“EMDR was really upsetting. My therapist would like me to try it again, but I am worried.”
EMDR is a great evidence-based treatment choice for PTSD, and a variety of other reasons individuals may seek therapy. This can be a life changing treatment, however for some, it can be fairly intense. One may experience anything from mood swings to unpleasant dreams while processing their traumatic memories. These effects of the treatment typically resolve after the first couple of sessions. After that, I find clients look forward to their EMDR sessions, processing previously undiscovered feelings and ideas about their trauma.
Recently, I came across a TikTok where a person was expressing concern about resuming EMDR with a new therapist, after experiencing some distressing side effects. Many people likely find themselves in this same position, without knowing what to do next. The therapist is the expert, right?
Share your concern.
Express your concerns to the new therapist. If after sharing these concerns and talking them through. If you don’t want to do EMDR again, don’t.
What is your motivation?
If you decide to move forward, why? If it is to please your therapist, or out of fear of “questioning” what plan is, it is likely the results won’t be desired. You are a partner in building your treatment plan. This may lead to a conversation where you gain a better understand of why your therapist feels EMDR is a good fit for you. Regardless, whatever your therapeutic goal is, there are likely multiple evidence-based treatments to bring you relief.
Empathetic and competent clinicians love questions such as “What other evidence-based treatments have been shown to be effective for this?”. Be a collaborator. I personally provide 3 different evidence-based treatments for the diagnosis of PTSD. My client’s and I work together to choose the best treatment for them. Sometimes we use a variety of approaches to fit different presenting problems.
Some individuals want to have EMDR treatment again, because they recognize that they maybe did not have the right conditions in place the first time around. They are fearful or anxious, however, they hope to overcome this for the chance to heal. If this is you, below are considerations that can make the second time a more healing experience.
The relationship with your therapist is as important as the treatment.
EMDR is an 8-step process. The beginning stages include making sure we get a thorough history. We also educate you on the EMDR process. While these things are happening, rapport should be being built as well. All quality trauma work should begin with establishing a trusting and healthy therapeutic relationship between therapist and client.
Think about the last time you received EMDR treatment. Did you feel fully comfortable with your therapist? How about now? If you have a better relationship with your therapist now, that could make all the difference. If you don’t feel entirely comfortable, it may be time to slow down and work on your relationship with your therapist.
Diagnosis and Disassociation
There are some diagnosis’ that can be challenging or not indicated for the use of EMDR. Ask your therapist what they have diagnosed you with (yes, you can do that!). Then, inquire about the use of EMDR with that diagnosis. Also, be sure your therapist has given you the DES assessment. This checks for levels of disassociation. For those with severe disassociation, it is highly recommended EMDR is only to be done by a specialist in this type of EMDR.
Techniques
Although EMDR follows a “protocol” there is some flexibility. For example, in the “safe comfort place” and “Container” are exercises in EMDR that help make the treatment more comfortable. Feel free to ask if you can spend more sessions on these techniques, to build your resilience.
Delivery
The majority of search on the efficacy of EMDR is with the use of bilateral eye movement. For this reason, many therapists use this as a default. This may be administered with hand movements or an electronic light bar.
That being said, there are other methods for bilaterally stimulation of the brain. One might choose these other methods because the research says it gives better results for the presenting problem. An example for this is using audio stimulation when treating chronic pain with EMDR.
Another reason to choose a method other than eye movement, is a physical limitation. For some, an injury or another factor may require using “hand tappers” or audio. Another method of delivering EMDR can be self-tapping. This is using your hands to bilaterally stimulate yourself on your head, neck or legs.
Target memory
A target memory is the memory, event or feeling you are treating at a given time. Generally, we target the earliest memories first. We process the same target each session until you no longer feel distressed by it. Then, if there is another trauma, you will move to the next one until we have addressed them all.
When determining our target, we employ a “float back technique”. This means going to the earliest memory relevant to your presenting concerns. It may even appear to be unrelated. Discussing with your therapist what target to begin with is key. Beginning with a less distressing memory or issue can build resilience and help you acclimate to EMDR treatment.
Environment & After Care
If doing EMDR in the office, does your therapists office feel safe? Do you typically feel uncomfortably cold? Are there distracting noises outside the window? Tell your therapist. It will be hard allowing the process to occur naturally if you are physically uncomfortable or feeling unsafe.
If you are doing EMDR from home, there are some great tools to receive the same quality of treatment. In my practice, we use Remotemdr.com. Check if your laptop is in a comfortable position. I recommend having water handy, tissues and a trash can. A laptop screen is a must, as you won’t receive the same results on your cell phone. If you have headphones that can provide options, block out outside noise, and allow you to use audio bilateral stimulation. You may want to dim the lights as well.
After your first few sessions, be sure to leave room in your schedule to rest if needed. Avoid planning commitments for immediately after the session. Enlist social supports to be available in case you need to reach out.
Alternatives
As we discussed in the beginning, there are other options for treatment. For PTSD, looking into CPT, Prolonged exposure therapy, Accelerated Resolution Therapy, Narrative Exposure therapy or Trauma focused CBT could be great options. For more information this is a great place to start Treatments for PTSD (apa.org).
Mikah Watford, LPC, LCDC
Advanced Clinical Trauma Specialist
Founder and Clinical Director of MW Psychotherapy
