What are Phases 3 & 4 of EMDR Therapy?
Phase 3 of EMDR Therapy is known as the assessment phase. This phase is intended to be rather quick in nature, as its purpose is to activate the memory that you and your therapist have chosen to work on. Phase 4 of EMDR Therapy is known as the desensitization phase. This is the phase that most people think of when they think of EMDR Therapy - this is the part where you focus on the memory, move your eyes, and begin to reprocess stressful life experiences.
Let's go into more detail how and why each of these phases of EMDR Therapy work.
Phase 3 of EMDR Therapy: The Assessment Phase
At this point, you and your therapist have already developed an EMDR therapy treatment plan and have chosen a target memory to start reprocessing. You should have also had space to discuss with your EMDR therapist how you will manage any concerns or fears about starting EMDR therapy, as well as how you will manage any distress that may occur during the reprocessing phase of EMDR therapy.
When starting a 'new target' in EMDR therapy, (a memory that you have identified as needing to be reprocessed) your therapist will ask you a series of 7 questions to bring to mind the memory to be reprocessed. These questions are designed to target the three components of memory: the cognitive, the emotional, and the somatic.
When a target is considered 'incomplete' your therapist will use a shorter variation of those 7 original questions to reengage the memory. Most memories tend to take more than one reprocessing session, so in this case it is considered 'incomplete'. You and your therapist will continue working on it in your next session, and the process will continue until it is cleared out, thus marking it as 'complete'.
Why is phase 3 of EMDR Therapy important?
In order to begin reprocessing a memory, we must bring the past into focus in the present. The goal here is not to retraumatize you, but instead access the memory safely in the present, with your EMDR therapist, while maintaining dual awareness. This means our goal is for you to have one foot in the past and one in the present, so you can access the pain from the past, while staying grounded in the present.
Phase 3 is always done leading directly into Phase 4. Your EMDR therapist will not begin this phase unless there is plenty of time in the session to reprocess as well as contain/ground in the present before the session ends.
How can I expect phase 3 of EMDR Therapy to look and feel?:
Your EMDR Therapist will quickly take you through a series of 7 questions about the memory that you are working on. These questions are designed to light up both the left and right hemispheres of your brain, which activates your nervous system so that you can begin to reprocess the memory.
The 7 Target Questions of EMDR Therapy Are:
Image: What image represents the worst part of the memory?
Negative Cognition (NC): What is the belief that you have about yourself when you think of this image?
Positive Cognition (PC): What would you prefer to belief about yourself?
Validity Of Cognition (VOC): On a scale of 1-7, how true do the words (PC) feel to you now as you think of the memory?
Emotion: What emotion(s) are you noticing right now?
Subjective Units of Disturbance (SUD): On a scale of 0-10, how disturbing does the memory feel to you now?
Body: Where do you notice it in your body? (tension, tightness, discomfort?)
Again, the goal of phase 3 of EMDR Therapy is to quickly activate the nervous system to begin the reprocessing. You can expect this phase to be quick and lead directly into phase 4 of EMDR Therapy.
Phase 4 of EMDR Therapy: Desensitization
What does desensitization mean in EMDR Therapy?
Up to this point, the Bilateral Stimulation (BLS) in EMDR Therapy that you have become familiar with, is slow and short sets (used in Phase 2). During Phase 4 of EMDR, you will notice that the bilateral stimulation speed is faster and the time in between passes is longer.
It's important to have realistic expectations around speed of reprocessing memories in phase 4 of EMDR. In most cases, it may take more than one session to fully clear out or bring a memory down to a Subjective Unit of Disturbance (SUD) of 0 with a clear Body Scan.
EMDR Therapy cannot take a “bad experience” and turn it into a “good experience”, but it can stop the "bad experience" from affecting you day-to-day. The goal of reprocessing in EMDR Therapy is to help your brain correctly store the traumatic memory in a way where it is no longer hijacking your nervous system (and causing intense reactions) whenever you are triggered in the present.
The goal of phase 4 of EMDR Therapy is to desensitize the target memory, and reduce the level of disturbance and associated symptoms (including thoughts, feelings, actions and sensations.)
The reality of reprocessing in EMDR Therapy is that it's pretty common to feel worse before you feel better. That means that it's working! Trust the process and know that in some cases the level of disturbance (SUD) may increase before decreasing.
Why does it phase 4 of EMDR Therapy work?
The speed and length of BLS used in Phase 4 mimics what happens in our brains during REM sleep. (If you've ever watched someone's eye lids when they're sleeping you may have noticed their eyes moving left and right- this is exactly what BLS does). The length and speed of BLS is what promotes the reprocessing of the traumatic memory.
Desensitization of a memory helps promote the digestion of experience(s). New adaptive information that we may not have recognized or acknowledged may come up. A reduction of maladaptive information/thoughts may occur as well. Basically, what happens here is once all the information about an experience is brought to the surface, your brain has the opportunity and ability to keep what is helpful and get rid of what is not helpful.
Some common shifts people experience during Phase 4 of EMDR Therapy may include:
Increased compassion for self and others
New insights/awareness
New core beliefs and shedding of old maladaptive beliefs
Continuity/consistency of sessions important at this stage of treatment. Your therapist may even recommend a longer session at this point to help speed up the processing of the traumatic memory.
How can I expect phase 4 of EMDR Therapy to feel?:
When EMDR was first developed, the bilateral-stimulation that speeds up the reprocessing was done using eye movements. Originally, this was your EMDR therapist moving their fingers horizontally left and right for you to follow.
As time went on, other forms of BLS were identified such as tapping [(using the butterfly-hug, tapping the tops of your knees, or using buzzers (if working in person)]. There is audio bilateral stimulation as well, which plays a sound in one ear and then in the opposing ear back and forth, mimicking the same pattern of eye-movements or tapping. (P.S.- EMDR Therapy is equally as effective, both virtually and in person!)
Depending on what works best for you, your EMDR therapist may decide to use a combination of bilateral-stimulation, such as eye-movements paired with tapping, or tapping paired with audio BLS.
Up to this point, there may have been a blend of talk-therapy happening in your work. During the reprocessing phases of EMDR Therapy, you'll notice limited engagement in dialogue between you and your EMDR therapist. Your brain knows what it needs to process in order to feel more peace (and we don't want to get in the way of that!) We are giving your brain the tools and the space to do the work it can and will do.
Noticing what comes up without judgement is one of the most important factors during phase 4 of EMDR Therapy. During this part of EMDR Therapy, the thoughts, images, insights, sensations, etc. may appear unrelated or unimportant, but trust the process and know that you just need to notice and not judge or make sense of what is coming up.
What you notice in between sets of this phase of EMDR Therapy is unique and individual for each person. Your brain knows what to do and how to get there, so lean back, notice and observe what comes up, and just trust the process.
Your EMDR therapist will be looking out for any additional memories that are unrelated to the memory-network being worked on. If (or when) this happens, containment strategies will be integrated to honor what is coming up, but temporarily set aside so it doesn't impact the processing occurring at the moment.
You may notice between reprocessing sessions:
Shifts in insight or thoughts
Dreams
Triggers (new or old)
Symptoms (increase or decrease)
Physical sensations
This is why it is SO important between reprocessing sessions to practice your tools and coping skills acquired through Phase 2 of EMDR Therapy, the Resourcing Phase.
It is helpful to keep a log (such as the TICES log (Trigger, Image, Cognition, Emotion, Sensation) found in The EMDR Therapy Progress Journal by Dana Carretta-Stein) of any shifts/changes experiences between sessions.
If you missed Part 1- EMDR: Breaking Down the 8 Phases of this series - Check it out to learn more about EMDR Therapy and how it works. And read on for Part 3 of Breaking down the 8 Phases of EMDR Therapy.
Annabella Lipson is a Mental Health Counselor at Peaceful Living Mental Health Counseling.
She enjoys working with young adults & adults who are dealing with stress, anxiety, grief, trauma, PTSD and other challenges.
Annabella helps clients develop healthy communication skills, learn to tolerate and manage uncomfortable emotions and develop insightful decision-making skills.
Want to know even more about how EMDR Therapy works? Check out The EMDR Therapy Progress Journal: An interactive guide to support you through the life changing process of EMDR Therapy and overcome anxiety, depression, PTSD and other trauma-related stressors for good.