Understanding the SUDs in EMDR Therapy

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Often consultees are really confused about changes in the SUDs or lack of changes in the SUDs. Obviously, one metric of whether or not the memory is moving in an adaptive direction is if the client’s report of distress is decreasing. Client’s report of distress is captured in the Subjective Units of Disturbance. But, the SUDs isn’t one thing. It’s a playing field with a shifting end zone.

For instance, what is the SUDs when we first capture it in Phase Three? Yes, some activation has happened in Phase Three, but the client hasn’t really cracked the memory open and embodied that distress. The distress usually goes up in Phase Four before it starts to go down. Do you know what that means? It means that the client’s assessment of the distress in Phase Three wasn’t an accurate assessment of the amount of distress actually in the whole memory. That’s okay, we just need to see it for what it is. It’s an estimate of current activation, not the product of a digital scale.

What is the SUDs inside Phase Four? Depending on your script, the SUDs is an assessment of your right-now level of disturbance in this moment, not necessarily the amount of disturbance that remains in the memory. Remember that where you are in a particular memory channel when you take the SUDs will highly shape the number you get. For instance, if you take the SUDs here, you will likely get a higher number than if you take the SUDs here (which is why most scripts are very specific about when you take it).

Also, sometimes clients report that the SUDs went up between sessions and many times they report that it went down. What does that mean? I don’t know that it means very much. We aren’t done until there is no disturbance in the memory. If I give someone an eight-pound weight, some people will estimate that it weighs fifteen pounds. Others may say that it’s five. What matters is that you are still carrying it and that it still has weight. But what really matters is whether or not reprocessing seems to be happening and this isn’t always immediately correlated with a decrease in SUDs. You can ask the client on check-in, “was that session productive, did it feel productive, do you get a sense that anything shifted in it?”
I’m not saying that the SUDs doesn’t have a lot of utility. I’m saying that it’s not the fixed metric that many new EMDR therapists think it is and it’s not the only immediate metric of whether or not reprocessing is happening. We do want distress in the memory to be metabolized in Phase Four. We also need adaptive information to show up. We need the client eventually to be able to hold it, weigh it with their full awareness, and find it weightless and over. That’s a metric that makes sense and you know it when you see it.

Sometimes a memory will have an initial SUDs of three in Phase Three and in Phase Four it will go up to an eight and get stuck there for a while. Next session, it may go down to two. The following session, it may start at a four and then go to a zero. That sounds like great work on a memory that the client really needed to resolve. Again, the SUDs is one of the metrics that lets us know if reprocessing is happening. It’s not the only one, so don’t let that one number drive you crazy if it is going all over the place. You will know the end zone when your client arrives in it.