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Treating Veterans with PTSD
Treating Veterans with PTSD

Section 9
Phases of EDMR

Question 9 | CE Test | Table of Contents |
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

In the last section we discussed the Feelings Dial and Containment Skills. Both of these techniques offer PTSD clients a way to manage intrusive thoughts, images, feelings, or sensations.

In this section we will give a review of EMDR as a means of beginning the conversation about EMDR therapy with your PTSD client.

I felt that EMDR would be a helpful technique for Michelle. Before we began the process of EMDR, I felt it was important for Michelle to understand what EMDR is. I stated to Michelle, "EMDR stands for Eye Movement Desensitization and Reprocessing. I think it will be helpful for you to understand how the process works and its possible benefits." While this will likely be a review for you, it may be helpful to have as a reference if you feel that your client that is beginning EMDR can benefit from understanding what EMDR is.

What is EMDR?
I stated to Michelle, "The basic principle of EMDR is that you hold an upsetting memory in your mind while following a rhythmic set of eye movements which are believed to accelerate the processing of material." Here is a general overview of the 8 phases of EMDR that I stated to Michelle:

Phase 1: Client History and Treatment Planning
The first phase is client history and treatment planning where I gather your history to see if EMDR is right for you. Things like cardiac and respiratory problems may prevent a client from being a good candidate for EMDR. This history will also identify obvious traumatic events that need to be reprocessed.

Phase 2: Preparation
The second phase is preparation. In this phase our relationship must be developed so that you can trust me and report your disturbances and progresses accurately. I can help teach you ways to relax and feel comfortable as a means to cope with distressing arousal. In this phase you will also be taught how to maintain awareness.

Phase 3: Assessment
The third phase is assessment which is when we identify aspects of the target to process that best represents the traumatic memory. You then also identify a negative belief about herself that is associated with the event along with negative emotions and physical sensations. In this phase you will rate the strength of the negative and positive cognitions as well as the degree of disturbance of the identified negative emotions and physical sensations.

Phase 4: Desensitization
The fourth phase is desensitization. In this phase you will bring to the forefront of your mind the targeted material. I will then take you through a set of eye movements by following two of my fingers as I hold them about 12 inches away and move them rhythmically back and forth across your field of vision. After each set of eye movements, you will clear your mind and take a deep breath. I then ask what you ‘get now’ and the image or feelings change somewhat and helpful insights may emerge. As associated memories that need to be processed emerge, you then follow an additional set of eye movements until all aspects linked to a disturbing memory are processed.

Phase 5: Installing and Strengthening the Positive Cognition
In the fifth phase, installing and strengthening the positive cognition, your positive cognition is repeated. Positive cognition is reinforced with additional eye movements until it feels valid to you.

Phase 6: Body Scan
The sixth phase is body scan. In this phase, I ask you to notice any disturbing physical sensations remain as you bring up the target to ensure that all aspects of your traumatic memory have been processed. If disturbing physical sensations still remain, these sensations can be targeted for reprocessing with more eye movements.

Phase 7: Closure
The seventh phase is closure. In this phase I make sure that you are safe and comforted through self-calming strategies. Use a journal to record additional processing and calming techniques to contain arousal.

Phase 8: Reevaluation
The final phase is reevaluation. This phase happens at the beginning of the next session when we see whether positive results were maintained and new targets are identified or old targets that still need to be processed.

While this is likely a review for you, do you have a PTSD client, like Michelle, who could benefit from this opening discussion about EMDR treatment?

We will now move from discussing the 8 phases of EMDR to discussing the strengths of EMDR that you may wish to share with your clients beginning the EMDR process.

Strengths of EMDR:
For clients like Michelle, I like to discuss the strengths of EMDR to help them better understand how EMDR can benefit them. Here are the seven strengths that I stated to Michelle:

1. EMDR often causes rapid improvements.
2. EMDR looks at various aspects of traumatic memories (thoughts, images, feelings, physical sensations, and behaviors) and integrates them all in the processing.
3. Aspects that need to be processed arise naturally in the course of EMDR treatment so naturally the client maintains control.
4. EMDR clears out and defuses all aspects of memory networks that might be related to traumatic memory.
5. When a client processes one type of memory, the processing may cause a generalization to other similar memories.
6. Some clients may not feel ready or comfortable to discuss some traumatic memories and the memories do not need to be discussed in detail when using EMDR.
7. Homework is not required.

Reviewing these strengths regarding EMDR may help ease your PTSD client into using the technique. Have you found this to be true?
In this section we gave a review of EMDR as a means of beginning the conversation about EMDR therapy with your PTSD client. We began by discussing the eight phases of EMDR. These eight phases are client history and treatment planning, preparation, assessment, desensitization, installing and strengthening the positive conditions, body scan, closure, and reevaluation. We also discussed seven strengths of EMDR for your client which are causes rapid improvements; looks at various aspects of traumatic and integrates them all; aspects that need to be processed arise naturally; EMDR clears out and defuses all aspects of memory networks that might be related to traumatic memory; the processing may cause a generalization to other similar memories; memories do not need to be discussed in detail when using EMDR; and homework is not required.

In the next section we will discuss the four types of DSM criteria which categorize PTSD reactions. By understanding these different categories, you and client can get a better handle of how they can cope with their PTSD.

Schiraldi 211-216

EMDR beyond PTSD: A Systematic Literature Review

- Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Pérez, V., & Amann, B. L. (2017). EMDR beyond PTSD: A Systematic Literature Review. Frontiers in psychology, 8, 1668. doi:10.3389/fpsyg.2017.01668.

Peer-Reviewed Journal Article References:
Balbo, M., Cavallo, F., & Fernandez, I. (2019). Integrating EMDR in psychotherapy. Journal of Psychotherapy Integration, 29(1), 23–31. 

Jowett, S., Karatzias, T., Brown, M., Grieve, A., Paterson, D., & Walley, R. (2016). Eye movement desensitization and reprocessing (EMDR) for DSM–5 posttraumatic stress disorder (PTSD) in adults with intellectual disabilities: A case study review. Psychological Trauma: Theory, Research, Practice, and Policy, 8(6), 709–719.

Shapiro, R., & Brown, L. S. (2019). Eye movement desensitization and reprocessing therapy and related treatments for trauma: An innovative, integrative trauma treatment. Practice Innovations, 4(3), 139–155.

What are the eight phases of EMDR? To select and enter your answer go to CE Test.

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