Liz Frings

EMDR Without Talking About the Trauma: A Guide for Emergency Services Staff

Plenty of people in the police, ambulance and fire services put off therapy because they assume it means describing the worst job of their career, in detail and out loud, to a stranger. Some can't find the words. Some would rather not go back there. Some are worried about what hearing it will do to the person listening.

That last worry comes up often. In my experience, police officers often don't talk about their experiences at work because they know it can be too much for people, and as a result they tend to carry it alone. People who spend their working lives looking after others can find it hard to stop, even in a counselling room.

EMDR (eye movement desensitisation and reprocessing) can be done with very little description, and in some cases with none at all. This guide explains how, what the research says so far, and how to raise it when you first make contact. For the wider picture of how the therapy is adapted for people in these roles, see EMDR for emergency services staff.

How much talking standard EMDR involves

Standard EMDR already asks for much less talking than most therapies. There's no full account of the incident, and there's no homework beyond perhaps jotting down a few words about anything that comes up between sessions.

In the assessment phase you pick out:

  • the part of the memory that bothers you most, often a single image
  • the belief about yourself that goes with it, such as "I should have done more"
  • the emotion and where you feel it in your body
  • how disturbing it feels, on a scale of 0 to 10

During processing you hold that in mind during short sets of eye movements, taps or sounds, then say briefly what you noticed. A few words is often enough. "It's fading." "Now I'm thinking about the drive home." "Nothing much." The brain does most of the work between those words, and the clinician's job is to keep the process moving rather than to collect the story.

Some approaches with police officers do go through an incident moment by moment before processing, because it helps find the key moments to work on. That can be useful, but it isn't required. EMDR vs talk therapy covers the general difference in more detail.

Why talking can be harder for people in these jobs

Several things about the work make telling the story harder than it is for most people.

  • Protecting the listener. Crews and officers are used to shielding the public from what they've seen. That habit doesn't switch off in a counselling room.
  • Shame and responsibility. In my experience, people in these roles often carry a heavy sense of responsibility for how things turned out. Saying the details out loud can feel like a confession.
  • Fear of consequences. Some worry that what they say could reach their employer, or a court. Is counselling confidential? covers how that works in practice.
  • Never having the words. Control room staff often only heard an incident unfold. Others were so focused on the task that what they hold is fragments, not a story.

The Blind to Therapist protocol

For those who would rather share no details of what happened, there is the Blind to Therapist protocol, developed by UK clinicians David Blore and Manda Holmshaw and first formally published in 2009. An early form was used with coal miners in the 1990s, and Blore went on to work with train drivers. It is often shortened to B2T, and some research spells it Blind 2 Therapist.

Its authors say it has been used with many groups who find disclosure hard, including people whose work involves life-and-death decisions.

The structure of EMDR stays the same. The main differences are these:

  • A cue word instead of a description. You hold the memory in mind privately and choose a word to stand for it. The word should give nothing away. A number, a neutral object or a phrase like "only yesterday" works well.
  • No need to state the beliefs. Standard EMDR asks for a negative belief about yourself and a positive one you'd prefer. In this version you only share those if you want to.
  • Reporting change, not content. After each set, you say whether anything has changed, and nothing more. The clinician explains beforehand what change can look like. Sometimes it's obvious, like an image shifting or a feeling easing. Sometimes it's subtle, like a picture going slightly out of focus.

The authors say from their clinical experience that treatment doesn't suffer when the clinician doesn't know the content. They also say it can build trust, because the client sees the clinician trusting them. That is a clinical view rather than a trial result.

What the research says

Research on working without disclosure is still limited, and it's worth being clear about what exists.

  • Northern Iraq, 2020. A quasi-experimental study by Farrell and colleagues compared B2T with standard EMDR in a trauma training project and found support for it across several trauma groups, including Yezidi survivors of ISIS. It was not a randomised trial.
  • Online, single session, 2022. A pilot with 24 frontline mental health workers used B2T by video in one session. The authors found tentative support, noted there was no control group and no clinical population, and called for larger trials.

I'm not aware of any published trial that has tested it specifically with UK emergency services staff. The wider evidence for standard EMDR is much stronger, and does EMDR work for emergency services staff? sets that out.

The Flash technique

Another way of working that doesn't ask you to go over the memory is the Flash technique, developed by Dr Philip Manfield and colleagues in the US and first published in 2017. You bring the memory to mind only briefly at the start. Then, rather than focusing on it, you focus on something positive and absorbing, such as a favourite place, a person or an activity you enjoy. Every few seconds the therapist asks you to blink quickly a few times, with slow taps or eye movements in between. Now and then you check in with the memory, without dwelling on it. The aim is for it to feel less intense each time you check, without you ever having had to sit with it.

I've used the Flash technique with clients. It sits well alongside the container exercise described in side effects and shift work, because both let you keep a hard memory at arm's length while the work gets done.

The research is early but growing. A small randomised trial in Turkey in 2022 found that people affected by road traffic accidents improved more on anxiety and traumatic stress symptoms after three online group sessions of Flash than after a standard stress management module, although many participants dropped out and follow-up lasted only a month. Four studies with therapists attending training workshops, published in 2024, found that distress about a chosen memory fell by more than two thirds and stayed down at follow-up, but there was no control group and the participants weren't people seeking treatment. A trial with people diagnosed with PTSD has been set up in the Netherlands to compare it with standard EMDR. As far as I know, no study has looked at emergency services staff specifically.

What if I'm worried about the person listening?

Speaking as a trauma therapist, hearing difficult material is part of the work, and clinical supervision is there to support it. It's normal for a therapist to react to what they hear. The job is to stay present and attentive while you talk.

Even so, you don't have to test that. Saying "I don't want to tell you the details" is a perfectly good opening. The B2T authors also use the protocol when a clinician has been through something similar to the client, to protect them from being affected themselves.

What if I can't remember it clearly, or feel nothing?

EMDR doesn't need a clear or complete memory. You can work from a fragment, such as a sound, a smell, one image or a physical sensation. For control room staff, the target is often something heard, like a voice or the moment a line went quiet. In my experience that's fine. Where no picture comes, your therapist can simply ask you to think of the disturbing moment.

Feeling numb is common too. Years of switching off on shift, and the sense that an event wasn't real or was happening to someone else, can leave memories that feel flat. The preparation phase is there partly for this. It builds ways of staying steady before any processing starts, and the process begins from whatever is there. Feeling nothing at first doesn't mean the therapy can't help.

Do I have to relive it?

You bring the memory to mind for short periods while part of your attention stays on the eye movements or taps in the room. Some describe it as watching the memory rather than being back inside it. It can still be upsetting at times. You stay in control throughout and can stop whenever you choose. Side effects and the EMDR hangover covers what sessions can feel like and how they are closed so you can carry on with your day or your shift.

To see how a session runs from start to finish, read a session example.

If you'd rather not process incidents at all

Some people aren't ready to process specific memories yet, with or without words. That's a reasonable choice. Person centred counselling follows your lead, so you can talk about the job, the culture or home life in your own time, and person centred therapy for trauma describes how that works. Some begin there and move on to EMDR later, and for others it is enough to help on its own.

Frequently asked questions

Do I have to say what happened?

No. Standard EMDR needs only a little description, and the Blind to Therapist protocol needs none.

Does it work as well if I don't talk?

The research comparing the two is limited and has not been done with UK emergency services staff. The early studies are encouraging, and the protocol's authors report no loss of effect in their clinical experience.

Can it be done online?

Yes. The 2022 pilot above used it by video. Can EMDR therapy online be effective? looks at online sessions more broadly.

What do I say in the first session?

Only what you're comfortable with. Saying "there's a job I don't want to describe" is enough to plan from.

Raising it when you get in touch

If you would rather not go into the details, say so when you first make contact, and ask how the person you'd be working with would handle that. You can ask directly whether they use the Blind to Therapist protocol. I offer it myself, and it's worth asking any therapist you contact whether they do.

I offer EMDR therapy and person centred counselling in Nottingham and online. You can get in touch to ask about it before committing to anything.

If you are in crisis now, ring 999, ring NHS 111 and choose the mental health option, or ring Samaritans free on 116 123.

Sources

More about EMDR therapy