EMDR stands for Eye Movement Desensitization and Reprocessing, itself a subset of Bilateral Stimulation Therapy. Bilateral Stimulation Therapy is not well understood, but the gist is that activating both brain hemispheres (hence bilateral) helps people process traumatic memories. It’s increasingly being used in treating PTSD, but you don’t have to have severe trauma for it to be helpful.
I’ve been doing EMDR for around two years now in therapy, and it’s worth talking about.
Disclaimer: I am not a psychologist or therapist. I am a patient talking about my own experiences. None of this should be taken as me telling anyone to do anything.
Content Warning: I don’t usually do content warnings, but this is some sensitive stuff. Detailed discussion of psychological therapy and the mental wounds it is meant to treat. Some references to anorexia and PTSD as non-personal examples.
We all have memories that evoke strong emotions in us. Some of those memories are sources of happiness: a wedding, the birth of a child, a major success or a cherished evening spent with the people you love. Sometimes the memory is from a source of pain: a breakup, a failure, a loss. These memories affect us - present tense. They’re tied in to how we perceive ourselves and the world.
We have concepts in language and story for physical wounds that never fully healed. There’s the broken leg that leaves someone with a limp for the rest of their life, or the old scar that aches when it rains. We might talk about sucking venom from a snake bite or needing to clean out a cut before bandaging it so infection doesn’t set it. We’re aware that wounds need air, that what doesn’t kill you might make you stronger but it can also leave you crippled.
We have concepts in language and story for past misdeeds that come back to haunt people. We’ll say a politician has skeletons in their closet, or that nothing stays buried forever.
But we don’t have as many concepts in language and story for the idea of mental and emotional wounds that never quite healed. Sure, characters in a story have character flaws, and those flaws might be born from important moments in their life, the way that Anakin Skywalker was so traumatized by the loss of his mother that he was willing to commit unspeakable acts to prevent Padme’s death. But by and large character flaws are seen as baked-in, something intrinsic to the character that doesn’t change over time.
People aren’t characters. Over the course of our lives we accumulate damage, and our weaknesses and flaws and cracks are born not only from the core of our personalities but from the nature of the damage we accrue. The girl who’s made fun of for being chubby (regardless of any objective measurement of her weight) becomes anorexic; the soldier at war learns that the world is dangerous and their life could be threatened at any time.
When someone goes through trauma, they usually can’t process it well while it’s happening. A wound is inflicted in their psyche, but unlike a physical wound it’s largely invisible to others, and sometimes oneself. Because there’s nothing visibly wrong, people underinvest in healing that psychological damage.
A physical wound needs surgery or bed rest or physical therapy to heal; it’s an active process a person does, alongside the passive regeneration of their cells. Similarly, a mental wound needs processing and space and (sometimes) therapy to heal. It’s also an active process that a person does, alongside their brain’s natural recovery processes.
EMDR is an active process for healing mental wounds.
Different therapists may do EMDR a bit differently, although they take training before using it with their clients so there is a measure of standardization to the practice.
With my therapist, for instance, we don’t use eye movements - we use tapping, where I lay my hands on my knees and alternate tapping between my right and left knee. This works for me; other methods work for others. We still call it EMDR even though there aren’t any eye movements - the principle and the therapy are the same; we simply adjusted the nature of the bilateral stimulation for therapy via videoconferencing.
The first thing we do when embarking upon EMDR is to pick a memory, something that bothers me, that is tied into the way I process the world and the negative cognitions I have about myself. The idea is that me - the present me - is experiencing some form of suffering (anxiety and depression, in my case), and that suffering is tied historically to events in my life that reinforce the negative stories I tell myself. No one is born believing that they’re worthless or stupid or in a war zone; these are beliefs that our brains develop over time based on the experiences we have. In order to unravel the belief, one needs to find its sources, the memories of the experiences that generated that belief, and start there.
Given the complexity of the human mind, it’s never that simple; our beliefs about ourselves are generated and reinforced through many memories and experiences and there may not be an identifiable ‘root cause’, but it is possible to come up with a list of memories that all tie in to that belief.
As a theoretical example, take someone with anorexia. Their belief/negative cognition might be that they’re overweight and therefore ugly, or that their self-worth only comes from how attractive they are, or that no one will love them if they’re fat. These negative self-cognitions - the stories this person tells themself about who they are - are grounded in their memories, in events that happened to them over the course of their life. Perhaps a partner left them for someone more conventionally attractive. Perhaps they got made fun of for being pudgy in elementary school. Perhaps their parents put them on a diet when they were young.
Those memories are all tied together with the cognition in a tangled Gordian knot in their mind. There isn’t necessarily a precise ‘starting point’ or ‘root cause’ (although there could be, there just doesn’t have to be), but in EMDR you work on one memory at a time, so you’ve got to pick one.
Some people like to jump in and pick the hardest memories first; I was not one of those people. I picked an easier memory, something that hurt and felt bad and was connected to my own locus of negative self-cognition, but wasn’t central to it.
It’s easy to think to oneself - I’ve had this thought too - that a given memory doesn’t sound particularly traumatic. And if there exists some cosmic scale of trauma that objectively measures these things, then yes, maybe said memory is low on that list compared to, say, getting shot at or experiencing sexual violence. But everyone is different, and what psychologically wounds one person may be fine for another. A large part of what turns a memory into a wound is the meaning we make of it, and that doesn’t necessarily depend upon the memory itself. Comparing one person’s experience, wounds, and trauma to another’s in order to establish a hierarchy of pain is not a useful thing to do. Everyone’s experiences are valid, and no one’s pain lessens anyone else’s.
My therapist begins by grounding me in my body.
“Take a moment. Notice your feet on the floor. Notice your body supported by your chair,” my therapist tells me, her voice low and soothing.
A large part of EMDR, as I’ve been doing it, involves connecting with my body and my greater nervous system. A feeling might emerge as pain in a particular part of my body, and it’s important to be able to notice and pay attention to that. I’m a very cerebral person by default, so the practice of embodying my cognitions has been somewhat difficult for me. Shame, for instance, usually sits at the bottom of my stomach, while sadness tugs at the strings of my facial muscles. Anxiety is a spark traveling lightning-fast along my nerves, activating my body and preparing it to fight or flee.
“Now bringing up the image of…”
Next we recreate the scene of the memory. This is one of the most painful parts of the experience. In a lot of ways, by immersing yourself in the memory of your trauma you’re re-experiencing it, and that’s kind of the point. Part of EMDR is desensitization and adjustment: by re-experiencing the memory over and over, it begins to lose the powerful immediacy that renders it so traumatic. By bringing it up again and again in the context of healing, the emotions attached to the memory start to change.
When I first bring up the memory I’m working on, I’m usually flooded by emotions. I twitch, I shift, my muscles pull and release. It’s a wave of negative sensations that pass through me, and I’ve learned over time to let them, to be the rock jutting out of the seas that the waves crash against, knowing that I’ll still be here when the tide withdraws.
“And the thought, …”
My therapist attaches to the image the thought that we’re working on, the negative cognition or belief about myself that the memory roots and reinforces.
Next we do the check-in:
“On a scale of 0 to 10, where 0 is neutral and 10 is the highest level of emotional disturbance, where does this fall?”
If this sounds like something from a really stupid clinical questionnaire, well, yeah. I imagine it’s in the EMDR textbook. But it does provide an interesting function.
The purpose of this, at least from my end as a patient, is to gauge progress over time.
Not only do we begin a session with it, we’ll end the session with it as well, and I get to see progress made over the course of the last hour - but since I know we’ll be doing this again the next session and the next and so on, continuously, I get to see the slow decline of emotional disturbance over the months.
A memory that registered as a 9 at the beginning, that wrecked and wracked me with feelings of shame or guilt or pain or whatever - might, within a few months, be middling 5. Having done the process a few times, I now have faith that that 5 will become a 3, a 2, a 1, a 0. A memory that was snarled up in pain and anguish will, one day, be a sort of sad reflection. Wounds heal into scars. Scars fade over time.
Having an actual number attached to this lets me see the process as it works, even as I feel it working.
Once the check-in is done, my therapist will bring up the memory once more, grounding me in the sensory experience of it. She’ll set the scene as I’ve described it to her, and then tell me to start tapping as I picture it in my mind, allowing myself to feel whatever it is that I feel.
Entering a period of tapping - or eye movement, or any other bilateral stimulation - is a little like meditating. I have some experience with mindfulness meditation, and there are similarities in the experience.
As a quirk of my own mind, I can more or less tap on my knees in a consistent, alternating pattern on autopilot; I don’t have to pay active attention to keeping it going. So I start tapping, and then turn my attention to the memory I’m working on.
At this point, physical and emotional sensations start happening. I might experience sadness as my lips tremble and my face contorts, or a diffuse discomfort that spreads through the left side of my torso.
Much like mindfulness meditation, thoughts come and go like ripples in a river. I try to focus on the memory at hand, but by definition the memory is unpleasant to focus upon. My mind naturally tries to juke away, to dodge dip duck dive and dodge, and I have to patiently lead it back each time.
The goal of the tapping session is to hold the memory and the cognition in my head while observing what my body and emotions do. I’m not attempting to act on anything; I’m not suppressing pain or burying my feelings. It is, in fact, the opposite: by revisiting the memory and associated cognition, I’m reopening the wound.
EMDR, as I experience it, is a process of exhumation.
Pain and trauma are things we bury as they happen, as we prioritize dealing with the direct and immediate necessities of life, but they don’t decompose once buried.
That is not dead which can eternal lie, and with strange eons even death may die.
Psychological wounds can eternal lie. To heal they must first be unearthed, and so every session of tapping is another thunk of a shovel digging into the dirt, peeling away the years layer by layer until the wound is reopened and the healing can begin.
My therapist usually only lets the tapping go on for about thirty seconds at a time; it always feels quite short. Occasionally I’ve asked for more time or to let her know when I’m done, particularly if I’m trying to process something difficult or communicate with a part of myself that doesn’t want to talk, and this has been fine.
“And we’re gonna stop tapping. What are you feeling?”
My fingers come to a stop on my knees, and I try my best to communicate what happened during the tapping period. I’ve noticed that I tend to give two responses: one about what happened in my body, and one about what happened in my mind.
For the body I might talk about my throat feeling tense or full, or perhaps how fear or shame or guilt is pouring into me from my lower stomach, as if I was floating in a sea of bad emotions and a hole in the hull is allowing them to flood into me.
For the mind things can get abstract. Sometimes I’ll run into thoughts from a younger version of myself, or automated systems that shut down emotions when they pass a warning threshold. The whole thing is very personal and high-concept, and I do my best with metaphors and descriptive imagery to communicate.
After I give my report, my therapist will pick some part of it, say “Let’s go with that,” or “Let’s follow that and see where it leads,” and I’ll go back to tapping. I suspect, but don’t know for sure, that a large part of the skill involved from the therapist’s end shows up in knowing how to guide me: what to focus on from my self-reports of what I experienced, and what to let go of.
Sometimes something will come up and instead of telling me to follow a thought or feeling, my therapist will challenge me, presenting an alternative possibility or frame to understand the situation through, and then ask me to tap while holding that in my head. It’s quite effective.
For instance, if I’m thinking of something I did and the dominant feeling inside me is shame, my therapist might ask me if, had someone else done the thing I did, I would think they ought to be ashamed of themselves. Holding the two perspectives side by side in my head allows the dissonance to show between how I think about myself and how I think about others; we are often our own worst critic, and learning where that critique is not accurate can be useful in healing.
There are other things that have happened at this stage, some related to parts work and IFS therapy, others touching upon other modalities. My therapist and I are flexible, as I think you have to be to do this work. There’s no guarantee that the emotions and thoughts that show up during EMDR are going to make sense or even be expressible in language; I do the best I can to communicate and my therapist does the best she can to respond.
EMDR is an intense and difficult experience. I often feel like I’m coming out of a trance afterwards. My head will ache or feel hot, like I was overclocking my brain. I’ll feel emotionally wrung out and numb, unable to channel strong emotions for the rest of the day.
In the immediate aftermath, my therapist will often ground me back in my body and room. She’ll ask me to name five things I can see, four things I can touch, and three I can hear, or to find something orange in my room and pick it up.
After spending so much time deep in my own feelings and thoughts and past, it’s a relief to be present in the room, a body in the real world instead of a metaphor tossed about on a wine-dark sea of emotion.
Once the session is over she usually recommends going outside for a few minutes to decompress. Sometimes I’ll do that, other times I’ll lay down or read. The haziness, which I’ve heard called the ‘therapy hangover’, doesn’t usually go away until after I’ve slept.
Is EMDR worth it?
It’s a lot of work, a lot of time, a lot of reliving some of your most painful experiences over and over again.
Why do that?
I’ve completed two memories at this point, and I can say this:
The long-run result of the work I’ve done has taken memories filled with pain, anguish, anger, and shame, and turned them into occasions to look back with compassion. Peeling back the anger and the hurt layer by layer sucks, but it has allowed me to unearth a depth of empathy, for myself and for others, that I did not know that I had.
By recontextualizing an old failure or reframing an old hurt I am able to change the meaning that memory has in the narrative of my life, rewriting my own history with the benefit of hindsight and the wisdom I’ve accumulated in the intervening years.
Mistakes and regrets, the pain and trauma of living, will, if left to fester, pile up over the course of a life, dragging us backwards with every step we take. But we’re so used to carrying the weight that it doesn’t feel like there’s any other way.
It’s hard to feel the weight of a burden until you put it down, and as Ernest Becker said:
It is easier to lay down light burdens than heavy ones.
I - and I think most people - carry with me plenty of pain from my past. I’m very far from done, but EMDR has given me the chance to lay some of those burdens to rest.
Assuming you’re already in therapy and you’re curious, should you give EMDR a shot?
No one can answer that for you. The thing to keep in mind is that, while EMDR is a very powerful form of therapy and has been effective for many, it is a very intense and sometimes painful process. It is not unlike a kind of surgery for the mind, where to get at the diseased tissue one must first cut through skin and flesh alike.
If that’s not something you’re in a position to go through, I wouldn’t recommend it. Sometimes the right move is to stabilize, to triage the worst of your issues and reach an equilibrium where you aren’t descending into any vicious cycles.
However. If you are stable and do have the space and time and emotional bandwidth in your life, if you want to actually address and heal the psychological damage you’ve taken, if you’re willing to experience the pain and feel the feelings, then I have encountered no modality of therapy more effective than EMDR.