The 8-Phase Treatment Protocol
EMDR therapy utilizes a specially developed 8-phase treatment protocol. As you will see from the description of each phase, the protocol combines EMDR’s unique bilateral dual attention stimulation with elements from different therapeutic approaches. This serves to maximize and accelerate treatment effects. Bilateral stimulation (whether eye movements or tactile/auditory) is used during some of the phases.
Furthermore, as EMDR therapists use the 8 phases, they keep in mind that the treatment should target three time periods—the past, the present, and the future—each with its own focus. The past: disturbing memories and related events that happened in the past and caused the brain’s natural healing process to become blocked. The present: current situations or triggers that stimulate feelings of distress. The future: development of skills and attitudes needed for positive future actions.
Phase 1-History Taking: The therapist assesses your readiness and develops a treatment plan. As you tell your story, the therapist will help you identify possible targets for EMDR processing. These include distressing memories and current situations that cause you emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors you will need in future situations.
Note: If you disclose a problematic childhood, initial EMDR processing may be directed to childhood events rather than to adult-onset stressors or the identified critical incident.
Phase 2-Preparation: The therapist ensures that you have several different ways of handling emotional distress. You may learn a variety of grounding, imagery, and stress reduction techniques you can use during and between sessions. This is done expressly for your safety. Although the goal of EMDR is to produce rapid and effective change, it is important for you to be able to maintain equilibrium during and between sessions.
Phase 3-Assessment: Together, you and the therapist identify the disturbing memory to be targeted during the bilateral dual attention stimulation. Then, the therapist asks you a series of questions in order to get baseline measurements. You are asked for an image that represents the event, a negative belief that goes with it, a positive belief you would like to have, how true that positive belief feels on the validity of cognition scale (VOC), what negative emotion goes with the image and the negative belief, how disturbing this negative emotion is on the scale of subjective units of disturbance (SUDs), and, lastly, what you experience in your body as a result of the negative emotion (e.g., tension or discomfort in a specific area).
Phase 4-Desensitization: Bilateral dual attention stimulation is used to access disturbing memories and reactivate your brain’s blocked natural information processing. The brain reprocesses the disturbance so that it can be released and brought to an adaptive resolution. After the first set of bilateral stimulation is completed, you will have a brief check-in with the therapist, and then go back to another set. This will continue until the targeted event feels neutral and no longer distressing, at which point you will move to the next phase. (If you were to become distressed or have difficulty in progressing, the therapist follows established procedures to help you get back on track.)
Phase 5-Installation: The main goal in this phase is to link the reprocessed event to positive self-assessment. Now that the targeted event is no longer distressing, you are asked to think once again of the positive belief you identified in Phase 3. At this time, you may adjust the positive belief, if necessary, since it may have changed while the information was shifting during reprocessing. Then, bilateral stimulation is used to install the link between the event and your positive belief about yourself. More than one set may be necessary to get your VOC (see Phase 3) to an acceptable level, after which the treatment moves to Phase 6.
Phase 6-Body Scan: This is the final phase of accelerated reprocessing. While holding both the image of the distressing event and the positive belief, you are asked to mentally scan your body for residual tension or any other negative physical sensations. If there is any lingering discomfort, additional sets of bilateral stimulation are done until that is no longer the case.
Phase 7-Closure: The content of this phase depends on whether the session is deemed complete or incomplete when the allotted time is almost over. The therapist needs to leave sufficient time to close the session with proper instructions that are part of the protocol. It is also important to leave you in a positive frame of mind and a sense of well-being. Therefore, even if the therapist hears something during phase 5 or 6 that should be processed but that needs too much time, this material is left for the next session (hence, an “incomplete” session). You are reminded to keep a specific log until your next session and to practice the techniques you learned in Phase 2.
Phase 8-Reevaluation: Although this sounds like the last step, reevaluation actually opens each session after the first. The therapist does a follow-up, asking about your disturbance level as it relates to the memories that were processed in the last session. If that session was incomplete (as explained in Phase 7), the processing begins again with Phase 4.
In addition to the other EMDR sections on this website, if you would like to read more about EMDR’s beginnings, research and other related topics, go to the EMDR Institute website.