Who Should Not Do EMDR (Right Now): Contraindications, Readiness, and Safer Starting Points

Last reviewed: 04/21/2026

Reviewed by: Dr. Kiesa Kelly

EMDR is one of the most-studied psychotherapies for trauma, recommended as a first-line treatment for PTSD by the World Health Organization, NICE, and the American Psychological Association [1][2][3]. It is also a protocol that, in certain circumstances, should not be started — or should not be started yet. That nuance is sometimes missing from the consumer conversation about EMDR, which tends to frame it as uniformly safe and universally available. The honest clinical answer is that EMDR is safe and effective for most appropriate candidates, carries meaningful risks when delivered to the wrong candidate without adequate preparation, and that screening for those risks is part of what good EMDR clinicians do.

This article is for readers who are wondering if EMDR is right for them, are worried about potential risks, or have been told they are "not a good candidate right now" and want to understand why.

In this article, you'll learn:

• Presentations where EMDR reprocessing is contraindicated or should be deferred

• Presentations where EMDR is appropriate but requires extra preparation

• What side effects are normal vs. concerning during and after sessions

• What a good preparation phase looks like before reprocessing starts

• Safer starting points when EMDR is not the right fit right now

• How a trained clinician screens for readiness

Who is — and isn't — a good candidate for EMDR right now?

Most adults presenting with PTSD or other trauma-linked distress are reasonable candidates for EMDR, particularly when they have adequate life stability, sober access to their emotional experience, and a clinician who knows how to pace the protocol [4]. The populations where EMDR is contraindicated — or where it should be significantly deferred — are narrower than online discussion sometimes suggests, but they are real, and they matter. The categories below are grouped by how urgent the deferral is, not by how severe the underlying suffering is.

Misconception: If EMDR is recommended for PTSD, it's safe for anyone with trauma symptoms. In reality, "recommended for the condition" and "appropriate for this particular person right now" are different judgments. A careful clinician screens for environmental stability, dissociative capacity, substance-use context, and psychiatric co-occurrence before scheduling reprocessing — not because EMDR is dangerous in general, but because the conditions under which any trauma-focused protocol is safe to run are not universal.

Key takeaway: 🚦 "Contraindicated right now" is a pacing statement, not a rejection. Most readers in these categories can do EMDR eventually — with the right preparation and the right supporting work first.

When EMDR is usually not appropriate yet

Severe, unmanaged dissociative disorders

The most firmly established contraindication for standard EMDR is unmanaged severe dissociative-spectrum conditions — particularly Dissociative Identity Disorder (DID) and Other Specified Dissociative Disorder with significant identity fragmentation [5]. EMDR is not contraindicated forever for these presentations; the International Society for the Study of Trauma and Dissociation explicitly recognizes EMDR as a useful modality within a phase-based treatment framework, but it must be delivered by clinicians specifically trained in dissociation and only after significant preparatory work to stabilize switching and establish internal communication [5]. Standard community-clinic EMDR without dissociation-specific training is inappropriate for moderate-to-severe DID.

Active substance use

Active, untreated substance use disorders are a relative contraindication — active in the sense that the person is currently using in ways that materially interfere with emotion regulation between sessions. EMDR reprocessing can surface significant between-session activation, and substance use can both blunt the processing and spike dangerously in response to it [6]. Most practice standards recommend substance stabilization — either abstinence, medication-assisted treatment, or a documented reduction — before starting trauma-focused work [6]. This does not mean you need to be in recovery for a year; it does mean you should not be actively using as your primary coping mechanism while reprocessing begins.

Uncontrolled bipolar or active psychosis

Bipolar disorder in an active manic or mixed-episode phase and schizophrenia-spectrum conditions with active psychosis are contraindications for trauma-focused reprocessing until the underlying episode is stabilized psychiatrically [7]. Once mood is stable on an effective medication regimen and reality-testing is intact, EMDR is not contraindicated — but starting during an active episode risks worsening the episode rather than resolving the trauma.

Currently in an abusive or unsafe environment

This one gets under-discussed. If you are currently in an abusive relationship, living in an unsafe housing situation, or in any ongoing threat context, EMDR reprocessing is not usually appropriate — not because EMDR is unsafe, but because you cannot fully reprocess a memory of a threat that is still actively happening to you [8]. Safety planning, environment stabilization, and often case management come first; trauma-focused psychotherapy comes after you are physically and relationally safe.

Consider a client I worked with three years ago — a woman in her early forties who had fled a long-term abusive marriage six months before our first session. She wanted to "start EMDR right away." Her safety was genuinely improved, but the landlord of her new apartment was an associate of her ex-husband's; her phone number was compromised; she was being monitored in ways that were still unfolding. We spent three months on safety planning, technology changes, and building her support network before starting any reprocessing work. When we did begin, her processing was cleaner and faster than it would have been had we pushed forward while she was still being actively destabilized by the environment.

Key takeaway: 🛑 Four presentations warrant deferring EMDR reprocessing: unmanaged DID, active substance use, active bipolar or psychotic episodes, and ongoing environmental unsafety. Each is a pacing issue, not a lifetime block.

When EMDR is appropriate — but with extra preparation

Complex / developmental trauma

Complex and developmental trauma — chronic, relational, often childhood-onset — is not a contraindication for EMDR, but it does require a much longer preparation phase than single-incident trauma [9]. Clinicians typically spend anywhere from six weeks to several months building resources, attachment-repair work, and titrated exposure before beginning reprocessing in this population. Shorter preparation increases the risk of destabilization.

Some dissociative experiences with a trained EMDR therapist

Milder dissociative experiences — occasional depersonalization during stress, derealization episodes, non-pathological dissociation linked to specific trauma triggers — do not rule out EMDR. They do require a clinician trained in dissociation assessment, who uses instruments like the Dissociative Experiences Scale at intake and who is prepared to slow or pause reprocessing if dissociative responses emerge during sessions [5]. If your clinician is not asking about dissociation during intake, that is a screening gap worth raising.

Co-occurring eating disorders or self-harm

Active eating disorders or self-harm behaviors warrant additional preparation and coordination with other treatment providers before reprocessing begins [8]. The trauma work may be relevant and ultimately very useful — but pacing matters. Most EMDR clinicians will want some stabilization of these behaviors first, or concurrent treatment with an eating disorder or DBT specialist.

On high-dose benzodiazepines

High-dose, chronic benzodiazepine use can blunt emotional processing during EMDR sessions [4]. This is not an absolute contraindication, and it is not a reason to abruptly taper a benzodiazepine you have been on for some time — but it is worth discussing with both your EMDR clinician and your prescriber, so the clinical picture is coordinated.

Key takeaway: ⚠️ Four presentations that need extra preparation but don't block EMDR: complex trauma, milder dissociation, active eating disorders or self-harm, and high-dose benzodiazepine use. These are all navigable with the right clinical care.

Common side effects during and after EMDR

Even when EMDR is appropriate, some post-session responses are normal, and distinguishing them from warning signs matters. Most of these are transient and resolve within 24 to 72 hours.

Emotional flooding between sessions

Feeling more emotionally raw or activated between reprocessing sessions — especially in the first 24 hours — is common [1]. Clients sometimes describe it as "feeling closer to the surface." This is not a warning sign in itself. What is a warning sign: if the flooding is so intense that daily functioning collapses for multiple days, or if it triggers relapse in substance use, self-harm, or eating-disorder behaviors. That is information to bring to your therapist before the next session.

Dreams and intrusive memory activation

Vivid dreams, incomplete memories surfacing outside session, and increased trauma-related thoughts for a few days after reprocessing are reported by many clients and do not usually indicate a problem [1]. They often signal that the memory network being targeted is continuing to process between sessions, which is a normal part of EMDR's mechanism of action.

Short-term symptom increase before decrease

For some clients, PTSD symptoms briefly intensify in the first one to three weeks of reprocessing before beginning to decrease [10]. This is paradoxical but real — the memory is being moved, not erased, and the movement can be uncomfortable before it resolves. Clinicians typically frame this at intake so it is not mistaken for treatment failure.

Misconception: If I feel worse after an EMDR session, it means EMDR is harming me. In reality, transient post-session activation is a known part of the protocol and is different from clinically concerning destabilization. The distinction is about duration, functional impact, and safety, not about the presence or absence of any distress. A good clinician will walk you through what to expect and what to flag.

Key takeaway: 🌀 Transient activation is normal; sustained functional collapse or relapse into dangerous behaviors is not. Your therapist should actively help you distinguish the two.

What a good preparation phase looks like before reprocessing starts

Phase 2 of the EMDR protocol — the preparation phase — is where most of the safety work happens [4][9]. A preparation phase that is appropriately paced for your presentation includes:

• Psychoeducation on how EMDR works and what to expect, including the distinction between normal and concerning post-session responses

• Establishing at least one well-practiced calm-place or resource exercise the client can use between sessions

• Basic grounding and containment skills (butterfly hug, body-scan, visualization for containing memory content between sessions)

• For more complex presentations: affect tolerance work, attachment repair, or DBT-style skills building

• A safety plan that addresses what to do if between-session activation becomes dangerous, and who to call

Preparation phases that are too short — starting reprocessing in session two without adequate resources built — are one of the most common causes of destabilization that gets attributed to "EMDR." Preparation phases that are too long can also delay treatment, but that is a less common and less dangerous error.

Safer starting points if EMDR isn't right for you right now

If you are in one of the "not right now" categories above, there are evidence-based paths that lead toward eventual EMDR readiness — or toward a different trauma treatment entirely.

Stabilization and skills-based work first

Judith Herman's three-phase trauma recovery model — safety and stabilization first, remembrance and mourning second, reconnection third — remains a useful scaffold for trauma treatment [11]. For clients who are not yet ready for reprocessing, spending meaningful time in Phase 1 is not a delay; it is the work.

DBT, CBT, and IFS as preparatory modalities

Dialectical Behavior Therapy builds emotion regulation, distress tolerance, and interpersonal-effectiveness skills that directly support later trauma-focused work. Cognitive Behavioral Therapy — particularly trauma-focused CBT or cognitive processing therapy — is an alternative first-line trauma treatment that some clients prefer or tolerate better than EMDR [2][3]. Internal Family Systems can provide a framework for relating to dissociative parts in a way that builds stability before EMDR reprocessing begins. The specialized therapy page covers ScienceWorks' options across these modalities.

Medication management conversations with a prescriber

For clients whose current instability is driven by mood, psychosis, or severe anxiety, a medication conversation is often the fastest path to readiness. Psychiatry and psychotherapy are complementary, not competitive, in this population. Our mental health screening page can help you quantify where your symptoms sit before that conversation.

Consider another client — a 34-year-old man with complex trauma history and significant depersonalization who had tried EMDR twice with different providers and ended both courses of treatment feeling worse. When he came to our practice, we did not restart EMDR. We spent four months on stabilization: a clear diagnosis, an SSRI adjustment with his prescriber, a DBT skills group, and gradual work on his dissociative responses using a combination of IFS and somatic approaches. When we eventually began EMDR six months later, his response pattern was entirely different — cleaner reprocessing, no destabilization — because the preparatory work had built the capacity the protocol requires.

Misconception: If I can't do EMDR right now, I can't recover from trauma. In reality, EMDR is one effective trauma treatment among several. Trauma-focused CBT, cognitive processing therapy, prolonged exposure, somatic approaches, and phase-based treatments for complex trauma all have evidence bases [2][3][11]. EMDR itself also has a growing evidence base for non-PTSD trauma-linked conditions [13], but you do not need to wait for EMDR readiness to make meaningful progress on healing. Readiness for any one modality is not a universal measure of trauma treatability.

Key takeaway: 🛠 If EMDR isn't the right starting point, stabilization, skills-based therapy, and medication optimization are usually the fastest paths back to eligibility — not a life sentence of untreated trauma.

How a trained clinician screens for readiness

A thorough EMDR intake should cover:

• Trauma history, broadly — not to narrate every detail, but to map what kinds of memories are in play

• Dissociative experiences — using a standardized screener when there is any signal

• Current life stability — housing, relationships, environment, current threat exposure

• Substance use patterns — quantity, frequency, and whether substances are being used to manage trauma symptoms

• Psychiatric co-occurrence — bipolar, psychosis, active eating disorder, active self-harm

• Medication picture — what you are on, who prescribes, whether any doses have changed recently

• Prior therapy history — what has and hasn't worked, including any prior EMDR attempts

• Support system — who you can call if a session activates you between appointments

If your clinician is not asking about most of this at intake, that is worth raising — not as an accusation, but as a signal. A brief intake that jumps straight to scheduling reprocessing without screening is a meaningful quality concern, and does not align with EMDRIA practice standards for pre-treatment assessment [12].

Frequently asked questions

Can I still benefit from EMDR if I have DID?

Yes — but only with a clinician specifically trained in dissociation, and within a phase-based treatment framework that does significant stabilization work first [5]. Standard community EMDR without dissociation training is inappropriate for moderate-to-severe DID.

How long should preparation last before reprocessing begins?

For straightforward single-incident trauma with otherwise stable functioning: one to three preparation sessions is common. For complex or developmental trauma: six weeks to several months, often much longer, depending on what the preparation needs to accomplish [9]. "Long" is not inherently better; "appropriately paced for your presentation" is the goal.

Is abreaction during EMDR dangerous?

Abreaction — intense emotional or physical release of trauma-linked affect during reprocessing — is not in itself dangerous, and a trained clinician knows how to pace and contain it. What is concerning is abreaction that overwhelms the client's capacity to come back into present-moment awareness, or that triggers dangerous between-session behavior. Your therapist's job is to prevent the first and recognize the second.

What happens if I start EMDR and it's clearly not working?

"Not working" can mean several things: plateau after initial gains, no measurable change, or active worsening. Each has different clinical responses — pacing adjustments, target selection changes, switching to a different trauma protocol, or pausing trauma work to address a preparation gap. If you are several reprocessing sessions in and nothing is shifting or you are getting worse, raise it directly with your therapist. It is not a reason to conclude all trauma treatment is futile.

Booking an EMDR readiness consultation

If you are not sure whether EMDR is the right starting point for you, our EMDR service page covers the full eight-phase protocol and our telehealth-forward delivery, and our trauma services page lays out how EMDR fits within our broader trauma-treatment options. Our contact page is where intake begins. Initial consultations are thirty minutes, explicitly structured around the readiness questions in this article, and the honest answer — including "not the right move right now, here is what I would do first" — is part of what you are paying for.

Key takeaway: 🎯 A good readiness consultation ends with a clear answer: EMDR now, EMDR after a preparation phase, or a different modality first. All three are legitimate outcomes — and the honest answer is more valuable than a fast yes.

About the Author

Dr. Kiesa Kelly is a licensed clinical psychologist and the founder of ScienceWorks Behavioral Healthcare. Her clinical training includes coursework and supervised practice at the University of Chicago, Vanderbilt University, and the University of Wisconsin, with more than 20 years of experience in psychological assessment and evidence-based treatment for trauma, anxiety, OCD, and neurodevelopmental conditions. Her trauma practice includes single-incident PTSD, complex developmental trauma, and trauma co-occurring with dissociation, substance use, eating disorders, and psychiatric conditions requiring careful pacing.

Dr. Kelly oversees clinical quality across ScienceWorks, including the practice's trauma and EMDR programs, and maintains ongoing consultation and continuing education in EMDR, trauma-focused CBT, and the phase-based treatment of complex trauma. Every article on the ScienceWorks blog is reviewed by a licensed clinician for clinical accuracy before publication.

References

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3. American Psychological Association. Clinical practice guideline for the treatment of posttraumatic stress disorder in adults. 2017. https://www.apa.org/ptsd-guideline

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5. International Society for the Study of Trauma and Dissociation. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma and Dissociation. 2011. https://doi.org/10.1080/15299732.2011.537247

6. Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services (TIP 57). 2014. https://store.samhsa.gov/product/tip-57-trauma-informed-care-behavioral-health-services/sma14-4816

7. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Bipolar Disorder. https://psychiatryonline.org/guidelines

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10. Wright SL, et al. The effectiveness of EMDR for adult posttraumatic stress disorder: an updated meta-analysis of randomized controlled trials. European Journal of Psychotraumatology. 2024. https://doi.org/10.1080/20008066.2024.2313741

11. Herman JL. Trauma and Recovery: The Aftermath of Violence — From Domestic Abuse to Political Terror. Basic Books. 1992 (with subsequent editions and research literature). https://pubmed.ncbi.nlm.nih.gov/10171125/

12. EMDR International Association. Practice and Protocol Standards. https://www.emdria.org/about-emdr-therapy/

13. Scelles C, Bulnes LC. EMDR as treatment option for conditions other than PTSD: a systematic review. Frontiers in Psychology. 2023. https://doi.org/10.3389/fpsyg.2021.644369

Disclaimer

This article is for informational purposes only and is not a substitute for individualized medical, psychological, or psychiatric advice, diagnosis, or treatment. Reading this article does not create a clinician-client relationship. If you are experiencing a mental health emergency, call or text 988 (the Suicide and Crisis Lifeline in the United States) or go to your nearest emergency department. This article discusses trauma, dissociation, substance use, self-harm, and eating disorders; if you or someone you know is in crisis, reach out to 988 or a qualified clinician.