What to Expect in the First Few Sessions of EMDR Therapy
"Can I expect to process my memories in my first meeting with an EMDR therapist?"
"I hear EMDR Therapy is fast. Can I expect to work through my difficult memory in a couple of sessions?"
The short answer to both of these questions is, no. You should not expect to begin processing your troubling memories in your first meeting with an EMDR therapist. Each person will need a different number of sessions to prepare to process troubling memories. People with one troubling memory, or just a few of them, will be able to begin to process these memories after just a few sessions. People who have experienced extensive trauma tend to need more sessions to prepare.
EMDR Therapy is a protocol-based therapy that uses an eight phase approach, and the first two phases, create an infrastructure to be able to do the processing. Before coming to meet with me many clients have a read or heard a little about EMDR Therapy, but often people are only familiar with the processing aspect of EMDR, which is Phase 4. In fact, over the first few sessions, (could be three to five sessions, could be longer) during Phase 1 and 2 you will go through a process known as preparation and history-taking.
(In Phases 3 through 8
, we will choose a troubling memory/incident/situation that happened in the past and 'digest' or 'metabolize' whatever images, emotions, body sensations and troubling thoughts that still linger in the aftermath. Ultimately, the memory will feel neutralized - you will remember there was a troubling incident and some of the story associated with it, but the formerly troubling aspects will no longer bother you.) To read more, go to What to Expect in an EMDR Processing Session.
EMDR Therapy is most effective when a client feels a connection with the therapist - a sense that the therapist:
- has the client's best interest in mind (that sense of 'I've got you').
- will help the client to feel safe.
- will help the client to feel grounded and present
A big part of Phase 1 and 2 is establishing this relationship between the therapist and client. A client looks for symbols.
- Does my therapist seem to be listening?
- Does my therapist seem to understand and show empathy and caring?
- Does my therapist notice when emotion feels uncomfortable to me?
- Can my therapist tolerate strong emotion without trying to calm me down? When I want to calm down, can my therapist help me do that?
- Is my therapist curious?
- Is my therapist helping me feel safe? Do I feel safe here?
While going through the steps of Phase 1 and 2, an in-tune EMDR therapist will be very mindful of therapeutic relationship development. The in-tune therapist will notice moments of emotion, show compassion and empathy, let you know that it's okay to feel emotion - even strong emotion, and will reassure you that EMDR Therapy can help reduce the intensity of intrusive emotion.
Containment: helping you with strategies to be able to tuck away intrusive material
At this point in therapy, the therapist will also be assessing your capacity for containment which means helping you with strategies to be able to tuck away intrusive material if it's not the time and place to experience it. When we discuss a difficult or anxiety-provoking situation, the body can get activated with strong emotion and body sensation. The idea of containment is that we balance being able to mindfully notice and acknowledge the emotion/body sensation and to notice the point when it's okay to tuck it back away for now, to process at another time.
- In the therapy room is a good time to notice and experience emotion. It is the time and place. The therapist is here to help me manage big feelings and process the situations related to them.
- During a job interview or in the middle of a fitness class is not the time and place. Being able to tuck those sensations away until later, or my next therapy session, is known as containment.
Helping you develop positive resources and self-care strategies to use between sessions
In Phase 1 and 2, you will also develop positive resources. You will do an exercise to create a safe or calm place. I am influenced by EMDR clinician and writer Laurel Parnell's approach, so my clients tend to have imagery of a support team of figures who provide care, support, protection and wisdom. These resources are inherently helpful, but the process to developing them helps to prepare you for the processing work ahead.
As part of the process your therapist is assessing your readiness to do the processing work. As well, your therapist will hear about your day to day life outside of the therapy room, and discuss self-care, the strategies you use to manage stress and challenge in your life. The therapy can be difficult - ensuring you have strategies to look after yourself between sessions is important before beginning the processing work.
The process of History-Taking
If you have had other therapy, the actual history-taking approach will feel different with your EMDR therapist than it did with talk therapy. Our intention as EMDR therapists is different than in talk therapy. We EMDR therapists are looking for incidents from the past that were upsetting at the time and still feel upsetting. We are also looking for situations that evoke anxiety. We use a systematic process to identify what we call targets, and as you describe those incidents/situations we will ask you to notice the emotion/discomfort you feel in your body and evaluate its intensity on a 0 to 10 scale. This will help us to conceptualize and organize how we work with your history to reduce your stress and anxiety.
What we find is that the history-taking process is itself therapeutic. Not only is the therapist hearing the stories, honouring them and validating your emotional response, but also in allowing the story to be experienced in your body, even for only a few seconds, the body gets activated and allows some of the discomfort to be processed. Almost always the targets are less bothersome already by the time we get to the processing phase of EMDR therapy. In addition, the therapist is assessing and teaching containment: you mention the difficult story, notice the emotion, then tuck it away again, containing it.
Once we have created this infrastructure - developed a connection between therapist and client, discussed self-care, built trust, done a thorough history-taking process to identify the issues to process - then we will begin the processing.
For information about what happens when we are processing a target go to What to expect in an EMDR Processing Session