Phase 2: Preparation

Key features in this phase include:

• Strengthen therapeutic alliance to foster the client’s ability to tell the therapist what the client is experiencing throughout reprocessing.
• Educate the client about EMDR therapy processes and address client’s questions and concerns to ensure they can provide adequate informed consent.
• Enhance relaxation and affect regulation skills to appropriately facilitate dual attention during reprocessing and maintain stability between sessions. For clients with complex PTSD, it might be more beneficial to introduce affect regulation skills before proceeding with history-taking.
• Some clients may require more preparation phase for adequate stabilization and for the development of adaptive resources before dealing with disturbing memories.
• Some EMDR-derived techniques can be used to provide stabilization.

Phase 3: Target Assessment

Key features of this phase include:

• Engage with target memory before reprocessing begins.
• Identify components of the target memory: Image, Negative Cognition, Positive Cognition, Emotions, and location of disturbance in the body.
• Evaluate components of memory: Validity of the Cognition (VoC), Subjective Units of Disturbance (SUD).

Phase 4: Desensitization

Key features of this phase include:

• Begin eye movement (or other BLS) sets.
• Focus on the client’s negative affect, as reflected in the SUD scale. This phase of treatment encompasses all responses, including new insights and associations, regardless of whether the client’s distress level is increasing, decreasing, or stationary.
• Initiate processing of the target memory. The therapist asks the patient to focus simultaneously on the image, the negative cognition, and the body sensation.
• Use sets of dual attention Bilateral stimulation to activate the client’s information processing.
• During the desensitization phase, the clinician repeats the sets, with appropriate variations and changes of focus, if necessary, until the client’s SUD level is reduced to 0 or 1 (or is otherwise “ecologically appropriate” to the individual given his present circumstances). A zero or 1 SUD indicates that the primary dysfunction involving the targeted event has been cleared. However, reprocessing is still incomplete, and the information will need to be addressed further in the crucial remaining phases.

The memory is activated, and the clinician asks the client to notice his/her experiences while the clinician provides alternating bilateral stimulation. After each set of bilateral stimulation, the client reports their observations. These may include new insights, associations, information, and emotional, sensory, somatic, or behavioral shifts. The clinician uses specific procedures and interweaves if processing is blocked. The desensitization phase continues until the SUD level is reduced to zero (or an ecologically valid rating). It is important during this phase to assist the individual in maintaining an appropriate level of arousal and affect tolerance.

Phase 5: Installation

Key features of this phase include:

• Links the newly processed memory to the adaptive belief about the self, using fast dual attention BLS.
• Strengthens connections to adaptive memory networks and optimizes new learning.
• The therapist first asks the client to check for a potential new positive belief related to the target memory.
• The client selects a new belief or the previously established positive cognition.
• The clinician asks the client to hold this in mind, along with the target memory, and to rate the selected positive belief on the VOC scale of 1 to 7.
• The therapist then continues alternating bilateral stimulation until the client's rating of the positive belief reaches the level of 7 (or an ecologically valid rating) on the VOC Scale.

Phase 6: Body Scan

Key features of this phase include:

• After the positive cognition has been fully installed, the client is asked to hold in mind both the target event and the positive cognition and to scan her body mentally from top to bottom.
• The client identifies any residual disturbance in the form of body sensation.
• The therapist continues bilateral stimulation when these bodily sensations are present until the client reports only neutral or positive sensations.

Phase 7: Closure

Key features of this phase include:

• The client must be returned to a state of emotional equilibrium by the end of each session, whether or not the reprocessing is complete.
• Shifts client's focus of attention away from memory work and reorients to present-day context. The therapist may use a variety of techniques to orient the client fully to the present and facilitate the client's stability after the session and between sessions.
• Clients are prepared for the possibility of continued processing and the use of stabilization strategies as needed.
• The clinician should reassure the client that any disturbing images, thoughts, or emotions that arise between sessions indicate ongoing processing, which is a positive indication.
• The client is advised to maintain a log or journal to record thoughts, situations, dreams, and memories that may arise between sessions. This enables the client to create distance from emotional disturbances through writing. The client takes a “snapshot” that might be used as targets for the upcoming sessions.

Phase 8: Reevaluation

Key features in this phase include:

• Opens each session after the first reprocessing.
• Assess the client’s progress and client’s experience with previously targeted material.
• The client and counselor identify the next steps in the treatment plan.