What Happens in an EMDR Session Step by Step?

Eye Movement Desensitization and Reprocessing (EMDR) therapy might seem mysterious if you've never experienced it. The bilateral stimulation, the memory targeting, the processing—it can all feel a bit abstract. This comprehensive guide will walk you through exactly what happens in an EMDR session, step by step, so you know what to expect and can approach your therapy with confidence.

EMDR follows a structured eight-phase protocol, but sessions typically focus on phases 3-7 (the actual processing work) once preparation is complete. Let's explore what each step looks and feels like in practice.

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Before You Begin: The First Two Phases

Phase 1: History Taking and Treatment Planning

Before you ever experience bilateral stimulation, your therapist will spend several sessions understanding your history and planning your treatment. This isn't just paperwork—it's a crucial foundation for your healing journey.

What Happens:

• Comprehensive assessment: Your therapist asks detailed questions about your life history, trauma experiences, current symptoms, and goals
• Timeline creation: Together, you'll map out significant life events and identify patterns
• Target identification: Your therapist helps you pinpoint specific memories that need processing
• Safety planning: You'll discuss potential triggers and create strategies for managing difficult emotions

What It Feels Like: This phase can feel emotionally intense as you discuss difficult experiences, but it's also empowering. Many clients report feeling heard and understood for the first time. Your therapist is trained to create a safe, supportive environment where you can share at your own pace.

Phase 2: Preparation

EMDR preparation typically takes 1-3 sessions, depending on your history and needs. This phase is about building skills and resources before diving into memory processing.

What Happens:

• Therapist explains EMDR: Your therapist describes how EMDR works, what bilateral stimulation feels like, and what to expect during processing
• Resource development: You identify and strengthen positive memories, beliefs, and places that help you feel calm and safe
• Grounding techniques: You learn specific techniques to stay present and manage overwhelming emotions
• Safe/calm place visualization: You create a mental sanctuary you can return to whenever you feel distressed

What It Feels Like: This phase feels like learning and preparation. You might feel nervous anticipation mixed with hope. The grounding techniques often provide immediate relief—you're learning tools you can use right away, even before processing begins.

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The Core Work: Phases 3-7 in a Typical Session

Most EMDR sessions focus on the actual processing work. Here's what happens step by step:

Phase 3: Assessment

Each processing target (memory) begins with assessment. This happens before the bilateral stimulation starts.

What Happens:

• Memory selection: You choose a specific memory to work on from your treatment plan
• Image identification: You identify the most distressing visual aspect of the memory
• Negative cognition: You articulate the negative belief you hold about yourself related to this memory
• Positive cognition: You identify what you'd prefer to believe about yourself instead
• Validity of Cognition (VOC): You rate how true the positive belief feels on a 1-7 scale (1 = completely false, 7 = completely true)
• Emotions: You name the feelings the memory brings up (fear, shame, anger, etc.)
• Subjective Units of Distress (SUD): You rate current distress on 0-10 scale (0 = no distress, 10 = worst possible distress)
• Body scan: You notice where you feel the distress in your body (tight chest, stomach pain, etc.)

Example Assessment:

• Memory: Car accident at age 25
• Image: Red car hitting from the side
• Negative cognition: "I'm not safe"
• Positive cognition: "I'm safe now"
• VOC: 2 (positive belief doesn't feel true yet)
• Emotions: Fear, helplessness
• SUD: 8 (very distressing)
• Body sensation: Chest tightness, stomach knots

Phase 4: Desensitization (The Processing)

This is the heart of EMDR therapy. You'll focus on the memory while experiencing bilateral stimulation.

What Happens:

• Bilateral stimulation begins: Your therapist starts eye movements, tapping, or audio tones
• Sets of stimulation: You experience 20-40 seconds of bilateral stimulation, then brief breaks
• "Just notice" instruction: Your therapist reminds you to notice whatever comes up without judgment
• Continuous processing: You repeat sets until the memory loses its emotional charge

What You Might Experience:

• Initial distress: The memory feels intense at first
• Changing images: The visual aspects of the memory may shift or change
• Emotional processing: You might cry, feel angry, or experience various emotions
• Physical sensations: Body feelings might intensify then lessen
• Thoughts and insights: New perspectives or understanding may emerge
• Distress reduction: The SUD level gradually decreases

What It Feels Like: Clients often describe EMDR processing as:

• Like watching a movie of the memory that gradually becomes less intense
• Like your mind is organizing the information differently
• Sometimes physically and emotionally intense, but manageable
• Surprisingly fast—much quicker than talk therapy for the same material

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During Processing: Common Experiences

You might experience:

• Memory shifts: The memory might change details, perspective, or emotional tone
• Multiple memories: Other related memories might come up for processing
• Physical releases: Crying, shaking, yawning, or temperature changes
• Insight moments: Sudden understanding or reframing of experiences
• Emotional waves: Intense emotions that come and go in waves

Your therapist will:

• Check your SUD level: Periodically ask "What's the distress level now?"
• Guide you through blocks: Help you move through stuck places
• Ensure your safety: Monitor if you're staying within your window of tolerance
• Adapt the stimulation: Change speed, direction, or type as needed

Phase 5: Installation

Once the memory's distress level is low (typically SUD 0-1), you install the positive cognition.

What Happens:

• Focus on positive belief: You hold the positive cognition in mind while thinking of the original memory
• Continued bilateral stimulation: You experience more sets while focusing on the positive belief
• VOC monitoring: Your therapist checks the validity rating after each set
• Complete installation: Continue until VOC reaches 7 (completely true)

Example Installation:

• Target positive cognition: "I'm safe now"
• VOC progress: 2 → 4 → 6 → 7 (installation complete)
• What it feels like: The positive belief starts to feel genuinely true in relation to the memory

Phase 6: Body Scan

This crucial phase ensures the trauma is fully cleared from your nervous system.

What Happens:

• Hold positive belief: You think of the original memory and your new positive belief
• Systematic body scan: You mentally scan from head to toe, noticing any tension or discomfort
• Process remaining tension: Any areas of tightness or discomfort are processed with more bilateral stimulation
• Final clearing: Continue until your body feels completely neutral or positive

Common Body Scan Findings:

• Clear: No tension or discomfort (goal achieved)
• Residual tension: Specific spots (jaw, shoulders, stomach) that need targeted processing
• New insights: Body memories that emerge and need processing

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Phase 7: Closure

Every EMDR session ends with closure to ensure you feel stable and safe.

What Happens:

• Stability check: Your therapist assesses how you're feeling emotionally
• Grounding techniques: You practice specific techniques to return to the present moment
• Resource reinforcement: You might spend time with your safe/calm place visualization
• Coping plan: You and your therapist plan how to handle any emotions that might come up between sessions
• Schedule next session: You confirm your next appointment and discuss upcoming targets

What Closure Feels Like: The goal is to end every session with you feeling:

• Calm and centered: Emotionally regulated and present
• Grounded: Connected to your body and current reality
• Confident: Capable of handling any emotions that might arise
• Hopeful: Positive about your progress and future healing

Between Sessions: Integration and Processing

What Happens Between Sessions

EMDR processing continues between sessions, and integration is crucial for healing.

You might experience:

• Continued processing: Dreams, memories, or emotions related to your session work
• New insights: Further understanding or reframing of processed material
• Emotional shifts: Changes in mood, energy, or emotional responses
• Physical changes: Reduced tension, better sleep, or other physical improvements

Self-care recommendations:

• Journaling: Write down dreams, memories, or insights that arise
• Gentle self-care: Avoid overwhelming situations or intense therapy during integration
• Use your resources: Practice your grounding and calming techniques
• Stay connected: Reach out to support systems when needed

Phase 8: Reevaluation

The next session begins with reevaluation of previous work.

What Happens:

• Progress check: Your therapist asks how you've been feeling since your last session
• Target assessment: You check the previous target's VOC and SUD levels
• Memory stability: You discuss whether processed memories feel stable and neutral
• Treatment planning: You decide whether to continue with current targets or move to new ones

What Success Looks Like:

• Neutral memories: Original memories no longer cause distress when recalled
• Strong positive beliefs: Your new positive cognitions feel genuinely true (VOC 7)
• Physical relaxation: No body tension when thinking about past events
• Improved daily functioning: Better sleep, relationships, and emotional regulation

Special Considerations

Multiple Sessions vs. Single Memory

Most memories require multiple sessions to fully process:

• Simple memories: 1-2 sessions
• Complex trauma: 4-6 sessions per memory network
• Multiple related memories: Processing one often leads to others coming up

When Processing Is Difficult

Sometimes EMDR processing is challenging:

• Blocked processing: When memory seems stuck and isn't reducing in distress
• Emotional overwhelm: When emotions feel too intense to continue
• Dissociation: When you feel disconnected from your body or reality

Your therapist might:

• Use different bilateral stimulation: Change type, speed, or pattern
• Add resource strengthening: Spend more time with your safe place or positive memories
• Use cognitive interweaves: Provide gentle guidance to unstick the process
• Stop and return to preparation: Build more resources before continuing

Different Types of Bilateral Stimulation

EMDR can use various forms of bilateral stimulation:

• Eye movements: Following therapist's fingers or light bar side to side
• Tapping: Alternating taps on knees, hands, or shoulders
• Audio: Alternating beeps or tones through headphones
• Vibration: Hand-held devices that alternate vibrations

Your therapist will work with you to find the most comfortable and effective type for your needs.

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What You Need to Know

Session Length and Frequency

Typical EMDR sessions:

• Duration: 60-90 minutes (longer than traditional therapy)
• Frequency: Weekly or biweekly, depending on your needs and goals
• Total treatment: 8-20 sessions for most trauma presentations

Before Your Session

To prepare for EMDR:

• Eat a normal meal: Don't come overly full or hungry
• Avoid caffeine: It can interfere with relaxation and processing
• Wear comfortable clothing: You'll be sitting or lying down for extended periods
• Arrange aftercare: Plan gentle activities after intense processing sessions

During Your Session

To get the most from EMDR:

• Be honest about your experience: Report exactly what you're noticing
• Trust the process: Allow whatever comes up to emerge without judgment
• Use your resources: Don't hesitate to ask for grounding or breaks
• Stay curious: Notice patterns, insights, and changes without analyzing them

After Your Session

To support integration:

• Plan gentle activities: Avoid intense situations or conversations
• Stay hydrated and nourished: Support your nervous system's recovery
• Practice self-compassion: Healing isn't linear—be kind to yourself
• Keep notes: Document your experiences for discussion with your therapist

Common Questions About EMDR Sessions

"Will I have to talk about the details of my trauma?"

Not necessarily. While you'll identify the memory and related beliefs, EMDR focuses on the brain's processing rather than extensive verbal storytelling. Some clients prefer this aspect of EMDR as it feels less re-traumatizing than repeated detailed narration.

"What if I get overwhelmed during processing?"

EMDR therapists are trained to help you manage overwhelming emotions. They have multiple techniques to help you return to your window of tolerance, including resource strengthening, grounding techniques, or taking breaks. Your safety and stability are always the priority.

"How will I know EMDR is working?"

Clients typically notice several indicators that EMDR is working:

• Reduced distress: SUD levels decrease during and between sessions
• Memory changes: Visual aspects of memories shift or become less vivid
• New perspectives: Spontaneous insights or reframing of experiences
• Physical improvements: Better sleep, less tension, reduced somatic symptoms
• Daily life changes: Improved relationships, emotional regulation, and functioning

"Is EMDR permanent?"

The goal of EMDR is to create lasting change in how traumatic memories are stored and processed. Research shows that EMDR benefits are generally long-lasting, especially when all phases are completed and followed by proper integration.

The Journey of Healing

EMDR is a structured, evidence-based approach to healing trauma, but it's also deeply personal. Your experience will be unique to your history, nervous system, and healing process.

Remember:

• Trust your pace: Healing isn't a race—take the time you need
• Use your voice: Communicate with your therapist about what's working and what isn't
• Be patient with yourself: Some days will be easier than others
• Celebrate progress: Notice and acknowledge the changes, no matter how small

EMDR sessions can feel intense, mysterious, and transformative all at once. Understanding the step-by-step process can help you approach this powerful therapy with confidence and openness, allowing your brain's natural healing mechanisms to do their remarkable work.

Image Credits:

• Therapy room setup: Robina Weermeijer on Unsplash
• Therapist explaining process: Robina Weermeijer on Unsplash
• Bilateral stimulation in action: Robina Weermeijer on Unsplash
• Client in therapy session: Robina Weermeijer on Unsplash
• Calm after therapy session: Robina Weermeijer on Unsplash

This article is for informational purposes only and does not constitute medical advice. If you're considering EMDR therapy, please consult with a qualified EMDR-trained mental health professional to discuss your specific needs and treatment goals.