Types of therapyCompare
Eye movement desensitisation and reprocessing (EMDR) vs talking about trauma
For trauma, the therapies with the best evidence have one thing in common. They work directly on the memory of what happened, rather than only on how you’re coping now. They’re called trauma-focused therapies.
EMDR (eye movement desensitisation and reprocessing) A structured therapy for memories that still feel raw. You bring a painful memory to mind for short stretches while your attention is split, usually by following your therapist's hand as it moves from side to side. The aim is for the memory to become less upsetting. More in the jargon decoder is one of them. The others are talking therapies, grouped together as trauma-focused Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder (CBT). The three most common are cognitive processing therapy, prolonged Exposure (facing things in steps) Facing what you've been avoiding, a bit at a time, and staying long enough for the alarm to settle. For fear and anxiety, it's often the part of therapy that does most of the work. More in the jargon decoder , and cognitive therapy for post-traumatic stress disorder (PTSD).
For PTSD, these trauma-focused therapies work about as well as each other. The biggest practical difference is how much you’re asked to say out loud about what happened, and what you do between sessions.
What each one involves
EMDR. You bring the memory to mind for short stretches while following your therapist’s hand side to side, or while they tap your hands. You say a few words about what comes up, not the whole story. There’s little or no Between-session tasks (homework) Things some therapists give you to practise between sessions, such as tracking when a mood shifts or trying a different response to a situation. You go through how they went at the next session. More in the jargon decoder .
Cognitive processing therapy. Works on the beliefs that formed because of what happened — about blame, safety, trust, and yourself. You look at those beliefs closely, often on worksheets. Some versions include writing a detailed account of the event. There’s regular homework. It usually runs about 12 sessions.
Prolonged exposure. You tell the story of the memory out loud, in detail, and repeat it over several sessions. Sessions are often recorded so you can listen back at home. You also gradually go back to places and situations you’ve been avoiding. The idea is that facing the memory, rather than avoiding it, lets the fear settle. It usually runs about 8 to 15 sessions.
Cognitive therapy for PTSD. Works on why the memory still feels like a present threat. You go back over the worst moments and add what you know now, such as the fact that it’s over. That way the memory holds how things ended, as well as the fear. You also work out which sights, sounds and places set off the intrusions, and practise telling them apart from the thing that happened. About 12 sessions.
Trauma-focused CBT. Not a single treatment. It’s the family name for the three talking therapies above. They all work on the trauma directly, mixing some talking through of the memory, work on the thoughts attached to it, and gradually facing what you’ve been avoiding.
General counselling. Talking with a supportive therapist about your life and how you’re going, without working on the memory in a structured way. Counselling can help with a great deal, including stress, grief and relationships. For the specific symptoms of PTSD, it tends to help less than the trauma-focused therapies above.
How they compare
Australia’s national PTSD guidelines give their strongest recommendation to EMDR, and to the group of talking therapies known together as Trauma-focused CBT A family of talking therapies that work directly on the memory of something that happened, using the ideas of CBT. More in the jargon decoder (Phoenix Australia, 2020–21). Within that group they name three in particular:
- cognitive processing therapy
- prolonged exposure
- cognitive therapy for PTSD
The guidelines don’t rank one above the others.
A large 2020 review compared 20 treatments across 90 trials. EMDR and trauma-focused CBT did best, with no clear difference between the two. Counselling that wasn’t trauma-focused helped too, but less than either of them (Mavranezouli and colleagues).
So the research doesn’t pick a winner. The choice comes down to practical differences:
| EMDR | Talking-based trauma therapies | |
|---|---|---|
| How much you say about the memory | A few words at a time | Often a detailed account, sometimes repeated |
| Homework | Little or none | Usually regular |
| Main work | Holding the memory in mind with eye movements or taps | Talking, writing, looking at beliefs, facing avoided situations |
| Session length | Often 60 to 90 minutes for memory work | Usually about 50 minutes; prolonged exposure sessions are often 90 |
| Typical length | Often 6 to 12 sessions for a single event | Often 8 to 15 sessions |
All the trauma-focused therapies can be intense. They ask you to go towards the memory rather than away from it, which is thought to be part of why they help. A good therapist sets the pace with you.
What tends to shape the choice
How you feel about describing what happened. If putting it into words feels impossible, or you don’t want to say it out loud to anyone, EMDR asks for the least talking. If you want to make sense of it by talking it through, a talking-based therapy may feel more natural.
How much time you have between sessions. Cognitive processing therapy and prolonged exposure rely on work at home. If your life is stretched thin right now, the homework is worth weighing up.
Whether you like to understand what’s happening. Some people want a clear, logical explanation of how a treatment works. Cognitive processing therapy is very open about its method. How EMDR works is still argued about, which bothers some people and doesn’t bother others.
What you’ve tried before. If you’ve talked about it at length and the feeling hasn’t changed, a different kind of trauma therapy may help. If EMDR felt too fast or unpredictable, the step-by-step structure of a talking-based therapy may suit you better.
Who’s available. A good therapist offering a different trauma-focused Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder next month may be worth more than a therapist offering the approach you’d prefer, with a six-month wait.
When the trauma went on for a long time
Most of the research above is on PTSD after one event or a few events. For trauma that was repeated or started early in life — sometimes described as complex PTSD — the picture is less clear.
Australia’s guidelines don’t yet recommend any treatment specifically for complex PTSD. The studies needed to make one don’t exist yet. A review of 51 trials looked at people likely to have some features of complex PTSD. In those trials, trauma-focused CBT, exposure-based therapy and EMDR all helped PTSD symptoms more than usual care (Karatzias and colleagues, 2019). EMDR had far fewer trials than the other two, and very little data on whether it helps with how people see themselves.
Some clinicians think people need a long time to get steady before working on memories. Others think that only delays treatment. The guidelines treat this as an open question, and the research hasn’t settled the matter.
In practice, therapy for long-running trauma often takes longer and combines approaches. Therapies that work on deep patterns, such as schema therapy, are sometimes part of the mix.
Getting either in Australia
EMDR, cognitive processing therapy, prolonged exposure and trauma-focused CBT are all offered by Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder . Some are offered by other mental health professionals too. Training varies, so it’s fair to ask a therapist what trauma training they have, and how much of their work is with trauma.
How you pay changes what’s available. Paying the full fee, you can see anyone trained in these approaches, including Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder and Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder , whom Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder doesn’t cover. Workplace programs, community services and headspace A national youth mental health service for anyone aged 12 to 25, with centres around Australia and support online and by phone. It's free or close to it, you don't need a referral or a parent, and you can book it yourself. More in the jargon decoder , for people aged 12 to 25, can offer free or low-cost sessions, usually a set number.
With a Mental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder from your GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder , Medicare gives a Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder on up to ten individual sessions a calendar year. That applies with a psychologist, mental health social worker or Mental health occupational therapist An occupational therapist with a mental health endorsement. Their focus is on daily life, such as getting back to work, study and routine, alongside the therapy itself. More in the jargon decoder . EMDR is named on Medicare’s list of approaches for a Mental Health Treatment Plan, and the talking-based trauma therapies come under CBT, which is on the list too. Some sessions run longer than standard ones, so check what you’d pay.
If you’ve served in the Australian Defence Force, or you’re family of someone who has, Open Arms offers free counselling on 1800 011 046, 24 hours a day.
If things are difficult right now, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.
Where next
Whichever approach you look at, trust in the therapist matters at least as much as the method. Why who you see matters more than what they do explains why. If you’re not sure therapy is what you want, what therapy actually is covers the basics, and would I benefit from therapy? helps you work out whether it’s worth a try.
If memories are overwhelming right now, you don’t need to wait for therapy to talk to someone, and if you’re experiencing family, domestic or sexual violence, 1800RESPECT is on 1800 737 732.