EMDR Is More Than Eye Movements

I recently had the pleasure of connecting with Alison Leslie, LCSW, SEP, an EMDR trainer, consultant, and owner of Empower Healing. Alison brings particular expertise in integrating Eye Movement Desensitization and Reprocessing (EMDR) with somatic approaches that honor the body's role in trauma and healing. Her work also incorporates the human-animal bond and nature-based interventions to foster embodied safety, connection, and attachment. As a trainer and consultant, Alison supports fellow clinicians in deepening their understanding and clinical practice through trainings that emphasize curiosity, compassion, and body-based awareness.

For today’s’ newsletter, I set to explore a treatment many of us recognize by name but may know less about in practice. What happens beyond the eye movements? Why might preparation take time? And what should PMHNPs understand when referring a patient?

Alison offers a thoughtful look at that work, beginning with a moment that could unfold at any time with a client.

A written Q&A with Alison Leslie, LCSW, SEP

A patient smiles when you enter the exam room. What you cannot see is the racing heart, the feeling of being trapped, or the childhood memory stirred by a closed door.

That gap between what we observe and what a patient experiences is a useful place to begin understanding EMDR. In this conversation, Alison explores how earlier experiences can shape present reactions, what treatment involves, and why taking time to prepare can be meaningful clinical work.

Alison: Imagine a patient entering a cold room with unfamiliar equipment and a closed door. Their heart rate rises, and the more it rises, the more trapped they feel.

They may briefly remember childhood medical visits or having to hide how they received a bruise. Or they may simply notice a strong sensation that something is wrong. Even a well-intentioned knock at the door can startle them further.

When the provider enters, that internal distress may be hidden behind a polite smile. The appointment is happening in the present, but earlier experiences are influencing how the patient experiences it.

Alison: No. Memory includes experiences and stories we can consciously recall, but also learning that shows up through emotions, bodily sensations, expectations, and patterns of response.

Someone may experience fear or tension before they can name it or explain why it is happening. A scent, a look, or a physical sensation can carry meaning because of what came before.

That does not mean every uncomfortable reaction comes from trauma. It means the story a patient can tell us may be only part of what they are experiencing.

Alison: One foundational theory is the Adaptive Information Processing, or AIP, model, developed by Dr. Francine Shapiro. It proposes that we have a natural capacity to process experiences and connect them with other useful information.

With enough support and opportunity to recover, difficult experiences can become connected with learning such as, “I got through that,” “I can ask for help,” or “I have choices.”

The model proposes that overwhelming experiences may not become integrated in the same way. Images, emotions, beliefs, or body responses associated with the past may then become activated by something happening today.

This is a framework for understanding treatment, rather than a complete explanation of how the brain stores or processes trauma.

Alison: EMDR is a structured, eight-phase therapy. It includes history taking and treatment planning, preparation, assessment, desensitization, installation of a positive belief, a body scan, closure, and reevaluation.

The eye movements, or other forms of bilateral stimulation, are one component. The broader work includes understanding the person’s history, deciding what to address, preparing for difficult material, and checking how the person responds over time.

EMDR is an established treatment for PTSD. Researchers are also exploring its use for other concerns, including anxiety and depression, although the evidence varies by condition.

Alison: Before approaching difficult material, we need to consider whether the person can stay connected to the present while noticing something distressing from the past.

For someone who has spent years disconnecting from discomfort, noticing a difficult sensation while remaining present may itself be new learning.

Another person may find it difficult to experience comfort or connection without immediately expecting something bad to happen. Learning that those experiences can be tolerated also matters.

Preparation gives the person opportunities to develop and recognize those capacities. How much time that takes depends on the individual.

Alison: A person may become overwhelmed or disconnected. Instead of developing a greater sense of capacity, they may leave with the familiar belief, “I can’t do this,” or, “I am broken.”

That is why pacing matters. We want to help the person approach difficult experiences in a way they can engage with, while staying attentive to how they are responding.

Preparation is part of that clinical work. For some people, being able to notice discomfort and remain present is a meaningful step toward processing what happened.

Alison: The starting point depends on the treatment plan and the person’s current needs. A clinician may determine that approaching a past experience is appropriate, or that a protocol focused on a current challenge is a better starting point.

EMDR has a defined structure, but treatment planning still requires clinical judgment and collaboration with the client. The sequence and pacing should reflect the person being treated.

Alison: There are a few theories that help us understand why eye movements, or bilateral stimulation, may support reprocessing. One of the leading explanations is that recalling a distressing memory while performing another task places demands on working memory, which may reduce the memory's vividness and emotional intensity.

Another theory involves the orienting response, where the eye movements engage our attention and may influence physiological arousal as we process distressing material. We also know that EMDR involves dual attention, allowing clients to connect with past experiences while remaining aware of the present.

Historically, researchers also explored whether bilateral stimulation increased communication between the two hemispheres of the brain to support memory processing, although the evidence for that particular explanation has been limited.

What we know is that EMDR is an effective treatment for PTSD, even as we continue to learn more about the precise mechanisms that make it work.

For PMHNPs, understanding a therapy means knowing enough to have a meaningful conversation about it: why it might fit, what participation involves, and what the patient hopes will change. Those conversations can make a referral feel more purposeful and help connect psychotherapy with the rest of a patient’s care.

☕️☕️☕️ My thanks to Alison Leslie for sharing her time and perspective, and for helping bring the work beyond the eye movements into clearer view. For those interested in learning more, Alison can be found here.

This also connects with a broader question I explored in “The Best Psychotherapy? PMHNPs Should Be Asking a Different Question.” When a patient asks us where to turn, we have an opportunity to do more than name a treatment. We can help them clarify what they hope to change and what they need from therapy.