The Dangers of EMDR Therapy: What the Research Actually Shows

If you have been researching EMDR therapy and found yourself on pages describing it as dangerous, potentially harmful, or capable of causing false memories and psychological destabilisation, you are not alone. This content is plentiful, and some of it contains genuine information worth understanding. Some of it is also misleading, drawing on misunderstandings of how EMDR works or confusing poorly conducted treatment with the treatment itself.

I have been practising EMDR for more than 20 years, across the full range of clinical presentations — from single-incident adult trauma to the most complex early relational and developmental trauma. What I can offer here is an honest account of where the genuine risks lie, what the research actually shows, and what a responsible approach to EMDR looks like.

What EMDR Is, and Why It Is Sometimes Misunderstood

EMDR — Eye Movement Desensitisation and Reprocessing — was developed by Francine Shapiro in the late 1980s and has since accumulated one of the strongest evidence bases of any psychological treatment for PTSD. It is recommended by NICE in the UK, the WHO globally, and numerous national health authorities as a first-line treatment.

The treatment involves eight structured phases, beginning with history-taking and case conceptualisation, moving through preparation, assessment, and active reprocessing using bilateral stimulation (typically eye movements, though tapping and auditory tones are also used), and concluding with evaluation and closure.

The most important thing to understand about EMDR is that the reprocessing phases — the ones that involve directly approaching traumatic material — are only a portion of the treatment, and they are only appropriate once the preparation work is complete. A responsible EMDR practitioner does not begin reprocessing in the first session, or even the second. The preparation phase, which builds coping resources, stabilisation, and a sufficient therapeutic relationship, is not optional. It is foundational.

A significant proportion of the genuine clinical risks associated with EMDR can be traced back to one source: insufficient preparation before reprocessing begins.

The Real Risks: What the Evidence Shows

A 2025 paper published in ScienceDirect (Current Opinion in Psychology) titled “Adverse effects of Eye Movement Desensitization and Reprocessing therapy: A neglected but urgent area of inquiry” represents one of the most rigorous recent examinations of EMDR’s risk profile. Its conclusions are worth understanding carefully.

The authors found that adverse effects are real but underreported in the research literature. Most clinical trials of EMDR measure efficacy — does it reduce PTSD symptoms? — and adverse effects are not systematically monitored or reported. This is a genuine methodological gap in the field. It does not mean that adverse effects are common or severe; it means we have less systematic data on them than we should.

The paper also found that the most significant adverse effects tend to cluster around specific circumstances: working with people who are not adequately prepared or stabilised before reprocessing begins; applying EMDR to populations for whom its safety has not been adequately established (those with active psychosis, severe dissociation, or complex comorbidities); and treatment delivered by therapists without proper training in the protocol.

Common side effects that occur within the normal range of EMDR treatment include: emotional and physical fatigue after sessions, particularly when significant material has been processed; vivid or disturbing dreams in the days following a session; temporary heightening of emotional sensitivity; and occasional headaches. These are generally transient and resolve as therapy progresses. They are not signs that something has gone wrong — they are often signs that processing is occurring.

The Specific Populations at Higher Risk

EMDR is contraindicated, or requires significant modification, for several specific presentations:

Active dissociative disorders. EMDR’s reprocessing mechanism involves approaching and metabolising disturbing material. For someone who already has difficulty distinguishing present from past, or who dissociates readily under stress, EMDR reprocessing without significant stabilisation work can worsen fragmentation rather than resolve it. Experienced EMDR practitioners working with dissociative presentations use phase-oriented approaches that prioritise stabilisation and parts work for extended periods before any trauma processing begins.

Active psychosis. Reprocessing traumatic material requires a stable enough reality contact to distinguish a memory from a current event. In active psychosis, this distinction is already compromised. EMDR is not appropriate in this context.

Active substance dependence. Trauma processing can temporarily intensify distress, and for someone whose primary coping mechanism is substance use, this creates significant risk. Stabilisation — including sobriety — is generally a prerequisite for trauma processing work.

Severely dysregulated emotional states. Where a person has no capacity for self-regulation between sessions, or where emotional flooding during sessions cannot be adequately contained, EMDR reprocessing should wait.

Ongoing traumatic situations. EMDR processes memories — it is not effective, and may be harmful, when the traumatic situation is still actively occurring.

The False Memory Question

One concern that appears regularly is whether EMDR can create false memories. This is a question that has been examined in the research literature and deserves a direct answer.

The theoretical concern is that reprocessing, which involves some degree of reconsolidation of memory networks, might alter the accuracy of traumatic memories. The 2025 ScienceDirect review notes that “recent evidence suggests these effects are not robust or clinically concerning” — meaning that while the theoretical possibility exists, the evidence that EMDR systematically creates false memories in clinical practice is not strong.

Memory itself is reconstructive rather than simply reproductive — every time we recall a memory, we reconsolidate it with some possibility of change. This is true of all forms of psychotherapy, and of ordinary human memory. It is not a unique risk of EMDR.

The Mechanism Debate

A separate, and often misrepresented, area of controversy concerns how EMDR works — specifically, what role the bilateral eye movements play. Some researchers argue that the effects of EMDR can be attributed to the exposure elements of the treatment (approaching traumatic material in a structured way) rather than to the specific bilateral stimulation component.

This is an interesting scientific question. It does not, however, constitute evidence that EMDR is ineffective or harmful. The treatment works, by multiple meta-analyses and a wealth of clinical experience. Whether the eye movements are a specific active ingredient or primarily a focusing and attentional mechanism is a question for the research literature to resolve.

What a Responsible Approach Looks Like

The most important safeguard in EMDR is working with a properly trained practitioner who follows the full eight-phase protocol and is willing to take the preparation phase as seriously as it deserves.

Preparation is not a formality. It is where the therapeutic relationship is established, where coping and stabilisation resources are built, and where the therapist assesses whether reprocessing is safe to begin. In my practice, for clients with complex trauma histories, preparation may take weeks or months. This is not delay — it is the work.

A good EMDR practitioner will take a comprehensive history, including any history of dissociation, substance use, psychiatric diagnoses, and previous traumatic processing experiences. They will not begin reprocessing until there is confidence that the person has sufficient stabilisation resources and the therapeutic relationship is robust enough to hold what arises.

If you are considering EMDR, the most important questions to ask any potential therapist are: how will you decide when I am ready to begin reprocessing? What is your approach when something becomes overwhelming during a session? How do you work with dissociation if it arises?

A therapist who can answer these questions clearly and specifically is one with whom EMDR is likely to be conducted safely.

Further reading:

• EMDR on the NHS vs private: what you need to know
• What is EMDR therapy?
• Disorganised attachment style and trauma
• EMDR therapy at Harley Street

Dr Philippe Jacquet is an EMDR practitioner with over 20 years of clinical experience and a Jungian analyst specialising in trauma, addiction, and eating disorders. He practises at Harley Street, London W1.

References

• ScienceDirect / Current Opinion in Psychology (2025). Adverse effects of Eye Movement Desensitization and Reprocessing therapy: A neglected but urgent area of inquiry.
• Shapiro, F. (2014). The role of EMDR therapy in medicine. The Permanente Journal, 18(1), 71.
• de Jongh, A. et al. (2019). The status of EMDR therapy in the treatment of PTSD 30 years after its introduction. Journal of EMDR Practice and Research, 13(4), 261–269.
• NICE guidelines for PTSD (current).
• WHO guidelines on mental health and PTSD (current).