What Actually Happens in an EMDR Session? A Step-by-Step Guide

If you've been considering EMDR therapy — maybe your therapist suggested it, or you've read about it online, or someone you trust swears by it — you might also be carrying a quiet question in the back of your mind.

What actually happens in there?

It's a fair question. EMDR can sound mysterious from the outside. Eye movements. Processing trauma without talking about it in detail. People describe feeling better after sessions in ways they can't quite explain.

And if you're someone who has been through difficult experiences — experiences that may have left your nervous system on high alert — the idea of trying something new in therapy can feel like a lot.

So let's demystify it completely. Here is an honest, practical, step-by-step guide to what actually happens in an EMDR session — written the way I wish someone had explained it to me before my first one.

First — What Is EMDR and How Does It Work?

EMDR stands for Eye Movement Desensitization and Reprocessing. It was developed in the late 1980s by psychologist Francine Shapiro and has since become one of the most extensively researched therapies for trauma, PTSD, and anxiety in the world.

The basic premise is this: when something overwhelming happens, the brain's natural processing system can get disrupted. Instead of integrating the experience — filing it away as a memory that happened in the past — the nervous system can get stuck holding it in a state of unresolved activation. The memory remains raw, vivid, and emotionally charged, responding to present-day triggers as though the event is still happening.

EMDR uses bilateral stimulation — most commonly guided eye movements, but also tapping or auditory tones — to activate both hemispheres of the brain simultaneously while you hold a distressing memory or belief in mind. This bilateral activation appears to mimic the brain's natural processing that occurs during REM sleep, allowing the nervous system to finally integrate what it has been holding.

In practical terms: the memory doesn't disappear. But it loses its charge. It stops feeling like something happening now and starts feeling like something that happened then. The emotional intensity fades. The body relaxes. And the beliefs that grew out of the experience — "I am not safe," "It was my fault," "I am not enough" — can shift toward something truer and more adaptive.

You don't have to fully understand the neuroscience for EMDR to work. But understanding the basic mechanism can make the experience feel less mysterious and more trustworthy.

The 8 Phases of EMDR — What Actually Happens

EMDR follows a structured protocol with eight phases. Not every phase happens in every session — especially in the early stages of work, most of your time will be spent in phases one through three. As treatment progresses, phases four through seven are where the active processing happens.

Here's exactly what each phase looks like from the inside.

Phase 1 — History Taking and Treatment Planning

What happens: Your therapist gets to know you — your history, your current symptoms, what brings you to therapy, and what experiences you'd like to work on.

What this looks like in session: Conversation. Questions. A collaborative exploration of your story at whatever pace feels comfortable. You are never asked to share more than you're ready to share.

What you might notice: This phase can feel like regular talk therapy. Some clients are surprised that EMDR doesn't start immediately. But this groundwork is essential — it ensures that when we do begin active processing, we know where we're going and have a clear map for getting there.

How long this takes: Typically one to three sessions, sometimes more depending on the complexity of your history.

Phase 2 — Preparation and Resourcing

What happens: Before any processing begins, your therapist helps you build internal resources — tools and techniques to help you stay regulated during and between sessions.

What this looks like in session: You might practice a safe place visualization — identifying an image of a place, real or imagined, where you feel completely calm and secure. You might learn grounding techniques, breathing practices, or containment strategies that you can use if processing brings up more than you anticipated.

What you might notice: This phase is often surprisingly enjoyable. Creating internal resources can feel stabilizing and even comforting. Some clients wish they could stay in this phase longer — and that's completely okay.

Why this matters: EMDR is sometimes described as opening a window. The preparation phase makes sure you have what you need to handle what comes through that window — and to close it again when the session ends.

Phase 3 — Assessment

What happens: You and your therapist identify a specific target — a memory, image, or experience — to work on. This is the starting point for the active processing that follows.

What this looks like in session: Your therapist will guide you through identifying several specific components of the target:

• The image — what picture represents the most distressing part of the memory

• The negative cognition — a negative belief about yourself connected to the experience (for example: "I am not safe," "I am helpless," "I am not enough," "It was my fault")

• The positive cognition — what you would prefer to believe instead ("I am safe now," "I have choices," "I am enough," "It was not my fault")

• The VoC (Validity of Cognition) — how true the positive belief feels on a scale of 1 to 7, right now in your body

• The emotion — what emotion comes up when you hold the image and negative belief together

• The SUD (Subjective Units of Disturbance) — how distressing the memory feels on a scale of 0 to 10

• The body sensation — where in your body you feel the disturbance

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This might sound clinical when listed out. In practice it feels like a focused, gentle conversation — your therapist guiding you to tune into your experience at a level of specificity that most people haven't done before.

Phase 4 — Desensitization

What happens: This is where the bilateral stimulation begins. You hold the target memory, image, and body sensation in mind while your therapist guides eye movements — typically by asking you to follow their fingers or a light bar moving back and forth — or uses tapping or auditory tones.

What this looks like in session: You follow the bilateral stimulation for a set of movements — usually 20 to 30 back-and-forth passes. Then your therapist pauses and asks simply: "What do you notice?"

What comes up varies enormously from person to person and session to session. You might notice a shift in the image. A new memory or association. A change in the emotion or body sensation. A thought, an insight, or sometimes nothing specific — just a sense that something has shifted.

Your therapist doesn't lead you anywhere. They simply ask what you notice and follow where your processing goes. This is one of the most important things to understand about EMDR — you are not being directed toward a particular outcome. Your nervous system leads the way.

Sets of bilateral stimulation continue, with brief check-ins between each set, until the SUD level — the disturbance rating — reaches zero or near zero.

What you might notice: Processing can feel different every time. Some people notice strong emotions during sets. Others notice physical sensations — warmth, release of tension, a heaviness lifting. Some people notice almost nothing during the bilateral stimulation and experience shifts between sessions instead. All of these are normal. There is no right way for EMDR to feel.

Phase 5 — Installation

What happens: Once the disturbance level has reduced significantly, your therapist turns attention to the positive cognition — the belief you identified in phase three that you'd prefer to hold about yourself.

What this looks like in session: You hold the original target memory in mind alongside the positive belief — for example, "I am safe now" — and notice how true it feels in your body. Bilateral stimulation continues to strengthen and install this positive belief until it feels as true as possible.

What you might notice: This phase often feels qualitatively different from desensitization. Where phase four can feel effortful or emotionally activating, installation often feels settling — like something clicking into place.

Phase 6 — Body Scan

What happens: Your therapist guides you to scan your body from head to toe, noticing whether any residual tension, discomfort, or activation remains in connection with the target memory.

What this looks like in session: You hold the memory and positive cognition in mind and simply notice what you feel physically. If any disturbance remains, additional bilateral stimulation may be used to clear it.

What you might notice: Many clients are surprised by this phase — they find tension in places they weren't aware of, or notice a physical sense of release that feels distinct from the emotional processing. The body scan reflects EMDR's understanding that trauma is held in the body as well as the mind, and that complete processing needs to include both.

Phase 7 — Closure

What happens: Every EMDR session ends with closure — regardless of whether processing feels complete. Your therapist brings you back to the present moment and ensures you leave feeling grounded and stable.

What this looks like in session: You might return to your safe place visualization. Your therapist will check in about how you're feeling and remind you that processing can continue between sessions — that noticing new thoughts, feelings, dreams, or memories in the days following a session is normal and part of the work.

What you might notice: Closure is one of the most important phases of every session. EMDR doesn't leave loose ends open. You will not leave a session feeling destabilized or ungrounded — that is a non-negotiable part of the protocol.

Phase 8 — Reevaluation

What happens: At the beginning of the following session, your therapist checks in on how you've been since the last session — whether the processing continued, what you noticed, and whether the disturbance level has shifted further.

What this looks like in session: A brief but focused conversation before the session begins. Your therapist may ask about the target from the previous session and reassess the SUD and VoC levels to see where things stand.

What you might notice: Many clients are surprised to find that processing has continued between sessions — that the SUD level has dropped further without any formal work, or that new insights or memories have emerged that feel connected to what was processed.

Common Questions About EMDR Sessions

Do I have to talk about my trauma in detail?No — and this is one of the most significant differences between EMDR and traditional talk therapy. You don't need to narrate your experience or tell the story in detail. You hold the memory in mind while your attention is directed to the bilateral stimulation — the processing happens at a level below the narrative. Many clients find this to be the most profound relief they've experienced in therapy.

What if I can't visualize anything?That's completely okay. Some people are highly visual processors and others are not. EMDR can work through body sensations, emotions, or simply a sense of knowing — rather than clear mental images. Your therapist will work with however your processing naturally presents.

What if strong emotions come up during a set?Strong emotions during bilateral stimulation are normal and often a sign that significant processing is happening. Your therapist is trained to support you through whatever arises. You are never left alone with difficult material, and you can stop at any time.

How many EMDR sessions will I need?This varies significantly depending on the nature and complexity of what you're working on. Some people notice meaningful shifts in a handful of sessions. Others with longer or more complex histories work over a longer period. Your therapist will give you a realistic sense of timeline after the first few sessions.

Will I feel worse before I feel better?Some clients do notice that processing brings things to the surface before they settle. This is normal and generally temporary. The preparation phase exists specifically to make sure you have the tools to navigate this — and your therapist will monitor closely and adjust the pace as needed.

Is EMDR Right for You?

EMDR is highly effective for:

• Trauma and PTSD — both single-event and complex

• Anxiety and panic

• Performance anxiety

• Phobias

• Grief and loss

• Childhood wounds and attachment injuries

• Negative core beliefs about yourself

• Experiences that have never fully resolved despite other therapeutic work

  
  

If you've tried talk therapy and felt like something was still stuck — like the insight was there but the nervous system hadn't caught up — EMDR may be exactly what's been missing.

EMDR Therapy in Centennial, CO

At High Alpine Counseling, I offer EMDR therapy for teens and adults in Centennial, Colorado. If you've been curious about EMDR — or if you've been carrying something that talk therapy alone hasn't been able to reach — I'd love to connect.

In-person sessions are available in Centennial, with easy access from Greenwood Village, Highlands Ranch, Parker, Lone Tree, and the greater Denver metro area. Virtual EMDR is also available to clients throughout Colorado.

Reach out to schedule a free 20-minute consultation. Let's talk about whether EMDR might be the right next step for you.

Jess Hadford-Crook, MA, LPC

High Alpine Counseling | Centennial, CO