DR. ESSLIN TERRIGHENA shares what to expect in your EMDR sessions.
Often, we go to therapy because we have been grappling with an issue for a while and are reaching a point where we really need external help. Sometimes the step to therapy comes after all other options have been exhausted. As a result, many people go into the first therapy session with a mix of urgency, defeat, shame, and fear that maybe nothing will actually help to solve the problems they are facing. Driven by the hope for fast results, it can be tempting to jump to the processing part of EMDR as soon as possible to see whether it really works. However, there are three preparation stages that are crucial to the success of EMDR therapy: history taking, resourcing, and target formulation.
Here is an idea of what to expect at each step of the EMDR process:
This step of EMDR preparation usually happens in the first sessions and consists of getting a better understanding of you as a client. We take a look at your family history and development, starting in childhood and continuing all the way to your present moment. This aims to understand your wider context, health, family, career, values, fears, personality traits, relationships, experiences, and challenges that you may have faced. This is a good time to bring up things that are important to you and experiences that have significantly influenced you. Importantly, as part of history taking, we identify what primary issue that motivated you to seek therapy. We set goals together and make a plan of how to get there.
Resourcing entails techniques that can help to manage emotional turbulence and regulate emotional responses. For my sessions, this can be a mix of strategies that address thoughts, feelings, body, and behaviours. For example, we may use worksheets to identify and reframe negative core beliefs or identify problematic coping modes and alternatives, or we may use emotion observation and grounding techniques to enhance self-soothing. This may take a few sessions, depending on existing resilience strategies and the complexity of the challenges you are dealing with.
Target Formulation / Assessment
At this stage, we really deep dive into the issue that brought you to therapy. We will identify what negative core belief or core fear lies at the heart of the issue. This is generally expressed as a self-belief that has arisen from past incidents that have contributed to the distress we are feeling. For example, if we are struggling with anxiety or guilt after a car accident, what does that mean for or about us? Some self-beliefs arising from this may include, ‘I am not safe’, ‘I am powerless’, or I am responsible for bad things happening’.
Once we have got a negative core belief that accurately resonates with how you feel and your experience, we identify target memories for EMDR processing that have contributed to this belief and intense feelings of distress. These can be put into different orders, such as chronological (going as far back as you remember having felt this way), by intensity (what causes the most distress), or by intrusion (what images are most intrusive). We will determine what the worst part of each memory was and how intense each memory feels on a scale from 0-10 (SUDS scale).
At the assessment stage, we will also look at what positive adaptive belief you might want to get to. Sometimes this step is difficult to start with, so we may re-visit it after some of the processing has occurred. Sometimes, clients immediately know what belief they would like to get to. This is often experienced as, “I know the negative belief is not rational, but I cannot help feeling the way I do. The belief that seems more rational or true cognitively is…”. Positive self-beliefs can include, ‘I am safe’, ‘I am capable’, or ‘I am lovable’. We rate how true this belief feels to you from 1 to 7 (VOC scale).
Active EMDR processing includes a desensitization stage, where the intensity of the distress associated with the memory is desensitized, and a reprocessing stage, where the memory is reprocessed into our existing healthy belief system.
For these stages, we commonly use bilateral stimulation either through eye movements from left to right, sound alternating in left and right ears, or tapping / vibration alternating left and right on the body. This is based on the adaptive information processing (AIP) model which stipulates that bilateral stimulation helps the brain to heal from past trauma by enhancing communication between the left and right hemisphere, remove processing blockages, and allow the trauma memory to integrate appropriately into existing belief structures. For more information on how bilateral stimulation in EMDR works, please click here.
We may also make use of working memory taxation, whereby we integrate tasks during this processing stage that draw on the same brain resources as holding the memory in our mind does. This interrupts the intensity of the memory. Tasks can include maths, spelling, movement routines, or even games. For more information on how working memory taxation in EMDR works, please click here.
These methods can be used separately or combined. Usually, I will ask you to start with closing your eyes and bringing the memory to mind. During this attunement, we make the image as vivid as possible until you feel an emotional connection to it. We focus on the worst part of the memory and identify the distress intensity that it brings up for you emotionally and physically in the here-and-now.
Then we use bilateral movements, working memory taxation or both in short episodes which generally last anywhere between 5 to 120 seconds. During this time, you hold the memory in mind while completing the task at hand. After the interval, I will check in with you and ask you what you notice. You can share any feelings, thoughts, physical sensations, memories, insights, or behavioural urges that arise and give me a snapshot of what is coming up for you. Then, we continue with the next interval. Unless necessary, I will keep comments to a minimum during the active EMDR processing stage. This does not mean I am not listening, not interested, or that you are doing anything wrong. This is simply to allow your brain to enjoy uninterrupted processing. The magic of EMDR happens in your neural network.
You can communicate with me at any time during the process if you have any concerns, questions, or feel overwhelmed and need a break. It is common for there to initially be a small rise in emotional reactivity during the active processing stage, but over time the SUDS associated with the memory will decrease.
This stage generally occurs after the memory has been desensitized and reprocessed to a sufficient extent that you feel comfortable with. Here we return to your positive adaptive belief that you identified during the formulation step and check how true this belief feels to you now on a scale of 1 to 7 (VOC scale). Then we install this belief together with the memory.
As trauma is stored in the body, we complete a body scan after the active processing of each memory to identify and residual sensations that may still need to be processed.
Not every session with allow full processing of a past memory and reduction of feelings, negative thoughts, physical sensations or unhelpful behavioural urges. Whatever is processed, is processed for good, but some loose ends may remain when the first few processing sessions come to an end. We will practice self-soothing and grounding techniques to help the body to calm down after active processing. There may also be some take-home action points, such as journaling, to help guide the process. Journaling can be great not just to regulate our emotions and structure our thoughts, but also to track our EMDR progress over time.
If you would like to explore how EMDR Therapy could help you, book a consultation with psychologist Dr. Esslin Terrighena, please contact (852) 2521 4668 or firstname.lastname@example.org.
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