Introduction to intensive EMDR

Intensive EMDR refers to a particular way of delivering EMDR therapy. The intensive format consists of longer sessions than the standard 50 minute therapy hour, and the sessions are closely spaced together rather than once weekly as in traditional therapy. A typical scenario might be something like several longer sessions in a week, and this may include more than one session per day, but many variations on this theme are possible.

We should perhaps distinguish between intensive EMDR and an “EMDR intensive.” The EMDR intensive is a standard package of therapy, usually with a predetermined number of sessions. Intensive EMDR, however, is a more flexible arrangement that is crafted for and agreed with an individual client to meet their needs. Listen to an interview with Robert Grigore, an EMDRIA certified therapist in Canada (scroll down to Episode 15: EMDR Therapy Intensives).

Intensive EMDR can potentially be used to treat the same kinds of issues as regular EMDR. If you’re feeling ready to work on something that’s been calling for attention for some time, you can condense months of weekly therapy into an intensive format. With the appropriate preparation and support, significant progress can often be made in a short time. It’s also possible to work intensively on something that’s only just happened – a shock or trauma that’s stood you still in your tracks, which you need to sort out before you can pick up your life again.

In addition to the standalone format outlined above, intensive EMDR could be a significant enhancement to a more traditional therapy. If your regular therapist doesn’t offer EMDR and you’re looking to do some adjunctive trauma work, the intensive format might be a very convenient way of achieving this. This could include, for example, where there’s historical trauma that seems to be keeping the therapy in a stuck place, or when highly distressing events are impeding progress. Similarly, if your triggers are not resolving with traditional therapy, EMDR may be able to help.

Introduction to intensive EMDR

Intensive EMDR refers to a particular way of delivering EMDR therapy. The intensive format consists of longer sessions than the standard 50 minute therapy hour, and the sessions are closely spaced together rather than once weekly as in traditional therapy. A typical scenario might be something like several longer sessions in a week, and this may include more than one session per day, but many variations on this theme are possible.

We should perhaps distinguish between intensive EMDR and an “EMDR intensive.” The EMDR intensive is a standard package of therapy, usually with a predetermined number of sessions. Intensive EMDR, however, is a more flexible arrangement that is crafted for and agreed with an individual client to meet their needs. Listen to an interview with Robert Grigore, an EMDRIA certified therapist in Canada (scroll down to Episode 15: EMDR Therapy Intensives).

Intensive EMDR can potentially be used to treat the same kinds of issues as regular EMDR. If you’re feeling ready to work on something that’s been calling for attention for some time, you can condense months of weekly therapy into an intensive format. With the appropriate preparation and support, significant progress can often be made in a short time. It’s also possible to work intensively on something that’s only just happened – a shock or trauma that’s stood you still in your tracks, which you need to sort out before you can pick up your life again.

In addition to the standalone format outlined above, intensive EMDR could be a significant enhancement to a more traditional therapy. If your regular therapist doesn’t offer EMDR and you’re looking to do some adjunctive trauma work, the intensive format might be a very convenient way of achieving this. This could include, for example, where there’s historical trauma that seems to be keeping the therapy in a stuck place, or when highly distressing events are impeding progress. Similarly, if your triggers are not resolving with traditional therapy, EMDR may be able to help.

Intensive EMDR - Key Points

  • A bespoke programme, based on intensive EMDR sessions, agreed with each individual client.
  • Double length sessions: 110 minutes.
  • Multiple sessions a week.
  • Flexible scheduling.
  • Online using Zoom or Bilateral Base.
  • Comprehensive assessment and treatment planning.
  • Resourcing as appropriate.
  • May include ego state therapy, flash, creative techniques and recommended between-sessions activities.
  • At least one follow-up appointment, or more as needed.
  • Months of weekly therapy can be achieved in a much shorter time.
  • Deeper work is often possible with intensive EMDR than can be achieved in 50 minute weekly sessions.

“There is mounting evidence suggesting that by increasing the frequency of treatment sessions, posttraumatic stress disorder (PTSD) treatment outcomes significantly improve. … The results of this case series suggest that an intensive program using EMDR therapy is a potentially safe and effective treatment alternative for complex PTSD.”

Bongaerts et al. (2017, p. 84)

Treating veterans with PTSD

E. C. Hurley (2018) studied the effectiveness of EMDR therapy in treating veterans with PTSD on an outpatient basis using two treatment formats: intensive EMDR twice a day for ten days, and a second format of one session each week. The results indicated that both treatment formats produced statistically significant treatment effects that were maintained at 1-year follow-up.

Another study looked at the safety and efficacy of a brief, remotely administered intensive trauma-focused treatment (based on imaginal exposure and EMDR) for people with PTSD and CPTSD.

“The results support the notion that intensive, trauma-focused treatment is feasible, safe and associated with a large decrease in PTSD and Complex PTSD symptoms, even when it is brief, and applied fully remote.”

Bongaerts et al. (2022, p. 1)

What is intensive EMDR like?

The essence of what I offer for intensive EMDR is a bespoke treatment programme designed for and agreed with each individual who chooses to work in this intensive way. Programmes of intensive EMDR are always designed according to what is clinically appropriate for that person. The programme is responsive to the journey of the client as it unfolds, and the degree of intensity can always be adjusted as appropriate. Elements of the programmes I offer include:

  • Double sessions multiple times a week, or perhaps over more than one week. A double session is 110 minutes.
  • Flexible scheduling at mutually agreed times. This is especially important for international clients who may be in different time zones.
  • Online sessions using Zoom and/or a specialist EMDR video platform called Bilateral Base.
  • A comprehensive assessment and treatment planning process before beginning intensive EMDR work. This starts with an initial conversation, by telephone or on Zoom, to advise on the suitability of intensive EMDR for you. If we agree to go ahead, the assessment process includes history taking, filling out some questionnaires, and structuring the work we want to do. The questionnaires are for EMDR preparation and to give us baseline information about your symptoms before we start treatment. This allows us to monitor progress and can guide decisions about future treatment if necessary.
  • Resourcing as appropriate. Safety is always important in EMDR therapy, but especially so when working intensively. Self-care, emotional regulation and grounding are included in the treatment planning process.
  • We may include ego state therapy, Flash Technique, creative techniques, etc. Ego state therapy is about working with parts of the psyche, which is especially relevant where there is complex trauma. Flash is an effective way of decreasing distress levels on particularly triggering memories and can be used as part of EMDR or as a standalone modality. Transpersonal therapy has a rich heritage of creative techniques which can be brought in to support and augment the EMDR process.
  • There will be a follow-up appointment a few weeks after the intensive EMDR sessions and possibly a second follow-up appointment a few months later if required. The follow-up is to check-in with how the client is and to review how they are doing with integrating the EMDR work.  We re-do some of the questionnaires and discuss if anything needs further clinical attention.

Preparing for intensive EMDR

A commonly reported side effect of EMDR is feeling tired after a session and this can be especially so when working intensively. So it’s advisable to clear some space in your diary over the period of intensive EMDR work for self-care, rest and integration. You may find you prefer to retire early and you might be remembering dreams. There may also be some suggested homework to do between sessions. If you have a partner, friend or other relative that you can confide in about your period of intensive EMDR therapy, this can be extremely helpful and supportive.

What is intensive EMDR like?

The essence of what I offer for intensive EMDR is a bespoke treatment programme designed for and agreed with each individual who chooses to work in this intensive way. Programmes of intensive EMDR are always designed according to what is clinically appropriate for that person. The programme is responsive to the journey of the client as it unfolds, and the degree of intensity can always be adjusted as appropriate. Elements of the programmes I offer include:

  • Double sessions multiple times a week, or perhaps over more than one week. A double session is 110 minutes.
  • Flexible scheduling at mutually agreed times. This is especially important for international clients who may be in different time zones.
  • Online sessions using Zoom and/or a specialist EMDR video platform called Bilateral Base.
  • A comprehensive assessment and treatment planning process before beginning intensive EMDR work. This starts with an initial conversation, by telephone or on Zoom, to advise on the suitability of intensive EMDR for you. If we agree to go ahead, the assessment process includes history taking, filling out some questionnaires, and structuring the work we want to do. The questionnaires are for EMDR preparation and to give us baseline information about your symptoms before we start treatment. This allows us to monitor progress and can guide decisions about future treatment if necessary.
  • Resourcing as appropriate. Safety is always important in EMDR therapy, but especially so when working intensively. Self-care, emotional regulation and grounding are included in the treatment planning process.
  • We may include ego state therapy, Flash Technique, creative techniques, etc. Ego state therapy is about working with parts of the psyche, which is especially relevant where there is complex trauma. Flash is an effective way of decreasing distress levels on particularly triggering memories and can be used as part of EMDR or as a standalone modality. Transpersonal therapy has a rich heritage of creative techniques which can be brought in to support and augment the EMDR process.
  • There will be a follow-up appointment a few weeks after the intensive EMDR sessions and possibly a second follow-up appointment a few months later if required. The follow-up is to check-in with how the client is and to review how they are doing with integrating the EMDR work.  We re-do some of the questionnaires and discuss if anything needs further clinical attention.

Preparing for intensive EMDR

A commonly reported side effect of EMDR is feeling tired after a session and this can be especially so when working intensively. So it’s advisable to clear some space in your diary over the period of intensive EMDR work for self-care, rest and integration. You may find you prefer to retire early and you might be remembering dreams. There may also be some suggested homework to do between sessions. If you have a partner, friend or other relative that you can confide in about your period of intensive EMDR therapy, this can be extremely helpful and supportive.

Intensive EMDR vs weekly therapy

The frequency of EMDR sessions that works best for someone is a very individual thing. Clearly, intensive EMDR offers the potential for more rapid progress than weekly therapy. This is not only due to the closely spaced sessions, but also with longer session times, you spend a smaller proportion of each session on check-in and closing and more time on doing EMDR processing of trauma material.  And with less time between sessions, there is less of a catch-up to do at the beginning of each meeting.  So as well as allowing faster progress, intensive EMDR tends to be a more focused and efficient way or working. In addition, the client will feel more supported during their EMDR journey because of the more frequent contact with the therapist.

Ad de Jongh and Suzy Matthijssen in the Netherlands are very active in researching EMDR and intensive trauma treatment. Matthijssen et al. (2024) found that “an intensive outpatient trauma treatment programme … is effective for patients suffering from PTSD as a result of multiple traumatization.” De Jongh and Hafkemeijer (2024) recently reported successful treatment of comorbid CPTSD and borderline personality disorder using intensive EMDR. They concluded there is growing evidence that EMDR is effective for treatment of interpersonal trauma in early childhood as well as for PTSD.

De Jongh & Hafkemeijer (2024), Matthijssen et al. (2024, p. 1)

Sandra Paulsen, PhD

Any summary of intensive EMDR therapy should recognise the work of the illustrious Sandra Paulsen in America’s Pacific Northwest. A clinical and consulting psychologist and former academic, her work focuses on resolving early trauma using the intensive EMDR format over three full days. She has published widely, mainly through books and book chapters.

In Neurobiology and Treatment of Traumatic Dissociation she says “extended sessions of half- to full-day sessions, structured with breaks, are the ideal way to employ the ET [early trauma] approach. This is because in brief sessions patients and therapist are more typically operating in a left-hemisphere frame of reference. As therapist and client get into the nuances of ET work, … time slows down and the work becomes more of implicit memory in the right hemisphere, wordless, somatic, and held in the relationship field between therapist and patient. As such, in a short session one only begins to get into the material when one runs out of time.” (Lanius et al., 2014, p. 438.)

The time spent between EMDR sessions is not wasted, however. Processing doesn’t stop at the end of a session, but will almost certainly continue for some time afterwards.

In addition, the time between sessions is important for integration. This refers to how the insights and processing are incorporated into the person’s life narrative and sense of self.  This of course affects their feelings, their behaviour, how they live their life, the decisions they make, and many other things. When someone prefers to have more flexibility in session content, and more time for reflection and integration, then weekly or sometimes twice-weekly therapy may suit them very well. But if you’re ready to do the work of therapy in a concentrated way and to be active in supporting the process between sessions, then you may be ready for intensive EMDR.

There are also some very practical reasons why you might prefer intensive EMDR to weekly sessions. For busy people with irregular schedules, intensive therapy may solve the problem of trying to adhere to regular weekly appointments. If you have some time, such as annual leave, a sabbatical from work, or holidays from study, you may feel ready to do some therapy that’s difficult to fit in at other times.

For adjunctive EMDR, the intensive format may be a very convenient option if your regular therapist is not EMDR-trained. With appropriate contact between the two therapists, the EMDR can be done with either concurrent or post-intensive integration work with the regular therapist.

 

“When we work in implicit memory, with unconscious dynamics, there is a keen requirement for the therapist to listen with what Theodor Reik called,
‘the third ear’ of intuition,
to discern that untold story between the lines.”
(Paulsen, 2018, p. 139).

Just like there is no universally applicable definition of trauma that covers everything that might cause a person intractable emotional pain and reactivity, there is no cookie cutter version of EMDR with which to treat it. Trauma-focused treatment may take us to the explicit memories of what happened – more recently or perhaps long ago. The implicit story of what was hardly formulated in cognitive memory may also emerge in EMDR treatment – one’s personal myth, as well as one’s trauma (Jung, 1995). Intensive EMDR allows us to approach this level of work. This is the art of applying the science of EMDR.

Make an Enquiry

If you would like more information about psychological therapy and how we may be able to work together to address your concerns,
you are warmly invited to call, email, or message me through the form on the Contact page.

07801 273768 / info@karenjwilliams.co.uk

 

References

Bongaerts, H., Van Minnen, A., & de Jongh, A. (2017). Intensive EMDR to treat patients with complex posttraumatic stress disorder: A case series. Journal of EMDR Practice and Research11(2), 84-95. http://dx.doi.org/10.1891/1933-3196.11.2.84

Bongaerts, H., Voorendonk, E. M., Van Minnen, A., Rozendaal, L., Telkamp, B. S. D., & de Jongh, A. (2022). Fully remote intensive trauma-focused treatment for PTSD and Complex PTSD. European Journal of Psychotraumatology13(2), 2103287. https://doi.org/10.1080/20008066.2022.2103287

De Jongh, A., & Hafkemeijer, L. C. S. (2024). Trauma‐focused treatment of a client with complex PTSD and comorbid pathology using EMDR therapy. Journal of Clinical Psychology80(4), 824-835. https://doi.org/10.1002/jclp.23521

Hurley, E. C. (2018). Effective treatment of veterans with PTSD: Comparison between intensive daily and weekly EMDR approaches. Frontiers in Psychology9, 1458. https://doi.org/10.3389/fpsyg.2018.01458

Jung, C. G. (1995). Memories, dreams, reflections: An autobiography. Fontana.

Lanius, U. F., Paulsen, S., Paulsen, S. L., & Corrigan, F. M. (Eds.). (2014). Neurobiology and treatment of traumatic dissociation: Towards an embodied self. Springer.

Matthijssen, S. J., Menses, S. D., & Huisman-van Dijk, H. M. (2024). The effects of an intensive outpatient treatment for PTSD. European Journal of Psychotraumatology, 15(1), 2341548. https://doi.org/10.1080/20008066.2024.2341548

Paulsen, S. L. (2018). Neuroaffective embodied self therapy (NEST): An integrative approach to case formulation and EMDR treatment planning for complex cases. Frontiers in the Psychotherapy of Trauma and Dissociation1(2), 125-148. https://doi.org/10.46716/ftpd.2017.0009

 

References

Bongaerts, H., Van Minnen, A., & de Jongh, A. (2017). Intensive EMDR to treat patients with complex posttraumatic stress disorder: A case series. Journal of EMDR Practice and Research11(2), 84-95. http://dx.doi.org/10.1891/1933-3196.11.2.84

Bongaerts, H., Voorendonk, E. M., Van Minnen, A., Rozendaal, L., Telkamp, B. S. D., & de Jongh, A. (2022). Fully remote intensive trauma-focused treatment for PTSD and Complex PTSD. European Journal of Psychotraumatology13(2), 2103287. https://doi.org/10.1080/20008066.2022.2103287

De Jongh, A., & Hafkemeijer, L. C. S. (2024). Trauma‐focused treatment of a client with complex PTSD and comorbid pathology using EMDR therapy. Journal of Clinical Psychology80(4), 824-835. https://doi.org/10.1002/jclp.23521

Hurley, E. C. (2018). Effective treatment of veterans with PTSD: Comparison between intensive daily and weekly EMDR approaches. Frontiers in Psychology9, 1458. https://doi.org/10.3389/fpsyg.2018.01458

Jung, C. G. (1995). Memories, dreams, reflections: An autobiography. Fontana.

Lanius, U. F., Paulsen, S., Paulsen, S. L., & Corrigan, F. M. (Eds.). (2014). Neurobiology and treatment of traumatic dissociation: Towards an embodied self. Springer.

Matthijssen, S. J., Menses, S. D., & Huisman-van Dijk, H. M. (2024). The effects of an intensive outpatient treatment for PTSD. European Journal of Psychotraumatology, 15(1), 2341548. https://doi.org/10.1080/20008066.2024.2341548

Paulsen, S. L. (2018). Neuroaffective embodied self therapy (NEST): An integrative approach to case formulation and EMDR treatment planning for complex cases. Frontiers in the Psychotherapy of Trauma and Dissociation1(2), 125-148. https://doi.org/10.46716/ftpd.2017.0009