Moving Past Trauma: EMDR, the Brain & the Power of the Therapeutic Relationship
If you’ve read our popular post, EMDR in NYC: How It Works and What You Might Experience, you might be familiar with this modality and its healing capabilities.
Written by Avi Klein
3 min read
Key Takeaways:
What is EMDR? EMDR is an integrated trauma processing model designed to alleviate symptoms like anxiety, panic, depression, and chronic relationship difficulties caused by unprocessed distressing memories. Early childhood or acute trauma can trap a person in unhelpful, false core beliefs (e.g., "I am not lovable" or "I am unsafe"). EMDR helps clients safely process these blocks, allowing the brain's natural memory networks to connect with adaptive information and create a healthy narrative of who they truly are.
The Science Behind Bilateral Stimulation (BLS) EMDR utilizes alternating right-and-left stimuli—such as eye movements or handheld "tapper" devices. There are two primary clinical theories for why BLS is so effective: first, it activates the right hemisphere of the brain (the emotional and somatic processing center), whereas traditional talk therapy primarily targets the left hemisphere. Second, BLS taxes the client's working memory, which gently distracts the intellectualizing parts of the mind that usually block access to deeply painful, avoided material.
Why We Must "Slow Down to Speed Up" A common point of frustration for eager clients is the preparatory phase. Pia emphasizes that therapists must ensure a client is fully capable of experiencing intense emotion and safely regulating both inside and outside of the session before reprocessing begins. This involves building concrete grounding, mindfulness, and distress tolerance skills so that the client is never destabilized.
Single-Incident vs. Developmental Trauma The timeline for EMDR depends heavily on history. A client processing a single adult trauma (like a car accident or robbery) who otherwise had a secure childhood can often move through reprocessing quite rapidly. Conversely, clients with developmental or early childhood trauma (growing up in an abusive home, childhood medical isolation) require a significantly longer preparatory phase to build systemic safety before touching the memories.
The Crucial Role of the Therapist's Presence Despite the misconception that EMDR is a cold, manualized protocol where the therapist simply "lets a machine work," the therapeutic relationship is everything. Because clients often close their eyes during reprocessing, they rely deeply on the felt presence, attunement, and grounding voice of the therapist to remain anchored in the present moment, ensuring they do not slip into a traumatic flashback or a state of unbearable loneliness.
Eye Movement Desensitization and Reprocessing (EMDR) is a highly effective, evidence-based trauma processing model utilized by our team at Downtown Somatic Therapy. Our Clinical Director, Avi Klein, LCSW, recently sat down for a conversation with senior therapist Pia Wallgren, LCSW, to discuss the inner workings of EMDR, its common internet misconceptions, and why a safe therapeutic relationship is critical to the processing phase.
Watch the Full Interview
Intrigued by EMDR but unsure how it works? Watch Avi and Pia’s full conversation below, where they break down the neurobiology of bilateral stimulation, dismantle internet myths, and explain why structural safety and a trusted therapeutic relationship are essential for healing trauma.
Join Avi Klein, Clinical Director at Downtown Somatic Therapy, and therapist Pia Wallgren for an engaging discussion about Eye Movement Desensitization and Reprocessing (EMDR), a unique somatic approach to healing and transformation.
If this discussion sparked your curiosity, be sure to revisit our original article, EMDR in NYC: How It Works and What You Might Experience, for a deep-dive into this body-based modality.
Interview Transcript
Avi Klein: Welcome to the Downtown Somatic Therapy podcast. I'm here with Pia Wallgren, who's one of our most senior therapists here. Pia, we're going to talk about EMDR today.
Pia: Thank you.
Avi Klein: There's a lot about EMDR on the internet. A lot of people who reach out to us are interested in EMDR and you have a lot of experience with EMDR and you have a strong interest in it. So I wanted to talk to you about it. And I guess, you know, since we've known each other for a while now, I know that EMDR was not the first thing you learned as a therapist—it's something you sort of arrived at over time. So, I'm just curious to hear for you, how did you become interested in EMDR? What was that journey like?
Pia: It's actually, I was first in contact with EMDR a long, long time ago before I even thought about becoming a therapist. Somebody, a friend of mine had had some difficult childhood experiences, some childhood trauma, and was offered EMDR. And I just saw firsthand how the symptoms that this person was experiencing just went away quite magically, in a way. And so I had the benefit of being exposed to EMDR in that way from just hearing about it and not from the lens of a therapist who might wonder, you know, "How does this work?" or "What's the modality?", "What are the steps?", right? It was just something I knew worked by the time I became a therapist. And then, I think I always held it as something that I wanted to become trained in, but I had other priorities for a while. And then eventually the time became right and I took the training, the basic training, the first training. Yeah.
Avi Klein: You said that word magic, and I want to come back to that because I feel like people use that word a lot with EMDR specifically. But I'm also curious, for people who don't know—and I think at this point, you know, we're both trained in it, but I think you have more experience practicing EMDR than I do—but my general sense of EMDR is that it has a reputation of being a sort of like manualized, more like by-the-book structured approach than other kinds of therapies. We both have a training in AEDP, for example. You come from a background that is more open-ended. So I was just curious, like, what's your sense? How do you practice EMDR that might make it different from the way other people practice EMDR?
Pia: I think for me, many times I practice it with clients that I have an existing relationship with. And so I think the beauty of EMDR is that it is, yes, it does have eight distinct phases that you follow with each memory that you're targeting. But within that, you can rely just on your other clinical skills. Among other things, there's a preparatory phase that you have to go through before you can get to the reprocessing, which is what I think most people know—anyone who knows about EMDR who's never tried it. And that preparatory phase is all about building a relationship, creating safety in that relationship.
As the therapist, taking the time to assess what, not just what the symptoms are, but how a client might cope—both in ways that they're telling me that they cope, but maybe also in ways that I can observe as we're taking history and talking about what it is we're gonna do and how EMDR works. And there's also ways throughout the reprocessing part where, yes, the therapist does take a step back, and at the same time, you're really leaning on that relationship of safety. So the intention is that the client really feels that you are there with them. And sometimes you don't need—not using words is exactly what they need, but every now and then they might need to hear your voice in some way to let them know that they're okay, they're doing great. At the end of a processing of a memory or at the end of the full treatment, you're still processing together what their experience was like. And so the relationship is still very much there, I would say.
Avi Klein: Right, right. Yeah. Yeah. So let's back up for a moment for people who don't... because you're saying a lot of stuff that is, I think, really interesting and important. But for people who have, you know, I think a very common thing that I've noticed is a prospective client might reach out. Somebody's told them about EMDR. They don't really know what it is or they just heard that there's something magical about it or something very powerful about it and they want to do it, how would you explain what EMDR is?
Pia: Briefly, I would call it a trauma processing model. I think on the one important prong is that it helps us reprocess traumatic or distressing experiences. Generally—
Avi Klein: Yeah. And why do we need to do that?
Pia: Because if we don't, what tends to happen, if we have unprocessed experiences, it can lead to symptoms like anxiety, panic, depression, angry outbursts. It can also leave us with relationship difficulties or complications. Very often, especially early trauma can leave us with beliefs about ourselves and the world or people around us that aren't helpful or aren't true. If we walk through the world believing that we're bad or that we're not lovable, that usually really, really influences our overall experience and wellbeing. And the purpose of EMDR is to alleviate not just the symptoms, but also to help us create or reconnect with a narrative of who we truly are, which is that we're good and that we deserve love and enjoyment out of our lives.
Avi Klein: Yeah. Yeah, so to bring it back to how are we doing that in EMDR? Like how exactly? I mean, that's big.
Pia: Yeah, yes. I mean, I think honestly, we never know exactly how the modalities work, but I would say that there are two main theories. We use bilateral stimulation in EMDR, which means that we are engaging both sides, right and left sides of the brain through... you can use different techniques. We use tappers, which means there can be handheld devices that go right-left-right-left. Eye movement right to left was the original bilateral movement, and we know that there is something about accessing the right brain in particular that helps us recover and heal from traumatic or distressing experiences. In conventional talk therapy, we often only access the left brain, which is also very important. And for some people, that's enough. But for many people, you actually need to access the right side also to fully process. And that's what the bilateral stimulation allows.
A newer, pretty widely accepted theory now also is that what the bilateral stimulation does is that it taxes our working memory, which just means that any way that we might have of blocking ourselves to access difficult content—it could be intellectualizing or it could be I'm literally thinking I don't want to go there, I don't want to go there—with the bilateral stimulation, those parts get occupied elsewhere. And that's what allows us the access. Yeah.
Avi Klein: Right. That's interesting. Huh. Cool. Cool. So—
Pia: But we don't have imagery or any kind of proof that that is exactly what is happening, but I think they're pretty good theories.
Avi Klein: Yeah, yeah, yeah, yeah. And so that through this processing, something's going to change. That's the expectation.
Pia: Mm-hmm. Mm-hmm. So with a traumatic experience that you were not able to process fully at the time, for instance, if you were a child, right, and either living in a traumatic environment or for whatever reason you didn't have access to adults who could help you fully process, the belief is that those memories do not get linked up with what we call adaptive information. And so for instance, if you were hit by a car and you didn't get to fully process that afterwards, then a part of this memory will live unprocessed and a part of you might, under certain circumstances, think that I am about to die, for instance, if that's what you were left with after that experience, because it's not able to link up to the adaptive information, namely that you survived. And so opening that up allows your otherwise adaptive memory network to, yeah, to connect with that—that I actually survived, I'm safe. And that's where we'll see symptom reduction and things like anxiety and panic, or even could be phobias that develop after an experience like that. Yeah. Yeah.
Avi Klein: Yeah. Yeah. Yeah. So walk me, walk me through when someone comes and wants to start EMDR, there's actually a pretty good amount of preparation that we do before we get into the reprocessing. People are usually very eager to just jump in and do that. So, you know, and I think they can find some of the preparation a little frustrating. So what's important about that? Why do we have to do that?
Pia: Yeah, I mean first of all I always want to honor that part of a client that comes in and that's really eager. That's a really positive drive that we should leverage and affirm. That's great. You have something in you that wants to feel better, that knows that there's something else out there for you. We slow it down in order to speed up is one way that I say to kind of convince people that it's worth the extra time. What we have to know both as the therapist and as the client before you start the reprocessing is that you are comfortable and capable of experiencing intense emotion—both during the reprocessing and in the session with the therapist, but also if it comes up between sessions when you're home on your own.
And so this means that on the one hand, you have to be able to access... you have to have some access to your body and to your emotions. You also have to feel confident in your own skills, like grounding skills or mindfulness skills, relaxation techniques that you can use if you feel activated between sessions. And so those are skills that we're gonna build together or that as the therapist I'm at least gonna want to see that you can access them. And also that you, as the client, feel comfortable having that experience in the company of the therapist. So we're also making sure that the relationship is being formed and that it feels safe and comfortable.
Avi Klein: Yeah. Yeah. Yeah. You're naming a couple of things that I guess I want to... I think they're so helpful for people to know because I think—and I'm curious if this is your experience too—well, before I say what I think, what are some common misconceptions that people have about EMDR? Because I think you're kind of speaking to some of them. So I'm curious. Yeah.
Pia: Yeah. Some people assume that it's very fast. And it is true. It can be fast for certain kinds of trauma, but not for all, right? Some people might believe that the reprocessing is almost like a flashback and that you have to go through some kind of hellish experience in order to heal. And while it's true that sometimes it's almost like it gets worse before it gets better, that doesn't have to always be the case. But that's also the whole point of ensuring that these resources and skills are there before we start, because you might have a very intense emotional experience, but you then also know and have been given the experience before you start of, I'm feeling really anxious. Okay, but here's my list of coping mechanisms or tools that I can use that I know help bring me down to a level where I feel comfortable enough again.
Avi Klein: Yeah, I think that's sort of what prompted me to ask the question because I think some people have this hope that EMDR is kind of like a silver bullet or a way of... they might be able to move past their symptoms without facing the painful or uncomfortable memories that they're trying to move through. So when you're talking about coping skills and that it's really important actually that you have the same practices that you probably need in any other kind of therapy to take care of yourself throughout the week. That's just as important in EMDR.
Pia: Yeah. And another, the beauty also of EMDR is that there's very clear ways of, I guess, titrating those experiences. And that's also where the therapist leans on clinical skills, right? Very closely observing where a client is at during any given time, right? And if I see that it's getting very, very intense, I'm going to make sure that the client knows that they are safe here with me, they're not alone. Yeah. And of course we would never kind of accompany a client into that state and then say, session's over, time's up, now you have to leave. The sessions are also designed in such a way that I ensure that by the time you leave, you are zipped up and feel okay and ready to go out into the world again.
Avi Klein: Mm-hmm, mm-hmm, mm-hmm. So one thing I want to ask you about is we use... so EMDR is a trauma therapy. That word trauma is much more widely used now, which is great, but it means different things and it applies to different kinds of experiences. And a big differentiator when we're talking about trauma is maybe like what we would call developmental trauma—things that happen maybe repeatedly, especially when we were young—versus a single traumatic event, especially, perhaps, when you're an adult and you might have more resources, higher brain functions are online. And so how do you approach those two different experiences? How do you approach them differently?
Pia: Yeah. Yeah. Yeah, I... It's pretty safe to say that generally speaking, unless you've had a lot of therapy before you come in wanting to try EMDR, those preparatory phases are going to be much longer if the type of trauma we're treating is from early years. Or even, you know, when we say early years, that could mean that you maybe lived in an abusive environment, that you suffered at the hands of your parents, but it could also be things like there was a traumatic birth or some illness early in life that caused you to maybe be separated from your parents, for instance, when you were an infant even. That impacts our... that impacts us physiologically, ways that are healable. But it takes longer than the person who comes in who's had an otherwise very lucky life and who maybe has been in a car accident or been robbed or something like that, yeah.
Avi Klein: Mm-hmm. Right. Yeah. So since you're trained in different modalities, how do you think about incorporating EMDR versus other approaches? What goes through your mind when you're trying to choose a treatment approach for someone?
Pia: It's really hard to say, but I mean, I think the formula for me is first we sit together for a while so that I can learn about what your... what has your experience been? Your life experience, your experience with other therapies or other therapists, and really together, you know, it's also... I try to not make it as kind of a black box mystery. I try to be very transparent. Maybe not in the first session—it's not very helpful to talk about different methods and things like that, that's not very connecting—but eventually to just share, here are some different routes that we can go. And I think this could be helpful for you. What do you think?
If somebody comes in and asks for EMDR, I certainly say, yes, let's have a look at that and also understand that with certain types of, especially this early childhood kind of traumatic experiences, we might be looking at a pretty long preparatory phase before we can get to the reprocessing that you might be familiar with. So it's really... it's a collaboration, and I use my clinical expertise to make sure that we're not heading into something that I don't think is going to benefit the client. Because of course the risk with too much trauma processing too soon is that a client might be destabilized and re-traumatized, worst-case scenario, right? And as therapists, that's something that we will never want to allow.
Avi Klein: Yeah. Right. Yeah. Yeah. It seems to me like you're really advocating for a gentle, attuned approach when it comes to incorporating this. How do people generally respond to that? Like if someone is coming in and wants to do EMDR and you're in the position of saying, well, hey, for these reasons, I think we really need to take our time and make sure you're shored up in these ways. How does that... I don't know if that's generalizable, but how does that typically land for people?
Pia: No, it is. Some people are very, okay, whatever you say, I trust. And some people might find that they're actually really into that preparatory part because maybe they don't have a lot of coping tools. And so they're all in. And some people are very impatient. And I try to validate that, as I said before. I understand the impulse to want to go fast. But I also... I try to be kindly firm about how, you know, we know what works, we know what doesn't work, and that's how it is. But also kind of stick with it and stick with me and you'll see. I feel confident that you won't regret letting it be slower in the beginning and just really leaning on that relationship.
Avi Klein: Yeah. Yeah. Yeah. I feel in part that some of this is... is influenced by the fact that a lot of people get recommended EMDR when other kinds of therapy isn't working. And that sort of makes sense on one level. There's something that... that maybe talk therapy isn't touching, but then they're frustrated because they've been at it for a while and they want to move past this. And so, you're not necessarily their first therapist and they want to see change.
Pia: Yeah. Yeah. Usually, if that's the case, we often find, right, Avi, that it is somebody who has experienced early childhood trauma or distress, right? And a couple of things come to mind. One thing is that there is... there's a lot of research and training accessible to us as therapists that handle that very part, right? There's early trauma protocols for EMDR, for instance, and that also involves really investing in that preparatory phase, and that is also EMDR, right? That is what we have to make clear, is that it is not just the eye movement or the things that we might have seen on social media or on TV, that that is just one part.
And the other thing that comes to mind is that also is... kind of a beauty of EMDR is we don't always have to use words. On the one hand, for some people, talk therapy might have been very distressing because talking about it just makes them so anxious or triggers panic or intense shame. And with EMDR, there are ways of moving at a fast clip where you're not necessarily recounting your whole life story or the traumatic memory. We can use shorthands, we can use code words. As you're going through the reprocessing, you don't have to tell the therapist everything that you're experiencing. For some people, it can be relieving to hear those parts too when we explain why it could take longer. Yeah, I think that's what's coming to mind now.
Avi Klein: Yeah, yeah, yeah. I mean, it's... I think you're describing something that can be very flexible for people, right. But that also, I think, requires people to similarly accept, be flexible with themselves and accept where they are, which is always a requirement in therapy.
Pia: Yeah. Right, and sometimes educating what happens to us physiologically when we experience trauma or when we experience it at an early age is also a big revelation, right? If I say to someone that your nervous system responded to this distress in the hospital when you were an infant by dissociating, and so that circuitry to your full emotions, it was disconnected and it hasn't been reconnected since, and that's where we have to start—we have to start with connecting to your body and to your emotions again. That... being able to explain some of that physiological, neurobiological stuff, even though that's not at all what we're trained in as psychotherapists, can be very organizing and helpful for some people as well.
Avi Klein: Yeah. Yeah. I know I have to let you go in a moment, but the last thing I want to ask you about is again, I think maybe we're sort of like, dispelling some, some misconceptions about EMDR, but it does have this reputation sometimes of being this... this kind of therapy where the therapist lets a process happen. It's about this bilateral stimulation and the client is just processing. And there is something very cool about how much people can do when it's set up properly. But I'm also curious to hear your thoughts on the therapist's role in all of this. Let me make it more specific: the therapist's role when we're doing this processing that really can be quite internal.
Pia: Yeah, I think it starts again, it starts in those preparatory phases where we're building a relationship. And then where during the reprocessing, the client—vast majority of clients choose to do reprocessing, in my experience at least, by closing their eyes so they don't see me, but they feel me, I think. And that means something, right? It means something. And it is true that during that reprocessing, mostly what you will hear me saying is literally—it's very brief—it's literally, "What came up? Go with that." That's it. In the beginning, that might seem weird or sound disconnected, but it really isn't. It really isn't.
The purpose of dipping in like that every now and then during the reprocessing is to... for me to know that the client is still here in the present and not in a flashback or something very distressing. I also gauge that by observing them, and it helps them know that too because every now and then they'll hear me and my voice. And I think, and then again at the end of a session or at the end of the full treatment, we're always closing out by processing a little bit what happened. Not too much, because we're not trying to go into it again if we're ending the session, but coming together again more fully, I guess, compared to during the reprocessing. Does that answer the question? Is that the question that you asked?
Avi Klein: Yeah, yeah, yeah, yeah, I think, I think what I'm hearing is that there are ways both the work that you do beforehand kind of lets the clients begin to sense your presence and that you can refer back to it while they're processing with your voice, with just how you are in the room with them, and that that is grounding, I think. Helps keep them safe. It reminds them that even though they're doing this internal process, they're not alone.
Pia: Exactly. And also part of the preparatory work is to make sure that the client knows that they are completely in control. If they need to stop, if they want to pause, if they want to ask me something, then I'm here. And that's to just trust themselves in that way also, which is very often what part of what we're building, right? It is an increased trust in yourself that you can take care of yourself, that you are safe, yeah, and that you can lean on other people for support.
Avi Klein: That's a lovely place to end, I think. Well, thank you, Pia. And if people... I know maybe at this recording, I don't think you're taking clients, but if people are interested in working with you, they can always reach out to you through our website.
Pia: Yeah? Yeah, yeah, absolutely. Thank you.
