What to Expect in EMDR Therapy

Before your first session

Most of what happens before your first session is simple, even if your nervous system might be telling you otherwise. You'll fill out an intake form, schedule the appointment, and arrive (in person or via video) at the agreed time. Most people who reach out to us are doing it after a long stretch of thinking about it. Whatever you're carrying when you arrive, you don't need to have it figured out before you get there.

The intake conversation will cover the practical pieces: insurance and payment, scheduling, what to expect from the format, and a brief outline of why you're reaching out. You don't need to recount your full history on this call. Our intake team is there to make sure you find the right fit, not to assess your readiness for therapy.

For in-person sessions, you'll get directions to the office and parking information. For telehealth, we'll send you a secure video link before the appointment and walk you through the technology if you'd like. We have a separate telehealth page with more detail on how online sessions work.

The first session

The first session is mostly about getting to know each other and beginning to understand what brought you in. Your therapist will ask about what you're hoping to work on, your relevant history (what feels safe to share, not everything), and what your day-to-day life looks like. They'll also explain how EMDR works, what the eight phases look like, and what the early sessions will likely involve.

An important thing to know: your therapist will not ask you to detail all of your past traumas during this first session. There's a clinical reason for that, and it's designed to keep you safe. Talking about a painful event in detail can activate the memory network and bring up intense feelings before you and your therapist have built the trust and skills to work with them. The first session is not the right time for that work.

What the first session usually does include: a sense of who your therapist is and how they work, an early outline of what you're hoping for, some questions about your strengths and resources, a discussion of confidentiality and how the practical pieces work, and time at the end to ask anything you want to ask.

Most people leave the first session feeling something between relief and uncertainty. Both are normal.

The early sessions: building the foundation

The early sessions of EMDR (sometimes called the preparation phase, or Phase 2) often surprise people. They expect to start eye movements right away. They don't, and there are good reasons.

What the early sessions involve:

Building the therapeutic relationship. EMDR is a relational therapy. Trust between you and your therapist matters for the work that follows.
Learning grounding and resourcing skills. Calm-place imagery, container exercises, body-based grounding techniques you can use during processing and between sessions.
Introducing dual attention stimulation (DAS). Trying out the bilateral component (eye movements, taps, or audio tones) on neutral or positive material so you know what it feels like before any difficult content is involved.
Mapping what you'll be working on. Identifying the experiences, beliefs, or patterns that the EMDR work will eventually target. This is collaborative.
Confirming readiness. Your therapist is checking, throughout these early sessions, that you're resourced enough for the work that follows.

If you find yourself feeling like the work is moving slowly or like you're not "really doing therapy yet," that's a sign your therapist is being thoughtful. The skills you build in this phase directly support how smoothly the processing phase goes later. Trust the process even if it feels indirect. You're doing the real work.

When EMDR processing actually starts

There's no fixed timeline for when active EMDR processing begins. For some people, it starts as early as the second or third session. For others, particularly those with complex trauma or limited prior therapy experience, the preparation phase takes longer (sometimes several sessions, sometimes more) before the work shifts into the processing phases.

Your therapist will check in with you about timing. They are not trying to drag the work out, and they are also not trying to rush you. The goal is to start processing when you are resourced enough to do it well, which is different for everyone.

When the rhythm shifts into processing, you'll know. The session structure changes. You'll be asked to bring a specific memory, image, or pattern to mind. You'll identify the emotions, body sensations, and beliefs that go with it. And then the bilateral stimulation begins.

What a processing session looks like

Processing sessions are different from the conversation-based sessions of the preparation phase. Here is the rough shape of one.

Setting up the target

Together with your therapist, you'll choose a specific memory or pattern to focus on. You'll identify the image that comes to mind when you think of it, the emotions you feel, the body sensations that come with it, and a negative belief about yourself that's connected ("It was my fault," "I'm not safe," "I'm not enough"). You'll also identify the positive belief you'd like to be able to hold instead.

The processing itself

Your therapist will guide you through sets of dual attention stimulation while you hold the memory in mind. After each set, they'll ask what came up. There are no right or wrong answers. You might notice the memory becoming less vivid, your emotions shifting, new thoughts surfacing, or your body relaxing in a way that surprises you. Sometimes nothing seems to be happening; that's also okay.

You don't need to narrate the memory in detail. You hold it; your therapist holds the space. You can pause or stop the process at any moment by signaling your therapist (typically a hand gesture you'll agree on in advance). You are in control throughout.

Closing the session

Your therapist will not let you leave a session activated and unsettled. If the processing on a particular memory is not complete by the end of the session, they'll guide you through a closing process (sometimes called containment) so you can put the material aside until next time. You should leave each session feeling at least as grounded as when you arrived.

The eight phases of EMDR are described in more depth on our main EMDR page if you want to read about them clinically.

Between sessions

EMDR work continues between sessions even when you're not in the office. Your brain keeps processing for hours, sometimes days, after a session. This is part of how the work happens. It can also feel surprising if you weren't expecting it.

What you might notice:

Vivid dreams, sometimes related to what you worked on, sometimes seemingly unrelated
Stronger emotions or shifts in mood that come and go more than usual
New connections or insights arising naturally, often in unexpected moments
Fatigue, especially in the first day or two after a processing session
Body sensations showing up as the nervous system continues integrating

What helps: keep the day after a processing session lighter than usual if you can. Don't schedule anything demanding. Watch something comforting. Move your body in ways that feel good. Get rest. Use the grounding skills your therapist taught you in the preparation phase. If something significant comes up that feels like more than you can hold, reach out to your therapist between sessions.

Many people find brief journaling helpful: noting dreams, emotions, or shifts you noticed during the week. Bring whatever you noticed to your next session. Your therapist may use it as a starting point.

Common worries before starting

Here are some of the worries we hear most often. None of them are signs that you shouldn't do this work.

"What if I don't remember the trauma clearly?"

You don't need detailed conscious memory of an experience for EMDR to work with it. Your nervous system carries the imprint either way, and the work can engage with present-day symptoms and body responses regardless of what you remember explicitly. This is especially common for early-childhood material.

"What if I dissociate during a session?"

Some level of dissociation is common during trauma processing and your therapist is trained to recognize it and bring you back. The preparation phase includes building grounding skills specifically for this. Significant dissociation may shift the pace of the work, but it does not stop the work.

"What if it doesn't work for me?"

EMDR has a strong evidence base, but it's not a guarantee, and it doesn't work the same way for everyone. If a particular target doesn't shift the way you and your therapist expected, the work adapts. Sometimes the issue is preparation; sometimes it's the choice of target; sometimes it's that another approach fits better. Your therapist will work with you on the next step.

"What if I get triggered between sessions and can't manage it?"

This is part of why the preparation phase matters. By the time you start processing, you'll have specific tools to use when something comes up. You'll also have a way to reach your therapist if needed. You're not on your own with this.

"What if I cry, or get angry, or do something embarrassing?"

You won't be the first person who has, and your therapist will not be surprised. Strong emotion is part of how trauma processing works. The therapy office is one of the few places where the full range of what you're carrying is welcome. You don't have to perform composure to be a good client.

Frequently Asked Questions

How many sessions before EMDR processing actually starts?

It varies. For some people, processing can begin as early as the second or third session. For others, particularly those with complex trauma or limited prior therapy experience, the preparation phase takes longer (sometimes several sessions or more) before active processing begins. The pace is set by what your nervous system needs, not by an external timeline.

What if I can't do the eye movements?

There are several alternatives. Dual attention stimulation can be delivered through gentle alternating taps on your hands or knees, small handheld buzzers, or audio tones that alternate between your left and right ears through headphones. Many people prefer one of the non-visual options. Your therapist will help you find the type that fits.

What if I cry during a session?

You will not be the first person who has cried in our office, and you will not surprise your therapist. Strong emotion is part of how trauma processing works, and crying can be part of that. Your therapist will be there with you, will help you stay grounded, and will close the session in a way that leaves you stable.

Will I feel worse before I feel better?

Sometimes, briefly. EMDR processing can stir up material that has been held in the background, and the days following a processing session can include vivid dreams, stronger emotions, or fatigue as your brain continues working. This is typically temporary and is generally a sign that healing is happening. Your therapist will prepare you for what to watch for and give you techniques to manage discomfort between sessions.

Can I take a break from EMDR?

Yes. Pausing EMDR for a period (a busy work stretch, a major life transition, a season where you need to be more resourced before continuing trauma work) is something we plan around together. Therapy is collaborative; you do not have to push through if the timing is wrong.

What if I get triggered between sessions?

Your therapist will teach you grounding and self-soothing techniques during the preparation phase that you can use between sessions. You'll also have a way to reach your therapist if something significant comes up. Triggering between sessions is common, especially as processing begins, and there are concrete things to do when it happens.

How long until I see results?

It depends on what you're working through. Single-incident trauma can resolve in three to six processing sessions for many people. Complex or developmental trauma typically takes longer. Many people start noticing shifts (less reactivity to triggers, sleep that feels less heavy, the memory becoming less vivid) earlier than they expected, even before the processing on a particular target is complete.

Should I journal between sessions?

Many people find brief journaling helpful, particularly noting any thoughts, dreams, body sensations, or emotional shifts that come up between sessions. Your therapist may ask about these at your next appointment. Journaling is not required; some people find it useful, others find it gets in the way.

Can I bring someone with me to my first session?

For adults, the first session is typically with you and your therapist. A support person can wait in the waiting room or, for telehealth, in a different room. For children and adolescents, a parent or caregiver is usually involved. If you want a support person more directly involved, that's a good conversation to have with your therapist as part of treatment planning.

Clinically reviewed by

Sarah Martin, LCPC, NCC

Clinical Director, Trauma Specialists of Maryland

Sarah is a Licensed Clinical Professional Counselor and Board Certified Counselor with over 8 years in the mental health field. She is trained in EMDR, and works with clients across the full course of EMDR treatment from preparation through reevaluation.

Read full bio

If you'd like to start

A consultation can help you figure out whether EMDR is the right fit for what you're working on and, if it is, who on our team would be a good fit.

Schedule a consultation Meet our therapists

If a form doesn't feel right, you can also email us at info@traumaspecialistsofmd.com. We're here either way.