Learning from EMDR: A Practice Advisory for IEMT Practitioners

Reported concern

Posters describe increased anxiety, panic, anger, tearfulness or low mood during a course of EMDR. Intrusive memories are unwanted recollections that come to mind. They may feel more frequent or harder to manage, and familiar triggers may provoke stronger reactions. Accounts range from brief emotional rawness to distress that persists between appointments and feels like a loss of previous stability. Some describe this as retraumatisation; that is their interpretation of the experience, not a diagnosis established by this review.^{[1] [2]}

The uncertainty is whether the distress is temporary and manageable, whether the work needs to change, or whether their overall situation is deteriorating. People seek help deciding how long to tolerate feeling worse and when to question continuing. Severity, duration and loss of everyday functioning are therefore important parts of what they are reporting.^[25]

Practice response

• Ask what has changed from the client’s usual baseline, how long it lasts, and what it prevents them from doing. Record their account without assuming its cause.
• Distinguish temporary discomfort, lack of improvement and continuing deterioration. Do not reassure automatically that feeling worse proves the work is succeeding.
• Use a report of worsening to reconsider the plan with the client. A standard explanation about “processing” should never replace attention to their actual experience.

Reported concern

The informal term “EMDR hangover” covers a range of experiences after appointments: marked tiredness, mental fog, difficulty concentrating, headaches, muscle tension, nausea or dizziness. Sleep-related accounts include vivid dreams, nightmares and disrupted sleep. These effects may become most apparent after the person has left the session, when they are trying to work, rest or resume ordinary responsibilities.^{[3] [5] [26]}

Reports differ in how long this lasts. Some describe recovery over a day or two; others describe disruption lasting a week or longer. The unpredictability can make it difficult to plan around appointments. Some contributors also describe meaningful benefit from EMDR, so post-session burden and perceived improvement can coexist. “Hangover” is a community expression, not a defined diagnosis or an explanation of what caused the symptoms.^{[3] [4]}

Practice response

• At the next contact, ask about the period after the appointment before starting further work. A settled appearance in the room does not tell you how the rest of the week went.
• Discuss realistic arrangements around work, travel and caring responsibilities. Avoid assuming that every client can take time off or has someone available to help.
• Treat new or persistent physical symptoms as information requiring attention; do not label them a necessary release of trauma or assume an emotional cause.

Reported concern

Some posters describe attending for months with little change in the problems that brought them to therapy. Others report initial improvement followed by a plateau, or repeated work on the same memory without understanding what remains to be achieved. There can also be a gap between what happens in the room and what happens afterwards: recalling a memory may become easier while panic or distress in everyday situations continues.^{[6] [7] [8]}

This leaves the person unsure how to judge progress, how much longer to continue, and what would count as completion. Without an agreed way of reviewing benefit, repeated sessions can feel directionless. These accounts raise separate questions about immediate changes, lasting changes and the usefulness of the overall course; they do not establish why a particular person has not improved.^[24]

Practice response

• Agree one or two concrete changes the client hopes to notice, and record the starting point in their own terms. Examples might concern a particular situation, activity or emotional response.
• Compare immediate changes with what persists outside the appointment. A lower in-session rating is useful information, but it does not answer every question about benefit.
• Agree a review point. When progress is absent or the burden outweighs the benefit, discuss the rationale for continuing, changing course or ending, rather than simply repeating more sessions.

Reported concern

People describe knowing that an event was important while being unable to connect it with an emotion, bodily sensation or clear image during the session. Others report their attention drifting, their mind going blank, or a sense of detachment that they describe as dissociation. These experiences can leave them unable to do the task as they understand it, even when they want to participate.^{[9] [10]}

A related difficulty arises when distress is connected with a prolonged or poorly remembered period of life rather than one clearly defined episode. Selecting a single memory can then feel artificial or impossible. The resulting frustration may be interpreted by the person as evidence that they are unsuitable for the method. These descriptions need clarification individually; blankness, uncertain recall and feeling disconnected should not automatically be given the same explanation.^{[9] [11]}

Practice response

• Clarify what “blank” means to this person. An absence of words, difficulty following an instruction and a frightening sense of disconnection are different experiences.
• Do not press the client to produce a memory, intensify an emotion or supply a more dramatic account. An uncertain recollection should remain uncertain.
• If engagement becomes difficult, review what the client can comfortably attend to and whether the proposed work remains suitable. Seek supervision where the presentation exceeds your experience.

Reported concern

Posters ask what they are supposed to focus on, how to keep a memory in mind while following the moving stimulus, how to use a distress rating, and what to say when nothing new happens. Some find their attention divided between performing the eye movements and noticing their internal experience. Instructions that appear straightforward to a practitioner can therefore feel ambiguous to the person receiving them.^{[12] [13]}

This confusion can become pressure to produce a particular emotion, insight or sign of improvement. People may worry that “nothing changed” is an unacceptable answer or that difficulty with the task means they are failing at therapy. Their attention then turns towards judging their performance. The reported problem includes both unclear instructions and uncertainty about whether their actual experience is welcome.^{[12] [14]}

Practice response

• Explain one task at a time in ordinary language, including what the person may say when nothing changes. Check understanding without making it an examination.
• Ask open questions before offering interpretations. Leave room for “no change”, “I don’t know”, discomfort and disagreement.
• Notice whether praise is being attached mainly to improvement. Keep your response equally receptive when a client reports uncertainty or an unwanted effect.

Reported concern

Some accounts describe moving into distressing memories before the person feels prepared, or continuing at a pace that feels difficult to manage. Others describe limited confidence in the coping exercises offered. Imagining a safe place, for example, may feel inaccessible or upsetting, leaving the person without the sense of reassurance the exercise was intended to provide.^{[15] [16] [17]}

The concern also extends to session endings and the interval before the next appointment. Posters describe leaving while still unsettled or detached, with uncertainty about how to manage what follows. Preparation, pace and aftercare are connected here: being willing to begin does not necessarily mean feeling able to manage the aftermath. These accounts concern perceived readiness and support; they do not establish a universal number of preparation sessions.^{[16] [18]}

Practice response

• Find out what has helped or hindered this client in previous emotionally demanding work. Check that the explanation and proposed pace make sense to them.
• Agree a clear way to signal a pause. Do not interpret silence or apparent compliance as evidence that the pace is comfortable.
• Protect time for closure. Check the person’s present experience and immediate plans, and avoid opening new demanding material near the end merely to complete an intended sequence.

Reported concern

Complaints about the therapeutic relationship centre on how concerns are received. Some posters describe feeling that confusion or a lack of progress was treated as something they were doing wrong. Others report that a frightening experience was insufficiently acknowledged, or that they felt pushed to continue. One discussion describes being told that EMDR was complete while the person still felt confused about their progress and remaining needs.^{[14] [18] [19]}

The shared issue is a loss of confidence that the person’s account will influence what happens next. It may become difficult to question the pace, say that an exercise has not helped, or disagree about ending. These are one-sided, unverified descriptions and cannot establish misconduct. They nevertheless identify a practical concern: collaboration can break down when the client feels their experience is being dismissed.^{[14] [18] [19]}

Practice response

• Invite criticism explicitly: ask what has felt unhelpful, confusing or too much. Do not make the client responsible for protecting your confidence in the method.
• Acknowledge the impact of a difficult experience before offering your explanation. Check whether your understanding matches theirs.
• Discuss changes and endings collaboratively. Make feedback and complaints routes easy to find, and avoid presenting a client’s decision to stop as a personal failure.

Reported concern

Post-session demands are described in practical terms as well as emotional ones: difficulty concentrating at work, reduced productivity, needing recovery time, struggling with parenting demands, or feeling more irritable with other people. An appointment occupies a limited part of the week, but its reported effects may extend into responsibilities that cannot easily be postponed.^{[3] [20]}

Some accounts describe a repeating cycle of a demanding session, several days of recovery and then another appointment. Even someone who regards the therapy as helpful may struggle to sustain that pattern alongside ordinary life. This theme concerns whether the overall arrangement is workable, as well as how the person feels during treatment. An account of improved distress in the room can leave these wider difficulties unaddressed.^{[3] [20]}

Practice response

• Ask about concrete activities and responsibilities, not only intensity ratings. Include what the client is doing less of, avoiding or struggling to sustain.
• Use this information when discussing appointment timing and whether the current plan is workable. Do not assume a difficult week can be solved by generic self-care advice.
• Review cumulative burden across appointments. Repeated recovery periods deserve attention even when each individual session seems manageable.

Reported concern

Access difficulties include finding an available practitioner, obtaining suitable appointment times, and locating care covered by insurance. When private fees are involved, uncertainty about the length of treatment makes it harder to judge the likely financial commitment. These pressures vary across healthcare systems, so the accounts do not support one general estimate of the cost or availability of EMDR.^{[21] [22] [23]}

Cost can also affect the person’s experience within therapy. One poster describes pressure to improve because a family member is helping to pay. If progress is unclear, a person may struggle to decide whether to continue spending, pause or look for another option. The concern therefore includes access to care, the ability to sustain it, and the pressure that financial expectations can place on the process.^[22]

Practice response

• Explain charges and cancellation arrangements before booking, and distinguish a planned review date from a promise about how many sessions will be needed.
• Ask whether the cost or schedule is creating pressure. Include practical feasibility when discussing the value of continuing.
• Keep the option to pause or stop explicit. Explore other suitable services when relevant, and avoid language suggesting that stopping means abandoning a breakthrough that is just about to happen.