With learning to drive a car, the real learning for me happened after I had passed my test. I found myself travelling longer distances, navigating unfamiliar roads alone with a road atlas (no satnavs in the early 90s). My therapy journey has felt similar. Training offered a structured, manualised way of understanding therapy, but in practice, people do not fit neatly into formulations.
Formulations are helpful in building understanding and identifying patterns. However, they do not always translate into therapeutic change. Where I found I needed to develop most was in supporting clients who experienced sessions as helpful, felt better for a few days, and then returned to elevated distress between sessions.
EMDR And Between-Session Regulation
EMDR training helped me think differently about this. The stabilisation work within Phase 2 (Preparation) highlighted that clients can learn practical ways of supporting themselves between sessions, often building on what has already been introduced in therapy.
EMDR follows a structured eight-phase approach (History, Preparation, Assessment, Desensitisation, Installation, Body Scan, Closure, and Re-evaluation). In practice, these phases are not linear. Clinicians move between them depending on client need, with stabilisation and preparation revisited throughout therapy.
Between-session regulation is not the same as processing, and self-directed EMDR is not recommended within the literature. Many clients have never been explicitly taught how to regulate their emotions and can feel at the mercy of them. Between sessions, this may present as increased anxiety, emotional sensitivity, unexpected memories, or disrupted sleep. This can affect how clients experience their day-to-day lives, their relationships, and their overall sense of stability.
Some clients find it helpful to have a simple way to support settling between sessions. If it would be useful, you can access a short auditory stabilisation audio here.
The Role Of Slow Bilateral Stimulation
Slow bilateral stimulation (BLS) became something I used regularly within this phase of work. When introduced carefully within sessions, many clients reported noticing a shift. In practice, slow bilateral stimulation is often used as part of stabilisation work, supporting clients to gently access and strengthen calmer, more adaptive states without moving into processing.
Slower forms of BLS are typically used within EMDR to support stabilisation and the strengthening of adaptive networks, rather than activating traumatic material. Within EMDR protocols, slow BLS is consistently used during resourcing and preparation work (e.g. Parnell, 2013; Shapiro, 2018; Hase, 2021), often alongside imagery such as a peaceful place.
Although research specifically examining slow BLS for between-session use remains limited, its role within preparation provides a clinically meaningful foundation for cautious extension beyond the therapy session.
One proposed mechanism for bilateral stimulation more broadly is its effect on working memory. Research suggests that engaging attention in a dual task may reduce the vividness and emotional intensity of distressing mental imagery. While this has primarily been explored in the context of trauma processing, it offers a possible explanation for why some clients experience a gentle settling effect when using slower forms of bilateral stimulation within resourcing.
For a broader explanation of how bilateral stimulation works within EMDR, including the main theoretical models, you can read more here.
You can also read more about the evidence for slow bilateral auditory stimulation and its role in regulation here.
In clinical practice, this understanding often shapes how we support clients between sessions.
Clinical Use Between Sessions
In clinical practice, this often translates into supporting clients to use simple, self-directed strategies between sessions.
I found that many clients appeared to manage better when they had something active they could do. Slow alternating tapping or self-hugging, often paired with bringing to mind a calming or positive experience or imagery, can provide a way of supporting the nervous system to settle.
An additional benefit is that this requires no equipment and can be practised independently. Clients are doing something active to support themselves, and may begin to develop more adaptive beliefs about their own capacity to cope.
Importantly, this work is not about eliminating distress entirely. I often frame this as noticing even small shifts—perhaps a reduction of one or two points on a 0–10 scale—as a meaningful step. This helps to set realistic expectations and reinforces that regulation develops gradually through practice.
Stabilisation As The Foundation
Stabilisation is required to varying degrees depending on a client’s existing capacity to regulate their emotions. We can often get a good sense of this within sessions through history taking, assessment, psychometric measures, and clinical observation.
However, between sessions can feel more challenging, particularly once memory networks have been activated using bilateral stimulation. A session may end in a contained and settled way, yet clients can still experience heightened emotions, distress, or sleep disturbance afterwards.
The re-evaluation phase provides an important opportunity to review how clients have coped between sessions, and a return to stabilisation is often both necessary and clinically appropriate.
Stabilisation is not optional. It underpins safe processing. Within Phase 2, we support clients in developing ways to manage heightened emotional states through grounding, orienting, and resourcing, helping them remain within their window of tolerance both within and between sessions.
Resourcing supports the development of affect regulation. Importantly, it offers clients something they can use independently, without equipment, allowing them to notice even small shifts in their internal state.
Clinical Considerations And Cautions
- Slow BLS is not a replacement for therapy and is not intended for trauma processing. Its use between sessions is as an adjunct, supporting settling rather than activating memory networks.
- Clients should be advised to stop if they notice increasing distress or activation. Some may not find it helpful, and for others—particularly those who struggle with dissociation or maintaining dual awareness—it may be contraindicated.
- While many clinicians observe benefits in practice, there are currently no randomised controlled trials examining slow BLS specifically for between-session use, audio-based homework, or self-directed application. It is therefore best understood as a therapist-guided, individually tailored extension of preparation-phase work.
Summary
- Between-session regulation plays a central role in safe and effective trauma therapy. Stabilisation is not optional—it underpins processing.
- While direct research into between-session use of slow bilateral stimulation remains limited, its established role within EMDR resourcing and stabilisation provides a clinically meaningful foundation for cautious, therapist-guided use.
- When clearly framed as a stabilisation tool—not a processing intervention—slow BLS may offer additional support for some clients between sessions as they begin to integrate therapeutic learning into everyday life.
Applying This In Practice
In practice, many clients struggle most with maintaining regulation between sessions—particularly following difficult or activating work.
To support this phase of therapy, I’ve developed clinician-designed bilateral audio resources for stabilisation and nervous system regulation between sessions.
• Explore the full audio library → Willow Tree Wellbeing Audio Library
• Or try a short stabilisation audio → Access a Free Stabilisation Audio Sample
About the Author
Donna Dickinson is a BABCP-accredited CBT therapist and EMDR-trained psychotherapist with over 19 years of NHS experience in trauma-focused work. Her clinical interests include nervous system regulation and stabilisation in therapy. She develops clinically informed audio resources to support stabilisation and regulation within trauma-informed practice.
References
Hase, M. (2021). The use of slow bilateral stimulation in EMDR therapy: A review of clinical practice and emerging perspectives. Frontiers in Psychology.
Parnell, L. (2013). Attachment-Focused EMDR: Healing Relational Trauma. New York: W. W. Norton & Company.
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). New York: Guilford Press.