What to Expect in EMDR Therapy: A Realistic Guide for Women in Perimenopause

What to Expect in EMDR Therapy:

A Guide for Women in Midlife Who Are Curious

By Edwige Theokas, Planting Seeds Counseling

If you've been thinking about EMDR therapy but something keeps holding you back, you are not alone.

Most of the women who reach out to me describe the same reluctance and confusion.

They've read a little about EMDR. They've heard it can help.

But they don't really know what to expect from EMDR therapy, and are unsure what an EMDR therapy session looks like.

And the uncertainty of not knowing feels like a barrier to starting.

Some worry they have to revisit their worst memories and talk about them in graphic detail.

Some are worried it won't work for them because they don't have a "big enough" trauma.

Some are in perimenopause and wondering if the hormonal chaos will make it too hard.

I want to answer all of those concerns in this post, as directly and honestly as I can.

For me, I have found that EMDR is genuinely one of the most powerful tools I have seen for the kind of work women in midlife need to do.

I don't want the fear of the unknown to get in the way.

Let me note that there are lots of different types of therapy that can support women navigating midlife and perimenopause.

They include Somatic therapy, Exposure therapy, Internal Family Systems therapy, Equine therapy, and Cognitive Behavioral Therapy, just to name a few.

I don’t believe that there is just one type of therapy that can support you, and you should be open to finding the kind of therapy that helps you best.

For me, I have practiced EMDR because I saw the healing that worked with clients who have experienced significant trauma in their lives.

But I have also learned to incorporate other modalities along with EMDR.

And I have seen that EMDR can be transformative for people who have not experienced trauma.

I hope to give you some clarity so that you can decide whether EMDR is right for you. 

What EMDR Is (And What It Isn't)

Let's start with the basics, in plain language.

EMDR stands for Eye Movement Desensitization and Reprocessing.

It was developed in the late 1980s by psychologist Francine Shapiro and has since become one of the most extensively researched trauma therapies in existence.

It is recognized as an effective evidence-based treatment by the World Health Organization, the American Psychological Association, and the Department of Veterans Affairs

What EMDR does

It helps the brain finish processing experiences that got stuck.

When something traumatic (or deeply stressful) happens, the memory doesn't always get stored in the normal, narrative way.

Instead, it stays in a kind of raw, unprocessed form.

That's why traumatic memories can feel so vivid and so present, even decades later, because somatically and neurologically, they haven’t been metabolized, processed and categorized like most experiences.

EMDR uses a technique called bilateral stimulation (more on this below) to help the brain shift into a processing mode, so the memory can be filed away properly.

The experience doesn't disappear, but it loses its emotional charge.

What EMDR isn't

It is not hypnosis. You are fully conscious and in control throughout.

It is not a technique where you have to describe your trauma in graphic, detailed narrative form.

Instead, the process asks you to access the memories in your brain AND body.

It is not something that will leave you feeling cracked open with nowhere to go.

The therapy protocol builds safety and stability into the work before and after every processing session so that these experiences can be safely contained and not leak into your everyday life.

Who EMDR Is For

One of the most common things I hear is: "I don't think I'm traumatized enough for EMDR."

*EMDR was originally developed to treat PTSD, but it has been used effectively for a very wide range of experiences, including:

- Anxiety and panic

- Depression

- Chronic stress and burnout

- Grief and loss

- Medical trauma (including difficult birth experiences)

- Childhood emotional neglect (not abuse, but the subtler experiences of not feeling seen, supported, or safe

- People-pleasing and perfectionism

- Low self-worth and shame

- Relationship patterns that repeat no matter what you try

- Perimenopause - specifically the way this transition activates old wounds, intensifies emotional reactivity, and brings decades of unprocessed material to the surface.

You do not need to have experienced a dramatic, identifiable traumatic event to benefit from EMDR.

What you need is a nervous system that is holding something it hasn't fully processed.

Many of us have that, especially women who have spent years taking care of everyone else at their own expense.

The Eight Phases of EMDR: What Actually Happens

EMDR is a structured therapy.

It has eight phases, which I'll walk through here so you know what to expect.

In reality, the work doesn't feel rigid or formulaic, but the structure is there, and it exists for good reason.

As you read through these, you'll notice something: EMDR has a pattern.

It opens, it goes somewhere, and it closes.

That pattern is worth paying attention to, because it's the reason the question of session length comes up.

Phase 1: History and Treatment Planning

Before we do any processing, I want to understand you.

We spend time in our early sessions talking about your history, what brings you to therapy, what experiences have shaped you, and what you want to get out of the work.

This is not a fast phase.

I'm not looking to rush to the "real" work.

This phase is “real” work.

Without building trust, understanding your history, including your nervous system's particular patterns, your strengths and resources, and what's most important to address, I cannot do the deeper work with you safely or effectively.

For women in perimenopause, this phase often includes conversation about where you are hormonally, whether you're working with any other providers, and how your nervous system tends to respond under stress.

I want to know what helps you feel grounded, and what sends you into dysregulation.

Phase 2: Preparation

This is one of the most important phases, and it's often underemphasized in how people describe EMDR.

Before we ever touch a difficult memory or experience, we build your capacity.

We focus on establishing grounding and stabilization techniques - specific tools you can use to regulate your nervous system, both in and out of session.

We practice safe place imagery, resource development, and containment strategies.

We make sure you have a solid enough foundation that when we go into harder material, you can go in knowing you have something to come back to.

For women in perimenopause, I pay particular attention to this phase.

Perimenopause can create variability in nervous system regulation.

 Some weeks your window of tolerance is wider, other weeks it's narrow.

I want to make sure we do not start processing before you have the capacity to handle what comes up.

Going too fast, too soon is not helpful.

Your safety is the foundation.

*A note on pacing.

In a weekly 50-minute format, preparation typically takes its own several sessions before any processing begins

This is appropriate, but some women find this frustrating when they arrive wanting to start and get going on the healing.

In a longer session, there is room to build the foundation and begin using it in the same sitting.

Neither is better. But it is worth considering your circumstances so that you know best what to look for. 

Phase 3: Assessment

In this phase, we identify a specific target to work on.

This might be a memory, an experience, an image, a belief, or a pattern.

I ask you to identify what the "worst part" of the memory feels like: the image, the negative belief about yourself connected to it (something like "I'm not safe," or "I'm not enough," or "It was my fault"), the emotion, and where you feel it in your body.

We also identify what you would rather believe about yourself in relation to this experience - what feels true or possible even if you don't fully believe it yet. (Something like "I am safe now," or "I did the best I could.")

This targeting phase is precise. It's the difference between talking about an experience and actually working with it at the nervous system level.

Phase 4: Desensitization

This is the phase most people are curious about (and most worried about).

I ask you to hold the target memory (the image, the negative belief, the emotion, the body sensation) lightly in mind, while I introduce bilateral stimulation.

Most often, this means following my fingers with your eyes as I move them back and forth or holding tappers.

Some clients prefer auditory bilateral stimulation (tones that alternate from ear to ear through headphones) or tactile bilateral stimulation (gentle taps on alternating hands or knees).

And then... you just notice what comes up.

This is the part that surprises people.

You're not asked to narrate the memory out loud.

You're not asked to analyze it or explain it.

You just notice what shows up (images, emotions, body sensations, other memories, new thoughts), and we do short sets of bilateral stimulation, pausing periodically for you to report what you're noticing.

What happens during EMDR desensitization is genuinely hard to predict, and that's part of what makes it remarkable.

Memories shift. Beliefs update. Emotions that felt stuck start to move.

Physical sensations change.

The raw, activated quality of the memory begins to settle.

Most people describe it as the difference between watching a scene on a screen right in front of your face versus watching it on a TV across the room.

The content is the same, but the distance and the charge are different.

Throughout the process, you are in control.

You can stop at any time. Nothing happens to you that you do not consent to.

The bilateral stimulation doesn't cause you to enter a trance or lose awareness. You are present, conscious, and fully able to pause or redirect.

Here is the thing about this phase that nobody tells you in advance: processing has its own arc, and it does not consult the clock.

Sometimes a target settles in twenty minutes.

Sometimes the first forty minutes are your system deciding whether it's safe to go there at all, and the actual movement happens after that.

Women who have spent thirty years being competent are particularly prone to this. You are very good at presenting a clear, organized, well-managed account of the problem, and the true sentence tends to arrive later than you'd expect.

That's not a flaw in the therapy you engage in. It could simply be a feature of the method, and it’s worth knowing about when you choose a format. 

Phase 5: Installation

Once the charge around a memory has settled significantly, we move to installing the positive belief (the one you identified in Phase 3).

We use bilateral stimulation to strengthen the connection between the memory and this more accurate, more compassionate way of seeing yourself.

It doesn't feel forced.

By the time we get here, the positive belief usually feels genuinely more true, because the nervous system has updated.

It's not a cognitive reframe imposed from outside.

It's something that tends to emerge naturally once the original wound has been processed.

Phase 6: Body Scan

After processing a target, we do a body scan.  I ask you to run your attention from the top of your head down through your body and notice if there's any remaining tension, tightness, or activation connected to the target we just worked on.

If there is, we address it.

If the body is clear, we move toward closing.This phase matters because trauma is stored in the body, not just the mind. The body has to agree that the work is done. 

Phase 7: Closure

Every EMDR session ends with a deliberate closure process. If we've completed processing a target, we close cleanly.

If we ran out of time mid-processing, I use specific techniques to help you contain what's been opened, so you leave feeling stable and grounded rather than raw.

This is non-negotiable.

You will not leave my office in the middle of a process without a plan for how to take care of yourself.

It is also, honestly, where the arithmetic of a 50-minute session gets interesting.

A standard session has to hold the whole shape: arriving and settling, reconnecting to where we left off, the processing itself, and then a real closure, because closing something you've opened takes actual time, not a rushed two minutes at the door.

Once you account for the front and back ends, the genuinely open working middle is often closer to thirty minutes than fifty.

Thirty minutes is enough. I do this work weekly with women all the time, and it moves.

But it does mean that more of the sessions end at a natural pause rather than a natural completion, and that the next week often begins by re-establishing ground you'd already reached.

This doesn’t mean that longer sessions are necessary.

But it does explain why some women, once they understand the shape of the work, decide they'd rather have fewer, longer appointments than more, shorter ones.

I've put the options side by side further down in a table.

Phase 8: Re-evaluation

At the beginning of the next session, we check in.

How did you feel after the last session? What came up between sessions?

Did the processing continue to unfold (which sometimes happens (insights, emotional shifts, new connections)?

Has the target changed?

This phase keeps us calibrated.

We don't just move on to the next thing without checking that the previous work has settled.

What's Different When You're Also Navigating Perimenopause

EMDR is safe and effective during perimenopause, but there are things I adjust in my approach that are worth knowing about.

I account for hormonal variability.

Some weeks in perimenopause, your nervous system is fairly regulated.

Other weeks (often correlated with where you are in your cycle, if you're still having cycles), your window of tolerance is narrowed and your system is more reactive.

I check in at the beginning of every session about how you're doing hormonally and adjust accordingly.

We may do more stabilization work in a session where you're more dysregulated.

We may do deeper processing when your system is more regulated.

I follow your nervous system, not a predetermined protocol.

We may move more slowly at first.

For women in perimenopause who are already running at a deficit (depleted from sleep disruption, overwhelmed by life demands, managing hormonal symptoms), the preparation phase is especially important.

I'd rather spend three sessions building your foundation than rush into processing and destabilize you.

The content will likely be rich.

Perimenopause has a way of surfacing decades of material.

Women in this season often come to EMDR with layers of accumulated experience (decades of caretaking, unexpressed and unallowed anger, grief, identity shifts, the ways the medical system has failed them.

There is usually a lot to work with. That's not a problem.

That's actually where the most transformative work happens.

Appointments themselves are a logistics problem.

This is the least clinical point on the list and often the most decisive.

A weekly appointment is not only fifty minutes, but it's the drive, the parking, the arriving early, the re-entry afterward, and the week-to-week negotiation with work and school pickup and a calendar that a sick kid can blow up without warning.

For a woman already running at a deficit, the appointment count can be as much of a barrier as the appointment length.

It is worth counting the whole cost, not just the clinical hour, when you decide what format to commit to.

I encourage you to pursue hormonal support alongside therapy.

EMDR does not fix hormones, and hormones are a real piece of the picture.

For women in perimenopause, working with a menopause-informed physician or OB-GYN to address the biological dimension, while also doing EMDR for the emotional and nervous system dimension, can produce the most meaningful and lasting results.

These two things are not in competition. They support each other. 

How Long Should an EMDR Session Be?

Short answer: Fifty minutes is the standard and a perfectly good container.

Most EMDR in the world happens in it, because this is the reality of our medical model and society’s obligations.

You do not need a longer session for EMDR to work, and I don't want anyone reading this to conclude that the standard format is somehow a compromised version.

It isn't.

Longer answer: the fifty-minute hour is an artifact of how insurance and scheduling evolved, not of how memory reprocessing works.

Once you've read the eight phases above, you can see why that occasionally matters. So rather than a two-way choice, it's worth seeing the three formats side by side.

Read more | [What actually happens in a two-hour session →](https://www.plantingseedscounselingnj.com/blog/what-happens-two-hour-therapy-session) |

 EMDR Intensives

Weekly EMDR therapy provides steady, consistent support.

You build a relationship over time, work at a gradual pace, and have ongoing containment between sessions.

For women who are earlier in their healing journey, who need week-to-week stability, or who want to take things slowly, weekly sessions are often the right fit.

Plenty of my clients stay here for the entire time that we work together, and it works.

Two-hour sessions have become increasingly in demand, and they're the option most women don't know exists.

They're not an intensive - there's no half-day commitment, no large deposit, no clearing your calendar.

They're a single appointment with enough room that the processing arc and the session can end at the same time.

Women tend to land here for one of two reasons: either the weekly rhythm keeps stopping them right as something starts to move, or the logistics of a weekly appointment are the part that isn't sustainable.

EMDR Intensives are a concentrated format - typically several hours over one or two days - for women who have a defined focus and want sustained, uninterrupted time on it. You can read more about the benefits here.

A note on intensives, because the marketing around them in this field is often overstated: the research does not show that intensive EMDR outperforms weekly EMDR.

Research has shown intensive daily EMDR to be equivalent to the standard weekly schedule in outcome.

What the intensive format reliably buys is time and follow-through - the same work is compressed, with a dramatically lower dropout rate (0% versus 8% in that study).

That's a real and meaningful advantage, especially for women whose lives make a months-long weekly commitment fragile.

But it's a different claim than "faster healing," and I'd rather tell you the accurate version.

You can also alternate between the session types.

Many women start weekly, hit a stretch where the format is the constraint rather than the content, do one two-hour session to get through it, and return to weekly.

The format types are a way to be flexible

You are not choosing a track you have to stay on.

How to Know If You're Ready For EMDR Therapy

If you've read this far, you're probably more ready than you think.

The question I hear most is: "Am I ready for EMDR?"

And my honest answer is: if you have enough stability in your daily life that you're functioning (not perfectly, but getting through the days), if you have some tolerance for sitting with uncomfortable feelings, and if there are specific experiences or patterns you want to address, then you're likely a good candidate.

You don't need to have everything figured out. You don't need to know exactly what you want to work on.

You don't need to be in a great place hormonally or emotionally before you start. You just need to be willing to show up.

You also don't need to decide on a format before you begin. That's a conversation, not a prerequisite - and it's one we can have after you've felt what the work is actually like.

The first step is a consultation.

We'll talk about where you are, what you're looking for, and whether EMDR and whether you think that, I, specifically, feel like a good fit.

Book a free 15-minute consultation

Frequently Asked Questions About EMDR Intensives

Is EMDR therapy painful or scary?

Most people find EMDR to be less scary than they expected.

You are fully conscious and in control throughout, and nothing happens without your consent.

Processing can bring up emotions (which can feel uncomfortable), but a skilled EMDR therapist paces the work carefully, builds stabilization capacity before any processing begins, and ensures you leave every session grounded.

Many women describe EMDR as deeply relieving rather than frightening.

How long is an EMDR session? 

A standard EMDR session is 50 minutes, and that is a perfectly effective amount of time.

Most EMDR is delivered this way, because of the limitations of insurance coverage and people’s schedules.

Because EMDR sessions include settling at the start and a deliberate closure at the end, the open working middle of a 50-minute session is usually closer to 30 minutes.

I have found the two-hour session to be more effective, but I understand the limitations that prevent many from utilizing it.

Some women prefer a two-hour session, which has roughly a 90-minute working middle and lets a processing arc finish inside a single appointment.

Longer sessions are an option, not a requirement.

Do I need longer sessions for EMDR to work?

No. EMDR works in the standard weekly format.

That's how the overwhelming majority of EMDR is delivered, including a great deal of the research behind it.

Longer sessions aren't a better version of the therapy; they're a different container for it.

They tend to suit women who keep running out of time right as something starts to move, or for whom the weekly appointment itself is the unsustainable part.

If neither of those is you, weekly is a good place to start.

How many EMDR sessions will I need?

This genuinely varies by person and by the nature of what you're working on.

Some issues, such as a specific recent event, can shift significantly in a small number of sessions (4-6 sessions).

Others, like complex trauma, deeply held beliefs about yourself, and patterns that developed over decades, take more time.

In a weekly format, many women notice meaningful change within 8–16 sessions, though the work may continue beyond that.

Will I have to talk about every detail of what happened to me?

No. EMDR is not a narrative therapy.

You are not asked to tell me the full story of your trauma in detail.

We identify specific targets, and you hold them internally while I guide you through bilateral stimulation.

You decide how much you share verbally.

Many women find this aspect of EMDR to be a relief. You don't have to put things into words you don't have words for.

Can EMDR make things worse? 

When done appropriately, EMDR is safe and well-tolerated.

However, processing does sometimes bring up unexpected emotions or memories between sessions.

The brain continues the processing work outside of the office, which can feel disorienting.

This is why a good EMDR practice includes strong stabilization, containment strategies, and clear protocols for what to do if things feel hard between sessions. I provide clients with a toolkit to help them prepare before and after sessions.

I highly recommend that clients “take it easy” after a particularly taxing session to allow emotions and processing to land.

If your symptoms are currently very severe or you're in acute crisis, we would want to stabilize first before moving into processing.

Do I need a trauma history to benefit from EMDR?

No. EMDR helps with a wide range of issues: anxiety, burnout, chronic stress, self-worth issues, relationship patterns, grief, perfectionism.

The common thread is not a dramatic event, but a nervous system that is holding something that hasn't been fully processed.

Most women I work with have accumulated experience of this kind, even if they wouldn't call it trauma.

Is EMDR covered by insurance?

As a private-pay practice, I do not bill insurance directly.

However, EMDR therapy is an established, evidence-based treatment that is often reimbursable through out-of-network benefits, HSA/FSA accounts, or health reimbursement arrangements.

I can provide documentation to support out-of-network reimbursement. I encourage you to check with your insurance provider about your specific coverage.

How is EMDR different from CBT or traditional talk therapy?

Traditional talk therapy and CBT work primarily through cognitive and narrative pathways: you think, you understand, you reframe, and you practice new responses.

These approaches can be genuinely helpful.

EMDR works differently: it targets the body sensations and tries to access memories at the neurological level where memories and beliefs are stored, helping the brain actually digest experiences rather than just think about them differently.

Many women find EMDR reaches things that talking alone cannot, particularly experiences that don't respond to insight or reframing because they were forgotten and they're held in the body and nervous system, not just the mind.

If you’re interested in a consultation, book here.

Edwige Theokas, LPC, is an EMDRIA Certified therapist and the founder of Planting Seeds Counseling in Bordentown, NJ. She specializes in EMDR and EMDR Intensives for women in midlife and perimenopause. She is currently pursuing Certified Menopause Practitioner training.

Learn more at plantingseedscounselingnj.com