Who Should Not Do EMDR Therapy?
Alex Penrod, MS, LPC, LCDC — Founder & EMDR Therapist | Neuro Nuance Therapy and EMDR, PLLC
Understanding when EMDR therapy may need to be delayed, adapted, or approached with additional preparation.
Eye Movement Desensitization and Reprocessing (EMDR) therapy is a widely used trauma treatment that can be highly effective when applied with appropriate assessment and pacing. EMDR therapy helps individuals process distressing memories and traumatic experiences through structured phases that include bilateral stimulation and mindful awareness.
However, EMDR treatment is not appropriate for everyone at every point in time. Determining who should not do EMDR therapy is less about diagnosis and more about readiness, stability, and the ability to remain present during EMDR sessions. A trained EMDR therapist evaluates these factors carefully to ensure that treatment supports healing rather than increasing emotional distress.
This page explains when EMDR therapy may not be the right fit right now and why preparation or stabilization may be necessary first.
Readiness Matters More Than Diagnosis
A common misconception is that certain mental health conditions automatically rule someone out of EMDR therapy. In practice, suitability is rarely determined by labels alone. EMDR works through trauma processing that relies on a stable environment, support outside of therapy, emotional regulation, dual awareness, and nervous system flexibility.
When these elements are not yet in place, the effects of EMDR therapy can feel overwhelming or destabilizing rather than integrative. Understanding how EMDR works through the Adaptive Information Processing model helps clarify why readiness and pacing are central to effective trauma therapy.
Situations Where EMDR May Not Be Appropriate Right Now
Active Emotional or Life Instability
EMDR therapy requires enough stability to tolerate emotional activation between sessions. When someone is experiencing an ongoing crisis, unsafe circumstances, active substance abuse, relational turmoil, or extreme emotional intensity outside of therapy, EMDR sessions are often postponed.
In these situations, the priority is safety, stabilization, and restoring a sense of control. EMDR may become an effective treatment later, once the nervous system is better supported by treatment for other issues, a stable environment, and a reliable support system.
Active Suicidal Ideation or Ongoing Self-Harm
When a person is experiencing active suicidal thoughts or ongoing self-harm behaviors, EMDR therapy is typically postponed until safety and stabilization are established. This is not because EMDR is inherently unsafe, but because trauma processing can temporarily increase emotional intensity and distress.
During periods of elevated risk, therapy often focuses on stabilization, containment, and strengthening coping strategies to reduce immediate danger. Once suicidal ideation or self-harm urges are better managed and a person has sufficient internal and external supports in place, EMDR therapy may become appropriate as part of ongoing trauma treatment.
Ongoing risk and readiness assessment is an essential part of responsible EMDR in clinical practice, and decisions about timing are made collaboratively to prioritize safety and long-term healing.
Severe Dissociation Without Adequate Preparation
Severe dissociative disorders do not automatically exclude someone from EMDR therapy. Many individuals with dissociation related to traumatic events or childhood trauma can benefit from EMDR for complex trauma when the treatment approach is adapted appropriately.
However, when dissociation prevents a person from staying oriented or present during a therapy session, beginning trauma processing too early can increase fragmentation, making treatment ineffective at best and destabilizing at worst. Preparation that includes grounding techniques, coping skills, and parts work to strengthen internal stability is often required before reprocessing begins. Working with a therapist experienced in dissociation informed EMDR is essential in these cases.
Inability to Stay Present During Sessions
EMDR relies on the ability to maintain awareness of both the present moment and a target memory. When someone cannot consistently remain present due to difficulty tolerating intense emotions, body sensations, or fear of recalling memories, EMDR treatment may not be effective yet.
This difficulty is not a personal failure. It is an indicator that additional stabilization, coping strategies, or emotional regulation skills may be needed before engaging in bilateral stimulation and deeper trauma processing. In some cases, a skilled EMDR therapist may begin EMDR by first processing the fear of doing EMDR itself.
Physical and Mental Health Issues
In some cases, EMDR may be postponed until a medical doctor or health care provider can provide assurance that exposure to traumatic memories can be safe, tolerable, and productive. Pregnancy, heart conditions, traumatic brain injuries, eating disorders, and mood disorders such as bipolar disorder are examples of situations where coordination with medical care may be necessary to ensure EMDR is safe. An EMDR therapist will make referrals or coordinate with other providers when these issues arise during intake and screening.
Expecting EMDR to Be a Quick Fix
EMDR is a structured and evidence based treatment approach, but it is not an instant solution. Individuals who expect rapid results without preparation, or who feel pressure to resolve traumatic stress disorder symptoms immediately, may struggle with the pacing required for effective EMDR therapy.
Successful trauma treatment respects the nervous system and allows time for integration. Moving too quickly can increase physical sensations, emotional sensitivity, or emotional overwhelm rather than promote healing. In some cases, partners or family members may unintentionally push a loved one into trauma processing too quickly. Education for a client’s support system can help relieve this pressure.
What This Does Not Mean
Determining that EMDR therapy is not appropriate right now does not mean that EMDR is unsafe or ineffective. It does not mean that trauma histories must be discussed in detail in talk therapy, and it does not mean that EMDR will never be helpful.
In many cases, postponing EMDR treatment reflects sound clinical judgment and an informed decision about timing. For individuals with post traumatic stress disorder, PTSD symptoms, anxiety disorders, or panic attacks, readiness often determines whether EMDR becomes a positive and effective treatment experience. Rather than needing a different type of exposure therapy, it is often the development of a more stable foundation for trauma therapy in general that is needed.
How a Skilled EMDR Therapist Determines Readiness
Assessing readiness for EMDR therapy is an ongoing clinical process. A trained EMDR therapist considers factors such as emotional regulation, dissociation, coping capacity, and external supports when developing a treatment plan. As mental health care professionals, EMDR therapists are trained to discuss the benefits of EMDR, potential risks, and treatment options with clients.
Preparation may involve strengthening coping skills, improving emotion regulation, using other therapy techniques, and ensuring that trauma processing occurs within a manageable window of tolerance. EMDR is adjusted or paused when necessary to support long term positive outcomes rather than short term task driven agendas.
For a more comprehensive understanding of EMDR as a trauma therapy approach, reviewing how EMDR therapy is structured and applied can provide helpful context.
Unsure Whether EMDR Is Right for You?
Many people considering EMDR therapy are uncertain whether it is a good fit for their current circumstances. That uncertainty is normal and often appropriate.
A consultation with a mental health professional trained in EMDR can help clarify readiness, pacing, and whether EMDR treatment aligns with your current needs. At Neuro Nuance Therapy and EMDR, PLLC, EMDR therapy is used when it supports stability, safety, and effective trauma processing. For individuals seeking EMDR therapy in Austin, TX, consultations are available to help determine whether EMDR is the right next step.
Disclaimer: This page is meant for educational purposes only and should not be taken as medical or clinical advice for the diagnosis or treatment of any medical condition. Consult with a licensed mental health professional for personalized guidance.