The short answer
EMDR can be safe and very helpful for people who dissociate. What makes the difference isn't whether you dissociate, but whether your therapist recognises it and adapts the work.
Standard EMDR moves into traumatic memories fairly quickly. With significant dissociation, that can be too much, too fast. You might go blank, switch, feel nothing at all, or feel flooded for days afterwards. None of that means EMDR is wrong for you. It means the pace and the preparation need to change.
What the research says
For people with PTSD and dissociative symptoms, the news is encouraging. In an intensive trauma-focused programme that combined EMDR with other trauma therapy, people with the dissociative subtype of PTSD improved just as much as everyone else (Zoet et al., 2018). In another study, difficulties with regulating emotions, often thought to rule out trauma processing, improved along with the PTSD, including for people with the dissociative subtype (van Toorenburg et al., 2020).
Dissociative disorders such as OSDD and DID are a different matter. Here a phase-oriented approach is recommended: stabilisation and work with the parts first, then trauma processing, then integration (Dorahy et al., 2014). EMDR can be part of the second phase, carefully adapted.
What adapted EMDR looks like
In my work it means a few things.
- Screening first
- Everyone is screened for dissociation before EMDR, for example with the Dissociative Experiences Scale. If the score is high, we look more closely.
- Getting to know the system
- If there are parts, we map them: who protects, who holds the pain, who keeps daily life going.
- Agreement of all parts
- We only work on a memory when every part has agreed. No part gets overridden.
- Smaller pieces
- We work with a slice of a memory at a time, and keep one foot firmly in the present.
- Time to settle
- Every session ends with enough time to come back fully, so you leave steady.
“Dissociation isn't an obstacle to EMDR. It tells us how to do it.”
What preparation looks like
Preparation isn't a waiting room. It's where you build what you'll need: ways to ground yourself in the present, a sense of how much your system can hold, and, if there are parts, a way for them to communicate and to agree. For some people that takes a few sessions. With DID it can take months, and that time is part of the treatment, not a delay before it.
Signs it's moving too fast
Losing time in or after sessions, feeling unreal for days, a sudden rise in nightmares or self-criticism, or a part that suddenly refuses to come to therapy. None of these mean you've failed. They mean the pace needs to change, and a good therapist will want to know.
Questions to ask a therapist
Do you screen for dissociation before EMDR? How do you work with parts? What happens if I go blank or switch during a session? Have you worked with OSDD or DID before? A therapist who works with dissociation will welcome these questions.
Intensives and dissociation
People sometimes ask whether an intensive format is too much with dissociation. It can actually help, because longer sessions leave time to settle properly before you go home. With DID or OSDD we usually begin with a few stabilisation sessions, and the work always follows the system's pace. There's more on my EMDR intensives page.
References: Zoet, H. A., Wagenmans, A., van Minnen, A. and de Jongh, A. (2018). Presence of the dissociative subtype of PTSD does not moderate the outcome of intensive trauma-focused treatment for PTSD. European Journal of Psychotraumatology, 9(1), 1468707. van Toorenburg, M. M. et al. (2020). Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD? European Journal of Psychotraumatology, 11(1), 1724417. Dorahy, M. J. et al. (2014). Dissociative identity disorder: an empirical overview. Australian and New Zealand Journal of Psychiatry, 48(5), 402–417.
