Starting EMDR therapy as a neurodivergent person requires thoughtful preparation to ensure you receive accommodations and modifications that support your success. Understanding what standard EMDR involves, how it can be adapted for your neurotype, and how to advocate for your needs will help you get the most effective treatment possible.
Understanding Standard EMDR Protocol
Phase 1: History Taking and Treatment Planning
- Comprehensive background assessment
- Trauma history collection
- Treatment goal setting
- Safety assessment and planning
Phase 2: Preparation and Resource Development
- Teaching coping and grounding techniques
- Building internal resources and strengths
- Preparing for trauma processing
- Establishing therapeutic relationship
Phase 3: Assessment
- Identifying specific traumatic memories to target
- Rating distress levels (SUDS scale)
- Identifying negative and positive beliefs
- Assessing body sensations
Phase 4: Desensitization
- Processing traumatic memories using bilateral stimulation
- Monitoring distress levels throughout
- Continuing until distress significantly decreases
- Allowing natural associations and insights
Phase 5: Installation
- Strengthening positive beliefs about the traumatic experience
- Using bilateral stimulation to reinforce positive cognitions
- Increasing confidence in positive beliefs (VOC scale)
- Integrating new perspectives
Phase 6: Body Scan
- Checking for remaining physical tension or distress
- Ensuring trauma is fully processed somatically
- Addressing any remaining body sensations
- Confirming complete processing
Phase 7: Closure
- Returning to calm, stable state
- Using grounding techniques
- Planning between-session coping
- Scheduling next appointment
Phase 8: Re-evaluation
- Checking progress from previous session
- Assessing any new material that emerged
- Planning continued treatment
- Adjusting approach as needed
Standard Bilateral Stimulation Methods
Visual Stimulation
- Following therapist’s finger movements with eyes
- Watching light bars or visual stimuli
- Alternating visual focus between left and right
Auditory Stimulation
- Alternating sounds in left and right headphones
- Bilateral musical or tonal stimulation
- Rhythmic auditory patterns
Tactile Stimulation
- Handheld buzzers alternating between hands
- Tapping on hands, knees, or shoulders
- Textured objects for bilateral touching
How Neurodivergence May Affect Standard EMDR
Autistic Considerations
Potential Challenges
- Eye contact and visual tracking: May be uncomfortable or overwhelming
- Social demands: Standard therapeutic interaction may be taxing
- Sensory sensitivities: Bilateral stimulation might be over-stimulating
- Communication differences: Literal interpretation and processing time needs
- Executive function: Multi-step protocols may be overwhelming
- Change resistance: Difficulty with unpredictable therapy flow
Common Adaptations Needed
- Alternative bilateral stimulation methods
- Reduced social demands and eye contact
- Sensory environment modifications
- Extended processing time
- Concrete, literal communication
- Predictable session structure
Potential Challenges
- Attention regulation: Difficulty maintaining focus throughout sessions
- Hyperactivity: Need for movement during processing
- Executive function: Challenges with complex, multi-step protocols
- Emotional dysregulation: Intense emotions may be overwhelming
- Working memory: Difficulty holding multiple elements simultaneously
- Time awareness: May lose track of time or feel sessions are too long/short
Common Adaptations Needed
- Shorter, more frequent sessions
- Movement integration during processing
- Simplified, clear instructions
- Built-in breaks and attention resets
- Visual or auditory cues for session structure
- Flexible pacing based on attention state
Learning Differences Considerations
Potential Challenges
- Processing speed: May need more time for instructions and responses
- Language processing: Difficulty with complex verbal instructions
- Memory differences: Challenges with recall or working memory
- Reading/writing: Difficulty with written materials or homework
- Academic trauma: School-related memories may be particularly triggering
- Self-esteem: Shame about learning differences may interfere
Common Adaptations Needed
- Multi-sensory instruction and processing
- Extended time for responses and processing
- Alternative communication methods
- Modified written materials
- Accommodation of specific learning profile
- Address academic trauma and shame
Pre-EMDR Preparation Steps
Self-Assessment and Preparation
Identify Your Needs: Before starting therapy, consider:
- What accommodations have helped you in other settings?
- What sensory sensitivities or preferences do you have?
- How do you best communicate and process information?
- What environments feel most comfortable and safe?
- What coping strategies already work well for you?
- What past therapy experiences were helpful or harmful?
Gather Information
- Medical records and previous diagnoses
- List of current medications and their effects
- Previous therapy experiences and what worked/didn’t work
- Educational records including accommodations received
- Support system information (family, friends, professionals)
- List of strengths and coping strategies you already use
Prepare Questions and Concerns: Write down:
- Specific accommodations you think you’ll need
- Questions about how EMDR will be modified for you
- Concerns about standard therapy approaches
- Goals for trauma therapy
- Information about your neurotype you want therapist to know
- Fears or worries about starting EMDR
Practical Preparation
Schedule Considerations
- Choose times when you’re most alert and regulated
- Consider medication timing and effects
- Plan for energy expenditure and recovery time after sessions
- Build in buffer time before and after appointments
- Consider transportation and parking logistics
- Plan for potential sensory overwhelm after sessions
Support System Preparation
- Inform trusted people about your therapy start date
- Arrange for additional support during early therapy phases
- Plan check-ins with support people after difficult sessions
- Consider bringing support person to first appointment if allowed
- Discuss confidentiality boundaries with support system
- Create crisis support plan for between sessions
Self-Care Planning
- Identify calming activities for before and after sessions
- Plan comfort items to bring to sessions
- Prepare sensory regulation tools and strategies
- Create post-session routine for integration and recovery
- Stock up on comfort foods and self-care items
- Clear schedule for reduced demands on therapy days
Advocating for Accommodations
Essential Accommodations to Request
Sensory Environment Modifications
- Adjustable lighting (dimmer options, natural light)
- Sound control (white noise, quiet environment, music options)
- Temperature regulation and air quality control
- Comfortable seating with movement options
- Minimal visual distractions and clutter
- Access to sensory tools (fidgets, weighted items, textures)
Communication Adaptations
- Extended response time without pressure
- Written session summaries and homework instructions
- Visual supports and graphic organizers when helpful
- Clear, concrete language avoiding idioms and abstractions
- Permission to communicate via preferred methods (email, text)
- Reduced eye contact expectations
Session Structure Modifications
- Flexible session length (shorter or longer as needed)
- Built-in breaks for movement and regulation
- Predictable session routines and clear agendas
- Advance notice of any changes to routine
- Permission to bring comfort objects and support items
- Option to record sessions for later review (with consent)
Processing Adaptations
- Alternative bilateral stimulation methods
- Slower pacing with frequent check-ins
- Permission to stim or self-regulate during processing
- Multiple ways to express thoughts and feelings
- Accommodation of hyperfocus or attention wandering
- Flexibility in homework and between-session practice
How to Communicate Your Needs
Direct Communication: Be specific about what you need:
- “I need to be able to move around during sessions”
- “I process information better when I can see it written down”
- “I need advance warning before we switch topics or activities”
- “I work better with shorter, more frequent sessions”
- “I need to bring fidget tools to help me focus”
Explain the Why: Help therapists understand the neurological basis:
- “My ADHD makes it hard to sit still for long periods”
- “My autism means I process language more literally”
- “My sensory sensitivities make certain sounds overwhelming”
- “My dyslexia affects how I process written instructions”
- “My executive function challenges make complex instructions difficult”
Provide Examples: Share what has worked in other settings:
- “In school, I used a standing desk and it helped my attention”
- “My previous therapist always provided written summaries”
- “At work, I use noise-canceling headphones to reduce distractions”
- “I do better when instructions are broken into smaller steps”
- “I focus better when I can doodle or use fidget tools”
What to Expect in Your First Sessions
Initial Assessment Adaptations
Extended Evaluation Process: Your therapist should spend extra time understanding:
- Your specific neurotype and how it affects you
- Previous trauma related to being neurodivergent
- What accommodations you’ve used successfully
- Communication preferences and processing style
- Sensory needs and environmental preferences
- Strengths and coping strategies you already use
Accommodation Trial Period: Expect to spend several sessions:
- Testing different bilateral stimulation methods
- Adjusting the therapy environment
- Establishing communication patterns
- Building therapeutic relationship
- Learning modified coping strategies
- Creating personalized safety plans
Collaborative Treatment Planning: You should be involved in:
- Setting realistic and personalized goals
- Choosing which traumas to address first
- Planning session structure and pacing
- Identifying potential barriers and solutions
- Creating backup plans for difficult moments
- Establishing between-session support strategies
Common First Session Experiences
What May Go Well
- Feeling understood and accepted for who you are
- Therapist demonstrating knowledge about your neurotype
- Clear explanation of how EMDR will be adapted for you
- Comfortable therapy environment with necessary accommodations
- Feeling hopeful about the therapeutic relationship
- Validation of your experiences and needs
Potential Challenges
- Initial anxiety about new therapy experience
- Uncertainty about whether accommodations will work
- Worry about therapist understanding your needs
- Fatigue from masking or trying to appear “normal”
- Overwhelm from new environment and expectations
- Fear based on previous negative therapy experiences
Advocating During Ongoing Treatment
Monitoring Accommodation Effectiveness
Regular Check-ins: Continuously assess whether accommodations are working:
- Are you feeling comfortable and supported?
- Is your attention and focus sustainable during sessions?
- Are you able to communicate effectively with your therapist?
- Do you feel safe to be authentically yourself?
- Are you making progress toward your goals?
- Do you need any adjustments or additional accommodations?
Requesting Changes: Don’t hesitate to ask for modifications:
- “I think I need shorter sessions to maintain focus”
- “Could we try a different type of bilateral stimulation?”
- “I’d like to adjust the lighting in the room”
- “Can we spend more time on preparation before processing?”
- “I need more breaks during our sessions”
- “Could you provide written summaries of our sessions?”
Addressing Problems
When Accommodations Aren’t Working: If something isn’t effective:
- Be specific about what’s not working and why
- Suggest alternative approaches you’d like to try
- Ask for therapist input on possible solutions
- Request consultation with other professionals if needed
- Consider whether this therapist is the right fit
- Remember that finding the right approach may take time
Communication Breakdowns: If you’re not being understood:
- Ask for clarification of therapist responses or instructions
- Rephrase your concerns in different ways
- Request written communication to supplement verbal
- Ask therapist to repeat back what they heard you say
- Suggest taking a break to reset communication
- Consider bringing support person to help facilitate communication
Managing Challenges and Setbacks
Common Neurodivergent EMDR Challenges
Attention and Focus Issues
- Mind wandering during bilateral stimulation
- Hyperfocus making it hard to shift between topics
- Distractibility interfering with processing
- Fatigue affecting attention quality
- Medication effects on concentration
Sensory Overwhelm
- Bilateral stimulation becoming too intense
- Environment changes affecting comfort
- Processing bringing up sensory memories
- Accumulation of sensory input throughout session
- Post-session sensory recovery needs
Communication Difficulties
- Struggling to find words for experiences
- Therapist misunderstanding your communication style
- Difficulty expressing emotions or sensations
- Processing speed not matching therapy pace
- Literal interpretation creating confusion
Solutions and Strategies
For Attention Challenges
- Request shorter processing periods with more breaks
- Ask for attention cues and redirections as needed
- Use movement or fidgeting to support focus
- Try different bilateral stimulation methods
- Discuss medication timing with prescriber
- Build attention breaks into session structure
For Sensory Issues
- Immediately communicate when overwhelm begins
- Have clear signals for reducing stimulation intensity
- Use familiar sensory tools for regulation
- Plan extra recovery time after sessions
- Modify environment proactively rather than reactively
- Develop personalized sensory diet for therapy days
For Communication Problems
- Ask for processing time before responding
- Use alternative communication methods when needed
- Request clarification of therapist questions or comments
- Provide written information between sessions
- Use visual supports or drawings to communicate
- Ask therapist to check understanding frequently
Building Long-Term Success
Ongoing Advocacy Skills
Self-Awareness Development: Continue building awareness of:
- What accommodations work best for you
- How your needs may change over time
- Warning signs of overwhelm or shutdown
- Your communication patterns and preferences
- Strengths you can build on in therapy
- Environmental factors that support your success
Communication Skills: Develop abilities to:
- Clearly articulate your needs and preferences
- Provide feedback about therapy effectiveness
- Request changes or adjustments as needed
- Educate therapists about your neurotype when necessary
- Set boundaries around inappropriate demands or expectations
- Advocate for yourself in professional relationships
Building Support Networks
Professional Team: Consider building relationships with:
- Primary EMDR therapist with neurodiversity competence
- Psychiatrist familiar with neurodivergent medication needs
- Occupational therapist for sensory and daily living support
- Educational or vocational consultant for accommodations
- Peer support specialist or neurodivergent mentor
- Other neurodivergent clients for mutual support and understanding
Personal Support: Develop networks, including:
- Family members who understand and support your neurodivergence
- Friends who accept and celebrate your authentic self
- Neurodivergent peers who share similar experiences
- Online communities for ongoing support and resources
- Mentors who can provide guidance and perspective
- Professional advocates who can assist with system navigation
Celebrating Your Strengths
Recognizing Neurodivergent Assets
Throughout your EMDR journey, remember your strengths:
- Pattern recognition: Ability to see connections others miss
- Attention to detail: Thoroughness and precision in processing
- Systematic thinking: Logical, organized approach to healing
- Authenticity: Honest communication and genuine self-expression
- Resilience: Lifetime experience adapting to challenges
- Innovation: Creative problem-solving and unique perspectives
- Passion: Deep engagement with meaningful activities and relationships
- Empathy: Understanding of others who face similar challenges
Building on Existing Coping Strategies: Your therapist should recognize and build on:
- Self-regulation techniques you already use
- Environmental modifications that work for you
- Communication strategies that feel comfortable
- Learning methods that match your processing style
- Support systems you’ve already developed
- Interests and activities that bring you joy and grounding
Preparing for EMDR as a neurodivergent person requires thoughtful planning, clear communication, and ongoing advocacy. Remember that you deserve therapy that honors your neurotype while effectively addressing your trauma. Don’t settle for providers who won’t accommodate your needs – quality, neurodiversity-affirming EMDR is available and worth seeking. Your neurodivergent identity is not a barrier to healing; with the right accommodations and support, it can actually be a strength in your therapeutic journey.