Dangers of EMDR Therapy: Highlighting Risks and Responsible Practices

Executive Summary

Eye Movement Desensitisation and Reprocessing (EMDR) is a well-established psychotherapeutic approach designed to help individuals process and recover from traumatic experiences. EMDR has gained popularity for its rapid effectiveness in addressing conditions such as Post-Traumatic Stress Disorder (PTSD), anxiety, and phobias. However, although it is widely regarded as safe, there are potential dangers and risks associated with its practice. When EMDR is delivered irresponsibly, without proper precautions or preparation, it can lead to emotional distress, retraumatisation, or ineffective outcomes.

This whitepaper aims to provide a balanced and critical exploration of the dangers of EMDR therapy, discussing how these risks arise and highlighting the importance of responsible practices for both therapists and clients. It covers the specific risks, the populations that may be more vulnerable during treatment, and ethical considerations that ensure safe delivery of EMDR. By fostering awareness of both the risks and benefits, this document promotes a more responsible, patient-centred approach to the use of EMDR therapy.

Introduction

Since its development by Francine Shapiro in the 1980s, EMDR therapy has been supported by extensive studies demonstrating its efficacy, particularly in treating PTSD and other trauma-related disorders. By guiding clients through controlled exposure to traumatic memories and combining this with bilateral stimulation (e.g., eye movements), the therapy aims to desensitise emotional reactions and reprocess negative beliefs.

While EMDR has been hailed as a groundbreaking intervention, it is important to understand that it is not without its risks. Much of the focus has been placed on its benefits, often overshadowing potential dangers such as psychological overwhelm, emotional instability, or an exacerbation of symptoms. These challenges primarily arise when the therapy is administered improperly or to clients who are not suitable candidates for such an approach.

This whitepaper explores the potential dangers of EMDR, highlighting the circumstances in which risks may appear, and provides guidance on ensuring responsible, ethical practice.

What is EMDR Therapy?

How EMDR Works

EMDR is a structured therapy that centres on processing distressing memories through bilateral stimulation, such as side-to-side eye movements, auditory signals, or tactile input. The therapy typically occurs over eight structured phases, which include:

1. History Taking: The therapist evaluates the client’s past experiences and develops a treatment plan.
2. Preparation: The therapist helps the client develop coping mechanisms to manage distress during treatment.
3. Assessment: The therapist identifies specific memories and negative beliefs for targeted reprocessing.
4. Desensitisation and Processing: Guided by the therapist, the client focuses on distressing memories while participating in bilateral stimulation.
5. Installation: Positive beliefs are strengthened and reinforced.
6. Body Scan: The therapist helps the client identify lingering physical stress associated with trauma.
7. Closure: Emotional grounding is reinforced for the end of the session.
8. Re-evaluation: Past progress is reassessed to guide further treatment.

While this structured format aims to ensure emotional safety and positive outcomes, certain risks can arise if any of these phases are mishandled or skipped by an inexperienced therapist.

Potential Dangers of EMDR Therapy

Despite its significant success in treating trauma, EMDR therapy is not universally appropriate, and several dangers can arise depending on the therapist’s qualifications, the client’s current emotional state, and the nature of the traumatic material.

1. Risk of Retraumatisation

One of the most significant risks of EMDR therapy is retraumatisation — the process of re-experiencing trauma during treatment in a way that is overwhelming, destabilising, or damaging.

• How This Happens: During the desensitisation phase, clients are deliberately guided into recalling painful or distressing memories. Without proper emotional grounding, this recall can become too intense, leading to heightened distress or worsening symptoms.
• Consequences: Prolonged emotional dysregulation, flashbacks, or an exacerbation of PTSD symptoms.
• Populations at Risk: Especially vulnerable are clients with severe trauma histories, complex PTSD, or poorly developed coping mechanisms.

Example: A client with unresolved childhood abuse may experience overwhelming emotions when recalling their past, especially if bilateral stimulation is insufficiently paced or if the therapist fails to intervene when distress escalates.

2. Exacerbation of Symptoms

In some cases, EMDR may temporarily aggravate existing issues instead of alleviating them. Common examples include:

• Increased anxiety.
• Nightmares or intrusive memories.
• Difficulty regulating emotions outside of therapy sessions.

This exacerbation often occurs when the therapy is initiated without sufficient emotional preparation or when clients are encouraged to confront trauma before they feel ready.

3. Emotional Flooding

Emotional flooding refers to the experience of intense, overwhelming emotions that arise suddenly during treatment.

• How This Happens: Therapists may unintentionally encourage clients to revisit traumatic events without gradually introducing distressing material, leaving them unprepared for the emotional intensity that emerges.
• Impact: Clients may become overwhelmed to the point where they feel emotionally paralysed or disengage from the therapy process altogether.

4. Incompetence or Lack of Therapist Training

The success of EMDR relies heavily on the competence of the therapist. A poorly trained or inexperienced therapist increases the likelihood of clients experiencing harm.

• Common therapist failures include:
  • Skipping important preparation phases.
  • Poor management of client distress during desensitisation.
  • Weak understanding of bilateral stimulation techniques.

The therapist’s role in pacing and modulating the intensity of sessions is critical. Without these skills, clients may experience ineffective treatment or unintended harm.

5. Suitability Concerns for Certain Populations

EMDR is not ideal for everyone, and its use without proper screening can lead to complications.

• Complex Trauma Histories: Clients with multiple layers of trauma (e.g., survivors of chronic abuse or neglect) may need extended preparation phases and may not respond well to the standard structured approach.
• Severe Dissociation: Those with dissociative disorders may feel disconnected from the therapeutic process, or worse, the therapy may trigger further dissociation.
• Neurological or Cognitive Impairments: EMDR’s focus on memory and attention may not work well for clients with brain injuries or cognitive disorders.

For these populations, EMDR requires significant modification or alternative approaches to avoid ineffective or harmful outcomes.

6. Unanticipated Emotional Triggers

Even with adequate preparation, clients may uncover previously suppressed or forgotten traumatic memories during EMDR therapy. This can create new stressors that were not part of the initial therapy goals.

Challenge for Therapists: It can be difficult to address these newly uncovered traumas within the time-limited structure of traditional EMDR therapy, leaving clients feeling under-supported.

Responsible Practices: Reducing the Risks of EMDR

To ensure safe and effective application, EMDR therapy must be delivered responsibly. Below are the core guidelines and recommendations for ethical, risk-free practice:

1. Thorough Client Screening

Before initiating EMDR, therapists should complete a comprehensive assessment to determine:

• The client’s emotional stability and readiness for therapy.
• The presence of co-occurring conditions (e.g., dissociative identity disorder or psychosis).
• Trauma history, including depth and complexity.

Assessment tools and interviews should be used to gauge the client’s capacity to engage with potentially distressing material without becoming dysregulated.

2. Prioritise Emotional Preparation

The preparation phase of EMDR is essential for mitigating risks. Therapists should equip clients with emotional tools such as:

• Grounding techniques (e.g., mindfulness, deep breathing).
• Emotional safe spaces or visualisations for distress management.
• Clear expectations about how the therapy will progress.

Clients must feel capable of managing distress prior to beginning any desensitisation work.

3. Gradual Pacing

EMDR should not feel rushed or forced. Therapists need to carefully pace each session to prevent emotional flooding or retraumatisation. Key considerations include:

• Spending sufficient time on preparation before introducing trauma memories.
• Monitoring the client’s emotional state throughout sessions.
• Applying bilateral stimulation incrementally and revisiting coping strategies if distress arises.

4. Ongoing Check-Ins and Support

Therapists need to ensure that clients remain supported throughout the therapeutic journey. This includes:

• Regular check-ins to assess client well-being.
• Adjusting therapy plans as needed to reflect progress or emerging challenges.
• Providing resources for emotional support between sessions (e.g., crisis lines or self-soothing strategies).

5. Specialist Training for Therapists

EMDR is a specialised therapy requiring robust training. Ensuring therapists are properly qualified is crucial for minimising harm. Specifically:

• Therapists should be certified by reputable training organisations (e.g., EMDR Europe Association).
• Clinicians should undergo supervision with experienced EMDR practitioners to improve their skills.

Conclusion

Like any form of psychotherapy, EMDR therapy carries certain risks, particularly when administered without appropriate care, preparation, or expertise. The dangers of retraumatisation, emotional flooding, or symptom aggravation can have significant consequences for clients if their therapy does not follow responsible practices. Vulnerable populations such as those with complex trauma, dissociation, or emotional instability require particular caution and adaptation.

When delivered by qualified therapists who prioritise client-centred care, EMDR continues to demonstrate profound benefits in helping clients process trauma and reduce distress. By understanding the risks and implementing responsible practices, therapists can ensure a safe and effective therapeutic experience for all clients.

This whitepaper highlights the importance of rigorous screening, gradual pacing, emotional preparation, and professional training in the effective delivery of EMDR therapy. By adhering to these principles, the therapy can unlock transformative results while safeguarding against unnecessary harm.