This chapter examines how to prepare patients for the reprocessing phases of the standard eye movement desensitization and reprocessing (EMDR) therapy procedure. The essential elements of the preparation phase covered in the chapter include providing patients the fundamental information needed for informed consent, and offering guidance and metaphors to orient patients to standard EMDR reprocessing procedures. The Preparation Phase in the EMDR approach to psychotherapy corresponds with the initial stabilization or ego-strengthening phase of treatment in the consensus model of treatment for trauma. An essential aspect of the preparation phase is patient education. Patients need to understand their diagnosis, symptoms, the impact of adverse and traumatic experiences, the stages of the treatment plan and what to expect during EMDR reprocessing. For those with histories of exposure to traumatic life experiences, normalizing the development of posttraumatic stress disorder (PTSD) is essential.

This chapter describes the assessment phase of the standard eye movement desensitization and reprocessing (EMDR) protocol for treating posttraumatic stress disorder (PTSD). The two main purposes of the Assessment Phase are to access key aspects of the maladaptive memory network and to establish baseline measures for the level of disturbance in the target, rated with the subjective units of disturbance (SUD) scale, and the felt confidence in a positive self-appraisal, rated with the Validity of Cognition (VoC) scale. In the Assessment Phase, one identifies the image or other sensory memory, negative cognition (NC), positive cognition (PC), specific emotion, and body location of the felt disturbance. The focus of the therapeutic work in EMDR reprocessing sessions is on the reorganization of the memory network. The last step in the standard assessment phase of the selected target is identifying the location of physical sensations associated with the maladaptive memory network.

This chapter explores two case examples: the first one, an adolescent girl named Hannah, and the other, a young man named Justin. Both were treated with eye movement desensitization and reprocessing (EMDR) therapy for panic disorder without agoraphobia (PD). In the case of Hannah, the chapter includes near-verbatim summaries for some of her EMDR reprocessing sessions. Through the work with EMDR therapy, she quickly overcame her panic attacks, raised her grades significantly, and gained a new sense of strength to help her cope with the manipulative behaviors of her alcoholic mother. The case of Justin illustrates a treatment plan that needed to consider the interaction of a preexisting PD with a recent traumatic exposure that led to the onset of depersonalization disorder. The idea that EMDR therapy might stimulate the same parts of his brain active in random eye movement sleep appealed to Justin.

This chapter examines additional issues that need to be considered when applying eye movement desensitization and reprocessing (EMDR) therapy to the treatment of individuals with panic disorder (PD) and panic disorder with agoraphobia (PDA). It reviews the literature on effective treatments for PD and PDA with a focus on cognitive and behavioral therapies, pharmacotherapy, and EMDR therapy. The chapter reviews the case reports and controlled studies on the application of EMDR therapy to PD and PDA to consider what lessons can be learned from these reports to guide EMDR therapy clinicians. It explains step by step through two-model treatment plans for using EMDR therapy for treating PD and PDA, one for simpler cases with PD without agoraphobia or other co-occurring disorders, and the other for more complex cases of PDA or PD with generalized anxiety disorder, avoidant personality disorder, and other co-occurring anxiety or personality disorders.

This chapter examines additional issues to be considered when applying eye movement desensitization and reprocessing (EMDR) to the treatment of individuals with specific phobias. It considers the nature of specific phobias, both those of traumatic and nontraumatic origins. It also examines the similarities and differences of specific phobias of a traumatic origin with posttraumatic stress disorder (PTSD). The chapter discusses the limited controlled research on all treatments for specific phobias of a traumatic origin. It reviews the literature on case reports of EMDR treatment for specific phobias and describes all eight phases of the standard protocol for EMDR treatment of specific phobias including how to identify targets, how to prepare patients, and the sequence of treatment for applying EMDR reprocessing. The chapter reviews a series of case vignettes that illustrate key aspects of applying EMDR therapy to the treatment of specific phobias.

This chapter provides an overview of the standard eight-phase model of eye movement desensitization and reprocessing (EMDR) therapy and the general three-pronged protocol that provides the framework for the specific treatment protocols for diagnostic groups. It briefly touches on clinical situations where the general principle of treatment planning based on the three-pronged protocol must give way to an initially inverted protocol for treatment planning that starts with reprocessing targets in the future, then on the present, and addresses past targets only after significant treatment gains have been achieved. The chapter explores the theoretical and practical aspects of the EMDR therapy approach to case formulation, treatment planning, and selecting and preparing patients with posttraumatic stress disorder (PTSD) and other post-traumatic syndromes for EMDR reprocessing. Screening for a possible dissociative disorder is essential before offering EMDR reprocessing on either traumatic targets or resource installation.

This chapter lists and examines essential criteria to consider when assessing patient stability and readiness for the standard eye movement desensitization and reprocessing (EMDR) procedural steps. In considering a patient’s suitability and readiness for standard reprocessing, five kinds of issues need to be considered: medical concerns; social and economic stability; behavioral stability; mood stability; and complex personality and dissociative disorders, life-threatening substance abuse, and severe mental illness. Depersonalization and derealization as expressions of primary structural dissociation are frequently the only dissociative symptoms in patients with posttraumatic stress disorder (PTSD). The chapter reviews standardized assessment tools that can assist clinicians in assessing symptom severity, screening for dissociative disorders, and monitoring treatment progress and outcomes. The trauma assessment packet includes four test instruments, along with three research and clinical articles, which together provide a comprehensive assessment of trauma histories at different ages.

This chapter describes the Reevaluation Phase and completing the treatment plan of the standard eye movement desensitization and reprocessing (EMDR) protocol for treating posttraumatic stress disorder (PTSD). Reevaluation begins during the History Taking and Preparation Phase in which we consider the impact of patients’ disclosure of information, perceptions of the clinician’s responses, as well as the impact of skill building and stabilization exercises on patients’ stability, symptoms, and functioning. Monitoring patient responses to treatment is essential to the macro level of reevaluation. In other cases, mild regressions in functioning, especially after a session in which a traumatic memory was incompletely reprocessed, can be quickly overcome by resuming reprocessing to fully resolve the memory. Just as recurrent nightmares are symptoms of PTSD, so changes in these dreams after EMDR reprocessing of the memories are sometimes signs of shifts in the way information about traumatic experiences has been modified.