PTSD Treatment With EMDR: What to Expect
By Dr. Mary Kate Roohan, PsyD (CA PSY34538) | Last updated: September 25, 2026
If you are considering EMDR for post-traumatic stress disorder (PTSD) or complex trauma, you are probably hoping for a clear explanation of how this therapeutic modality works and for a better understanding of whether this therapy approach is right for you. This guide provides these answers. I am a psychologist who provides EMDR, as do several clinicians on our team. My hope is that you leave with enough information to have a grounded conversation with a therapist to determine if EMDR is the right step for you.
Key Takeaways
● Eye Movement Desensitization and Reprocessing (EMDR) is a structured, phased psychotherapy for PTSD and complex trauma that uses bilateral stimulation while a client attends to a distressing memory.
● Major clinical guidelines, including those from the U.S. Department of Veterans Affairs, list EMDR among the recommended trauma-focused psychotherapies for PTSD.
● EMDR does not require you to describe the traumatic event in detail or complete written homework between sessions.
● EMDR is not appropriate for everyone. Active crisis, unmanaged dissociation, and certain medical conditions typically call for preparation work before EMDR reprocessing or a different modality first.
● A well-trained EMDR therapist screens carefully, paces the work to align with your needs, and adapts the protocol for complex trauma, dissociation, and neurodivergence.
What EMDR Actually Is
EMDR is an eight-phase, trauma-focused psychotherapy developed by Francine Shapiro in the late 1980s. During memory processing phases, you briefly hold a distressing image, thought, body sensation, and belief in mind. At the same time, your therapist guides you through bilateral stimulation, usually side-to-side eye movements, alternating taps, or alternating tones.
The framework behind this is called the Adaptive Information Processing model. The working theory is that some memories get stored in a way that keeps them emotionally raw and reactive, and that structured attention plus bilateral stimulation helps the brain reprocess and file them differently.
The scientific debate about why EMDR works, whether the eye movements themselves add unique benefit beyond the exposure and attention components, is ongoing. What is less contested is that EMDR reduces PTSD symptoms for many people, which is why it appears on major clinical guidelines, including those of the U.S. Department of Veterans Affairs.
How EMDR Works: The Eight Phases
EMDR is not one technique repeated across sessions. It moves through phases. While EMDR approaches vary slightly from clinician to clinician, here is a sneak peek of a standard EMDR protocol.
1. History and treatment planning. Your therapist gathers your trauma history, screens for dissociation and safety, and identifies target memories.
2. Preparation. You learn grounding, containment, and resourcing skills. This phase is protective and critical to EMDR success. If preparation is rushed, later phases can destabilize you.
3. Assessment. You and your therapist identify a specific target: an image, a negative belief ("I am not safe"), a preferred belief ("I am safe now"), body sensations, and emotional intensity.
4. Desensitization. You hold the target in mind during sets of bilateral stimulation. Your therapist checks in between sets and follows what emerges.
5. Installation. You strengthen the preferred belief while it feels believable in your body.
6. Body scan. You notice remaining physical activation tied to the memory.
7. Closure. You return to a regulated state before leaving the session, whether processing is complete or not.
8. Reevaluation. You start the next session by checking what shifted, what returned, and what is next.
The first two phases are where a careful clinician earns your trust, so it is important to look for a psychologist or therapist who takes preparation seriously rather than treating it as a warm-up.
What a Session Feels Like
When the EMDR process begins, a session typically runs 50 to 90 minutes because processing sets need time to complete and close. You will likely meet with your therapist at least once a week. It is also becoming more common for clients to participate in EMDR intensives, which are essentially immersive experiences that last for a day or weekend focused on trauma treatment.
After you have completed the resourcing stages of the EMDR protocol, you will move to picking a target memory and then work to desensitize to the memory. During desensitization, many clients notice that memories, images, sensations, or associations arise, shift, or fade across sets. Some clients cry, feel numb, or experience calm. Most clients ultimately notice a memory becoming less vivid or less charged by the end of reprocessing, which may occur over the course of numerous sessions.
I remind my clients that you are not required to narrate the traumatic event in detail to heal from the trauma. According to a patient overview from Cleveland Clinic, EMDR does not require detailed verbal disclosure of the trauma or between-session writing assignments in the way some other trauma therapies do. That difference matters for clients who cannot yet put the event into words, or for whom repeated verbal retelling has felt retraumatizing.
Between sessions, you may notice vivid dreams, emotional waves, or new associations. Your therapist should give you a plan for these, including grounding skills and how to reach them if you become distressed.
How EMDR Compares to CPT and Prolonged Exposure
Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are the two other trauma-focused psychotherapies most often recommended alongside EMDR. All three have evidence supporting their use for PTSD. The VA/DoD guideline recommends all three (VA/DoD, 2023), while the American Psychological Association's guideline lists CPT and PE as first-line options and suggests EMDR as a second-line option (American Psychological Association, 2025). Choosing among them often comes down to fit, not superiority.
● CPT is heavily cognitive. You examine the beliefs your trauma produced ("It was my fault," "The world is entirely unsafe") and work with written worksheets to test and revise them. This tends to suit clients who find verbal, structured, homework-based work clarifying.
● PE involves repeated, gradual, in-session and out-of-session engagement with the trauma memory and with previously avoided situations. It can be effective, and it is demanding. Clients who are ready to lean into challenging avoidant tendencies are more likely to benefit from this approach.
● EMDR relies less on verbal disclosure and less on formal homework. It does, however, require the client to expose themselves to traumatic material in their mind (if they reach this stage of the process). Clients who freeze when asked to narrate the event, or who struggle to complete between-session assignments, sometimes tolerate EMDR better.
Any comparison across these modalities depends on the study, the population, and the outcome measured. If a therapist tells you one is definitively superior for everyone, I would treat that as a red flag. Ask instead which one fits your history, your nervous system, and your capacity right now.
Does EMDR Work?
For many people with PTSD, yes. Randomized trials and clinical guidelines support EMDR as an effective trauma-focused treatment, which is why it is recommended in guidelines from the VA/DoD (2023) and the World Health Organization (2013), among others. That said, effectiveness varies by person, trauma type, comorbidities, and clinician skill.
I want to discuss treatment for complex PTSD (C-PTSD) briefly, also referred to as “complex trauma.” C-PTSD is a diagnosis in the ICD-11 but is not currently included in the DSM-5-TR; however, there is a growing awareness of the number of clients who are presenting with complex trauma. I hope to see this diagnosis added in the next edition of the DSM, as the symptoms encompass the experiences of many people.
Treatment of C-PTSD usually involves prolonged, repeated, developmental, or relational trauma; the work is longer, the preparation phase is more substantial, and processing is more paced. If you are participating in EMDR for complex trauma, a lengthier process is likely a feature of an informed clinician providing ethical care (not a sign something is wrong).
Risks, Side Effects, and When EMDR Is Not the Right Fit
EMDR is generally well-tolerated when delivered by a properly trained clinician. Common temporary effects during active processing can include increased emotional intensity between sessions, vivid dreams, fatigue, or brief spikes in symptoms. Your therapist should prepare you for this and give you tools to manage it.
EMDR is not automatically appropriate for everyone. Situations that generally call for preparation, adaptation, or a different modality first include:
● Active suicidal crisis or acute self-harm risk that has not been stabilized.
● Unmanaged substance use that would interfere with regulation between sessions.
● Significant dissociative symptoms without adequate preparation. Standard EMDR protocol is often modified for dissociative presentations, including dissociative identity disorder, and some clinicians pause processing entirely until stabilization work is done.
● Certain medical or neurological conditions may require coordination with a physician before processingbefore processing may be warranted.
● A current life situation that is genuinely unsafe (for example, ongoing intimate partner violence), where the priority is stabilization and safety planning.
When Treatment Stalls or Doesn't Work
Sometimes EMDR stalls. Processing loops without shift, distress spikes without settling, or symptoms return between sessions and stay elevated. A skilled EMDR therapist has options here: returning to preparation and resourcing, using interweaves to unblock stuck processing, adjusting the target, slowing the pace, or pausing EMDR to do stabilization or parts work.
If your therapist keeps pushing through a stall without changing approach, I would speak directly to them about your concerns. If nothing shifts, a second opinion or a different modality is a reasonable next step. The therapy process is rarely linear, and it is important to keep checking in with yourself about what you need.
EMDR for Neurodivergent and Queer Clients
Standard protocols were not built with every client in mind, and thoughtful adaptation matters.
Research on EMDR with autistic adults is still limited. In a survey of EMDR therapists who work with autistic clients, therapists emphasized adapting to the individual rather than following one script, and commonly described offering alternatives to eye movements (such as tactile or auditory bilateral stimulation), using very clear language, taking time to understand how a client describes their own thoughts and emotions, and allowing more time for preparation and closure (Fisher et al., 2023). Whatever your neurotype, it is reasonable to ask a prospective therapist how they would tailor sessions to you.
For queer and trans clients carrying identity-based trauma (family rejection, medical harm, chronic minority stress, targeted violence), the therapist's cultural attunement is part of the treatment. Ask a prospective EMDR therapist how they work with identity-based trauma, whether they treat minority stress as a stressor or pathologize the identity itself, and how they think about systemic harm as a source of PTSD symptoms.
How to Vet an EMDR Therapist
A few concrete questions to ask before you commit:
● What is your EMDR training? Look for training through an EMDR International Association (EMDRIA)-approved program. EMDRIA certification indicates that the clinician has completed additional consultation hours and continuing education.
● Do you offer full-protocol EMDR, or EMDR-informed work? "EMDR-informed" is an umbrella term that encompasses a wide range of training, so it is reasonable to ask about your clinician’s experience.
● How do you screen for dissociation, and how do you adapt the protocol if it is present?
● How do you decide when a client is ready to move from preparation into processing?
● What is your plan if processing stalls or destabilizes me between sessions?
● How do you work with my specific identity and history (e.g., neurodivergence, cultural background, queerness, complex trauma, medical trauma)?
The informed consent conversation should cover realistic timelines, expected side effects, what happens if you dissociate mid-session, and how between-session distress will be handled. If this conversation does not naturally happen, it is important to ask for it.
Access, Cost, and Practical Realities
Finding a well-trained EMDR therapist can take time. Waitlists are common, insurance networks may be thin, and out-of-network costs are a real barrier. If cost is a factor, I would ask potential providers about sliding scale, community mental health options, training clinics with supervised EMDR therapists, and whether your insurance offers out-of-network reimbursement. Ask any provider for a written fee schedule and their superbill process before starting.
FAQ
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I think it is important to be mindful of the use of the term "go wrong" when referring to treatment. There is risk associated with trauma work, which means that sometimes processing destabilizes you and does not resolve before the session ends, dissociation increases, or symptoms worsen and stay elevated. When a skilled clinician helps you move through these elements of the process, you are not in a position where things are “going wrong”; rather, you are moving through the therapeutic process.
If, however, you feel worse in a sustained way after beginning EMDR therapy, then it is important to tell your therapist or psychologist directly and shift the treatment approach moving forward.
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Major clinical guidelines recognize EMDR as an effective trauma-focused psychotherapy for PTSD, and clinicians often adapt it for complex trauma. EMDR produces meaningful symptom reduction for many people. Effectiveness varies by trauma presentation, comorbidities, therapist skill, and fit. Complex, developmental, or relational trauma generally requires longer preparation and more paced processing.
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A processing session usually runs 50 to 90 minutes, unless you are participating in an EMDR intensive, which can include day-long sessions.
Each session looks different depending on what stage of the protocol you are in. In some sessions, you may focus on resourcing and grounding skills. In other sessions, you may identify a target memory with an image, a negative belief, and body sensations, then hold that in mind during sets of bilateral stimulation while your therapist checks in between sets.
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Yes. Emotional fatigue after sessions is a commonly reported effect, especially during active desensitization phases. If the exhaustion you are experiencing is getting in the way of your day-to-day life, you will work with your psychologist to adjust the protocol to reduce its intensity.
A well-trained EMDR therapist prepares you for the potential “side effects” of reprocessing and gives you grounding and containment skills before reprocessing begins.
If You Are Considering EMDR
If you are weighing EMDR for PTSD or complex trauma, I would encourage a consultation with a therapist trained in the full protocol who can assess whether EMDR fits your situation or whether preparation work, a different modality, or a combined approach makes more sense for you right now. Our practice offers trauma therapy across California and works with clients seeking an EMDR therapist in Los Angeles. If you would like to talk it through, you can fill out our intake screener. Support starts with a simple conversation - and you are closer to a plan than you think.
References
American Psychological Association. (2025). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. https://www.apa.org/ptsd-guideline
Fisher, N., van Diest, C., Leoni, M., & Spain, D. (2023). Using EMDR with autistic individuals: A Delphi survey with EMDR therapists. Autism, 27(1), 43–53. https://doi.org/10.1177/13623613221080254
U.S. Department of Veterans Affairs & U.S. Department of Defense. (2023). VA/DoD clinical practice guideline for management of posttraumatic stress disorder and acute stress disorder. https://www.healthquality.va.gov/guidelines/MH/ptsd/
World Health Organization. (2013). Guidelines for the management of conditions specifically related to stress. https://www.who.int/publications/i/item/9789241505406
This article is for educational purposes and is not a substitute for professional evaluation or treatment. If you think you or someone you love may benefit from therapy or psychological assessment, please reach out to a licensed clinician.
If you are in crisis: Call or text 988 (Suicide & Crisis Lifeline), text HOME to 741741 (Crisis Text Line), or go to your nearest emergency room.
