EMDR Therapy – Basic Training Weekend 1

PROTOCOLS AND WORKSHEETS

FOR CLINICAL PRACTICE

THE FOLLOWING FORMS MAY BE DUPLICATED FOR USE:

➢ EMDR Therapy Psychosocial Interview Agenda – Client Selection

Criteria Checklist

➢ AIP History Taking and Treatment Planning Worksheet

➢ Phase 2: Preparation Checklist

➢ Procedural Steps for Installing a Safe/Calm Place

➢ Assessment Phase 3 Worksheet

➢ Treatment Session Summary Notes

➢ Reevaluation Worksheet

➢ Procedural Steps for Installing Future Templates

➢ Procedural Steps Outline

➢ Principles and Procedures for Enhancing Current Functioning with EMDR-

Resource Development and Installation Guidelines

➢ EMD

➢ Impact of Event Scale (Revised)

➢ Adverse Childhood Experience (ACE) Questionnaire

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EMDR THERAPY PSYCHOSOCIAL INTERVIEW AGENDA

—CLIENT SELECTION CRITERIA—
CHECKLIST

The following may be treated as a clinical checklist or worksheet:

□ OK: Has been addressed and is appropriate for EMDR therapy.

□ PROBLEM: Problem/Concern.
Wait until completion of Basic Course or until further preparation and
stabilization have been achieved.

□ CONSULTATION: Consultation indicated with EMDR clinician

with expertise in area of concern.

CLINICAL CONCERNS:

CLIENT STABILITY -DEVELOPMENTAL DEFICITS - ABILITY TO

MANAGE STRESS

□ OK □ PROBLEM □ CONSULTATION

Client has been screened for Dissociative Disorder. DD rules out use of EMDR therapy by
Part One-trained clinicians. See Clinical Signs of Dissociative Disorders and DES in
Appendix. In addition to a Mental Status Exam, the DES or the MID (see Appendix)
should be used for any client of whom you have concerns. Special preparation for DD
clients is needed to establish their capacity to maintain dual awareness in order for
reprocessing to occur. Indicators of poor psychic development include but are not
limited to:

□ Years of unsuccessful psychotherapy

□ Minimal or poor responses to psychotropic medications
□ Depersonalization and/or derealization
□ Dissociative Disorder
□ History of hospitalizations
□ Somatic symptoms
□ Chronic instability at home and/or at work
□ Inability to learn from experience
□ Previous unsuccessful treatment of addictions and/or compulsions
□ Secondary gains to maintaining their symptomatology

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ACUTE PRESENTATIONS

□ OK □ PROBLEM □ CONSULTATION

The following situations require caution and case consultation:

□ Major loss, illness or injury

□ Life threatening substance abuse
□ Recent suicide attempt(s)
□ Self-mutilation
□ Serious assaultive or impulsive behavior
□ Psychotic episode

STABILIZATION

□ OK □ PROBLEM □ CONSULTATION

Adequate stabilization/self-control strategies in place

Client must have a workable means of managing distress as necessary
during and between sessions
Client has adequate life supports (friends, relatives, etc.)
Systems/issues that might endanger client have been addressed
Client able to call for help if indicated
Medical marijuana use
Client is safe at home

MEDICAL CONSIDERATIONS

□ OK □ PROBLEM □ CONSULTATION

General physical health/medical condition/age considered (possible exacerbation with

stress)
Medications
Inpatient if necessary to manage danger to client or others
Eye pain contraindicates EMs until cleared by physician (use alternate forms of
stimulation)
Any neurological impairment or physical complication inappropriate for Weekend
1/Part 1 clinicians
Pregnancy: first trimester cautions; other complications

TIMING CONSIDERATIONS/READINESS

□ OK □ PROBLEM □ CONSULTATION

Timing of life events (projects, demands, work schedules, vacations, etc.)

Availability of both therapist and client for continuity of sessions, support, and follow-
up
Willingness/ability to participate in the treatment plan
90-minute sessions (if possible) 50 minutes minimum

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PHASE ONE: AIP HISTORY TAKING AND

TREATMENT PLANNING WORKSHEET

This worksheet is designed to help you take an AIP-informed history and develop a
treatment plan specific to a presenting issue. You will practice using the Floatback
Technique (or Affect Scan) as well as direct questioning to identify relevant
experiences in the client’s memory network that are informing their current
symptoms. It will also help you prioritize what memories to process and keep track
of them as they resolve.

PRESENTING COMPLAINT:

“Let’s talk about the issue you have decided to work on (this weekend). Tell me
more about it.”

RECENT EXAMPLE OF PRESENTING COMPLAINT:

“What recent experience have you had that represents this issue?”

“What other recent experiences have you had that represents this issue?”

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PAST EXPERIENCES:

Use direct questioning, or the Floatback Technique, as scripted below to identify the
past experiences associated with the client’s current difficulties. Use the most
disturbing experience from the recent events described above.

“As you bring up the recent experience of _________, notice the image that comes
to mind (pause), the negative thoughts you’re having about yourself (pause), the
emotions and sensations you’re experiencing right now (pause), and let your mind
floatback to an earlier time when you may have felt this way before and just notice
what comes to mind…”

After each association:

“As you focus on this experience, notice what else comes to mind…”

If Floatback doesn’t yield results or is too demanding, try Affect Scan:

“As you bring up the recent experience of _________, notice the feelings you’re
having right now (pause), notice where you’re feeling them in your body (pause),
and let you mind scan back to an earlier time when you may have felt this way
before and just notice what comes to mind…”

Repeat instructions having the client focus on each association briefly until s/he
can’t access any more associations:

“Is there anything else? Continue to floatback and notice what else emerges.”

Identify the first and worst experiences in the memory network. Record the client’s
experiences using headlines, taking note of the first and the most disturbing
experiences:

Experiences Age
_____________________________ ________________

_____________________________ ________________

_____________________________ ________________

_____________________________ ________________

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PRESENT TRIGGERS:

“Are there other situations, people or places in your life now that bring up these
negative reactions?”

FUTURE TEMPLATE:

“How would you like to be able to handle these situations (present triggers) in
the future?”

Redirect Client’s focus of attention to Safe/Calm Place, shifting state to

end clinical session.

TREATMENT PLAN SUMMARY:

Target Memory selected for the first reprocessing session:

Circle One:

Touchstone Memory Worst Other Past Experience

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PHASE TWO: PREPARATION CHECKLIST

Check □ when completed:

Explanation of EMDR
□ AIP/REM

“When a disturbing event occurs, it can get locked in the brain with the
original picture, sounds, thoughts, feelings and body sensations, EMDR
seems to stimulate the information and allows the brain to reprocess the
experience. That may be what is happening in REM or dream sleep--the eye
movements (tones, tactile) help to reprocess the associated material. It is
your own brain that will be doing the healing and you are the one in
control.”

EMDR Seating Position

□ Seating arrangement (ships passing)

Eye Movements
□ Comfortable distance from client’s face
□ Comfortable speed (horizontal EMs)
□ Alternative directions (- / \)

Alternative Bilateral Stimulation (to be used only if necessary)

□ Tapping
□ Auditory

Client Stability/Coping Strategies

□ Metaphor (train/video)

“In order to help you ‘just notice’ the experience, imagine riding on a train
or watching a video while the images, feelings, thoughts, etc., are just
passing by.”

□ Stop signal

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PROCEDURAL STEPS FOR CREATING Formatted: Pattern: Clear (Background 1)

A SAFE/CALM PLACE

INSTRUCT Use with or without eye movements.

CLIENT TO USE Use other coping skills if more appropriate
AS NEEDED (containment or other resource).

IMAGE "Please think about an experience you have had, or a place you have
been or imagine being at a place that feels calm or safe. Perhaps being
at the beach or in the mountains or an activity you enjoy. What image
represents your place? Describe what you see.”

EMOTIONS and "As you think of that experience, notice what you see, hear, and feel?
SENSATIONS What emotions are you experiencing? What sensations do you have in
your body?"

ENHANCEMENT "Focus on your Safe/Calm Place--its sights, sounds, smells, and

sensations. Tell me more about what you are experiencing."

EYE “Bring up the image of this place. Concentrate on where you feel the
MOVEMENTS pleasant sensations in your body and allow yourself to enjoy them.
Concentrate on those sensations and follow my fingers. (4-8 slow BLS)
What are you noticing now?”

If positive: “Focus on that. (BLS) What do you notice now?”

If negative: Redirect attention away from the image, setting aside any
negative parts and return to the positive, if possible. If successful, then “Focus
on that. (BLS) What do you get now?” If not successful, then identify another
calm or safe experience making sure there are no associations with people, or
shift to a mindfulness or breathing exercise.

CUE WORD “Is there a word or phrase that represents your Safe/Calm Place?
Think of_______ and notice the positive feelings and sensations you
are having when you think of that word. Concentrate on those
sensations and the word/phrase ______ and follow my fingers. (4-8 BLS)
(Pause.) What are you noticing now?” (Pause for a response.) Repeat and
enhance positive feelings with sets of BLS as long as the experience continues to
strengthen.

SELF-CUING “Now say that word __________ and notice how you feel.”

CUING WITH “Now imagine a minor annoyance (SUD 1-2) and notice how you feel.
DISTURBANCE Bring up the cue word(s) ________and notice any shifts in your
experience. What do you notice?”

SELF-CUING “Think of another mildly annoying incident (SUD 2-3), notice how you
WITH feel, then bring up that word______ by yourself, especially noticing any
DISTURBANCE changes in your body when you focus on your cue word.”

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ASSESSMENT AND REPROCESSING WORKSHEET

INSTRUCTIONS: “Often we will be doing a simple check on what you are experiencing.
I’ll ask you to give me brief feedback as to what is going on. Sometimes things will change
and sometimes they won’t. There are no supposed to’s in this process. So just give as
accurate feedback as you can as to what is happening without judging whether it should be
happening or not. Just let whatever happens, happen. Remember, you have your STOP
signal should you need it.”
TARGET MEMORY: Experience chosen to be reprocessed:

IMAGE
Most disturbing: “What picture represents the worst part of the experience as you think
of it now?”

If no picture: “As you think of the experience, what is the worst part of it?”

COGNITIONS - NC & PC
Negative Cognition - NC
“What words go best with that picture that express your negative belief about yourself as
you think of it now?”

Positive Cognition:
“When you bring up that picture, what would you prefer to believe about yourself instead?

Validity of Cognition (VOC)

“When you think of that picture, how true do those words (repeat the Positive Cognition)
feel to you now on a scale of 1 to 7, where 1 feels completely false and 7 feels completely
true?”

1 2 3 4 5 6 7
Completely false Completely true Commented [D3]:
EMOTIONS/FEELINGS
“When you bring up that picture and those words (Negative Cognition above), what
emotion(s) do you feel now?”

SUD (SUBJECTIVE UNITS OF DISTURBANCE)

“On a scale of 0 to 10, where 0 is no disturbance or neutral and 10 is the highest
disturbance you can imagine, how disturbing does the memory feel to you now?”

0 1 2 3 4 5 6 7 8 9 10
No disturbance Highest disturbance
LOCATION OF BODY SENSATION
“Where do you feel it in your body?”

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PHASE FOUR: Desensitization: Track channels of associations as they emerge about the
memory and other experiences:

BEGIN PROCESSING ON THE TARGET MEMORY: “I’d like you to bring

up that picture, those negative words (repeat the Negative Cognition),
notice where you are feeling it in your body, and follow my fingers.”
BLS generally 20 or more passes customized to the client’s need.
Formatted: Font: (Default) Verdana, 11 pt

RESUME PROCESSING ON AN INCOMPLETE TARGET MEMORY (See

Reevaluation for instructions on setting up an incomplete session): “Bring
to mind the experience, the emotions and sensations you’re having now,
and follow my fingers.”

A. REPROCESS:
“Take a breath; let it go. What are you noticing now? (Pause for a response.) Go with
that.” (BLS generally 20 or more passes/customized to need of client).

Repeat: “Take a breath; let it go. What are you noticing now? Go with that.” (BLS
generally 20 or more passes/customized to need of client) as long as client reports
change or new information (as many sets of BLS as necessary) until the client stops
reporting change for two consecutive sets of BLS, then ask (B).

B. BACK TO TARGET:
“When you go back to the original memory, what are you noticing now? (Pause for a
response.) Go with that.”
(BLS generally 20 or more passes/customized to need of client).

Repeat: “Take a breath; let it go. What are you noticing now? (Pause for a
response.) Go with that.” (set of BLS) Continue with sets of BLS as long as client
reports change or new information (as many sets of BLS as necessary).

When the client goes back to original target after two consecutive sets of BLS and
still reports no change check SUD (see C below).

C. CHECK SUD:
“When you bring up the original memory, on a scale of 0 to 10, where 0 is no
disturbance and 10 is the highest disturbance you can imagine, how disturbing does
it feel to you now? Go with that.” (sets of BLS).

If SUD is 1or 2, ask, “Where do you feel it in your body? Go with that.”
(set(s) of BLS)

REPEAT Steps A, B, and C until SUD is 0 (or ecologically sound).

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PHASE FIVE: Installation: Linking the desired Positive Cognition with the original
memory/experience:

1. “Do the words (repeat the PC) still fit, or is there another positive statement that
fits even better?”

“Think about the memory and those words (repeat the selected PC). From 1 (completely
false) to 7 (completely true), how true do they feel?”

2. “Hold them together.” (do BLS)

3. “On a scale of 1 to 7, how true do those words (PC) _________ feel to you now?”

4. Continue sets of BLS until the VOC no longer strengthens. Once the VOC=7 (or
ecological), go to Phase 6: Body Scan.

If client reports a 6 or less, check appropriateness and address blocking belief (if
necessary) with additional sets of BLS.

NOTE: If running out of time, set aside the blocking belief to be addressed at
a later time and proceed to Closure for Incomplete Session.
PHASE SIX: Body Scan: “Close your eyes and keep in mind the original memory and the
words, (repeat the selected Positive Cognition). Then bring your attention to the different parts
of your body, starting with your head and working downward. Any place you find any tension,
tightness or unusual sensation, tell me.”

If any sensation is reported, do BLS. If a positive/comfortable sensation, do BLS to strengthen

the positive feeling. If a sensation of discomfort is reported—reprocess until discomfort
subsides.

PHASE SEVEN: Closure: Procedure for bringing closure to incomplete target: An incomplete
session is one in which a client’s material is still unresolved, i.e., the client is still reporting
distress, the SUD is greater than 0, the VOC is less than 7, or Body Scan isn’t clear.

Steps:
1. Give the client the reason for stopping. “We are almost out of time and we will need to
stop soon. (Give encouragement and support for the effort made.) You have done some
very good work and I appreciate the effort you have made. What feels like the most
important thing you have learned about yourself or for yourself today?”

2. Offer a containment exercise: “I suggest we do a relaxation or a container exercise before

we stop.” Clinician suggests either a relaxation exercise or containment strategy
(Container; Safe Place; Light Stream, etc.).

3. Read the “Debrief the Experience” section to the client as scripted below:
Closure for all Sessions: Debrief the experience
“The processing we have done today may continue after the session. You may or may not
notice new insights, thoughts, memories, or dreams. If so, just notice what you are
experiencing-take a snapshot of it in a log (what you are seeing, feeling, thinking, and the
trigger on the TICES grid). Use the Safe Place exercise to manage any disturbance that comes
up. Remember to use a relaxation technique daily. We can work on this material next time. If
necessary, you can call me.”

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TREATMENT SESSION SUMMARY NOTES

For Record-Keeping Purposes

CIRCLE APPROPRIATE ITEMS:

NAME__________________________________ DATE ___/___/___

PRESENTING ISSUE:_____________________________________________

_______________________________________________________________

TARGET MEMORY:
_______________________________________________________________
Past Present Trigger Future Template

Target Memory Status: Complete Incomplete

Stabilization Exercise used at the end of the session? Yes/No

Safe Place Light Stream Breathing Other_________________

Client Stability when leaving session:

Poor Fair Good Excellent

Treatment Summary Notes:

______

______

______

Issues/associations that arose during processing to be re-evaluated at later time:

______

______

______
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REEVALUATION WORKSHEET

REEVALUATION (Global)

“Tell me what you have noticed that is different in your life since our last
session.”

“What changes have you noticed in your response to the issue we have been
working on?”

“Any new insights?”

“Any dreams?”

“Are you noticing any changes in your behavior, your attitude about it, or your
feelings?”

“Are you aware of any changes in your symptoms?”

TARGET (Memory Specific)

“As you bring to mind the (target) memory we focused on during our last
session, what are you noticing now?

“What has changed or is different about the experience as you think of it?”

“Any new insights or thoughts?”

“Any new connections?”

“When you think of the experience, on a scale from 0-10, how

disturbing is it to you now?”

Note to Clinician: Remember to review History Taking and Treatment

Planning Worksheet (see next page) to determine how to best
proceed if Target Memory from previous session has been resolved.

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TREATMENT PLANNING CONSIDERATIONS

TREATMENT PLAN:

1. Original Target Memory is complete (SUD=0, VOC=7, clear Body Scan).

2. Check remaining experiences identified during History-Taking as well

as associations that emerged during reprocessing:

Past
Reprocess past experiences that are still disturbing.
Apply standard procedures for Phases 3-8 until fully reprocessed.
Present
Reprocess present triggers that are still disturbing.
Apply standard procedures Phases 3-8 for each trigger that did not generalize
from reprocessing past experiences.
Future Templates
As past experiences and present triggers are resolved, proceed to “Procedural
Steps for Installing Future Templates.”

INCOMPLETE TARGET MEMORY ASSESSMENT (SUD>0)

SUD>0: Procedures for restarting an incomplete Target Memory.

Memory: “Bring up the memory we have been working on. What is the image that
represents the worst part of it as you think about it now?"
Emotions: “What emotions are you experiencing now?”
SUD: “On a scale from 0-10, how disturbing is it?”
Body Location: “Where do you feel it in your body?”
Reprocessing: Go to “Resume Processing for Incomplete Session,” on second page
in worksheet to continue reprocessing from previous session.
If the Target Memory is a SUD = 0 and the Positive Cognition for the Target
Memory is VOC<7: Go directly to Phase 5 in your Assessment and Reprocessing
Worksheet for resuming the Installation Phase. Follow procedural steps through
Closure.

If the Target Memory is SUD=0, the Positive Cognition for the Target
Memory is VOC=7and the Body Scan is not clear: Go directly to Body Scan and
complete.

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Formatted Table

PROCEDURAL STEPS FOR INSTALLING FUTURE TEMPLATES

INTRODUCTION

“We have worked on past experiences relating to your issue, as well as current
situations that have triggered you. I would like to suggest that we now work on how
you will respond in the future to the same or similar situations.”
IDENTIFY DESIRED OUTCOME - STEPS

STEP 1: Identify the future situation (similar to previously identified recent

experience/ present trigger) where a more adaptive response is needed. Discuss
with client to ensure he has the necessary skills to implement it. Identify the
desired positive cognition (PC).

STEP 2: Ask the client to imagine a scene/image of coping appropriately in the

future holding in mind the Positive Cognition (PC) and the feeling.

“I’d like you to imagine yourself coping effectively with a similar situation in the
future. With the new positive belief (___________) and a feeling of __________
(e.g., calm, confidence) imagine stepping into this scene. Notice how you are
handling the situation and what you are thinking, feeling, and experiencing in your
body.”

After a sufficient pause, ask: “What are you noticing?”

➢ If client’s response is POSITIVE: Target the scene and reinforce with BLS
(one or two sets) and then install the Positive Cognition (PC) until VOC
is 7 (or ecologically appropriate).
➢ If client’s response is NEUTRAL or uncertain, ask for clarification (lack skills or
experience, need for a plan). Generate with client desired response. Target
the scene as above.
➢ If client’s response is NEGATIVE: Identify any difficulties, problem solve, and
generate a desired response. Target the scene as above.

STEP 3: Ask the client to run a MOVIE of the sequence from start to finish of
responding adaptively to the situation, holding in mind the Positive Cognition (PC).
“Now I would like you to run a movie of dealing effectively with this situation,
holding in mind the positive belief (state PC) you have about yourself.”
Add BLS (either EM or tactile with eyes closed) as he runs the movie to strengthen
the positive feelings and process any disturbance that may arise. If the client hits
any blocks, address as above until he is able to play the movie from start to finish
with a sense of confidence and satisfaction.

NOTE: If client remains blocked, further processing of past memories may be

needed.

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GENERATE CHALLENGE SITUATIONS Formatted Table

1. Create multiple scenarios where there is an unanticipated or undesirable
outcome and generate an adaptive response to that situation. Process and
install PC to VOC of 7 (or ecologically appropriate) for each situation.
Offer example(s) if client cannot generate them:

“I’d like you to think of a challenge situation that could occur. What are you
noticing?”

2. Target challenging situation starting with the scene of adaptive coping (holding
in mind the PC and feeling), as described in procedural step 2 above, and
reinforce with BLS if client’s response is positive. Then proceed with Installation
of PC.

➢ If client’s response is negative: Identify any difficulties, debrief and process

as needed. Problem solve and generate with client desired response. Target
the scene as above and install PC.

3. Run movie using BLS to reinforce. Repeat until VOC is 7 or ecologically

appropriate and there is an adaptive response throughout.

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