Gary Peterson Phases of EMDR

Carolina House Symposium

Workshop with Gary Peterson, M.D. 2013 Durham-handouts-1.pdf

Powerpoint Slides from a lecture on EMDR (extracts)

Phases of EMDR

1. Client history taking
2. Client preparation
3. Assessing target event
4. Desensitization Process
5. Closure
6. Re-evaluation


  • If it agreed that that EMDR would be used in therapy, there are several steps in preparation for the actual processing of the material. A degree of trust must exist between the client and clinician. The clinician explains the theoretical background for EMDR and describes the actual steps in the process.
  • The clinician learns about the client’s self-soothing skills and teaches the client new skills to increase the ability of the client to tolerate the processing of traumatic material.
  • One of the calming techniques used in EMDR is to establish a “safe place” in the client’s imagination to which the client can return during times of emotional disturbance.
  • The clinician discusses the types of bilateral stimulation (BLS), and they decide what kind of bilateral attention process they will use.
  • Safety procedures are discussed and set in place. The client’s concerns and fears are addressed.
  • The clinician might apply BLS during this phase to develop and enhance psychological resources before beginning information reprocessing (Phase 4: Desensitization).
  • BLS for resource building is applied with a short set of very slow alternating movements.
  • Prior to moving to the next phase (Phase 3: Assessment) the client must be able to change emotional states from being troubled/disturbed to feeling neutral, stable, or positive. This is so the client will be able to recover from a disturbing state that can occur from the reprocessing of a disturbing event.


  • Picture the situation
  • Establish negative cognition (NC)
  • Establish positive cognition (PC)
  • Validity of Cognition (VoC)
  • Subjective Units of Disturbance (SUD)
  • Emotion and somatic components

The assessment of the target event begins the EMDR reprocessing session. The client is asked what the target incident will be. He/she is asked what picture represents the worst part of the experience.

The client associates words that best go with the picture (or experience) that express a negative belief (Negative Cognition (NC)) about self in the present time while attuning to the disturbing event.

Negative Cognition Properties

  • Negative belief around target issue
  • First person present tense (I am …)
  • Statement of being (vs. doing)
  • Child-like perspective
  • Irrational quality
  • Generalizable
  • Next, the client decides what he/she would like to believe about self in place of the negative thought.
  • The client assesses the validity of this positive thought (Positive Cognition (PC)) relative to the target experience, on a seven-point scale (Validity of Cognition (VoC) scale 1-7).
  • The client then names the emotions associated with the target event and scales the disturbance level on an eleven-point scale (Subjective Units of Disturbance (SUD) scale 0-10).
  • The client identifies the location of the body sensation associated with the disturbance.

Negative Cognitions

I am a bad person
I am worthless
I am shameful
I am unlovable
I am incompetent

Positive Cognitions

I am a good person I am worthwhile
I am honorable
I am lovable
I can take care of myself


  • The desensitization phase is the core of the information processing. It begins with the client holding in focus a picture of the traumatic event, a negative self-perception and a body sensation associated with a disturbing event.
  • The clinician then helps the client focus on a bilateral stimulus (BLS) while holding the target event in mind.
  • The stimulus may consist of rapid hand movements or moving lights in the client’s field of vision; alternating tones to the ears, or alternating taps on the hands.
  • These sets of bilateral attention may last from less than a half-minute to, in rare situations, several minutes, depending on the client’s response. The client is asked to bring his awareness to the office and to comment on whatever comes in awareness.
  • After giving a short description of what thought, feeling or experience that comes up in the client’s mind, the client does another set of bilateral stimulation.
  • Over many sets of BLS, the therapist supports the client through the processing of whatever images, thoughts, feelings or sensations that come into awareness.
  • When the processing of the disturbing memory is complete, as measured by the amount of residual disturbance of the memory (SUD =0), the positive thought (positive cognition) is revisited, reconfirmed as appropriate and scaled as to validity in the presence of the original experience.
  • Sets of bilateral stimulation are applied until the positive thought is experienced as being totally valid (7 on a scale of 1-7).
  • The client is asked to close his/her eyes, concentrate on the target experience and mentally scan the entire body.
  • If sensations or lack of sensations are reported, short sets of bilateral stimulation are applied until any negative sensation subsides or positive sensations are fully experienced.


  • The client is guided to a neutral or positive emotional state prior to leaving the session.
  • The client may continue to process the material for days after a session, perhaps having new insights, vivid dreams, strong feelings, intrusive thoughts, or renewed recall of past experiences.
  • These experiences may feel confusing to the client, but they are considered to be a continuation of the healing process.
  • The client is asked to keep a record of new sensations and experiences and report them to the clinician at the next session. If the client becomes concerned or surprisingly disturbed, he/she should let the clinician know right away.


  • At the beginning of the next session, the client reviews the week, discussing any new sensations or experiences and reviewing his/her log. The disturbance of the previous session’s target experience is assessed to help decide on the course of action.
  • Generally, the eight-phase process is applied to past events, current triggers and anticipated future events related to the target event (Three Pronged Approach).


Training is complex/expensive
Client preparation can be elaborate
Sessions may take more than 50 minutes
With incomplete sessions, residual processing discomfort may be present


“Several lines of evidence suggest that EMDR may help in the treatment of PTSD by turning on memory processing systems normally activated during Rapid Eye Movement (REM) sleep but dysfunctional in the PTSD patient.

…EMDR through the repetitive redirecting of attention, activates brain systems normally present during REM sleep. Any alternating, lateralized stimulation regimen, whether eye movements, tapping, or binaural sound, could activate these systems by forcing the brain to constantly reorient to new locations in space.

In this manner, EMDR can ‘push-start’ the broken- down REM machinery that is required for the brain to effectively process traumatic memories.”

(Stickgold, 2002)

[Editor’s Note] I feel the hypothesis above should be taken as a tentative suggestion. It seems to lack scientific rigour, but Stickgold is clearly building on the general consensus that the alternating eye movements of EMDR do reproduce the REM sleep phenomenon. That sleep phenomenon is understood to aid the process of permanent memory consolidation in the neocortex. Stick gold’s hypothesis as reported by Peterson adds little to that general knowledge. Ed.




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