EMDR Ottawa: A Case Example

The EMDR experience can be difficult to picture, which can make starting therapy feel even more intimidating. To help, here is a fictional case example that offers a clearer sense of the EMDR process and a glimpse into what sessions are like.

Background and Symptoms Before EMDR

Maria is a 34‑year‑old nurse who was in a serious car accident 18 months ago while driving home from a night shift.Since the accident she has experienced:

• Intrusive images of the oncoming headlights multiple times per day

• Nightmares about crashing 3–4 times per week, frequent middle‑of‑the‑night awakenings

• Intense anxiety and sweating when she has to drive at night, sometimes full panic attacks

• Avoidance of highways and night shifts, leading to conflict with her employer

• Hypervigilance (easily startled, scanning for danger, tense shoulders and jaw)

• Negative beliefs such as “I’m not safe,” “The world is dangerous,” and “I shouldn’t be allowed to drive”

She meets criteria for PTSD related to the accident. She has had some supportive talk therapy but feels “stuck,” like “my body is still in the car.”

Treatment Phase 1–2: History Taking and Preparation

Phase 1 – History & Treatment Planning

In the first two sessions, the therapist gathers a detailed history: the accident, prior stressors, supports, and current functioning.They collaboratively identify target memories:

• The moment she saw the headlights right before impact

• Lying in the ambulance hearing the siren

• Returning to driving for the first time after the accident

They also note positive resources: times she has felt competent and safe at work, moments of successfully driving during the day, and supportive relationships. The therapist explains EMDR, the eight phases, and what bilateral stimulation is like, emphasizing that Maria is in control and can pause any time.

Phase 2 – Preparation

Over 1–2 sessions, they build regulation skills:

• Safe/calm place imagery with bilateral stimulation (e.g., imagining sitting by a quiet lake)

• Grounding skills (5‑4‑3‑2‑1 senses, feeling feet on the floor, orienting to the present)

• Containment imagery (“mental filing cabinet” or “lock box” to temporarily set aside distressing material)

Maria practices these between sessions and starts to feel more confident: “I’m nervous, but I think I can handle looking at this now.”

Treatment Phase 3–6: Processing the Target Memory

Phase 3 – Assessment

They begin with the main target: the instant before impact. The therapist asks Maria to bring up:

• The worst image: seeing the headlights crossing into her lane

• The negative cognition (NC): “I’m going to die” or “I am not safe”

• A desired positive cognition (PC): “I survived and I am safe now,” or “I can handle driving”

• Emotions: terror, helplessness, shame at “causing trouble” for others

• Body sensations: tight chest, clenched jaw, nausea

• SUD rating (0–10): she rates distress as 9/10

• Validity of positive cognition (VOC, 1–7): she rates “I am safe now” as 2/7

Phase 4 – Desensitization

Using bilateral stimulation (e.g., therapist’s fingers moving side to side, tappers, or alternating sounds), Maria focuses on the target image.After each short set (about 20–30 seconds), the therapist asks what she notices now. Responses over several sets might be:

• “The headlights are really close, I feel frozen.”

• “Now I notice the sound of the brakes, and my heart is racing.”

• “I’m seeing the paramedics; they’re talking to me, I’m not alone.”

• “I realize I did everything I could; the other driver was speeding.”

The therapist gently redirects attention back to “just notice that” and continues sets.Distress gradually drops: from SUD 9 to 6, then to 4, then to 1–2 across several sessions. New adaptive material emerges, like realizing she survived, that medical staff helped her, and that she has driven safely many times since.

Phase 5 – Installation

Once SUD is at 0–1, the focus shifts to installing the positive cognition.They pair the target memory with the PC “I survived and I am safe now” while continuing bilateral stimulation. Maria begins to feel the statement more in her body. Her VOC for the PC increases from 2 to 6–7, indicating it feels true at a deep level.

Phase 6 – Body Scan

With eyes closed, Maria holds the original incident in mind along with the new positive belief and scans her body from head to toe.Initially, she notices a residual tightness in her chest, which becomes the focus of a few more sets of bilateral stimulation until her body feels mostly neutral and relaxed. When she brings up the accident now, she reports only a mild heaviness in her stomach that eventually fades.

Treatment Phase 7–8: Closure and Reevaluation

Phase 7 – Closure

At the end of each processing session, whether the memory feels fully resolved or not, the therapist helps Maria return to a grounded state. They use:

• Calm place imagery with bilateral stimulation

• Breathing exercises

• Brief debrief: what she noticed, what she can expect between sessions

She is reminded to notice any new dreams, thoughts, or shifts in behavior and to use her grounding skills as needed.

Phase 8 – Reevaluation

At the start of subsequent sessions, the therapist checks:

• Her SUD rating when thinking of the accident

• Strength of the positive belief

• Current symptoms (nightmares, driving anxiety, hypervigilance)

Over a number of sessions, they process related targets (sirens in the ambulance, returning to driving, a later fender‑bender that re‑triggered her). By the final sessions, Maria’s SUD for the original crash scene is consistently 0–1, and her VOC for “I survived and I am safe now” remains 7.

How Maria Felt After EMDR

By the end of treatment (about 10–12 sessions total, including preparation and follow‑up), Maria reports:

• She can think about the accident with a sense of distance: “It was awful, but it’s over now.”

• Nightmares have decreased from several times per week to maybe once a month, and when they occur, they are less intense and easier to shake off.

• She can drive at night on familiar routes with only mild, manageable anxiety, using breathing and grounding if needed.

• Her body feels less “on edge” day‑to‑day; she notices her jaw is less clenched, and she startles less at sudden noises.

• Her self‑talk has shifted from “I’m not safe” and “I’m broken” to “I got through something really hard and I’m capable.”

When asked to summarize the impact, Maria says: “It feels like my nervous system finally caught up to the reality that I survived. Before, it was like part of me was still stuck in the car. Now it feels like a memory, not like it’s happening again.”

While every person’s story and pace in EMDR is unique, this vignette is meant to give you a felt sense of what the process can look like from the inside. If parts of the story resonated with you, it may be worth exploring EMDR further with your Ottawa EMDR therapist to see whether this approach could be a supportive next step in your own healing.