Not the theory. The hour itself: where you sit, what you are asked, how much you have to say out loud, and how it ends.
Most people who are considering EMDR are not stuck on whether it works. They are stuck on a more specific worry: that they will have to sit in a room and describe the worst thing that ever happened to them, out loud, in order.
That is not what the reprocessing part of EMDR asks you to do. It is the single most useful thing to know before you start, and it is rarely the first thing anyone tells you.
If you are still working out what EMDR therapy is and what the evidence says, How Do You Heal From Something You Can't Talk About? covers that ground. This is about the hour.
EMDR is structured in eight phases, and the first two happen before any memory work begins. Phase one is history and planning: your therapist learns what happened, what sets you off now, and what you want to be different, and the two of you pick targets. Phase two is preparation. Your therapist explains the process and answers your questions, and you learn and practice specific ways to bring your own distress down, which EMDRIA describes as building internal resources.
This usually takes more than one appointment, and that is not the session being wasted. Phase two exists because the skills get used later. When reprocessing stirs something up between appointments, what you learned in preparation is what you use. A therapist who moves to the memory before those are in place is skipping the part that makes the rest tolerable.
It is fair to ask at the start roughly how long preparation tends to take and what would tell you both that you are ready. The answer varies by person and by clinician, and the question is a normal one.
Phase three sets up the target. Your therapist asks you to bring the memory to mind and to pick out a few things: the image that stands for the worst of it, the belief about yourself that comes with it, the feeling, and where you notice it in your body. Then two numbers. How disturbing it feels right now from 0 to 10, which EMDR calls Subjective Units of Distress. And how true a preferred belief feels from 1 to 7, the Validity of Cognition rating.
Notice what that is and is not. It is a handful of specific questions, and the American Psychological Association notes this step can take as little as 30 seconds. It is not a narrative. You are identifying the pieces, not telling the story.
Then phase four, desensitization, which is the part people picture. You hold the target in mind while your therapist delivers bilateral stimulation, usually eye movements following their hand or a light bar, sometimes alternating taps or tones. EMDRIA calls it dual attention: part of your attention is on the memory, part is on the present moment and the task in front of you.
It happens in short sets. After each one your therapist stops and asks some version of what you notice now, and you say what came up. Often that is a sentence. Sometimes it is a few words, or an image, or that your shoulders dropped. Then another set. Whatever surfaces is allowed to surface, including things you did not expect and things that seem unrelated, and the instruction is close to just let it happen. Over the sets the distress rating usually comes down, and you are asked for it again as you go.
So the talking in an EMDR session is mostly about what is happening right now, in short pieces, rather than a retelling of what happened then. People who have avoided trauma therapy because they could not face narrating it tend to find this is the specific relief.
Emotion during the sets is ordinary and expected. Things move: people cry, get angry, feel suddenly very tired, notice shaking or heat or a lump in the throat. Your therapist is not surprised by any of it and does not need you to manage it for them.
Some sessions are flat instead, and people often read that as failure. It is not necessarily anything. What matters over time is the rating and the symptoms, which is what phase eight is for: every later session opens by checking back on what you already processed, to see whether the distress has stayed down. If it has, you move to the next target. If it has not, you stay with it.
This is the other thing worth knowing in advance. Phase seven is closure, and it happens whether or not the memory finished processing. Your therapist deliberately brings you back to the present and settles you before you leave, using the skills from preparation, and checks that you are ready to walk out into your day.
In other words, the session is not designed to end wherever the clock lands. If a target is only half done, you are brought out of it on purpose and it gets picked up next time. EMDRIA treats a target as complete when distress is at zero, the preferred belief rates a full seven, and a body scan comes up clear, which is phase six: you hold the memory and the new belief and check yourself from head to toe for anything still humming.
Between sessions, things can keep moving. New thoughts, dreams, memories surfacing at odd hours. Worth asking your therapist what they want you to do with that, because most have a specific answer.
No, and the structure is honest about it. The reason preparation is a phase rather than a formality is that readiness differs, and the decision to begin reprocessing is made with your clinician rather than by a rule. If you are in crisis now, or there is more going on than one memory, the sequencing changes and preparation gets longer. None of that is a verdict on whether EMDR could help you eventually. It is about the order.
On whether it works: the 2023 clinical practice guideline from the US Departments of Veterans Affairs and Defense recommends EMDR for post-traumatic stress disorder alongside cognitive processing therapy and prolonged exposure, and recommends psychotherapy over medication for PTSD on the grounds of larger and longer-lasting improvement. Those are guideline recommendations about groups of people, not a prediction about you, and a good clinician will not offer you one.
If the reason you have not tried trauma therapy is the talking, it is worth knowing that the most intensive part of EMDR asks for the least of it.
The Healing Effect works with clients across Arizona, in person and by telehealth for clients located in the state. You can ask us about EMDR through our contact form, including whether it is likely to suit what you are bringing. There is more on our EMDR page and on our trauma and PTSD page.
And if you want one question to ask on a first call, this is a good one: what does preparation look like with you, and how will we know when we are ready to start. The answer tells you a lot.
If the calm on the outside is costing you a lot on the inside, our care team can help you find a therapist who fits, at your pace.
Reach OutAfter the history and preparation phases, a reprocessing session starts by setting up a target: an image, the belief that goes with it, the feeling, where you notice it in your body, and two ratings. Then you hold the target in mind while your therapist delivers bilateral stimulation in short sets, stopping after each one to ask what you notice. The session ends with closure, where you are deliberately brought back to the present.
Not in the way most people fear. The setup asks for specific elements rather than a narrative, and the American Psychological Association notes that step can take as little as 30 seconds. During the sets, what you say is mostly about what you are noticing right now, often in a sentence or a few words. For people who have avoided trauma therapy because they could not face retelling it, this is usually the relevant difference.
You might, and it is ordinary. Emotion during the sets is expected: crying, anger, tiredness, shaking, physical sensations. Some sessions are flat instead, which is also normal and does not mean it is not working. Your therapist is not startled by any of it.
There is no simple list, and the decision is made with your clinician rather than by a rule. The preparation phase exists because readiness varies. If you are currently in crisis, or there is more going on than a single memory, preparation usually takes longer and the order of work changes. That is about sequencing rather than a judgment that EMDR could never help.
That is anticipated. Closure is its own phase and happens whether or not reprocessing is complete. Your therapist settles you in the present before you leave, and the target is picked up at the next appointment. The following session also opens by rechecking what was already processed.
Neither the American Psychological Association nor EMDRIA publishes a fixed number, and it depends on what you are working on and how many targets there are. What is specified is how a target is judged complete: distress at zero, the preferred belief rated fully true, and a clear body scan.
The Healing Effect is not a crisis service. If you are in crisis or thinking about harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline, available 24 hours a day, 7 days a week.
Sources:
American Psychological Association. Exploring the 8 phases of EMDR (phase descriptions, the 0 to 10 Subjective Units of Distress scale, and the note that bringing the target memory to awareness can take as little as 30 seconds).
EMDR International Association (EMDRIA). 8 Phases of EMDR Therapy (dual-attention bilateral stimulation as eye movements, taps or other methods; Subjective Units of Distress and Validity of Cognition baselines; closure regardless of whether reprocessing is finished; completion defined as distress 0, validity of cognition 7 and a clear body scan).
US Department of Veterans Affairs and US Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. 2023 (EMDR recommended alongside cognitive processing therapy and prolonged exposure; psychotherapy recommended over medication). The recommendation list was read through the International Society for Traumatic Stress Studies summary of the guideline rather than in the full guideline document.
Tell us a little about what is going on and our care team will help you find a therapist who fits, at your pace.
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