What is EMDR? Understanding Eye Movement Desensitisation and Reprocessing

When people first hear about EMDR, the eye movements tend to throw them. The idea that moving your eyes from side to side could help with something as serious as trauma sounds, at first, unlikely. I understand that response. It took the field a long time to fully accept it too. The evidence base, however, has now been built up over more than three decades, and EMDR is recommended by NICE in the UK as one of the first line treatments for post traumatic stress disorder.

I am Dr Raminta Petrauskaite, an HCPC-registered Clinical Psychologist working with adults across Bournemouth, Christchurch, Poole, and the wider Dorset area. This article looks at what EMDR is, what it actually involves, and the difficulties it tends to help most.

What EMDR is

Eye Movement Desensitisation and Reprocessing was developed by Dr Francine Shapiro in the late 1980s. The approach is built around an observation that has now been supported by a large body of research. Traumatic memories appear to be stored differently from ordinary memories. They can stay raw, sensory, and present-tense long after the event itself has passed, which is why someone can be reminded of something that happened years ago and feel it as if it is happening now.

EMDR is designed to help the brain process those memories more completely, so that they can be remembered without the same intensity of distress. The work is structured, gentle, and considerably less verbal than traditional talking therapies. For many of the people I see, that turns out to be one of its biggest strengths.

How EMDR actually works

A typical EMDR session involves the therapist guiding you through a structured set of steps, while you focus on a specific memory and, at the same time, follow a form of bilateral stimulation. This is usually eye movements following the therapist’s fingers, although tapping or auditory tones are sometimes used instead.

The current best understanding is that this dual focus, holding the memory in mind while engaging in bilateral stimulation, taxes the working memory in a way that allows the brain to process the memory more adaptively. The neurobiological model is still being refined in research, and some clinicians draw parallels to what happens during REM sleep, when the brain naturally consolidates memories and emotions.

The key clinical point, regardless of the underlying mechanism, is that the emotional charge attached to the memory tends to reduce. The memory does not disappear. It does, however, stop feeling as if it is happening now.

The eight phases of EMDR

EMDR is a structured therapy, and the structure is part of what makes it safe. It moves through eight phases, although these do not always sit neatly inside single sessions.

Phase 1: history and assessment

We spend time understanding what has happened, what you are bringing now, and which memories or themes might be useful to work with. No reprocessing happens in this phase.

Phase 2: preparation and stabilisation

You learn grounding and self-soothing techniques before any reprocessing begins. This phase is often longer for people with complex or layered experiences, and is one of the things that distinguishes EMDR delivered by an experienced clinician from a quicker, less safe version of the same work.

Phase 3: assessment of the target memory

We identify the specific image, belief, emotion, and bodily sensation linked to the memory we will be working on. This is done at your pace.

Phases 4 to 6: desensitisation, installation, and body scan

These phases involve the bilateral stimulation itself. The aim is to reduce the distress associated with the memory, strengthen a more helpful belief, and check that the body has settled.

Phase 7: closure

Each session ends with grounding and a clear closing. You do not leave the room in the middle of difficult material.

Phase 8: re-evaluation

At the start of the following session, we check how the previous work has settled, and decide what to focus on next.

If you are wondering whether EMDR might be right for what you are carrying, a free 20-minute consultation gives you space to ask questions before deciding anything.

Buttons: [ Book a Free Consultation ]   [ Ask a Question ]   [ View Fees ]

What EMDR can help with

EMDR was originally developed for post traumatic stress disorder, and that is still the area where the evidence base is strongest. NICE recommends it as one of the first line treatments for PTSD, alongside trauma focused CBT (NICE, 2018). The World Health Organization and the American Psychological Association have made similar recommendations.

Beyond PTSD, EMDR is also used for a wider range of difficulties where past experiences appear to be at the root, including anxiety and panic, specific phobias, complicated grief, performance anxiety, and some forms of depression. It is also increasingly used in the treatment of difficulties that do not always look like trauma on the surface, such as long standing low self-worth, chronic pain, and patterns that trace back to early relational experiences.

What to expect in EMDR sessions

Most courses of EMDR for a single, focused difficulty take somewhere between six and twelve sessions, although this varies considerably depending on what you are bringing. Complex trauma usually needs longer, with more time spent in stabilisation before any reprocessing.

One of the things people often appreciate about EMDR is that you do not have to describe the memory in detail or talk about it at length. You hold the memory in mind, follow the bilateral stimulation, and notice what comes up. The work happens largely inside you, with the therapist there to guide and to keep you safe. Many people leave a session feeling that something has shifted, even if they would struggle to put it into words.

Is EMDR right for you?

EMDR is a powerful approach and, for many of the people I see, it has done what years of talking therapy did not. It is not, however, the right starting point for everyone. People who are in acute crisis, who are heavily dissociated, or who do not yet have stabilisation skills in place are usually better served by a longer preparation phase, or by a different approach altogether. Part of my role in an initial consultation is to be honest with you about that.

Frequently asked questions

Is EMDR safe?

When delivered by a properly trained Clinical Psychologist or EMDR-certified therapist with adequate stabilisation in place, EMDR is generally considered safe and well tolerated. It can be emotionally demanding, which is why the phased structure exists.

Will I have to relive the trauma in detail?

No. EMDR does not require you to describe what happened in detail. You hold the memory in mind, and most of the work happens internally.

How is EMDR different from CBT?

CBT works largely with thoughts and behaviour. EMDR works with how a memory is stored and felt in the body. They sometimes complement each other, and the right starting point depends on the individual.

Can EMDR be done online?

Yes. Online EMDR is well established now, with adapted protocols for bilateral stimulation. It works well for many of the people I see who prefer the flexibility.

Final thoughts

Trauma is not simply something that happened. It is something that the system did not have a chance to process at the time. EMDR offers a structured way of letting that processing happen now, in a safer setting, with someone alongside you. For many of the people I work with, it has been the thing that finally allowed the past to feel like the past.

Reach out for support

If you would like to talk through whether EMDR might be right for you, I offer a free twenty minute consultation by phone or video call. You can get in touch through the contact page, book online, or arrange a free 20-minute consultation first. There is no obligation to book afterwards.

Related reading

• What Are Flashbacks? — How trauma creates flashbacks, and how EMDR helps reprocess them.
• What is a Clinical Psychologist? — What a Clinical Psychologist does and how to verify their qualifications.
• What is Acceptance and Commitment Therapy (ACT)? — When ACT is a useful companion approach to trauma work.

References

Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures. Guilford Press.

National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder: NICE guideline NG116. https://www.nice.org.uk/guidance/ng116

World Health Organization (2013). Guidelines for the management of conditions that are specifically related to stress.

American Psychological Association. Clinical Practice Guideline for the Treatment of PTSD.

Van der Kolk, B. A. et al. (2007). A randomized clinical trial of Eye Movement Desensitization and Reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 68(1), 37-46.