An EMDR therapist who has treated trauma for 18 years shares her 11 most important pieces of advice

• EMDR (Eye Movement Desensitization Therapy) is one of the leading treatments for PTSD and trauma.
• The 8-prong treatment plan involves identifying and working through distressing memories.

Marisol Solarte-Erlacher is a licensed psychotherapist and consultant who has worked with hundreds of people, using EMDR therapy to treat trauma and other mental health conditions for 18 years. Now, she's the president-elect of the EMDR International Association.

EMDR stands for Eye Movement Desensitization and Reprocessing. It's a type of therapy that was developed to treat post-traumatic stress disorder (PTSD), and is now used to treat other mental illnesses too.

At first a skeptic of EMDR, Solarte Erlacher has since seen success with many people she's helped treat over the years, including people with trauma who develop PTSD that interferes with their day-to-day lives.

Here are the 11 things Solarte-Erlacher thinks people considering therapy should know about EMDR therapy.

1. It's backed by science

EMDR was developed in 1987 by psychologist Francine Shapiro specifically to treat PTSD.

Since then, there's been a hearty body of research to support the effectiveness of EMDR. For example, a 2018 scientific analysis found that EMDR is more effective than other forms of treatment at reducing symptoms of PTSD and other trauma.

Moreover, studies have shown 77%-90% of people with PTSD no longer had the condition after 3-12 sessions of EMDR.

The World Health Organization (WHO) lists EMDR therapy as the first-line treatment for PTSD. The Department of Veterans Affairs also says that EMDR is one of the most effective treatments for PTSD.

"It's easy to be skeptical, but EMDR therapy has really been found to be effective," Solarte-Erlacher says.

2. There's disagreement about why it works

Despite widespread agreement about the effectiveness of EMDR, doctors and researchers aren't sure why it works.

Many providers believe that it's related to how EMDR engages both sides of the brain, an approach known as bilateral stimulation.

Typically EMDR uses eye movement, like blinking one eye and then the other, to trigger bilateral stimulation. But it may also use lights, sound, or touch.

Now, why this is important for treating trauma is still a mystery, but here's what EMDR experts believe is happening.

When you experience trauma, the memory is stored in the amygdala, the part of the brain that responds to fears and threats. While practicing EMDR, the therapist will work with the client to move the memory from the amygdala — so it can no longer trigger fear — into working memory — which is responsible for acute cognitive tasks.

A therapist does this by asking you to recall the memory and then talk through why it's distressing for you. For example, if your trauma is related to a horrible break up, then you might discuss how that break up has affected your self-esteem and confidence with dating others.

Where bilateral stimulation comes into play is that while you're working through the traumatic memory you're also practicing some form of bilateral stimulation. And, for reasons still unclear, this combination stops the pain from building further on that memory, teaching your brain to no longer feel distressed.

Throughout the COVID-19 pandemic, bilateral stimulation through self-tapping has also seen a rise — as demonstrated by the likes of Prince Harry. This involves a client administering their own taps, often with guidance from an EMDR certified therapist.

3. There's a specific protocol

EMDR is a structured therapy, meaning that providers must follow a specific, replicable, and time-limited approach.

Anyone seeking EMDR should look for a therapist who's been certified by an organization like the EMDR International Association, Solarte-Erlacher says. These providers have an understanding of the clinically-proven guidelines for providing EMDR treatment.

"People believe that just moving the eyes is the thing that facilitates healing. But it's much more complex," she says.

When Shapiro developed EMDR therapy, she outlined an 8-phase approach, which protocol dictates you and your provider follow in order. How long it takes to move through each phase will depend on your unique therapeutic needs. The phases are:

1. History and treatment planning: You'll discuss your trauma history and what you want from treatment. The provider will assess the mental health and coping resources you currently have.

2. Preparation: According to Debbi Dubnar, MS, LPC, adapted from the Basic Training Manual of Dr. William Zangwill, preparation can also include education on traumatic memories, education on EMDR overall, addressing client fears, and providing resources for some key EMDR terms (such as bilateral stimulation)

3. Assessment: The clinician takes a baseline measurement of your response to the trauma you'll be working on.

4. Desensitization: Eye movements and bilateral stimulation begin, while you think about the traumatic event. This repeats until your distress at the memory is removed or reduced.

5. Installation: You replace the distressing belief with a positive belief, repeating until that feels true.

6. Body scan: You think about the traumatic event and your new positive belief, while scanning the body for any remaining distress.

7. Closure: The therapist works with the client to establish emotional safety and a sense of mental stability before the end of the session. This is done through relaxation activities, discussion of the client's feedback, and "homework" if it's appropriate.

8. Reevaluation: At each session, you and your therapist will check in following EMDR reprocessing, re-evaluate the traumatic memories being targeted, check in on how you felt between sessions, and choose what to focus on during the following session. .

4. There are two important measurements

As you move through EMDR treatment, your provider will use two measurements to gauge how you're responding to treatment. The measurements are:

• Subjective units of disturbance (SUD): When you identify an emotion, usually negative, that you associate with your traumatic memory, the provider will ask you to rate on a scale of 0 to 10. Ten is the worst possible disturbance, while zero indicates a neutral feeling. The goal of treatment is to get the patients SUD to 0 in most cases, although in some cases an SUD of 1 is appropriate.
• Validity of cognition (VOC): As part of therapy, you'll identify a positive thought related to the traumatic memory. The therapist will ask you to rate it on a VOC scale that goes from 1 to 7, where 1 means the positive thought feels completely false, and 7 means it feels completely true. The goal of treatment is to have a VOC score of 7.

So by the end of your last EMDR session, ideally you should have an SUD of 0 and a VOC of 7. That means you've replaced a distressing memory with one that elicits a positive feeling.

While these metrics are valuable, your therapist will also check in on how you truly feel following each session. Logically understanding that you are safe and debunking a core negative belief is valuable, but there is a difference between logically knowing this and truly, emotionally feeling this within yourself. Feeling, rather than understanding, your positive cognitions is the goal.

5. You'll work on one memory at a time

Each 8-phase cycle of EMDR targets one traumatic memory, Solarte-Erlacher says. Sometimes, it's easy to identify the source of trauma: for example, someone who is seeking EMDR after a car accident.

But for people with many childhood traumas, it can be difficult to identify which memory to work on. As part of the history and treatment planning, your therapist will help you identify what memory to address first.

"Usually, the therapist will identify what they think is the earliest and most distressing memory, and start there," Solarte-Erlacher says. Subsequent traumas can be addressed during future EMDR cycles.

6. EMDR can work quickly

Studies show that EMDR can work more quickly than cognitive behavioral therapy (CBT) for reducing symptoms of trauma.

The number of sessions that you'll need will depend on your unique situation, but in many cases, EMDR is administered once a week for three months, equating to a total of 12 sessions.

"Because of the effectiveness, it can take less time to find resolution than with a regular talk therapist," Solarte-Erlacher says.

7. You need to have coping skills for EMDR

During an EMDR session you'll be asked to think about traumatic events, so it's very important that people have the coping mechanisms to deal with that before starting treatment.

In fact, becoming overwhelmed emotionally is one of the only risks of EMDR, but it's a serious one worth recognizing before you begin.

"With EMDR, you have to have some skills to tolerate intense and difficult emotions," Solarte-Erlacher says.

That's why, during the first phase of treatment, your provider will help identify the resources you have available.

For example, you may have positive memories, a mindfulness practice, or strong relationships that you can lean on when you feel overwhelmed by EMDR.

In some cases, the clinician might work with you to develop the skills you'll need, like the ability to calm yourself through breath work, to cope before starting EMDR.

This can also include providing resources, filling and validating gaps in knowledge, and identifying protective factors. The therapeutic relationship can be a protective factor in itself, as establishing trust between you and your therapist is crucial.

"EMDR therapists are attuned to the skills and resources that people need to continue," Solarte-Erlacher says.

8. It's not a fit for people who abuse drugs or alcohol

EMDR has been shown to reduce cravings and depression among people with substance use disorder. However, Solarte-Erlacher says it's important that people undergoing EMDR treatment are sober.

"If you have an ongoing dependence to substances, you can't reprocess effectively," she says.

It's ok to drink recreationally when going through EMDR, but not to drink as a coping mechanism.

9. It's for more than just trauma

EMDR was developed specifically for treating PTSD. That's still what it's most commonly used to treat. However, EMDR can help treat a variety of mental health conditions including:

• Anxiety
• Depression
• Phobias
• Eating disorders
• Obsessive-compulsive disorder
• Personality disorders, like borderline personality disorder
• Dissociative disorders, including dissociative identity disorder
• Gender dysphoria
• Chronic pain
• Sleep disorders
• Grief

"This is a pretty far-reaching treatment," Solarte-Erlacher says.

10. It can be done remotely

Even before the pandemic, the EMDR International Association was providing guidance for remote EMDR sessions. Although the research is limited, early evidence shows that EMDR therapy can effectively be delivered over telehealth.

11. It's not a magic solution

"Some people come to EMDR thinking it's quick, fast, and easy," Solarte-Erlacher says. Unfortunately, that's not the case.

"EMDR is not a silver bullet. It's not going to be the thing that's going to transform things immediately," she says. "Clients who are most successful are really committed to the process."

Much like many other forms of psychotherapy, it also doesn't seem to work for everyone.

The goal of EMDR is to provide total reprocessing of a memory. So, after 12 weeks you should no longer experience symptoms of trauma related to the memory you reprocessed. However, you might need further sessions to cope with other traumatic memories.

Insider's takeaway

EMDR is a clinically-proven therapy that's highly effective in treating PTSD and many other mental health conditions.

If you're interested in trying EMDR, it's important to work with a clinician who has been trained in this specific form of therapy.

Although EMDR can be effective in 12 sessions or less, it is emotionally intense and requires effort, support, and coping mechanisms from the patient.

"It's hard work, but absolutely worth it," Solarte-Erlacher says.