Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition

1. EMDR Therapy: An Empirically Supported, Integrative Approach

Our clinical work with EMDR therapy shows us that suffering can be transformed—not only into art but into life.

Evidence-based treatment. EMDR therapy is recognized internationally as an effective treatment for trauma and a wide range of experientially based disorders, supported by numerous randomized controlled trials (RCTs). It's not just a technique, but a comprehensive psychotherapy approach integrating elements from various psychological orientations.

Comprehensive approach. EMDR emphasizes the comprehensive clinical picture, incorporating multifaceted personal growth and integration into wider social systems. It addresses images, beliefs, emotions, physical responses, internal stability, resiliency, and interpersonal systems.

Liberation from the past. The eight-phase EMDR therapy aims to help clients move beyond past traumas into a healthy and productive present. It facilitates learning from negative experiences, desensitizes present triggers, and incorporates templates for appropriate future action.

2. Adaptive Information Processing: The Core of EMDR

The pathological structure is inherent within the static, insufficiently processed information stored at the time of the disturbing event.

AIP model. The Adaptive Information Processing (AIP) model posits that most pathologies stem from earlier life experiences that create patterns of affect, behavior, cognitions, and identity structures. EMDR therapy aims to access and transform dysfunctionally stored information, facilitating a natural healing process.

Information processing system. The AIP model suggests an innate information-processing system exists, which can be blocked by trauma. EMDR therapy activates this system, allowing the brain to process information and restore mental health.

Memory reconsolidation. EMDR processing allows the more positive and empowering present affect and cognitions to generalize to the associated memories throughout the neurophysiological network and leads spontaneously to more appropriate behaviors by the client. The adaptively resolved memory is then restored in altered form through the process of memory reconsolidation.

3. Targeting Disturbance: The Key to Effective EMDR

Clients are best served by clinicians who are guided by research and are willing to learn, expand their skills, and experiment with innovative methods.

Components of a target. Effective EMDR processing relies on clearly defined targets, including the image, negative cognition, positive cognition, emotions, and physical sensations. These components help clients understand the trauma context and facilitate rapid processing.

Subjective Units of Disturbance (SUD). The SUD scale is used to measure the intensity of negative feelings associated with the target memory, providing a baseline for assessing progress. The goal is to reduce the SUD level to 0 or 1, indicating that the primary dysfunction has been cleared.

Validity of Cognition (VOC). The VOC scale measures the client's belief in the positive cognition, with the aim of increasing its validity to a level of 7, signifying complete truth. This cognitive restructuring is a crucial aspect of EMDR therapy.

4. The Eight Phases of EMDR Therapy: A Structured Approach

Understanding these principles will allow the clinician to customize treatment to the individual needs of each client.

Structured approach. EMDR therapy follows a structured eight-phase approach:

• History taking and treatment planning
• Preparation
• Assessment
• Desensitization
• Installation
• Body scan
• Closure
• Reevaluation

Client safety. Each phase plays a crucial role in client safety and treatment effectiveness. The eight phases are designed to ensure optimal activation of the client’s innate information-processing system and thus achieve full resolution of the presenting problem.

Comprehensive treatment. The eight phases are geared to contribute to positive treatment effects through an interaction of client containment and information processing. The eight phases afford all clients a comprehensive treatment of past, present, and future.

5. Navigating Abreactions and Blocks: Essential Clinical Skills

Our clinical work with EMDR therapy shows us that suffering can be transformed—not only into art but into life.

Abreaction management. Abreactions, or the reexperiencing of traumatic memories at a high level of disturbance, are a normal part of EMDR processing. Clinicians must be prepared to facilitate abreactions and provide support to clients.

Strategies for blocked processing. When processing becomes blocked, clinicians can employ various strategies, such as altering the eye movement, focusing on body sensation, scanning visual cues, and redirecting to the target. These techniques help to restimulate the information-processing system.

Client safety. The clear objective is helping people. Clients are best served if their clinicians are trained. Adequate training means greater likelihood of success—and less likelihood of harm.

6. The Three-Pronged Protocol: Addressing Past, Present, and Future

One of the basic premises of EMDR therapy is that most psychopathologies are based on early life experiences.

Comprehensive approach. The standard three-pronged EMDR therapy protocol addresses the past, present, and future. It targets etiological events, current triggers, and templates for appropriate future action.

Targeting the past. The first prong focuses on identifying and reprocessing early life experiences that have set the foundation for the pathology. This involves accessing and transforming dysfunctional information stored in the brain.

Working on the present. The second prong addresses present triggers that stimulate the dysfunctional material. This involves desensitizing current triggers and reducing inappropriate levels of distress.

Incorporating the future. The third prong incorporates templates for appropriate future action, allowing clients to excel individually and within their interpersonal systems. This involves enhancing positive imagery, beliefs, and affects.

7. Standardized Protocols: Tailoring EMDR to Specific Needs

Understanding these principles will allow the clinician to customize treatment to the individual needs of each client.

Standardized procedures. EMDR therapy includes standardized procedures and protocols for special situations, such as single traumatic events, recent traumatic events, phobias, complicated grief, and illness and somatic disorders. These protocols provide a framework for effective treatment.

Recent events. Protocols for recent traumatic events, such as the Recent Event Protocol and EMDR Protocol for Recent Critical Incidents, are designed to address the unique challenges of processing recent traumas. These protocols emphasize rapid intervention and stabilization.

Specialized protocols. Protocols for phobias, complicated grief, and illness and somatic disorders offer tailored approaches to address the specific needs of these populations. These protocols incorporate elements such as exposure, cognitive restructuring, and somatic awareness.

8. Cognitive Interweaves: Proactive Strategies for Challenging Clients

In this spirit, the development of EMDR therapy over the past 30 years has moved it from a simple technique to an integrated psychotherapy approach.

Proactive intervention. The cognitive interweave is a proactive strategy for working with challenging clients who experience blocked processing or abreactions. It involves introducing new information or perspectives to stimulate the information-processing system.

Foundation of the interweave. The interweave is based on the understanding that pathologies are represented by dysfunctional information that is physiologically stored and that can be accessed and transformed directly. It is a way to help clients connect disparate neural networks.

Interweave choices. Interweave choices include providing new information, using metaphors or analogies, employing the Socratic method, and addressing issues of responsibility, safety, and choices. The goal is to facilitate assimilation and promote adaptive processing.

9. EMDR Therapy for Complex Trauma: A Phased Approach

We went from Kitty Hawk to the moon in little more than 50 years. Yet despite such monumental technological advances, millions of people suffer unremitting pain, and a cycle of violence continues unchecked worldwide.

Noncompliance issues. Issues of noncompliance can arise in EMDR therapy, particularly with clients who have complex PTSD. These issues may stem from client safety factors, secondary gains, or fears of change.

Complex PTSD. EMDR therapy for complex PTSD requires a phased approach that emphasizes stabilization, trauma processing, and integration. This approach addresses the unique challenges of clients with multiple traumas and attachment deficits.

Sexual abuse victims. EMDR therapy can be highly effective for sexual abuse victims, but it requires careful attention to client readiness, structure, integration, and cautions regarding memory work. The goal is to empower survivors and help them lead normal lives.

10. Research Validates EMDR's Efficacy and Mechanisms

The continued evolution of EMDR from a simple technique to a complex psychotherapy approach has been based largely on research and clinical observation.

Procedural elements. EMDR therapy's procedural elements, such as exposure, perceived mastery, attention to physical sensation, cognitive reframing, and free association, contribute to its effectiveness. These elements work together to facilitate information processing and promote healing.

Eye movements and alternative stimuli. The eye movements and alternative bilateral stimuli used in EMDR therapy have been the subject of extensive research. These stimuli may activate the orienting response, working memory, or REM sleep mechanisms.

Future research. Future research should continue to explore the mechanisms of action of EMDR therapy and to evaluate its efficacy for diverse clinical applications. This research should also address broader clinical and professional concerns, such as clinical responsibility and global responsibility.

11. Ethical Considerations and Global Responsibility in EMDR Practice

Surely, as a society, we need to redirect more of our vast resources and pay greater attention to the alleviation of global suffering.

Clinical responsibility. EMDR therapy should be used only by licensed mental health professionals or those under direct supervision of licensed clinicians. Adequate training and supervision are necessary for clinicians to achieve competency and to ensure client safety.

Global responsibility. As a profession, we have an obligation to alleviate global suffering. This includes expanding our efforts in humanitarian assistance and promoting access to scientifically evaluated treatments worldwide.

Continued evolution. The continued evolution of EMDR therapy from a simple technique to a complex psychotherapy approach has been based largely on research and clinical observation. The need for controlled research to examine the EMDR therapy approach is indisputable.

Last updated: February 20, 2025