EMDR Therapy: What It Is, How It Works, and Who It Can Help

EMDR — Eye Movement Desensitisation and Reprocessing — is one of the most effective and most evidence-based therapies for trauma, and one that is still widely misunderstood. The name can make it sound more technical, or more unusual, than it is in practice. This article explains clearly what EMDR therapy is, how it works, what it is most commonly used to treat, and what the process of receiving it actually involves.

How EMDR Works

Understanding how EMDR works requires a brief account of how the brain stores and processes memory — and what happens to that process when an experience is traumatic. Under normal circumstances, the brain processes experiences during sleep, particularly during REM sleep, which is characterised by rapid eye movements. During this processing, experiences are integrated: the emotional intensity of the memory is reduced, and the memory is stored in a way that allows it to be recalled without re-experiencing the associated distress.

Traumatic experiences appear to disrupt this natural processing. The memory is stored in a raw, unprocessed state — with its original emotional intensity, sensory qualities, and associated beliefs intact. When something in the present triggers this stored memory, the person re-experiences the distress of the original event as though it were happening again. This is the mechanism behind flashbacks, intrusive thoughts, and the hypervigilance that characterises PTSD and other trauma responses.

The Role of Bilateral Stimulation

EMDR works by engaging the brain’s natural processing system while the distressing memory is held in mind. The method for doing this is bilateral stimulation — typically the use of guided eye movements, though tapping or audio tones are also used. The therapist guides the client to follow a moving stimulus with their eyes while simultaneously holding a specific distressing memory, thought, or feeling in attention. Research suggests that this bilateral stimulation mimics the processing that occurs during REM sleep, allowing the brain to resume the processing of the stored memory that was disrupted at the time of the original experience.

What Happens to the Memory

As EMDR processing proceeds, clients typically notice that the emotional intensity of the targeted memory reduces — sometimes significantly, sometimes gradually over multiple sessions. The memory remains, but it changes in quality: it becomes a memory of something that happened, rather than something that is happening again. The associated beliefs about the self that the traumatic experience produced — beliefs such as “I am not safe” or “I am to blame” — also change as the processing proceeds, and are replaced by more realistic and more adaptive beliefs. The goal is not to eliminate the memory but to allow it to be held in a way that does not continue to produce present-day distress.

What EMDR Is Used to Treat

EMDR was originally developed specifically for PTSD, and the evidence base for its use with PTSD is substantial and well-established. It is now widely used for a broader range of conditions in which difficult memories or adverse experiences play a significant role.

PTSD and Complex Trauma

Post-Traumatic Stress Disorder — whether arising from a single traumatic event or from a pattern of repeated adverse experiences — is the condition for which EMDR has the strongest evidence base. NICE guidance recommends EMDR (alongside trauma-focused CBT) as a first-line treatment for PTSD in adults, and the evidence for its effectiveness, including in complex PTSD arising from childhood trauma or prolonged adverse experiences, is extensive. EMDR is often preferred by clients with PTSD because it allows processing of traumatic material without requiring detailed verbal narration of the traumatic events.

Anxiety, Phobias, and Other Presentations

Beyond PTSD, EMDR is increasingly used for anxiety disorders, phobias, panic disorder, and the psychological effects of adverse childhood experiences that do not meet the criteria for PTSD but nevertheless produce significant ongoing distress. It is also used for depression when the depression has roots in specific adverse or traumatic experiences, and for a range of other presentations including grief, performance anxiety, and the psychological effects of medical procedures or illness. The common thread is the presence of specific memories or experiences that continue to affect present functioning — which is the mechanism that EMDR directly addresses.

What an EMDR Session Involves

People who are unfamiliar with EMDR sometimes imagine that it involves the therapist waving a finger in front of the client’s eyes for an hour. The reality is a structured, carefully paced therapeutic process that typically takes place over multiple sessions.

The Phases of EMDR

EMDR therapy follows a structured eight-phase protocol. The first phases involve establishing a strong working relationship between client and therapist, taking a thorough history of the client’s experiences and symptoms, and developing stabilisation resources — the internal tools the client will use to manage difficult feelings if processing produces significant distress. This preparation phase is not skipped, even with clients who are eager to proceed to processing: adequate preparation is one of the factors most associated with effective outcomes.

The processing phases involve identifying specific target memories for processing, establishing the associated negative beliefs, and beginning the bilateral stimulation sequences while the client holds the memory in attention. Sessions are paced by the client’s response: the therapist follows the client’s processing rather than directing it, and processing pauses when the client needs it to.

How Many Sessions Does EMDR Take

The number of sessions required for EMDR varies considerably depending on the nature and complexity of the trauma being processed. For a single-incident trauma in an adult with good psychological resources, significant progress is often made within a relatively small number of sessions. For complex trauma arising from childhood adverse experiences, or for presentations involving multiple traumatic events, the process tends to be longer. A trained EMDR therapist will be able to give a clearer estimate after the initial assessment. Hope Therapy offers both individual EMDR sessions and longer therapeutic programmes, depending on what best fits the person’s needs.

How EMDR Compares to Other Therapies

People considering EMDR frequently want to know how it compares to other therapies they may have experienced or heard about — particularly CBT and talking therapy more generally.

EMDR and CBT

EMDR and trauma-focused CBT are the two therapies most consistently recommended for PTSD, and both have strong evidence bases. They differ in their approach to traumatic material: trauma-focused CBT involves working directly and repeatedly with the trauma narrative, examining the thoughts and beliefs associated with the trauma, and restructuring the cognitive patterns that the trauma has produced. EMDR does not require the client to narrate the traumatic events in detail, which many clients find preferable — particularly for traumas that feel very difficult or shameful to put into words. Both approaches are effective; the choice between them often comes down to personal preference and the specific nature of the trauma being treated.

EMDR and General Counselling

General counselling and psychotherapy provide a valuable space for exploring experience, developing self-understanding, and addressing the effects of difficult life experiences. They work primarily through the therapeutic relationship and through verbal exploration of the client’s inner world. EMDR is a more targeted intervention that directly processes specific traumatic memories, and it typically produces faster change in trauma-related symptoms than general counselling alone. Many therapists integrate EMDR with other approaches, using EMDR for trauma processing alongside the broader relational work of counselling.

Is EMDR Right for You?

EMDR is not the right choice for everyone, and a good EMDR therapist will conduct a thorough assessment before beginning to determine whether it is appropriate. There are some situations in which EMDR is contraindicated or where additional preparation is needed before processing can safely begin — certain medical conditions, certain psychiatric presentations, and situations where the person does not yet have adequate psychological stability to manage the distress that processing may produce.

For most adults who have experienced trauma and are experiencing its ongoing psychological effects, EMDR is a well-evidenced and often highly effective option. The best starting point is a consultation with a trained EMDR therapist who can assess your specific situation, answer your questions, and help you determine whether EMDR is the right next step for you.

What to Ask at a First Consultation

If you are considering EMDR and attending a first consultation with a therapist, several questions are worth raising: What is the therapist’s training and experience in EMDR? What approach will they use to the preparation phase? How many sessions are they likely to recommend and why? What happens between sessions, and what support is available if processing produces difficult feelings outside the session? A good EMDR therapist will answer these questions clearly and will not proceed to processing until adequate preparation has been done.

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THE AUTHOR

Ian Stockbridge

• MBACP (Senior Accredited)

Founder & Clinical Director — Hope Therapy & Counselling Services

MBACP (Senior Accredited) · SNCPS (Acc) · BSc (Hons) CBT · PGCert Clinical Supervision

Founder of Hope Therapy, published author, clinical supervisor, and co-presenter of The Talk Room Podcast. Practising therapist with 25+ years of senior leadership experience.

Before Ian Stockbridge was a therapist, he was a leader. For more than 25 years he worked in senior management and directorial roles across commercial organisations — at times managing teams of more than 200 people. He was effective at it. But the longer he did it, the harder something became to ignore. The people around him were struggling. Capable, committed, often high-achieving people carrying invisible weight that had nowhere to go. Stress accumulated quietly across months and years. Anxiety managed behind professionalism. Relationships and mental health dealt with in the margins of a working life that left little room for either.

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