Re: Question concerning EMDR

Hi. This response is *accurate* but necessarily less *specific* than you might wish. Client selection criteria and cautions are not absolutes, they are things to be considered in context. Remember that only licensed mental health professionals (and advanced trainees on a licensure track) are even eligible to be trained in EMDR. This is because using EMDR safely and effectively requires a lot of clinical skill, understanding, and judgment. So the items I mention below are not to be interpreted as strict criteria, but as issues to pay attention to, as potential problems which may be resolved.

Selection criteria: EMDR is potentially appropriate for anyone whose presenting problem may be due (to some extent) to upsetting past experiences which have not been resolved. Such experiences might include major trauma or loss, or other experiences which have somehow contributed to the presenting problem. For example, I have had adult clients with social phobia (extreme shyness etc.) which was partially a result of childhood experiences in which the client had been made to feel scared, ashamed, etc. for freely expressing him/herself. Another example is the child with an undiagnosed learning disability or attention-deficit disorder, who has had daily experiences of school frustrations and failures, leading to a discouraged, apathetic, and/or angry attitude towards school. In couples therapy, the couple might "escalate" in a certain type of confrontation, and it turns out that each of them is especially reactive to something that reminds them of a prior upsetting experience.

It turns out that most people who come for therapy can potentially benefit from EMDR (at least in my opinion), because their problem does (at least in part) come from unfortunate lessons learned from past experiences. When those experiences are processed to resolution with EMDR, the clients are in a much better position to solve their current problems. Please note that this does not mean that EMDR is the only thing that would happen in therapy; it may be used as one intervention within the context of an overall treatment approach.

Cautions: The cautions to consider in using EMDR are generally the same as cautions involved in doing any trauma-focused work in therapy. For example, it is important to discuss the treatment plan with the client in sufficient detail that the client has a reasonable understanding of what s/he is choosing to do. It is important to make sure that the client understands how to stop the process if s/he wants to. It is important not to go ahead with trauma-focused work until the client seems stable enough to be able to handle it (and to help the client build stability over time, towards this goal). It is important to check for medical conditions (e.g. prior eye surgeries, prior heart attacks etc.) which might entail eye-movement-related or stress-related risk, and to seek medical advice in such cases. If a legal case is pending related to the focus of therapy (for example, a possible lawsuit re an assault), certain procedures should be followed to mitigate the possibility of damaging the legal case; or at least, to give client information and choice in this regard.

More detail about client selection as well as cautions can be found in Shapiro's 1995 text, EMDR: Principles, Protocols, and Procedures (Guilford). However, even this text is not sufficient for safe and effective practice, even in the hands of otherwise qualified mental health professionals. The EMDR International Association has developed criteria for Certification of EMDR therapists who have received training from an accredited source, and then had a minimum number of hours of supervised practice as well as continuing education. Fully trained and certified therapists are probably the best bet for knowing how to use selection and caution considerations. Even then, though, there's no way a certification process can guarantee therapist competence, nor can even a competent therapist be the right therapist in every situation. So it is still important to rely on referrals from people you trust, and to use your own judgment, in selecting a therapist.

Replies:

Re: Question concerning EMDR, by Sandra Paulsen, Ph.D., 3/12/00 Re: Question concerning EMDR, by Jackie, 3/14/00 Re: Question concerning EMDR, by Sandra Paulsen, Ph.D., 3/14/00

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