Phase 1: HISTORY TAKING
Only use this worksheet after you have taken a full history
Phase 2: PREPARATION
2.1 For eye-movements, the therapist places the chair to the side of the clients (“ships passing in the night”). For other BLS, chairs can be facing or to the side.
2.2 Explanation of EMDR
Please give the client the information below in your own words:
“Old disturbing memories can be stored in the brain in isolation; they get locked into the nervous system with the original images, sounds, thoughts and feelings involved. Similar events in the present tend to trigger this old distressing material. In another part of your brain, you already have the information you need to resolve this problem; the two just don’t connect. Once EMDR starts, a linking takes place. New information can come to mind and resolve the old problems. This is what happens spontaneously in REM or dream sleep when eye movements help to process unconscious material.”
2.3 Specific Instructions
“We’ll do the eye movements (or other BLS) and then we’ll talk about what comes up. What I will do is check what you are experiencing; all you need to do is tell me what is happening as best you can, without judging it in any way. Sometimes things change quickly and sometimes they take a little time. There are no right answers in this process. Let whatever happens happen.”
2.4 Construct a stop signal
“If at any time you feel you have to rest or stop, raise your hand or tell me and we will stop.”
Established a stop signal……..…………………………..………………………
2.5 Glasses, bifocals, contact lenses
Ask the client about eye problems and ask him/her to let you know if s/he experiences any eye discomfort.
Eye problems………………………………………………………………
2.6 Establish the appropriate distance and direction of eye movements
“Where does it feel most comfortable to have my hand?” Therapist moves hand towards and away from the client’s face and tests the speed of the eye movements. S/he also tests the speed of EMs the client can comfortably manage to track. Faster eye movements enhance processing.
2.7 Demonstrate Alternatives to horizontal eye movement
Diagonal eye movements, tapping, buzzers or alternating sounds in headphones (if available)
2.8 Metaphor to Use
“It helps to create a feeling of distance between yourself and the painful experience. For example, imagine you are riding on a train and just watching the scenery go by or you are watching the events as if they are a movie. What works best for you?”
Metaphor:……..……………..……………………………..………………………
2.9 Establish a Safe Place and Butterfly Hug.
Remind the client of the Butterfly Hug and their Safe Place that you established earlier. If needed, do the exercises again. If the client finds it difficult to imagine a peaceful and safe place you will need to spend more time on preparation.
Safe place:……..…………………………………………..…………………..………………
Phase 3: ASSESSMENT
3.1 Target image
“What picture or image represents the worst part of the memory?” or “What image captures the whole memory?”
Write it down:…………..…..………………………………..………………………
If there is no clear picture or image, ask:
“When you search for an image, what comes up?”
3.2 Cognitions
Negative Cognition:
“When you imagine that picture what words best express your negative beliefs about yourself?” or “When you think of that memory, what negative thoughts do you have about yourself now?”
Negative Cognition:……..………………………………..……………..…………
Positive Cognition:
“When you bring up that picture or memory and those negative words, (therapist repeats the client’s Negative Cognition) what would you like (or prefer) to believe about yourself now?”
Positive Cognition:……..………………………………..……………..…………
3.3 Emotion
“When you bring up that picture or memory and those words (therapist repeats client’s negative cognition) what emotions do you feel now?
Emotion …………………………………………………………………..
SUDs – Subjective units of distress or Level of Disturbance (useful but not essential)
“On a scale of 0 – 10, where 0 is no disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does it feel to you now?”
0 1 2 3 4 5 6 7 8 9 10
(no disturbance/neutral) (highest disturbance)
3.4 Sensation (location in the body)
“Where do you feel that feeling in your body?”
A description of the sensation is useful but not essential; the location is more important. Numbness or “block” is a sensation:
Body location:……..………………………………………..……………..…………
Phase 4: DESENSITISATION
4.1 Notice whatever comes up during processing.
Stress the importance of not deliberately avoiding any information. Be alert to any signs of confusion or hesitation in the client.
“Remember, it is your own brain that is doing the healing and you are the one in control. I will ask you to mentally focus on the target and to follow my fingers with your eyes. Just let whatever happens, happen, and we will talk at the end of the set. Don’t ignore anything that happens. Anything that comes up is connected in some way. If you want to stop, just raise your hand.”
4.2 Beginning processing first set with eye-movements (Bilateral Stimulations BLS)
“I’d like you to bring back the memory and the picture that represents the worst part, then repeat to yourself those negative words (therapist repeats the client’s negative cognition), and notice what you are feeling it in your body. Now follow my fingers,” Do eye movements or tapping (BLS).
Begin eye movement slowly. Increase the speed as fast as the client can comfortably follow the movement. (Remember to check for eye discomfort).
At least once or twice during each set of eye movements, or when there is an apparent change, (facial, breathing, etc) comment to the client: “That’s it”, “Good”, “You’re doing well”.
It is helpful to support the client, especially as emotions come up. “That’s it. It’s old stuff. Just observe. Just notice it”. Use the agreed metaphor, .ie. “It’s just scenery from the train”).
After a set (approximately 24) of BLS, instruct the client to “rest, and take a deep breath.”
“What do you get now?” or “What do you notice?”
4.3 Continuing processing
When the client gives feedback that suggest any change, however slight, say “Go with that” or “Continue.”
As long as there is some change, continue to repeat these steps of eye movement, reassurance, feedback, changes reported, continue, eye movements etc.
Once client reports no change, neutral or positive material, this indicates the first part of the memory is processed. Move to the next stage 4.4.
If you are unsure whether or not you have reached the end of a memory move to 4.4 anyway.
4.4 Returning to target
“I would like you to return to the memory that we started with”.
“What do you notice now?”
Listen to what your client says and closely monitor their reaction.
Have him/her then focus on whatever comes up, and do a further set of 24 EMs.
Ask: “What do you get now” or “What do you notice”.
If the client describes new material or any disturbance, continue with a further 24 Eye Movements.
Continue to process the memory as in 4.3 above until the client again reports no change or neutral or positive material. That suggests another part of the memory is complete.
Repeat step 4.4 by returning to target again.
Continue to repeat steps 4.3 and 4.4 as long as there is still material to process.
Continue the above until you consider the client’s level of disturbance is low or no new meaningful associations emerge.
4.5 Taking a SUDs reading
Only move to this stage when you think that you have completed processing the memory. Do not take SUDs too often as this can be confusing.
Ask: “I would like you to return to the memory”. (Wait for client to re-connect to the memory.) “On a scale of 0 -10, where 0 is no disturbance or neutral, and 10 is the highest disturbance you can imagine, how disturbing does it feel to you now?”
If the SUD score is greater than 0 continue to process the memory with BLS, repeating steps 4.3 and 4.4 as necessary.
If at any time re-processing stops, change speed, direction of eye movements or switch modality, e.g. tapping.
Phase 5: INSTALLATION
5.1 Install positive cognitions
This phase begins when you have reached 0 SUD’s or low levels of distress. It links the desired positive cognition with the original memory:
“I would like you to return to the original memory.”
“Do the words (therapist repeats the client’s positive cognition) still fit or is there another positive statement that is better?”
Use whatever Positive Cognition the client prefers.
Ask the client to link the PC and the original memory in his/her mind and do a set of 24 fast EMs.
Feedback: “What happened?” or “What do you notice”.
If new positive information comes up repeat EMs.
Continue to link the PC to the original memory by repeating the above as long as there is positive change. What it is complete, move to the body scan.
Phase 6: BODY SCAN
6.1 Scan the body
“Close your eyes. Concentrate on the memory and the positive cognition (repeat the words) and mentally scan your entire body from head to toe. Tell me what you notice.”
If any sensation is reported, ask your client to breathe into that place and do 24 fast EMs.
If a positive/comfortable sensation is achieved, do one set of EMs to strengthen the positive feeling.
If any sensations of discomfort are reported ask your client to bring his/her attention to it and continue to re-process until all the discomfort subsides.
Phase 7: CLOSURE
7.1a When the session is complete, give the client the following information in your own words:
Explain to the client that the session is coming to an end: “We are almost out of time and we will have to stop soon.”
Give encouragement and support for the effort made: “You have worked really hard, what is the most important/positive thing you have experienced today?” Reflect that back.
“You may feel a little out of it after the session, so take time to rest or settle before you get on with your day (particularly driving). Often the processing and feeling of being unsettled lasts a day or so—it takes a night or two of sleep and dreaming for the process to work through. You should feel something change by the third day.”
“Over the next week, you may notice new insights, thoughts, memories or dreams; if so, take a note of them and write them down.”
“We can review and work on any new material next time. If you feel it is hard to cope, remember to use the Butterfly Hug and your Safe Place.”