice and Research, 5(2), 42-56.

CASE EXAMPLE

Rost, C., Hofmann, A., & Wheeler, K. (2009). EMDR treatment of workplace trauma: A case series. Journal of EMDR Practice and Research, 3(2), 80-90.

References & Resources

JOURNAL ARTICLE

Shapiro, F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice and Research, 1, 68–87.

BOOK

Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols and procedures. (3rd ed.). New York, NY: Guilford Press.

WEBSITE

EMDR International Association
A professional association for EMDR practitioners that maintains information about training and certification in the provision of EMDR.

WEBSITE

EMDR Institute
Founded by Dr. Francine Shapiro, the developer of EMDR, and provides information about research and training in EMDR.

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