EMDR vs. Traditional Talk Therapy: Which Is Right for You?
Choosing the right therapy can feel confusing. With many different approaches available, how do you know which one might best suit your needs?
Two approaches you may come across are EMDR (Eye Movement Desensitisation and Reprocessing) therapy and more traditional forms of talking therapy.
Both can support psychological wellbeing, but they differ in their structure, methods and the difficulties they are commonly used to address. Understanding those differences can help you have a more informed conversation with a therapist about what might be appropriate for you.
What Is Traditional Talk Therapy?
“Talk therapy” is a broad term rather than one specific treatment. It can include approaches such as Cognitive Behavioural Therapy (CBT), psychodynamic psychotherapy, counselling, humanistic therapies and other psychological treatments.
These approaches are not all the same.
Some focus on thoughts and behaviours, others explore relationships and past experiences, while some place greater emphasis on the therapeutic relationship and the client’s own process of understanding and change.
Talking therapies may help people explore:
- thoughts and emotions
- relationship patterns
- current difficulties and stressors
- past experiences
- beliefs about themselves and other people
- ways of coping
Some talking therapies are also specifically designed to treat trauma. For example, trauma-focused CBT is one of the psychological treatments recommended by NICE for PTSD.
What Is EMDR Therapy?
EMDR is a structured psychological therapy originally developed by Francine Shapiro and is particularly well known as a treatment for post-traumatic stress disorder (PTSD).
Rather than requiring someone to give a detailed verbal account of everything that happened, EMDR involves attending to aspects of a distressing memory while engaging in bilateral stimulation, most commonly guided eye movements.
EMDR follows a structured treatment protocol that includes assessment, preparation, processing of traumatic memories and evaluation of progress.
You can read more about what happens during an EMDR session.
How Does EMDR Work?
EMDR is effective for PTSD, but precisely why it works continues to be researched.
One influential explanation involves working memory. Holding a distressing memory in mind while simultaneously carrying out another task, such as following moving fingers with the eyes, may place demands on working memory and reduce the vividness and emotional intensity of the memory.
This is a more cautious explanation than the popular claim that EMDR works simply by “activating both hemispheres of the brain”. The scientific evidence does not support reducing EMDR’s mechanism to that explanation.
EMDR is usually understood within the Adaptive Information Processing model developed as part of the therapy, although research into the mechanisms responsible for its clinical effects continues.
EMDR and PTSD
EMDR has a substantial evidence base for PTSD.
In the UK, NICE recommends both trauma-focused CBT and EMDR for adults with PTSD in appropriate circumstances.
This is important when comparing EMDR with “talk therapy”, because it would be misleading to suggest that talking approaches are ineffective for trauma. Trauma-focused CBT is itself an evidence-based first-line treatment.
What Happens During EMDR Therapy?
EMDR treatment normally progresses through a number of phases rather than beginning immediately with processing traumatic memories.
The process can include:
- taking a history and understanding the difficulties bringing you to therapy
- developing a treatment plan
- preparation and discussing ways of managing distress
- identifying memories, thoughts, emotions and physical sensations relevant to treatment
- periods of memory processing using bilateral stimulation
- reviewing what has changed
- checking progress between and across sessions
The pace and length of treatment vary considerably depending on the individual, the nature of the traumatic experiences and any other difficulties that need to be considered.
EMDR vs Talk Therapy: Key Differences
Focus
Some forms of talking therapy explore a wide range of experiences, including current relationships, emotions, behaviour, identity and personal history.
EMDR is more structured and often focuses specifically on distressing memories and the thoughts, emotions and physical responses associated with them.
Method
Talking therapies generally rely heavily on conversation, reflection and the therapeutic relationship, although the techniques used differ considerably between approaches.
EMDR combines discussion and therapeutic formulation with a structured memory-processing procedure involving bilateral stimulation.
How Much Do You Have to Talk About the Trauma?
One reason some people are interested in EMDR is that they do not normally have to describe every detail of a traumatic experience to their therapist.
The therapist needs sufficient information to understand what is being worked on and to conduct therapy safely, but much of the detailed processing can remain internal to the client.
You might also find Philip’s article on whether EMDR can work without talking in detail about trauma useful.
Length of Treatment
It is sometimes claimed that EMDR is always faster than talking therapy. In practice, there is no single timeframe that applies to everyone.
A relatively contained traumatic event may sometimes require fewer sessions than longstanding or repeated trauma, but treatment length depends on many factors.
Therapy should therefore be planned around the individual’s needs rather than promising a particular number of sessions.
Emotional Intensity
Both EMDR and talking therapies can involve difficult emotions.
During EMDR, traumatic memories may temporarily feel emotionally intense while they are being processed. Preparation, pacing and communication with the therapist are therefore important parts of treatment.
If you are already having EMDR, Philip’s guide to what you may notice between EMDR sessions explains this in more detail.
Is EMDR Better Than Talk Therapy?
It is more useful to ask whether a particular therapy is appropriate for a particular person and problem than whether one form of therapy is universally “better”.
For PTSD, both EMDR and trauma-focused CBT have strong evidence and are recommended treatments.
For other difficulties, a different type of talking therapy may be more appropriate. Someone wanting to explore relationships, identity, longstanding emotional patterns or broader personal development may have different therapeutic needs from someone seeking treatment for a specific traumatic memory.
Some therapists also work integratively, drawing on more than one therapeutic approach where appropriate.
Which Therapy Might Be Right for You?
If you are experiencing PTSD symptoms or distress linked to traumatic memories, EMDR may be one option worth discussing with an appropriately trained therapist.
If you want to explore broader emotional, relationship or life difficulties, another form of psychotherapy or counselling may be more appropriate, or it may form part of a wider therapeutic approach.
The decision should take account of:
- what you would like help with
- your symptoms and current circumstances
- your previous experiences of therapy
- your preferences
- the evidence for treating the particular difficulty
- the therapist’s training and experience
- whether you feel comfortable working with that therapist
Exploring EMDR Therapy
If you are considering EMDR, you can learn more about EMDR therapy with Philip Bruce, including how the approach is used with trauma and related difficulties.
If you are unsure which type of therapy might fit what you are experiencing, you can also contact Philip to arrange an initial consultation.
The aim is not simply to choose the therapy with the most compelling label. It is to find an appropriate therapeutic approach, with an appropriately trained practitioner, for you and the difficulties you want help with.
