Is feeling worse before feeling better normal with EMDR?

Short lived increases in emotion or arousal can occur when processing traumatic material. Therapists manage this with careful pacing, grounding, and regular review to keep treatment safe and tolerable, consistent with Australian PTSD guideline recommendations [1].

What to Expect From Your First EMDR Session in Brisbane

Q: What happens during the first EMDR session?

The first EMDR session focuses on assessment and preparation. Your therapist explains the EMDR model and phases, completes a structured history and goals review, and teaches coping and grounding skills so you can regulate during and between sessions. The emphasis is on safety, consent, and readiness rather than immediate trauma reprocessing, in line with Australian treatment recommendations [2].

Q: How should I prepare for my first EMDR session?

Preparation can include planning calm routines such as gentle movement or mindful breathing, noting goals and common triggers, and prioritising sleep the night before. These steps support emotional regulation and engagement with EMDR procedures, consistent with Australian primary care guidance for trauma informed treatment [5].

Q: How many EMDR sessions will I need?

A typical EMDR course often spans around eight to twelve sessions, though some people need fewer or more depending on trauma history, goals, and complexity. Clinicians regularly review progress and adapt the plan within Australian guidance for trauma focused care [4].

Q: How will I know if EMDR is working?

Signs that EMDR is working include reduced distress when reminded of the event, improved day to day functioning, and stronger, more adaptive beliefs about yourself. Clinicians often use simple measures such as SUDS and VOC ratings to track progress across sessions [3].

nurturedthoughts
Jan 1
7 min read

Starting EMDR therapy in Brisbane can feel both exciting and a bit overwhelming, especially if you are not sure what to expect. EMDR, Eye Movement Desensitisation and Reprocessing, therapy is an evidence based trauma focused treatment recommended in Australian clinical guidance, and understanding what your first emdr session brisbane involves can reduce uncertainty and help you feel prepared (Phoenix Australia, Australian PTSD Guidelines) [1]. By clearly understanding what your first EMDR session involves, you can approach therapy with confidence, knowing exactly what lies ahead. In this article, we explore how to prepare for your session, what actually happens during a typical EMDR appointment, common reactions you might experience afterwards, the number of sessions usually required, and practical ways to track your progress.

How to Prepare for Your EMDR Session in Brisbane

Preparing well for your EMDR session can significantly boost your confidence and comfort. A bit of thoughtful preparation ensures you get the most from your therapy. Here are a few things you can do to make your first EMDR session go smoothly:

Stay open and curious. EMDR therapy is different from traditional counselling. Rather than lengthy discussion alone, EMDR uses structured procedures and bilateral stimulation within a validated protocol, and a receptive mindset supports engagement with this process (APS, Demystifying EMDR) [3].
Practise calming activities beforehand. Gentle movement, mindful breathing, and brief relaxation practices can reduce arousal before the appointment, which supports regulation during the session (Phoenix Australia, Treatment recommendations) [2].
Keep a therapy journal. Noting your goals, recent triggers, and questions helps you and your clinician set a clear focus, and offers a way to track shifts in distress and beliefs across sessions (APS, Demystifying EMDR) [3].
Prioritise rest. Consistent sleep and basic self care improve attention and emotional regulation, which are helpful for trauma focused therapy sessions (RACGP, PTSD resources for GPs) [5].
Manage your expectations gently. The first appointment typically focuses on history taking, safety planning, and coping strategies rather than immediate trauma reprocessing, so you can build a foundation for later phases of EMDR work (Phoenix Australia, Treatment recommendations) [2].

When you are prepared in these ways, attending your first EMDR session in Brisbane can become something you look forward to rather than worry about.

The Structure of a Typical EMDR Session in Brisbane

EMDR therapy follows a structured, safe, and predictable process. Each session carefully builds on the previous one to protect emotional safety and to support change in how traumatic memories are stored and linked (RACGP HANDI, trauma focused psychological therapy) [6]. Here is what you can expect from the typical structure of EMDR:

Phase 1: Understanding Your Experiences

Your therapist will explore your history, current symptoms, and therapy goals. Together, you identify target memories, triggers, and negative beliefs to guide the work ahead. This phase also includes discussion of consent, pacing, and how progress will be measured (Phoenix Australia, Australian PTSD Guidelines) [1].

Phase 2: Learning Coping and Relaxation Techniques

Before engaging with traumatic material, you learn skills for regulation and grounding, such as calm breathing, sensory grounding, and visualising a safe place. You also agree on stop signals so you can pause at any time. These strategies support stability during and after sessions (APS, Demystifying EMDR) [3].

Phase 3: Selecting Key Memories

With your clinician, you select memories, images, sensations, and beliefs that contribute to current distress. This collaborative case formulation sets priorities for reprocessing in later sessions and ensures work proceeds at a pace that is appropriate for you (Phoenix Australia, Treatment recommendations) [2].

Your initial EMDR session primarily covers Phases 1 and 2. You are unlikely to begin trauma reprocessing immediately. Instead, the first session helps you become comfortable with your therapist, the setting, and the procedure, which sets the stage for deeper work in future sessions (RACGP, PTSD resources for GPs) [5].

For a practical overview of commonly used therapy elements, see our short guide on trauma focused therapy components at Fellow Academy.

Common Emotional Reactions and How to Manage Them

EMDR can feel emotionally intense, especially at first, because it targets how distressing memories are stored and linked. Short lived increases in emotion or arousal can occur during or after sessions and are expected within trauma focused therapy when appropriate supports are in place (Phoenix Australia, Treatment recommendations) [2]. Here is what you might encounter and how you can manage these feelings:

Typical Reactions You May Experience

Temporary emotional intensity. Some people notice brief increases in anxiety, sadness, anger, or tearfulness during or after sessions. These shifts often settle as regulation skills are used and as processing progresses (Phoenix Australia, Australian PTSD Guidelines) [1].
Physical reactions. Headache, fatigue, or body tension can occur for a short period after sessions and usually reduce with rest, hydration, and gentle activity, especially when coping strategies are used as planned with the clinician (RACGP, PTSD resources for GPs) [5].
Changes in dreaming and memory vividness. Dream content can feel more vivid or symbolic as the brain continues to process between sessions. This does not mean something is wrong and often settles over time (APS, Demystifying EMDR) [3].

Helpful Ways to Manage These Reactions

Plan quiet time after sessions, and use simple regulation skills you practised with your therapist, such as paced breathing or a safe place visualisation (APS, Demystifying EMDR) [3].
Maintain basic self care, for example hydration, nutrition, and gentle movement, and limit overstimulating environments on session days (RACGP, PTSD resources for GPs) [5].
Keep brief notes about triggers, emotions, and relief strategies that helped, then bring these observations to the next appointment for review with your clinician (Phoenix Australia, Treatment recommendations) [2].

These reactions are natural signs that therapy is working on the memory network and are expected to ease as treatment continues with appropriate pacing and support (Phoenix Australia, Australian PTSD Guidelines) [1]. For an orientation to trauma informed care principles that clinicians follow, see our Fellow Academy explainer, internal link prompt.

How Many EMDR Sessions Are Usually Needed

The number of EMDR sessions you need varies with the nature of your experiences, current symptoms, and the pace that feels safe and sustainable. Australian consumer guidance commonly describes a course of 8 to 12 sessions, while noting that some people require a shorter or longer pathway depending on complexity and goals (Black Dog Institute, PTSD treatment) [4]. Your clinician will review progress regularly and adjust the plan as needed in line with Australian guidelines for trauma focused therapy, which include EMDR as a recommended approach (Phoenix Australia, Australian PTSD Guidelines) [1].

Tracking Your Progress Over Time

Clearly tracking your progress helps you see change, supports motivation, and guides clinical decision making. In EMDR, progress is usually monitored with a combination of clinician rated and client reported indicators:

Subjective Units of Distress Scale, SUDS. You rate distress linked to a target memory. Decreasing SUDS over sessions indicates less emotional reactivity (APS, Demystifying EMDR) [3].
Validity of Cognition, VOC. You rate how true a positive belief feels, for example I am safe now. Increasing VOC scores suggest strengthening of adaptive beliefs over time (APS, Demystifying EMDR) [3].
Function and wellbeing notes. Journalling short observations about sleep, concentration, triggers, and relationships gives practical evidence that day to day life is improving, which complements clinical measures (Phoenix Australia, Treatment recommendations) [2].

Clinical reviews at agreed intervals, for example after several sessions, help ensure treatment is on track and that pacing remains safe. If symptoms escalate between sessions or feel unmanageable, contact your therapist or seek professional support promptly, as recommended in Australian guidance (RACGP, PTSD resources for GPs) [5].

Frequently Asked Questions

What happens during the first EMDR session?

Your therapist completes a structured assessment, explains the EMDR model and phases, and teaches simple coping skills so you can regulate during and after sessions. The focus is on safety, consent, and preparation rather than immediate trauma reprocessing (Phoenix Australia, Treatment recommendations) [2].

How should I prepare for my first EMDR session?

Plan light routines that promote calm, for example mindful breathing or a brief walk, organise notes about goals and triggers, and prioritise sleep the night before. These steps support regulation and engagement with the procedure (RACGP, PTSD resources for GPs) [5].

How many EMDR sessions will I need?

A typical course often spans 8 to 12 sessions, with flexibility for shorter or longer pathways depending on history and goals. Your clinician will review progress and adapt the plan within Australian guidance for trauma focused care (Black Dog Institute, PTSD treatment) [4].

Is feeling worse before feeling better normal?

Short lived increases in emotion or arousal can occur when working with traumatic memories. Your therapist will use pacing, grounding, and review to keep the process safe, consistent with Australian recommendations (Phoenix Australia, Australian PTSD Guidelines) [1].

How will I know if EMDR is working?

You will notice reduced distress to reminders of the event, improved day to day function, and stronger, more adaptive beliefs about yourself. SUDS and VOC scores provide simple ways to visualise progress session by session (APS, Demystifying EMDR) [3].

At Nurtured Thoughts Psychology, we specialise in providing warm, supportive, and effective EMDR therapy in Brisbane, tailored to your goals and at a pace that feels right for you (RACGP, PTSD resources for GPs) [5].

Disclaimer: This information is general in nature and is not a substitute for personalised medical or psychological advice. Please consult a registered health professional for guidance that considers your specific circumstances.

References

[1] Phoenix Australia, Centre for Posttraumatic Mental Health. (2020, updated). Australian guidelines for the prevention and treatment of acute stress disorder, posttraumatic stress disorder and complex PTSD. Melbourne, VIC: Phoenix Australia. https://www.phoenixaustralia.org/australian-guidelines-for-ptsd/

[2] Phoenix Australia, Centre for Posttraumatic Mental Health. (2022). PTSD guidelines, treatment recommendations [PDF]. Melbourne, VIC: Phoenix Australia. https://www.phoenixaustralia.org/wp-content/uploads/2022/11/PTSD-Guidelines-Chapter-6-Treatment-recommendations.pdf

[3] Australian Psychological Society. (2019). Demystifying EMDR. APS InPsych. Melbourne, VIC: APS. https://psychology.org.au/for-members/publications/inpsych/2019/june/demystifying-emdr

[4] Black Dog Institute. (n.d.). Post traumatic stress disorder, treatment options. Randwick, NSW: Black Dog Institute. https://www.blackdoginstitute.org.au/resources-support/post-traumatic-stress-disorder/treatment/

[5] Royal Australian College of General Practitioners. (2014–2024). PTSD resources for general practitioners, trauma focused psychological therapies and primary care management. East Melbourne, VIC: RACGP. https://www.racgp.org.au/afp/2014/november/ptsd-an-update-for-general-practitioners

[6] Royal Australian College of General Practitioners. (n.d.). Trauma focused psychological therapy involving dual attention for PTSD [HANDI]. East Melbourne, VIC: RACGP. https://www.racgp.org.au/clinical-resources/clinical-guidelines/handi/conditions/mental-health/trauma-focused-psychological-therapy