What is adjunct EMDR?
I specialize in adjunct EMDR, which is when a client comes to me specifically for EMDR, based on a referral from their therapist. They may see an EMDR therapist alongside their regular therapist or during a pause in their therapy. I require open consent to exchange information for the duration of treatment. I will have a phone or video conversation with therapists about the referral before the client’s first visit.
Often, clients want to do EMDR to be relieved of longstanding difficult emotions or a feeling of being stuck. However, there are significant defenses that support keeping these emotions locked into their current configuration. That is actually quite adaptive. I trust clients’ instincts about proceeding with EMDR, but I do have some basic requirements for readiness, which you will find are fairly consistent among EMDR therapists:
Clients need to have a little bit of stability, enough to stay aware of the present moment while recalling their trauma. Having this dual awareness is crucial for EMDR to be effective. I want to know if they can maintain their present level of functioning while in therapy and that they are not actively suicidal. EMDR can work to reduce dissociation, but being fully dissociated frequently would require an EMDR therapist who specializes in DID.
Parts Work/Internal Family Systems: I often do parts work alongside EMDR with clients. Having parts of ourselves segmented and protected is quite common among those who have PTSD. So, some familiarity with this concept is good preparation. Another important preparation for EMDR is having familiar, reliable, and internalized strategies for grounding and containing discomfort when upset. Those skills can be strengthened in EMDR Phase 2.
Please feel free to email me or call if you have questions.
Is my client ready for EMDR?
Francine Shapiro outlines several important steps in ascertaining if a client is ready to utilize EMDR (New Notes, 2006) to process disturbing material. The signs of readiness include being able to tolerate distressing affect associated with the unprocessed material.
The client must be able to just “let whatever happens happen.” The client must be able to change mental and emotional states and have positive networks. The client must be able to maintain dual attention during processing and tolerate Bilateral Stimulation.
Steps to assess readiness for target processing:
1. Screen for dissociative disorders, utilizing DES or other appropriate means.
2. Assess for active psychosis or major vegetative depression.
3. If loss of consciousness occurred during the event or there is any other physical issue of concern, contact the client’s medical provider, with the client’s permission (obtain written consent).
4. Determine if the client is a danger to self or others.
5. Assess for current crisis, if other than any crisis being fueled by a recent traumatic incident.
6. Ascertain if the client can change state, ie, self-soothe, using some method (safe place, breathing, etc.) and tolerate/regulate positive and negative affect.
7. Determine if the client can maintain a connection to the therapist and their own sensations during BLS (dual attention).
8. Client has adequate internal and external resources available that they will utilize.
If the client does not meet this readiness criterion, either the referring clinician or I will assist the client in becoming more stable and extend the time in Phase 2 Preparation, as necessary.
If the client is not psychiatrically stable and cannot be assisted in becoming stable in an outpatient setting, I will make the appropriate referrals for the client’s safety and stabilization, incorporating the referring clinician in treatment planning according to consent of the client.