By Carol Miles, MSW, LCSW
One of the most common questions I hear from newly trained EMDR clinicians is: "How do I know we are actually done?"
You follow the protocol. You see the SUDs come down. But when you get to Phase 8 (Re-evaluation), a little voice of doubt creeps in. You wonder: Did we really clear the root? Is the client just telling me what I want to hear? Is the change going to stick?
This uncertainty is normal. Transitioning from talk therapy—where progress is often nebulous—to EMDR, where we look for distinct neurological shifts, takes time to master.
To help you build confidence in your case conceptualization and treatment planning, here are the seven clinical markers I look for that tell me processing has been successful.
The first sign is often the most obvious, but we need to look closer than just "I feel better." We are looking for distance.
When a client brings up the target memory in a re-evaluation session, it shouldn't activate significant affect or autonomic arousal. The memory often feels "fuzzy," "far away," or like looking at an old photograph rather than a movie.
Watch the physiology. Even if they say they are fine, are they holding their breath? True processing results in regulated physiology—shoulders down, breathing even, and micro-expressions that match their report of "neutral."
In EMDR, we don't just want the client to think the Positive Cognition (PC); we want them to feel it.
During Phase 8, check the Validity of Cognition (VOC). It should remain high (ideally a 7 on the scale), but I always look for somatic alignment. Does the client sound congruent when they say, "I am good enough"? Is there a resonance in their voice? If the PC generalizes beyond the session—for example, they report feeling "good enough" at work during the week—you know the neural network has effectively shifted.
We must always verify effectiveness across the entire 3-Pronged Approach. Success isn't just about the past; it's about the present and future.
Past: The original memory remains neutral (SUD = 0).
Present: The client reports fewer "hot spots." Their Window of Tolerance has expanded; things that used to escalate them now feel manageable.
Future: When you run a Future Template, it feels accessible. They can visualize success without anxiety spiking.
Data matters. We look for the SUD (Subjective Units of Disturbance) to decrease toward zero and stay there across sessions.
If you open a session and the SUD has crept back up, or the VOC has dropped, don't panic. It is rarely a failure—it is information. Residual disturbance often points to a "feeder memory" or a separate target we haven't hit yet. It doesn't mean the processing didn't work; it means the web is larger than we thought.
The body keeps the score, and it also tells us when the game has changed. Look for shifts that the client might not even connect to therapy, such as a reduced startle response or a decrease in chronic tension headaches.
Sleep is a huge indicator. More consistent sleep and fewer hyperarousal awakenings suggest the nervous system is no longer stuck in "threat mode," allowing for deeper rest.
Finally, look at their life outside the therapy room. Neurobiology should translate to functionality.
Are they engaging in activities they used to avoid? Is there greater relational flexibility and better conflict repair with a partner? When a client returns to daily functioning without disproportionate emotional effort—without "white-knuckling" through the day—we know the processing has integrated.
If you aren't seeing these markers, it is rarely about your skill; it is usually about the target. If processing loops or stalls, I usually check for four things:
Blocking Beliefs: Is there an underlying schema ("If I heal, I lose my connection to them")?
Dissociation: Is there a part of the self not on board with the healing?
Feeder Memories: Do we need to re-sequence and go earlier on the timeline?
Pacing: Do we need to slow down and allocate more resources?
Trusting the EMDR protocol takes practice. If you are feeling stuck in Phase 8 or need help refining your treatment planning, this is exactly what we work on in consultation.
You don't have to carry the clinical load alone. Reach out to us now.