What Actually Happens in an EMDR Session?
Understanding What EMDR Is — and Isn’t
Eye Movement Desensitization and Reprocessing. That's a mouthful, isn't it? Maybe your therapist suggested it, maybe a friend swore by it, maybe you read about it at 1am during one of those nights. It might sound like a promising treatment, or maybe a little far-fetched. Fair enough, either way. Essentially, you want to know what you're actually walking into.
Understanding What EMDR Is (and Isn't)
The goal is straightforward: help your brain finish digesting an experience that got stuck in your psyche and nervous system, so the memory can sit in your past, where it belongs, rather than hijacking your present. The car accident becomes simply historical and factual: something that happened once, not an alarm that goes off every time you merge onto the highway.
I'm often asked if EMDR involves hypnosis. The answer is no. You're fully awake, aware, and present. The therapist isn't some Svengali pulling strings; you're in the driver's seat, and your engaged collaboration is the more important ingredient. Your job is simply to pay attention: the feelings and thoughts that arise, the sensations in your body, the memories that surface. Your therapist's job is to guide your noticing through carefully attuned pacing and sometimes even gentle challenges, so that your brain and body can file away the memory, experience, or belief as something that is done and dusted.
This isn't the kind of therapy where you narrate every excruciating memory, detail by painful detail. It's not prolonged exposure, where you repeatedly narrate the memory aloud until the distress fades. Your therapist will likely ask you to touch a piece of it: an image, a feeling, a thought, or a sensation, and hold it in mind while bilateral stimulation (eye movements, tapping, auditory cues) runs. From there, you simply notice whatever arises next. And then what arises after that, and next after that. You will do a lot of noticing. That is the digestion occurring.
I've read in some places that EMDR does not require you to go back to past experiences in your mind. That's not quite accurate. There is some wishful advertising in that. The truth is that you do make contact with the story or belief, but you don't relive and re-litigate it.
The Eight Phases
Technically, EMDR follows a structured eight-phase protocol. In practice, those phases don't map onto sessions in a neat and tidy, textbook fashion. Some stretch across weeks; others take minutes, and sometimes you move back and forth between them in the same session. Think of the eight-phase model less as something to level up through and more like gears on a bike that you toggle back and forth between depending on the terrain in front of you. You don't go faster by grinding through a high gear on a steep hill; you drop into a lower gear so you can pedal through without falling off or stalling out. Much like how the gears on your bike aren't obstacles to overcome ("I can't wait to get through all the gears!") but are tools you use to adjust your ride to the contours of the road, your therapist's skillful guidance through these phases helps your nervous system learn or re-learn how to modulate, soothe, and return to balance.
1. History and Treatment Planning. Together, you and your therapist will stake out the terrain and start mapping it. This means taking a detailed history and connecting it to current symptoms, triggers, and negative beliefs about yourself. Sometimes even going through history can be quite activating, and this is where your therapist may adjust things and actually toggle to the next phase, and return to history later.
2. Preparation. In this phase you are building the foundations necessary to work with difficult emotional material. That means building and strengthening internal resources to calm your mind and body. This includes grounding and coping mechanisms. The aim here is to increase your emotional capacity bit by bit so that your nervous system is equipped for deep processing.
This phase is also a testing ground of sorts. Your therapist is gauging your nervous system's capacity to return to baseline after introducing activating material, so that they know how to safely and effectively pace treatment for you.
3. Assessment. You and your therapist select a target memory or core belief to work on, and break it down to its specific components: the image or video reel that plays in your mind, the emotion you feel, the negative belief about yourself, and the body sensations you notice. You are essentially teeing the memory up for the next phase, where you will process it.
4. Desensitization. This is the part you may be picturing when you hear "EMDR": bilateral stimulation, which means eye movements, alternating taps, or tones sounding in one ear and then the other. You hold the images, feelings, thoughts, and sensations in mind while your therapist guides the stimulation, stopping regularly to ask what you're noticing and adjust as needed. (Notice how what people typically think of as "EMDR" is just one of eight phases. All eight matter; it's a comprehensive treatment, not a technique.)
Some people will notice shifts in emotion or negative thinking, increased clarity, or just feeling more distance from the memory. However, some people may not notice much of anything in the moment. That's okay too. Processing is very different person to person. Someone who doesn't notice much of anything may be surprised when they return to the next session and find the memory less distressing.
5. Installation. Once the stress and turmoil of the memory fades, your therapist will guide you through installing a more accurate belief in its place ("I did the best I could," or "I'm safe now," or "I'm fine as I am"), again using bilateral stimulation to strengthen this new neural network.
6. Body Scan. We know clearly now that trauma lives in the body as much as in the mind. The somatic processing of emotions is crucial. Any lingering tension or unease gets digested until your body gets the message as well: "I'm safe."
7. Closure. Processing may or may not be complete at the end of session. Regardless, your therapist will make sure you feel grounded and ready to leave. Don't panic if the work doesn't feel finished yet; that is normal. Treatment unfolds over several or more sessions, and it's why your therapist spends all that time preparing and building your emotional capacity with you beforehand.
8. Re-evaluation. At the start of the next session, your therapist will check what has (or has not) shifted. What is new, same, or different? You will collaboratively decide whether to pick back up where you left off or if adjustment is needed.
It's worth reiterating, and remarkable to see in practice: a stuck memory or belief gets to be finally filed away as past business, and newer, more helpful beliefs take root and grow.
What Is Bilateral Stimulation Even Doing?
Bilateral stimulation means engaging both hemispheres of your brain and body: tracking movements with your eyes, side to side, tapping alternately on either side of your body (on your knees or chest), or listening to audio cues that switch between ears.
Research is clear that EMDR works. Exactly why bilateral stimulation itself helps is where researchers don't fully agree. The most promising line of thinking at this point is that attending to both the stimulation and the memory at once taxes working memory just enough that the distress becomes bearable and the encoded memory accessible to work with. For now, we have to tolerate the uncertainty of exactly what is happening. What I can say is that the felt experience for folks is pretty consistent: sighing, yawning, the body relaxing. The nervous system letting go of something it had a vice grip on.
You Are in the Driver's Seat
A lot of hesitation with EMDR is some version of: "What if something comes up and I can't handle it?" My instinct, based on experience, is that you'll be surprised by how much you can actually handle. People are rarely surprised by what comes up. They usually already know it's there. What surprises them is discovering they are ready to face it. But I don't mean to minimize this. Something unexpected could pop up, and that's exactly what preparation is for. All that work on building grounding and coping capacity isn't just going through the motions. It's so that you can stop and pull back when you need to. At any point, you have the power to pull the brake. I would never encourage a patient to move forward when they don't feel ready, and neither should your therapist. I'll make a last note here to say that a good EMDR therapist will know that "I can't handle it" is its own EMDR target just waiting to be processed.
What Happens After: Integration in the Days That Follow
There is a saying in EMDR trainings for therapists: "Processing will continue." It's true. Processing doesn't stop when the session ends. Your brain will keep working with the material, not necessarily consciously, but under the surface, in between sessions. Some people report feeling unusually tired in the hours after, while others report feeling lighter almost immediately, like they finally have clarity they can't fully explain. The reactions run the gamut, and they just mean EMDR is doing its thing.
A few things are common enough that you should know about them in advance:
Vivid or unusual dreams. These are not unusual and can be related or unrelated to the target memory. Your brain is integrating information and rewiring neural networks while you sleep. This will settle down in a day or two.
Emotional fatigue. Feeling unusually emotional and/or drained in the first 24 to 48 hours after a session is common and expected. You are processing a lot of information, and this takes real neurological effort.
New memories or connections. Sometimes a session will open a door to related memories you hadn't consciously been thinking about. Your therapist will help you track this and decide what, if anything, to do with it during the next session.
A shift in reactivity you can't fully explain. Sometimes the clearest sign that things are shifting as a result of your work is the realization, days or weeks later, that a situation that used to flood you just doesn't. It just... doesn't have the same bite it used to.
None of the above is dramatic or something to worry about. It's just good to know so that you can plan. It can be helpful to plan downtime rather than something demanding right after the work. Drink water, rest when you can, and make note of (but resist overanalyzing) what comes up. Your therapist will help you sort through and integrate during the next session.
Is EMDR Right for You?
EMDR was originally developed for PTSD, but it's since become a well-researched approach for a much wider range of concerns, including anxiety, depression, grief, phobias, and, frankly, just painful memories that still reverberate long after they should, in the form of negative beliefs ("I'm shameful," "I'm bad").
It tends to help the people who know, intellectually, that a thought isn't rational or fair, but can't seem to let it go. There's a gap between their intellectual and emotional understanding. EMDR works with that gap.
That said, EMDR isn't automatically the right starting point for everyone, or for every stage of treatment. A careful assessment with a therapist is needed to determine whether it's helpful for where you are right now. If it's not yet, your therapist may recommend building stability and coping skills first, so that when you are ready for EMDR, the work has a foundation to build on top of.
Lastly, remember that technique doesn't trump relationship. The method itself matters, but EMDR needs a stable, healthy, and collaborative relationship to fit into.
Working Together
If you've been considering EMDR and want a clearer sense of what it would actually be like, I offer a free initial consultation. I work with adults in EMDR therapy in person in McLean, Virginia, and via telehealth throughout Virginia, Maryland, and Washington, D.C.
Reach out here to schedule.