Clients need to be aware that the process of eye movement desensitization and reprocessing (EMDR) treatment can be disturbing and that dissociated material may surface during therapy. Because EMDR has the potential for rapid uncovering of this unsuspected material, some of which may be extremely distressing an assessment needs to be made of the client’s ability to handle strong emotions. For some clients there may be ambivalence about recovery from their dysfunction or distress. Common secondary gains include the loss or reduction of a compensation claim or disability pension. It is strongly recommended that EMDR is not used with clients who have dissociative disorders (DD) unless therapists are confident and competent in their EMDR practice as well as in working with this client population. The chapter also presents a snapshot of Emma’s assessment that should be gathered to determine suitability for EMDR.

This chapter focuses on the desensitization phase during which the therapist processes the dysfunctional material. It explores a range of issues that are frequently raised in this phase, including therapist anxiety and abreactions and explores challenges during the desensitization phase, such as blocked processing and the use of cognitive interweaves. It is not only the client who gets anxious about the desensitization phase. It can be very daunting to the new EMDR practitioner. Performance anxiety can be a block for the therapist as well as for the client. The therapists’ role is distinct in this phase and involves supporting the client verbally with minimum intervention unless the client is stuck. They should help the client to focus on the flow of feelings, thoughts, and body sensations as they unfold. The therapist will observe the nonverbal signs, troughs and peaks of sensations, and will monitor the changes.

This chapter provides an overview of working with clients who present with more complex trauma. Many of the clients that come for Eye Movement Desensitization Reprocessing (EMDR) will have a history of complex trauma or a chaotic childhood. Clients who have experienced complex trauma may lack basic life skills or have missed out on developmental stages due to a chaotic childhood, for example, parents who were absent, neglectful, or abusive. Clients may not have been taught how to regulate their emotions in early childhood. They may present with impulsive, risk-taking, or suicidal behaviors. Before carrying out the desensitization phase of EMDR, individuals need to have an adequate level of resilience and be sufficiently resourced. Clients with Dissociative Identity Disorder (DID) display at least two distinct and enduring “alters” or identity states that recurrently take control of their behavior.

This chapter discusses the client’s ability to self-regulate and handle high levels of affect. The maintaining factors of the effects of trauma- or anxiety-based disorders include fear, avoidance, and loss of control. Building or reinforcing coping strategies allows the client to regain some sense of control over what is happening, which, in turn, can have a positive impact on the fear and avoidance. Many novice Eye Movement Desensitization Reprocessing (EMDR) therapists report additional performance anxiety when their client is a mental health professional. Hyperarousal after a traumatic experience is normal. It occurs when a person’s brain believes that person is at risk again because it misreads an external signal or trigger. Grounding techniques can be taught very easily to clients and are another tool to help the client prepare for dealing with a possible abreaction while undergoing EMDR therapy.

This chapter focuses on the assessment phase and importance of negative cognitions (NCs) drawing heavily on illustrative case vignettes. Janoff-Bulman introduced the notion of an “Assumptive World Theory” to describe how individuals make assumptions about themselves and the world they live in. According to McCann and Pearlman’s Constructionist Self-Development Theory (CSDT), people give meaning to traumatic events depending on how, as individuals, they interpret them. Person-centered counseling refers to “self-concept” describing the individual’s self-image largely based on life experience and attitudes expressed by significant others, such as family, teachers, and friends. Therapists should familiarize the client at an early stage with the mechanics of DAS and allow them some control in choosing the technique to be used. In choosing the target memory, the therapist and client need to determine the touchstone event, that is, the earliest memory linked to the current pathology.

Traumatic events adversely affect many people during their lifetime, and the primary focus of support services is on helping the individual, group, or community to recover from the experience. This chapter provides an overview of psychological injury including the constructs of compassion fatigue (CF), vicarious trauma (VT), and burnout. The causal factors involved in developing these injuries are examined with an emphasis on the raised risks for eye movement desensitization and reprocessing (EMDR) practitioners. Compassion stress is the natural outcome that can result from knowing about trauma experienced by a client, friend, or family member. Secondary Traumatic Stress Disorder (STSD) is synonymous with CF and described as “the natural consequent behaviors and emotion resulting from knowing about a traumatizing event experienced by a significant other-the stress results from helping or wanting to help a traumatized or suffering person”.

This chapter focuses on case studies of installation, body scan, closure, and reevaluation of eye movement desensitization and reprocessing (EMDR). The installation phase is concerned with integrating the positive cognition (PC) with the targeted memory. The PC should be checked for ecological validity and rated on the validity of cognition (VOC) scale. Closure is important at the end of any therapy, and particularly so after EMDR desensitization. As such, it is important to allow sufficient time for closure, debriefing, safety assessment, and homework. As with any therapy, clients will sometimes find that something occurs that disrupts the therapeutic plan. Modeling, education on social skills, and testing out new behaviors will now be the focus of therapy. This may be an unexpected crisis, such as a relationship breakdown or being diagnosed with cancer, and clients will need support in making adjustments in their present life.

Eye Movement Desensitization and Reprocessing (EMDR) consultants can also use this measure in their consulting groups to assist consultees in understanding when work with clients have an impact on the therapist. The purpose of using the Clinician Self-Awareness Questionnaire includes assisting in raising awareness of what may be triggering the therapist, assessing what may be coming from the therapist and what may be coming from the client, and developing EMDR relational strategies. Different problems can arise in different phases of the protocol. Sometimes, client information may not evoke negative arousal in the therapist when the client is actively processing. Often times, the therapist’s triggers are from old memories. These memories may be explicit; at other times, implicit. As therapists begin to notice these moments in themselves, they may aid themselves and their clients in continuing productive processing by using the Clinician Self-Awareness Questionnaire.

It is helpful to introduce the concept of Adaptive Information Processing, to help Eye Movement Desensitization and Reprocessing (EMDR) clients understand the nature of how our brains work. The second phase of EMDR is called the Preparation Phase. When EMDR first started, practitioners often went from Phase 1-Client History Taking to Phase 3-Assessment Phase with just a brief moment to introduce the client to the specifics such as the mechanics of EMDR, including bilateral stimulation (BLS), sitting position, and stop signals. For some clients, this has worked well, however, as time went on, practitioners often reported that something more was needed before beginning desensitization and reprocessing. The idea of tapping into the client’s natural resources began within the Standard EMDR Protocol itself. In the face of man-made or natural catastrophes, practitioners have found that building resources are essential aspects of working with recent trauma, especially for children.

The Wedging or Strengthening Technique has been modified in Germany and is called the Absorption Technique to create resources to deal with what the client is concerned about in the future, or having stress about working with eye movement desensitization and reprocessing (EMDR) in the future, a present trigger or even an intrusive memory. Having clients imagine a strength or skill that would help them during the problem often helps them to reduce their anxiety. Focusing on a specific strength or coping skill may create a wedge of safety or control that will assist clients with the difficult situation in the future. During the Future Phase of the Inverted Protocol for Unstable complex post-traumatic stress disorder (C-PTSD) use the Absorption or Wedging Technique to develop as many different resources for the different issues about which the client might be concerned.