The After Effects of EMDR Therapy

Most people walk out of an EMDR session and get in the car. They have work to go back to, or the school run, or a shop to stop at. And then somewhere between the car park and the front door they notice they feel strange. Wiped out. Or oddly light. Or close to tears for no reason they can name.

Nobody warns you about the drive home. They should.

EMDR does not stop when the session stops. That is the single most useful thing to understand about it, and it explains almost everything that follows.

Why there are after effects at all

The premise of EMDR is that a traumatic memory has been stored badly. It sits in the nervous system in a raw state, still carrying the images, beliefs, emotions and body sensations that were present when the event happened. Processing is the work of getting that memory filed properly, so that it becomes something that happened to you rather than something that is still happening to you.

That is not a small piece of work, and the brain does not do it all in ninety minutes and then clock off. Shapiro was explicit about this in her clinical writing, and it is why the eighth phase of EMDR exists at all. Reevaluation is the session where your therapist asks what happened to you in the week since. Not as a pleasantry. As data.

Rotem Brayer puts it plainly in The Art and Science of EMDR: the brain remains in processing mode after the client leaves the room. Which means the week between sessions is part of the treatment, not a gap between treatments.

What you might actually notice

Tal Croitoru, writing for clients rather than clinicians, names three side effects of EMDR. They are worth taking one at a time.

Tiredness. This is the common one. Not always, but often. It is the natural result of a process that has been working your emotions, your senses, your thinking and your body all at once for the best part of an hour. People describe it as being flattened, or as the tiredness that follows a long cry, or a hard run. It usually passes within a day.

A rise in distress before the fall. Processing a single traumatic event usually takes between one and three sessions. If the work is not finished when the session ends, the memory may continue to press on you until the next one. More thoughts about the event. More dreams about it. This is not the treatment failing. It is the treatment continuing.

Acting out in the present. This is rare and Croitoru says he has seen it only a handful of times. It happens when the material is so intense that the person loses track of whether the feeling belongs to now or to then, and behaves as though it belongs to now. Getting up and leaving the room, for example.

Beyond that list, the things clients most commonly report between sessions are these. Dreams, sometimes vivid, sometimes obviously about the target and sometimes not. New memories surfacing, often ones you had not thought about in years, sometimes ones you did not know you still had. Emotional volatility, where you cry at an advert. A body that aches in places you cannot account for. And, just as often, an unfamiliar sort of calm.

You should also be prepared to feel nothing at all. Shapiro was careful about this too. Some clients show little apparent change in the room and process the material later. Others show a lot of change in the room and then nothing much happens for a week. Neither is a verdict on how the treatment is going.

The gaping trapdoor

Here is the part that matters most, and the part I want you to actually read rather than skim.

A properly run EMDR session does not end with you distressed and unable to bring yourself back down. Phase 7 of the protocol, closure, exists precisely to prevent that. Your therapist should be leaving real time at the end of every session to help you regulate: the calm place exercise, the container exercise, grounding, breathing, whatever works for you. If you are leaving sessions repeatedly in pieces, that is a problem with how the therapy is being delivered, not a sign that you are too broken for it to work.

Brayer is direct about the stakes. Ending a session while a client is at a level of disturbance they cannot regulate can lead to a rapid deterioration, which can mean suicidal thoughts, risky behaviour, hospital admission. This is not a small point of technique. It is the difference, as he puts it, between an unpleasant evening and a trip to A&E.

So before you start processing, you and your therapist should have a plan for the bad night. What will you do if the distress becomes too much? Who will you call? Which regulation strategies do you actually use, as opposed to the ones you nod along to in session and forget by Tuesday?

If your therapist has not raised this with you, raise it with them.

If you are in crisis, in the UK you can call Samaritans free on 116 123, at any hour, on any day.

The log

Both Shapiro and Brayer want clients to keep notes between sessions, and they want it for the same reason: the material that surfaces after a session is the raw material of the next one.

Shapiro's version is the TICES log. Six columns on a sheet of paper. Trigger, image, cognition, emotion, sensation, and a distress rating from 0 to 10. When something disturbing comes up during the week, you write it down briefly and you move on. You are not journalling your feelings. You are taking a reading.

Brayer's version is looser. Journal if you can. If you will not journal, put notes in your phone. A dream, a memory, a moment where something got to you. He notes that people forget this material fast, and a fragment of a note is often enough to bring the whole thing back in the next session.

The reason both of them insist on it is that these fragments become targets. The nightmare you had on Thursday is not noise. It is a direct route into the memory network you are working on, and once the nightmare image has been processed, Shapiro observed, the dream generally stops recurring.

What to actually do in the days after a session

Take the evening off if you can. Not everyone can, and Brayer notes that plenty of clients go straight back to their inbox. But if there is a session you can protect, protect the one you have just done hard work in.

Sleep matters more than people think. Brayer lists poor sleep among the reasons processing gets stuck. During dream sleep the brain runs a kind of overnight consolidation, and if it does not get that, it turns up to the next session less ready to work.

Do not go looking for it. There is a temptation, once you know the brain keeps processing, to sit at home poking the memory to see whether it still hurts. Do not. Let it work.

Tell your therapist the truth at the next session. Not the sanitised version. If you had four bad nights, if you drank more than usual, if you thought about not coming back. That is exactly the information phase 8 exists to gather, and if you polish it you get a worse treatment.

And if the disturbance is high and holds, do not wait a week in silence. Shapiro is clear that clients who are very distressed after an incomplete session may need to be seen more often than weekly, and that a phone check-in in between is sometimes the right call. Ask for it.

The bit nobody tells you about the good after effects

The after effects that get discussed are the difficult ones, because those are the ones that need managing. But the changes people notice in the weeks after processing are often quiet and easy to miss.

The memory becoming flat. Still there, still true, still yours, but no longer taking the room's air out when it arrives.

The trigger that stops triggering. You hear the song, or drive past the junction, or smell the aftershave, and nothing happens.

The belief moving. Not because you argued yourself out of it, but because it simply stopped feeling true. People are often more surprised by this than by anything else.

These are the after effects too. They are just harder to notice than a bad Tuesday.

The point

EMDR asks something of you in the days after the session, and if you are not told that in advance, you will interpret every hard evening as evidence that it is going wrong.

It usually is not going wrong. It is going.

But that only holds if the therapy is being done properly: with preparation before you process, with real closure at the end of every session, with a plan for the bad night, and with a therapist who wants to hear how the week actually went rather than how you would like it to have gone.

The week between sessions is the treatment. Treat it that way.

This is general information, not clinical advice. If you are having EMDR and something feels wrong, tell your therapist. If you are in crisis, contact your GP, NHS 111, or Samaritans on 116 123.