What happens in an ART session, step by step

An Accelerated Resolution Therapy (ART) session follows a set order. You rate how distressing a memory feels, briefly recall it while following the clinician’s hand with your eyes in sets of about 40 movements, let the body sensations settle, then replace the distressing images with ones you choose. The session ends with a check of the memory, a look ahead at future triggers, and a closing assessment.

That order is not a guess. The researchers who ran the early ART studies published it as a list of seven components (Kip et al. 2012). What follows walks through those components in plain English. Individual sessions vary in pace, but the shape stays the same.

Before the eye movements start

1. Choosing what to work on. You and the clinician agree on a specific memory or scene, not everything at once. You do not have to describe it. Knowing roughly what it is, and how upsetting it is, is enough to start.
2. Rating the distress. You rate how distressing the memory feels right now on a 10-point scale. Researchers call this a SUDS rating (Subjective Units of Distress). It gives both of you a baseline to compare against later.
3. Talking through the plan for the images. The clinician explains that later in the session you will be invited to replace the distressing images with different ones of your choosing. In ART this step is called Voluntary Image Replacement, or Voluntary Memory Replacement. It is explained up front so nothing later comes as a surprise.

Recall and eye movements

This is the part most people picture when they hear about ART. The clinician moves a hand back and forth in front of you and you follow it with your eyes, left to right. In the published protocol each set is a fixed 40 eye movements (Kip et al. 2014).

1. Brief, deliberate recall. During a set, you bring the memory to mind and notice the sensations, thoughts and emotions that come with it. The research describes this as a short period of about 30 to 45 seconds, and says it can be done “verbally or non-verbally”. You can keep it entirely in your head.
2. Sensation checks between sets. After a set, the clinician asks what you notice in your body: tightness, heat, a racing heart, nausea. The protocol then uses a further set of eye movements aimed specifically at easing those physical sensations.
3. Repeat until the charge drops. Recall, eye movements, check, eye movements again. The aim at this stage is to reduce the anxiety and body sensations attached to deliberately recalling the memory.

What you do during all of this is fairly simple: follow the hand, notice what comes up, and say what you notice in your body. You can ask to stop or slow down at any point.

Replacing the images

Once the physical charge has come down, the session moves to the step that makes ART different from its close relative, EMDR. The clinician guides you through what the research calls “therapist-directed implementation of a creative intervention” from the ART manual, so that you can replace the distressing images with a scene of your choosing (Kip et al. 2012).

One technique the developers name is the “Director” intervention, in which you are guided to establish a new version of the scene to deal with “unfinished business,” in a way the researchers compare to Gestalt therapy. The new images are yours. The clinician structures the process, but you decide what goes in the picture.

This is covered in more depth on the page about Voluntary Image Replacement. The short version: you still know what happened. What changes is the picture your mind goes to.

Checking the result

1. Trying to recall the original scene. The clinician asks you to try to bring up the original distressing scene and compare it with the new one. This shows whether the replacement has taken hold. In one study, treatment of a scene was counted as complete when only the replacement scene could be accessed, “although knowledge of the original scene remained in memory” (Kip et al. 2014).
2. Looking ahead at triggers. You talk through situations coming up that might set the symptoms off, such as an anniversary, a place, a sound.
3. Closing the session. The session ends with a closure assessment. You are not sent out of the room in the middle of the process.

How long it takes, and how much gets done

In the published studies, sessions lasted about 60 to 75 minutes (Kip et al. 2012). The same researchers wrote that it is possible to work through up to three scenes in a one-hour session. That is an upper limit, not a target.

In my practice, ART sessions often run longer than a standard 50-minute therapy session. We agree the length in advance, so you know when you are expected to finish. For a first course of ART I generally recommend meeting in person, because the eye movements are directed in real time and I want to be able to see how you are doing.

There is no homework between sessions. The developers’ own materials say so, and a 2014 case report in a military journal described the protocol as “without homework” (Kip et al. 2014, case report).

What the session is not

• It is not something done to you while you are switched off. You stay awake and talking, and you decide whether to continue.
• It is not a recital of your trauma. You can do the recall silently.
• It is not a guarantee. Studies report averages across groups of people; they cannot tell you how your own sessions will go. See how many sessions ART takes for what the studies actually found.

If you want to know whether ART is a reasonable place for you to start, the first step is an assessment. Get started, and read what the first appointment covers if you like to know what to expect.