EMDR Therapy: How It Works and What to Expect

EMDR therapy — eye movement desensitization and reprocessing — is a structured psychotherapy for distressing memories, most often used with trauma and PTSD. It was developed by Francine Shapiro, PhD, in the late 1980s. A session pairs recall of a difficult memory with guided bilateral stimulation, such as side-to-side eye movements, and follows a set sequence of eight phases. It is one of several approaches a licensed mental health professional may offer; it is not a diagnosis, a test, or something you do on your own.

What EMDR is and where it came from

EMDR is a therapy model, not a single technique. Shapiro developed it in the late 1980s, and it is now delivered in eight phases. The name describes the core idea: a person brings a distressing memory to mind while doing something that creates alternating left-right stimulation — most often following the therapist’s fingers with the eyes, though tapping or sounds are also used.

The therapy is mainly associated with trauma and PTSD. That does not mean it is only for those experiences; a therapist may use it for other distressing memories. What it is not: a form of hypnosis, a medical procedure, or a way to erase a memory. People often describe the aim as taking the charge out of a memory so it can be remembered without the same intensity.

The eight phases, in plain words

EMDR is delivered in eight phases. The exact pacing varies by person and therapist, but the sequence is part of the model.

1. History and planning. The therapist learns about your background, what brings you in, and what you want to work on. Together you identify targets — memories or experiences that will be addressed.
2. Preparation. The therapist explains the process and teaches ways to manage distress, such as calming or grounding skills, so you have tools if a session feels intense.
3. Assessment. For a chosen target, you identify the memory, a negative belief about yourself connected to it, a preferred positive belief, and the emotions and body sensations that come up. You may rate how disturbing the memory feels and how true the positive belief feels.
4. Desensitization. While you hold the memory in mind, the therapist adds bilateral stimulation. You notice what comes up — thoughts, images, feelings, body sensations — and report briefly between sets. This phase continues until the disturbance rating comes down.
5. Installation. The focus shifts to strengthening the positive belief you identified, pairing it with bilateral stimulation.
6. Body scan. You bring the memory and positive belief to mind and scan your body for any remaining tension or discomfort, working on what remains.
7. Closure. Each session ends with a return to calm, using the skills from preparation, so you leave in a settled state rather than in the middle of a difficult memory.
8. Reevaluation. At the start of the next session, the therapist checks how the work has held and decides what to do next.

What bilateral stimulation means

Bilateral stimulation is stimulation that alternates between left and right. In EMDR it is most often side-to-side eye movements guided by the therapist, but it can also be alternating taps (for example, on the knees or hands) or alternating sounds. The person recalls a distressing memory while the stimulation is happening. The therapist guides the pace and checks in between short sets.

What a session involves

Therapy sessions in general are typically held once every 1-2 weeks for about 30 to 50 minutes, but EMDR sessions are often longer than that; ask the therapist how long sessions will be. Frequency is something you and the therapist decide together. Early sessions are mostly history-taking and preparation. Later sessions focus on a specific target memory.

In a processing session, the therapist may ask you to bring up the memory, notice where you feel it in your body, and then follow the stimulation for a short set. Between sets, you give a brief report — what came up, how disturbing it feels now — and then continue. The therapist keeps the session structured and closes it out with a calming step.

You are awake and in control throughout. You can ask to pause or stop. A good therapist will explain what will happen before it happens and check that you are willing to continue.

Who offers EMDR and what training to ask about

EMDR can be offered by licensed mental health professionals — psychologists, clinical social workers, counselors, marriage and family therapists, psychiatric nurses and psychiatrists. Licensure is set by the state, and titles and requirements differ by state. A license tells you the person is accountable to a state board; it does not by itself tell you how much EMDR training they have.

EMDR training is a separate course of study from the license, usually with a training organization and a consultation component. Ask directly:

• Which state license do you hold, and is it current?
• What EMDR training have you completed, and when?
• Do you use the full eight-phase model, and how do you decide when a person is ready for processing?
• How do you handle a session that becomes overwhelming?
• What is your experience working with the kind of memory or experience I want to address?
• What are your fees, and do you take my insurance?

For a broader map of how EMDR sits alongside other approaches, see types of therapy explained. If trauma is the main concern, trauma and PTSD therapy walks through the main options.

How guidelines describe EMDR for PTSD

The American Psychological Association’s PTSD guideline for adults strongly recommends CBT, cognitive processing therapy, cognitive therapy and prolonged exposure, and conditionally recommends brief eclectic psychotherapy, EMDR and narrative exposure therapy. A conditional recommendation is a weaker recommendation than a strong one.

The VA’s National Center for PTSD names cognitive processing therapy, EMDR and prolonged exposure as the talk therapies that work best for PTSD. These are descriptions of the evidence base, not a promise about what will happen for any one person. EMDR is one option among several; the choice is made with a licensed professional who can explain the alternatives.

EMDR compared with other trauma-focused approaches

CBT is described in more detail on the page about cognitive behavioral therapy. The approaches differ in what they ask of you between sessions and in how the therapist structures the work. None is universally the right choice.

What goes wrong, and common misconceptions

Expecting it to be passive. EMDR is not something done to you while you relax. You are actively recalling material and reporting what comes up. The preparation phase exists because the work can be intense.

Skipping preparation. A therapist who jumps straight into processing a difficult memory without teaching calming skills or explaining the phases is skipping a step the model includes. You can ask why.

Assuming any therapist who lists EMDR is fully trained. Training varies. Ask about the specific training and consultation, not just whether the therapist “does EMDR.”

Thinking it erases memories. The aim is to reduce how disturbing a memory feels, not to remove it. Memories remain; the charge is what the work targets.

Believing it is only for PTSD. It is mainly used for trauma and PTSD, but a therapist may apply it to other distressing memories. That is a clinical judgment, not a diagnosis you make yourself.

Not discussing confidentiality. Ask what is kept private and what the limits are. Mental health professionals are mandated reporters of child abuse and neglect in many states, and rules vary by state. Psychologists must discuss confidentiality at the outset.

Staying with a poor fit. Rapport and trust matter. If therapy has gone on for what feels like a reasonable time without improvement, talk with the therapist; it may make sense to explore other professionals or approaches.

If you are in crisis or having thoughts of suicide, in the US call or text 988 (the 988 Suicide & Crisis Lifeline), or call 911 in an emergency.

Before you call

EMDR is a structured therapy with a defined sequence, mainly used for trauma and PTSD, delivered by licensed professionals with additional training. It is one of several approaches, and the American Psychological Association’s guideline and the VA describe it as an option for PTSD. Ask about license, training, the eight phases, and how the therapist handles intense sessions. The choice of approach belongs with a licensed professional who can explain the alternatives and answer your questions.