The 8 Phases of EMDR: Why Preparation Comes Before Processing

At a glance

EMDR has eight phases: history and treatment planning, preparation, assessment, desensitization, installation, body scan, closure, and re-evaluation. These are parts of a treatment structure, not eight appointments on a calendar. A therapist may return to earlier work as new needs appear. Michael Hase's protocol paper describes EMDR as a comprehensive psychotherapy rather than a stand-alone eye-movement exercise. ^[1]

Begin with a map, not a race

The first phase is history and treatment planning. In everyday language, this means understanding the concern, the person's context, and the proposed goals. Choosing a target belongs within the assessment and planning process; it is not an extra ninth phase. A target should have a clear relationship to the treatment plan rather than being selected simply because it is the most upsetting story someone can recall.

The second phase is preparation. This is where the therapist explains the approach, discusses consent and communication, and helps establish ways to manage the work. A practical question is, “What will we do if this becomes too much?” Preparation is not a test of whether a client is cooperative or already calm enough to deserve treatment. It should serve an identifiable purpose. ^[1]

As an editorial example, two people may both seek help after an accident but need different preparation. One needs a clearer explanation of the process and a way to signal a pause. Another also needs a reliable private place for telehealth and a plan for support afterward. Those differences do not tell us who is stronger. They tell us what the treatment setting must account for.

Assessment and active processing

The third phase, assessment, brings a specific target into focus. The fourth, desensitization, involves processing the distress associated with that target. The fifth, installation, attends to a more adaptive belief related to it. The sixth, body scan, checks for remaining physical disturbance associated with the work. These are simplified descriptions for orientation, not instructions for carrying out the procedure independently. ^[1]

An adaptive belief should not require denial. A person who was harmed does not need to decide that the harm was acceptable. A credible shift might involve recognizing that responsibility belonged to someone else or that more choices exist now. The language should remain the client's, and uncertainty should be allowed. “I am beginning to consider another explanation” can be more honest than performing certainty for a therapist.

Ending the session is part of treatment

The seventh phase is closure. The eighth is re-evaluation, including checking the work again at a later appointment. Keeping these separate matters: finishing an appointment and reviewing the lasting result are different tasks. A calmer feeling at the end of one session does not by itself establish that all relevant difficulties have resolved. The VA patient guide describes EMDR as a course of treatment with discussion and review, not uninterrupted processing from beginning to end. ^[2]

Our practical recommendation is to make the ending predictable. Clients should understand what the plan is between appointments and how to raise concerns. Clinicians should avoid implying that a session must reach a dramatic conclusion to count as useful. An unfinished target is a reason for thoughtful closure and review, not an invitation to rush past the person's limits or the end of the appointment.

Preparation does not mean an indefinite delay

A randomized study of 121 adults with PTSD related to childhood abuse compared a preliminary skills intervention followed by EMDR with EMDR without that additional skills course. It did not find an added benefit from requiring the preliminary course in that study population. The comparison was not between careful treatment and no assessment. It does not show that preparation, consent, or risk evaluation can be discarded. ^[3]

The practical interpretation is a middle path. Some clients need additional support before or alongside trauma-focused work; others may not benefit from an automatic prolonged delay. “Preparation first” is useful only when preparation has a defined purpose. A therapist should be able to explain what is being developed, how it will be evaluated, and when the plan will be reconsidered.

A conversation clients can use

Instead of asking only, “When do we start the eye movements?” try asking, “What are we working toward in this stage?” That makes room for a concrete answer. It can also reveal whether the plan is clear. A useful explanation might connect preparation to communication, maintaining contact with the present, practical safety, or understanding the treatment choice.

You can also ask how the therapist will recognize that more support is needed. These questions are not an attempt to supervise your own clinician. They are part of understanding the care you are receiving. A phased approach should make treatment more understandable, not turn it into a mysterious sequence that only the professional is allowed to interpret.

For clinicians: make the structure visible

Our editorial recommendation is to explain the phases in language that suits the client and to revisit the explanation when the work changes. Name the difference between a treatment phase, an individual session, and the overall course of care. Avoid treating a standard sequence as a guarantee of duration or outcome.

The eight phases are useful because they keep the intervention connected to planning, consent, integration, and follow-up. Their value is not that every client travels through them identically. It is that active processing remains part of a considered treatment relationship rather than becoming an isolated technique.