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.

This chapter describes the procedures used in the desensitization phase- phase 4 of the standard Eye movement desensitization and reprocessing (EMDR) protocol for treating posttraumatic stress disorder (PTSD). Standard EMDR reprocessing begins with the desensitization phase. The goal of the desensitization phase is to foster spontaneous emotional information processing that leads to synthesis between the maladaptive memory network of the selected target memory and other adaptive memory networks. During reprocessing, rapport is maintained by the pacing of the sets of BLS and the periodic brief pauses for patient reports than by the verbal interaction between clinician and patient. Before starting reprocessing, one should reinforce the patient’s orientation to dual attention. With effective reprocessing, patients can make reports that remain focused primarily on shifts within the selected target. In the desensitization phase, the purpose of returning to target is to determine if there is more material that needs to be reprocessed.

This chapter summarizes two composite cases to illustrate eye movement desensitization and reprocessing (EMDR) treatment principles. The first case talks about a single-incident adult trauma. The patient, Gladys, is a 32-year-old married woman who became fearful while driving and at home after a recent motor vehicle crash in which she sustained physical injuries. The case of Gladys illustrates the use of interweaves for responsibility, safety, and choices, which helped Gladys at crucial moments in her reprocessing to move through challenging material within the framework of a standard length treatment session. The patient in the second case, Eva, is a 23-year-old college student who decided to take a break from school after episodes of drinking to the point of blacking out and having sex with men she didn’t know. Her history included childhood sexual abuse by her father that had never been addressed.

This chapter describes the Installation, Body Scan, and Closure Phases-Phases 5, 6, and 7-of the standard eye movement desensitization and reprocessing (EMDR) protocol for treating posttraumatic stress disorder (PTSD). The aim of the Installation Phase is to extend reprocessing and ensure generalization of treatment effects with a complete integration of a new perspective on the target memory network. The first step in the Installation Phase is to check to see if there is a better, more appropriate positive cognition (PC). Tension in the neck and shoulders that emerged during the Installation Phase and was reported in the Body Scan Phase is likely to be linked to the targeted material. If this tension were not cleared in the Body Scan Phase, the session would be classified as incomplete. The Closure Phase serves several purposes. It provides a structured sense of completion to each EMDR reprocessing session.

This chapter presents the conceptual framework for understanding eye movement desensitization and reprocessing (EMDR) therapy. It begins with a review of selected aspects of four models of psychotherapy that historically most directly support understanding the evolution of EMDR therapy. The early history and evolution of EMDR therapy in turn have been strongly associated with the search to understand and treat the relationship between trauma and dissociation. Classical behavior therapy views posttraumatic stress disorder (PTSD) through the lens of conditioning in which a powerful conditioned association is formed between specific cues were present at the time of adverse or traumatic experiences and the intense state of alarm evoked by the experience. In EMDR therapy, various strategies can be employed to support the goals of stabilization and symptom reduction. Some stabilization strategies commonly used in EMDR therapy were developed in other traditions such as progressive relaxation, self-hypnosis, biofeedback, and meditation.

This chapter examines sources of difficulty clinicians newly trained in eye movement desensitization and reprocessing (EMDR) therapy face in developing and following a treatment plan. It considers a series of essential elements of case conceptualization including degree of structural dissociation and attachment classification; standardized tools and clinical strategies for history taking including EMDR-specific forms and the use of bridge techniques; issues surrounding recovered memories and the plasticity of memory; and a brief introduction to the history of and concepts in attachment theory including the impact of attachment organization in phases of psychotherapy; tools and clinical strategies for assessing adult attachment classification. The chapter examines a research supported, symptom informed model for target sequencing in EMDR therapy and close with a sample treatment plan based on a prototype case of a rape survivor. It reviews three standardized tools to assist in gathering information about patients’ histories, presenting complaints, and treatment goals.

Clinicians currently being trained or recently trained in eye movement desensitization and reprocessing (EMDR) therapy face a range of issues when introducing EMDR therapy into their practice settings. To support clinicians in educating their systems, resources are available from both the EMDR International Association (EMDRIA) and the EMDR Humanitarian Assistant Programs (EMDR HAP) online stores. Coordination of care with other professionals involves educating them about the approach and the methods that we use. Decisions on scheduling the length of each treatment session depend on treatment setting, stage of therapy, stability of the patient, experience of the clinician, the treatment plan, and systems issues. Patients will be appreciative of their gains, and these initial experiences are essential to clinicians’ professional development. When most clinical issues arise during EMDR reprocessing, the Adaptive Information Processing (AIP) model informs the selection of standardized procedures.

This chapter examines the role of consultation and supervision in completing the requirements established by the Eye Movement Desensitization and Reprocessing (EMDR) International Association (EMDRIA) for basic training in EMDR therapy and for achieving advanced recognition as an EMDRIA-Certified Clinician in EMDR therapy and as an EMDRIA-Approved Consultant. EMDRIA describes consultation in basic training as involving “teaching, practicum” and review of “clinical use” of EMDR therapy. Consultation as part of basic training in EMDR therapy is intended to support trainees to be able ’to safely and effectively integrate the use of EMDR therapy into their clinical setting’. The chapter focuses on some of the issues of professional development, ethics, and recordkeeping that those wanting to move toward and those who already are providing EMDR therapy consultation should consider. The central role of supervision in achieving minimal acceptable standards of knowledge and skill is consistently recognized by state licensure board’s requirements.

This chapter covers a wide range of strategies for maintaining and restoring effective reprocessing in the desensitization phase-phase 4-of the standard eye movement desensitization and reprocessing (EMDR) protocol for treating posttraumatic stress disorder (PTSD). It begins with clarifying standard sequences and decision trees that guide clinical work. When reprocessing target memories that are strongly, emotionally charged, it is not unusual for patients to experience intense emotional responses during reprocessing. The chapter examines the issues and strategies for supporting patients experiencing prolonged, intense emotional responses. It explores when and how to use interventions to deliberately stimulate an adaptive memory network to encourage synthesis with the selected target memory, which Shapiro refers to as ’cognitive interweaves’. When one have developed and installed resources during the Preparation Phase of treatment, these resources can be re-accessed as interweaves during ineffective reprocessing to assist patients in locating adaptive memory networks.

This chapter reviews the adaptive information processing (AIP) model, which is the theoretical foundation of the eye movement desensitization and reprocessing (EMDR) approach to psychotherapy. It examines how the concept of memory networks has evolved from its roots to the way it is used in EMDR therapy. The concept of dual attention can be viewed as a state in which consciousness is in balance and where attention can fluidly shift between current sensory perceptions and relevant memory networks. The chapter also reviews research on the specific effects of trauma and early developmental deficits on information processing. The chapter considers what theory and outcome data suggest regarding the effects of different modes of bilateral sensory stimulation during EMDR reprocessing. For clinicians and patients with significant training and experience in models of verbal psychotherapy, initial experiences of optimal responses to EMDR therapy can seem dramatically rapid and comprehensive.