In recent months, I’ve noticed an increasing number of clients reaching out for EMDR psychotherapy with similar stories of past EMDR (Eye Movement Desensitization and Reprocessing) experiences that, “didn’t go as expected.” Common phrases I hear include, “I had EMDR with another therapist, and it was a bad experience,” or “There was no preparation and no treatment planning before we started” or “I felt horrible the day after and didn’t know what to do to calm myself down.” These experiences, unfortunately, highlight a critical issue in the implementation of EMDR: the necessity of taking adequate time for preparation and planning and ensuring that clients have resources (called “resourcing in EMDR”) to self-regulate after and in between sessions. Furthermore, for those trained in EMDR, this highlights the need to seek professional consultation often and to know when to refer.

Why Preparation, Treatment Planning, and Resource-Building are Essential in EMDR Therapy

The EMDR process is much more than simply moving eyes back and forth while recalling a traumatic event. Preparation, treatment planning, and resource-building are foundational elements of EMDR, as emphasized by numerous experts and research in the field.

1. Preparation Phase: According to the EMDR International Association (EMDRIA), the preparation phase in EMDR Therapy is crucial for establishing a sense of safety and trust between the client and therapist. This phase involves educating the client about the EMDR process, discussing expectations, and establishing a strong therapeutic alliance. A study by Korn (2009) highlights that neglecting this step can lead to overwhelming emotional responses and exacerbate symptoms rather than alleviating them .
2. Treatment Planning: Comprehensive treatment planning in EMDR Therapy is necessary to identify the target memories for processing. The therapist and client collaborate to establish a hierarchy of distressing memories, determining which events to address first. This ensures that EMDR is applied systematically and tailored to the client’s specific needs. How the therapist and their client decide on treatment planning is as varied as the diversity of clients and reasons one reaches out for EMDR. Your therapist needs to have comfort to adapt to your way of communicating, accessing memories and matching your comfort level. Research suggests that individualized treatment planning improves EMDR outcomes and reduces the risk of re-traumatization (Shapiro, 2018) .
3. Resource-Building: Resource-building involves developing coping strategies and internal resources that the client can use to manage distress. This might include techniques such as guided imagery, “safe” or calm-place exercises, or relaxation methods. These resources serve as vital tools for clients to handle emotional responses during and after EMDR sessions. Leeds (2009) emphasizes that clients without sufficient internal resources may find EMDR destabilizing rather than healing. I have conducted thousands and thousands of hours of EMDR with clients and, though every person is unique, part of knowing a client is “resourced” enough comes with clinical-insight that is gained through the multitude of hours of practice of EMDR. There are some clients who can safely proceed with EMDR after one session of resourcing, while others require weeks, months or even years of learning how to ground in safety and calm. In sum, the majority of those seeking EMDR only need one to two sessions of resourcing (with ongoing coping skills injected as needed); but, if your EMDR-therapist jumps this step (which is what many of the prospect phone calls I get are infering has occured when they say “I had a bad experience”), this can lead to serious instability between sessions.

Why Rushing EMDR Therapy Can Be Harmful

Rushing into EMDR without adequate preparation can lead to adverse outcomes. Clients may become overwhelmed by the emotional intensity of processing traumatic memories without the necessary coping mechanisms in place. This can result in a “bad experience,” as many of my clients have reported from their past encounters with the therapy. And in full disclosure, humans are complex beings. I have worked wiht clients for years, who have demonstrated capacity to handle EMDR and report “it works and I feel better.” Then, seemingly out of the blue a session goes side-ways and they are checking-in for an urgent session one to two days afterwards. Does your EMDR therapist have the capacity in their scheudle to handle these situaitons? Do you have a crisis plan? Has your EMDR therapist talked to you adequalty about how to handle situiatnios like this if they arise. If not, be wary.

EMDR Therapy May Not Be for Everyone

It’s also important to acknowledge that EMDR may not be suitable for everyone. While my peers know I am an EMDR-nut because of how I’ve seen it transform people’s lives, and while it has been shown to be highly effective for many individuals, particularly those with PTSD, there are cases where EMDR might not be the best therapeutic approach. Research by Cusack et al. (2016) suggests that clients with severe dissociative disorders, certain personality disorders, or those who are not yet stabilized might require alternative or adjunctive therapies before considering EMDR. I have (and do) work with client’s with varying dissociative symptoms. Unfortunately there isn’t a playbook or a script for working through these symptoms. There are ample trainings (I’ve done many). There are experts on EMDR and Dissociation (I’ve trained with many of them and keep one on speed-dial to pay for consultation when needed). These symptoms with EMDR requires a deep, meaningful therapeutic rapport between the clinician and the client built on trust and understanding: understanding that the clinican will not let the client down and understanding from the client that they will make all efforts to apply coping strategies to their best ability, reporting back honestly if they do not work so new strategies can be developed. But, in the end, an EMDR clinican MUST know when to refer and when to apply more specialized approaches, like 4-blinks, fractionated processing, etc….

In sum, client readiness is a key factor. Some individuals may need to spend more time in the preparation and resource-building phases before they feel ready to engage in the processing of traumatic memories. In some cases, clients may find that other therapeutic modalities, such as Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT), align better with their needs and treatment goals. I have referred clients who are better suited to DBT (which is a great resourcing therapy) and who reach out to thank me. Some even return with skills learned through those therapeutic experiences, ready to dig in with EMDR.

Conclusion

EMDR therapy can be a transformative healing process, but it requires time, careful preparation, and a well-thought-out treatment plan. Skipping these essential steps can lead to negative experiences, reinforcing the misconception that EMDR “doesn’t work” or is inherently distressing. As with any therapeutic approach, EMDR must be tailored to the individual, taking into account their unique history, needs, and readiness for processing. If you are considering EMDR, ensure that your therapist emphasizes the importance of these preparatory phases and collaborates with you to build a strong foundation for your healing journey and please do not be scared to ask questions like, “are you certified,” “do you plan on getting certified”, “where are you on your certification journey,” “do you consult with a professional,” “can you tell me about advanced EMDR trainings you’ve taken.” Let me be clear, EMDR is amazing and it has changed 100s of my client’s lives. EMDR has also been destabilizing for some, but I have not lost those clients. At its core, the therapeutic rapport must be a tight bond for healing.

I offer EMDR therapy in Washington DC; EMDR therapy in Virginia and EMDR therapy in Florida. My office for in-person sessions is in Fort Lauderdale, FL and is tucked away in a safe, secure, quiet and low-key, residential location. I work with adults (18+), established professionals from a variety of industries, and high-profile individuals. My clients know me to be a clinican of my word. If I say I will follow-through, I do. Finally, I am resourced in the communities I offer services, with connections for other types of therapy, hospitalization, IOP, or psychiatry, and will (at your request) coordinate care with other medical practitioners who are willing to colaborate.

References:

1. Korn, D. L. (2009). EMDR and the treatment of complex PTSD: A review. Journal of EMDR Practice and Research, 3(4), 264-278.
2. Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures. Guilford Press.
3. Leeds, A. M. (2009). A Guide to the Standard EMDR Therapy Protocols for Clinicians, Supervisors, and Consultants. Springer Publishing.
4. Cusack, K., Jonas, D. E., Forneris, C. A., et al. (2016). Psychological Treatments for Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis. Psychological Trauma: Theory, Research, Practice, and Policy, 8(3), 334-345.