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How to Know When Your Client Is Ready to Start EMDR Processing
13-step checklist to assess whether your client is stable enough to begin EMDR processing.
Each client’s readiness for EMDR processing is unique to them. Use this handy list, along with your clinical judgment, to assess your client’s stability and determine if they are ready to start processing.
1. Do you have an established therapeutic relationship? Trust is essential, since clients often find themselves in a very vulnerable state when processing trauma memories. They will often tell you that they feel safe and connected with you, and if haven’t shared this, you can simply ask.
2. Can your client hold positive states? If your client is able to effectively use the resourcing exercises after having practiced them in your office, this is a good sign.
3. Is your client able to maintain awareness? Test your client’s ability to keep one foot in the present and one foot in the past by starting with a recent mildly disturbing incident. Are they able to go back and forth between focusing on this incident and then returning their attention to the safety of the present? If they can’t, they are not ready to process.
4. Does your client experience dissociation? Clients who dissociate are at a higher risk of decompensation, but dissociation alone is not a contraindication for EMDR processing. What’s important are the client’s awareness of the dissociative process and their ability to bring themselves back to the present.
5. Is your client able to tolerate intense body sensations? If somatic memories arise, make sure they are able to regulate with their breath or other somatic interventions.
6. Is there a current crisis in your client's life? Clients who are experiencing substantial crises may not be able to simultaneously process disturbing material. Hopefully, by the time the crisis is over, they will be ready to start processing.
7. Is your client at risk of harming themselves or others? When clients express suicidal or homicidal ideation, focus on their safety before attempting any EMDR work.
8. Is there a pending legal case? Active legal involvement does not always prevent clients from starting processing, but it should be taken into consideration. Educate the client and, if necessary, talk with their attorney about any potential consequences EMDR may have on the case.
9. Are there any health concerns? If your client has health conditions that may be worsened by EMDR processing (e.g., heart disease or certain neurological issues), consult with their medical providers.
10. Are there any secondary gains or loses? Clients who identify with their symptoms may fear getting better, since successful processing will inevitably lead to some form of loss. Moreover, clients who improve in treatment can also lose things such as government benefits or peer support. If you identify any secondary gains and losses, make sure to discuss them with your client.
11. Is your client afraid to start EMDR processing? Never push them to start processing if they don’t feel ready. Instead, help them address these fears with further education and more resourcing.
12. Is your client pressuring you to start processing? On the other hand, never let your client pressure you into starting processing before you feel they are ready.
13. Does your client experience repeated attachment wounds in childhood? Standard EMDR preparation strategies may not be enough for clients with attachment wounds and developmental trauma. Supplementing EMDR with the developmental needs meeting strategy (DNMS) or AI-EMDR may be needed.
1. Do you have an established therapeutic relationship? Trust is essential, since clients often find themselves in a very vulnerable state when processing trauma memories. They will often tell you that they feel safe and connected with you, and if haven’t shared this, you can simply ask.
2. Can your client hold positive states? If your client is able to effectively use the resourcing exercises after having practiced them in your office, this is a good sign.
3. Is your client able to maintain awareness? Test your client’s ability to keep one foot in the present and one foot in the past by starting with a recent mildly disturbing incident. Are they able to go back and forth between focusing on this incident and then returning their attention to the safety of the present? If they can’t, they are not ready to process.
4. Does your client experience dissociation? Clients who dissociate are at a higher risk of decompensation, but dissociation alone is not a contraindication for EMDR processing. What’s important are the client’s awareness of the dissociative process and their ability to bring themselves back to the present.
5. Is your client able to tolerate intense body sensations? If somatic memories arise, make sure they are able to regulate with their breath or other somatic interventions.
6. Is there a current crisis in your client's life? Clients who are experiencing substantial crises may not be able to simultaneously process disturbing material. Hopefully, by the time the crisis is over, they will be ready to start processing.
7. Is your client at risk of harming themselves or others? When clients express suicidal or homicidal ideation, focus on their safety before attempting any EMDR work.
8. Is there a pending legal case? Active legal involvement does not always prevent clients from starting processing, but it should be taken into consideration. Educate the client and, if necessary, talk with their attorney about any potential consequences EMDR may have on the case.
9. Are there any health concerns? If your client has health conditions that may be worsened by EMDR processing (e.g., heart disease or certain neurological issues), consult with their medical providers.
10. Are there any secondary gains or loses? Clients who identify with their symptoms may fear getting better, since successful processing will inevitably lead to some form of loss. Moreover, clients who improve in treatment can also lose things such as government benefits or peer support. If you identify any secondary gains and losses, make sure to discuss them with your client.
11. Is your client afraid to start EMDR processing? Never push them to start processing if they don’t feel ready. Instead, help them address these fears with further education and more resourcing.
12. Is your client pressuring you to start processing? On the other hand, never let your client pressure you into starting processing before you feel they are ready.
13. Does your client experience repeated attachment wounds in childhood? Standard EMDR preparation strategies may not be enough for clients with attachment wounds and developmental trauma. Supplementing EMDR with the developmental needs meeting strategy (DNMS) or AI-EMDR may be needed.
The Art and Science of EMDR
Therapists who are trained in EMDR can facilitate healing in the most profound ways. But successful treatment requires more than following a rigid script or a protocol. It requires bringing both the art and science of EMDR into the therapy room.
In The Art and Science of EMDR, clinicians will learn how to do just that. Grounded in the principles of neurobiology and the science of deliberate practice, this book teaches both new and seasoned EMDR clinicians how to apply the phase-based model of EMDR in a more holistic way. Instead of conceptualizing EMDR in an inflexible and linear manner, clinicians will learn how to adapt the protocol to each client’s needs while maintaining authenticity to the model (and to who they are as therapists and humans).
In The Art and Science of EMDR, clinicians will learn how to do just that. Grounded in the principles of neurobiology and the science of deliberate practice, this book teaches both new and seasoned EMDR clinicians how to apply the phase-based model of EMDR in a more holistic way. Instead of conceptualizing EMDR in an inflexible and linear manner, clinicians will learn how to adapt the protocol to each client’s needs while maintaining authenticity to the model (and to who they are as therapists and humans).
Meet the Expert:
Rotem Brayer, MEd, LPC, is a licensed professional counselor, certified EMDR therapist, EMDR consultant, and advanced EMDR trainer. He is the founder of The EMDR Learning Community (emdr-learning.com), a community that brings EMDR therapists together and provides education on EMDR therapy and the integration of this modality with other treatment approaches. As the founder of EMDR Denver, a practice that helps clients heal with an "EMDR first" approach, Rotem divides his time between consulting on cases, coaching EMDR therapists, and helping clients heal from the effects of trauma and attachment wounds.
Learn more about his educational products, including upcoming live seminars, by clicking here.
Learn more about his educational products, including upcoming live seminars, by clicking here.
