If you’re considering EMDR therapy, it’s natural to have questions about what actually happens in a session. Unlike traditional talk therapy, EMDR involves some unique elements—bilateral stimulation, specific phases, and a structured approach to processing difficult memories—that can feel unfamiliar at first.
This guide walks you through what to expect before, during, and after EMDR sessions, including how to prepare, what the process involves, and what you might experience along the way. Understanding what’s ahead can help you feel more comfortable and get the most from your therapy.
What is EMDR therapy?
Eye Movement Desensitisation and Reprocessing (EMDR) is a structured psychotherapy approach developed by Dr Francine Shapiro in 1987. It’s designed to help people process distressing memories and experiences that may be contributing to current difficulties like anxiety, trauma symptoms, or emotional distress.
EMDR is recognised internationally as an effective treatment for post-traumatic stress disorder (PTSD). The World Health Organization recommends EMDR as a first-line treatment for trauma, and in Australia, the Phoenix Australia Guidelines (endorsed by the NHMRC) give EMDR a strong recommendation for adults with PTSD—equivalent to Trauma-Focused Cognitive Behaviour Therapy.
What makes EMDR different from other therapies is its use of bilateral stimulation—typically eye movements, but sometimes tapping or auditory tones—while you briefly focus on a distressing memory. This process appears to help the brain reprocess memories in a way that reduces their emotional charge. Research published in the Journal of EMDR Practice and Research continues to explore exactly how this works, with theories involving memory reconsolidation and changes in how memories are stored.
How to prepare for your first EMDR session
Your first EMDR appointment won’t typically involve the eye movements or bilateral stimulation you may have heard about. Instead, the initial sessions focus on building a foundation for the work ahead.
Before your appointment
There are a few things that can help you get the most from your sessions:
Consider your goals. It can be helpful to think about what you’d like to address in therapy, though you don’t need to have everything figured out. Your therapist will help you identify specific targets for treatment.
Know that you’re in control. A common concern is whether you’ll be forced to talk about traumatic experiences in detail. In EMDR, you don’t need to provide a lengthy narrative of what happened. You’ll work with your therapist to identify memories to target, but you maintain control over how much you share verbally.
Plan for afterwards. Some people feel tired or emotionally stirred after EMDR sessions, particularly once active processing begins. If possible, avoid scheduling demanding activities immediately after your appointment. Having some quiet time afterwards can be helpful.
Bring questions. Your therapist will explain the process, but having your questions ready ensures nothing gets forgotten.
What happens in your first session
Your initial session will likely focus on:
Getting to know each other. Your therapist will want to understand your background, what brings you to therapy, and what you’re hoping to achieve. This isn’t about diving deep into traumatic material—it’s about building a picture of your life and experiences.
Learning about EMDR. Your therapist will explain how EMDR works, what the process involves, and answer any questions you have. This is your opportunity to understand the approach and decide whether it feels right for you.
Discussing your history. You’ll talk about your experiences and symptoms in a way that helps your therapist understand what might be contributing to your current difficulties. This helps with treatment planning but doesn’t require detailed trauma descriptions at this stage.
Assessing readiness. Your therapist will consider whether EMDR is appropriate for your situation and whether any preparation work might be helpful first.
The eight phases of EMDR therapy
EMDR follows a structured eight-phase protocol developed by Dr Shapiro. Understanding these phases can help demystify the process.
Phase 1: History taking and treatment planning
This phase involves your therapist gathering information about your history, current symptoms, and goals for therapy. Together, you’ll identify potential target memories—specific experiences that may be connected to your current difficulties.
Your therapist will also assess factors that might influence treatment, such as your support systems, coping resources, and any considerations that might affect the timing or approach of therapy.
This phase typically takes one to four sessions, depending on the complexity of your situation.
Phase 2: Preparation
Before any memory processing begins, your therapist ensures you have the tools to manage any distress that might arise. This preparation phase is crucial and shouldn’t be rushed.
During preparation, you’ll:
- Learn more about what to expect during and between sessions
- Develop or strengthen self-regulation techniques
- Practice calming strategies like “safe place” or “calm place” visualisation
- Establish signals you can use to pause or stop processing if needed
- Build trust with your therapist
The preparation phase helps ensure you feel resourced and stable before moving into memory processing. For some people, this takes a session or two; for others, particularly those with complex trauma histories, more time may be needed.
Phase 3: Assessment
When you’re ready to work on a specific memory, the assessment phase helps set up the target for processing. Your therapist will guide you to identify:
The target memory: A specific image or moment that represents the experience you’re working on.
The target belief: A negative thought about yourself connected to the memory, such as “I’m not safe” or “I’m powerless.”
The preferred positive belief: How you’d rather think about yourself in relation to that memory, such as “I can protect myself now” or “I have choices.”
Current emotions: What feelings come up when you think about the memory now.
Baseline measurements: Your therapist will ask you to rate the intensity of your distress (on a scale of 0-10, called the SUD or Subjective Units of Disturbance scale) and how true the positive belief feels (on a scale of 1-7, called the VOC or Validity of Cognition scale).
These elements create a clear starting point for processing and a way to measure progress.
Phase 4: Desensitisation
This is where the bilateral stimulation begins. Your therapist will guide you to hold the target memory in mind while following their fingers with your eyes (or using another form of bilateral stimulation, like tapping or auditory tones).
During desensitisation:
- You’ll focus briefly on the memory while engaging in bilateral stimulation
- After each set of eye movements (typically 20-30 seconds), you’ll take a breath and notice what comes up
- You might experience thoughts, images, emotions, or physical sensations—your therapist will ask about body sensations as part of the processing
- You simply report what you notice, without trying to control or analyse it
- Your therapist guides you through multiple sets until your distress level decreases
This phase continues until the memory no longer feels as disturbing—ideally reaching a 0 or 1 on the distress scale. The time this takes varies considerably depending on the memory and individual factors.
Phase 5: Installation
Once the distressing aspects of the memory have reduced, the installation phase strengthens the positive belief you identified earlier. Your therapist will guide you to pair the original memory with the positive cognition while continuing bilateral stimulation.
The goal is for the positive belief to feel increasingly true and connected to the memory. This is measured using the VOC scale, aiming for a score of 6 or 7 (where 7 means the belief feels completely true).
Phase 6: Body scan
Trauma and distressing experiences are often held in the body as well as the mind. In the body scan phase, your therapist will ask you to think about the original memory along with the positive belief while scanning your body for any remaining tension or discomfort.
If any physical sensations remain, these become the focus of additional bilateral stimulation until they resolve. This phase helps ensure processing is complete at both cognitive and somatic levels.
Phase 7: Closure
Every EMDR session ends with closure, regardless of whether processing is complete. This phase ensures you leave the session feeling stable and grounded.
During closure:
- Your therapist will guide you through calming techniques if needed
- You’ll discuss what to expect between sessions
- You’ll review self-care strategies
- You might be encouraged to keep a journal noting any thoughts, feelings, or memories that arise during the week
If a memory wasn’t fully processed within the session, your therapist will help you contain it safely until the next appointment. Processing often continues between sessions, and your therapist will explain what this might look like.
Phase 8: Reevaluation
Each subsequent session begins with reevaluation. Your therapist will check:
- How you’ve been since the last session
- Whether any new material has emerged
- Whether previously processed memories remain low in distress
- What the next focus of treatment should be
This phase ensures that gains are maintained and guides ongoing treatment planning.
What happens during the eye movements?
The bilateral stimulation component of EMDR often prompts the most questions. Here’s what you might experience:
Types of bilateral stimulation
While eye movements are most common, other forms of bilateral stimulation may be used:
Eye movements: Following your therapist’s fingers (or a light bar) as they move back and forth across your field of vision.
Tapping: Gentle, alternating taps on your hands, knees, or shoulders, either by your therapist or using handheld devices.
Auditory tones: Sounds that alternate between your left and right ears through headphones.
Your therapist will discuss options with you and find what works best. Some people have strong preferences; others find all forms equally effective.
Common experiences during processing
During bilateral stimulation, people report a wide range of experiences. You might notice:
Changing images: The memory might shift, fade, or transform in various ways.
Emerging memories: Other related memories or experiences might surface.
Emotions: You might feel sadness, anger, fear, or other emotions—sometimes intensely, though usually briefly.
Physical sensations: Tension, warmth, tingling, or other body sensations are common.
Insights: New perspectives or understandings often emerge spontaneously.
Relief: Many people notice a gradual sense of the memory becoming less charged.
There’s no “right” way to experience EMDR. Your job is simply to notice what happens without trying to make anything specific occur. The brain seems to do its own processing when given the opportunity.
Staying in control
An important aspect of EMDR is that you remain in control throughout. You can:
- Stop at any time by raising your hand or saying “stop”
- Keep your eyes open or closed
- Share as much or as little verbally as you wish
- Take breaks when needed
- Let your therapist know if anything feels too intense
Your therapist is there to guide and support you, not to push you beyond what feels manageable.
What to expect after an EMDR session
Understanding what might happen after your session can help you prepare and respond appropriately.
Immediately after your session
Different people have different experiences immediately following EMDR:
Tiredness: Processing can be mentally and emotionally demanding. Feeling fatigued after a session is common.
Lightness or relief: Some people feel noticeably lighter, as if a weight has lifted.
Continued emotional processing: Emotions stirred during the session might continue to settle.
Vivid dreams: Some people notice more vivid or meaningful dreams following EMDR sessions.
Physical sensations: Body sensations related to the processing might continue briefly.
Most of these experiences resolve within hours to a day or two.
Between sessions
Processing often continues between appointments. You might notice:
- Memories, thoughts, or feelings related to your therapy surfacing
- Dreams connected to the material you’ve been working on
- New insights or perspectives emerging
- Gradual shifts in how you feel about the target memory
Keeping a brief journal of what you notice can be helpful. This information can guide your next session and help track progress.
Self-care between sessions
Taking care of yourself between sessions supports the therapeutic process:
Use your resources. Practice the calming techniques you’ve learned in the preparation phase.
Be gentle with yourself. Processing difficult material takes energy. Allow yourself extra rest if needed.
Stay connected. Maintain contact with supportive people in your life.
Note what comes up. Jot down significant thoughts, memories, or dreams to discuss with your therapist.
Reach out if needed. If you’re struggling between sessions, contact your therapist. They can offer guidance and support.
When to contact your therapist
While some emotional stirring between sessions is normal, certain experiences warrant reaching out:
- Feeling significantly worse or unable to cope
- Intense or persistent distressing symptoms
- Thoughts of self-harm
- Uncertainty about whether what you’re experiencing is expected
Your therapist would rather hear from you than have you struggle alone.
How many EMDR sessions will you need?
This is one of the most common questions, and the honest answer is: it depends.
Factors that influence treatment length
Several factors affect how many sessions you might need:
Nature of the trauma: Single-incident traumas (like a car accident) often resolve more quickly than complex or repeated traumas.
How long ago it occurred: Recent events may sometimes process more quickly, though this isn’t always the case.
Your personal history: Previous experiences, particularly childhood experiences, can affect how memories are stored and processed.
Support and stability: Having good support systems and coping resources can facilitate processing.
Other factors: Physical health, current life stressors, and other mental health conditions can all influence treatment length.
General timeframes
Research provides some general guidance, though individual experiences vary considerably:
For single-incident trauma, studies suggest that many people experience significant improvement within 3-6 sessions of active processing (not counting preparation sessions).
For complex trauma—particularly experiences that were repeated, prolonged, or occurred in childhood—treatment typically takes longer, often 12 or more sessions. Some people benefit from ongoing therapy over months or even years.
It’s worth noting that EMDR doesn’t always follow a linear path. You might feel worse before you feel better, or experience rapid progress followed by a plateau. Your therapist will help you understand what to expect and track your progress.
How you’ll know it’s working
Signs that EMDR is having an effect might include:
- The target memory feeling less distressing when you think about it
- Fewer intrusive thoughts or flashbacks
- Reduced anxiety or emotional reactivity
- Feeling less triggered by reminders
- Shifts in negative beliefs about yourself
- Improved sleep
- Greater sense of calm or emotional regulation
Progress isn’t always dramatic or immediate. Sometimes changes are subtle and become more apparent over time.
Is EMDR safe? Understanding potential side effects
EMDR is considered a safe and well-researched therapy when conducted by a trained clinician. However, like any effective treatment, it can involve some discomfort as part of the healing process.
Common temporary experiences
During treatment, you might temporarily experience:
Increased emotional intensity: Processing difficult memories can bring up strong emotions. This is often part of the healing process, but your therapist will help you manage it.
Heightened awareness of symptoms: You might notice your symptoms more as you start paying attention to them.
Vivid dreams: Dreams related to therapy content are common and usually settle.
Fatigue: Emotional processing can be tiring.
Physical sensations: Headaches, light-headedness, or other physical symptoms occasionally occur.
These experiences typically resolve quickly. The term “EMDR hangover” is sometimes used to describe the tiredness or emotional sensitivity some people feel after intensive sessions.
Who might need additional considerations
EMDR isn’t appropriate for everyone, or may require modifications for some people. Your therapist will assess whether EMDR is suitable for you, considering factors such as:
Current stability: If you’re in crisis or very unstable, stabilisation work may be needed before EMDR.
Dissociative symptoms: People who experience significant dissociation may need a modified approach or additional preparation.
Complex trauma: Extensive trauma histories often require longer preparation and a more gradual approach.
Physical health conditions: Certain conditions, like some eye problems or pregnancy, may require modifications.
Substance use: Active substance abuse typically needs to be addressed before or alongside EMDR.
Certain mental health conditions: Some conditions may require careful consideration of timing and approach.
A thorough assessment helps ensure EMDR is used safely and effectively for your particular situation.
What if EMDR doesn’t seem to be working?
Sometimes progress feels slow, or EMDR doesn’t seem to be helping. This can happen for various reasons:
- More preparation work might be needed
- The treatment targets might need adjusting
- Other factors (like current stressors or unaddressed issues) might be interfering
- A different therapeutic approach might be more suitable
If you’re concerned about progress, discuss this with your therapist. Adjustments can often be made, or alternative approaches considered.
Accessing EMDR in Australia
If you’re considering EMDR therapy in Australia, here’s what you need to know about accessing treatment.
Medicare rebates
EMDR is eligible for Medicare rebates when provided by an appropriately qualified practitioner under the Better Access to Mental Health Care initiative.
To access Medicare rebates, you’ll need a Mental Health Treatment Plan from your GP. This involves an appointment where your GP assesses your mental health needs and refers you to a psychologist or other mental health professional.
With a Mental Health Treatment Plan, you can access up to 10 individual psychology sessions per calendar year with a Medicare rebate. The rebate amount depends on the type of practitioner—clinical psychologists receive a higher rebate than registered psychologists—but there may still be a gap fee depending on the practitioner’s charges.
Finding an EMDR-trained therapist
When looking for an EMDR therapist, consider checking their training and credentials:
EMDRAA accreditation: The EMDR Association of Australia (EMDRAA) provides voluntary accreditation for practitioners who have completed recognised EMDR training. You can search their directory for accredited practitioners in your area.
Training levels: EMDR training involves multiple stages. Practitioners may be at different levels, from having completed basic training to being fully accredited practitioners or consultants.
Professional registration: Ensure your therapist is registered with AHPRA as a psychologist, counsellor, or other relevant mental health professional.
Questions to ask a potential therapist
When considering an EMDR therapist, you might ask:
- What EMDR training have you completed?
- Are you accredited with EMDRAA?
- How much experience do you have with EMDR?
- Have you worked with concerns similar to mine?
- What does a typical treatment plan look like?
- What are your fees, and do you offer Medicare rebates?
A good therapist will welcome these questions and help you make an informed decision.
Frequently asked questions
How long is an EMDR session?
Standard EMDR sessions typically run for 50-60 minutes, similar to other therapy sessions. Some therapists offer extended sessions (90 minutes or longer) for EMDR, which can allow for more complete processing within a single appointment. Your therapist will discuss session length options with you.
Do I have to talk about my trauma in detail?
No. Unlike some therapies that involve detailed verbal recounting of traumatic experiences, EMDR doesn’t require you to describe what happened in detail. You’ll need to identify target memories and briefly describe what you’re working on, but the processing itself doesn’t depend on talking through the event. You share only as much as you feel comfortable sharing.
Will I lose control or forget things?
EMDR doesn’t involve hypnosis, and you remain fully conscious and in control throughout. You can stop the process at any time. Rather than forgetting memories, most people find that the memories remain but feel less distressing—more like something that happened in the past rather than something happening now.
Can EMDR bring up memories I’ve forgotten?
EMDR can sometimes bring related memories into awareness, including memories you may not have thought about in a long time. However, EMDR doesn’t aim to recover “repressed” memories, and therapists are trained to work with whatever emerges naturally during processing rather than to search for hidden memories.
Is it normal to feel worse before feeling better?
For some people, yes. Processing difficult material can temporarily increase awareness of symptoms or bring up uncomfortable emotions. This is often part of the healing process. Your therapist will help you manage any increased distress and ensure you have coping strategies in place. However, persistent worsening should be discussed with your therapist.
What if I cry during the session?
Crying during EMDR sessions is completely normal and nothing to be embarrassed about. Processing emotional material often involves emotional release. Your therapist is trained to support you through whatever emotions arise. Many people find that allowing emotions to surface is part of what helps them heal.
Can EMDR work for things other than PTSD?
Yes. While EMDR was originally developed for trauma and has the strongest research base for PTSD, it’s now used for a range of conditions. The EMDR International Association notes that EMDR is used for anxiety, depression, phobias, grief, performance anxiety, and other difficulties. Research support varies across conditions, so discuss your specific concerns with your therapist.
How is EMDR different from other trauma therapies?
EMDR differs from traditional talk therapy in several ways: it uses bilateral stimulation, doesn’t require detailed verbal description of trauma, follows a specific eight-phase protocol, and often produces results in fewer sessions than some other approaches. Compared to trauma-focused CBT (another evidence-based trauma treatment), EMDR involves less homework and less explicit focus on changing thoughts, instead allowing the brain’s natural processing mechanisms to work.
What happens if we don’t finish processing a memory in one session?
It’s common for memories not to fully process within a single session, especially with complex material. Your therapist will use the closure phase to help you contain the material safely until your next appointment. You’ll learn techniques to manage any distress that arises between sessions, and processing will continue at your next appointment.
Can I do EMDR online?
EMDR can be delivered effectively via telehealth. Therapists have developed adaptations for online delivery, including using the client’s own eye movements, butterfly hug (self-tapping), or virtual light bars. Research is emerging on the effectiveness of online EMDR, with early studies suggesting comparable outcomes to in-person treatment for many people.
Finding support
If you’re experiencing distress, support is available:
- Lifeline Australia: 13 11 14 (24-hour crisis support)
- Beyond Blue: 1300 22 4636 (anxiety and depression support)
- 1800RESPECT: 1800 737 732 (sexual assault and domestic violence support)
- SANE Australia: 1800 187 263 (complex mental health support)
For Aboriginal and Torres Strait Islander peoples, 13YARN (13 92 76) offers culturally safe crisis support.
Taking the next step
Starting any new therapy can feel daunting, and EMDR’s unique approach might seem unfamiliar at first. But understanding what to expect can help ease any uncertainty.
The key things to remember are: you’ll start gradually with preparation before any processing begins; you remain in control throughout; your therapist will guide you at a pace that’s right for you; and it’s okay to ask questions or express concerns at any point.
If you’re considering EMDR, the first step is finding a qualified therapist you feel comfortable with. They can help you determine whether EMDR is appropriate for your situation and what treatment might look like for you.
This article is intended for educational purposes and does not constitute medical or psychological advice. If you are experiencing mental health difficulties, please consult a qualified health professional.