EMDR Session

Session overview

• Phase of EMDR protocol: Desensitisation (Phase 4)
• Focus of the session: Car accident from June 2023
• Current life circumstances: Recent anniversary of accident triggering increased nightmares and hypervigilance while driving

Target memory and components

• Target Memory/Incident: Being trapped in car after collision, waiting for emergency services
• Negative Cognition: “I am helpless”
• Positive Cognition (PC): “I can handle difficult situations”
• Validity of Cognition (VOC) Rating: 3/7
• Emotions Associated with Memory: Fear, panic, shame
• Subjective Units of Disturbance (SUD) Rating: 8/10
• Body Sensations: Tightness in chest, difficulty breathing, tingling in hands

Processing details

• Bilateral Stimulation (BLS) method used: Horizontal eye movements, 24-36 passes per set
• Client’s response during BLS: Initially reported increased physical sensations (chest tightness, shallow breathing), followed by spontaneous memories of previous instances of feeling trapped
• Observed themes, patterns, or insights: Connection between current feelings of helplessness and childhood experiences of being unable to affect outcomes
• Adjustments to BLS or processing approach: Slowed down eye movements when client reported intensified body sensations; interweaved cognitive prompt when processing stalled
• New associations or memory links: Connected to memory of being locked in closet as a child during hide-and-seek game

Outcome of processing

• SUD Rating at End of Session: 4/10
• VOC Rating at End of Session: 4/7
• Reduction/change in distress: Client reported feeling “lighter” and less restricted in breathing
• Changes in emotional or somatic reactions: Reduced chest tightness, breathing normalised, hands no longer tingling

Installation phase

• Reinforced Positive Cognition (PC): “I can handle difficult situations”
• Strength of VOC after installation: 5/7
• Client’s acceptance of PC and any barriers: Client reported the positive cognition felt “mostly true” but noted lingering doubt about ability to remain calm in unexpected situations

Body scan phase

• Somatic feedback: Residual tension noted in shoulders
• Remaining disturbances or neutral sensations: Slight “knot” in stomach when thinking of memory
• Integration of Positive Cognition into body awareness: Client reported feeling “more grounded” and “settled” when pairing PC with deep breathing

Closure

• Techniques used for closure: Container exercise, present-focused grounding (5-4-3-2-1 sensory technique)
• Emotional state at session end: Calm, reported feeling “back in the present” with reduced distress
• Homework or between-session activities assigned: Continue with daily container exercise; practice deep breathing paired with PC when noticing anxiety while driving
• Psychoeducation or coping strategies discussed: Reviewed normal trauma response patterns and window of tolerance concept

Therapist’s reflections

• Good progress with initial desensitisation; client demonstrated capacity to stay within window of tolerance while processing
• Strong engagement with process; appropriately communicative about internal experience
• May need to address childhood experiences of helplessness that emerged during processing in future session