EMDR Therapy Quarterly

Introduction

Working in a cancer setting as a clinical psychologist, I have often been struck by how frequently trauma threads through the cancer experience – from the moment of diagnosis, intensive treatments, and living with difficult side effects to the uncertainty of living with an ongoing threat, including ongoing fears of recurrence that may persist long after treatment has ended (Lebel et al., 2016). Although there is a growing evidence base supporting EMDR for cancer-related trauma, its application within psycho-oncology remains relatively limited compared to other trauma contexts (Capezzani et al., 2013).

In this piece, I reflect on my experience of adapting EMDR therapy for people living with and beyond cancer, exploring what it means to work with trauma when the threat may still be present. Research has increasingly recognised that a cancer diagnosis and its treatment can be experienced as traumatic, with a significant minority of patients meeting the criteria for post-traumatic stress symptoms (Kangas et al., 2002; Mehnert & Koch, 2006).

This piece represents my personal reflections on working as a clinical psychologist using EMDR to help people affected by cancer. I aim to explore the nuances of this area of work, focusing on what is unique about being diagnosed with cancer and experiencing the treatment. I aim to bring a trauma lens to what is often seen as a physical and medical experience, where the psychological impact of diagnosis and treatment can be lost. I hope to share here what I have learned in terms of what can make EMDR challenging in this context and how it can be best adapted to meet the needs of people with cancer.

The nature of trauma in cancer

Trauma in the context of cancer is often complex and ongoing (Kangas et al., 2002). A cancer diagnosis can place a person in a prolonged state of threat, with treatment lasting many months and, for those living with incurable disease, continuing indefinitely. Even when treatment is completed, the possibility of recurrence frequently remains psychologically salient, with many people experiencing significant and persistent fear of the cancer returning. Research has increasingly recognised that cancer-related trauma is often characterised by prolonged exposure to threat rather than a discrete traumatic event (Kangas et al., 2002).

Cancer treatments can be invasive, painful and physically exhausting, often leaving people feeling powerless and out of control. Side effects may persist long after treatment has ended, and additional medical complications can result in repeated hospitalisation and further medical intervention. In contrast to single-incident trauma, cancer-related distress may accumulate over time, with repeated exposure to invasive or painful procedures and limited opportunity for psychological recovery between them (Mehnert et al., 2017).

A distinctive feature of cancer-related trauma is that the threat is experienced as coming from within the body. Many people describe a sense that their body has become unsafe, untrustworthy or a source of pain and failure. This can profoundly affect a person’s relationship with their body, as well as their sense of health, identity and future. This experience of threat originating within the body has been described in phenomenological accounts of illness, in which the body comes to be experienced as unsafe, unpredictable or betraying (Carel, 2016).

Cancer and its treatment may also disrupt relationships, employment and roles within families, while raising fears about mortality and provoking significant existential distress. These disruptions are well documented within psycho-oncology literature, which highlights the impact of cancer on identity, relationships and existential meaning (Mehnert et al., 2017).

For some, cancer does not fit neatly with their existing understanding of illness. Many people feel physically well at the point of diagnosis, and it is often the treatment rather than the disease itself that causes them to feel unwell. After treatment, individuals may find themselves physically and psychologically worse than before diagnosis, struggling to reconcile this with expectations of recovery held by themselves and others.

Hospital-based care can further compound distress. Repeated procedures, loss of privacy and interactions with professionals who lack sensitivity or clear communication may inadvertently add to the psychological burden. Even when cancer has been treated effectively, the ongoing possibility of recurrence can remain ever-present, shaping how people experience safety, uncertainty and threat in their daily lives. Poor communication and loss of control within medical settings have been identified as significant contributors to psychological distress following serious illness (Fallowfield & Jenkins, 1999; Guolo et al., 2025).

Adapting EMDR in the context of illness
There is a growing body of evidence supporting the use of EMDR for trauma related to medical illness and cancer (Capezzani et al., 2013; Carletto et al., 2019; Portigliatti Pomeri et al., 2021). However, clinical experience suggests that careful consideration and adaptation are often required to ensure that EMDR is applied in a way that is both safe and effective within the context of ongoing physical illness.

One of the most important considerations is timing. Cancer treatment can involve sustained periods of threat, uncertainty and physical vulnerability (Kangas et al., 2002). During active treatment, emotions are often intense, and this is an understandable response to a frightening and life-altering situation. For some individuals, formal trauma-focused therapy may not be indicated at this stage (Cordova et al., 2017). Instead, supportive interventions, such as access to social support, psychoeducation or peer groups may be sufficient to help normalise emotional responses and reduce isolation. Being understood by others who “get it” can be profoundly containing, particularly in contexts where people feel pressure to minimise or sanitise their distress. Stabilisation and resourcing work is often very helpful, particularly in supporting people in attending treatment.

There are, however, circumstances in which EMDR during treatment may be appropriate (Faretta & Borsato, 2016). For example, a particularly distressing treatment experience may lead someone to avoid or refuse further medical care, or to experience intrusive memories, nightmares or flashbacks that significantly interfere with daily functioning or adherence to treatment. In such cases, it may be important to use EMDR to process the traumatic experiences and support the person to be in a better position to make decisions about their ongoing engagement in treatment.

In addition, some individuals bring pre-existing trauma histories into the cancer context (Cordova et al., 2017). For some, experiences such as childhood or adult sexual abuse may be reactivated by treatments involving intimate examinations, bodily exposure or invasive procedures, particularly in cancers such as breast, gynaecological or prostate cancer. In these situations, distress may be less about the cancer itself and more about the implicit loss of control and bodily autonomy. Awareness of this intersection can be crucial in formulation, timing and decisions about whether EMDR may support engagement with both psychological and medical care.

Practical flexibility is often necessary (Faretta & Borsato, 2016). Many cancer treatments, such as chemotherapy, follow cyclical patterns, with side effects peaking in the days immediately following treatment and easing thereafter. Clients may prefer not to attend therapy during treatment weeks, or may need sessions scheduled around fluctuating energy levels and medical appointments. Therapists may need to accommodate cancelled or rearranged sessions when someone unexpectedly feels unwell or too fatigued to attend.

When EMDR is undertaken after treatment has largely concluded, physical factors may still require careful consideration. Fatigue is common post-treatment, and many individuals report fluctuating energy levels and ongoing physical symptoms long after the end of their treatment (Hussey et al., 2024). As a result, people may function better at particular times of the day, for shorter sessions or at a slower pace, and attention to comfort can support sustained engagement in therapy. Symptoms such as neuropathy, pain or medication-related aches may necessitate adjustments to seating, positioning or methods of bilateral stimulation, allowing the individual to remain physically settled while maintaining dual attention. Across these contexts, adapting EMDR does not mean abandoning the core principles of the model (Shapiro, 2018), but rather applying them with sensitivity to the embodied and fluctuating realities of living with and beyond cancer.

Working with existential and anticipatory themes

Working with EMDR in the context of cancer, particularly when addressing the fear of recurrence, often involves operating at the edge of a fundamental tension – processing past traumatic experiences of diagnosis or treatment while acknowledging the ongoing reality that the cancer could return. Fear of recurrence is a common and understandable response following curative treatment (e.g., Lebel et al., 2016; Simard et al., 2013), and in itself does not indicate psychological difficulty. However, for some individuals, the intensity of this fear can become disabling, significantly interfering with their ability to live a meaningful and engaged life.

Clinical formulation in this area requires careful attention to both psychological trauma and realistic medical risk (Cordova et al., 2017). The likelihood of recurrence varies significantly depending on the diagnosis and treatment, and understanding this context is important. Trauma related to cancer treatment may present as heightened vigilance to bodily sensations, repeated health-related checking or persistent anxiety about illness more generally. In practice, such presentations are sometimes conceptualised solely as health anxiety and referred for standard cognitive-behavioural interventions. Overlooking the link to past traumatic experiences can leave the underlying distress unprocessed, potentially compounding rather than alleviating suffering.

EMDR offers several ways of working within this complexity. In some cases, processing past traumatic targets, such as moments of diagnosis, invasive procedures or experiences of poor communication or care can reduce the intensity of present-day fear and restore a greater sense of trust in medical professionals or systems (Faretta & Borsato, 2016). In other situations, particularly where distress is connected to concern about anticipated future events, the Flashforward technique can be helpful in addressing feared future scenarios related to illness, treatment or deterioration, where the concerns are catastrophic and disproportionate to the likelihood of occurrence (e.g., Logie & de Jongh, 2014).

Where cancer is incurable, or where there is a high likelihood of recurrence, ongoing side effects or repeated hospital admissions, the Future Template (Shapiro, 2018) can play an important role once relevant past trauma has been processed (Faretta, 2019). Rather than offering false reassurance, this work can support individuals to feel more resourced and psychologically prepared to face future challenges, fostering a sense of agency in the context of uncertainty.

Across these applications, EMDR may facilitate, not the removal of fear, but the integration of meaning around traumatic experiences. Through adaptive processing, individuals may come to hold a more coherent narrative of what they have endured, allowing distressing memories to sit alongside values, relationships and sources of purpose. This is consistent with the Adaptive Information Processing model, in which traumatic experiences are integrated into broader memory networks, allowing for greater coherence and flexibility (Shapiro, 2018). In this way, EMDR can support people to live fully in the present while acknowledging, rather than avoiding, the realities of their illness and mortality.

The therapist’s experience

Working with people living with cancer involves sitting alongside individuals who are facing, or have faced, life-threatening illness. The threat has been very real. Over time, this work exposes therapists to aspects of illness and treatment that may previously have been unfamiliar; for example, the harshness of some treatments, the enduring impact of side effects and the way in which lives and identities can be irrevocably altered. At times, it also involves sitting with the knowledge that the person in front of you may die. In this work, you will hold your own sense of loss, sadness and grief while working alongside people who die.

Bearing witness to this reality and supporting people to process their experiences can be profoundly meaningful. Helping people to find meaning, joy and peace, even in the face of illness and death, has been one of the greatest privileges of my career. While this work can be very rewarding, it can also be emotionally demanding (Meier & Beresford, 2006). There have been moments in my work where I have felt helpless in the face of the scale of what someone is living with, and uncertain about what I could offer when the situation itself could not be changed. This work requires careful attunement, particularly when mortality, fragility or profound uncertainty are present in the room. It also demands a willingness to tolerate not knowing and to resist the pull towards reassurance or problem-solving when these are not what is needed. Over time, I have come to understand that the value of the work does not lie in eliminating distress or altering inevitable outcomes, but in helping people live more meaningfully in the present, to reconnect with what matters to them and to integrate past experiences so they do not continue to intrude unnecessarily.

Regular supervision has been essential in supporting this work (Hession & Habernicht, 2020). Having a consistent space to reflect on the emotional impact of working alongside people affected by cancer, to notice and make sense of my own responses, and to acknowledge feelings of sadness, loss or helplessness has helped me remain grounded, compassionate and present with clients, while maintaining appropriate professional boundaries. Professional guidance emphasises the role of supervision in sustaining safe, ethical and reflective psychological practice. The British Psychological Society (2018) highlights supervision as a core component of applied psychological work, particularly in managing the emotional demands and complexity inherent in clinical roles. Similarly, regulatory standards from the Health and Care Professions Council (2022) position supervision within broader expectations of reflective practice, self-awareness and working within one’s limits of competence.

In conclusion

Working with trauma in the context of cancer invites a different therapeutic stance from that adopted when danger has clearly passed. EMDR is often associated with the processing of past events that are no longer occurring; however, cancer-related trauma frequently exists alongside ongoing uncertainty, risk or physical decline. This requires clinicians to hold both psychological processing and present-day reality with particular care.

In this context, EMDR is not about removing fear, grief or awareness of mortality. Nor is it about offering reassurance where reassurance would be misleading. Instead, the work often involves supporting individuals to metabolise and integrate what has already happened so that their nervous system is not continually drawn back into moments of overwhelming threat. By reducing the intrusive impact of past experiences, people may be better able to engage with the present, even when that present includes uncertainty or loss.

This approach requires careful ethical consideration. Therapists must remain attuned to when trauma-focused work is likely to be supportive and when it may risk overwhelming someone who is already managing significant physical or emotional demands. It also calls for humility – an acceptance that therapy cannot resolve the existential realities of illness but can offer a space in which these realities are faced with honesty, dignity and compassion. Used thoughtfully, EMDR can help people living with and beyond cancer to reclaim a sense of agency and meaning, even when the future is unclear. In doing so, it supports, not a return to who someone was before cancer, but the integration of illness into a life that remains worth living.

I write from my position as a clinical psychologist working with people affected by cancer and their families within a third sector organisation. I do not have personal lived experience of cancer; however, my perspective is shaped by several years of clinical work in oncology contexts and by training in trauma-informed approaches, including EMDR therapy. My practice has been informed by working in settings where psychological trauma has not always been explicitly recognised within cancer care, and this article reflects an attempt to bring a trauma-informed lens into a space that has traditionally focused on physical treatment and outcomes. This article is offered as a practice-based reflection informed by clinical experience and professional training.