If you're on the fence about adding EMDR therapy to your practice, I get it. I was too. Eight years ago I sat through my Part 1 training thinking the bilateral stimulation piece sounded a little too neat for how messy trauma actually is in the room. Then I ran my first full protocol with a client I'll call M. — a nurse with a needle phobia so severe it was threatening her license — and watched her SUDS score drop from an 8 to a 1 in a single session after months of talk therapy had gotten us nowhere. I was sold, and I've used EMDR therapy with trauma and PTSD clients every week since.
This isn't a training substitute — you need EMDRIA-approved training and supervised practice hours before you run this with clients. But if you're deciding whether it's worth pursuing, or you're trained and want a sharper sense of where it actually earns its keep in a caseload, here's what I've learned from a decade of using it in private practice.
What EMDR Actually Does (Without the Jargon)
Eye Movement Desensitization and Reprocessing works on the theory that traumatic memories get stored differently than ordinary memories — frozen, with the original sensory and emotional charge still attached, instead of filed away as "something that happened in the past." Bilateral stimulation (eye movements, tapping, or alternating tones) seems to mimic what happens during REM sleep, when the brain naturally processes and files daily experience. You're not erasing the memory. You're helping the brain finish a filing job it got interrupted on.
That's the client-friendly explanation I actually use. Most of my clients don't care about dual attention stimulus theory — they want to know why we're doing something that looks a little strange, and "your brain got stuck processing this, and we're going to help it finish the job" lands every time.
The Eight Phases, and Where Therapists Actually Get Stuck
You know the phases from training: history-taking, preparation, assessment, desensitization, installation, body scan, closure, reevaluation. In theory it's clean. In practice, two phases are where I see new EMDR therapists struggle most.
Phase 2: Preparation Is Not Optional
I cannot overstate this. Skipping or rushing resourcing — teaching the calm/safe place, container exercise, and grounding skills before you ever touch a target memory — is the single biggest reason EMDR sessions go sideways. If a client doesn't have a reliable way to self-soothe when a memory gets activated, you're setting up a flooding experience, not a processing one. I spend a minimum of two full sessions on resourcing with complex trauma clients, sometimes more. It feels slow. It isn't wasted time.
Phase 3: Target Selection With Layered Trauma
With single-incident trauma — a car accident, an assault — target selection is fairly straightforward. With clients who have chronic, developmental trauma, you're often looking at a whole network of linked memories, and picking the wrong starting target can send a session in directions you didn't plan for. I use a simplified version of the "floatback" technique here: ask what's the earliest memory connected to this same negative belief ("I'm not safe," "It's my fault"), and often that's your real starting point, not the most recent or most vivid incident.
Where EMDR Fits Alongside Other Modalities
I don't run EMDR in isolation. Clients with significant emotional dysregulation often need DBT distress tolerance skills built first — you cannot process a target memory with someone who has no way to come back down afterward. Clients with strong cognitive distortions layered on top of the trauma benefit from some CBT groundwork so they have language for the negative and positive cognitions phases. And for clients whose trauma lives more in the body than in narrative memory — chronic tension, dissociation, numbing — I'll pull in somatic techniques before and during EMDR to keep them anchored in present-moment body awareness.
This is why I built out a full EMDR-specific set of intake forms, resourcing scripts, target sequencing worksheets, and SUDS/VOC tracking sheets for my own practice, which I later packaged as our EMDR Therapy Worksheets Mega Bundle — it's the exact paperwork I use session to session, not a generic template pulled from a textbook.
A Note on Readiness
Not every trauma client is an EMDR client, at least not yet. I hold off with clients who are actively using substances to cope, who are in an unstable housing or safety situation, or who dissociate so readily that I can't reliably keep them in a window of tolerance during the session. That's not a permanent no — it's a "let's build stabilization skills first" yes. Rushing into reprocessing with an under-resourced client is how you end up with a dropout after one bad session, and understandably so.
The Takeaway
EMDR earns its reputation, but the phases everyone skims past in training — preparation and target selection — are exactly where outcomes are won or lost. If you're newer to this modality, slow down phases 1 and 2 more than feels necessary, track SUDS and VOC scores every session so you can actually see progress instead of guessing at it, and don't be afraid to weave in DBT, CBT, or somatic tools when a client needs more scaffolding before reprocessing work can hold. That combination — patience on the front end, structure throughout — is what makes EMDR sustainable in a real caseload, not just in a training manual.
0 comments