The 8 phases of EMDR therapy, explained

Why the structure matters

EMDR is based on the adaptive information processing (AIP) model. Distressing experiences that were never fully processed stay stored with their original images, emotions, body sensations and beliefs, and these are triggered again in the present. The eight phases make sure that the client is stable enough to access such memories, that a memory is activated in a way you can measure, and that every session ends safely.

The structure is also what the guidelines ask for. The NICE guideline on PTSD, for example, says EMDR should be based on a validated manual and delivered by trained practitioners with ongoing supervision.

Phase 1: History taking and treatment planning

The therapist gathers the client's history, current symptoms and goals, and checks whether EMDR is suitable right now. Together they identify targets: past events at the root of the problem, present situations that trigger it, and future situations the client wants to handle differently. This past–present–future sequence is often called the three-pronged approach. Screening for dissociation belongs in this phase too, for example with the Dissociative Experiences Scale (DES).

Online: also note the address the client usually joins from, an emergency contact and the local emergency number. You need these if a session goes wrong.

Phase 2: Preparation

The therapist explains how EMDR works, agrees on a stop signal and teaches the client ways to regulate emotions, such as a calm place exercise or a container. The goal is that the client can tolerate the distress that reprocessing may bring up and can return to the present. For clients with complex trauma, this phase can take many sessions.

This is also when the client gets used to the bilateral stimulation itself: the speed, size and type that feel comfortable. Our guide to calm place, container and resource exercises covers this phase in detail.

Online: test the stimulus on the client's screen and headphones now, not halfway through a reprocessing set.

Phase 3: Assessment

The therapist activates the target memory in a structured way. The client identifies:

• the image that represents the worst part of the memory,
• the negative cognition (NC): a present-tense belief about themselves, such as “I am powerless”,
• the positive cognition (PC) they would prefer to believe, such as “I can protect myself now”, rated on the Validity of Cognition scale (VoC, 1–7),
• the emotions they feel now, how disturbing it feels on the SUD scale (0–10), and where they feel it in the body.

These baseline ratings let you measure progress. See how to use the SUD and VoC scales.

Phase 4: Desensitisation

The client holds the target in mind while following sets of bilateral stimulation. After each set the therapist asks a short, open question (“What do you notice now?”) and usually says “go with that” for the next set, staying out of the way of the client's associations. When processing loops or gets stuck, the therapist can change the direction, speed or type of stimulation, or use a cognitive interweave: a short question or statement that brings in information the client is missing.

The phase continues until the SUD is 0, or 1 if a small remaining disturbance makes sense in the client's situation. This is called ecological validity.

Online: you need to see the client's face between sets, and preferably during them. A second device for the video call helps.

Phase 5: Installation

The therapist checks whether the original positive cognition still fits, or whether a better one has emerged. The client then holds the positive cognition together with the target memory during sets of bilateral stimulation. The therapist checks the VoC after each set, aiming for 7: completely true.

Phase 6: Body scan

With the target and the positive cognition in mind, the client mentally scans their body from head to toe. Any remaining tension or unusual sensation is processed with further sets until the body feels clear. A clear body scan is a sign that processing of the target is complete.

Phase 7: Closure

Every session ends with closure, whether or not the target was finished. If it wasn't, the therapist helps the client contain what is left and return to a calm state, for example with the calm place or a container exercise. The therapist explains that processing can continue between sessions, that new memories, dreams or insights may come up, and asks the client to note them in a short log.

Online: the client goes straight back into their home life when the call ends. Plan at least ten minutes for closure, and check that they are oriented and safe before you hang up.

Phase 8: Reevaluation

At the start of the next session, the therapist checks the previous target. What is the SUD now? Has the positive cognition held? What came up in the log? If the target is resolved, the work moves on to the next target in the plan: other past memories, then present triggers, and finally a future template, in which the client imagines handling a future situation with their new resources.

How many sessions does EMDR take?

That depends on the number and kind of traumatic experiences. For adults with PTSD, the NICE guideline says EMDR is typically delivered over 8 to 12 sessions, and more when clinically indicated, for example after multiple traumas. Phases 1 and 2 can take one session or many. Phases 3 to 8 may cover one target in a session, or one target may take several sessions.

Running the phases with Remote EMDR

• Phases 1 to 3 and 7 to 8 are mostly conversation. Run them on your video call as usual.
• For bilateral stimulation in phases 2, 4, 5 and 6, send the client the patient link. They see only the stimulus; you start and stop sets and adjust speed, pattern and sound from the toolbar.
• With a free account you can keep SUD and VoC ratings and session notes in a patient dossier, so the reevaluation in phase 8 starts from your own record.