Understanding EMDR: What It Is and What to Expect
EMDR is a trauma-focused therapy that’s gained significant recognition over the past few years. If you’ve been recommended EMDR, or are interested in learning more about what it involves, then this post is for you.
This guide was primarily written for my clients, but it can be used by anyone to gain a general understanding of EMDR and what it involves.
What it is
EMDR stands for Eye Movement Desensitisation and Reprocessing. Desensitisation means that it decreases the intensity of an emotionally intense memory or image, and Reprocessing means we’re bringing in new meaning and attaching that memory or image to more helpful internal beliefs. It's an evidence-based therapy that was developed by psychologist Francine Shapiro in the late 1980s, after she noticed that when she moved her eyes back and forth while thinking about something distressing, her distress reduced. EMDR has since become a well-researched treatment for trauma and PTSD, now recommended by the World Health Organisation. EMDR can also be used for anxiety, depression, and other mental health conditions, though this research is significantly newer.
Our brains are built to heal
EMDR draws from the idea that our brains are built to heal. When we get a papercut, our bodies naturally know what to do, and over time the cut heals. We don’t really have to think about, or do, anything. Sometimes, we might be left with a scar, but the cut no longer hurts like it once did.
Our brains work in a similar way. After a difficult experience, our brains are designed to process what has happened so that we can move forward. Most of the time, this happens naturally, generally while we’re sleeping. Sometimes an experience is so overwhelming, or happens at a time when we don't have the resources to process it, that it gets stuck. Rather than being properly stored in our memory networks, it stays raw and present, as if a part of us is still living inside that moment. Whenever we experience a reminder of that memory, some of the feelings or beliefs associated with that time can still come up. We may know, logically, that we’re safe, but not feel it emotionally.
EMDR works by activating our brain's natural processing system, helping experiences or memories that have been stuck in our brain move through and link to more adaptive memory networks.
How it works
Researchers have developed several theories to explain why EMDR is effective. Two that I find make the most intuitive sense are:
The working memory theory
When you recall a distressing memory while simultaneously doing something that engages your attention, such as following something with your eyes or focusing on a rhythmic tapping, your brain has less capacity to hold the memory at its fullest intensity, allowing it to process in the background without experiencing heightened distress. Over time and with repeated processing, the memory becomes less vivid, less emotionally charged, and less intrusive.
The REM sleep theory
During REM (rapid eye movement) sleep, your eyes move rapidly while your brain processes the experiences of the day, sorting and integrating them into long-term memory networks. EMDR is thought to activate a similar process while you are awake. The bilateral stimulation (using both hemispheres of the brain alternately) may mimic this natural processing, supporting your brain to process memories, like it would during sleep.
These are two of several theories, and the full picture of why EMDR works is still being explored. What the research consistently shows, across many different explanations, is that it does help many people integrate difficult memories into more helpful networks.
What it isn't
It isn't hypnosis. You are fully awake and aware throughout EMDR processing, and nothing happens without your knowledge.
It isn't about reliving everything in detail. You don't need to narrate your experiences in full. You can share as much or as little as feels right.
It isn't something you can do wrong. There is no right way to experience EMDR.
What we'll do together
Before any processing begins
Before we move into active processing, I'll take time to make sure you feel settled and prepared. This phase focuses on building a shared toolkit of grounding and self-regulation strategies, things that you can use during and between sessions to support yourself. This stage is genuinely important to not rush through, as it sets a lot of the groundwork to work through the processing and feel able to cope.
We also want to develop clear goals and “target memories” that we would like to work on together, so that when we get to a processing session, we can jump straight into it.
What bilateral stimulation actually looks like
During processing, you'll hold a memory or experience in your mind while engaging in bilateral stimulation (activating both sides of the brain alternately). In a session, this might look like:
Following my hand movements with your eyes. For this we may need to sit a little closer together than in a regular session, and I'll check in about what feels comfortable.
Self-tapping, alternating tapping on your own hands, knees, or chest, guided by my rhythm.
Pulsators, small handheld devices that pulse alternately in each hand.
Something else entirely. We may get creative depending on what works best for you.
During processing
You might notice memories, images, emotions, or physical sensations shift and move during processing. This is a normal part of EMDR. I'll check in with you regularly, and you are always in control of what you share.
At the end of each session
We'll always take time to reflect on what came up, return to your grounding strategies, and plan together for what comes next. Making sure each session closes safely, and you’re not stuck in the memory, is a priority, even if we didn’t finish processing that experience in one session.
At the start of the next session
After any processing session, I'll check in at the start of your next appointment about how you've been. It's common for processing to continue between sessions, with memories, dreams, or emotions coming up in the days after. If this happens, we can talk about it before we continue.
A note for neurodivergent clients
I work with a lot of neurodivergent clients, and EMDR often needs to look a little different for them. A few things worth knowing:
Sensory sensitivities
Eye movements, tapping, and pulsators are all options, and we'll find what feels comfortable rather than distracting or overwhelming. If something isn't working, we'll try something else.
Building a shared language for emotions and interoception
Many neurodivergent people experience alexithymia or interoceptive differences, which means identifying or putting words to emotions and physical sensations can be genuinely difficult, not just uncomfortable. EMDR doesn't require you to articulate exactly what you're feeling. As part of our preparation work, I'll help you develop a shared language for what's happening internally, so that you have a way to communicate during processing that works for your brain. This might be colours, numbers, images, or simply noticing that something has shifted.
PDA and check ins
Some people have a persistent drive for autonomy (sometimes called PDA), meaning that even well-intentioned requests can feel like demands that trigger resistance or distress. During processing, I'll be checking in and asking you to notice or report what's happening. If this feels like pressure, please let me know. We can adjust how check-ins work, whether that's changing the wording, using a signal instead of words, or simply leaving more space. There's no expectation of how you should respond.
Aphantasia
Some people experience aphantasia, meaning they don’t have any mental imagery or visualisation when remembering a situation. EMDR often refers to “visualising” a memory or bringing a “picture” to mind, which isn’t possible for people who experience aphantasia. However, EMDR can still work for clients who can’t use this visualisation, and the same effects can be achieved just from a thought, a sound, a sensation, or just knowing about a situation. We’ll find the best way to bring up these memories that works for you, you don’t have to be able to picture it.
Common questions
Will I feel worse before I feel better? Processing can sometimes bring up emotions or sensations between sessions as your brain continues to work. I'll make sure you have strategies to support yourself, and I'll always check in about how you've been tracking between appointments.
How many sessions will I need? This varies significantly depending on the individual and the complexity of what's being processed. We'll talk about this as our work together progresses. There's no fixed timeline.
What if I find it too much? You are always in control of the pace. If something feels too overwhelming, we slow down, return to grounding, or shift focus entirely. Nothing will be pushed.
Do I have to do eye movements? No. Tapping or pulsators are equally effective alternatives, and we'll find what works best for you.
Do I have to talk about everything in detail? No. You can share as much or as little as feels right. EMDR doesn't require you to narrate your full history.
Can you do EMDR online? Definitely. There are small adjustments that can be made to make EMDR work online (like using online programs, or focusing on self-tapping), and it can be just as effective as in-person therapy.
I hope this has been helpful in understanding EMDR a little bit more. If anything here raises anything for you, please reach out. There are no silly questions.