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EMDR Therapy: Why Protocol Adherence Matters


diver in the ocean

I'm going out on a limb here but I'm going to assume that you would never go deep sea diving without a plan and preparation.


Diving into the depths of your mind and how it has developed around the unfortunate traumas you have experienced is not different - trust me the mind is deep!


EMDR Therapy includes the use of carefully developed protocols. Even with 13 years of regular experience in EMDR therapy sessions, even as an experienced EMDR Consultant for other clinicians, I would never dream of not following the pre-scripted protocols every single session.


My clients have become used to me pulling out the early calm place protocol script and the phase 4 script for them as we begin active reprocessing. Even though I can recite it in my sleep assuming that I will not error or be distracted assumes that I am not human.


The EMDR protocol is a roadmap for therapists and clients to follow, ensuring a systematic and comprehensive approach to healing.

The protocol comprises of eight essential and distinct phases, each serving a unique purpose in the therapeutic journey. This is the working document of your treatment plan. Adherence to this protocol is essential, as it provides a structured framework that facilitates the processing of traumatic memories and promotes the integration of positive beliefs.


EMDR Therapy Phase 1: History-Taking and Treatment Planning:

The initial phase involves a thorough assessment of the client's history, identifying specific target memories and formulating treatment goals. Therapists work collaboratively with clients to establish a foundation of trust and gather essential information that will inform subsequent phases.


EMDR Therapy Phase 2: Preparation:

The preparation phase focuses on equipping clients with coping skills and relaxation techniques. Establishing a sense of safety and stability is crucial before delving into the reprocessing of traumatic memories. Therapists ensure that clients have a toolkit of resources to manage any emotional distress that may arise during EMDR sessions.


EMDR Therapy Phase 3: Assessment:

The assessment phase involves identifying and prioritizing target memories for reprocessing. Therapists guide clients in vividly recalling the memories, exploring associated negative beliefs, and determining desired positive beliefs to replace them.


EMDR Therapy Phase 4: Desensitization:

At the core of EMDR is the desensitization phase, where bilateral stimulation (typically through eye movements) is introduced. This process enables clients to process distressing memories by fostering adaptive information processing. Adherence to the prescribed bilateral stimulation is crucial for the effectiveness of this phase.


EMDR Therapy Phase 5: Installation:

In this phase, positive beliefs identified during the assessment are strengthened and "installed" to replace the negative beliefs associated with target memories. The bilateral stimulation continues to support the integration of positive cognitions.


EMDR Therapy Phase 6: Body Scan:

The body scan phase involves assessing and addressing any residual physical tension or discomfort associated with the processed memories. Therapists guide clients in releasing any remaining somatic sensations linked to the traumatic experiences.


EMDR Therapy Phase 7: Closure:

Closure is a critical component, ensuring that each EMDR session concludes with a sense of stability and containment. Clients are equipped with self-soothing techniques to manage any emotions that may linger after the session.


EMDR Therapy Phase 8: Reevaluation:

The final phase involves a reevaluation of progress and the identification of any residual distress. Therapists and clients collaboratively determine whether additional reprocessing is necessary or if the treatment goals have been achieved.


The Impact of Adherence on Therapeutic Outcomes with EMDR Therapy


Adherence to the EMDR therapy protocol is foundational to the success of the treatment. Several key aspects highlight the significance of protocol adherence in achieving positive therapeutic outcomes in EMDR Therapy:


  1. Structured Progression: The protocol provides a clear and structured progression through the therapeutic journey. This systematic approach ensures that therapists and clients address each aspect of the trauma, from its origin to the integration of positive beliefs. Deviating from the protocol can lead to incomplete processing and hinder the overall effectiveness of EMDR. The words and lack of during the protocol script are chosen for specific reasons.

  2. Client Safety and Stability: The preparatory phases of the protocol prioritize the safety and stability of the client. Skipping or rushing through these phases can leave clients ill-equipped to manage the emotional intensity that may arise during desensitization and reprocessing. Adherence to the preparation phase fosters a secure therapeutic environment.

  3. Targeted Processing: The protocol's emphasis on target identification and prioritization ensures that the most significant and distressing memories are addressed first. Adherence to this aspect enhances the efficiency of EMDR by targeting core issues and gradually addressing related memories.

  4. Positive Belief Integration: The installation phase, where positive beliefs are strengthened, is a key element in promoting lasting change. Adherence to this phase ensures that the therapeutic work goes beyond mere desensitization, empowering clients to embrace new, positive perspectives about themselves and their experiences.

  5. Preventing Abreaction: Abreaction, the sudden and intense release of emotion during therapy, can be overwhelming for clients. The structured nature of the protocol, including the closure phase, helps prevent abreaction by gradually guiding clients through the processing of distressing material and providing tools for emotional regulation.

Each of the steps in the reprocessing script is set in a specific way for specific reasons. Clinicians activate different sensations and parts of the memory to align before we begin the dual attention stimulus. This is also essential if reprocessing themes rather than specific events.


One of the most important aspects of the script is the "SUDS" - subjective units of disturbances taken at the beginning - this gives us a baseline as well as assures the clinician that they are on the right target. It also tells us how the client experiences the trauma and if it is affected aligned.


In EMDR Therapy the SUDS are taken again periodically during the dual attention stimulus to advise the clinician how the client is progressing, or not, as they work through the traumatic material.


Clients are advised to be as honest as possible and to avoid "therapist pleasing" or providing the answer you think your clinician wants. There is nothing wrong with you if your SUDS are not reducing - clinicians are trained on what to do if your SUDS are not reducing - and if you don't tell us we can't help!


EMDR Therapy Clients are also asked to scale the "believeablity" of the helpful or adaptive information we are about to reprocess. Again, this provides a baseline and is asked at a specific point in the protocol to assist the client in ensuring that parts of your brain do have a connection to the place you want to ultimately land.


EMDR Therapy Protocol Adherence: Challenges and Considerations


While the EMDR therapy protocol is a well-established and evidence-based framework, therapists may encounter challenges in strictly adhering to it. These challenges may include client resistance, time constraints, or the emergence of unexpected issues during sessions. Strong therapists need to approach these challenges with flexibility and adaptability while maintaining the core principles of the EMDR approach.


EMDR therapy has less talking and more direction from the clinician, this is highly contrary to the training clinicians receive to be "non-directive" and to engage clients in talking and sharing. However, in EMDR therapy too much talking about the trauma can actually negatively impact the client.


"Telling your trauma story in detail over and over is highly retraumatizing as it activates the part of the brain that does not realize the trauma is over."

Time. Strong phases take time - clients and clinicians alike can fatigue and become impatient when they do not receive the "quick delivery" of dual attention stimulus - however, as noted above the safety of case formulation is paramount when exploring the deep ocean of your mind.


Cost. EMDR Therapy is usually used by advanced practitioners with decades in the field because a strong foundation in trauma therapy is vital. Initial raining, consultations with peers and consultants, case formulation and costly ongoing training for clinicians who are wise to be certified by the EMDRIA body can be expensive. As a result EMDR Therapy can sometimes be costly -


EMDR therapy protocol adherence is the guiding force that navigates the healing waters of trauma processing. The structured approach ensures that therapists and clients embark on a journey that is thorough, safe, and transformative. As the field of psychotherapy continues to evolve, the continued exploration and refinement of the EMDR protocol contribute to its effectiveness in addressing the complex landscape of trauma and mental health. Through faithful adherence to this protocol, therapists and clients alike can unlock the potential for profound healing and lasting positive change.


Ethical, strong and committed EMDR Therapists adhere to protocols and ensure they receive ongoing consultation and training in this evolving field.



 

EMDR Therapists

Farah Kurji BSW, MSW, RCSW & Associates is a proud team of professional EMDR Therapy. You can book your free consultation HERE to see if it's the right time for you!

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