EMDR Therapy That Does Not Stop at the Memory

How EMDR Works

EMDR is built on the Adaptive Information Processing (AIP) model, developed by psychologist Francine Shapiro in 1987. The model holds that your brain has a built-in system for processing and integrating experiences. When something overwhelming happens, that system gets disrupted. The memory does not get processed the way ordinary memories do. Instead, it gets stored in its raw form: the images, the sounds, the body sensations, the emotions, and the beliefs about yourself that formed in that moment (“I am not safe,” “It was my fault,” “I am powerless”).

These unprocessed memories are what drive symptoms. When something in the present resembles the original experience, even slightly, the old memory activates. The fear, the helplessness, the shame flood back as though the event is happening now.

EMDR uses bilateral stimulation (BLS) to reactivate and “unstick” the brain’s processing system. BLS can take the form of guided eye movements (following the therapist’s hand or a moving light), alternating taps on the hands or knees, or alternating tones through headphones. Research suggests this works by taxing working memory while the traumatic material is held in mind, reducing the emotional intensity of the memory and allowing the brain to refile it as something that happened in the past rather than something happening now.

What Happens in an EMDR Session

EMDR follows a structured eight-phase protocol. Understanding the phases helps demystify the process.

• Phase 1: History and treatment planning. Your therapist gathers a thorough history, identifies target memories, and develops a treatment plan. This looks like a typical intake session.
• Phase 2: Preparation. Your therapist explains how EMDR works, answers your questions, and teaches grounding and calming techniques (breathing exercises, Safe Place visualization, containment strategies). For people with complex trauma, this phase may take several sessions. Rushing it increases the risk of destabilization.
• Phase 3: Assessment. Together you identify a specific memory to target. You identify the most disturbing image associated with it, the negative belief it created about you (“I am helpless”), the positive belief you would rather hold (“I can handle difficult things”), and your current level of distress on a 0 to 10 scale.
• Phases 4 through 6: Desensitization, installation, and body scan. This is the core reprocessing work. You hold the target memory in mind while following bilateral stimulation. Each set lasts about 20 to 30 seconds. Between sets, your therapist checks in: “What are you noticing now?” You report whatever comes up: thoughts, feelings, images, body sensations, sometimes things that seem completely unrelated. Over multiple sets, the memory typically loses its emotional charge. When distress reaches zero, your therapist helps strengthen the positive belief. A body scan checks for any residual tension.
• Phase 7: Closure. Your therapist ensures you leave the session feeling stable and grounded. If the processing is incomplete, containment strategies are used.
• Phase 8: Reevaluation. Each subsequent session opens with a check on what has shifted, what has maintained, and what needs further attention.

You do not need to describe your trauma in extensive detail. EMDR does not require the kind of prolonged verbal retelling that some other trauma therapies use. Many people find this to be one of its most significant advantages.

The Evidence Behind EMDR

The research base for EMDR is substantial. Over 30 randomized controlled trials support its use for PTSD. Here is what the evidence shows:

In a study of single-trauma survivors, 84 to 90 percent no longer met criteria for PTSD after three sessions (Rothbaum, 1997; Wilson et al., 1995). A Kaiser Permanente study found that 100 percent of single-trauma and 77 percent of multiple-trauma participants no longer had PTSD after an average of six sessions. Among combat veterans, 77 percent were free of PTSD after 12 sessions (Carlson et al., 1998). An NIMH-funded study found EMDR superior to fluoxetine (Prozac) for both PTSD and depression, with 91 percent maintaining their gains at follow-up (van der Kolk et al., 2007).

A 2020 meta-analysis across 76 trials found EMDR achieved a large effect size (g = 0.93) compared to control conditions (Cuijpers et al., 2020). A 2025 meta-analysis in the British Journal of Psychology found EMDR to be the most cost-effective of 11 interventions assessed for PTSD (Simpson et al., 2025).

The organizations that recommend EMDR as a frontline treatment include:

• The World Health Organization (2013) recommends EMDR and trauma-focused CBT as the only two psychotherapies for PTSD in adults. The WHO specifically notes that EMDR does not require detailed descriptions of the event, direct challenging of beliefs, extended exposure, or homework.
• The American Psychological Association (2017) conditionally recommends EMDR for PTSD treatment.
• The VA/DoD Clinical Practice Guidelines (2023) give EMDR their highest recommendation level, alongside Cognitive Processing Therapy and Prolonged Exposure.
• The International Society for Traumatic Stress Studies gives EMDR a “strong recommendation” for adult PTSD, one of only eight strong recommendations across 125 total.

What EMDR Can Help With

EMDR was developed for trauma and PTSD, and that remains its strongest evidence base. But research supports its use for a wider range of conditions, particularly when those conditions have roots in disturbing life experiences.

PTSD and Complex PTSD

The primary indication, with the deepest evidence. Our PTSD and Complex PTSD Therapy page covers this in detail.

Anxiety

Six randomized controlled trials show significant anxiety reduction with EMDR. When anxiety is rooted in specific experiences (a car accident that produced driving phobia, a medical procedure that created healthcare avoidance, a humiliation that generates social anxiety), EMDR can access the source memory in ways that talk therapy alone may not.

Depression

A 2024 meta-analysis of 25 randomized controlled trials found EMDR achieves a medium-to-large effect size for depression (Hedges’ g = 0.75). Van der Kolk’s NIMH-funded study found EMDR superior to fluoxetine for depression as well as PTSD.

Grief and Loss

When grief becomes complicated or stuck, EMDR can help process the specific moments that keep replaying: the phone call, the hospital room, the last conversation. Our Grief and Loss Therapy page addresses grief more broadly.

Phobias and Performance Anxiety

EMDR is effective for specific phobias (dental, flying, medical procedures) and performance anxiety where the fear is rooted in a specific past experience.

Why We Do EMDR Differently

This is where our approach parts from most EMDR practices in Philadelphia.

EMDR is a powerful tool for processing specific traumatic memories. For people who experienced a single overwhelming event in adulthood (a car accident, an assault, a natural disaster), EMDR alone may be sufficient. The research reflects this: van der Kolk’s landmark 2007 study found that 75 percent of adult-onset trauma survivors achieved asymptomatic functioning through EMDR.

But the same study found that only 33 percent of childhood-onset trauma survivors achieved the same outcome. The difference is not about EMDR’s limitations as a technique. It is about the nature of the trauma itself.

Complex trauma, the kind that develops from repeated harmful experiences in childhood, from attachment disruption, from growing up in an environment where safety was unpredictable, does not create a single stuck memory. It creates a relational world. It shapes how you understand yourself, how you relate to others, how you experience closeness and conflict and vulnerability. It encodes in patterns that are distributed across thousands of small moments, many of them pre-verbal, none of them stored as a single memory you can point to and say “that is the one.”

This is why we embed EMDR within a relational psychodynamic framework. In our practice, EMDR is not the whole treatment. It is one instrument in a larger therapeutic process. Your therapist works with you over time to build a genuine therapeutic relationship, one characterized by safety, attunement, and consistency. Within that relationship, EMDR becomes more effective because you have the relational ground to go deeper. And between EMDR sessions, the relational work continues: understanding your patterns, exploring how early experiences shaped your current relational life, and gradually building new ways of being in connection with others.

Published clinical work supports this integration. Hemda Arad’s Integrating Relational Psychoanalysis and EMDR (Routledge, 2018) demonstrates how EMDR can break through emotional impasses that words alone cannot reach, while relational psychodynamic therapy provides the meaning-making context that EMDR processing alone does not offer. Paul Wachtel argues that EMDR can disrupt relational cycles at the somatic and memory level while psychodynamic work addresses their systemic and relational dimensions. Laurel Parnell developed Attachment-Focused EMDR specifically because standard EMDR, while effective for many, has limitations for clients with attachment difficulties or chronic relational trauma.

Germany, notably, requires that EMDR can only be delivered when embedded within one of the major psychotherapeutic frameworks: behavioral, systemic, psychodynamic, or psychoanalytic. This is not a restriction. It is a recognition that trauma processing works best within a larger therapeutic context.

The Connection to Attachment

If you have read our Attachment Therapy page, you know that roughly 40 percent of adults carry insecure attachment patterns. You also know that attachment patterns can change. Research on “earned secure attachment” shows that adults who experienced insecure childhoods can develop the capacity for secure, satisfying relationships through later corrective relational experiences.

EMDR can process the specific memories that created insecure attachment. Relational psychodynamic therapy provides the ongoing corrective relational experience that builds new attachment capacity. Together, they address both what happened to you and how it shaped the way you relate to everyone since.

What EMDR Is Not

• EMDR is not hypnosis. You are fully conscious, aware, and in control throughout. There is no trance, no suggestibility, no altered state.
• EMDR does not erase memories. It reduces the emotional charge attached to them. After processing, you remember what happened, but it no longer hijacks your nervous system when triggered.
• EMDR is not a quick fix. While it often works faster than traditional talk therapy, it follows a rigorous, structured protocol. For complex trauma, treatment may span months.
• You cannot do EMDR on yourself. Self-help apps and YouTube videos claiming to offer EMDR are not EMDR. The protocol requires a trained therapist who can monitor your processing, manage distress, and ensure safety.

EMDR via Telehealth

Research from 2021 through 2023 consistently shows that telehealth EMDR produces symptom reduction comparable to in-person delivery. Over 80 percent of clients in studied populations reported feeling comfortable with online EMDR. EMDRIA (the EMDR International Association) officially supports telehealth delivery.

For telehealth EMDR, bilateral stimulation is delivered through a moving dot or light bar on screen, alternating tones through headphones, or self-administered Butterfly Hug guided by your therapist. You will need a laptop or tablet (not a phone), a stable internet connection, headphones, and a quiet private space.

We offer both in-person and telehealth EMDR sessions. Telehealth is available to anyone in Pennsylvania.