EMDR

What is EMDR?

Eye Movement Desensitisation and Reprocessing (EMDR) is a structured therapy designed to help people process traumatic memories. It was developed by Francine Shapiro in the late 1980s and is now one of the most widely used and researched trauma treatments in the world.

EMDR is recommended by NICE (the National Institute for Health and Care Excellence) as a treatment for post-traumatic stress disorder (PTSD) and is used by NHS trauma services across the UK.¹

Unlike most talking therapies, EMDR does not rely primarily on verbal processing. Instead, it uses bilateral stimulation - typically guided eye movements, but also tapping or sounds that alternate between left and right sides - to help the brain process and integrate traumatic memories.

How EMDR works

The eight phases

EMDR follows a structured eight-phase protocol:

Phase 1: History and treatment planning - the therapist gathers information about your history and identifies the traumatic memories to target in treatment.

Phase 2: Preparation - the therapist explains how EMDR works and helps you develop coping skills for managing distress during and between sessions. This phase is particularly important for neurodivergent people, as it establishes safety and predictability.

Phase 3: Assessment - you and the therapist identify a specific traumatic memory to work on. You identify an image associated with the memory, a negative belief about yourself connected to it (such as “I am not safe” or “I am broken”), and a preferred positive belief.

Phase 4: Desensitisation - the core processing phase. You hold the traumatic memory in mind while the therapist guides bilateral stimulation (usually by moving their fingers from side to side while you follow with your eyes). You notice whatever comes up - thoughts, feelings, images, body sensations - and report back briefly between sets of eye movements.

Phase 5: Installation - once the distress associated with the memory has reduced, the therapist helps strengthen the positive belief you identified earlier.

Phase 6: Body scan - you check for any remaining physical tension or discomfort related to the memory.

Phase 7: Closure - the therapist ensures you are in a stable state before the session ends, using the coping skills from Phase 2 if needed.

Phase 8: Re-evaluation - at the next session, the therapist checks how you are doing and whether further processing is needed.

What bilateral stimulation does

The exact mechanism of bilateral stimulation is not fully understood, but research suggests it may work by stimulating the brain’s natural information processing system - similar to what happens during REM sleep. This helps “unfreeze” traumatic memories that have become stuck and allows the brain to integrate them into broader memory networks, reducing their emotional charge.

Why EMDR is relevant for neurodivergent people

Higher rates of trauma

Neurodivergent people experience trauma at significantly higher rates than the general population. This includes:

• Childhood abuse and neglect - neurodivergent children are at greater risk of maltreatment
• Bullying and peer victimisation - one of the most common traumatic experiences for neurodivergent people across the lifespan
• Relational trauma - chronic experiences of being misunderstood, invalidated, rejected, or forced to suppress who you are
• Minority stress - the cumulative impact of living as a stigmatised minority, including discrimination, social exclusion, and internalised shame
• Medical and institutional trauma - negative experiences with healthcare, education, or diagnostic processes

Beyond single-event trauma

For many neurodivergent people, trauma is not a single event but a pattern of experiences that accumulates over time. Years of masking, social rejection, feeling “wrong,” and being told you need to try harder can create a form of developmental or relational trauma that is just as impactful as a single traumatic event.

EMDR can be used to process both discrete traumatic memories and broader patterns of relational trauma, though the approach may need adapting for complex trauma.

Why EMDR may be more accessible

For neurodivergent people who find traditional talking therapy difficult, EMDR has potential advantages:

• Less verbal processing required - you do not need to describe the trauma in detail. You hold the memory in mind and notice what comes up, but the processing happens largely without extensive narration.
• Structured and predictable - the eight-phase protocol provides clear structure, which many neurodivergent people prefer
• Body-based processing - some neurodivergent people process emotions through the body rather than through identified thoughts. EMDR works with somatic experience as well as cognitive and emotional processing.

Adaptations for neurodivergent people

A Delphi survey of 103 EMDR therapists identified 124 adaptations used when treating autistic clients, with 27 used “always or often” by at least 80% of therapists. The adaptations centred on three key principles: flexibility, clear communication, and awareness of individual differences.³

Bilateral stimulation alternatives

Eye movements are the most common form of bilateral stimulation in EMDR, but they do not suit everyone. Some neurodivergent people find eye movements:

• Visually overwhelming or dysregulating
• Physically uncomfortable (particularly if there are co-occurring eye movement or visual processing differences)
• Intrusive or anxiety-provoking

Alternatives include:

• Tapping - the therapist taps alternately on your hands or knees, or you tap yourself
• Auditory stimulation - sounds alternating between left and right ears through headphones
• Butterfly hug - crossing your arms over your chest and tapping alternately on each shoulder
• Tactile devices - handheld buzzers that alternate vibration between left and right hands

A good EMDR therapist will always offer alternatives and let you choose what feels most comfortable.

Sensory and environmental considerations

• Adjust lighting, reduce background noise, and attend to temperature in the therapy room
• Allow movement, fidgeting, or position changes during sessions
• Offer breaks when needed
• Be aware that bilateral stimulation itself is a sensory experience and may need careful calibration for people with sensory sensitivities

Communication adaptations

• Explain the EMDR process clearly and in advance, ideally in writing as well as verbally
• Check in frequently about comfort and understanding
• Use concrete, explicit language
• Allow longer processing time - some neurodivergent people process trauma non-linearly, jumping between different events or time periods, which is normal and should be expected
• Do not rush silence - some people need longer to notice and report what is happening internally

Alexithymia and emotional processing

For people who experience alexithymia (difficulty identifying and describing emotions), the standard EMDR protocol may need adjusting:

• Use emotion vocabulary lists or visual aids to help identify feelings
• Focus on body sensations rather than named emotions
• Use scaling (rating distress on a number scale) to track progress when emotional labels are difficult
• Accept that processing may look different - some people process through images, body sensations, or fragments of memory rather than through identified emotions

What to expect

Before you start

Your therapist will spend time getting to know your history and building your coping skills before any trauma processing begins. This preparation phase is particularly important for neurodivergent people and should not be rushed.

During processing

A typical EMDR session lasts 60 to 90 minutes. The processing phase can bring up strong emotions, body sensations, and unexpected memories. Between sets of bilateral stimulation, the therapist will ask you briefly what you notice. You do not need to give detailed descriptions - a word or phrase is enough.

Some people find that processing continues between sessions. You may have vivid dreams, new memories surfacing, or shifts in how you feel about the targeted event. This is normal and is a sign that processing is continuing.

After EMDR

Many people notice a significant reduction in the emotional charge of traumatic memories after EMDR - the memory is still there, but it no longer triggers the same intensity of distress. Some people describe it as the memory moving from “happening right now” to “something that happened in the past.”

Finding an EMDR therapist

In the UK, look for therapists registered with:

• EMDR Association UK - the professional body for EMDR practitioners in the UK, which maintains a register of accredited therapists
• BACP, UKCP, or BPS - many EMDR-trained therapists are also registered with these broader professional bodies

When contacting a therapist, ask:

• Are you accredited by the EMDR Association UK?
• Do you have experience working with neurodivergent clients?
• What alternatives to eye movements do you offer?
• How would you adapt the EMDR protocol for someone with sensory sensitivities or alexithymia?

Further reading on neurobetter

• Counselling and therapy - overview
• PTSD and complex trauma
• Masking
• Late diagnosis
• Emotional dysregulation

neurobetter services

• Local services directory - find therapists near you
• Ask a Counsellor - get a confidential response from a registered counsellor