EMDR Therapy: What a Session Is Like and Who It Can Help
Some memories do not stay in the past. A sound, a smell, a tone of voice, or a stretch of highway can drop you straight back into a moment you thought you had left behind. Your heart pounds, your body reacts, and you know in your head that you are safe now, yet your nervous system did not get the message. If you have tried talking it through and still feel stuck, you may have heard of EMDR therapy and wondered whether it is legitimate, what it feels like, and whether it could help you.
I'm Dr. Matthew McKeithan, a licensed clinical psychologist with 15 years of experience in trauma work. In this article I'll explain how EMDR works, what actually happens in a session, what the research says, who it tends to help, and where its limits are. If you are in San Francisco or elsewhere in the Bay Area and looking for an EMDR therapist you can see by secure video, I'll cover that as well.
Key takeaways
EMDR (eye movement desensitization and reprocessing) helps the brain reprocess distressing memories so they lose their emotional charge.
Major guidelines, including the World Health Organization's, recognize EMDR as an effective treatment for post-traumatic stress.
You do not have to describe every detail of what happened, and you stay in control throughout.
Good EMDR starts with preparation and stabilization, not an immediate dive into the hardest memory.
EMDR can often be done by secure video, which suits busy Bay Area schedules.
What is EMDR therapy?
EMDR stands for eye movement desensitization and reprocessing. It was developed by psychologist Francine Shapiro in the late 1980s and has since become one of the most widely used treatments for trauma. While you bring a distressing memory to mind, you follow a rhythmic, back-and-forth stimulation, usually eye movements, alternating taps, or alternating tones. This is called bilateral stimulation.
The idea behind it is that traumatic experiences can get stored in a raw, unprocessed way. They remain stuck in a state of high alert, so the memory feels like it is happening now rather than then. EMDR is designed to help the brain finish the job of filing that memory away as something that happened in the past.
How trauma stays stuck in the body and mind
When something overwhelming happens, the brain's survival systems take over. Thinking slows, the body mobilizes, and the memory can be encoded in fragments: images, sensations, emotions, and beliefs about yourself like I am not safe or it was my fault. Later, a reminder can set off the same alarm even when there is no danger.
That is why people with trauma often describe reacting before they have time to think. The Greek tragedian Aeschylus wrote of pain "which cannot forget" falling "drop by drop upon the heart", in a line that has been quoted for centuries because it names something so many trauma survivors recognize. The goal of treatment is not to erase what happened. It is to let the memory become something you remember rather than something you relive.
What the research says
EMDR is one of the more studied trauma treatments. The World Health Organization recommends both trauma-focused cognitive behavioral therapy and EMDR for children, adolescents, and adults with post-traumatic stress. The American Psychological Association's clinical practice guideline for PTSD lists EMDR among the treatments it conditionally recommends, alongside strongly recommended approaches such as cognitive behavioral therapy and prolonged exposure.
It is worth being straightforward about the limits. Researchers still debate exactly why EMDR works. Some think the bilateral stimulation taxes working memory so the memory becomes less vivid, others point to its similarity to exposure therapy, and others focus on the emotional regulation it supports. The mechanism is not fully settled, but the evidence that it can reduce PTSD symptoms is solid enough that major guidelines include it.
Who EMDR may help
EMDR was first studied for post-traumatic stress, and that remains its strongest evidence base. People seek it after:
Car accidents, medical events, or sudden losses.
Childhood neglect, abuse, or chaotic early experiences.
Assault, violence, or other threats to safety.
Military service, first responder work, or other high-exposure careers.
A single memory that still feels vivid, or a pattern of experiences that left a deep mark.
Clinicians also use EMDR for related problems such as anxiety, phobias, and grief, though the research is less developed there. If you want to learn more about how I approach trauma work, you can read about trauma therapy at Your Kind of Happy.
What an EMDR session is actually like
The standard EMDR protocol has eight phases. In practice, it starts well before any eye movements. We spend time on history, on building coping and grounding skills, and on making sure you feel steady enough for the work. Only then do we choose a target memory and begin reprocessing.
During reprocessing, I ask you to bring up an image from the memory, the belief attached to it, and where you feel it in your body. Then you follow the bilateral stimulation in short sets. Between sets, I ask what you noticed, and you simply report whatever comes up: a thought, a sensation, a different memory, or nothing at all. You are not expected to narrate the whole story, and you can pause at any point. Many people say it feels like watching a train of associations roll by, with someone steady beside them.
A small moment from my own training
Part of EMDR training involves practicing the method on each other, using mild, everyday memories rather than anything heavy. I picked an irritating memory about a long-ago airport mix-up, expecting nothing much. By the end of the session I was surprised at how quickly it went from a tight, red-hot annoyance to a flat, almost funny story. It was a small experience, but it taught me why this method has such loyal fans among clinicians. It also taught me that no, the eye movements are not a cartoon hypnotist's pendulum, and no, nobody quacks like a duck.
That is the light side of it. The heavy side is that the real work with trauma deserves care, pacing, and a therapist who can slow things down when you need it to.
Common concerns about EMDR
"Will I have to relive everything?" You will bring the memory to mind, but with one foot in the present and a steady pace. Many people find EMDR less overwhelming than they feared.
"Is it hypnosis?" No. You are awake and in control the whole time, and you can stop whenever you like.
"What if I cannot remember much?" You do not need a clear memory. Fragments, sensations, and feelings can all be worked with.
"Can it make things worse before they get better?" Sometimes feelings stir up between sessions, which is why preparation and coping skills come first. If you have severe dissociation or are in an unsafe situation, it may be wiser to stabilize before reprocessing.
How EMDR fits with other approaches
EMDR is not the only door to healing, and for many people it works best as one piece of a bigger plan. I often combine it with somatic work to help the body settle, with CBT or ACT skills for the thoughts and behaviors that grew up around the trauma, and with ordinary supportive conversation. Some people do better with a different trauma-focused approach altogether, and that is a conversation worth having honestly at the start.
How many sessions you need depends on what you are working through. A single-incident memory can take far fewer sessions than years of complex experiences. We would review progress together as we go rather than guess in advance.
EMDR by secure video for San Francisco and the Bay Area
If you live in San Francisco, getting across town for a weekly appointment can be a project of its own. Secure video lets you do the work from home, in a space where you already feel somewhat safe, and then step straight into your evening without the drive. Many therapists, including those who work with trauma, now offer EMDR online using on-screen bilateral stimulation or self-tapping techniques.
A systematic review by Greenwood and colleagues found that video-based psychotherapy produced outcomes comparable to in-person care for the conditions it studied. That research did not focus on EMDR specifically, so it is fair to treat it as encouraging rather than conclusive. Many clients tell me the comfort of their own space helps them stay grounded during the harder moments.
What you can try this week
Practice a grounding skill. Press your feet into the floor, name five things you can see, four you can hear, and three you can feel.
Make a safe-place image. Picture somewhere calm, real or imagined, and notice how your body responds.
Track your triggers gently. Without judging, jot down when you feel suddenly overwhelmed and what happened just before.
Build in recovery. After a hard day, do something soothing on purpose: a walk, a shower, music.
Reach out. Tell someone you trust that you are thinking about getting support.
These are starting points. Trauma deserves professional care, and you do not have to carry it by yourself.
Your next step
If a memory still has a hold on you and you are curious whether EMDR could help, you do not have to decide everything today. Book a free 15-minute consultation or schedule a full session. You can also browse more articles on the Your Kind of Happy blog.
About the author
Dr. Matthew McKeithan, Psy.D., is a licensed clinical psychologist licensed in California and South Carolina, with 15 years of experience working extensively with trauma. He provides integrative, trauma-informed counseling for individuals and couples, including CBT, ACT, EMDR, somatic work, and DBT-informed individual therapy. He is a husband and father of four. Sessions are offered by secure video across California. Learn more about Dr. McKeithan.
Serving San Francisco and the greater Bay Area by secure video, along with clients across California.
This article is for educational purposes and isn't a substitute for an individual evaluation, therapy, or medical advice. If you are in crisis, call or text 988.
Sources
World Health Organization. Guidelines for the management of conditions specifically related to stress. Geneva: WHO; 2013.
American Psychological Association. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. 2017. apa.org/ptsd-guideline
Shapiro F. Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress. 1989;2(2):199-223.
Greenwood H, Krzyzaniak N, Peiris R, et al. Telehealth versus face-to-face psychotherapy for less common mental health conditions: systematic review and meta-analysis of randomized controlled trials. JMIR Mental Health. 2022;9(3):e31780.
Aeschylus. Agamemnon, in Edith Hamilton's translation.