EMDR therapy: how it works and who it is for

“A friend says they erased her car accident in a few sessions just by moving her eyes. Is that true? Would it work for me too?”

I hear this question more often than I would have expected. Sometimes it comes from someone who, years later, still flinches at the screech of brakes. Sometimes from someone who has read an article about a miracle method and half hopes, half suspects it is hocus-pocus. And sometimes from someone who has already tried a great deal and simply wants somebody to tell them honestly what this thing is, how it works and whether it is for them.

Let me say straight away where I stand. I am a marriage and family therapist in training under supervision, and I am training in relational family therapy. I do not practise EMDR, and I will not present it as though I did. In this post I will try to explain what research tells us about EMDR, how it works, who it is well supported for and when it is better to start somewhere else — and how to find someone who is properly trained to offer it.

What EMDR is, and what it doesn’t promise

EMDR stands for Eye Movement Desensitization and Reprocessing. It is a structured psychotherapy method designed mainly to treat the after-effects of traumatic experiences. The person focuses briefly on a painful memory while following a bilateral stimulus: most often the therapist’s fingers moving left and right, sometimes alternating taps on the hands or sounds through headphones. You will also find a short explanation in the knowledge base under EMDR.

EMDR does not erase the memory. This is perhaps the most important correction to the stories that do the rounds. After successful treatment the person still remembers the event — they know what happened and can talk about it. What changes is how the memory acts: it no longer hits the body with full force, it no longer pulls them back into that moment as if it were happening now. A raw wound becomes a scar. That is not a small thing. But it is not forgetting.

Why does this question matter at all? Because traumatic experiences are far more common than we tend to think. In a large World Health Organization survey covering people in 24 countries, around 70 per cent of respondents reported having lived through at least one event that professionals classify as traumatic. Yet only around 4 per cent of all respondents developed post-traumatic stress disorder in their lifetime. Most people, then, gradually recover on their own after a terrible event. For a minority, though, the memory gets stuck — and it is for these people that methods such as EMDR were developed. You can read more about post-traumatic stress disorder in the knowledge base.

From a walk in the park to international guidelines

The story of how EMDR began sounds almost too neat to be true, but its author described it herself many times. In 1987 the American psychologist Francine Shapiro noticed during a walk that the unpleasant thoughts she had been carrying lost their edge while her eyes were flicking rapidly back and forth. She began testing this on herself, then on volunteers, and in 1989 she published the first study with people who had traumatic memories.

At first the profession was understandably sceptical. A method discovered on a walk and built on moving your eyes sounds like something that sells well but fares badly under scrutiny. During the 1990s there was a great deal of heated debate about EMDR, and some critics dismissed it as a fad. But the method was then tested in numerous controlled studies, and Shapiro developed it into a precise eight-phase protocol.

In 2013 the World Health Organization, in its guidelines on the management of conditions specifically related to stress, recommended EMDR as one of two psychotherapies for post-traumatic stress disorder in children, adolescents and adults — alongside trauma-focused cognitive behavioural therapy. Some national guidelines recommend it too, for example the British NICE guidelines. Getting from fad to international recommendation took roughly a quarter of a century of research.

Eight phases: how EMDR works

People often imagine EMDR as something that happens instantly: you sit down, the therapist waves their fingers, the memory disappears. In reality, the eye movements are only one part of a considerably longer process. The protocol has eight phases, and the first two — which go unnoticed because nothing dramatic happens in them — are often decisive.

In the first phase the therapist gets to know the person’s history, and together they choose what to work on: which memories lie behind today’s difficulties, what gets triggered in the present and what the person would like to be different. In the second phase the person learns how to calm themselves when emotions overwhelm them, and finds out what lies ahead. This is not a formality. Someone who has no way of returning to balance should not start opening their hardest memories.

In the third phase the memory is carefully “measured”: which image is the worst, which negative belief about oneself is tied to it (for example “I am helpless” or “it was my fault”), which emotion comes up, where in the body it is felt and how strong the distress is on a scale from 0 to 10. A belief the person would rather hold about themselves is also chosen. Only in the fourth phase comes the part everyone knows: short sets of bilateral stimulation, during which the person stays with the memory and then says what came up. It might be a new image, a different memory, a bodily sensation or nothing in particular. The therapist doesn’t explain or interpret, they simply guide the next set.

Once the distress has eased, there follow the installation of a truer belief about oneself, a body scan and closure, which makes sure the person doesn’t leave the session unsettled. At the next session, in the re-evaluation, the therapist checks what has changed in the meantime.

Why would moving your eyes help at all?

This is a question where it is worth being honest: we don’t yet have a precise answer. There are several explanations, and the field has not settled definitively on any of them.

The best researched is the working memory explanation. Working memory is a kind of desk on which the brain holds information at any given moment — and the desk is small. When a person recalls a painful memory while following moving fingers, the two tasks share the space. The memory therefore cannot be as vivid, colourful and emotionally charged as usual. The researchers Marcel van den Hout and Iris Engelhard showed in a series of experiments that after this kind of recall a memory later seems less vivid and less unpleasant. When the memory is “saved back”, it is saved in a somewhat weakened form.

A second explanation emphasises reprocessing: a traumatic memory is thought to be stored separately, cut off from other memories and from what the person knows today. During EMDR it is thought to link up with them — so that the person not only understands but also feels in their body that it is over and that they were not to blame. A third explanation says that what matters are simply the ingredients EMDR shares with other effective trauma treatments: a safe relationship, gradual confrontation with the memory and a new perspective on it.

It is this third possibility that has prompted the most debate. If the essence lies in facing the memory, are the eye movements needed at all? Research has given different answers. An older meta-analysis by Davidson and Parker from 2001 found no clear added effect of eye movements. A more recent meta-analysis by Lee and Cuijpers from 2013, however, showed that eye movements further reduce the vividness and unpleasantness of memories — in both clinical and laboratory studies. So the question is not closed, but today it is harder to claim that the eye movements are mere decoration.

What research says about effectiveness

For post-traumatic stress disorder EMDR is one of the most researched methods, and international guidelines list it among the recommended treatments. In comparisons with trauma-focused cognitive behavioural therapy it often turns out to be roughly as effective. This matters because it means EMDR is not a “better” or “faster” route for everyone, but one of several well-supported routes — more acceptable to some people because they don’t have to describe in detail what happened or do homework between sessions.

The evidence is strongest for adults with a single traumatic event: a road accident, an assault, a sudden loss, a traumatic birth. With complex trauma, repeated over years and often in childhood, the picture is more complicated. EMDR is used there too, but usually with longer preparation and as part of broader treatment. For other difficulties — depression, anxiety, chronic pain, addiction — there are studies and promising results, but the evidence is considerably thinner than for post-traumatic stress disorder. When someone promises you that EMDR will fix almost everything, that is a good reason to be cautious.

One more thing is worth knowing. Effectiveness in research doesn’t mean every individual will feel the same improvement. Some people’s symptoms fall sharply, others’ less so, and some drop out of treatment. This is true of all trauma treatments, not just EMDR. And that is precisely why the choice — of method, therapist and timing — carries real weight.

Who it suits, and when caution is needed

EMDR makes the most sense when the difficulty has a clear target: a memory or several memories that intrude, return in nightmares or are triggered by everyday things — a sound, a smell, a scene. When the person knows “where” the distress comes from, and when their life in the present is stable enough to tolerate feeling worse for a while during treatment before feeling better.

Caution is needed when the danger is still present — when someone still lives with a person who threatens them, or is in an environment where the trauma keeps repeating. Then the first task is safety, not reprocessing memories. The same applies with marked dissociation, when someone loses contact with themselves or with time, with active addiction and in a severe life crisis. This doesn’t mean EMDR is never an option, only that other steps come first. I have written in more detail about how to judge the right moment for trauma treatment in When is it time to work on trauma, and when not yet.

If you are having thoughts of harming yourself, or feel you can no longer carry the distress, don’t wait for any method. In Slovenia you can call the crisis line Klic v duševni stiski on 01 520 99 00 (every day from 7 pm to 7 am) or the Samaritans helpline on 116 123 (24 hours a day). If you are in immediate danger, call 112. If you are experiencing violence, the SOS helpline for women and children who are victims of violence is available in Slovenia on 080 11 55.

How to choose an EMDR therapist

EMDR is not a technique you can learn from a video or at a one-day workshop. A therapist needs a foundational psychotherapy training and, on top of it, specific EMDR training with supervision. In Europe, training and accreditation are coordinated by the EMDR Europe association. When you are looking for a therapist, it is entirely appropriate to ask:

• where and when they completed their EMDR training, and whether their work is supervised;
• what experience they have with the kind of difficulty you are bringing;
• how the preparation will go, and what happens if you become overwhelmed during reprocessing;
• what they will do if EMDR doesn’t work for you.

A good therapist will answer these questions calmly and concretely, without promising a number of sessions after which “everything will be solved”. Part of a first conversation might sound like this (composed, not a real person):

“I just want you to erase it. So that I never see that car again.”
“I understand that you want it to disappear. I have to be honest with you: the memory will stay. What I hope is that it will stop treating you as if it were happening now.”
“And what if it overwhelms me while we’re doing it?”
“That’s why for the first few sessions we won’t open the memory at all. We’ll learn how you can come back here, into the room, when it gets too much. Once you can do that, you can decide whether we go on.”
“I decide?”
“You do. And you can stop me at any time.”

That last sentence matters. With trauma, a person has often lost choice and control. Good treatment — with EMDR or without it — gradually gives them back.

Where I fit into this

Because I work in marriage and family therapy, what interests me most about trauma is what happens to it in relationships: how it affects a partnership, parenting, how close someone dares to let another person come. Trauma rarely stops at one person. When someone can’t sleep because of nightmares, when they pull away at every touch, when they react strongly to something their partner experiences as trivial, the whole family carries the consequences.

Here I can help put into words what is going on, understand the patterns and find ways to feel safe in the relationship again. But I do not practise EMDR, and I do not treat post-traumatic stress disorder with methods I am not trained in. If I notice that someone would benefit from specialised trauma treatment, I tell them so and help them think about where to turn. Sometimes both can run in parallel: individual trauma treatment with one therapist and work on the relationship with another.

The body, too, has its say in trauma. I wrote about how trauma becomes written into bodily experience in How trauma stays written in the body — and how the body can let it go, and about approaches that work through the body in Somatic methods for trauma: work that goes through the body.

An exercise for today: the calm place

This exercise is not EMDR and it is not trauma treatment. It is a simple calming exercise that many approaches use in a similar form — including EMDR in its preparation phase. Its purpose is to give you a place inside yourself where you can retreat for a moment when things get too much. Don’t use it to bring up difficult memories; if they surface during it, return to your breath and open your eyes.

1. Choose a place. Real or imagined, where you feel calm and safe. It doesn’t have to be idyllic: it can be your kitchen on a Sunday morning. If no place comes to mind, that’s fine too — you can build one gradually.
2. Fill it with your senses. What do you see? What do you hear? What is the air temperature like, what do you feel under your feet, is there a smell? Give each sense a few breaths.
3. Notice your body. Where in your body do you feel that you are in the calm place? Perhaps your shoulders drop a little or your breath lengthens. Just notice; don’t correct anything.
4. Give it a word. Choose one word that sums up the place, for example “sea” or “kitchen”. It will help you call up the feeling later.
5. Come back. Open your eyes, look around the room and name three objects you can see. Repeat the exercise for a few days while you are calm — that way it will be within reach when you aren’t.

If you would like a few more tools of this kind, take a look at the grounding 5–4–3–2–1 exercise in the knowledge base.

Where EMDR isn’t the answer

Because EMDR is well researched and has an appealing origin story, it is easy to overrate. So here are some limits.

Not every hard experience is a trauma that needs to be “processed”. Most people gradually recover after a terrible event without any special treatment. In the first weeks after an event, sleeplessness, intrusive memories and irritability are often a normal reaction, not an illness. Rushing into “therapising” straight after an event is not necessarily helpful. If, however, the symptoms are not easing after a few weeks, or are getting worse, it is time to talk to a professional.

Not all distress is tied to a memory. If the difficulty lies in a relationship that is ongoing now, in a life situation that isn’t changing, or in patterns that formed slowly without any single event, EMDR is not the natural first choice. Then a conversation about what is happening, how it repeats and what could be different often makes more sense.

It isn’t the only good method. Trauma-focused cognitive behavioural therapy, cognitive processing therapy and prolonged exposure are also well supported. I described why approaching fear works better than avoiding it, using panic as an example, in Exposure: why panic has to be approached, not avoided. Which one suits someone better depends on them: how much they want to talk, how much homework they are willing to do, which therapist they feel safe with. Psychotherapy research shows again and again that the relationship with the therapist is one of the strongest predictors of outcome — across all methods.

And it isn’t a shortcut around pain. Anyone hoping to bypass their trauma with EMDR may be disappointed. During treatment you do meet the memory — in smaller, more manageable doses, but you meet it. I explained why suffering in itself doesn’t make you stronger in “What doesn’t kill you makes you stronger” — why that isn’t true of trauma. Processing is not the same as suffering; it is suffering that someone accompanies and that comes to an end.

What to remember

• EMDR is a structured method with eight phases; the eye movements are only one part of it.
• It doesn’t erase the memory, it takes away its force: a raw wound becomes a scar.
• For post-traumatic stress disorder it is recommended by international guidelines, including the World Health Organization’s — as one of several well-supported methods, not the only one.
• When danger is still ongoing or distress is severe, safety and stabilisation come first.
• Choose an EMDR therapist for their training and for whether you feel safe with them.