What is EMDR, how is it carried out and who is it considered for? Learn about the stages, limits and alternatives of eye movement desensitisation therapy.
If you have been researching trauma therapy, you have most likely come across the abbreviation EMDR. It is sometimes described on social media in exaggerated terms such as "the method that erases trauma with eye movements", and sometimes dismissed outright as having "no scientific basis". The truth lies somewhere between these two extremes. EMDR is a structured psychotherapy method developed for working with traumatic memories, and it is one of the approaches known in the trauma field. In this article I try to explain, in an informative way, what EMDR is, how a session generally proceeds, which explanations exist for how it works, who it is considered for and what its limits are. This article is an introduction to a method; which approach suits you can only become clear in an assessment with a specialist.
What Is EMDR?
EMDR is the abbreviation of "Eye Movement Desensitization and Reprocessing". The method was developed by a psychologist in the United States in the late 1980s and has since spread across different countries.
The basic idea of the method is this: traumatic experiences, together with the intense emotional and bodily load of the moment they were lived, can be stored in the brain in an "unprocessed" form. For this reason, even years later, when the person recalls the memory, they may feel intense fear, shame or helplessness as if the event were happening again. EMDR aims to reprocess these memories so that they become less distressing and are experienced as memories belonging to the past.
The distinguishing feature of EMDR is that while the person focuses on a particular aspect of the traumatic memory, a practice called bilateral stimulation is carried out at the same time. The best-known form is the therapist moving their hand from side to side while the person follows the movement with their eyes. Instead, sounds given to the two ears in turn or light taps on the hands can also be used.
When Is EMDR Used?
EMDR has been researched most in connection with post-traumatic stress disorder. In the guidelines of some international organisations, including the World Health Organization, it is among the approaches recommended for post-traumatic stress disorder alongside trauma-focused cognitive behavioural therapy. If you are curious about the symptoms of post-traumatic stress, you can take a look at the article on post-traumatic stress disorder.
Its use for anxiety, panic, phobias, grief and some other problems is also being researched. However, the evidence in these areas is not as strong as for post-traumatic stress disorder, and research continues. It would therefore not be right to see EMDR as a method that "helps with every problem".
In Turkey, especially after the 6 February 2023 earthquakes, trauma therapies, including EMDR, have come to be talked about more often. Many people have started asking, "Which therapy is suitable for my earthquake memories?" This question is important; but the answer is always specific to the person and depends less on the name of the method than on the person's needs and the therapeutic relationship.
How Does an EMDR Session Proceed?
EMDR is not just random eye movements; it is described as a structured, eight-phase protocol. Below is a general summary of these phases:
- History taking and planning: The therapist assesses the person's history, current problems and which memories can be worked on. Whether the person is suitable for EMDR is considered at this stage.
- Preparation: The method is explained, a relationship of trust is built with the person and calming techniques for coping with difficult feelings are taught. Work such as "safe place" imagery can be done at this stage.
- Assessment: The memory to be worked on is chosen. The most distressing image of the memory, the negative belief linked to it (for example, "I am helpless") and the positive belief the person would like to hold instead (for example, "I am safe now") are identified. The level of distress is rated.
- Desensitisation: While the person focuses on the memory, sets of bilateral stimulation are applied. After each set, the person is asked what comes to mind, and the process continues until the level of distress falls.
- Installation: Work is done to strengthen the positive belief alongside the memory.
- Body scan: The person is asked to notice any tension remaining in the body while thinking about the memory.
- Closure: The session is ended while the person is calm and balanced. Information is given about reactions that may occur between sessions.
- Re-evaluation: At the next session, the effects of the previous work are reviewed.
These phases show that the method is not just "eye movement", and that preparation and safety are at the centre of the process.
When working with trauma, whichever method is used, the first question is not "Which memory shall we work on?" but "Does this person feel safe enough?"
What can you feel after sessions?
After EMDR or other trauma-focused work, some people feel lighter, while others may experience reactions such as tiredness, emotional sensitivity, vivid dreams or old memories coming to mind. These reactions are usually part of the process and are addressed with the therapist at the next session. For this reason, it can help to leave yourself some space on session days and plan a calmer schedule rather than an intense work meeting or an important decision.
Who might EMDR not be suitable for?
As with any method, there are situations in EMDR that require careful assessment. When a person is currently living in ongoing danger (for example, a relationship in which violence continues), is going through an intense crisis, has severe experiences of dissociation or detachment, or when their skills for coping with difficult feelings are still very fragile, it is necessary to focus on stability and safety before working directly with traumatic memories. In some physical health conditions, additional assessment may also be required. These decisions are made by a specialist who assesses the person's history in detail.
How Does EMDR Work? Current Explanations
How EMDR has its effect is still a debated subject in the field. The main explanations put forward are:
The working memory explanation
According to this explanation, the amount of information our mind can hold at one time is limited. When a person thinks about a traumatic memory while also following a movement with their eyes, mental resources are divided. This can reduce the vividness and emotional intensity of the memory. When the memory is stored again in a less intense form, it can be less distressing on later recall as well. This explanation is one of the views most supported by experimental studies.
The information processing model
According to the approach that developed the method, the brain has a natural information-processing system, and trauma blocks this system. EMDR helps the stuck memory connect with other memory networks and be processed in an adaptive way. Although this model is clinically useful as a guide, its mechanisms at the level of the brain have not yet been fully explained.
Are eye movements really necessary?
This is the most debated question about EMDR. Some researchers suggest that most of the method's effect comes from making controlled contact with the traumatic memory in a safe setting, that is, from elements it shares with other trauma-focused therapies. Others argue that bilateral stimulation makes an additional contribution. This debate continues. What you need to know as a reader is that EMDR is a researched method, but the questions about how it works have not been fully answered.
Common misconceptions about EMDR
- "EMDR is hypnosis." No. During EMDR the person is fully conscious, aware of what they are experiencing and able to stop the process at any moment. The person stays in communication with the therapist throughout the session and describes what they feel.
- "It erases trauma in a single session." No. The number of sessions varies according to the person and the type of trauma experienced. In complex trauma in particular, the process is longer and phased. Memories are not erased; the aim is for them to be recalled in a less distressing way.
- "I can do it myself at home with videos." Although there are videos online titled "do EMDR", working with traumatic memories without preparation and support can bring up intense feelings that are hard to cope with. EMDR is a method that must be carried out by a specialist with specific training in this area, with the person's safety in mind.
- "It is suitable for everyone." It is not. In some cases, work on stability and safety is needed first; for some people, other approaches may be more suitable.
What Can You Do for Yourself Before Starting Trauma Therapy?
Whichever method is used, some steps can help you while you prepare to work with trauma.
Strengthen your calming skills
In trauma therapy, when difficult memories are touched, calming skills act as a safety net. You can regularly practise a breathing exercise of a few minutes with your out-breath longer than your in-breath, a grounding exercise in which you notice five things around you and touch four, or a calm-place imagery. These skills also help in everyday moments when you are triggered.
Write down your questions
When you go to see a specialist, writing down the questions on your mind makes the meeting more productive. You can ask:
- Which approach do you work with, and why might it be suitable for my situation?
- How does the process go and what is done in the first stage?
- What can I do if I struggle between sessions?
- What training have you had?
Asking a therapist which method they work with and what training they have had is your most natural right. For more information on choosing the right specialist, you can take a look at the article on how to choose a psychologist.
Keep your expectations realistic
No method removes the traces of trauma all at once. Recovery is usually a process with ups and downs, and it takes time. Knowing this prevents disappointment after difficult sessions. Also remember that a therapeutic relationship in which you feel safe matters more than the name of the method. Paying attention to whether you feel understood in the first sessions helps you tell whether you are in the right place.
When Should You Seek Professional Support?
It is important to consider seeking support from a specialist in these situations:
- If nightmares, intrusive memories and being constantly on edge after a traumatic event have continued for more than a month
- If avoiding places and situations that remind you of the event is narrowing your life
- If you are experiencing intense guilt, shame or hopelessness
- If clear difficulties have appeared in your work, school or relationships
These symptoms on their own do not amount to a diagnosis; assessment is possible through conversations with a specialist. Whether medication support is needed is decided by a psychiatrist. If you have thoughts of harming yourself or do not feel safe, please call 112 (emergency services) without delay.
How Is Trauma Addressed in Therapy? EMDR and Other Approaches
EMDR is not the only option in trauma therapy. Trauma-focused cognitive behavioural therapy is one of the most researched approaches in the field. In this approach, what trauma reactions are is explained, thoughts that develop after trauma, such as "It was my fault" and "Nowhere is safe", are examined, and contact with avoided memories and situations is re-established in a gradual, controlled and safe way. You can read the basic principles of cognitive behavioural therapy in the article on what is cognitive behavioural therapy.
In long-term trauma that began in childhood, the schema therapy perspective can contribute to understanding deep beliefs and relationship patterns. Whichever method is chosen, the common ground is the same: a safe therapeutic relationship, respect for the person's pace, and prioritising stability and safety.
My own work is based on cognitive behavioural therapy and supported by schema therapy knowledge; I do not practise EMDR. If you are considering working with EMDR, I recommend seeing a specialist who has had specific training in this area. You can find information about individual work related to trauma on the individual therapy page.
Frequently Asked Questions
Is EMDR a scientific method?
EMDR is a method that has been researched, particularly in the area of post-traumatic stress disorder, and appears in some international guidelines. However, how it works and the exact contribution of eye movements are still debated.
How many sessions does EMDR take?
The number of sessions varies according to the person, the type of trauma and progress during the process. Trauma linked to a single event and long-term childhood trauma are not addressed in the same amount of time. The preparation phase is also an important part of the process. For this reason, it is healthier to be cautious about approaches that promise you an exact number of sessions from the start, and to review the process with your therapist at regular intervals.
Can I do EMDR on my own?
It is not recommended. Working with traumatic memories without preparation and support can bring up feelings that are hard to cope with. This method should be carried out with a specialist trained in the field, with safety in mind.
Is EMDR or cognitive behavioural therapy more suitable?
There is no single answer to this question that holds for everyone. Both approaches are used in the trauma field, and which is suitable is judged according to the person's experiences, preferences and needs. Knowing that you can make this decision together with a specialist may guide you.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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