EMDR therapy has an image problem, and the image is the eye movements.

The vast majority of people who have heard of it have heard one thing: Follow the therapist’s finger with your eyes as you think about something bad; then you feel better. As explained like that, it sounds like a party trick, so a lot of people that will benefit from it will never look further.

The eye movements are authentic. They are also the least interesting component.

The problem it was built for

The hard times pass. The charge on the memory, not the memory itself. You can remember the item, tell about it, and experience its somethings that are commensurate to how long ago it was and how important it is now. This occurs naturally, spontaneously and without any effort or treatment and this is the way the mind works.

Occasionally it doesn’t. An experience remains as it is experienced in its senses, in its physical response and in its sense of immediacy. Ten years later, the memory doesn’t seem to be real. It seems like an occurrence is taking place.

When people talk about unprocessed, they are referring to this. It’s not a metaphor about denial or avoidance. It’s a description of a memory that wasn’t filed properly, and is continuing on as though the event is happening right now.

The effects are seldom spectacular. Much more often they manifest as a startle response that never abates, a year after year of bad sleep, as a reaction to a smell or as a reaction to a tone of voice that has no meaning at the time, or as an avoidance that feels like personality these days.

What happens in a session

Fewer than they would think and much less talking.

The therapist requests that you call up the memory and the belief that has become attached to it. It’s typically a version of I’m not safe or it was my fault or I can’t help it and is usually the first time the person says it out loud as it doesn’t feel like a belief. It is like a fact.

Then there is the bilateral stimulation: eye movements or alternating taps or sounds to each ear. This is carried out in short sets while you are thinking on the material. The therapist will ask, “What did you get when you did your sets?,” and whatever was obtained is what will be the subject of the next set.

The drift, as people talk about it, is that one.That’s a kind of drift, as people talk about it. Associations arrive unbidden. Memories come up that are related to the original memory but are not directly tied to the original event. The content is transferred instead of being studied.

It is not necessary to tell in detail what happened. This should be clear, as this is the number one reason why people refuse treatment for trauma before starting it. The therapist must have sufficient knowledge to know what is being worked on. They don’t need the story.

The charge will tend to decrease during sessions. It doesn’t go away and it shouldn’t. That’s because when you remember it, it no longer produces the physical response, and the belief that goes with it begins to seem like it actually happened, not like it’s true.

Nobody is certain why it works

This is where actual truth and marketing fiction are distinct.

There is significant evidence to support the use of EMDR with P.T.S. and it is included in the treatment guidelines of health care providers all over the world. Reasons for are not as clear.

One of the most favored theories is that bilateral stimulation uses working memory, which means that the traumatic image is stored in a weaker form, and it is reconsolidated in that weakened state. Or that it’s like processing that occurs during REM sleep. Or that the therapeutic conditions (structured attention, safe context, repeated brief exposures) would work without regard to what the eyes are doing.

There have been some debates on this, and they’re not always amicable. The chonest answer is that a treatment might be effective but the mechanism you are debating could turn out to be incorrect, as in many aspects of medicine.

As a patient it is important to know that it is not a matter of what should happen, it is a matter of how it happens.

What it isn’t

It is not hypnosis. You’ll be awake, aware and in control all the way. You may pause at any time and stopping is as much a part of the protocol as advancing.

This is NOT one session. The preparation phase — creating stability, ensuring that there are options available for what you surface — is before any processing work and is not an efficient way to do things. If the therapist is looking to start processing in the first session, they’re doing it wrong.

It’s not reserved for war veterans or catastrophic situations. Much of its use is smaller, older: a humiliation of childhood, a procedure of medicine, a time of unease, no one else noticed. The likelihood of processing is not well predicted by the severity of an event.

It isn’t suitable for everyone at this time. If it is an acute crisis or an ongoing unsafe situation, or there isn’t enough stability to withstand what arises, the right answer is not yet. A health care professional who informs you that is their job, not their way of excluding you.

If you are considering it

There are two questions that you can ask a potential therapist and both are completely valid.

What kind of training do they undergo? There is a need for specific accredited training in EMDR, in addition to a general psychology qualification. Ask directly. The question will be asked frequently enough that it will not be rude and everyone who is properly trained will answer without hesitation.

How do they prepare themselves? The answer should include stabilisation prior to processing, and the clear impression that you are pacing, not the schedule.

Most people would agree the bottom line is relatively clear cut: for duration, EMDR therapy generally takes less time than a freely exploratory talking treatment for a particular unprocessed memory; and for verbal demands it is generally less than people might expect. If your difficulty is a trait rather than a single event for example something you developed early in life that you recognise in the way you behave with people then an alternative approach is often an appropriate first step, and a good clinician will tell you.

It is the eye movements that is the part that people remember. They are not the part that matters.

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