In the last blog post, we looked at why EMDR works. Now, we can look at what the EMDR process looks like.
Before we get into any actual reprocessing, we need to decide what we want to look different, a step in the EMDR process that looks like a talk therapy session. This might sound familiar, as it is the Adaptive Information Processing (AIP) model in action, which I wrote about in the last blog post. We spend a session (or a few) discussing what is troubling in the present and how we want that to look different in the future. Then we need to figure out what memories are influencing the current issue so we know what we need to reprocess. For example, if someone wants to accomplish stronger self-advocacy skills through EMDR, we would complete some memory mapping – literally mapping out which memories are influencing the current issue – and decide which memory we want to reprocess first. Usually, this is the earliest memory (the earlier the memory, the greater the generalization effect, and the fewer memories we ultimately need to reprocess in that memory network) but sometimes this can also be the most distressing memory or the most recent one.
The actual reprocessing takes an entire session – sometimes several. When a client comes in on a reprocessing day, we get right into “setting up the memory” that we have mutually decided on. Here’s what that means:
- What is the worst part of the memory when you think about it now? – This establishes the past-present connection (remember this from the AIP model?) between current distress and the past memory. By determining what part is the worst, we are getting to both the heart of the memory and the distress.
- What image represents this worst part for you? – This gives us something concrete to bring to mind and also shows what is currently stored maladaptively in the brain. At times, a sound, smell, or taste may be more poignant and can be targeted instead of an image.
- What negative belief comes to mind as you think about this image now? – This again establishes past-present connection and is stated in the present tense, as this shows the impact this memory is having on current issues. Negative beliefs fall into one of three categories:
- Responsibility/defectiveness – I am worthless, inadequate, not good enough, unlovable, invisible, etc.
- Safety/vulnerability – I am unsafe, I cannot trust anyone, I cannot protect myself, etc.
- Power/choices – I am not in control, I am powerless, I am helpless, I can’t handle it, I can’t trust myself, etc.
- What positive belief do you want to feel about yourself when we are done reprocessing this memory? – This ignites the kindle of change and gives us something to work toward in the reprocessing. It is usually the exact opposite of what the negative belief is.
- When you bring to mind the image (from above) and the positive belief, how true does this statement feel on a 1-7 scale, where 1 is totally false and 7 is totally true? – This will help us measure progress, and also ensure that we have picked negative and positive beliefs that accurately depict maladaptively stored information. Typically, clients rate the positive belief as very low (1-2), as they find the positive belief to feel very untrue when they think about the memory before reprocessing it.
- When you bring to mind the image and negative belief, what emotions come up for you now? – Again, we are establishing the past-present connection by thinking about the past memory while also noticing the present emotions.
- How distressing does this feel on a 0-10 scale, where 0 is neutral and 10 is the most distress you can imagine? – This will help us determine progress, as we will check back in on this toward the end to ensure that the distress level is 0, or as close to it as ecologically possible.
- Where do you feel this distress in your body? – Trauma and maladaptive memories are usually stored in the body. By tapping into current physical sensations, we are seeing where this memory is stored and continuing to establish the past-present connection.
Once we have set up the memory, the reprocessing begins by using bilateral stimulation – that movement across the body’s midline, mentioned in the previous post.
The client brings to mind the image from the memory we have chosen, the negative belief, noticing the emotions and physical sensations, and then begins bilateral movements. There is typically silence at this time, until I tell them to stop. At this point I check in and ask what they noticed. Clients might report changes to the image, emotions, or thoughts related to the target memory; another related memory coming to mind; or shifts in physical sensations. After the client reports the changes, I tell them to “go with it,” meaning hold that in their mind and begin bilateral stimulation again. This is allowing us to move through the different channels associated with the memory and continues until the client stops reporting changes.
Throughout reprocessing, and especially at the end, we will return to the target memory to see what remains of it. By the end of reprocessing (and yes, this could be within one session), the client will report a more adult perspective on the situation if the memory is from childhood or a more calm perspective if the memory is from adulthood. At this point, we check the distress levels. It should be zero, or as close to it as possible, meaning that the body is calm and the client is no longer experiencing those strong visceral emotions. A caveat: zero distress does not mean that they feel “better” about every memory. They might still feel sad or disgusted – but it will be at a level that is appropriate to the memory and the body will be calm when experiencing these emotions.
At this point, we’re nearly done! Now it is time to install the positive belief that we discussed when setting up the memory. The client can use either the same one or a different one if a different statement feels like it would be a better fit, now that they are in a better place with the memory. After checking to see how true it feels now (on that 1-7 scale), they will pair the original experience with the positive belief and complete a set or two of bilateral stimulation in order to increase the strength of the connection. Once the positive belief feels absolutely true, we ensure that the body is calm and nothing is lingering. If there is any tension or tightness, we complete a set of bilateral movements focusing solely on the physical sensations. If not, we are done for the day!
The next post will look at how the present and future come into play with EMDR, as we are not completely done with a memory until we check these elements as well. Depending on timing, this can happen during the session when we target the past experiences, but sometimes it must wait until the following week.