Written by Quinn Landes, LMHC, LPC on September 26, 2026

In this article, we’ll explore what EMDR is, how it’s used in trauma treatment, and why it’s faced controversy since its first development in 1987. We’ll look at what EMDR sessions actually involve, including bilateral stimulation like eye movements or tapping, and how the process allows a client’s own associations to guide the work. Finally, we’ll examine the debate over why EMDR works at all and consider how factors like the therapeutic relationship and a client’s expectancy may play a larger role in healing than any specific technique. If you’re considering EMDR or are simply curious about it, I hope this article will help you better understand what EMDR involves and how or why it might be effective for you.

What is EMDR?

Eye Movement Desensitization and Reprocessing, or EMDR, was discovered by Francine Shapiro as an intervention for the treatment of trauma in 1987. It was initially named for its use of bilateral (side-to-side) eye movements but has since expanded from an intervention into a therapeutic framework that treats a variety of conditions. In her book on EMDR, “Eye Movement Desensitization and Reprocessing (EMDR) Therapy”, Shapiro claims that EMDR includes (or finds

compatibility with) other psychotherapeutic approaches due to...

  • “the importance of childhood memories” (Psychodynamic)      
  • “the importance of focused attention on dysfunctional reactions and behaviors” (Classical Behaviorism)
  • its “being a client-centered approach” (Person-Centered or ”Rogerian”)
  • its “strong affective and experiential basis” (Emotion-Focused Therapy)
  • its “[addressing of] the concept of positive and negative self assessments” (Cognitive Therapy)
  • its “emphasis on the physiological responses related to a client’s presenting dysfunction” (The Body Keeps The Score by van der Kolk)

In my own experiencing, learning, and use of EMDR I’ve noticed—and heard form other clinicians—of EMDR also sharing aspects of free association and clinical hypnosis.

Taken together, this may suggest that EMDR is less of a completely distinct method and more a structured way of engaging processes that show up across existing therapies, or it may be an inclusive culmination of those psychotherapeutic treatments.

Criticisms & Controversy

From its onset, and through its decades of development, EMDR has been controversial in the psychological community. For example, its eye-movements have not been found to be more effective than other forms of bilateral stimulation (such as bilateral finger-tapping and critics argue that the effective parts of EMDR are due to the standard treatment techniques contained within it, and not in its characteristic novelties. While research finds EMDR to be no more affective than other approaches such as trauma-focused Cognitive Behavioral Therapy, it does find EMDR to be effective. I have my own thoughts and opinions on some of these points that I’ll save for the end of the article.

What does EMDR Treatment Look Like?

EMDR is an 8-phase, 3-prong protocol. The 3 “prongs” are the inclusion of past, present, and future: past events, present triggers, and desired future responses to those triggers.

The 8 phases are,

  1. History taking & treatment planning. This is the, "So what brings you in?" phase. The problem that brings you to therapy is identified and related past experiences, present triggers, and future desired outcomes are discussed. This is where the first target memory for EMDR is explicitly identified and agreed upon.
  2. Preparation & Stabilization. This is where you are told specifically what to expect from EMDR so you can give informed consent for the process. This is also where coping/self-regulation skills are taught, and any other needs or resources for coping with EMDR during and after session are identified and planned. The method and logistics of bilateral stimulation (BLS) are also planned and decided on here.*
  3. Target Assessment. This phase takes some baseline measurements and primes the target memory to kick off BLS. You'll be asked about what the worst part or image of the target memory is, negative beliefs, positive beliefs, how true the positive beliefs feel right now, and how disturbing the target memory is. Then, starting with focus on a body sensation or emotion related to recalling the target memory, you start BLS.
  4. Desensitization. This is the actual BLS part EMDR is known for. You'll do a brief set of BLS, pause for a moment to be asked what you notice, then resume BLS for another set. Thoughts, feelings, and bodily sensations will come up. The therapist is just supposed to ask what you notice now, tell you "go with that", and resume BLS. No digging or dwelling here--the BLS is doing the work on that. During this phase, the therapist is listening to whether the memory is changing or staying the same and whether is becoming more positive (“adaptive”) or negative. They'll occasionally ask you to reset to the original target memory, take another measurement of distress level, then resume BLS.
  5. Installation. This looks a lot like phase 4, but rather than "healing" or reducing the negative, it is installing or increasing the positive, adaptive thought or perspective. The therapist will take measurements of how true your positive thoughts about yourself feel and will give you sets of BLS that should help it feel more true with repeated sets.
  6. Body Scan. Trauma has a physical component so this phase will have you check how your body feels to you during a brief mental scan of it. If any tension, tightness, or strange sensations are found, that may be a sign that a little more trauma was tucked away somatically where it got missed. More BLS sets will be done on that sensation until the body scan is clear.
  7. Closure. This will be done at the end of every session with BLS in it, whether a trauma was finished reprocessing or not. This is just a brief cool-down to help transition you out of reprocessing mode so that you can leave the session and go about your day with some stability.
  8. Re-evaluation. If you've completed reprocessing the current target memory, other past memories and present triggers will be checked as candidates to be the new target memory. This is also where a "future template" is developed. Developing a future template involves BLS and has you imagine a future scenario where you might encounter something that touches on that past trauma and its resulting negative beliefs. BLS will help grow resiliency for the new positive belief to help inoculate you against future retraumatization due familiar painful experiences.

*What BLS specifically looks like may be the aspect of EMDR that varies the most, depending on logistics and client preference. It may look like the client using their eyes to follow my fingers as I wave them broadly side to side, or instead of fingers, there may be a light bar on a tripod. If a client has a problem or discomfort with their eyes, the bilateral stimulation can come from sounds alternating between ears, preferably with headphones, but finger snapping is a low-tech version that can be done as a last resort if everyone is comfortable with the physical proximity. Aside from vision and hearing, bilateral stimulation can be done through touch either through the client “butterfly/eagle tapping” near their own collar bone, or with computer-controlled “buzzers” that the client can either hold in their hands or wear on their wrists while they vibrate in alternating patterns.

Final Thoughts on EMDR

Not all "EMDR" is the Same

After I received my basic EMDR training from EMDR International Association (EMDRIA), I joined online communities and discussions to learn more about others’ experiences with EMDR. What I learned is that not all EMDR trainings are apparently created equal. Or, at the very least, not all therapists deliver EMDR with equal fidelity. For example, many EMDR clients online seem surprised to hear about its eight phases, they’ll feel ill-prepared for handling the intense emotions of reprocessing, or they’ll feel the positive effects of EMDR were temporary or completely went away after they experienced another disturbing event. These issues, to me, seem to suggest that the client may not have received thorough preparation during the before and after phases of reprocessing.

Many therapists--and before my training I was one of them--assume that EMDR is a technique to be inserted within their own therapeutic approach. This is a misconception. EMDR is a full therapeutic approach with several techniques within it. If EMDR, or any part of it, is delivered by a therapist that isn’t following EMDR’s 8-phase protocol, then what’s being done can’t properly be thought of as EMDR.

Placebo, Expectancy, & Hope

As a psychotherapist, I center my practice and continued learning around the treatment of trauma and complex trauma and have training in multiple approaches. I’m not particularly for or against EMDR, but I think part of its controversy raises an important discussion about how we judge the

“realness” of a particular intervention’s outcomes. In medical research, it’s scientifically relevant to know whether a significant, measurable effect came from a drug/chemical/etc., or if it came from the test subject’s expectation of a change (the “placebo effect”). For developing non-drug techniques, interventions, and treatments, it’s also important to know why it’s working, in my opinion, to better understand which parts of it contributed to a good outcome so that we can build and develop those findings to be better, more accessible versions of that treatment in the future.

However, the opinion of myself and a growing number of clinicians, if a drug or treatment is found to only work because of the placebo effect, that doesn’t mean it fully failed to work. I think in common language, we’ve come to see the placebo effect as a sign of failure or falsehood, but what if we called it “hope” instead? Consider how that shifts our perspective and acceptance of its power. I’m not saying that treatments should be based on deception but I am trying to point out that the way a treatment is presented and administered is a powerful variable.

There are many psychotherapeutic approaches or frameworks: Psychoanalysis, Person-Centered, Adlerian, Cognitive-Behavioral Therapy, Existential Therapy, Gestalt, Rational Emotive Behavior Therapy, Dialectical Behavioral Therapy, Solution-Focused Brief Therapy, and many more. When research compares them to discover which ones work the best, the research finds that across the board, a very large majority of any framework’s effectiveness comes from the therapeutic relationship.  In short, if you like and trust your therapist, that’s what matters most. It may be that hope and expectancy play a big part in a person’s willingness to engage with a given therapeutic approach, or it may be that they tap into something beyond the therapy itself. In any case, its effects shouldn’t be ignored.

In my practice of treating anxiety, OCD, phobias, and trauma, I’ve found that despite the technical differences of different therapeutic tools and approaches, they all largely seem to be different ways of accomplishing the same tasks. Professionally, I see EMDR as an additional tool in my toolkit for accomplishing those tasks. Whether it is the way or just a way is irrelevant—what matters most to me as a therapist is making sure the “active ingredients” of healing and recovery are present and get to where they need to be.