Many Eye movement desensitization and reprocessing (EMDR) clients process in a straightforward manner with few direct therapeutic interventions on the part of the clinician. For others, however, processing to completion without any additional interventions is unlikely. The reasons for blocked processing are varied and multifaceted. This chapter explores guidelines for facilitating abreactions, strategies for blocked processing, and applying more proactive interventions for achieving full treatment effect. These interventions are intended to mimic a natural progression toward resolution. Clinicians who are trained in EMDR therapy are already familiar with many of the strategies particularly the strategies for clients who present with affect regulation difficulties or with complex trauma. Clinical supervision and/or consultation in these cases are always recommended. This chapter explores, three types of client responses—normal, overaccessing, and underaccessing—and strategies the clinician can apply when the client displays either low or high levels of emotions and/or blocked processing.

This chapter provides an overview of didactic and clinical accommodations, including information on accommodating the various forms of assessment that are used in health science programs. It offers specific guidance with regard to accommodating overnight call, students with color-vision deficiency, autism spectrum disorders, blood-borne diseases and those who are deaf and hard-of-hearing. A section on the inclusion of service animals helps programs develop appropriate protocols for animals that may be entering the clinic. Throughout the chapter, practice examples afford the reader an opportunity to apply the guidance to real student scenarios, while case examples provide a legal framework for determining reasonable clinical accommodations. Determining accommodations is an interactive process between the student and the disability resource professional (DRP) or responsible campus entity. The chapter helps DRPs and institutions understand how to work collaboratively to determine and implement reasonable accommodations in all types of health science education settings.

Acute care hospitals and ambulatory health care facilities employ more social workers than other settings including individual and family services, schools, and state and local government agencies. The number of practicing health care professionals continues to rise and health care is now the largest employer in the United States. Acute care hospitals often include medical and surgical units, and patients need services that are required to be supervised by licensed medical personnel. Ambulatory settings provide diagnosis, treatment, and care that is not inpatient, and the treatment and care do not require the specialized services. This chapter identifies dialysis social work in nephrology settings as ambulatory care. It provides case exemplars to highlight acute and ambulatory care social work and the processes that are involved in assessment, intervention, and treatment. The chapter explicates areas of strength and concern in the present state of acute and ambulatory care social work practice delivery.

This chapter presents a review of adaptive behavior assessment from conceptual, technical, and practical perspectives. Although adaptive behavior is a construct with relevance across multiple disability populations served by rehabilitation professionals, its greatest relevance concerns persons with intellectual disabilities (ID). This chapter presents adaptive behavior assessment within an ID context. It begins by describing the population of persons with ID and how they are defined through federal legislation and professional associations. Specific focus is placed on the growing importance of adaptive behavior in the process of identifying persons with this disability. The chapter then presents a review of standardized and informal approaches to adaptive behavior assessment. To illustrate its professional importance and use of best-practice approaches, the chapter then addresses three practice areas where adaptive behavior assessment plays a key role in contemporary practice with persons with ID, including death penalty evaluations, community-based habilitation, and culturally responsive assessment.

Although mental health professionals embrace broad assessment protocols, which attempt to incorporate biopsychosocial, and, more recently, the cultural and spiritual identities of the individual, attention is rarely given to the individual's unique internal and external sources of strength and support. The limitations of traditional medical model diagnosis, particularly in the form of the Diagnostic and Statistical Manual of Mental Disorders classification system, have been noted by many researchers and practitioners. At the same time, research has focused on predictive factors in treatment outcome, both in terms of client characteristics and in the utility of evidence-based treatment protocols applied to specific mental disorders. The cumulative themes in contemporary discussions of diagnostic systems and effective treatments, logically related to diagnosis, suggest the need for an additional core component of the diagnostic system, for which the authors advocate the Intersectionality/Resiliency Formulation.

This chapter explains a set of guidelines to help mental health professionals and clients move away from the gender stereotypes that perpetuate inequality and illness. Identifying dominance requires conscious awareness and understanding of how gender mediates between mental health and relationship issues. An understanding of what limits equality is significantly increased when we examine how gendered power plays out in a particular relationship and consider how it intersects with other social positions such as socioeconomic status, race, ethnicity, and sexual orientation. To contextualize emotion, the therapist draws on knowledge of societal and cultural patterns, such as gendered power structures and ideals for masculinity and femininity that touch all people’s lives in a particular society. Therapists who seek to support women and men equally take an active position that allows the non-neutral aspects of gendered lives to become visible.

Adolescents experience barriers in access to sexual and reproductive health care, leading to a disproportionately high burden of disease and morbidity. Teens and young adults may avoid or delay accessing care due to perceived or experienced bias or judgement from healthcare providers or perceived or experienced inability to access care independently. Establishing positive, trusting relationships with adolescents is key to promotion of life-long health. Confidentiality plays a critical role in developing strong client-provider relationships, particularly for adolescent clients. Perception of confidentiality impacts an adolescent’s decision to seek care, disclose behaviors and concerns, as well as return for follow-up care. This chapter addresses the specific sexual and reproductive health needs of adolescents including care for common gynecologic conditions in adolescence as well as pregnancy. There is also information about mental health, suicide prevention, bullying, sexting, and age specific vaccination recommendations.

Professional health and wellness coaches (HWCs), along with allied healthcare professionals trained to use basic coaching skills, offer the promise in assisting patients to prevent or better manage their chronic disease in making sustainable healthy lifestyle changes. While the HWC does not assume the traditional expert approach of many types of healthcare professionals, there is an element of sharing health information with clients. Specifically, when the HWC believes that objective information might help the client in advancing the coaching process or the client requests information, information is shared, after permission is granted by the client. The HWC strategically employs interaction skills by asking open-ended questions, providing affirmations, responding with perceptive reflections and summary statements in order to engage the client, define his or her focus, resolve ambivalence, evoke motivation, and move toward action.

For women and their children to be safe, healthcare providers must have compassion, be vigilant and practice evidence-based care within a healthcare system that has a culture of safety. Safety requires nursing advocacy, communication, appropriate use of the chain of command, and evidence-based practice. Evidence-based practice is essential to maximize safety and minimize adverse outcomes. Evidence based practice needs to be efficient and equitable. Childbirth safety also requires competent, unbiased, compassionate, and vigilant care. Advocacy requires a nurse to recognize, verbalize, and mobilize. Communication among the healthcare team members is imperative to help ensure the individuals required to provide safe care to the mother and baby or babies are available in a timely manner. Competent nurses will individualize the plan of care and inform the obstetric care provider of threats to maternal and fetal safety so that interventions are customized to prevent adverse outcomes.

Health professionals are often called upon to intervene in complex ethical dilemmas that involve respecting an older adult's autonomy while also considering protective interventions to ensure safety. This chapter addresses the foundational ethical competencies for psychologists and geropsychologists including the unique challenges associated with surrogate decision making, legal, clinical, and psychosocial interventions specific to working with vulnerable older adults, ethical dilemmas that can emerge within various situations including assessment and integrated care settings, detection and intervention strategies in cases of elder abuse, neglect, and exploitation, and ethical approaches to research with older adults. Finally, the authors discuss the multicultural dimensions that influence how ethical and legal issues are conceptualized and addressed. The micro-and macrosystems in which older adults live and thrive require a level of cultural sensitivity, an understanding of aging processes, and knowledge about professional ethics and legal standards involved in decision making.

This chapter explores sex, aging, and EMDR therapy. Aging and sexuality are not often discussed in the field of mental health, even though aging is something that we are all doing everyday. Older adults face menopause, sexual dysfunction/changes, and changes in body functioning and image. Internalized ageist myths and stereotypes can prevent older adults from having a positive outlook on the aging process. It is extremely important that these views do not prohibit older adults from getting help from healthcare providers. All healthcare providers need to be open and comfortable with talking about sex and aging.

Anemia is a common medical disorder of pregnancy. Two of the most common causes of anemia during pregnancy are iron deficiency and physiologic anemia caused by blood volume expansion greater than the red blood cell mass. However, other inherited and acquired causes of anemia should not be overlooked. Iron requirements increase significantly during pregnancy and, unfortunately, many individuals start pregnancy without sufficient stores to meet the increased demands. Health care providers need to educate individuals about the importance of taking an iron supplement during pregnancy and dietary sources of iron. This chapter addresses assessment of anemia during pregnancy, management, and patient education. Anemia may be characterized several ways such as by the causative mechanism, whether inherited or acquired, by a reduction in the number of red blood cells (RBCs) or the RBC size (mean corpuscular volume–MCV), which results in decreased ability to carry oxygen to tissues.

The assessment of sex and relationship problems is dependent, in part, on the setting in which issues are presented, the training of the provider, and practical matters such as time constraints. In the PLISSIT model, P stands for permission, LI and SS stand for limited information and simple suggestions, and IT stands for intensive therapy. Initial assessment of sexual problems is nearly always the same, whatever the setting. The following six-step assessment will cover most any situation: establishing rapport; defining the problem; ruling out medical and other organic causes; if no medical cause, or if there are medical causes and the mental health professional is working in collaboration with healthcare provider, establishing a realistic goal; providing information and suggestions that may resolve the problem; and if two or three attempts to resolve the problem with information and suggestions is ineffective, treating or referring for treatment with intensive therapy.

Human trafficking, also known as trafficking in persons or modern-day slavery, is a crime that involves compelling or coercing a person to provide labor or services or to engage in commercial sex acts. The coercion can be subtle or overt, physical, or psychological. The exploitation of a minor for commercial sex is human trafficking, regardless of whether any form of force, fraud, or coercion was used. Sex trafficking is the recruitment, harboring, transportation, provision, obtaining, patronizing, soliciting, or advertising of a person for a commercial sex act. Sex trafficking is divided into two distinct subcategories: adult sex trafficking and child sex trafficking. This chapter discusses etiology and incidence, and risk factors of human trafficking, and guidelines for primary care providers responding to suspicion or disclosures of human trafficking. It also discusses trauma-informed care, treatment and management, definition and types of female genital mutilation.

In conducting psychological assessments to identify psychopathology, it is essential that clinicians continue to engage in activities that help them remain current on the state of the science. The models to conceptualize psychopathology, the diagnostic criteria, and the instruments used to inform clinicians in arriving at diagnoses and treatment plans continue to evolve. The assessment of psychopathology is rooted in knowledge of the empirical evidence of the diagnostic criteria, and a lack of current information of the empirical evidence can lead to faulty application of assessments or incorrect conclusions regarding diagnoses. Interviews, behavioral observations, self-report inventories, psychological testing, historical/medical record review, functional assessment, and clinical judgment are all necessary in the formation of a diagnostic picture that provides an accurate depiction of clients’ current issues and the selection of interventions that are likely to be the most effective.

In the early 20th century, asthma was considered as one of the “Holy Seven” psychosomatic disorders and thus was thought to be amenable to psychological therapy. In multiple case reports, hypnosis has been reported to have beneficial effects on the subjective aspects of asthma, which include symptom frequency and severity, coping with asthma-specific fears, managing acute attacks, and frequency of medication use and health visits. Asthma is treated with a combination of anti-inflammatory and bronchodilator medications that typically are inhaled. Hypnosis may also be efficacious for decreasing airway obstruction and stabilizing airway hyper-responsiveness in some individuals. There are several additional hypnotic techniques, such as breathing techniques, subconscious exploration, and age regression, which can be useful in the treatment of patients with asthma. Patients can be taught to use some of these techniques through self-hypnosis on an as-needed basis.

Abnormal uterine bleeding (AUB) is one of the most common patient concerns in the adolescent population. AUB is defined by menstrual bleeding that occurs outside of the normal range and can include irregular bleeding patterns; prolonged or short bleeding episodes; and heavy or light bleeding. In order to determine abnormal bleeding amounts and/or patterns, it is important to understand the normal parameters for a menstrual cycle in this age group. Nurses and healthcare providers must collect as much information as possible about the menstrual bleeding to help determine the appropriate plan of care.

Self-care is critical when someone works with clients or patients who have experienced trauma. Providers might also be dealing with their own trauma history. Burnout is possible, as are compassion fatigue and secondary traumatic stress. Burnout is a gradual process. Secondary traumatic stress can be gradual but can also happen suddenly. Burnout is a process during which a person disconnects from work and relationships. The common causes of burnout are overwork, unrealistic expectations, lack of sense of coherence, perfectionism, and codependency and overinvolvement. Compassion fatigue appears to be relatively common among those who work with abuse survivors. Countertransference is a psychoanalytic term that has relevance to trauma work. Providers should take time to take care of their bodies. This means getting enough sleep, eating nutritious foods, exercising, connecting with others, and maintaining a spiritual life.

This chapter describes the current status of caregiving in the United States. Who are caregivers and what tasks they routinely do are discussed. The diversity of caregiving is also considered. Physical, psychological, social, and financial ramifications of caregiving are described along with benefits reported. The chapter concludes with recommendations on how healthcare professionals can support caregivers.

Polyps are the most common benign tumors of cervix and are found most often during the menstruating years. They are soft, pear-shaped (finger-like), red to purple lesions, and are usually pedunculated growths from the surface of the cervical canal. They are very friable and contain a large number of blood vessels, particularly near the surface. Typically, polyps are not cancerous (benign) and are easy to remove. Polyps do not usually grow back. However, women who have polyps once are at risk of growing more polyps. Pelvic examination will reveal smooth, red, or purple finger-like growths on the cervix. They are often removed during a routine pelvic examination. A cervical biopsy will most often show cells that are consistent with a benign polyp. Rarely, there may be abnormal, precancerous, or cancer cells in a polyp.

Chronic renal failure poses a singular challenge for health professionals who deal with illness-related disability and rehabilitation. The course of progressive chronic kidney disease (CKD) leading to renal failure often spans many years; during the period before dialysis or renal transplantation is undertaken, the patient may experience disabilities related to cardiovascular disease, anemia, malnutrition, metabolic bone disease, neuropathy, muscle wasting, and acid-base and electrolyte disturbances. Dialysis treatment and transplantation significantly prolong the lives of patients with renal failure. A better understanding of the pathophysiological basis for many of the disabling aspects of chronic renal failure has led to therapies that may reduce the frequency and/or severity of these aspects of the disease. Prevention of disability and rehabilitation has become increasingly important as the number of patients treated with dialysis therapy and renal transplantation has become more common.

This chapter defines chronic pain, types, and causes; describes medical characteristics of two emerging chronic pain conditions namely chronic migraines and fibromyalgia; and discusses symptomology, diagnosis, and treatment issues associated with these conditions. It explores the medical, psychosocial, and vocational aspects of chronic pain, and examines the characteristics of populations most likely to experience chronic pain. The chapter presents recommendations for providing responsive rehabilitation counseling services to the growing numbers of individuals living with chronic pain who are served by rehabilitation counselors across all employment settings. As myths about chronic pain are so prevalent, rehabilitation counselors must carefully examine their own potential biases and misconceptions about chronic pain, its causes, and treatment. Complementary health approaches are often used by people with chronic pain and may include yoga, spinal manipulation, massage therapy, heat and cold applications, meditation, acupuncture, herbal medicines, vitamins, and minerals.

Chronic pain syndromes are composed of a multifactorial relationship between biologically based neurological triggers and pathways; psychologically mediated moods, emotions, and behaviors; and socially developed responses, interactions, and consequences. The complex interplay between these factors can devastate a patient’s quality of life, as well as make the diagnoses, treatment, and ongoing management of chronic pain syndromes by health care professionals exceedingly difficult, resulting in psychological and physical disability. In chronic pain, the imprinted signals and perceived pain may persist for several weeks, months, or even years after the original injury has healed. Treatment of chronic pain creates yet another dimension of complexity, as it requires a multimech-anistic, multimodal, or multidisciplinary approach for effective management. Chronic pain often is mixed nociceptive and neuropathic or primarily neuropathic and is associated with imprinted neuroanatomical and chemical changes in the peripheral and central nervous systems, which results in abnormal processing.

This chapter focuses on office automation and systems that are useful in the mental health field, along with principles to be aware of when considering the use or purchase of such systems. Most managers have to rely on input from outside in order to form an opinion about how to resolve complex issues. The complexity of the issue increases significantly when the current federal health care laws are incorporated into the task of choosing appropriate clinical information management software. The significance of Health Insurance Portability and Accountability Act (HIPAA) would seem to dictate at least a brief foray into its content because it lays the foundation for virtually everything that is happening in the clinical information management (CIM) realm. The information provided in the chapter can give a backdrop by which current practices can be examined for goodness of fit with the available client information management systems.

Writing clear and descriptive clinical case notes is very different from most other types of writing. This chapter provides an overview on writing clear, concise, and effective case notes. Counselors have an explicitly stated legal and ethical duty to create and maintain client records on every client. Failure to maintain adequate records could form the basis of malpractice as it breaches the standard of care expected from a mental health professional. Counseling students should remember that like all other counseling training, developing good, clear, and concise clinical writing skills takes time and comes through experience. The practicum and internship placements are good beginning points for developing good clinical writing skills.

This chapter examines three common childhood disorders (conduct disorders, anxiety disorders, and depressive disorders) using the Intersectionality/Resiliency Formation framework, with special attention to important developmental processes at play. It focuses on two specific disruptive disorders, oppositional defiant disorder and conduct disorder because these disruptive behavior disorders are more likely to arouse negative reactivity in persons in child's environment and also pull mental health professionals toward a negative focus on pathology. These two disorders are seen in mental health and community clinics more than any other disorders in minors, are often co-occurring with other psychiatric disorders, and may be complicated by substance abuse and severely delinquent behavior. As externalizing disorders, they are visible to observers and disruptive in the child's environment, whereas externalizing disorders are often less salient to caregivers, teachers, and peers. The chapter focuses on diagnostic developmental considerations when evaluating these and other common disorders in children and adolescents.

Increasingly, women are using complementary and alternative medicine (CAM) therapies for preventive and palliative care as alternative or adjunct therapies to their traditional medical care. This chapter discusses the most commonly used therapies for a variety of conditions that affect women. Women may not perceive vitamins, minerals, herbs, and supplements as medications. Because drug interactions exist with both prescription and over the counter products, it is important for the clinician to ask each woman about the use of CAM therapies at every visit. Women who are pregnant and/or breastfeeding should not use any CAM therapies without consulting their health care provider. Alternative therapies refer to treatment approaches that, though used for many years, have not been evaluated and tested by conventional methods and rigorous research. The chapter provides the general categories of CAM, reasons for selection/use of CAM, concerns regarding CAM, considerations, and frequently used/recommended CAM therapies.

This chapter explores four common ethical principles impacting neonatal care such as autonomy, beneficence, nonmaleficence and justice. It discusses recommendations for palliative and end-of-life care for infants and identifies situations and conditions that create moral distress. The chapter analyzes case presentations to identify the critical issues affecting the family and staff and synthesizes an approach to infants at the end of life, including care of families. It describes important aspects of critical discussions with parents in the neonatal intensive care unit (NICU). The chapter suggests best practices for communicating with parents and professional care for high-risk infant. Advances in neonatology and perinatology have affected major improvements in mortality and morbidity of high-risk infants. Neonatal health care providers strive to provide care that will promote the best interests of infants who are unable to make their own decisions.

This chapter highlights the importance of identifying a concussion team leader (CTL) one person in the building who is responsible for facilitating the concussion team. The school nurse is essential in collaborating with district administration in the formulation of a concussion management policy. A signed release of information (ROI) is important to allow the school to receive and discuss medical information related to a concussion with a student’s health care provider. It is also essential that the concussion team model include a procedure for periodic review of the team structure and the concussion management policy, given the changes in concussion protocol that grow out of research. This chapter includes a discussion of maintaining student privacy through following Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations.

Mental health professionals who work with students must be well-versed in the protective factors that maximize youth academic, social and personal success. One can and must cultivate healthy communities and teach youngsters to advocate for themselves as one advocate for them. Significant research points to strategic ways one can strengthen schools, families and communities. All too often, violence, substance abuse, bullying, sexual assault, suicidal ideation and more threaten student well-being. The profession calls upon professional school and mental health counselors to be ethical, skilled, culturally attuned and ready to engage in prevention and intervention as they work with students and families. This chapter expresses familiarity with social challenges to healthy child development. It helps to recognize the crucial role of professional school and clinical mental health counselors in the cultivation of positive school and community contexts. The chapter hypothesizes counseling from a strengths-based, curious, and creative stance.

The U.S. health care system is a highly complex and often volatile mixture of free enterprise, philanthropy, and public sector health care. It is also the most expensive health care system in the world both in per capita dollars spent and in the proportion of national economic output spent on health care. This chapter provides a general overview of the organizational structure of the U.S. health care system; in particular, how dollars are allocated to health care purchase in terms of the facilities, services, technologies, and human resources that comprise the resources of the health care system. Significant attention is also devoted to the structure of the health care “safety net” generally defined as the clinics, hospitals, and individual health care providers that care for a disproportionate share of the poor, the uninsured, those afflicted by stigmatizing health conditions, and persons otherwise isolated from the mainstream health care system.

Identity gives people a sense of constancy and centeredness across the sometimes-turbulent change that comes with living. This chapter presents the developmental concept of identity through its manifestations at different levels of community, revealing a complex and systemic context for rehabilitation counseling. Each level of identity such as personal, social, and collective, denotes a potential point of counseling exchange with the family. The chapter describes how the experience of disability challenges the family system and how that experience is inculcated at each level of identity for each participating member. It is important for a family-inclusive profession to contemplate the meaning of rehabilitation counseling in the context of family identity. The working alliance between the counselor and the family eschews the clinical for an intentional community of purpose that emerges from a joint common cause: full community inclusion for the person with a disability, and support for the participating family.

Suicide is a problem that knows no cultural boundaries. As the minority population in the United States continues to grow, it is essential for health and mental health providers to develop culturally relevant prevention and intervention efforts to address these at-risk populations. Risk and protective factors vary across culture and ethnicities, as do attitudes and perspectives regarding suicide acceptability. Intervention and prevention efforts should be guided by culturally relevant risk and protective factors for suicide and an understanding of attitudes toward suicide among the target population. This chapter explores the diverse demographic and ethnic profile of suicidal behavior in the United States and reviews known psychosocial risk factors for suicide within these cultural groups. It reviews the critical factors related to culture to be considered when conducting a risk assessment with suicidal clients. The chapter explores the treatment of suicidal individuals from culturally competent and evidence-based practice perspectives.

The fundamental challenge in partnering with persons with diabetes to improve health outcomes is that while the clinical treatment and education occur in the health care provider’s office, patients’ health behaviors occur on an ongoing basis outside the provider’s office, in the patient’s home, school, community, and workplace. Without insulin, the glucose accumulates dangerously in the blood causing the symptoms of diabetes and damaging body organs. The disease develops gradually as normal glucose tolerance progresses to impaired glucose tolerance to overt diabetes under the influence of risk factors such as obesity, inactivity, genetics, and a high carbohydrate diet. The early stages of diabetes may be asymptomatic; however, as hyperglycemia worsens, frequent urination, frequent thirst, fatigue, and weakness will occur. Diabetic neuropathy correlates directly with the duration of diabetes and the degree of poor glucose control.

This chapter begins with a discussion of the importance of a clear understanding of psychiatric diagnoses for all allied health professionals. Given the historical prevalence of psychiatric diagnoses, it is a good use of our time to review the seminal diagnostic systems that inform diagnosis in clinical counseling. Clinical counselors and other mental health professionals may be the first health care providers to have established any type of therapeutic relationship with their client, revealing information that previously had never been a focus of any other professionals’ clinical attention. The accurate diagnosis of psychiatric conditions leads to appropriate referrals, selection of the most appropriate evidence-based treatments, and ultimately amelioration or elimination of problematic symptoms that negatively impact health and functioning. The most commonly used diagnostic system for psychiatric conditions worldwide is the International Classification of Diseases (ICD) system.

This chapter discusses disaster planning for pregnant and postpartum individuals and their infants, and provides guidelines for care whether evacuating or sheltering in place. Because injuries are common during disasters, it provides guidelines for assessment and management of minor trauma. More attention has been given to the need for disaster preparedness as a result of terrorist attacks and natural calamities, such as devastating hurricanes, tornadoes, wild-fires, tsunamis, and earthquakes, in various parts of the world. Despite these incidents, the public is still not adequately prepared to respond to a major disaster. Obstetric and Neonatal Nursing (AWHONN) position statement encourages nurses to participate in all phases of disaster planning. Obstetric, neonatal, and women’s health care providers can serve a vital role in addressing the many health needs of pregnant individuals, new mothers, and infants and reduce risk and morbidities.

Eye movement desensitization and reprocessing (EMDR) therapy is an eight-phase protocol. Dr. Shapiro and the EMDR International Association are precise about what EMDR therapy is and what it is not; and, even if one of the eight phases is eliminated, it cannot be called EMDR therapy. This chapter briefly touches on some of the eight phases and more extensively on others. An effort is made to enhance and expand on key areas that can assist the clinician in client selection, target selection, and adaptive resolution. The chapter offers a description of the goals and objectives of each phase as described by Shapiro. There must be an adequate level of trust between the clinician and client for EMDR processing to be successful. If a sufficient level of trust or bonding has not been established, do not undertake EMDR processing. Do not implement EMDR reprocessing unless the client is ready.