ART explained for family and friends

If someone close to you is starting Accelerated Resolution Therapy (ART), the most helpful things you can do are simple: don’t ask for the story, make session days easy, and keep a quiet eye on how they are doing without hovering. This page explains what ART is, what they may be like after a session, what helps and what doesn’t, and how to look after yourself along the way. It was written to be passed on, so if someone sent it to you, they are probably telling you something about what they need.

What ART is, in three sentences

ART is a structured, brief trauma therapy, developed in 2008, in which the person briefly brings a distressing memory to mind while following the therapist’s hand with side-to-side eye movements, which are meant to settle the physical distress attached to it. The person then replaces the distressing images with a scene of their own choosing, a step called Voluntary Image Replacement. They still remember what happened, and they do not have to tell the therapist, or anyone else, the details.

It is worth knowing that ART is a newer therapy with a smaller research base than established trauma treatments such as cognitive processing therapy, prolonged exposure and EMDR. The 2023 VA/DoD guideline found the evidence insufficient to recommend for or against it. Studies have used between one and five sessions, with participants averaging about three to four, but there is no set number for any one person. More detail is in the research and how many sessions.

What they may be like after a session

ART sessions often run longer than an ordinary therapy hour, and the work can bring up strong feelings and body sensations. Afterward, the person you care about might be:

• Tired, quiet or wanting some space
• Emotional, flat or low for a day or so
• Sleeping less well, or having more vivid dreams
• More on edge or easily startled than usual
• Much the same as always

Any of these can happen. In the published ART trials, a few participants reported low mood, disturbed sleep, extra anxiety or more nightmares after sessions. These effects were uncommon and not serious, and the low mood that was reported passed before the next session. If after-effects go on for more than a few days or seem to be getting worse, gently encourage them to tell their therapist.

How to help

1. Don’t ask for the story. One reason people choose ART is that they don’t have to describe what happened. Asking, even kindly, can feel like pressure to relive it. Let them lead. “I’m here if you want to talk, and it’s fine if you don’t” is often all that needs saying.
2. Make session days easy. Offer a ride, take a chore off their list, keep the evening quiet, have something easy to eat. Practical help usually lands better than questions.
3. Ask what they need, simply. “Company or space tonight?” is easier to answer than “How did it go?” Accept the answer, even if it is “space.”
4. Keep ordinary life ordinary. Routines, meals, a walk, a film. Normal is steadying, and they don’t need to be treated as fragile.
5. Be patient with the pace. Change, where it happens, is rarely a straight line. Try not to count sessions or measure progress out loud.
6. Notice without monitoring. Pay attention to sleep, drinking and mood over days, not hours. If something worries you, say so once, kindly and directly, rather than watching and saying nothing.

What not to do

• Don’t press for details of the memory, or ask what the replacement image was. That belongs to them.
• Don’t bring up the event to “test” whether the therapy worked.
• Don’t ask “Is it fixed?” or say it should be over by now.
• Don’t compare their therapy with someone else’s, or with what you have read online.
• Don’t expect updates from the therapist. What happens in therapy is confidential, and what to share is the client’s choice.
• Don’t take a short-tempered or withdrawn evening personally. It is usually about the day, not about you.
• Don’t make alcohol the default way to wind down on session nights.

Looking after yourself

Living alongside someone’s trauma is hard work, and it often goes unacknowledged. You are allowed to be tired, worried or frustrated, and you are allowed support of your own.

• Keep your own routines, friendships and time off. You can’t be steady for someone else if you are running on empty.
• Consider talking to a counselor of your own. You don’t need a crisis to justify it.
• If your family is connected to the military, Vet Centers offer free, confidential counseling to eligible veterans, service members and their families. Their around-the-clock call center is 1-877-927-8387.
• Local options for veterans and their families are gathered in veteran support organizations in San Antonio.
• Learn a little, then stop reading. The ART glossary covers the words you may hear; you don’t need to become an expert.

When to be worried, and what to do

Most difficult days after therapy are just that: difficult days. Take it more seriously if you notice any of these:

• Talk of suicide, of being a burden, or of not wanting to be here
• Heavy or escalating drinking or drug use
• Not sleeping or eating for several days
• Seeming very disconnected, confused or unable to function
• Any sign they may not be safe, or that someone else may not be

If it is not an emergency, encourage them to contact their therapist and offer to sit with them while they do. If you think someone is in immediate danger, call 911. For thoughts of suicide, the 988 Suicide & Crisis Lifeline takes calls and texts at 988, and veterans can call 988 and press 1. More options are in crisis lines and support services in Texas and on the suicidal thoughts help page.