What Stops EMDR From Working? Understanding Barriers and How to Overcome Them

Eye Movement Desensitization and Reprocessing (EMDR) therapy has helped countless people heal from trauma and distressing memories, yet like any therapeutic approach, it doesn't work for everyone under every circumstance. Understanding what can stop EMDR from working effectively is crucial for both clients and therapists to optimize treatment outcomes and achieve lasting healing.

Client-Related Barriers

Insufficient Preparation and Stabilization

One of the most common reasons EMDR doesn't work effectively is inadequate preparation phase work.

Signs of Insufficient Preparation:

• Overwhelming emotions during or between sessions
• Difficulty with grounding and regulation techniques
• Feeling constantly on edge or hypervigilant
• Inability to maintain dual awareness during processing

What's Needed:

• Strong grounding and centering skills
• Reliable safe place imagery
• Effective affect regulation strategies
• Adequate internal resources for stabilization
• Understanding of the EMDR process and expectations

Solutions:

• Spend more time in Phase 2 (Preparation)
• Develop additional resource states
• Practice coping skills between sessions
• Consider adjunct therapies like DBT or skills training

Complex Trauma and Dissociation

Complex trauma presents unique challenges that can interfere with standard EMDR protocols.

Challenges with Complex Trauma:

• Fragmented sense of self and identity
• Chronic dissociation and emotional numbing
• Multiple traumatic memories affecting each other
• Difficulty establishing safety and trust
• Overwhelm from the volume of traumatic material

Why It Complicates EMDR:

• Standard protocols may be too intense
• Memory networks are highly interconnected
• Risk of overwhelming the system
• Difficulty maintaining present-moment awareness

Solutions:

• Use phased treatment approaches (stabilization first)
• Implement specialized EMDR protocols for dissociation
• Work with parts or ego states
• Extend preparation phase significantly
• Consider slower, more gradual processing

Lack of Motivation or Readiness

EMDR requires active participation and willingness to engage with difficult material.

Indicators of Poor Readiness:

• Missing or canceling appointments frequently
• Resistance to homework or between-session practice
• Minimal engagement during processing
• Questioning the need for therapy
• External pressure rather than internal motivation

Underlying Issues:

• Fear of facing traumatic memories
• Secondary gain from current symptoms
• Lack of trust in the therapeutic process
• Timing conflicts with life circumstances
• Ambivalence about change

Solutions:

• Explore readiness and motivation openly
• Address fears and concerns about processing
• Set realistic, collaborative goals
• Consider motivational interviewing techniques
• Build therapeutic alliance and trust

Inadequate Support Systems

External factors can significantly impact EMDR effectiveness.

Lack of Support Challenges:

• No one to talk to between sessions
• Unsupportive or invalidating environment
• High stress levels from work or family
• Financial or housing instability
• Current ongoing trauma or abuse

Impact on EMDR:

• Limited capacity for processing between sessions
• Re-traumatization from unsupportive relationships
• Reduced energy and focus for therapeutic work
• Safety concerns interfering with healing

Solutions:

• Build support networks during therapy
• Address safety concerns before processing
• Connect with community resources
• Develop stronger self-reliance and coping skills
• Consider group therapy or support groups

Therapist-Related Barriers

Insufficient Training and Experience

The therapist's skill level significantly impacts EMDR effectiveness.

Signs of Inexperienced EMDR Therapists:

• Inadequate case conceptualization
• Poor target selection and sequencing
• Insufficient preparation work
• Difficulty managing abreactions
• Inadequate closure and reevaluation

Common Training Gaps:

• Limited understanding of trauma dynamics
• Poor knowledge of dissociation and complex trauma
• Insufficient practice hours
• Lack of consultation or supervision
• Incomplete EMDR certification

Solutions:

• Seek properly certified EMDR therapists
• Verify training and experience level
• Ask about consultation and ongoing education
• Request specialized experience for complex cases
• Consider second opinions if progress stalls

Poor Case Conceptualization

Effective EMDR requires careful assessment and treatment planning.

Case Conceptualization Challenges:

• Missing key trauma memories
• Incorrect target sequencing
• Inadequate understanding of symptom connections
• Failure to address maintaining factors
• Overlooking resource development needs

Results of Poor Planning:

• Minimal progress despite multiple sessions
• Processing wrong or less important targets
• Incomplete resolution of symptoms
• Client frustration and hopelessness

Solutions:

• Comprehensive trauma history assessment
• Clear treatment planning and goal setting
• Regular reevaluation and plan adjustment
• Integration of multiple theoretical perspectives
• Ongoing consultation and case review

Inflexible Protocol Application

EMDR protocols should be adapted to individual needs, not rigidly applied.

Signs of Rigid Application:

• One-size-fits-all approach to every client
• Refusal to modify protocols for special needs
• Insufficient attention to client feedback
• Mechanical processing without therapeutic relationship

Problems with Inflexibility:

• Missing important nuances and individual needs
• Creating additional stress or resistance
• Failing to address unique presentations
• Poor therapeutic alliance

Solutions:

• Adapt protocols to individual needs
• Maintain flexibility in treatment approach
• Prioritize therapeutic relationship
• Use client feedback to guide adjustments
• Integrate complementary therapeutic approaches

Inadequate Therapeutic Alliance

The quality of the therapeutic relationship is crucial for EMDR success.

Alliance Challenges:

• Poor therapist attunement and empathy
• Lack of trust or safety in the relationship
• Cultural or personality mismatches
• Therapist boundaries or availability issues
• Insufficient therapist presence during processing

Impact on EMDR:

• Reduced willingness to be vulnerable
• Difficulty accessing and processing memories
• Increased resistance and avoidance
• Higher dropout rates

Solutions:

• Prioritize relationship building
• Ensure cultural competence and sensitivity
• Maintain consistent boundaries and availability
• Address ruptures and repair when they occur
• Consider therapist change if alliance cannot improve

Technical and Protocol Barriers

Inadequate Bilateral Stimulation

The choice and delivery of bilateral stimulation affects processing effectiveness.

Bilateral Stimulation Challenges:

• Inappropriate speed or intensity of eye movements
• Poorly fitted tapping or audio stimulation
• Client difficulty with the chosen method
• Inconsistent or irregular stimulation patterns
• Therapist technique problems

Impact on Processing:

• Reduced effectiveness of memory reprocessing
• Increased cognitive load or distraction
• Client discomfort or resistance
• Slower or incomplete processing

Solutions:

• Find the optimal stimulation method for each client
• Adjust speed and intensity based on feedback
• Ensure proper therapist technique
• Offer multiple stimulation options
• Monitor effectiveness and adjust as needed

Poor Target Selection and Sequencing

Choosing the right memories to process in the right order is crucial.

Target Selection Errors:

• Starting with too intense memories
• Missing key underlying traumas
• Processing peripheral rather than core issues
• Failing to identify connection between memories
• Ignoring developmental trauma sequence

Consequences:

• Overwhelming the client's system
• Limited progress on presenting issues
• Incomplete symptom resolution
• Client frustration and hopelessness

Solutions:

• Comprehensive trauma assessment
• Careful target selection and sequencing
• Regular reevaluation of treatment plan
• Understanding memory network connections
• Processing from present to past when appropriate

Inadequate Closure and Resource Development

Proper closure prevents incomplete processing and overwhelming between sessions.

Closure Challenges:

• Rushing through closure phase
• Failing to ensure complete stabilization
• Inadequate resource installation
• Poor homework or between-session planning
• Missing safety checks before session end

Risks of Poor Closure:

• Overwhelming emotions between sessions
• Sleep disturbances or nightmares
• Increased dissociation or numbing
• Reduced willingness to continue therapy

Solutions:

• Allow adequate time for closure (15-20 minutes)
• Ensure complete return to present moment awareness
• Install resources and positive cognitions
• Provide clear between-session guidelines
• Verify stability before ending sessions

Systemic and Environmental Barriers

Insurance and Financial Constraints

Practical barriers can prevent effective EMDR treatment.

Financial Challenges:

• Insufficient insurance coverage
• High out-of-pocket costs
• Limited number of authorized sessions
• Inability to afford consistent treatment
• Employment conflicts with therapy schedule

Impact on Treatment:

• Premature termination of therapy
• Inadequate frequency or duration of sessions
• Increased stress interfering with processing
• Incomplete resolution of trauma

Solutions:

• Explore sliding scale or reduced fee options
• Research insurance coverage thoroughly
• Consider group EMDR or intensive formats
• Look for community mental health resources
• Plan financial commitment for complete treatment

Time and Scheduling Constraints

Consistent, adequate time is essential for EMDR effectiveness.

Time-Related Barriers:

• Inconsistent session attendance
• Shorter session lengths than recommended
• Extended breaks between sessions
• Work or family scheduling conflicts
• Long commute times to therapy

Impact on Processing:

• Lost therapeutic momentum
• Inadequate time for complete processing
• Reduced integration between sessions
• Increased stress and life disruption

Solutions:

• Prioritize therapy scheduling consistency
• Plan for adequate session length (90 minutes)
• Minimize breaks between sessions
• Explore telehealth or closer therapy options
• Discuss scheduling adjustments with employer

Ongoing Stress and Life Events

Current life stress can interfere with trauma processing capacity.

Common Stressors:

• Job changes or job loss
• Relationship conflicts or divorce
• Health problems or medical treatments
• Financial difficulties or legal issues
• Caregiving responsibilities

Impact on EMDR:

• Reduced processing capacity
• Increased overwhelm and dissociation
• Focus shifted from trauma to current stressors
• Reduced energy for therapeutic work

Solutions:

• Address current stressors before processing
• Develop stronger coping strategies
• Adjust treatment intensity during high stress
• Consider brief breaks or reduced session frequency
• Integrate stress management techniques

Biological and Neurological Factors

Medication Interactions

Certain medications can affect EMDR processing effectiveness.

Problematic Medications:

• Benzodiazepines (Xanax, Klonopin, Ativan)
• High-dose antidepressants
• Antipsychotic medications
• Mood stabilizers
• Muscle relaxants

Impact on Processing:

• Reduced emotional access during processing
• Blunted memory reconsolidation
• Increased dissociation or numbing
• Slower cognitive processing

Solutions:

• Discuss medication concerns with prescribing physician
• Consider medication adjustments if possible
• Allow extra time for processing
• Focus on building stronger resources
• Monitor effectiveness carefully

Neurological Conditions

Certain brain conditions can interfere with EMDR processing.

Challenging Conditions:

• Traumatic brain injury (TBI)
• Seizure disorders
• Neurodegenerative conditions
• Severe ADHD or attention deficits
• Autism spectrum disorders

Processing Challenges:

• Difficulty with bilateral stimulation
• Poor memory access or organization
• Sensory processing issues
• Attention and focus difficulties

Solutions:

• Adapt protocols for specific conditions
• Modify bilateral stimulation methods
• Allow longer processing time
• Integrate complementary approaches
• Consult with medical providers

Chronic Health Conditions

Physical health affects emotional processing capacity.

Health-Related Barriers:

• Chronic pain conditions
• Autoimmune disorders
• Fatigue syndromes
• Hormonal imbalances
• Sleep disorders

Impact on EMDR:

• Reduced energy for processing
• Increased baseline stress levels
• Difficulty with attention and focus
• Body scan challenges

Solutions:

• Address health concerns when possible
• Adapt session length and frequency
• Focus on building physical resources
• Integrate body-based healing approaches
• Monitor for overexertion

Psychological and Cognitive Barriers

Severe Dissociation

High levels of dissociation can prevent effective EMDR processing.

Dissociation Challenges:

• Difficulty staying present during processing
• Fragmented sense of self
• Time loss or memory gaps
• Emotional numbing or detachment
• Multiple personality states

Impact on Therapy:

• Inability to access traumatic memories
• Poor integration of processing results
• Safety concerns during processing
• Slow or minimal progress

Solutions:

• Extensive stabilization work before processing
• Specialized dissociation protocols
• Parts work and ego state therapy integration
• Grounding and orientation techniques
• Slower, more gradual processing approach

Cognitive Limitations

Cognitive abilities affect EMDR processing capacity.

Cognitive Challenges:

• Limited abstract reasoning ability
• Poor memory access or organization
• Difficulty with metaphor or imagery
• Intellectual disabilities
• Language or communication barriers

Processing Difficulties:

• Trouble identifying target memories
• Difficulty with cognition rating scales
• Problems with positive cognition development
• Limited insight and reflection ability

Solutions:

• Simplify language and concepts
• Use concrete, tangible approaches
• Extend preparation and practice phases
• Incorporate more somatic techniques
• Adjust expectations and goals

Resistance and Defense Mechanisms

Psychological defenses can interfere with trauma processing.

Common Resistances:

• Intellectualization and rationalization
• Minimization or denial
• Projection or displacement
• Avoidance and withdrawal
• Somatic conversion

Impact on EMDR:

• Limited emotional access during processing
• Incomplete memory processing
• Therapeutic alliance challenges
• Slow or stalled progress

Solutions:

• Address resistance directly and compassionately
• Explore underlying fears and concerns
• Build stronger therapeutic alliance
• Use resistance as therapeutic material
• Consider pacing or approach adjustments

Overcoming Barriers: Strategies for Success

Comprehensive Assessment and Planning

Thorough preparation prevents many common barriers.

Essential Assessment Components:

• Complete trauma history and timeline
• Current symptom assessment and severity
• Resource and support system evaluation
• Medical and medication review
• Treatment readiness and motivation assessment

Planning Strategies:

• Develop comprehensive treatment plans
• Establish clear, collaborative goals
• Plan for potential barriers and solutions
• Create phased approaches for complex cases
• Schedule regular reevaluation points

Building Strong Foundations

Investing time in preparation prevents later problems.

Key Preparation Elements:

• Extensive resource development
• Strong grounding and regulation skills
• Clear understanding of EMDR process
• Established safety and containment skills
• Developed affect tolerance capacity

Foundation Building:

• Don't rush preparation phase
• Practice skills extensively between sessions
• Create multiple resource states
• Establish clear boundaries and expectations
• Develop coping strategies for difficult times

Adaptability and Flexibility

Tailoring approach to individual needs enhances effectiveness.

Flexible Adaptation Areas:

• Bilateral stimulation methods and speed
• Session length and frequency
• Protocol modifications for special needs
• Integration of complementary approaches
• Adjusting pace based on client response

Adaptation Strategies:

• Regularly assess what's working and what isn't
• Be willing to modify approach as needed
• Consult with colleagues and supervisors
• Stay current with EMDR developments
• Prioritize client needs over rigid protocols

Ongoing Monitoring and Adjustment

Continuous assessment prevents problems from developing.

Monitoring Areas:

• Progress toward treatment goals
• Symptom changes between sessions
• Client satisfaction and engagement
• Therapeutic alliance quality
• Side effects or difficulties

Adjustment Strategies:

• Regular treatment plan reviews
• Honest feedback solicitation
• Willingness to try new approaches
• Early problem identification and intervention
• Collaboration with other providers as needed

When EMDR Isn't the Right Approach

Alternative Indications

Sometimes other approaches may be more suitable.

Consider Alternatives When:

• Client strongly prefers other approaches
• EMDR contraindications are present
• Previous EMDR attempts have failed
• Complex trauma requiring different approach
• Specific symptoms respond better to other treatments

Alternative Approaches:

• Somatic Experiencing
• Sensorimotor Psychotherapy
• Internal Family Systems
• Trauma-Focused CBT
• Psychodynamic psychotherapy

Combining Approaches

Integration can often enhance effectiveness.

Complementary Approaches:

• Skills training (DBT, emotion regulation)
• Body-based therapies (somatic experiencing, yoga)
• Family or couples therapy
• Medication management
• Support groups and community resources

Integration Strategies:

• Coordinate care between providers
• Time different approaches appropriately
• Ensure approaches complement rather than conflict
• Monitor for overloading or overwhelm
• Maintain clear treatment goals

Conclusion

EMDR therapy is a powerful and effective approach for healing trauma, but various factors can interfere with its success. Understanding these barriers—from client readiness and therapist skill to systemic issues and biological factors—helps both clients and therapists anticipate and address challenges proactively.

The key to overcoming EMDR barriers lies in:

• Thorough Preparation: Building strong foundations before processing
• Individualized Approach: Adapting protocols to specific needs and circumstances
• Ongoing Assessment: Continuously monitoring progress and adjusting approach
• Collaborative Partnership: Working together to identify and solve problems
• Flexibility and Persistence: Being willing to modify approach while maintaining commitment

When barriers arise, they don't necessarily mean EMDR "doesn't work" for a particular person. Often, they indicate the need for modified approaches, additional preparation, or integration with other therapeutic methods.

By understanding potential barriers and addressing them early and systematically, most clients can successfully use EMDR to process traumatic memories and achieve lasting healing. The journey may require patience, adaptation, and sometimes creative problem-solving, but the transformative potential of EMDR therapy remains worth pursuing.

Healing is rarely a straight path, but understanding and addressing barriers can help you navigate the journey toward recovery with greater success and confidence.