While EMDR can be transformative for many, there are certain situations or conditions where it’s better to pause or choose another approach first. In my solo practice, I always start by making sure you’re as safe, stable, and supported as possible—so if any of the following apply right now, EMDR would likely be delayed until we address those needs first:
Active suicidal thinking or ongoing self-harm.
If you’re experiencing intense urges to harm yourself or are in crisis, the focus needs to be on safety planning and stabilization (for example, building coping strategies, connecting with crisis resources, or addressing suicidal ideation directly) before we dive into processing painful memories.
Uncontrolled dissociation or feeling “totally checked out”.
EMDR asks you to hold a memory in mind while doing bilateral stimulation. If you tend to dissociate completely—losing awareness of your body or surroundings—you need skills to stay grounded first. Otherwise, the process can feel overwhelming and unsafe.
Untreated psychosis, severe mania, or active severe mental health symptoms.
Revisiting distressing memories during an active psychotic episode or in the grips of mania can worsen confusion or distress. We’d want to help you achieve more emotional stability and work with any psychiatric treatments first.
Ongoing substance use that makes it hard to stay present.
If substances (alcohol or drugs) are being used in a way that interferes with staying focused or awake during sessions, it’s better to prioritize stabilization—such as a referral for addiction support, before engaging in trauma processing.
Seizure disorders that aren’t well controlled
Although bilateral eye movements are low-risk, they still carry a small chance of triggering a seizure if you have uncontrolled epilepsy. In those cases, we’d coordinate closely with your medical team or pause until your seizure activity is better managed.
Recent traumatic brain injury or other serious medical/neurological conditions:
If you’ve had a recent head injury (concussion) or certain neurological issues (like vestibular problems), moving your eyes rapidly back and forth might be uncomfortable or contraindicated. We’d need clearance from a physician and possibly adapt or delay EMDR.
Severe cognitive impairment or developmental challenges that make it hard to follow instructions:
EMDR relies on your ability to notice sensations, thoughts, and emotions in the moment. If cognitive processing is significantly impaired, we’d explore other modalities (for example, stabilization therapies or somatic approaches) first.
Lack of regular session availability or commitment:
EMDR works best when sessions occur consistently. If you can’t commit to a weekly (or sometimes more frequent) schedule, it becomes difficult to maintain the continuity needed to process memories safely. In that case, we might start with supportive therapy to build skills until you can fully engage.
“Not right now” doesn’t mean “never.”
In my practice, I focus on meeting you where you are. If any of the above apply, it simply means we’ll start by strengthening your coping resources—grounding techniques, safety planning, emotion regulation skills, or medical stabilization—before moving into EMDR. Once you have that foundation, we can revisit EMDR as a powerful tool for processing and healing.
