EMDR: Eye Movement Desensitization and Reprocessing for Counseling Practice
Learn EMDR theory, the eight-phase protocol, adaptive information processing model, and clinical applications for counseling exams.
What Is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) is an integrative psychotherapy approach developed by Francine Shapiro in 1987. Originally designed for treating Post-Traumatic Stress Disorder (PTSD), EMDR has become one of the most widely researched and recognized trauma therapies in the world. Both the World Health Organization and the American Psychological Association recognize EMDR as an effective treatment for PTSD. The approach uses bilateral stimulation (typically eye movements) while the client processes traumatic memories, facilitating the brain's natural healing capacity.
The Adaptive Information Processing Model
EMDR is guided by the Adaptive Information Processing (AIP) model, which proposes that the brain has an inherent capacity to process and integrate experiences. When a traumatic event overwhelms this processing system, the memory is stored in an unprocessed form, retaining the original sensory experiences, emotions, and beliefs associated with the trauma. These "stuck" memories are the source of current symptoms. EMDR therapy facilitates the resumption of normal information processing, allowing the traumatic memory to be integrated with adaptive information and stored appropriately.
The Eight Phases of EMDR
Phase 1: History Taking and Treatment Planning
The therapist gathers a comprehensive history, identifies target memories for processing, and develops a treatment plan. Past events that have created the pathology, current triggers, and future needs are all identified.
Phase 2: Preparation
The therapist establishes therapeutic rapport, educates the client about EMDR, and teaches self-regulation techniques (safe place visualization, containment exercises, breathing techniques) for managing distress during and between sessions.
Phase 3: Assessment
The target memory is activated by identifying: the visual image that represents the worst part, the negative cognition (a negative self-referencing belief such as "I am powerless"), the desired positive cognition, the Validity of Cognition (VOC) scale rating (1 to 7), the emotions associated with the memory, the Subjective Units of Disturbance (SUD) scale rating (0 to 10), and the location of body sensation.
Phase 4: Desensitization
The client focuses on the target memory while simultaneously engaging in bilateral stimulation (eye movements, taps, or auditory tones). Sets of bilateral stimulation are followed by brief check-ins. Processing continues until the SUD rating decreases to 0 or 1.
Phase 5: Installation
The positive cognition is strengthened and installed by pairing it with the target memory during bilateral stimulation until the VOC rating reaches 6 or 7.
Phase 6: Body Scan
The client holds the target memory and positive cognition in mind while scanning their body for any residual tension or discomfort. Any remaining body sensations are targeted with additional bilateral stimulation.
Phase 7: Closure
The therapist ensures the client returns to a state of equilibrium before ending the session, using the self-regulation techniques taught in Phase 2 if needed. The client is briefed on what to expect between sessions.
Phase 8: Reevaluation
At the beginning of subsequent sessions, the therapist checks treatment effects, assesses whether previously processed targets remain resolved, and determines whether new targets need attention.
Bilateral Stimulation
The mechanism of bilateral stimulation remains debated. Leading theories include the working memory hypothesis (bilateral stimulation taxes working memory, reducing the vividness and emotionality of traumatic memories), the orienting response theory (eye movements activate an orienting response that promotes a state of relaxation), and the interhemispheric interaction hypothesis (bilateral stimulation enhances communication between brain hemispheres). Eye movements are the most common form, but alternating taps and auditory tones are equally effective.
Clinical Applications
EMDR has the strongest evidence for PTSD, but research also supports its use for anxiety disorders, depression, grief, phobias, chronic pain, and performance anxiety. EMDR has been adapted for children, couples, and group settings. Recent applications include early intervention after acute trauma and treatment of complex PTSD.
Training and Competency
EMDR is considered a specialized treatment requiring formal training beyond basic counseling education. Training typically involves a two-part program with supervised practice. Counselors should not attempt EMDR without proper training and should maintain ongoing consultation.
Exam Tips
- Francine Shapiro developed EMDR in 1987
- The Adaptive Information Processing (AIP) model is the theoretical foundation
- Know all eight phases, particularly assessment (Phase 3) and desensitization (Phase 4)
- SUD (Subjective Units of Disturbance) and VOC (Validity of Cognition) scales are key assessment tools
- Bilateral stimulation can be eye movements, taps, or auditory tones
- EMDR is an evidence-based treatment for PTSD recognized by WHO and APA
Practice What You Learned
Study with 2,000+ flashcards and 240 practice exams across LCSW, LMSW, NCE, and NCMHCE.