Integrating EMDR into Your Existing Practice
If you're a therapist who has recently completed EMDR training or is considering it, you're likely wondering how this powerful modality will fit into your existing therapeutic approach. Eye Movement Desensitization and Reprocessing (EMDR) therapy isn't just another technique to add to your toolbox; it's a comprehensive treatment approach that can transform how you work with clients who have experienced trauma.
At Raincross Family Counseling, our EMDR Consultant Reba Machado has guided countless therapists through the process of integrating EMDR into their practices. Whether you're working in private practice, community mental health, or specialized settings, understanding how to thoughtfully incorporate EMDR alongside your existing modalities can enhance your effectiveness and expand your capacity to help clients heal.
Understanding EMDR's Place in Your Practice
EMDR therapy is built on the Adaptive Information Processing (AIP) model, which proposes that psychological difficulties arise when distressing experiences are inadequately processed and stored in memory networks. Through bilateral stimulation and a structured eight-phase protocol, EMDR helps the brain reprocess these experiences, reducing their emotional charge and integrating them more adaptively.
This foundation differs from many therapeutic approaches you may already use. Cognitive Behavioral Therapy (CBT) focuses on changing thought patterns and behaviors. Psychodynamic therapy explores unconscious processes and early relationships. Solution-focused therapy emphasizes strengths and future goals. Mindfulness-based approaches cultivate present-moment awareness.
EMDR complements rather than replaces these approaches. Understanding how it fits alongside your current work is essential for integration. Our consultation services can help you develop this understanding through individualized guidance based on your specific practice context.
Assessing Client Appropriateness for EMDR
Not every client needs EMDR, and not every moment in therapy is the right time for EMDR processing. Developing sound clinical judgment about when to use EMDR is crucial:
Strong Candidates for EMDR: Clients with identified traumatic experiences (single incident or complex), PTSD symptoms, anxiety or phobias rooted in specific experiences, distressing memories that remain emotionally charged, and negative self-beliefs connected to past events.
Considerations Before EMDR: Current substance dependence that isn't stabilized, severe dissociation without adequate coping resources, active suicidality requiring crisis management, unstable living situations that prevent safe processing, and certain medical conditions that require consultation.
The key is that EMDR requires sufficient stability and resources to process distressing material safely. This is where your existing therapeutic skills become essential. You may need to spend time in preparation phase work, building client resources before beginning reprocessing.
The Preparation Phase: Where Integration Begins
Phase 2 of the EMDR protocol (Preparation) is where integration with your existing approach often happens most naturally. This phase involves establishing a therapeutic relationship, explaining EMDR to clients, assessing client readiness, and teaching self-regulation skills.
Your existing therapeutic modalities can strengthen this preparation work. CBT skills like thought records and behavioral experiments help clients develop awareness of their triggers and responses. Mindfulness practices provide grounding and present-moment awareness that support safe processing. Somatic approaches increase body awareness essential for EMDR. Solution-focused questions help identify client strengths and resources.
Many therapists find that the preparation phase takes longer than they initially expect, particularly with complex trauma clients. This isn't a failure of EMDR; it's appropriate clinical pacing that ensures clients have what they need to process safely. EMDR consultation can help you determine when clients are ready to move from preparation to processing.
Integrating EMDR with Specific Modalities
How EMDR fits into your practice depends partly on your primary therapeutic orientation:
For CBT Practitioners
EMDR and CBT share some common ground but approach change differently. CBT works to modify thought patterns through conscious cognitive restructuring. EMDR facilitates change through memory reprocessing, often with less emphasis on verbal analysis.
You can integrate these approaches by using CBT for symptom management and skill-building while employing EMDR for trauma processing, helping clients identify negative cognitions that align with both CBT and EMDR frameworks, and using behavioral experiments between EMDR sessions to reinforce new beliefs.
For Psychodynamic Therapists
Psychodynamic therapy's attention to early experiences, attachment patterns, and unconscious processes aligns well with EMDR's work on early memories and their ongoing impact. You might use psychodynamic understanding to inform target selection in EMDR, explore how clients' relationship with you reflects attachment patterns, and understand resistance to EMDR processing through a psychodynamic lens.
For Family Systems Therapists
As marriage and family therapists, many of us at Raincross work from a systems perspective. EMDR, while primarily individual-focused, can be integrated into systems work by processing individual trauma that impacts relational patterns, using EMDR with one family member while maintaining awareness of system dynamics, and addressing how one person's healing might shift family equilibrium.
Family therapy and EMDR can work in tandem, with family sessions supporting the relational context while individual EMDR sessions address personal trauma.
For Mindfulness-Based Practitioners
Mindfulness skills are invaluable in EMDR work. The present-moment awareness central to mindfulness supports clients in noticing what arises during processing without becoming overwhelmed. You can integrate these by teaching mindfulness as a resource during preparation, using mindful awareness during bilateral stimulation, and helping clients maintain dual awareness (one foot in the past, one foot in the present).
Practical Integration Considerations
Beyond theoretical integration, practical matters shape how EMDR fits into your practice:
Session Length and Structure: Standard EMDR processing sessions often run 60-90 minutes, longer than typical talk therapy sessions. You'll need to consider your scheduling structure, whether you can offer extended sessions, and how to pace processing within your available time.
Documentation: EMDR requires specific documentation including target identification, baseline SUDS and VOC scores, and session-by-session progress notes. This may differ from your current documentation practices.
Physical Setup: EMDR requires space for bilateral stimulation, whether through eye movements, tactile devices, or auditory tones. Your office setup may need minor adjustments.
Client Education: Clients need clear information about EMDR before beginning. This includes explaining how it differs from talk therapy, setting appropriate expectations, and addressing common concerns or misconceptions.
Common Integration Challenges
Therapists integrating EMDR often encounter similar challenges:
1. Maintaining Protocol Fidelity While Remaining Flexible
The EMDR protocol provides essential structure, yet rigid adherence without clinical judgment can be problematic. Learning when to follow the standard protocol and when to adapt requires experience and consultation.
2. Managing Incomplete Sessions
Sometimes processing sessions don't reach complete resolution within available time. You need strategies for safely closing sessions, supporting clients between sessions, and returning to incomplete processing effectively.
3. Addressing Abreactions
When clients have intense emotional or somatic responses during processing, it can feel concerning, especially early in your EMDR practice. Understanding what supports continued processing versus when to intervene requires skill development.
4. Working with Complex Trauma
Clients with extensive trauma histories require different approaches than single-incident trauma. You may need additional training in protocols for complex PTSD, dissociative disorders, or attachment trauma.
5. Navigating Insurance and Documentation
Some insurance companies have questions about EMDR, or documentation requirements may differ from standard psychotherapy. Understanding how to communicate about EMDR in ways that satisfy administrative requirements while maintaining clinical integrity is important.
Individual consultation provides space to work through these challenges with an experienced EMDR consultant who can offer guidance tailored to your specific situations.
Building Confidence with EMDR
Many therapists feel uncertain when beginning EMDR practice. You might worry about doing it "right," fear that processing won't work, doubt your ability to handle intense emotions, or wonder if clients would do better with more experienced EMDR therapists.
These concerns are normal. Building EMDR confidence takes time and requires practicing with appropriate clients (starting with more straightforward cases), receiving regular consultation on your EMDR work, trusting the process rather than trying to control it, and learning from each session regardless of outcome.
Remember that you already possess many skills that support EMDR work: creating safety, building therapeutic relationships, managing difficult emotions, and helping clients develop resources. EMDR adds to rather than replaces this foundation.
The Role of Ongoing Consultation
EMDRIA requires 20 hours of consultation for certification, but consultation benefits extend far beyond meeting this requirement. Regular consultation helps you develop case conceptualization skills, work through challenging cases, maintain protocol fidelity, build confidence, and stay current with developments in EMDR practice.
At Raincross, we offer both individual and group consultation for therapists at all levels of EMDR experience. Group consultation provides opportunities to learn from others' cases and diverse perspectives. Individual consultation allows deep focus on your specific practice needs and complex cases.
EMDR with Specific Populations
As you integrate EMDR, you may wonder about its application with populations you serve:
Children and Adolescents: EMDR with younger clients requires adaptations to the standard protocol, including shorter sessions, more preparation work, creative methods for bilateral stimulation, and close attention to developmental stage.
Couples: While EMDR is primarily individual therapy, it can address individual trauma that impacts relationships. Some practitioners use modified approaches for processing relational injuries with both partners present, though this requires additional specialized training.
Cultural Considerations: Our diverse Riverside community requires cultural sensitivity in EMDR work. This includes understanding how culture shapes trauma responses and healing, adapting the protocol for cultural appropriateness, and respecting spiritual or religious frameworks that inform how clients make meaning of their experiences.
Measuring EMDR Outcomes
Tracking client progress helps you assess EMDR's effectiveness in your practice. Standard EMDR measures include SUDS (Subjective Units of Disturbance Scale) for distress levels, VOC (Validity of Cognition Scale) for belief strength, and symptom measures administered periodically.
Beyond formal measures, notice changes in how clients talk about traumatic experiences, their ability to engage with previously avoided situations, their overall functioning and quality of life, and their sense of self and future possibilities.
Creating a Sustainable EMDR Practice
As you integrate EMDR, consider sustainability for yourself as a clinician. Trauma work is demanding, and EMDR processing can be intense. Protecting your own well-being includes maintaining your own therapy or consultation for processing vicarious trauma, setting appropriate boundaries around your EMDR caseload, ensuring you have adequate training for the complexity you're treating, and engaging in regular professional development.
Individual therapy for therapists can provide essential support as you navigate the challenges of trauma work.
Next Steps in Your EMDR Journey
If you've completed basic EMDR training and are ready to integrate this approach into your practice, consider beginning with clients who have relatively straightforward trauma histories, seeking regular consultation on your EMDR cases, joining peer consultation groups with other EMDR-trained therapists, pursuing specialized training for specific populations or presentations you work with, and working toward EMDRIA certification to deepen your expertise.
The journey of integrating EMDR into your practice is ongoing. Each client teaches you something new about the process, and your skill and confidence will develop over time with experience and support.
At Raincross Family Counseling, we're committed to supporting clinicians throughout the Inland Empire in providing effective trauma treatment. If you're seeking consultation as you integrate EMDR into your practice, we invite you to reach out to learn more about our consultation services.
Ready to take the next step in your mental health journey? At Raincross Family Counseling, we're here to support you with compassionate, personalized care in the heart of the Inland Empire and beyond. Whether you're seeking individual therapy, couples counseling, family therapy, or specialized EMDR treatment, our experienced team is ready to walk alongside you toward healing and growth. Contact us today!
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