EMDR therapy has been around since 1989 and is recognized by the World Health Organization, the American Psychological Association, and the Department of Veterans Affairs as an effective treatment for trauma. But if you’re considering EMDR, you probably want the full picture. What can actually go wrong?

Here’s the honest answer. EMDR is generally considered low risk. A recent review of 51 randomized controlled trials found that adverse effects were rarely even mentioned in the research, and when they were, they tended to be mild and temporary. But “low risk” isn’t “no risk.” Understanding what might happen helps you prepare and make informed decisions about your treatment.

Research suggests that about 10 to 20 percent of people experience a temporary increase in symptoms during EMDR treatment. This makes sense when you think about it. You’re asking your brain to access and work through material it has been avoiding, sometimes for years. That process stirs things up.

You might notice more anxiety between sessions, feel emotionally raw, or find that memories you haven’t thought about in ages suddenly pop into your head. Some people describe feeling like they’ve opened a box they can’t close, at least temporarily.

This usually settles down as processing continues. But if you go in expecting to feel better immediately after every session, you might panic when the opposite happens. Knowing this is normal helps you ride it out instead of thinking something has gone terribly wrong.

The most commonly reported negative experience in EMDR is emotional flooding. This is when feelings become so intense during processing that you feel overwhelmed rather than helped. Instead of the memory losing its charge, it feels bigger and more present than before.

Flooding is more likely when therapy moves too fast, when you don’t have solid coping skills in place, or when your therapist isn’t experienced enough to read the signs that you’re getting overwhelmed. A skilled therapist watches for subtle shifts in your body language, breathing, and responses that indicate you’re approaching your limit.

The eight phase structure of EMDR exists partly to prevent flooding. The preparation phases teach you stabilization techniques and assess whether you’re ready for processing. When therapists skip or rush through these phases, the risk goes up significantly.

Working with traumatic material can trigger physical responses. Your body stored reactions to the original event, and those sensations can resurface during EMDR. Headaches, fatigue, nausea, lightheadedness, and rapid heartbeat are all possible.

Headaches get mentioned frequently, likely because of the eye movements themselves. If you’re prone to migraines or get headaches easily, your therapist can use alternative forms of bilateral stimulation like tapping or audio tones instead of eye movements. The research suggests these work just as well.

Fatigue after sessions is extremely common. Many people describe feeling mentally and emotionally drained, like they’ve done something genuinely hard. Because they have. Planning lighter activities after EMDR sessions is usually a good idea.

Many people report vivid dreams, increased dreaming, or dreams directly related to traumatic material during EMDR treatment. Some have nightmares, while others dream about trauma content in ways that feel neutral or even resolved.

This appears to be part of how your brain continues processing between sessions. The same mechanisms that make EMDR work during the day seem to keep going while you sleep. While this can be unsettling, especially if you were hoping for better sleep during treatment, it usually indicates that processing is happening.

Sleep disruption beyond dreams is also possible. Some people feel too activated to sleep well after sessions. Others sleep more than usual as their brain works through difficult material.

As you process one memory, related memories can come up unexpectedly. You might remember details you had forgotten about the event you were working on, or entirely different memories from other periods of your life might emerge.

For some people, this helps fragmented experiences start making more sense. But it can also be distressing, especially if what surfaces feels overwhelming or raises questions about events you hadn’t considered traumatic before.

The research on recovered memories suggests that while forgotten memories can return, memory is also reconstructible and not always accurate. A good therapist handles this carefully, neither dismissing what comes up nor suggesting interpretations of events. They let you make sense of your own experience without leading you toward any particular conclusion.

Dissociation means feeling disconnected from yourself or your surroundings. You might feel like you’re watching yourself from outside your body, or the world might seem unreal. For people with complex trauma histories, EMDR can sometimes trigger dissociative episodes.

This happens because the therapy involves accessing traumatic memories, and when the brain encounters something overwhelming, dissociation is one of its protective responses. If you have a history of dissociative symptoms, this doesn’t mean you can’t do EMDR, but it does mean you need a therapist with specialized training who can pace the work appropriately.

Severe dissociative disorders like Dissociative Identity Disorder require extensive preparation work before EMDR processing begins. The International Society for the Study of Trauma and Dissociation recommends that therapists working with these populations be experienced specifically in dissociative disorders, not just EMDR. Using eye movements too early with these clients can reactivate too much traumatic memory too quickly, potentially causing destabilization.

Certain situations make EMDR inappropriate or at least require significant caution. Active psychosis, active substance abuse, uncontrolled bipolar disorder, severe heart conditions, and uncontrolled seizure disorders all complicate treatment.

EMDR requires the ability to distinguish between past traumatic memories and present reality. During a psychotic episode, this distinction is already compromised. Similarly, being under the influence of substances interferes with the ability to stay present and engaged with the process.

Ongoing crisis situations also make EMDR premature. If you’re currently in an unsafe environment where trauma is still happening, processing past memories while new ones are accumulating doesn’t make sense. Stabilization and safety come first.

If you live in PA and are wondering whether these concerns apply to you, reach out to one of our Philadelphia EMDR therapists for a free consultation.

Many of the actual dangers of EMDR come down to who is doing the therapy. EMDR requires specialized training beyond what therapists learn in graduate school. A therapist without proper training might move too fast, miss signs that you’re becoming overwhelmed, or skip the preparation phases that make treatment safer.

The risk of adverse effects increases significantly with inadequately trained therapists. They may not know how to handle dissociative responses, may not recognize when processing has become flooding, or may not have the skills to help you regulate when things get intense.

Understanding what training an EMDR therapist should have helps you ask the right questions when choosing a provider. EMDRIA certification or completion of an EMDRIA approved training program indicates a baseline level of competence.

Every therapy carries some risk. Talk therapy can bring up painful emotions. Medication has side effects. Even doing nothing has consequences when trauma symptoms are affecting your daily life.

EMDR has been extensively studied and is recognized as safe by major health organizations worldwide. The potential benefits for trauma recovery are well documented. For many people, those benefits significantly outweigh temporary discomfort during the process.

The question isn’t whether EMDR has any risks. It’s whether those risks are manageable for your specific situation and whether the potential benefits make them worth taking. That’s a conversation to have with a qualified therapist who can assess your individual needs and readiness.

We offer in-person EMDR therapy at our Philadelphia and Haddonfield offices, with online sessions available for clients anywhere in Pennsylvania and New Jersey.

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