Should You Do EMDR Trauma Processing In The First Sessions?
Updated: Sep 29, 2019
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapeutic method - tool that is based on the principle of bilateral stimulation –originally right-left eye movements– and aims in processing traumatic and distressing memories.
In a previous blog post, the requirements before starting EMDR trauma processing were discussed. In this post, we will explore the reasons why EMDR trauma processing is not recommended to occur too soon in therapy, before the client is first stabilized.
This is especially true:
When the client has major issues with attachment and/or dissociation, and is unable to successfully undergo the trauma-focused portion of treatment without additional preparation.
When the client’s symptoms are so disruptive that skipping the stabilization phase risks further deterioration in the client’s status or life situation, while awaiting completion of treatment.
Even if it would be requested by a client, it would be against my own values, way of working and training guidelines to do EMDR in the first session(s). I consider it both irresponsible and potentially dangerous for a therapist to do so.
EMDR has been proved to be effective and to provide positive outcomes in a relatively short time. It is a promising method not only for treating single and complex traumas (PTSD & Complex PTSD) but for a variety of other mental health issues such as chronic pain, anxiety, phobias, panic attacks, attachment traumas, acute trauma, addictions, complicated grief, obsessive-compulsive disorder etc. If you are interested, you can read more about what EMDR is here.
EMDR acts faster and more efficiently compared to other therapy methods, and its success is long-term. Research has proved that after only 3 EMDR sessions lasting 90 minutes each, PTSD symptoms have completely dissipated in 84–90% of cases.
However, because of its fast efficacy the method has also been known to be easily abused, exactly because of clients requesting trauma processing too soon, or therapists offering to do it too soon. But especially during the very first session is a definite no-go!
EMDR has various and quite detailed protocols that instruct how it should be applied. EMDR Standard Protocol consists of the following phases:
Stabilization and Preparation for EMDR, EMDR Processing Session, and Evaluation in Next Sessions.
Out of these phases, though for some it could be paradoxical, the most important is the first one, Stabilization and Preparation for EMDR.
During this phase, a series of important milestones must be first completed, before moving to actual trauma processing.
In order to explain this simply, EMDR often uses the “Fairytale Model”.
Imagine that your trauma to process is a big bad dragon that you need to slay. You wouldn’t go about in the dragon’s lair without any prior preparation or training first, would you? That would guarantee failure, as it would probably mean that the dragon would consume you before you would have even the slightest chance to attack it!
Instead, you would first need to be stabilized, realize your strengths and weaknesses, obtain valuable tools and weapons and most of all the self-assurance that You Are Strong Enough to Face and Kill your Dragon.
This is exactly the aim of the Stabilization phase:
Obtaining Trauma History: You and your therapist will first explore the history of the current trauma together, your coping skills and avoidance methods, the consequences of the traumatic incident on a cognitive, emotional and psychological level. You will also be trained in recognizing your "triggers", your "hot spots" that you are most sensitive to and can provoke intense emotional reactions.
Establishing Objective Safety in the Present: A stable therapeutic relationship that is characterized by Trust in necessary prior to starting trauma work, as well as ensuring that the client is not currently in a traumatic or dangerous state . For example, if a client has been physically abused by their husband, they shouldn’t start trauma work unless they are safe; away from their abuser. While they remain in a traumatic environment , it is actually counter-productive and dangerous to start processing traumatic content because they run the risk of secondary traumatization - of being re-traumatized within the therapy context.
Achieving Mental, Emotional and Psychological Balance and Stability prior to Trauma Processing: During the Stabilization Phase, you will be trained in various relaxation and grounding exercises, you will be guided to develop emotional regulation techniques that work best for you, as well as distancing and stress-management techniques so that you will not be overwhelmed when processing trauma. Moreover, you will gain knowledge about how trauma affects you by psychoeducation.
In other words, You First Need to Be Empowered, Resilient and Stabilized in order to start processing trauma.
What can most certainly happen in case the Stabilization Phase is overcome , and one moves to the Trauma Processing Phase too soon, is that they can be overwhelmed, flooded with negative emotions and re-traumatized. The potential emotional consequences can be quite intense and severe.
It is an extreme scenario, but even a psychotic episode could be initiated by an EMDR processing session that occurs too soon, before the client is adequately prepared to relive traumatic content.
In my opinion, it would not be ethical to proceed to trauma processing in the first sessions- simply because your client’s safety and well-being should always be a first priority to you as a therapist.
Read more about the necessity of stabilization in EMDR therapy: