You may have heard that EMDR can help and still feel uneasy about trying it. What will you actually do? How much will you have to say? What happens if it brings up more than you expected? Those are useful questions to bring into therapy. Understanding the process helps us make decisions together about whether and how to begin.
Common questions about EMDR
I’m nervous about starting EMDR. Where do we begin?
I want to understand what makes you nervous. You might be worried about becoming overwhelmed, losing control, or having to describe something you’ve barely been able to think about. We can talk directly about those concerns instead of treating them as something to get past before the real work starts.
Preparation is part of EMDR. We spend time understanding your situation, discussing what the work involves, and developing ways to manage difficult feelings. This is built into the phases of EMDR treatment, which include history-taking and preparation before memory reprocessing. Taking that time helps us approach difficult material in a way you can manage.
What happens in the first EMDR session?
A first appointment and a first reprocessing session are different things. At the beginning of our work, I want to hear what brought you here, what is difficult now, and what you hope will change. We also consider what else is happening in your life and what support you have. That helps us decide whether EMDR fits and what preparation would be useful.
When we begin reprocessing, we agree on what to focus on. You bring that experience or reaction to mind while following eye movements or another form of alternating stimulation, such as tapping. We work in short sets and pause to notice what comes up. You may share a thought, feeling, image or physical sensation. Although you’re attending to the experience, you generally won’t need to describe it in detail.
There is no requirement to reach reprocessing by a particular appointment. The preparation and pace should reflect the person doing the work.
Can EMDR have side effects?
Focusing on painful experiences can bring up distress. That discomfort is a recognized risk of EMDR, and it’s something we prepare for and pay attention to throughout the work.
You may also notice thoughts, memories, feelings or dreams between sessions. Preparing for what may come up between appointments is part of bringing a session to a close. People’s experiences vary, and having a particular reaction—or not having it—doesn’t tell us by itself whether the treatment is helping.
Before we finish, we’ll talk about how you’re doing and how to handle what may come up afterward. If distress is persisting, increasing, or interfering with sleep or daily life, tell me. That gives us information we need to reconsider the pace, preparation or approach. You shouldn’t have to push through feeling worse because you think that’s what successful treatment requires.
Is EMDR overkill for my situation?
Comparing your experience with someone else’s may not help you decide what you need. I’m interested in how it affects you now: what brings the reaction back, what you find yourself believing about yourself, and what it gets in the way of.
That doesn’t mean every upsetting experience calls for EMDR. We can consider what you want help with, your readiness, and whether another approach would be more useful. EMDR is one of the recommended treatments for PTSD. The strength of the evidence varies for other concerns, so we also need to consider how well it fits the particular difficulty you want to address.
How is EMDR different from CBT?
Cognitive behavioral therapy, or CBT, is a broad family of approaches that examines how thoughts, feelings and behaviors relate to one another. Depending on the approach and the concern, the work may include examining interpretations, trying different responses, or gradually approaching situations someone has been avoiding.
EMDR takes a structured approach to processing distressing experiences. You attend to an experience and the reactions connected to it while following alternating stimulation, often eye movements. During reprocessing, we notice what emerges rather than spending the whole time discussing or deliberately challenging each thought.
The distinction isn’t simply past versus present, or feelings versus thoughts. Both can address how earlier experiences affect life now. In my practice, choosing an approach starts with what we’re trying to accomplish. Sometimes we use practical cognitive or behavioral work; sometimes EMDR is useful; sometimes the work includes both.
Considering EMDR with me
I offer online therapy in Massachusetts and Maine. My EMDR Therapy page explains how I use it within ongoing psychotherapy, as a standalone treatment, or alongside work with another primary therapist. If you’d like to discuss your situation, Getting Started explains how we can begin.