EMDR (Eye Movement Desensitization & Reprocessing) for Trauma

EMDR has been proven to help people overcome traumatic experiences, memories, and PTSD.

1. Professionals undergo a two-year certification process before conducting sessions.
2. They can treat people who have either “one-time” traumatic incidents (like car accident trauma) and/or long-term repeated traumas (such as in war, domestic violence, etc.) successfully.
3. If you’d like to learn more before deciding whether you want to try it, read on. You’ll learn what to expect in an EMDR session if you were “the client,” as well as what it takes to become certified as an EMDR provider, and more!
4. See the Table of Contents or scroll below it to get started.

What to Expect in an EMDR Session

Below, you will find the structure of a traditional EMDR (Eye Movement Desensitization and Reprocessing) protocol that a trained EMDR practitioner/provider would use to help a client.

• Stabilization & Safety: Teaching the patient self-soothing and coping skills before looking at the trauma.
• Memory Processing: Safely recalling or re-visiting the event using specialized cognitive or eye-movement techniques.
• Reintegration: Helping the person return to daily life with a new sense of meaning and control. 

American Psychological Association

EMDR Therapy in 8 Phases

This is the classic 8-phase framework, developed by Francine Shapiro. I’ve customized it a bit here to reflect the kind of content that might help a caregiver, who is processing the trauma of helping his or her loved one get through repeated life-threatening medical crises in which the patient was not expected to survive.

Note up front: EMDR requires specialized certification to administer. The bilateral stimulation (eye movements, tapping, tones) and reprocessing mechanics can activate intense material that needs a trained clinician to contain safely. What follows is the structural map of a session, useful for understanding the process.  IT IS NOT A SCRIPT TO RUN ON  YOURSELF OR OTHERS WITHOUT FIRST BEING CERTIFIED AS AN EMDR PROFESSIONAL.

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The Traditional 8-Phase EMDR Session

First, let’s define “SUDs.” I bet you already know about this, but had never heard it called “SUDs” before!

SUDs stands for Subjective Units of Disturbance (or Subjective Units of Distress).

It is a scale used by clients to rate the intensity of emotional distress or physical discomfort they feel when focusing on a specific traumatic memory, pain, or a target image. You’ll recognize it instantly

Phase 1: EMDR History Taking & Treatment Planning

• The EMDR provider will gather the client’s relevant history relating to the traumatic situation during what’s called “an Intake Session.”
• The next step is to identify the client’s target memories, e.g., a specific situation and the role the client was in at that time. Additionally, the provider may inquire about details regarding the feelings that the trauma caused.
• After hearing those responses, the provider then evaluates that client’s readiness to handle the emotions that may arise. Factors include the client’s potential dissociation, current stability, and the nature of their support system (if one exists).
  • Note: in psychology and psychiatry, dissociation is defined as a disconnection between a person’s thoughts, memories, feelings, surroundings, or identity.
  • Essentially, it is a defense mechanism where the brain temporarily “disconnects” from reality to protect itself from overwhelming emotional or physical pain, such as severe trauma.
  • During dissociation, a person
    • could feel as if they are floating outside their own body and are looking back at themselves  (depersonalization)
    • feel like the world around them isn’t real, or it looks foggy (derealization)
    • lose track of time and have gaps in their memory regarding the distressing event.
  • While it is a brilliant short-term survival strategy designed by the nervous system to endure an unbearable moment, chronic dissociation can disrupt day-to-day life.
  • It requires targeted therapeutic approaches (like EMDR) to process the underlying trauma and safely reset the nervous system.
• The client will be asked to identify related present-day triggers (meaning things that cause them to recall and/or re-enact the old event or memory, involving sights, sounds, and intense feelings).
  

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Phase 2 EMDR: Preparation

The EMDR provider will:

• Explain EMDR and what to expect.
• Establish a “safe/calm place” resource that the client can return to if distress becomes too intense.
• Teach self-soothing and grounding techniques.
• Build trust and set expectations about the reprocessing process.
  

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Phase 3: EMDR Assessment
For each target memory:

The client will:

• Identify the specific image that represents the worst part of the memory.
• Identify the negative cognition, belief, or mindset at that time. For example, the thoughts might have been things like, “I couldn’t save him/her/them,” “I have no control,” “No one will help me,” and/or “I’m powerless.”
• Create the desired “positive cognition,” meaning the desired new way of thinking (e.g., “I did everything I could,” “I can handle whatever comes.”). Note: the new way of thinking probably is TRUE!
• Rate the positive cognition’s felt truth (VoC scale, 1–7).
  • In EMDR therapy, the VoC scale stands for the Validity of Cognition scale, and it is essentially a “truth-o-meter” used to measure how deeply a person believes a positive, healing thought about themselves.
  • It uses a rating system from 1 (which means the positive thought feels completely false or like a lie) to 7 (which means it feels entirely true, down to one’s bones).
  • For example, a trauma survivor might logically know “I am safe now,” but, when they first start therapy, that thought might only feel like a 2 or 3 on an emotional level.
  • Throughout the EMDR process, the therapist tracks this number to see if the positive belief is strengthening, with the ultimate goal of getting that gut-level feeling as close to a rock-solid 7 as possible.
• Identify associated emotions and body sensations.
• Rate the current distress level using the SUDs scale, 0 – 10.
  

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Phase 4: EMDR Desensitization

• The client alllows the image, negative thoughts and emotions, plus associated body sensations to be kept in their minds while the practitioner initiates bilateral stimulation (eye movements, taps, or tones) in sets.
• After each set, the provider will briefly check in (“What are you noticing now?”) and let associations arise without steering them.
• The practitioner will continue repeating sets with the client, following whatever material surfaces, because memories often link with other memories of different events during processing.
• This process will continue until the SUDs score decreases toward 0 or an ecological low point.
  

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Phase 5: EMDR Installation

• The practitioner will strengthen the positive cognition identified in Phase 3.
• The point is to pair it with continued bilateral stimulation until the new interpretation of things feels as true as possible (VoC approaching 7).
  

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Phase 6: EMDR Body Scan

• After a period of exploration, the client scans the body for any residual tension or disturbance connected to the memory.
• Sometimes, the SUDs score is so low that the session is considered a success.
• If the client and therapist determine that more work should be done, they’ll either continue the process or schedule a new session.
• The provider helps overcome any remaining sensation by targeting it with further bilateral stimulation.
  

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Phase 7: EMDR Closure

• The provider will help the client to return to the safe/calm place resource.
• Practitioners must ensure that every client leaves in a stable, grounded state, even if processing is incomplete.
• The practitioner will debrief the client and provide additional guidance as to what may happen or what additional tools the person can use during the time between sessions (journaling, expected processing effects, etc.).
  

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Phase 8: EMDR Re-evaluation

• The provider begins the next session by requesting feedback from the client, including taking a new SUDs reading.
• They determine whether the treatment effects have held. If not, they try again. If so, they identify the next targets (e.g., moving to episode two or three).
  

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How Many EMDR Sessions Are Needed?

Research Shows Results Like These

Single-incident trauma (car accidents, one-time medical emergencies, assaults, natural disasters)

• One frequently cited study found 100% of single-trauma victims no longer met PTSD diagnostic criteria after just six 50-minute sessions.
• Other research shows 84 – 90% of single-trauma clients no longer meet PTSD criteria after three 90-minute sessions.

The Marcus et al. (1997) and Wilson et al. (1995, 1997) studies are the primary sources behind the “84–90% of single-trauma clients remitted after 3 sessions” and “100% after 6 sessions” figures.

• Most civilian randomized controlled trials report resolution within 3 – 6 sessions, particularly when sessions run longer (90 minutes).
• Broader clinical guidance puts the typical range at 6 – 12 sessions for a bounded, single event with no extensive prior trauma history and stable baseline functioning (a bounded single event, such as a car accident, medical emergency, one-time assault, or witnessing something catastrophic).

Combat-related / war-zone trauma (civilians or combatants)

• 77% of combat veterans were free of PTSD after 12 sessions in one widely cited study. (Carlson et al. 1998) is the primary source for the “77 – 78% of combat veterans PTSD-free after 12 sessions” figure. It’s a genuine RTC (Randomized Control Trial) comparing EMDR to biofeedback and routine care in combat veterans.
• Military and Veterans Administration-based studies commonly observe 6 -12 sessions before significant remission.
• More broadly, multiple-trauma exposure (which combat almost always involves – or other experiences with include repeated, layered events rather than one incident) shows a median of 6 -12 sessions across controlled trials, with some sources putting complex/multiple trauma at 12 – 20+ sessions when dissociation or prior trauma history is involved.
• Why the gap exists: Research consistently frames the difference in terms of trauma architecture rather than a diagnostic label.
  • A diagnosis of PTSD alone doesn’t predict how many sessions someone needs.
  • What matters is whether the trauma is a discrete, contained memory network or a repeated, layered one. 

Caveats re EMDR Stats in This Article

• These are “outcome statistics” from specific studies, not medical recommendations. The number of sessions needed for any instance of trauma depends heavily on individual factors, dissociation levels, and whether treatment is once or twice weekly.
• Session lengths vary across studies (50 vs. 90 minutes). Consequently, it skews how the numbers compare. (Think “comparing apples and oranges.” They’re both fruits, but they are very different from each other.)
• Several of the sources reporting these figures are clinical/practice blogs. They are not peer-reviewed journals about research results.
• For the best science, go to the primary studies. The most commonly referenced sources behind these numbers are Marcus, Marquis & Sakai (1997) for single-trauma civilian outcomes and Carlson et al. (1998) for combat veterans. It is worth researching the original published papers if you want to view primary sources rather than these secondary summaries.
  

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What is an EMDRIA Certified Therapist™?