Preparing for EMDR Therapy: What to Expect During Processing

Preparing for EMDR Therapy: What to Expect During Processing

If you're preparing for EMDR therapy, you may be wondering what to expect, how it works and whether there's anything you need to do during the process.

One thing that's helpful to understand is that you don't need to work everything out or try to make something happen.

EMDR (Eye Movement Desensitisation and Reprocessing) is a therapy that helps us work with distressing memories and experiences. It can help memories become less distressing and easier to make sense of in the present.

Understanding EMDR: A train journey

I sometimes describe EMDR processing as being a little like taking a train journey.

Imagine boarding a train at a particular station. This is our starting point, or what we call the target memory.

As the train begins moving, the scenery changes. We might recognise familiar places, notice something unexpected or find ourselves travelling through somewhere entirely different.

During EMDR, something similar can happen.

We may begin with one memory, but as processing continues, other memories, images, thoughts, emotions or physical sensations might emerge.

Sometimes the experience feels clear and connected. At other times, we might notice fragments or very little at all.

We don't need to decide which station comes next or direct every part of the journey.

Instead, we make space for whatever comes along.

What is happening in the brain?

EMDR is informed by the Adaptive Information Processing (AIP) model.

This model suggests that some distressing experiences may not have been fully processed and can remain connected with the emotions, beliefs and bodily sensations associated with the original experience.

For example, a childhood experience of feeling rejected might still bring up feelings of shame, loneliness or beliefs such as "I'm not good enough", even many years later.

During EMDR, we briefly bring a memory to mind while using bilateral stimulation, usually guided eye movements or alternating tapping.

Research suggests that eye movements can place demands on working memory, our ability to hold information in mind while doing something else. Attending to a memory and following eye movements at the same time may reduce how vivid or emotionally intense that memory feels.

This is one possible explanation for how EMDR works, although researchers continue exploring the mechanisms involved.

EMDR is an evidence-based treatment for post-traumatic stress disorder (PTSD).

What happens during processing?

During an EMDR session, we usually work with short sets of bilateral stimulation.

Between sets, I might ask:

What are you noticing now?

You might notice an image, a memory, an emotion, a thought or a sensation somewhere in your body.

Sometimes the original memory might become less clear, another memory might appear, or you might notice very little.

There is no right or wrong way to experience this.

During the processing stage, there may be less talking than in other forms of psychological therapy. We're making space for what comes up rather than trying to explain or analyse everything as it happens.

We may briefly discuss something, check how you're feeling or adjust the pace. At other times, we may simply continue.

Returning to the train journey, we don't need to know where every part of the journey will take us. We can notice the changing scenery without having to make sense of everything along the way.

I continue to help you stay connected to the memory while keeping one foot in the present, checking that the pace is manageable. If needed, we can pause, check in or talk when it's helpful. The process is collaborative, and you can ask to stop at any point.

What if the memory disappears?

Sometimes, during EMDR, the original image or feeling becomes less vivid or seems to disappear.

This doesn't necessarily mean anything has gone wrong.

Our attention, emotions and memories can shift during processing. Sometimes the original memory becomes easier to recall again; sometimes it feels different.

When we return to our starting station, the original target memory, we may discover that the scenery has changed.

Perhaps the memory feels more distant, less emotionally charged or easier to think about.

Returning to the original target doesn't always mean processing is complete. Sometimes the memory feels less distressing, but some emotional or physical discomfort remains. We take time to explore what has changed.

How can I prepare for EMDR?

Preparation is an important part of EMDR therapy, and it isn't something that needs to be rushed.

Before beginning memory processing, we spend time understanding your experiences, identifying what you would like to work on and developing ways to help you feel grounded and supported.

A few things can be helpful:

• You don't need to remember everything. We can identify particular memories or experiences together without requiring a detailed account of everything that happened.

• You don't need to make yourself feel distressed. Whatever you notice is useful information, including when you notice very little.

• You can ask questions. Understanding the process and feeling comfortable with your psychologist are important.

• Allow time afterwards. Some people feel tired or emotional after processing. Others feel settled or notice little immediate change.

• Notice what supports you. Music, movement, being outdoors, creative activities or spending time with supportive people may help you feel grounded between sessions.

Sometimes we may spend longer preparing before working directly with distressing memories. This is part of the therapy, rather than a delay.

Trusting the journey

Returning to the train analogy, we begin at a particular starting point, but we don't always know exactly where the journey will take us.

We may encounter unexpected connections, pause at certain points or need to take a different route.

And sometimes, when we return to where we started, the memory feels different.

EMDR isn't about finding the right answer or directing every step.

There is room to notice what happens, pause when needed and decide together what comes next.