What Happens in EMDR Therapy?
Eye Movement Desensitization and Reprocessing, commonly known as EMDR, is becoming an increasingly popular treatment for trauma, anxiety, depression, and other mental health concerns. While EMDR has helped many people feel more grounded and at peace in their daily lives, it can still feel intimidating if you’re not sure what to expect.
I’m Cassidy, a Philadelphia trauma therapist and art therapist, and I’m here to walk you through what an EMDR session might actually look like so you can decide if it feels right for you.
8 Phase Process
EMDR is designed to go at each individual’s pace, and it typically unfolds over the course of weeks or months, depending on the complexity of what you’re working on. In my sessions, I always keep clients in the loop about what phase we’re in and what that means. You can (and should!) ask your EMDR therapist to do the same if you’d like to track your progress and understand what’s ahead.
Phase 1: History Taking
Before jumping straight into trauma work, your therapist will take time to get to know you, your life experiences, and your goals for EMDR therapy. Your therapist will begin with what's called an intake session, where they’ll gather information about your background. They will ask you questions about things like your family, social life, education and career, substance use, mental health, trauma history, and more. Along with assessing whether you are a good candidate for EMDR therapy, your therapist is getting to know you during this phase so that they can best support you once you begin processing trauma.
The relationship you build during this phase is just as important as the information you share. Your therapist will work to establish a strong rapport and a sense of trust and safety, which becomes the foundation for doing deeper trauma work later on. Trauma work can feel deeply vulnerable, so it’s important that you feel safe, seen, and supported before moving forward.
This can take one session for some people, and many more for others. It depends greatly on your comfort level with opening up. If you're someone who needs time to feel comfortable opening up, that is completely okay. EMDR Phase 1 allows space for that.
Phase 2: Preparation/Resourcing
This phase is where many clients begin feeling relief just from learning ways to ground themselves more effectively. Phase 2 is designed to set you up for success with EMDR therapy and continue laying the groundwork for trauma processing.
Your therapist will assess your current coping skills, like how you manage stress, emotions, and daily challenges, and offer some additional EMDR-specific coping, or “resourcing” activities. These are practical strategies designed to calm your nervous system and help you feel more in control, especially if difficult memories or emotions come up later in therapy.
Some common EMDR coping activities are:
Visualization exercises, like imagining a calm or safe place
Container exercises, where you mentally set distressing thoughts aside for later
Breathwork and body awareness tools to help manage physical symptoms of stress
Your therapist will guide you through these exercises and help you find the ones that work best for you. They’ll also encourage you to begin practicing these techniques in daily life (not just in session), so they become more natural and accessible when you need them most.
By the end of Phase 2, you should feel confident in your ability to handle emotional intensity, both in everyday situations and during EMDR sessions. And if you don’t feel quite ready yet, that’s okay. This phase can take as long as you need.
Phase 3: Assessment
Phase 3 is the last phase before processing begins. It’s all about numbers, which will help you and your therapist track your progress through the EMDR process. In this phase, you and your therapist will begin mapping out specific memories, events, or issues (often referred to as “targets”) you would like to process using EMDR. If you’re not sure exactly what you want to process, your therapist can help you determine what bothers you most day-to-day. They can be recurring or intrusive thoughts, mental images, body sensations, unwanted memories, and more.
Once you and your therapist have created a list of targets, you will rate them each from 0 (no distress) to 10 (most distress imaginable). It can feel odd rating these targets, but it helps you see your progress over time.
For each target you will also identify a negative core belief that comes along with it, typically about yourself or the world. Then, you will determine what positive or neutral belief you would like to replace it with. Here are some examples of the core beliefs:
“I’m powerless” —> “I’m in control”
“I cannot trust anyone” —> “I can choose whom I trust”
“I’m not good enough” —> “I am deserving/fine/OK”
You’ll rate how true that positive belief feels in that moment using the Validity of Cognition (VoC) scale, which ranges from 1 (completely false) to 7 (completely true). This helps track how your beliefs shift over time as you work through each memory in EMDR.
While this phase is structured and organized, it is also deeply personal. It’s not about rushing through a checklist, it’s a way of identifying the beliefs and experiences that still feel unresolved and setting you up for real healing.
Phase 4: Desensitization
This is the phase where EMDR processing officially begins. All of the work you’ve done up to this point has been to prepare you for this phase. If you’ve looked up EMDR, you may have seen people tapping their shoulders, holding buzzers, or following a moving light back and forth. These are all forms of bilateral stimulation, which is a key part of EMDR. It means engaging both sides of the brain through rhythmic left-right movement, often using eye movements, self-tapping, or auditory tones.
You’ll be asked to focus on a specific target memory (identified in Phase 3), along with the thoughts, feelings, body sensations, and images that come with it. Then, you’ll engage in bilateral stimulation while thinking of the target, which helps your brain reprocess the memory in a way that reduces its emotional charge. Whether you’re using self-tapping, a light-bar, audio tones, or handheld buzzers, the rhythm will be slow and last only about 15-20 seconds in the beginning to avoid overwhelm.
The things that pop into your brain during those 15-20 seconds can feel completely random, and that’s okay. You don’t need to analyze or make sense of it all in the moment. Your therapist will guide you through the process and check in after each set of eye movements or taps to see what’s coming up.
The goal of desensitization is not to erase the memory Eternal Sunshine style, but to reduce how distressing it feels when you think about it. Many clients begin to feel lighter or more neutral toward a memory even after just one session of processing. If it’s too difficult, we might take a break and lean on those resourcing exercises (identified in Phase 2).
Phase 5: Installation
This phase takes it a step further than just reducing stress, it is meant to rebuild your sense of self, reclaim your narrative, and strengthen beliefs that support you in living your best life.
Now that the emotional intensity of the target has hopefully reduced (your therapist will check in how it feels from 0-10), it’s time to strengthen the positive or neutral belief we discussed in Phase 3 that you want to hold about yourself or the world in relation to that memory. This phase is intended to rewire your brain to replace the old, negative belief like “I’m in danger” with something more accurate and empowering, such as “It’s over now, I am safe.”
Your therapist will guide you in holding both the memory and the new positive belief in mind while continuing bilateral stimulation. This helps “install” the new belief more deeply, so it feels more true, not just something you’re saying, but something you feel in your body. You’ll also rate how true the positive belief feels to you from 1-7 after processing. The goal is to raise the score over time, but there’s no rush. Some people feel a shift quickly, while others take a bit longer, and both are totally normal.
Phase 6: Body Scan
Even when a memory no longer feels emotionally distressing, our bodies sometimes hold onto leftover tension. (That’s why one of the most popular books about trauma is called The Body Keeps the Score).
During Phase 6, your therapist will ask you to bring the target memory and the newly installed positive belief to mind, then slowly scan your body from head to toe. You’ll be checking in for any lingering discomfort, tension, or sensations that feel uncomfortable or “off.” These could be subtle, like a tight chest, clenched jaw, or heaviness in your stomach.
If something does come up, that’s totally okay. It doesn’t mean EMDR isn’t working, it just means there’s still a little more to process. Your therapist might guide you through more bilateral stimulation or slightly change your negative and positive beliefs to help clear those lingering sensations.
This phase helps ensure that healing isn’t just happening in your thoughts, it’s happening in your whole system. The goal is for your body to feel just as calm and grounded as your mind when you think about the memory.
Phase 7: Closure
One of the most important phases is Phase 7, as every EMDR therapy session must end with closure. This phase will help you return to a sense of calm, safety, and emotional balance before you leave the session. Your therapist will guide you through grounding exercises and check in to make sure you’re feeling stable. You might revisit some of the coping tools you practiced earlier in Phase 2, like deep breathing, visualization, or safe-place imagery.
Because EMDR can stir things up, your therapist may also suggest keeping track of any thoughts, emotions, or dreams that come up between sessions. You’ll be encouraged to use your resourcing tools throughout the week and bring anything that feels important to your next session. The main purpose of this phase is to make sure you’re “good to go” before you leave the office or end the virtual session.
Phase 8: Reevaluation
This final phase is where we zoom out and take a look at the big picture. In the beginning of each EMDR session and periodically throughout the course of therapy, your therapist will check in on previously processed memories to make sure the distress is still low and the positive belief you installed still feels true.
Sometimes, new layers of a memory or related memories may emerge, and that’s completely normal. Trauma healing isn’t always linear, and this phase helps us make sure you’re continuing to move forward (not just feeling better in the moment, but actually transforming how past experiences show up in your life.)
If you and your therapist agree that a target feels fully processed, you’ll move on to the next one on your list. The reevaluation phase also gives space to celebrate progress, notice shifts in how you see yourself and the world, and make adjustments to your goals as needed.
….Well, that was a lot! It may feel overwhelming seeing all of this laid out, but don’t worry. You don’t need to know ANY of this to start EMDR - this is just for people who are extra curious about what actually happens in EMDR. Your therapist will help guide you through everything each week. Your only job in EMDR is to show up as you are. That’s it!
EMDR & Art Therapy in Philadelphia
If you're feeling ready to work through what's been weighing you down, I'm here to help you process trauma at your own pace with compassion, creativity, and care. Feel free to send me an email at cassidy@keystonearttherapy.com or give me a call at 267-507-1692.
