Your questions about EMDR answered

Following our recent webinar, ' What is EMDR, how does it work, and how can it support you?', we received a lot of thoughtful questions. We answered as many as possible during the live session, but there were more than we could cover in the time available.

Below, our clinicians respond to some of the most common themes. These answers provide general information and are not a substitute for an individual clinical assessment. EMDR should be delivered by an appropriately trained practitioner who can consider your history, current circumstances and individual needs.

How do I know whether EMDR is suitable for me?

Suitability for EMDR is assessed individually. The first phase includes taking a thorough history, understanding the difficulties you are experiencing and considering your current support, coping strategies, safety and ability to manage distress.

You do not necessarily need to arrive with a formal PTSD diagnosis to discuss EMDR with a therapist. However, the clinician will need to understand your symptoms and determine whether EMDR, another treatment or a combination of approaches is most appropriate.

How do I know whether I am ready for EMDR sessions?

Readiness does not mean that you must feel completely calm or able to talk about everything in detail. It means that the therapist and client have established enough safety, trust and emotional regulation to begin the work at an appropriate pace.

Treatment should consider individual needs, preferences, coexisting conditions and social circumstances.

Do I need flashbacks to benefit from EMDR?

No single symptom determines whether EMDR is suitable. PTSD can involve nightmares, intrusive memories, avoidance, hypervigilance, emotional numbing, changes in mood, dissociation and physical reactions to reminders.

Someone who experiences frequent nightmares but not visual flashbacks may still benefit from a trauma-informed assessment. The important questions are how the experience is affecting the person now and what treatment is most likely to help.

A decision to offer or decline EMDR should therefore be based on a comprehensive assessment, rather than the presence or absence of one symptom.

Does the original trigger need to have gone away?

Not always, but present-day safety matters. EMDR is not designed to persuade somebody that they are safe when there is a genuine and continuing threat.

If an unsafe situation is ongoing, the initial focus may need to be practical safety, support and stabilisation. Where the current trigger cannot be removed, a therapist can assess whether work can safely begin and distinguish between a present danger and a reminder of something that happened in the past.

How many EMDR sessions do you usually need?

There is no set number. The length of treatment depends on factors including the nature and number of experiences, current symptoms, stability, support, coexisting difficulties and how processing develops.

A single, clearly defined experience may require fewer sessions than longstanding or repeated trauma. Preparation, assessment, closure and review are also essential parts of EMDR, so treatment involves more than the processing phase itself.

Can EMDR finish too early, and what happens if symptoms return?

EMDR is not usually intended to continue throughout someone’s lifetime. Treatment should include regular review of symptoms, goals and progress, followed by planned closure.

Ending treatment before important memories or symptoms have been addressed may leave some difficulties unresolved. Equally, returning symptoms do not automatically mean treatment has failed. New stress, loss, reminders or previously unaddressed experiences can sometimes activate trauma responses.

If symptoms return or continue to interfere with daily life, a further assessment can explore whether booster sessions, additional EMDR or a different form of support may be helpful.

Are there age limits for EMDR?

EMDR can be adapted for children, young people and adults. With younger people, the therapist may use simpler language, shorter activities, drawing, storytelling, play or support from a parent or carer.

Suitability depends on the person’s developmental stage, communication needs, circumstances and ability to engage safely, rather than age alone. guidance covers the recognition, assessment and treatment of PTSD in children, young people and adults.

Can EMDR be accessed through the NHS?

EMDR is recommended by as a treatment option for PTSD in defined circumstances, but local availability and referral routes vary. Access may be through a GP, NHS Talking Therapies or a specialist trauma service, depending on the person’s symptoms and local service criteria.

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How does EMDR work with complex PTSD or several interwoven experiences?

With complex PTSD, there may not be one clear incident or one obvious memory. A person may have numerous experiences linked by common beliefs, emotions, physical sensations or relationship patterns.

The therapist develops an individual formulation and agrees which areas to prioritise. They may begin with an early experience, a particularly distressing memory, a present-day trigger, a nightmare, a body sensation or a recurring belief such as “I am unsafe” or “It was my fault”.

Preparation and stabilisation may take longer, and processing is usually paced carefully. The protocol remains structured, but the treatment plan is adapted to the person. specifically recognises that people with complex PTSD can experience emotional dysregulation, dissociation, relationship difficulties and negative self-perception, all of which need to be considered in assessment and care.

How is EMDR adapted for autistic people and people with ADHD?

EMDR can be considered for neurodivergent people, but it should not be delivered as a one-size-fits-all intervention.

Possible adaptations include:

• using clear, concrete language

• agreeing a predictable session structure

• allowing additional processing time

• adapting the length or pace of sessions

• reducing sensory demands

• using tapping or sounds instead of eye movements

• using visual scales or descriptions rather than relying only on emotion labels

• allowing movement or breaks

• checking how the person experiences physical sensations and distress

• distinguishing longstanding neurodevelopmental characteristics from changes associated with trauma

A formulation should consider the whole person rather than assuming that every difficulty comes from either trauma or neurodivergence.

Can EMDR help with my phobias?

EMDR is best established as a treatment for PTSD, but some clinicians also use it when a phobia is connected to a distressing experience or memory. This may include fears associated with illness, vomiting, medical treatment, travel or other situations.

However, EMDR is not automatically the first or most appropriate treatment for every phobia. Cognitive behavioural therapy, including carefully planned exposure-based work, is also commonly considered. An assessment can explore the origins of the fear, the person’s symptoms and the available evidence-based options.

Can EMDR treat physical conditions or autonomic symptoms?

EMDR is a psychological therapy and is not a treatment for an underlying physical condition. It may be considered when trauma, anxiety or distress is contributing to someone’s response to symptoms, but physical symptoms should still be medically assessed.

Symptoms such as weakness, loss of muscle control, fainting, persistent nausea or changes in nervous-system functioning should not automatically be assumed to be psychological.

Can someone have EMDR if they have an eating disorder or are physically unwell?

This requires an individual clinical and medical assessment. If somebody is medically compromised, physically unstable or struggling to tolerate sustained attention, the immediate priority may be physical health and stabilisation.

The EMDR therapist may need to work alongside the person’s GP, eating-disorder team or other clinicians.

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What if I cannot identify what I am feeling?

Being unable to name an emotion immediately does not necessarily prevent EMDR. A therapist may work with physical sensations, images, sounds, impulses, thoughts, nightmares or changes in distress.

Can EMDR be retraumatising?

EMDR can bring difficult memories, emotions and physical sensations into awareness, so it can feel challenging. However, properly delivered EMDR is not simply asking someone to relive an experience without support.

Assessment, preparation, grounding, agreed stop signals, pacing and session closure are important safeguards. A therapist should monitor whether the person remains within a manageable level of emotional arousal and adapt or pause the work when necessary.

Someone should feel able to raise concerns with their therapist. If treatment consistently feels unmanageable, the plan should be reviewed rather than simply pushing ahead

How do you manage dissociation?

Dissociation can include feeling detached, unreal, numb or disconnected from the body or surroundings. It needs to be assessed carefully before and throughout treatment.

The therapist may spend longer on preparation, use shorter periods of bilateral stimulation, pause processing, use grounding techniques or work more gradually. Treatment should proceed at a pace the person can tolerate.

If dissociation increases significantly during or between sessions, the person should discuss this with their therapist so that the treatment plan can be reviewed.

Do I need a clear memory for EMDR to work?

Not necessarily. Some people remember only fragments, sensations, emotions, sounds, nightmares or the period before or after an experience.

EMDR should not be used to fill gaps or attempt to create a memory. Instead, the therapist works with what the person genuinely experiences now. That might be an image, a body response, a recurring belief, a trigger or the distress associated with not knowing exactly what happened.

The purpose is to reduce the current impact of the experience, not to prove or reconstruct uncertain events.

What if I cannot talk about what happened?

A person does not always have to provide a detailed verbal account. The therapist will still need enough information to assess safety and plan treatment, but EMDR can sometimes focus on an image, sensation or belief without requiring every detail to be spoken aloud.

This should be agreed between the individual and therapist. The client remains in control and can ask to pause at any point.

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Do you have to use eye movements?

No. Bilateral stimulation can be delivered through guided eye movements, alternating sounds or tapping. Light bars are one tool some practitioners use to guide the eyes from side to side.

The method should be agreed with the therapist and adapted where eye movement causes discomfort, fatigue, dizziness, sensory overload or physical difficulty. The alternative should still form part of a structured EMDR treatment delivered by a trained practitioner.

Can I practise EMDR on myself?

People can use grounding, paced breathing and coping strategies agreed with their therapist between sessions. However, independently trying to process traumatic memories through eye movements or tapping is not the same as receiving EMDR therapy.

Trauma processing can bring up unexpected distress, dissociation or connected experiences. For this reason, it is safer for formal EMDR processing to take place with an appropriately trained professional who can assess readiness, monitor reactions and help close the session safely.

Can other therapies be used alongside EMDR?

Yes. The overall plan may include psychoeducation, grounding, cognitive behavioural therapy, compassion-focused approaches, mindfulness, relationship work or other interventions.

The important issue is not simply how many approaches are used, but whether they form a clear, coordinated plan. Some people need preparatory work before processing; others may be ready to begin EMDR sooner.

Does EMDR require someone to blame?

No. The purpose of treatment is not to find someone to blame. Therapy explores the meaning the person has attached to the experience and whether beliefs such as “I caused this”, “I failed” or “I am unsafe” continue to create distress.

Where no person was responsible, EMDR can still address helplessness, loss, fear, grief or the sense that the world is unsafe. The focus is on helping the memory become less distressing and supporting a more balanced understanding of what happened.

What if I still believe what happened was my fault?

A therapist should not force a positive belief or tell someone what they must think. Instead, the belief can be explored carefully in the context of what happened, the person’s level of control and what they know now.

Change may happen gradually. If the belief remains firmly held, the therapist may slow down, gather more history or use an appropriate clinical intervention to help the processing move forward.

What is the difference between the PCL-5 and the Impact of Event Scale?

Both are questionnaires used to measure trauma-related symptoms, but they are not interchangeable.

The PCL-5 is aligned with the DSM-5 symptoms of PTSD. The Impact of Event Scale and its revised form measure distress such as intrusion, avoidance and hyperarousal associated with a particular event.

Questionnaire scores can support assessment and help track change, but they should not be used alone to diagnose PTSD. Interpretation should sit alongside a clinical interview and wider assessment.

How can someone train as an EMDR therapist?

EMDR training is intended for appropriately qualified mental health professionals who already have relevant clinical training, professional registration and experience.

Entry requirements differ between training providers, so holding an MSc in psychology alone does not necessarily establish eligibility to practise. Prospective trainees should check that a course is accredited by the relevant professional EMDR body and that it is compatible with their existing professional registration and scope of practice.

What is the most important factor in successful EMDR?

There is unlikely to be one factor that guarantees success. Important aspects include:

• a careful assessment

• an agreed and realistic treatment plan

• sufficient safety and preparation

• a trusting therapeutic relationship

• treatment adapted to the individual

• appropriate pacing

• the person feeling able to pause or give feedback

• regular review of progress and difficulties

EMDR is a collaborative therapy. A person does not have to perform perfectly, remember every detail or respond in the same way as somebody else.

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