About EMDR: Part 2 - The Origins of EMDR and the 8 Stages of Treatment

The discovery of EMDR began with a chance observation by Francine Shapiro in the late 80s.   While on a walk, Francine noticed that some of her disturbing thoughts were disappearing, and that their negative charge was greatly reduced.  Francine noticed that when she brought the disturbing material to mind, her eyes spontaneously began shifting from side to side, further decreasing the negative charge to the memories.   Fascinated, Francine began to mirror her experience and test it out on friends and colleagues.  She noticed some success, and further figured out how to change the eye movements when her patients became “stuck” in the disturbing material.   She worked with approximately 70 individuals in a 6-month period before coming up with her initial protocol, which she named EMD, or Eye Movement Desensitization.   From there, additional control studies were conducted and over time the protocol was updated and EMD became EMDR, Eye Movement, Desensitization, and Reprocessing. 

What is the Adaptive Information Processing Model? 

The Adaptive Information Processing model (Shapiro, 2001, 2002, 2007) is used to explain EMDR's clinical effects and guide clinical practice.

The Adaptive Information Processing model posits that our brains are equipped to manage and process diverse life experiences in a way that prepares us to handle new challenges ahead (the natural process of healing).   This process involves desensitizing the material by making it less emotionally charged, and updating our understanding of the event, storing it in a way that is adaptive and helpful to moving forward in life.  Sometimes, adverse or traumatic life experiences interfere with this natural healing process, meaning this traumatic material may become stuck in our nervous system as is, with all the thoughts, feelings, and belief systems that were present at the time of the event.  Additionally, this material may become stuck with the same or similar emotional charge that does not seem to be desensitizing or decreasing naturally, over time.  If stuck like so, we continue to react to reminders of the event in way that feels like it is happening now, instead of in the past. 

Here is a summary of how Francine Shapiro explains the AIP model in her book (Eye Movement, Desensitization, and Reprocessing, 2001):

“Briefly stated, the model regards most pathologies as derived from earlier life experiences that set in motion a continued pattern of affect, behavior, cognitions, and consequent identity structures.  The pathological structure is inherent within the static, insufficiently processed information stored at the time of the disturbing event.  In a wide variety of cases, pathology is viewed as configured by the impact of earlier experiences that are held in the nervous system in state-specific form.”

Click HERE to read the New York Times’ article:  Expert Answers on EMDR,  where Francine Shapiro answers reader’s questions about EMDR. 

What can one expect during EMDR treatment?

EMDR treatment is broken into 8 stages of treatment.  The length of time each client/therapist team spends in each stage is dependent on a variety of factors, including but not limited to, the complexity of past trauma, the client’s capacity for resourcing and self-regulation, the client’s level of stability, or the number of traumatic events.   Additionally, it is important to note that EMDR may not be appropriate for all clients, or additional therapeutic work may be recommended prior to EMDR.   For example, if a client is experiencing current life crisis or substance abuse relapse, EMDR may be put on hold until additional stabilization work can be completed.  

Also, stages 1 through 3 are typically done once at the earlier stages of treatment.  Stages 4 through 8 are repeated throughout treatment until all traumatic material is addressed.   Therefore, clients with only 1 traumatic experience may go through stages 1 through 8 in order, and only once.  While another client with multiple traumatic experiences, may go through stages 1 through 3 once, and then complete stages 4 through 8 a number of times, each time addressing a different traumatic memory. 

Stage 1: 

History Taking and Treatment Planning:

In this stage the counselor will be evaluating the major safety factors that will determine whether a client is suitable for EMDR and if so, what level of preparation work (stage 2) will likely need to be accomplished before reprocessing.  Evaluation includes an assessment of personal stability and current life constraints.  Once evaluation is completed, the counselor will begin the history-taking phase to capture the entire clinical picture, including symptoms that need to be addressed.  Additionally, at this time the client and therapist will begin to review which targets (memories) will need to be addressed with EMDR.   Finally, once all the historical information is collected and reviewed, the counselor will create a treatment plan outlining the remaining stages of treatment. 

Stage 2:

Preparation:

In the preparation stage, the counselor will complete the following:

Creating a safe therapeutic alliance

Providing psycho-education to the client, about the EMDR processing, effects, and risks. 

Addressing any client concerns about EMDR

Initiating relaxation and safety procedures. 

Since EMDR can be dysregulating for the client, it is important that the client is confident and comfortable implementing relaxation, grounding, and self-regulating strategies.   The speed of progress through stage 2 varies greatly between clients, due to the varied levels of ability for self-soothing and regulation.   Stage 2 can be anywhere from weeks, to months, to years, depending on what skills the client needs to develop in order to prepare for the remaining steps of EMDR. 

Stage 3:

Assessment:

In the assessment phase the counselor identifies specific aspects of the target memory, and establishes a baseline that will be used as a guide to the counselor during the desensitization stage.   The following are aspects of the target memory that will be identified in the assessment stage:

The image that best represents the disturbing memory

The negative cognition or words that go with the disturbing memory that represent a negatively held self-belief.

The positive cognition, or the belief system that the client would prefer to believe about themselves instead of the negative cognition

The emotion(s) that is evoked when the memory and negative cognition are brought to mind.

The body (physical) sensations that arise when the memory and negative cognition are brought to mind

Stage 4:

Desensitization using DAS/BLS:

In the desensitization phase the counselor implements what is knows as “EMDR reprocessing” by having the client access the target while using bilateral stimulation or dual awareness.  The goal of this stage is to reduce the client’s subjective level of distress from baseline to zero or neutral.  The trained counselor will guide the client through repeated sets, adjusting as appropriate to ensure the processing continues. 

Stage 5:

Installation

Prior to the installation phase, the client’s subjective level of distress is zero or neutral.   In the installation phase, the focus is on increasing the strength of the positive cognition identified in Stage 3.  The position cognition was identified as a replacement for the negative cognition.  The installation phase continues until the client’s positive cognition feels as though it is completely true for the client. 

Stage 6:

Body Scan

In the body scan stage, the client is asked to hold the memory and positive cognition in mind while they do a body scan to identify any residual body tension or uncomfortable sensations.  Additional sets of BLS/DAS are completed until any remaining body disturbance is resolved.

Stage 7:

Closure

Whether or not the reprocessing was complete (stages 4,5,6) it is important that the client return to a state of emotional stability prior to leaving session.  The counselor will leave time at the end of session to ensure proper closure techniques.  The counselor may engage the client in containment strategies to achieve emotional stability.  The counselor will also ask the client to keep a log or journal of thoughts, situations, dreams, or memories that may come up between sessions. 

Stage 8:

Re-evaluation

Re-evaluation or Stage 8 should be initiated at the beginning of each new session.  In this stage, the counselor reviews previously reprocessed targets to ensure that all material was successfully reprocessed.  Additionally, the counselor will review the client’s log, to see whether additional, disturbing material came up that may need to be the focus of additional EMDR sessions. 

In this Ted Talk, hear Tricia Walsh talk about her own experience of a client of EMDR:

Ted Talk:  May 16th, 2017 by Tricia Walsh

“In my first EMDR session I discovered that my body, my brain, and my eyes could heal me."