EMDR Phases 3 & 4
Eye movement desensitization and reprocessing therapy, commonly known as EMDR, is a mental health therapy approach that works to reduce distressing emotions that are linked to traumatic memories. EMDR treats the mental health conditions, often anxiety, depression or other symptoms, which occur because of the memories we have stored from these traumatic events.
In my first article on the phases of EMDR we looked at Phases 1&2-Client History/Treatment Planning and Preparation. Now we will look at Phases 3&4-Assessment and Desensitization.
Phase 3- Assessment
In phase three the client and therapist will work together to identify
the target memory that triggers emotional distress. This includes what incident caused the trauma? (Was it sexual assault, an accident, the death of a relative etc.?),and what is the most consistent image associated with the memory?
The first step is for the client to select a specific image or mental picture from the target event that best represents the memory. Then the client chooses a statement that expresses a negative self-belief associated with the event. Common negative cognitions could be statements such as, “I am helpless,” “I am worthless,” “I am unlovable,” “I am dirty,” “I am bad,” etc.
During phase three of EMDR therapy, a positive belief is also chosen to help counteract the negative emotions caused by the trauma. The client will pick a positive self-statement that he would rather believe. This statement could be “I am worthwhile/lovable/a good person/in control” or “I can succeed.”
The therapist will then ask the person to estimate how true the positive belief feels using the 1-to-7 Validity of Cognition (VOC) scale. “1” equals “completely false,” and” 7″ equals “completely true.” It is important to give a score that reflects how the person “feels,” not” thinks.”
During the Assessment Phase, the person identifies the negative emotions (fear, anger) and physical sensations (tightness in the stomach, headache) he or she associates with the target. The client also rates the level of disturbance, but uses a different scale called the Subjective Units of Disturbance (SUD) scale. This scale rates the feeling from 0 (no disturbance) to 10 (worst) and is uses this score to assess the disturbance that the client feels throughout the processing.
The goal of EMDR treatment, is for SUD scores of disturbance to decrease while the VOC scores of the positive belief to increase.
Phase 4- Desensitization
Phase four is where the processing of the memory and negative beliefs takes place. The therapist will use some form of Bilateral Stimulation (BLS) to stimulate the mind/brain to process whatever trauma is currently being held in the conscious mind. This usually involves instructing the client to follow hand movements back and forth or hold tappers in each hand.
After a number of eye movements or other form of BLS occur, the therapist will stop and ask, “What are you noticing now?” The client will comment in just a few words what they are noticing. This may be part of the memory, a feeling, or a body sensation. Most of the healing happens while the client is reviewing the memory with the BLS. The therapist will ask the client to continue by stating “Go with that”. The process then continues.
Depending upon the intensity of the response to the trauma, your therapist may adjust the length, speed and type of stimulation used to create the eye movements.
The therapist may have to “circle back” to the original memory multiple times depending on how deep or complex the trauma is, but the process remains the same. The therapist will keep asking the client to hold the memory and the belief and the feelings in mind, while also completing the BLS.
Eventually the memory will feel different. It will have less energy.
The therapist will keep offering BLS until the client is able to grade the memory at a much lower level of disturbance on the 1-10 scale, ideally at a zero –now the memory no longer bothers them. This is the goal of EMDR; to get the client from a point where the memory goes from 8 or 9 out of ten for intensity and unpleasantness, down to a 0-1 out of ten.
During reprocessing, maladaptively stored events are desensitized, integrated, and adaptively stored.
In my third and final segment of the phases of EMDR we will look at phases 5-8-Installation, Body scan and Re-evaluation.
If you have experienced trauma of any kind, and feel you could benefit from EMDR to reduce symptoms and to improve quality of life, feel free to reach out to me at Marsh Psychology Group.
Carol Van Kampen, LMSW is an individual private practice psychotherapist who specializes in anxiety, depression, grief, and trauma treatment at Marsh Psychology Group. Carol is EMDR trained. Contact her at marshpsychologygroup.com
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