EMDR Therapy Primer: Glossary of Terms

TL;DR: Download the glossary here

Looking for this glossary in a handy pdf? Click here to download →

Eye Movement Desensitization and Reprocessing (EMDR):

EMDR therapy is an integrative psychotherapeutic approach recognized as an evidence-based psychotherapy for the treatment of trauma, desensitization of distressing memories, and various other mental health conditions. It is not merely an eye movement technique but a comprehensive eight-phase, three-pronged process guided by the Adaptive Information Processing (AIP) model. Developed by Francine Shapiro, EMDR therapy views traumatic memories as unprocessed information that contributes to current psychological distress. The reprocessing of these memories is facilitated by focusing simultaneously on the disturbing experiences and bilateral stimulation (BLS), most commonly in the form of eye movements, but also including tactile or auditory stimulation. This dual focus is believed to activate the brain’s inherent capacity for adaptive information processing, allowing the traumatic event to be integrated in a healthier and less distressing way. The three-pronged approach of EMDR therapy comprehensively targets past events that laid the foundation for present difficulties, present triggers that evoke distress related to those past events, and future templates to help the client develop more adaptive coping mechanisms and desired responses. The ultimate aim of EMDR therapy is to achieve the most profound and comprehensive treatment effects possible in the shortest period of time, while maintaining client stability. By addressing the core of traumatic memories, EMDR therapy facilitates the desensitization of their emotional charge and promotes cognitive restructuring.

Adaptive Information Processing (AIP) Model:

The Adaptive Information Processing (AIP) model serves as the fundamental theoretical framework and underlying principles of EMDR therapy, providing an explanation for both the development of psychological pathology and the process of personality development. The AIP model posits that psychological dysfunction arises when disturbing memories are not processed adaptively at the time of the experience and are consequently stored in isolated memory networks in a state-specific form. This means that the emotions, beliefs, sensory information (such as eye movement associations), and physical sensations experienced during the traumatic event remain "stuck" and continue to exert a maladaptive influence on the individual's present experience. The AIP model suggests that the brain has an inherent tendency to move toward a state of health and adaptive resolution, similar to the body's natural healing response to physical injury. EMDR therapy is believed to activate this innate information processing system, facilitating the reprocessing of traumatic memories and their integration with more adaptive information and beliefs. The use of bilateral stimulation (BLS) in EMDR therapy is thought to facilitate this process by enhancing communication between the two hemispheres of the brain, thereby allowing the disturbing information to connect with existing adaptive information and be integrated into a broader, more coherent memory network. The goal is for the traumatic event to be stored with a reduced emotional charge and integrated with a more positive and realistic understanding, leading to symptom relief and psychological healing.

Bilateral Stimulation (BLS):

Bilateral stimulation (BLS) is a core component of EMDR therapy, involving the use of stimuli that alternately activate the left and right sides of the brain. The most common form of BLS used in EMDR therapy is directed eye movements, where the therapist guides the client's eye movements in a rhythmic pattern, typically horizontal. However, BLS can also be delivered through auditory stimulation, such as alternating tones heard through headphones, or tactile stimulation, such as alternating taps on the hands or knees. The specific type, speed, and intensity of BLS are tailored to the client's needs and comfort level. The purpose of bilateral stimulation (BLS) in EMDR therapy is believed to facilitate the reprocessing of traumatic memories and the desensitization of their associated emotional distress. While the exact neurobiological mechanisms are still being researched, several theories suggest that BLS may help to enhance communication between the brain hemispheres, promote the activation of the brain's adaptive information processing system, and facilitate the retrieval and integration of traumatic memories within a broader memory network. Some research indicates that eye movements, a primary form of BLS, may interfere with working memory, reducing the vividness and emotionality of traumatic memories. The choice of BLS modality (eye movements, tones, or tactile stimulation) is often guided by client preference and clinical judgment, although some findings suggest that a client's preferred method may not always be the most effective.

The Eight Phases of EMDR Therapy:

EMDR therapy follows a structured standard protocol consisting of eight distinct phases designed to comprehensively address traumatic memories and promote adaptive resolution. These eight phases provide a roadmap for the therapist and client, ensuring a systematic and thorough approach to treatment.

Phase 1: Client History and Treatment Planning: This initial phase involves a thorough history-taking to gather information about the client's past and present issues, identifying potential target memories and developing an overall treatment plan.
Phase 2: Preparation: In this phase, the therapist prepares the client for the EMDR process by explaining the therapy, addressing any fears or misconceptions, establishing a safe/calm place or other coping strategies, and introducing bilateral stimulation (BLS).
Phase 3: Assessment: This phase focuses on identifying and measuring the different components of the target memory, including the image, negative cognition (NC), positive cognition (PC), associated emotions, body sensations, Validity of Cognition (VoC) scale rating, and Subjective Units of Disturbance (SUD) scale rating.
Phase 4: Desensitization: This is the core reprocessing phase where the client focuses on the target memory and its components while engaging in BLS. The goal is to achieve desensitization, a reduction in the SUD level associated with the memory.
Phase 5: Installation: Once the SUD is significantly reduced, this phase focuses on strengthening and integrating the positive cognition (PC) related to the target memory using BLS, aiming for a VoC rating of 7 (feeling completely true).
Phase 6: Body Scan: The client focuses on any residual body sensations related to the target memory while engaging in BLS to ensure complete reprocessing.
Phase 7: Closure: The therapist ensures the client is stable at the end of each session, regardless of the level of processing achieved. This may involve reinforcing coping strategies or the safe/calm place.
Phase 8: Reevaluation: At the beginning of subsequent sessions, the therapist assesses the client's progress, the maintenance of treatment effects, and the need for further processing of the initial target or other related memorys.

Adherence to these eight phases and the three-pronged approach is crucial for effective EMDR therapy.

Three-Pronged Approach:

The three-pronged approach is a fundamental strategy in EMDR therapy that ensures comprehensive adaptive resolution of the client's presenting issues. This approach involves systematically targeting and reprocessing experiences across three temporal domains: past events, present triggers, and future templates. The first prong focuses on identifying and reprocessing past events, particularly touchstone memories or early experiences that are believed to have laid the foundation for the client's current difficulties and maladaptive patterns. Addressing these historical roots is crucial for dismantling the memory networks that perpetuate distress. The second prong involves targeting present triggers: current situations, stimuli, or internal states that evoke distress and negative reactions related to the unresolved past events. By desensitization of these present triggers, the client can experience greater emotional regulation in their daily life. The third prong focuses on creating future templates: imagined scenarios of desired responses and adaptive coping strategies in future situations that are anticipated to be similar to the targeted past events or present triggers. This proactive element helps to build the client's confidence and resilience in facing future challenges. The three-pronged approach ensures that EMDR therapy addresses not only the historical roots of trauma but also its current manifestations and the client's ability to function adaptively in the future. While the standard order of processing is typically past, present, and future, this may be adapted based on the client's specific needs and clinical presentation.

Target Memory:

The target memory is a specific and agreed-upon incident, experience, image, or the most disturbing aspect thereof that the client consciously focuses on during the active reprocessing phases (specifically the desensitization phase (Phase 4) and the installation phase (Phase 5)) of EMDR therapy. The selection of the target memory is a collaborative process between the therapist and the client during the client history and treatment planning (Phase 1) and assessment phase (Phase 3). An effective target memory is typically concrete rather than abstract and representative of the core of the client's presenting issue or the most distressing element of a traumatic event. During the assessment phase, the target memory is activated, and its various components are identified and measured, including the image that best represents the incident, the negative cognition (NC) associated with it, the preferred positive cognition (PC), the emotion felt, the body sensations experienced, the SUD scale rating of current distress, and the VoC scale rating of the positive cognition. The target memory serves as the focal point for the reprocessing with bilateral stimulation (BLS). As processing unfolds, associations to other related memory networks may arise, but the client is gently guided back to the target memory to continue the desensitization process until the disturbance is reduced. The goal is for the target memory to be reprocessed to a point where it no longer elicits significant distress and is integrated with a more adaptive understanding and a stronger belief in the positive cognition.

Touchstone Memory:

A touchstone memory is a specific type of past memory identified in EMDR therapy. It is considered a foundational memory that lays the groundwork for a client’s current presenting issue or problem. Often, the touchstone memory represents the first time a client may have formed a particular negative belief about themselves or experienced a specific type of distress. These memories frequently, but not always, originate in childhood or adolescence. Identifying and reprocessing touchstone memories earlier in the treatment can be particularly beneficial as they often lie at the core of maladaptive memory networks and contribute significantly to present dysfunction. Shapiro refers to the touchstone memory as a node to which similar events will attach in the continuous formation of a “neuro” or memory network that is critical to the client’s sense of self. It can act as a portal into the broader memory network, allowing different associations to arise during processing. Techniques such as the floatback technique or the affect scan can be used to help clients access and identify touchstone memories. Once identified, touchstone memories are targeted and reprocessed using the standard EMDR protocol, which can lead to more spontaneous and comprehensive healing across the associated memory network. Processing the touchstone event can sometimes lead to the resolution of many related present triggers and past events without needing to target them individually.

Present Triggers:

Present triggers refer to current stimuli – which can be internal (e.g., thoughts, emotions, body sensations) or external (e.g., people, places, situations, sounds, smells) – that evoke distress and negative reactions in the client. These triggers are typically related to past unresolved experiences, particularly traumatic memories that have not been adequately processed. Present triggers can elicit a range of distressing responses, including anxiety, fear, sadness, anger, flashbacks, intrusive thoughts, and physical discomfort. In EMDR therapy, after addressing past events, the focus shifts to identifying and reprocessing present triggers that continue to activate the client's distress and maladaptive patterns. The goal of reprocessing present triggers is to desensitize the client to these stimuli, reducing their ability to evoke a negative emotional or physical response. This involves targeting the trigger, identifying the associated image, negative cognition (NC), emotion, and body sensation, and then reprocessing this material using bilateral stimulation (BLS) until the Subjective Units of Disturbance (SUD) scale rating is significantly reduced. It is important to address present triggers as they represent the ongoing impact of unresolved past events on the client's current functioning and well-being. Successfully reprocessing present triggers can lead to a significant reduction in daily distress and an increased sense of control and emotional regulation. Following the reprocessing of each present trigger, a future template is often developed to help the client anticipate and respond more adaptively in similar situations.

Future Template:

A future template is a key element of the three-pronged approach in EMDR therapy, focusing on imagined scenarios of desired responses in future situations related to the targeted issues. After past events and present triggers have been identified and reprocessed, the focus shifts to preparing the client for future encounters that might have previously been triggering or anxiety-provoking. The development of a future template involves the client imagining themselves in a specific future situation related to their past trauma or present difficulties and envisioning a desired outcome – how they would like to feel, think, and behave in that situation. This process often involves identifying and incorporating new, more adaptive beliefs (similar to **positive cognition (PC)**s), skills (such as assertiveness or coping strategies), and emotional responses. While the client imagines this future scenario, bilateral stimulation (BLS) is used to strengthen the association between the situation and the desired adaptive response, reducing anticipatory anxiety and building confidence. Shapiro refers to this as targeting a future or positive template. The use of the future template provides the client with a means of resolving any anticipatory anxiety they may still experience in similar future situations and helps them to appropriately and properly assimilate the new information gained through the processing of past and present prongs by providing them with experiences that ensure future successes. There are different types of future templates, including those focused on desired outcomes, skills-building and imaginal rehearsal, and addressing anticipatory anxiety.

Assessment Phase (Phase 3):

The assessment phase (Phase 3) of EMDR therapy is a crucial stage that follows client history and treatment planning (Phase 1) and preparation (Phase 2). Its primary purpose is to identify, assess, and measure the key components of the target memory selected for reprocessing. This phase ensures that both the therapist and the client have a clear understanding of the specific elements associated with the target memory before active reprocessing begins. The therapist guides the client to focus on the chosen target memory and then systematically elicits information about: the image (or picture) that best represents the incident; the negative cognition (NC) – a negative belief the client holds about themselves related to the memory; the positive cognition (PC) – a positive belief the client would prefer to have; the primary emotion experienced during the event; the location of any body sensations associated with the memory; the client's current level of emotional distress rated on the Subjective Units of Disturbance (SUD) scale (typically a 0-10 scale); and the degree to which the client believes the positive cognition at present, rated on the Validity of Cognition (VoC) scale (typically a 1-7 scale). These components and baseline measures are recorded as they serve as a foundation for tracking progress during the subsequent desensitization phase (Phase 4) and installation phase (Phase 5). The assessment phase should always follow a specific order to effectively activate the trauma memory network, moving from cognitive and visual elements to emotional and somatic experiences.

Negative Cognition (NC):

A negative cognition (NC) is a negative belief associated with the target memory that the client currently holds about themselves. It is identified and assessed during the assessment phase (Phase 3) of EMDR therapy. The negative cognition typically reflects the client's interpretation of the traumatic event and often contributes to feelings of worthlessness, shame, guilt, fear, or lack of safety. It is crucial that the negative cognition is self-referencing and reflects what the client believes about themselves in relation to the target memory in the present moment. Examples of negative cognitions include "I am not safe," "It was my fault," "I am unlovable," or "I am powerless". The negative cognition is often elicited by asking the client, "When you focus on the image (or picture) that represents the worst part of the memory, what negative thought about yourself goes with that?". It is important for the therapist to help the client identify a negative cognition that resonates most strongly with the target memory. The negative cognition serves as one of the key elements that is targeted for change during the desensitization phase (Phase 4) of EMDR therapy. The goal is for the reprocessing to lead to a decrease in the believability of the negative cognition and an increase in the believability of the positive cognition (PC).

Positive Cognition (PC):

A positive cognition (PC) is a positive belief that the client would prefer to have about themselves in relation to the target memory. It is identified and assessed during the assessment phase (Phase 3) of EMDR therapy, following the identification of the negative cognition (NC). The positive cognition represents the desired direction of change – how the client would like to think about themselves in connection with the target memory after successful reprocessing. It should be realistic and attainable for the client, even if it doesn't feel completely true at the beginning of therapy. Examples of positive cognitions that might correspond to the negative cognitions mentioned earlier include "I am safe now," "I did the best I could," "I am worthy of love," or "I can handle things". The positive cognition is often elicited by asking the client, "What positive statement would you like to believe about yourself in relation to this memory?" or "What words would you like to go with the image that express your positive belief about yourself now?". During the installation phase (Phase 5) of EMDR therapy, the positive cognition is strengthened and integrated with the reprocessed target memory using bilateral stimulation (BLS). The therapist works with the client until the positive cognition feels completely true (rated a 7 on the Validity of Cognition (VoC) scale) when the client focuses on the target memory.

Validity of Cognition (VoC) Scale:

The Validity of Cognition (VoC) scale is a scale used to measure the degree to which the client believes the positive cognition (PC). It is typically an 11-point Likert scale ranging from 1 to 7 (though sometimes a 1-7 scale is explicitly used), where 1 represents that the positive cognition feels completely false or unbelievable in relation to the target memory, and 7 indicates that it feels completely true and fully integrated with the memory. The VoC scale is administered during the assessment phase (Phase 3) to get a baseline measure of the client's initial belief in the chosen positive cognition. It is then used again during the installation phase (Phase 5) to track progress as the positive cognition is strengthened and integrated with the reprocessed target memory using bilateral stimulation (BLS). The goal of the installation phase is for the client's VoC rating to reach a 7, signifying a strong and internalized belief in the positive cognition when thinking about the target memory. If the VoC does not reach a 7, the therapist may explore for blocking beliefs or consider whether the current level is ecologically valid for the client. The VoC scale provides a cognitive measure of the client's progress in EMDR therapy, complementing the emotional measure provided by the Subjective Units of Disturbance (SUD) scale.

Subjective Units of Disturbance (SUD) Scale:

The Subjective Units of Disturbance (SUD) scale is a scale used to measure the client’s current level of emotional distress associated with the target memory. It is typically an 11-point Likert scale ranging from 0 to 10, where 0 represents no disturbance or feeling completely calm when focusing on the target memory, and 10 represents the highest level of disturbance or distress the client can imagine. The SUD scale is administered during the assessment phase (Phase 3) of EMDR therapy to establish a baseline measure of the client's emotional distress related to the target memory. It is then used periodically during the desensitization phase (Phase 4) to track the client's progress as the target memory is reprocessed using bilateral stimulation (BLS). The goal of the desensitization phase is for the client's SUD rating to decrease significantly, ideally reaching a 0 or a level that is considered ecologically valid (an appropriate level of disturbance given the circumstances). The SUD scale provides a crucial emotional measure of the client's response to EMDR therapy and indicates when the emotional charge associated with the traumatic memory has been sufficiently reduced, allowing the therapist to move on to the installation phase. The SUD scale and the Validity of Cognition (VoC) scale work together to provide a comprehensive picture of the client's progress in EMDR therapy, addressing both emotional distress and cognitive belief.

Desensitization Phase (Phase 4):

The desensitization phase (Phase 4) is the primary reprocessing stage of EMDR therapy, where the client processes the target memory using BLS while focusing on the different components of the memory identified in the assessment phase (Phase 3). The goal of this phase is to reduce the disturbance associated with the memory, as measured by the SUD scale. The therapist instructs the client to focus on the image or incident, the negative cognition (NC), and the location of the negative body sensations, and then initiates bilateral stimulation (BLS), typically eye movements. After a set of BLS (usually around 20-24 passes), the therapist stops and asks the client, "What are you noticing now?". The client reports any shifts in image, thoughts, feelings, or body sensations. The therapist then instructs the client to "Go with that" and initiates another set of BLS, allowing the client's brain to make associations and process the memory. This process of focusing on the target memory and its components while undergoing BLS, followed by brief reports, continues in sets until the client reports a significant reduction in distress (ideally an SUD of 0 or 1, or a level considered ecologically valid) and the associated negative self-belief begins to shift. During this phase, new insights, emotions, and memories may emerge as the memory network is activated and reprocessed.

Installation Phase (Phase 5):

The installation phase (Phase 5) of EMDR therapy occurs after the desensitization phase (Phase 4) when the distress associated with the target memory, as measured by the SUD scale, has significantly reduced (ideally to a 0 or 1, or an ecologically valid level). The primary focus of this phase is strengthening and integrating the positive cognition (PC) with the reprocessed memory using BLS. The therapist instructs the client to focus on the target memory along with the chosen positive cognition (e.g., "I am strong," "I am safe now," "I am good enough"). The client is then asked to rate how true the positive cognition feels now, on the Validity of Cognition (VoC) scale (typically 1-7, where 7 means completely true). While the client holds both the target memory and the positive cognition in mind, the therapist administers sets of bilateral stimulation (BLS). After each set, the client is asked to notice any changes in how true the positive cognition feels. The installation phase continues with successive sets of BLS until the positive cognition feels completely true (a VoC rating of 7) when the client focuses on the target memory. This process helps to establish a strong and adaptive cognitive framework in relation to the previously distressing memory, promoting healing and resilience.

Body Scan (Phase 6):

The body scan (Phase 6) of EMDR therapy is conducted after the installation phase (Phase 5), once the positive cognition (PC) has been strengthened and feels true in relation to the reprocessed target memory. The purpose of the body scan is to identify and address any remaining physical sensations in the client's body related to the target memory while engaging in BLS. The therapist instructs the client to close their eyes, bring to mind the original event (incident, experience) and the positive cognition, and then to focus their attention on different parts of their body, starting from the head and moving downwards. The client is asked to notice any areas where they feel any tension, tightness, discomfort, or unusual sensations. If the client identifies any such body sensations, they are instructed to focus on that sensation while the therapist administers sets of bilateral stimulation (BLS). This processing continues until the body sensation subsides or resolves. The body scan is important because unresolved physical residue can sometimes indicate that the traumatic memory has not been fully processed at a somatic level. Ensuring a clear body scan (i.e., the absence of residual negative associated sensations) increases the probability of a positive treatment effect and indicates that the reprocessing of the dysfunctional material is nearing completion.

Closure Phase (Phase 7):

The closure phase (Phase 7) of EMDR therapy occurs at the end of each session, regardless of whether the target memory has been fully processed (i.e., SUD of 0, VoC of 7, and clear body scan) or if the session needs to end with incomplete processing. The primary goal of the closure phase is to ensure that the client leaves the session feeling stable and grounded, returned to a state of emotional equilibrium, and with a sense of safety and containment. If processing was incomplete, the therapist helps the client to contain any residual disturbance using techniques such as the safe/calm place exercise, the container exercise, or relaxation techniques. It is important not to recheck the SUD or VoC levels or revisit the target memory if processing is incomplete, as this could reactivate distress. The therapist briefs the client on what to expect after the session, reminding them that processing may continue, and encourages them to use self-soothing techniques and to keep a log (e.g., TICES log) of any emerging thoughts, feelings, memories, or dreams. The therapist also provides reassurance and lets the client know they can contact them if needed. Even after a complete session, a similar debriefing is conducted, reinforcing the positive processing and again mentioning the possibility of continued processing between sessions and the use of self-control techniques. The closure phase is essential for ensuring the client's well-being and stability both at the end of the session and in between sessions.

Reevaluation Phase (Phase 8):

The reevaluation phase (Phase 8) of EMDR therapy is an ongoing process that takes place at the beginning of each subsequent session following EMDR reprocessing. The purpose of this phase is to assess the client's progress, determine if the treatment effects from the previous session have held, identify any new material that may have emerged (such as related memories or present triggers), and plan the focus for the current session. The therapist checks the client's log (if they kept one) and asks about any changes they have noticed in their thoughts, feelings, behaviors, or dreams since the last session. The client is then asked to bring up the target memory that was worked on previously to reassess its current level of disturbance (using the SUD scale) and the believability of the positive cognition (PC) (using the VoC scale). If the target memory remains at a low level of disturbance (SUD of 0 or 1) and the positive cognition feels true (VoC of 7), the therapist and client can decide to move on to a new target. If the reprocessing was incomplete in the prior session, the reevaluation phase helps to determine where to resume the processing. The reevaluation phase is also crucial for ensuring that all three prongs of the EMDR approach (past events, present triggers, and future templates) are being addressed as part of the overall treatment plan and for determining when treatment goals have been met and therapy can be terminated.

Safe/Calm Place:

The safe/calm place is a resource development exercise used in the Preparation Phase of EMDR therapy to provide the client with a sense of safety and calm that can be accessed during or between sessions. During the preparation phase, the therapist guides the client to create an imagined place where they feel completely safe, calm, peaceful, and in control. This place can be real or imagined, and the client is encouraged to engage all their senses to make it as vivid and comforting as possible, noting the sights, sounds, smells, tastes, and tactile sensations. The client also identifies a cue word or image that they can use to quickly access this safe/calm place whenever needed. The safe/calm place serves several important functions in EMDR therapy: it introduces the client to bilateral stimulation (BLS) in a non-threatening way as BLS (often short, slow sets) is used to strengthen the feeling of safety and calm associated with the place; it provides the client with a self-regulation tool that they can use to manage any distress that may arise before, during, or after reprocessing sessions; and it helps the therapist assess the client's ability to shift emotional states. The safe/calm place can also be used during the closure phase of a session to help stabilize the client before they leave.

Resource Development and Installation (RDI):

Resource Development and Installation (RDI) are strategies used in the Preparation Phase of EMDR therapy to enhance a client’s ability to access positive feelings, cognitions, and behaviors, especially for clients with complex trauma or significant affect dysregulation. Unlike the safe/calm place exercise, RDI focuses on identifying, developing, and strengthening specific positive resources that the client may need to cope with distress or to facilitate reprocessing. These resources can include positive introjects (e.g., feeling loved, capable, or safe), positive affects (e.g., joy, courage, compassion), or adaptive behaviors (e.g., assertiveness, self-soothing). The RDI process involves the therapist helping the client to identify a desired resource, explore its qualities, and then use bilateral stimulation (BLS) (typically shorter and slower sets compared to reprocessing) to strengthen the client's access to and experience of that resource. The therapist may also help the client to link a cue word or image to the resource to facilitate easy access. RDI is particularly helpful for clients who have difficulty generating a safe/calm place or who lack sufficient internal resources to manage the intensity of reprocessing. By building and installing these positive resources before trauma work begins, RDI aims to increase the client's window of tolerance, enhance their ability to self-regulate, and create a stronger foundation for safely and effectively reprocessing disturbing memories.

Cognitive Interweaves:

Cognitive interweaves are therapist interventions used during the Desensitization Phase (Phase 4) of EMDR therapy to address blocked processing or maladaptive beliefs that emerge and impede the natural flow of reprocessing. When a client's processing seems blocked (e.g., no new associations or shifts occur across several sets of BLS, or the SUD level remains stuck), cognitive interweaves can be strategically introduced to stimulate new associations, challenge dysfunctional thinking, and help the client move towards adaptive resolution. Cognitive interweaves can take various forms, such as offering information, reframing a thought, posing a question that encourages a different perspective, or bringing in a relevant aspect of the Adaptive Information Processing (AIP) model. They are intended to gently guide the client's processing without taking over or directing it. Examples of cognitive interweaves include asking, "What would you tell a child who had this experience?" or reminding the client that "What was adaptive then may not be adaptive now". Cognitive interweaves should be used judiciously and sparingly, as the goal of EMDR therapy is to facilitate the client's own natural processing. If a cognitive interweave helps to unblock the processing and a shift occurs, the therapist should allow the client's brain to resume its spontaneous associative flow.

Abreaction:

An abreaction is an intense emotional release that may occur during the Desensitization Phase (Phase 4) of EMDR therapy. It represents a discharge of pent-up emotions associated with the traumatic memory as the client reprocesses the event. During an abreaction, the client may experience a surge of strong feelings, such as intense sadness, anger, fear, or grief, which can be accompanied by physical expressions like crying, shaking, or vocalizations. While some level of emotional response is a normal part of EMDR processing, an abreaction is characterized by a particularly high intensity of affect. It is important for the therapist to have prepared the client for the possibility of strong emotions and to have established safety measures, such as a stop signal, before reprocessing begins. During an abreaction, the therapist's role is to provide support and containment, reassuring the client that these feelings are related to the past and that they are safe in the present. The therapist continues with bilateral stimulation (BLS) until the intensity of the emotional response begins to subside, helping the client to move through the abreaction towards adaptive resolution. It is crucial for the therapist not to interrupt an abreaction prematurely unless the client requests to stop, as the release of emotion is often a sign that processing is occurring.

Blocked Processing:

Blocked processing occurs in EMDR therapy when the client’s reprocessing of a target memory stalls or no new associations emerge across two or more consecutive sets of bilateral stimulation (BLS). This can manifest as the client reporting "nothing," experiencing the same thoughts, emotions, or body sensations repeatedly without any shift, or the Subjective Units of Disturbance (SUD) scale rating remaining unchanged. Blocked processing indicates that the natural associative flow within the memory network has become impeded, preventing the traumatic memory from reaching adaptive resolution. There can be various reasons for blocked processing, including the presence of ancillary targets such as feeder memories, blocking beliefs, or fears related to the reprocessing itself or its potential outcomes. When blocked processing is identified, the therapist has several strategies they can employ to attempt to restart the processing. These include changing the mechanics of the BLS (e.g., speed, intensity, direction, modality), shifting the client's focus to their body sensations or back to the target memory, or introducing a cognitive interweave to offer a new perspective or address a potential blocking belief. The goal of these interventions is to remove the block and allow the client's innate adaptive information processing system to resume its natural course towards integrating the traumatic memory.

Memory Network:

A memory network in the context of EMDR therapy refers to the way the brain stores related memories, thoughts, images, emotions, and sensations that are linked to one another. According to the Adaptive Information Processing (AIP) model, these memory networks form the basis of our perceptions, attitudes, behaviors, and overall mental health. Disturbing or traumatic memories are believed to be stored dysfunctionally within these networks, often isolated and unprocessed, preventing them from linking with more adaptive information and leading to current distress and maladaptive responses. The goal of EMDR therapy is to facilitate adaptive resolution within these networks. During the desensitization phase (Phase 4), as the client focuses on the target memory and engages in bilateral stimulation (BLS), the memory network associated with that event is activated. The BLS is believed to help create new connections between the distressed memory network and more adaptive information stored in other networks, allowing for the reprocessing and integration of the traumatic memory. This process can lead to new insights, a reduction in emotional distress (SUD scale), a shift in negative cognitions (NC), and the strengthening of positive cognitions (PC). The concept of the memory network highlights the interconnectedness of our experiences and how reprocessing one traumatic memory can often lead to positive changes in related memories and triggers throughout the network.

Wrap up

Looking for this glossary in a handy pdf? Click here to download →

Frequently asked questions about EMDR:

Q: What is EMDR therapy and how does it relate to trauma?

A: EMDR therapy, or Eye Movement Desensitization and Reprocessing, is a type of therapy designed to help people reprocess traumatic memories. It uses specific techniques to address both the left and right sides of the brain, helping to reduce the impact of trauma on the client.

Q: How do EMDR sessions typically go?

A: In EMDR sessions, the clinician usually keeps an active list of any nodes that arise during reprocessing. They guide the client through the process of recalling traumatic events while using bilateral stimulation, like guided eye movements, to help desensitize the trauma.

Q: What are nodes in the context of EMDR therapy?

A: Nodes are specific memories or associations that are identified by the clinician as representing critical areas of dysfunction. These nodes can produce the same conditioned response when triggered, so addressing them is key in EMDR therapy.

Q: Can EMDR therapy really help with trauma?

A: Absolutely! EMDR works by helping clients reprocess traumatic memories, which can lead to a significant reduction in the distress associated with those memories. Many clients find that they can finally move past events that have the greatest emotional impact on their lives.

Q: What does it mean when a clinician says trauma may be a constellation of issues?

A: When a clinician says trauma may be a constellation, they mean that a single traumatic event can be linked to multiple related issues or symptoms. EMDR helps to address these interconnected memories and feelings during therapy.

Q: How does a clinician determine what to focus on during EMDR therapy?

A: The clinician usually keeps an active list of nodes that arise during reprocessing and reevaluates them throughout the sessions. They work collaboratively with the client to identify which memories or feelings are most pressing to address.

Q: Is EMDR therapy effective for everyone dealing with trauma?

A: While many people find EMDR therapy to be very effective, results can vary. It’s important for the clinician to tailor the approach to the individual needs of the client, as everyone's experience with trauma is unique.

Q: Where can I find more information about the neurobiological basis of EMDR therapy?

A: A great resource is the book "Neurobiological Foundations for EMDR Practice" by Uri Bergmann. Springer Publishing has a lot of literature on EMDR and its applications in treating trauma. They offer books and articles that can provide deeper insights into the therapy process. (We are not related to or compensated by the publisher for this information.)

Glossary of EMDR Therapy Terms: Eye Movement, Desensitization, and Trauma Reprocessing