Brainspotting vs EMDR: How They Differ

Two questions come up again and again when someone contacts me about trauma work: what is Brainspotting, and how is it different from EMDR? Often a third one sits underneath, asked politely: I’ve read that EMDR is the one with the research, so why would I do anything else?

I am trained in Brainspotting. I am not an EMDR therapist and I do not offer EMDR. What follows describes both well enough that you can tell which is likelier to suit you, and if that turns out to be EMDR, better that you know it now and go find the right person.

Where the two came from

EMDR (Eye Movement Desensitization and Reprocessing) was developed by Francine Shapiro in the late 1980s. Over the three decades since, it has become one of the most heavily studied treatments for post-traumatic stress in the world, and it appears in major treatment guidelines for PTSD, including those of the World Health Organization and the International Society for Traumatic Stress Studies.

Brainspotting grew out of that lineage rather than in opposition to it. David Grand was an experienced EMDR clinician when, in 2003, he noticed that as he moved his hand, a client’s eyes stopped and held at one particular point in her visual field. As he tells it, instead of continuing the sweep he kept his hand still there, and what opened up went past what the moving protocol had been reaching. Brainspotting was built from what followed. They’re cousins, not rivals.

What they have in common

More than the comparisons usually suggest. Both are body-aware: both work from the understanding that traumatic experience is held in the body and in the deeper, less verbal parts of the brain, not only in the story a person can tell about it. Both use a form of dual attention, where part of you makes contact with difficult material while another part stays anchored in the present, in the room, with the therapist. Both put real weight on resourcing, on building enough steadiness before going anywhere hard. And in both, the telling is optional in a way it isn’t in most talk therapy: you can work on something you’ve never described start to finish, which for a great many people is the whole reason they are willing to try either one.

What an EMDR session tends to look like

EMDR is a manualized, eight-phase protocol, and that structure is central to what it is. The phases move from history-taking and treatment planning, through preparation and resourcing, to selecting a specific target (an image, the belief attached to it, the emotion, where it sits in the body). From there the clinician guides sets of bilateral stimulation, classically eye movements following the therapist’s hand, sometimes alternating taps or tones, with brief check-ins between sets: what came up, what’s here now. Later phases install a more adaptive belief, scan the body for anything left activated, close the session down, and re-evaluate at the next one.

EMDR is taught in a standardized way, and that consistency is what its evidence base rests on: many clinicians delivering something recognizably similar.

What a Brainspotting session tends to look like

Brainspotting has far less of a set procedure. We find a relevant eye position, sometimes with a pointer, sometimes by tracking where your gaze locks when the activation rises, and then we hold it. That’s the main structural difference in one sentence: the eye position is held rather than moved.

From there my job is largely to stay out of the way. I hold the spot and I hold the relationship, we may use quiet bilateral sound, and you follow whatever comes: sensation, image, memory, a thought that arrives sideways. There are long stretches of silence, and I’m slow to interrupt, because the interruption is often what stops the process. You’re leading, even when it doesn’t feel like leading.

The evidence

This is where I want to be careful, because it’s the part people get sold.

EMDR has decades of randomized controlled trials and meta-analyses behind it, which is why it sits in international guidelines for PTSD. Brainspotting doesn’t have anything close to that. What exists is an emerging literature: an account of the mechanism from Corrigan and Grand, published as a hypothesis paper rather than a test of one, and a comparative study by Hildebrand, Grand and Stemmler that found Brainspotting performing comparably to EMDR in a naturalistic sample. It’s worth knowing, when you weigh those, that the Grand in both is the same David Grand who developed the approach. That’s an encouraging starting point. It isn’t a body of evidence.

An absence of large trials isn’t proof that something doesn’t work, and I wouldn’t use an approach I didn’t believe in. But it is not the same as having been tested. If what matters most to you is the trauma therapy with the deepest research base, that is EMDR.

What you would actually notice in the room

• How structured it is. EMDR has phases and a recognizable shape, and you’ll usually know where you are in the sequence. Brainspotting is looser and more improvised, and the shape of a session is discovered rather than planned.
• How much you say out loud. Neither one asks for the whole story, but EMDR does want a specific target picked out before the sets begin: an image, the belief attached to it, where it lands in the body. Brainspotting can begin with little more than “this thing, and it sits here in my chest.”
• Who sets the pace. In EMDR the clinician runs the sets and checks in at intervals. In Brainspotting the pace is mostly yours, which some people find freeing and others find disorienting at first.
• How it ends. Both take deliberate care with closing a session and with what happens in the days afterward, because processing doesn’t necessarily stop when the hour does.

Who tends to prefer which

These are tendencies rather than rules, and I hold them loosely. People who want a clear map, who feel safer knowing what the next step is, often do well with EMDR’s structure. People who find structure intrusive, who go blank when asked to narrate, or who have done a lot of insightful talking that hasn’t moved anything in the body, often take to Brainspotting.

But something cuts across the whole comparison. Decades of psychotherapy research keep landing on the same finding: the relationship between client and therapist accounts for a great deal of whether therapy helps, at least as much as the method does. Whether you feel safe enough with the person across from you to go near the material at all matters more than which of two reasonable approaches you pick. That’s a good reason to use a consultation to notice how the conversation feels, not only to compare technique names.

Someone books a consultation having researched both approaches for weeks, and opens by asking which one has the better outcome data. What comes out later in the conversation is that they have told the story of what happened only a handful of times, and can’t bear to tell it again. That, not the study count, is what shapes where the work goes next.

Neither one is a shortcut

Both get marketed as fast, and both can move things that years of talking didn’t. But neither is a quick fix, neither works the same way for everybody, and neither replaces stabilization. If you’re in crisis right now, if you’re not sleeping, if you’re unsafe, the first work is steadiness and support, not processing. Opening trauma material before there’s enough ground under you tends to make things harder, not better.

Trauma also rarely stays in one lane. It shows up in mood and in the body, and it shapes how close we can let people get, which is why I’ve written separately about how childhood trauma shapes adult relationships and about living with depression and anxiety.

How this works in my practice

I offer Brainspotting therapy in Santa Rosa inside individual therapy in Santa Rosa rather than as a standalone technique, so it sits alongside talk therapy and the psychodynamic and mindfulness-based work I draw on. I see clients in person at my office in Santa Rosa and across Sonoma County, and Brainspotting adapts well to a secure video session, so I also offer it through online therapy across California.

Every new client is welcome to start with a free consultation, and part of what that conversation is for is deciding whether this is the right approach and whether I’m the right clinician. If EMDR is what you want, or what you need, I will say so. Getting you to the right work matters more than keeping you in mine.