Document 1 Clinical Competencies for the Six Core Competencies: An Update on the Work of the EMDRIA Professional Development Subcommittee

Wendy J. Freitag, PhD, Chair; Jocelyn Barrett, MSW, LICSW, Co-Chair, Standards & Training Committee; Nancy Errebo, PsyD; Regina Morrow, Ed.S, LMFT, LMHC

Abstract: This document presents the efforts, to date, of The Professional Development Subcommittee to define standards for EMDR Therapy International Association (EMDRIA) credentialing, as charged by the EMDRIA Standards and Training Committee. The development of defining the standards at each credential level (Certification, Approved Consultant, and Approved Trainer) requires a multi-stage approach. This document, which reflects the second stage in the development process, identifies and delineates the Clinical Competencies for each of the Essential Competencies within the six Core Competencies for EMDRIA Certification in EMDR Therapy. This document will undergo review and public comment; therefore, what is presented here is subject to revision. Further, this document does not represent the policy of EMDRIA.

Building on Freitag’s (2012) foundation, the subcommittee proposed that a competency-based system of credentialing replace EMDRIA’s current hours-based requirement system. Competency-based training and practice of psychotherapy has emerged as a significant movement in response to the Institute of Medicine’s (2003) recommendation that mental health disciplines define a set of core competencies for clinical practice. The most recent effort in developing competency-based practice is in trauma mental health (Cook, Newman & The New Haven Trauma Competency Group, 2014).

Sperry’s (2010) Core Competency Model was chosen as the template for the subcommittee’s work because, like EMDR Therapy, Sperry’s model is integrative. Last year the subcommittee delineated Sperry’s Six Core Competencies and the Essential Competencies within each Core Competency as particular to the EMDR Therapy as defined by EMDRIA (2012). In the current document, each Essential Competencies has been further defined into Clinical Competencies particular to therapy. These Clinical Competencies define the knowledge, skills and attitudes that are necessary for EMDRIA Certification in EMDR Therapy.

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Core Competency # I:

Conceptual Foundation  

I.1. Conceptual Foundations of the EMDR Therapy Approach to Psychotherapy  The candidate demonstrates understanding of the Adaptive Information Processing (AIP) model that is the basis of the EMDR Therapy Approach to psychotherapy and the application of AIP in EMDR Therapy protocols. The candidate is able to clearly and succinctly define EMDR Therapy, articulate AIP principles to clients, colleagues, and the public, and describe the Eight Phases of EMDR Therapy and the Three-Pronged Protocol (EMDRIA, 2012).  The candidate demonstrates the capacity to understand, articulate, and elucidate the following fundamental principles of the EMDR Therapy Approach as defined by EMDRIA:  

1) EMDR Therapy is an approach to psychotherapy, not a technique (EMDRIA, 2012). 2) EMDR Therapy is an integrative psychotherapy approach that evolved primarily from

clinical experience. Integrative has several meanings (International Integrative Psychotherapy Association, 2013). a) It draws from many views of human functioning: client centered, behavioral,

psychodynamic, cognitive, body-focused, Gestalt, and cognitive neuroscience (Norcross & Shapiro, 2002; Shapiro, 2001, 2002a).  

b) It is intended to integrate the personality, bringing unassimilated negative information together with positive resources to empower a whole human capable of love and service (EMDRIA, 2012; Parnell, 2007; Shapiro, 2002a; Siegel, 2002).  

c) It is intended to bring together the affective, cognitive, behavioral, physiological, and spiritual systems of a person to facilitate healing of psychological disorders (EMDRIA, 2012; Krystal, et al., 2002; Parnell, 2007; van der Kolk, 2002).  

3) EMDR Therapy is based on the Adaptive Information Processing (AIP) model. The principles of AIP are as follows (EMDRIA, 2012; Shapiro, 2001) a) Every individual has an inherent information processing system that naturally

reorganizes disturbing life events to an adaptive resolution. b) This information processing system is sometimes disrupted by life experiences that

are inadequately processed. c) EMDR Therapy protocols, combined with Bilateral Stimulation (BLS), activate the

inherent information processing system and keep it active until an adaptive resolution is achieved. The concept of self-healing is central to this principle.

d) EMDR Therapy reprocessing facilitates associations within and among memory networks, ultimately achieving the integration of the disturbing memory with the individual’s resources.

4) EMDR Therapy has Eight Phases, each with its own purpose and tasks (EMDRIA, 2012; Shapiro, 2001).

5) In the Three-Pronged Protocol, EMDR Therapy addresses past experiences that have set pathological trajectories, present stimuli that trigger problem emotions, body sensations, thoughts, and behaviors, and templates for desired future behaviors (EMDRIA, 2012; Shapiro, 2001).

6) EMDR Therapy occurs in the context of an empathic, collaborative therapeutic relationship (EMDRIA, 2012; Shapiro, 2001).

7) EMDR Therapy protocols and procedures are embedded in a comprehensive treatment plan guided by the client’s goals and the therapist’s expertise (EMDRIA, 2012; Shapiro, 2001).

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I.  1.  Conceptual  Foundations  of  the  EMDR  Therapy  Approach  to  Psychotherapy  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  that  EMDR  Therapy  is  an  approach  to  psychotherapy  not  a  technique,  and  that  BLS  is  only  one  component.  

2. The  candidate  understands  the  EMDRIA  definition  of  EMDR  Therapy.  

3. The  candidate  understands  that  EMDR  Therapy  was  derived  from  clinical  observation  rather  than  from  theory.  

4. The  candidate  understands  that  EMDR  Therapy  is  an  integrative  psychotherapy  for  the  following  reasons:  

a. It  draws  from  many  views  of  human  functioning.  

b. It  is  intended  to  integrate  the  personality.  

c. It  brings  together  affective  cognitive,  behavioral,  physiological  and  spiritual  systems  of  an  individual.  

5. The  candidate  understands  the  principles  of  the  AIP  Model.  

6. The  candidate  identifies  the  Eight  Phases  of  EMDR  Therapy  and  the  purpose  of  each  phase.  

7. The  candidate  understands  the  purpose  and  procedures  of  the  Three-­‐Pronged  Protocol.  

8. The  candidate  recognizes  and  describes  the  similarities  and  differences  between  EMDR  Therapy  and  other  approaches  to  psychotherapy.  

1. The  candidate  is  able  to  clearly  and  succinctly  communicate  the  definition  of  EMDR  Therapy,  AIP  principles,  and  EMDR  Therapy  protocols  to  clients.  

2. The  candidate  is  able  to  articulate  how  he  or  she  integrates  EMDR  Therapy  into  his  or  her  theoretical  orientation.  

3. The  candidate  is  able  to  clearly  and  succinctly  communicate  the  definition  of  EMDR  Therapy,  AIP  principles,  and  EMDR  Therapy  procedures  to  colleagues.  

4. The  candidate  is  able  to  clearly  and  succinctly  communicate  the  definition  of  EMDR  Therapy,  AIP  principles,  and  EMDR  Therapy  procedures  to  the  public.  

           

1. The  candidate  demonstrates  respect  for  the  AIP  Model  and  EMDR  Therapy  protocols  and  procedures.  

2. The  candidate  demonstrates  willingness  to  deepen  and  broaden  his  or  her  understanding  of  AIP  principles  and  EMDR  Therapy  procedures.  

3. The  candidate  demonstrates  willingness  to  develop  his  or  her  ability  to  communicate  about  AIP  and  EMDR  Therapy  in  speaking  and  writing.  

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I. 2. Theory of Personality  The candidate demonstrates the capacity to understand, articulate and elucidate a theory of personality based on the AIP model (EMDRIA, 2012).  The AIP model regards the personality as a constellation of characteristic patterns and responses, each of which is considered an interaction of genetic factors and experiences. The basis of personality development is regarded as the assimilation of experiences into the associative memory networks and accommodation of each experience into the person’s self-identity (Shapiro, 2001, 2002a).  

I.  2.  Theory  of  Personality  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  that  the  personality,  according  to  the  AIP  Model,  is  a  constellation  of  characteristic  patterns  and  responses.  

2. The  candidate  understands  that  personality  traits  are  an  interaction  of  genetic  factors  and  actual  life  experiences.  

3. The  candidate  understands  that  the  personality  develops  as  life  experiences  are  assimilated  into  memory  networks.  

4. The  candidate  recognizes  and  describes  similarities  and  differences  between  AIP  and  other  theories  of  personality  development.  

1. The  candidate  communicates  the  AIP  understanding  of  personality  to  clients,  colleagues  and  the  public.  

2. The  candidate  integrates  AIP  understanding  of  personality  development  with  his  or  her  preferred  theoretical  orientation.  

3. The  candidate  reconciles  differences  between  AIP  and  his  or  her  preferred  theoretical  orientation  that  might  interfere  with  fidelity  to  EMDR  Therapy  protocols  and  procedures.  

     

1. The  candidate  demonstrates  respect  for  the  AIP  Model  of  personality  development.  

2. The  candidate  demonstrates  willingness  to  conceptualize  personality  development  from  an  AIP  point  of  view.  

3. The  candidate  demonstrates  willingness  to  integrate  the  AIP  point  of  view  on  personality  development  with  his  or  her  theoretical  orientation.  

I.3 Theory of Psychopathology  

The candidate demonstrates the capacity to understand, articulate, and elucidate a theory of psychopathology based on the Adaptive Information Processing (AIP) model.  The Adaptive Information Processing (AIP) model hypothesizes that disturbing life experiences maladaptively encoded in memory and thereby preventing adequate linkage to adaptive information are the basis of psychopathology (Bergmann, 2012; EMDRIA, 2012; Shapiro, 2001; Stickgold, 2002). Singular traumatic experiences appear to disrupt the information processing system, resulting in a disturbing episodic memory that is unable to link to general semantic networks. Chronic adverse experiences appear to decrease flexibility in the information processing system, favoring one maladaptive way to process information (Leeds, 2009, Stickgold, 2002, 2013). New learning cannot link with this disturbing episodic memory because of the intense affect generated whenever the disturbing memory is stimulated by present

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events. When the disturbing information is stimulated, the individual feels, thinks, and behaves in a manner similar to how he or she did at the time of the disturbing event (EMDRIA, 2012; Leeds, 2009; Shapiro, 2001, 2002a).  

I.  3.  Theory  of  Psychopathology  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  that,  according  to  AIP,  disturbing  information  maladaptively  encoded  in  memory,  is  the  basis  of  psychology.  

2. The  candidate  understands  that,  according  to  AIP,  singular  maladaptively  encoded  episodic  memories  are  unable  to  link  to  more  adaptive  semantic  networks.  

3. The  candidate  understands  that,  according  to  AIP,  chronic  adverse  experiences  decrease  flexibility  in  the  information  processing  system,  favoring  one  maladaptive  way  to  process  information.  

4. The  candidate  understands  that,  according  to  AIP,  intense  affect  generated  by  present  stimuli  prevents  new  learning  from  linking  with  the  maladaptively  encoded  information.  The  candidate  understands  that,  according  to  AIP,  whenever  the  disturbing  information  is  stimulated  by  present  stimuli,  the  individual  thinks,  feels,  and/or  behaves  similar  to  the  way  he  or  she  did  at  the  time  of  the  disturbing  event.  

1. The  candidate  verbally  describes  the  basis  of  psychopathology  according  to  AIP.  

2. The  candidate  verbally  describes  how  disturbing  life  experiences  are  stored  in  the  nervous  system,  according  to  AIP.  

3. The  candidate  verbally  describes  why  new  learning  does  not  influence  maladaptively  encoded  information,  according  to  AIP.  

4. The  candidate  verbally  describes  how  disturbing  life  experiences  are  manifested  in  the  present,  according  to  AIP.  

5. The  candidate  verbally  explains  his  or  her  integration  of  the  AIP  model  of  psychopathology  into  his  or  her  preferred  theoretical  orientation.  

 

 

 

 

 

 

1. The  candidate  displays  respect  for  the  AIP  model  of  psychopathology.  

2. The  candidate  displays  willingness  to  integrate  AIP  into  his  or  her  preferred  theoretical  orientation.  

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I. 4. Theory of Psychotherapeutic Process:  EMDR Therapy is an integrative psychotherapy with principles, procedures, and protocols that are embedded in a comprehensive treatment plan. EMDR Therapy proceeds in eight distinct phases. EMDR Therapy addresses past experiences, current challenges, and desired future behaviors. In the reprocessing phase of treatment, Bilateral Stimulation (BLS) is employed to stimulate the inherent information processing system in its work of transmuting disturbing memories to an adaptive resolution. The client’s own brain is doing the healing, so the therapist is a guide, rather than a director, of the process. Thus, during this phase, the therapist refrains from offering interpretations or engaging in dialogue. As long as spontaneous reprocessing, indicated by shifts in affect and cognition, is taking place, the therapist gives minimal input. If reprocessing stalls, the therapist applies brief interventions to resume effective reprocessing. Phase Eight, Reevaluation, guides ongoing work towards the treatment goals and maintains client stability (EMDRIA, 2012; Leeds, 2009; Shapiro, 2001).  The candidate demonstrates capacity to understand, describe, elucidates the following:  

1) Identify the Eight Phases of the standard EMDR Therapy. Delineate the specific purposes, goals, and tasks of each phase.  

2) Identify the Three-Pronged Protocol. Delineate the purposes, goals, and tasks of each prong.

3) Describe the indicators of effective reprocessing in Phases Four and Five. 4) Describe the indicators of ineffective reprocessing and brief interventions to stimulate the

AIP and resume effective reprocessing in Phases Four and Five.    I.  4.  Theory  of  Psychotherapeutic  Process  

KNOWLEDGE   SKILLS   ATTITUDES  1. The  candidate  identifies  the  Eight  Phases  of  EMDR  Therapy.  

2. The  candidate  identifies  the  purpose  and  tasks  of  Phase  One:  History-­‐Taking.    a. Purpose:  Identifying  Memories  for  Reprocessing.    

b. Tasks:  • Assess  client’s  capacity  for  integration.  

• Assess  affect  tolerance  • Assess  internal  and  external  resources.  

• Assess  attachment  history  

• Assess  readiness  for  change  

• Assess  current  psychosocial  factors.  

• Assess  complexity  and  pace  

1. The  candidate  verbally  lists  the  Eight  Phases  of  EMDR  Therapy.  

2. The  candidate  verbally  lists  the  purposes,  goals,  and  tasks  of  each  of  the  Eight  Phases  of  EMDR  Therapy.  

3. The  candidate  verbally  delineates  the  Three-­‐Pronged  Protocol  of  EMDR  Therapy.  

4. The  candidate  verbally  communicates  the  concept  of  “staying  out  of  the  way  of  spontaneous  processing”  to  clients,  colleagues,  and  the  public.  

         

1. The  candidate  displays  respect  for  the  concept  of  self-­‐healing.      

2. The  candidate  displays  respect  for  committing  to  memory  the  Eight  Phases  and  Three-­‐Prongs  of  EMDR  Therapy.  

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of  treatment.    3. The  candidate  identifies  the  purpose  and  tasks  of  Phase  Two:  Preparation.  a. Purpose:  To  ensure  that  the  client  can  shift  emotional  states.  

b. Tasks:  • Establish  therapeutic  rapport  and  safety  

• Help  client  develop  the  capacity  to  tell  the  truth  about  internal  experience.  

• Educate  client  about  EMDR  Therapy  mechanics  and  procedures.  

• Establish  informed  consent  

• Teach  coping  skills  4. The  candidate  identifies  the  purpose  and  tasks  of  Phase  Three:  Assessment.  a. Purpose:  To  access  the  memory  as  it  is  currently  experienced.  

b. Tasks:  • Image  • Negative  Cognition  (NC)  • Positive  Cognition  (PC)  • VoC  (Validity  of  Cognition)  

• Emotions  • SUD  • Physical  Sensation  

c. The  candidate  understands  the  importance  of  “staying  on  script”  in  Phase  Three  

5. The  candidate  identifies  the  purpose  and  tasks  of  Phase  Four:  Desensitization  

   

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a. Purpose:  Reprocess  negative  life  experiences  to  a  positive  resolution.  

b. Tasks:  • Candidate  identifies  instructions  to  begin  Phase  Four.  

• Candidate  understands  length  and  rate  of  BLS  

• Candidate  understands  how  to  give  feedback  between  sets  of  BLS.  

• Candidate  understands  how  to  assess  whether  information  is  shifting.  

• Candidate  understands  the  importance  of  “staying  out  of  the  way  of  spontaneous  processing.”  

• Candidate  understands  strategies  for  keeping  process  moving.  

• Candidate  understands  when  to  return  to  target.  

• Candidate  can  define  Feeder  Memories.  

• Candidate  can  define  Blocking  Beliefs  

• Candidate  can  identify  how  to  handle  strong  emotional  responses  during  Phase  Four.  

6. The  candidate  identifies  the  purposes  and  goals  of  Phase  Five:  Installation.  a. Purpose:  Strengthen  linkage  of  target  memory  to  adaptive  semantic  memory.  

b. Tasks:  • Candidate  identifies  pairing  target  memory  with  Positive  Cognition  

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(PC)  until  VoC  =  7  6. The  candidate  identifies  the  purposes,  goals  and  procedures  of  Phase  Six:  Body  Scan.  a. Purpose:  Resolve  residual  physiological  disturbance.  

b. Task:  Direct  client’s  attention  to  body  and  apply  BLS.  

8. The  candidate  identifies  the  purposes,  goals,  and  tasks  of  Phase  Seven:  Closure.  a. Purpose:  • Ensure  that  client  shifts  to  neutral  or  positive  emotional  state  and  reorients  to  present  time.  

• Provide  information  about  continuing  reprocessing.  

• Assure  client  of  clinician’s  availability.  

9. The  candidate  identifies  the  purposes,  goals,  and  tasks  of  Phase  Eight:  Reevaluation.  a. Purpose:  • Systematic  evaluation  of  treatment  gains  

• Adjustment  of  treatment  plan.  

10. The  candidate  identifies  the  Three-­‐Pronged  Protocol  of  EMDR  Therapy:  Past,  Present,  and  Future.  

   

 

 

 

 

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Core Competency # II:

Relationship Building and Maintenance

II. 1. Establish An Effective Therapeutic Alliance  The candidate demonstrates capacity to achieve a therapeutic alliance during Phases One and Two that supports the reprocessing of disturbing life events (Leeds, 2009; Shapiro, 2001, 2005).  The candidate demonstrates capacity to describe the elements of establishing the therapeutic alliance that are particular to EMDR Therapy:  

1) The candidate helps the client develop trust not only in the therapist but also in the principle of self-healing and the AIP model.  

2) The candidate helps the client develop the capacity and skill to make the honest, accurate self-report of internal, private experience that is necessary to maintain client stability and guide reprocessing and ongoing treatment.  

3) The candidate recognizes and articulates potential difficulties in EMDR Therapy treatment that may arise from assumptions about the therapeutic alliance that are perceived to conflict with EMDR Therapy procedures. The candidate reconciles those conflicts and integrates EMDR Therapy and AIP into his or her preferred approach to establishing the therapeutic alliance in a way that maintains fidelity to EMDR Therapy procedures (Adler-Tapia & Settle, 2008; Korn, Zangwill, Leeds, 2009; Lipke, & Smyth, 2001).  

The candidate collaborates with the client to set treatment goals and tasks that take into account the client’s expectations and wants as well as the therapist’s expertise.  

II.1  Establish  An  Effective  Therapeutic  Alliance  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  describes  the  role  of  the  therapeutic  alliance  in  reprocessing  disturbing  life  experiences.  

2. The  candidate  describes  how  to  establish  a  therapeutic  alliance  in  terms  of  the  AIP  model.  

3. The  candidate  identifies  his  or  her  assumptions  about  establishing  the  therapeutic  alliance.  

4. The  candidate  identifies  and  reconciles  potential  conflicts  between  his  or  her  assumptions  about  the  therapeutic  alliance  and  EMDR  Therapy  procedures.  

5. The  candidate  describes  

1. The  candidate  explains  AIP  and  EMDR  Therapy  procedures  to  the  client  simply  and  effectively.    

2. The  candidate  works  collaboratively  with  the  client  in  setting  goals.  

3. The  candidate  helps  the  client  develop  trust  in  the  AIP  model  and  the  principle  of  self-­‐healing  a. Metaphor  b. Identifying  disturbing  life  experiences  for  reprocessing  

4. The  candidate  explains  to  the  client  how  the  clinician’s  demeanor  may  change  during  the  different  phases  of  EMDR  

1. The  candidate  demonstrates  trust  in  the  principle  of  self-­‐healing.  

2. The  candidate  demonstrates  respect  for  the  AIP  model.  

3. The  candidate  integrates  EMDR  Therapy  and  AIP  into  his  or  her  viewpoint  on  the  therapeutic  alliance  while  maintaining  fidelity  to  EMDR  Therapy  protocols.  

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how  to  maintain  fidelity  to  EMDR  Therapy  procedures  while  maintaining  the  therapeutic  alliance.  

       

Therapy.  5. The  candidate  demonstrates  the  capacity  to  help  the  client  develop  the  ability  to  observe  and  describe  his  or  her  inner  experiences  moment  by  moment  in  session.  

6. The  candidate  explains  how  the  therapeutic  relationship  may  be  affected  by  the  introduction  of  EMDR  Therapy.  

 

II. 2. Assess Readiness and Foster Treatment Promoting Factors  The AIP model posits that current problems are rooted in past disturbing life experiences. Reprocessing those negative experiences, using the Three-Pronged Protocol, in Phases Three through Seven, results in positive changes in feelings, thoughts, and behavior that occur naturally, organically, and without conscious effort (EMDRIA, 2012; Shapiro, 2001).  The candidate articulates, elucidates, and applies elements of motivation and readiness that are particular to EMDR Therapy:  

1) Client Readiness for reprocessing of disturbing life experiences in Phases Three through Eight comprises the following: (Leeds, 2009; Parnell, 2007; Shapiro, 2001)  

a) Affect tolerance  b) Ability to shift from a negative emotional state to a neutral or positive emotional

state  c) Adequate physical, social, financial, and emotional resources to sustain ongoing

treatment  d) Ability to devote adequate time and attention to the treatment without undue

interference from other commitments on the part of both client and therapist  e) The candidate is proficient in assessing readiness for reprocessing and in

interventions that remediate deficiencies and promote readiness.  2) Motivation to proceed with reprocessing may be reduced by fear and/or secondary gain

issues. The candidate is proficient in resolving those issues so that the client is able to reprocess disturbing life experiences.  

 

II.  2.  Assess  Readiness  and  Foster  Treatment  Promoting  Factors  KNOWLEDGE   SKILLS   ATTITUDES  

1.  The  candidate  understands  readiness  factors  for  EMDR  Therapy  reprocessing.  2.    The  candidate  understands  client’s  role  in  EMDR  Therapy  reprocessing.  3.  The  candidate  understands  criteria  that  indicate  the  use  

1. The  candidate  identifies  childhood  and  current  attachment  patterns.  (Phase1)  

2. The  candidate  identifies  nature  and  degree  of  dissociation.  (Phase  1)  

3. The  candidate  assesses,  teaches,  and  reassesses  

1. The  candidate  appreciates  the  importance  of  assessing  readiness  for  the  reprocessing  phases  (3-­‐8)  of  EMDR  Therapy  reprocessing  

2. The  candidate  

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of  Resource  Enhancement  and  Development.  4.  The  candidate  understands  risk  factors  for  premature  termination  of  treatment  if  EMDR  Therapy  reprocessing  is  started.                  

dissociation  reduction  skills.  (Phases  1  &  2).  

4. The  candidate  provides  psycho-­‐education  on  client’s  role  in  session,  (i.e.,  mindful  noticing  and  accurate  reporting  of  private  experiences).  (Phase  2)  

5. The  candidate  provides  a  metaphor  to  enhance  mindful  noticing?  (Phase  2)  

6. The  candidate  assesses,  teaches,  and  reassesses  anxiety-­‐reduction  skills.    (Phase  2)  

7. The  candidate  identifies  the  presence  or  absence  of  the  following  criteria  that  indicate  the  use  of  RDI  (Phases  1  &  2)  a. Impaired  self-­‐regulation  skills.  

b. Maladaptive  tension  reduction.  

c. Substance  abuse  d. Therapy  interfering  behaviors  

e. Fears  of  starting  EMDR  Therapy  reprocessing  

f. Standard  methods  for  self-­‐control  have  proven  to  be  insufficient.  

8. The  candidate  identifies  the  presence  or  absence  of  a  substantial  risk  that  the  client  would  terminate  treatment  prematurely  if  EMDR  Therapy  reprocessing  were  started  (Phases  1  &  2)      a. Shifts  from  idealizing  to  devaluing  clinician.  

b. Weak  ego  strength  c. Intolerable  shame  d. Re-­‐experiencing  of  painful  memories.    

*The  above  skills  have  been  adapted  from  Leeds,  2009)  

demonstrates  willingness  to  acquire  skills  for  increasing  client’s  readiness  for  the  reprocessing  phases  of  EMDR  Therapy.  

 

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II. 3. Recognize and Resolve Resistance and Ambivalence  The candidate articulates, elucidates, and applies understanding of resistance and ambivalence particular to AIP and EMDR Therapy (Dworkin, 2005; Leeds, 2009; Parnell, 2007; Shapiro, 2001).  

1) AIP views resistance and ambivalence as fears, phobias, or blocking beliefs originating in disturbing life events.  

2) The memories of the disturbing events can be targeted and reprocessed, thus organically resolving ambivalence and resistance to ongoing EMDR Therapy work.  

3) The candidate recognizes the impact of client’s and therapist’s attachment style on resistance and ambivalence in EMDR Therapy.  

4) Resistance and ambivalence can appear in any phase of EMDR Therapy.  

II.  3.  Recognize  and  Resolve  Resistance  and  Ambivalence  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  and  articulates  the  AIP  view  on  resistance  and  ambivalence.  

2. The  candidate  understands  methods  of  identifying  earlier  memories  associated  with  resistance  and  ambivalence.    

3. The  candidate  understands  the  impact  of  attachment  style  on  resistance  and  ambivalence  in  EMDR  Therapy.        

               

1. The  candidate  helps  client  identify  fears  regarding  EMDR  Therapy  reprocessing  (Phases  3  -­‐  8).  

2. The  candidate  helps  client  identify  earlier  memories  associated  with  fears  of  EMDR  Therapy  reprocessing.  

3. The  candidate  helps  client  identify  blocking  beliefs  regarding  EMDR  Therapy  reprocessing.  

4. The  candidate  helps  client  identify  earlier  memories  associated  with  blocking  beliefs.  

5. The  candidate  helps  client  identify  earlier  memories  related  to  attachment  figures.  

6. The  candidate  helps  client  resolve  resistance  and  ambivalence  by:  

a. Understanding  that  the  mere  identification  of  the  memory  may  alleviate  the  resistance  and/or  ambivalence  enough  to  proceed  with  reprocessing.  

b. Reprocessing  the  earlier  memory  associated  with  resistance  and/or  ambivalence.  

c. RDI  

1. The  candidate  displays  willingness  to  view  resistance  and  ambivalence  from  an  AIP  perspective.  

2. The  candidate  integrates  AIP  into  his  or  her  preferred  theoretical  view  of  resistance  and  ambivalence    

3. The  candidate  maintains  fidelity  to  EMDR  Therapy  protocols  and  procedures  while  addressing  resistance  and  ambivalence.  

   

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II. 4. Recognize and Resolve Transference-Countertransference Enactment  The candidate articulates, elucidates, and applies understanding of transference and countertransference enactment that are particular to EMDR Therapy.  

1) In addition to transference and countertransference to one another, both therapist and client may have transference to EMDR Therapy protocols and procedures themselves (Parnell, 2007).  

2) The transference-countertransference enactment may have its origins in earlier life experiences.  

3) The therapist responds effectively to transference material that spontaneously emerges during Phase Four, Desensitization (Dworkin, 2005; Leeds, 2009).  

4) The therapist recognizes his or her countertransference that arises from his or her own earlier life experiences (Dworkin, 2005; Parnell, 2007).  

II.4.  Recognize  &  Resolve  Transference-­‐Countertransference  Enactment  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  his  or  her  own  emotional  reactions  to  EMDR  Therapy  protocols  and  procedures  in  AIP  terms;  that  is,  that  the  clinician’s  reactions  to  EMDR  Therapy  may  have  their  origins  in  the  clinician’s  earlier  experiences.  

2. The  candidate  understands  client’s  transference  to  EMDR  Therapy  protocols  and  procedures  in  AIP  terms;  that  is  that  the  client’s  reactions  to  EMDR  Therapy  may  have  their  origins  in  the  client’s  earlier  experiences.  

3. The  candidate  understands  that  fidelity  to  EMDR  Therapy  protocol  is  associated  with  positive  treatment  outcomes.  

4. The  candidate  understands  that  transference  -­‐  countertransference  enactment  can  occur  in  any  phase  of  EMDR  Therapy.      

5. The  candidate  understands  that  the  client’s  

1. The  candidate  helps  the  client  identify  earlier  memories  associated  with  the  transference  -­‐countertransference  enactment.  

2. The  candidate  helps  the  client  resolve  the  transference  -­‐  countertransference  enactment  by:  a. Understanding  that  the  mere  identification  of  the  memory  may  allow  the  work  in  any  of  the  Eight  Phases  to  continue.  

b. Earlier  memories  associated  with  transference  may  become  EMDR  Therapy  targets  those  memories  for  reprocessing.  

3. The  candidate  identifies  and  resolves  earlier  memories  regarding  his  or  her  own  transference  to  EMDR  Therapy  protocols  and  procedures.  

4. The  candidate  identifies  and  resolves  earlier  memories  regarding  client’s  transference  to  EMDR  Therapy  protocols  and  procedures.  

1. The  candidate  displays  willingness  to  understand  transference  and  countertransference  in  AIP  terms.  

2. The  candidate  integrates  and/or  reconciles  AIP  with  views  on  transference  and  countertransference  of  his  or  her  preferred  theoretical  orientation.  

3. The  candidate  maintains  fidelity  to  EMDR  Therapy  protocols  when  working  with  transference  and  countertransference.  

       

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transference  material  that  emerges  in  Phase  4,  Desensitization,  is  associated  with  the  target  memory,  according  to  AIP.  

6. The  candidate  understands  that  the  clinician’s  countertransference  responses  may  have  their  origins  in  the  clinician’s  earlier  experiences.  

       

5. The  candidate  identifies  and  resolves  his  or  her  own  countertransference  material  that  arises  from  client’s  EMDR  Therapy  reprocessing.  

6. The  candidate  keeps  the  reprocessing  going  when  transference  material  arises  in  Phase  4.  a. Saying,  “Go  with  that.”  b. Identifying  feeder  memories  and/or  blocking  beliefs  if  necessary.  

c. Employing  Cognitive  Interweaves  as  necessary.  

 

II. 5. Recognize Therapeutic Alliance Rupture  The Candidate articulates, elucidates, and applies understanding of ruptures to the therapeutic alliance and the repair of those ruptures that are particular to EMDR Therapy and AIP.  

1) The client and therapist are able to communicate about the client’s inner experience in a way that allows EMDR Therapy to continue safely and effectively.  

2) The therapist recognizes and repairs ruptures to the therapeutic alliance as they occur in the therapeutic moment (Dworkin, 2005).  

II.  5.  Recognize  Therapeutic  Alliance  Rupture  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  describes  the  potential  for  rupture  to  the  therapeutic  alliance  in  each  of  the  Eight  Phases  of  EMDR  Therapy.  

2. The  candidate  understands  the  importance  of  recognizing  and  resolving  ruptures  to  the  therapeutic  alliance  in  the  therapeutic  moment.  

   

1. The  candidate  provides  psycho-­‐education  on  the  potential  for  alliance  rupture  in  each  phase  of  EMDR  Therapy.  

2. The  candidate  helps  the  client  recognize  therapeutic  rupture  and  communicate  explicitly  about  it  at  the  moment  it  occurs.    

3. The  candidate  communicates  with  the  client  about  the  therapeutic  relationship  in  all  phases  of  EMDR  Therapy  as  it  unfolds  in  the  therapeutic  moment.  

1. The  candidate  understands  the  importance  of  the  therapeutic  relationship  in  reprocessing  traumatic  memories.  

2. The  candidate  demonstrates  respect  for  the  importance  of  directly  communicating  with  the  client  about  therapeutic  ruptures.  

 

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Core Competency # III: Intervention Planning

III. 1. EMDR Therapy Approach to Performing a Comprehensive Assessment  

The candidate demonstrates capacity to understand, articulate, elucidate and apply the principles of AIP to obtain and organize information about the client problems, goals and resources across behavioral, affective, cognitive, and somatic domains (Leeds, 2009; Greenwald, 2007; Parnell, 2007; Shapiro, 2001). The Comprehensive Assessment occurs in Phase One, History-Taking and is revised as treatment proceeds through the other EMDR Therapy phases.  

1) Present complaints 2) Goals and Desired Outcomes 3) Type and severity of symptoms 4) Characteristic patterns of perceiving, thinking, and responding 5) Triggers or stressors that elicit negative pattern 6) Etiological events in maladaptive memory networks and adaptive memory networks 7) Intrapersonal, interpersonal, and systemic vulnerabilities 8) Intrapersonal, interpersonal, and systemic resources 9) Possible obstacles and challenges in the therapy process, especially those particular to

each of the Eight Phases of EMDR Therapy. 10) Preparation for termination of treatment

The candidate describes the difference between performing a comprehensive assessment in Phase One, History Taking, and Phase Three, Assessment (Shapiro, 2001).  The candidate demonstrates knowledge of standardized tools for history taking and treatment planning (Leeds, 2009).  

III.  1.  Performing  a  Comprehensive  Assessment  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  knows  that  the  Comprehensive  Assessment  is  performed  in  Phase  One,  History  Taking  and  is  revised  as  EMDR  Therapy  treatment  proceeds.  

2. The  candidate  describes  the  purposes  of  performing  a  Comprehensive  Assessment  in  terms  of  the  AIP  Model    a. Client  Selection  b. Identifying  potential  targets  for  reprocessing  from  negative  and  positive  life  events  

c. Identifying  present  

1. The  candidate  lists  the  client’s  presenting  complaints  (symptoms  in  behavioral,  cognitive,  affective,  and  somatic  domains).  

2. The  candidate  identifies  current    (present)  external  and  internal  stimuli  and  patterns  of  behaviors,  thoughts,  emotions,  and  body  sensations  associated  with  the  client’s  presenting  complaints  (symptoms).  

3. The  candidate  identifies  the  client’s  desired  future  behavioral,  somatic,  affective,  and  cognitive  changes.        

4. The  candidate  identifies  the  

1. The  candidate  demonstrates  an  attitude  of  collaboration  with  the  client  in  identifying  treatment  goals  and  target  memories.  

2. The  candidate  demonstrates  an  appreciation  that  history-­‐taking  is  an  ongoing  process  from  start  to  finish  of  EMDR  Therapy.  

3. The  candidate  demonstrates  willingness  to  accept  his  or  her  strengths  and  weaknesses  regarding  assessment.  

4. The  candidate  

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triggers  d. Identifying  future  goals  e. Determining  the  nature  and  extent  of  positive  and  negative  memory  networks.  

f. Determining  the  client’s  capacity  for  working  collaboratively  with  the  clinician.  

3. The  candidate  understands  how  to  utilize  current  behavioral,  cognitive,  affective,  and  somatic  complaints  (symptoms)  to  access  relevant  negative  memory  networks  for  the  purpose  of  identifying  disturbing  life  experiences  for  EMDR  Therapy  reprocessing.      

4. The  candidate  understands  how  to  utilize  future  goals  and  aspirations  (behavioral,  cognitive,  affective,  and  somatic)  to  access  relevant  positive  memory  networks  for  the  purpose  of  identifying  strengths  and  deficits  in  internal  and  external  resources  (i.e.,  those  that  will  support  EMDR  Therapy  reprocessing  of  negative  life  experiences).  

5. The  candidate  identifies  potential  obstacles  to  reprocessing  traumatic  memories  (i.e.,  medical  issues,  dissociation,  substance  abuse,  suicidal  ideation,  self-­‐harming  behavior,  Axis  II  features,  insecure  attachment  status,  fears,  secondary  gains).  

client’s  treatment  related  concerns  and  fears.  

5. The  candidate  obtains  a  history  of  the  client’s  adverse  and  traumatic  events,  especially  those  related  to  the  client’s  presenting  complaints.  

6. The  candidate  obtains  a  life  history  of  the  client’s  positive  events  that  represent  internal  and  external  resources,  especially  those  related  to  the  client’s  presenting  complaints.    

7. The  candidate  identifies  childhood  and  current  attachment  patterns.  

8. The  candidate  rules  out  medical  and  other  risk  issues  for  EMDR  Therapy  reprocessing.  

9. The  candidate  identifies  nature  and  degree  of  structural  dissociation?  

10. The  candidate  assesses  history  and  current  substance  abuse.  

11. The  candidate  assesses  history  and  current  danger  to  self  or  others.  

12. The  candidate  assesses  history  and  current  tension  reduction,  self-­‐injurious,  and  therapy  interfering  behaviors.  

13. The  candidate  tailors  the  assessment  in  Phase  One  to  the  therapeutic  setting.  

14. The  candidate  develops  a  collaborative  treatment  plan  and  sequence  of  targets.  

15. The  candidate  plans  for  termination  of  treatment.  

 *These  skills  have,  in  large  part,  

demonstrates  willingness  to  embrace  the  value  and  importance  of  performing  a  written  comprehensive  assessment.  

       

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6. The  candidate  demonstrates  knowledge  of  clinical  interviewing  and  standardized  tools  for  assessment  of  potential  obstacles  to  reprocessing  traumatic  memories  (i.e.,  dissociation,  substance  abuse,  attachment  status,  suicidal  ideation,  etc.).  

7. The  candidate  describes  the  difference  between  performing  a  comprehensive  assessment  in  Phase  One  and  the  steps  of  Phase  Three,  Assessment.  

8. The  candidate  describes  the  adaptation  of  performing  a  Comprehensive  Assessment  in  Phase  One,  History-­‐taking  in  various  therapeutic  settings,  (e.g.,  private  practice,  inpatient,  disaster,  etc.).  

been  adapted  from  EMDR  Therapy  Fidelity  Rating  Scale  for  History  Taking,  Case  Formulation,  Treatment  Planning,”  (Leeds,  2009).              

 

III. 2. Specify An Accurate Diagnostic Formulation  The candidate demonstrates the capacity to specify a focused descriptive appraisal about the nature and severity of client’s presenting symptoms and current functioning in Phase One, History-Taking. This appraisal includes a DSM and/or ICD diagnosis, and also specifies immediate treatment considerations, problems in living, and client’s capacity for the reprocessing phases of EMDR Therapy (Phases Three – Eight).  The candidate demonstrates knowledge of standardized diagnostic tools, especially those that have a bearing on capacity for effective EMDR Therapy reprocessing.  

III.  2.  Specify  an  Accurate  Diagnostic  Formulation    KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  demonstrates  understanding  of  DSM  and  ICD  diagnostic  systems.  

2. The  candidate  integrates  AIP  principles  with  DSM  or  ICD  diagnosis.  

1. The  candidate  lists  the  nature  and  severity  of  client’s  presenting  complaints  (symptoms).  

2. The  candidate  administers  and  interprets  standardized  diagnostic  tools,  if  appropriate.  

1. The  candidate  demonstrates  respect  for  the  diagnostic  process.  

2. The  candidate  recognizes  the  importance  of  assessing  the  client’s  capacity  to  reprocess  memories  of  traumatic  

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3. The  candidate  identifies  standardized  diagnostic  tools  that  have  a  bearing  on  effective  EMDR  Therapy  reprocessing.  

4. The  candidate  identifies  factors  (internal  and  external  resources)  that  determine  client’s  capacity  for  the  reprocessing  phases  of  EMDR  Therapy  (Phases  Three  -­‐  Eight).  

                 

3. The  candidate  incorporates  findings  from  standardized  diagnostic  tools  in  the  diagnostic  formulation,  if  appropriate.  

4. The  candidate  identifies  specific  DSM  or  ICD  Axis  I  diagnoses  and  identifies  or  rule  out  Axis  II  diagnoses.  

5. The  candidate  specifies  immediate  treatment  considerations  a. Medical  issues  b. Current  substance  abuse  c. Current  danger  to  self  and/or  others  

d. Current  tension  reduction,  self-­‐injurious,  and  therapy  interfering  behaviors  

e. Nature  and  degree  of  dissociation  

f. Attachment  status  6. The  candidate  writes  a  concise  descriptive  appraisal  of  nature  and  severity  of  client’s  symptoms  and  current  functioning  as  step  one  in  writing  a  comprehensive  case  report.  

 *These  skills,  in  large  part,  have  been  adapted  from  “EMDR  Therapy  Fidelity  Rating  Scale  for  History  Taking,  Case  Formulation,  Treatment  Planning,”  (Leeds,  2009).  

life  experiences  in  EMDR  Therapy  Phases  Three-­‐Eight.  

         

III.  3.  EMDR  Therapy  Approach  to  Developing  an  Effective  Clinical  Formulation  The candidate demonstrates the capacity to understand, articulate, and elucidate a compelling explanation for the client’s presenting problems and maladaptive patterns derived from developmental, social, and health histories and based on the AIP Model and the Three-Pronged Protocol of EMDR Therapy. The candidate understands, articulates, and elucidates the influence of cultural dynamics in the client’s behavior and functioning.

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The candidate understands, articulates, and elucidates assessment of attachment status and dissociation (Leeds, 2009; Parnell, 2007).

 

III.  3.  Developing  an  Effective  Clinical  Formulation  

KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  that  the  clinical  formulation  provides  an  explanation  of  the  development  and  perpetuation  of  symptoms  and  maladaptive  patterns.    

2. The  candidate  understands  that  the  clinical  formulation  is  a  link  between  the  diagnostic  formulation,  which  is  a  description  of  the  symptoms,  and  the  treatment  formulation,  which  specifies  interventions.  

3. The  candidate  understands  that,  according  to  AIP,  symptoms  and  maladaptive  patterns  originate  from  life  experiences.  

4. The  candidate  understands  that,  according  to  AIP,  internal  resources  and  strengths  originate  from  life  experiences.  

5. The  candidate  understands  the  role  of  attachment  status  in  the  development  and  perpetuation  of  symptoms  and  maladaptive  patterns.  

6. The  candidate  understands  the  role  of  dissociation  in  the  development  and  perpetuation  of  symptoms  and  maladaptive  patterns.  

1. The  candidate  writes  a  compelling,  concise  clinical  formulation  as  Step  Two  in  producing  a  written  case  report.  

2. The  candidate  develops  the  clinical  formulation  based  on  developmental,  social,  health,  and  cultural  factors  gathered  in  the  Comprehensive  Assessment.  

3. The  candidate  explains  the  client’s  presenting  complaints  (symptoms)  and  maladaptive  patterns  in  AIP  terms.  

4. The  candidate  identifies  key  adaptive  and  maladaptive  memory  networks  that  are  the  basis  of  the  client’s  presenting  complaints  and  maladaptive  patterns.  

5. The  candidate  integrates  other  theoretical  perspectives  with  AIP,  as  necessary.  

6. The  candidate  addresses  attachment  status  and  dissociation  issues  in  the  clinical  formulation.  

7. The  candidate  revises  the  clinical  formulation  as  treatment  proceeds.  

       

1. The  candidate  demonstrates  willingness  to  explain  the  client’s  complaints  (symptoms)  and  maladaptive  patterns  in  AIP  terms.  

2. The  candidate  demonstrates  willingness  to  integrate  and/or  reconcile  AIP  with  his  or  her  preferred  theoretical  orientation  for  the  purpose  of  maintaining  fidelity  to  EMDR  Therapy  protocols.  

3. The  candidate  demonstrates  willingness  to  accept  and  improve  his  or  her  strengths  and  weaknesses  in  writing  a  clinical  formulation.  

4. The  candidate  demonstrates  willingness  to  embrace  the  value  and  importance  of  performing  a  written  treatment  formulation.  

       

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III. 4. Develop an Effective Treatment Formulation  The candidate demonstrates the capacity to collaborate with the client to set treatment goals and treatment focus.  The candidate demonstrates the capacity to identify adaptive and maladaptive memory networks underlying the client’s problems using direct inquiry and also bridging techniques (Leeds, 2009; Parnell, 2007; Shapiro, 2001).  The candidate demonstrates the capacity to collaborate with the client to select and prioritize memories to target for EMDR Therapy reprocessing (Leeds, 2009; Parnell, 2007; Shapiro, 2001).  The candidate understands, articulates, and elucidates strategies for addressing treatment-related fears.  The candidate understands, articulates, and elucidates the client’s internal and external resources that will support EMDR Therapy reprocessing of target memories (Leeds, 2009; Parnell, 2007; Shapiro, 2001).  

III.  4.  Develop  an  Effective  Treatment  Formulation  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  how  to  collaborate  with  the  client  in  setting  treatment  goals  based  on  the  client’s  presenting  complaints  and  desired  treatment  outcomes.  

2. The  candidate  understands  strategies  for  identifying  adaptive  and  maladaptive  memory  networks.  

3. The  candidate  demonstrates  knowledge  of  identifying  and  prioritizing  targets  for  EMDR  Therapy  reprocessing  in  terms  of  the  Three-­‐Pronged  Protocol.  

4. The  candidate  demonstrates  understanding  of  identifying  and  resolving  client’s  fears  of  EMDR  Therapy  treatment.  

5. The  candidate  demonstrates  understanding  of  identifying  and  resolving  therapy-­‐interfering  behaviors.  

6. The  candidate  demonstrates  understanding  of  the  importance  of  the  client’s  internal  resources  to  the  

1. The  candidate  identifies  the  client’s  treatment  goals  (behavioral,  somatic,  affective,  and  cognitive  changes).  

2. The  candidate  uses  direct  questioning  to  identify  adaptive  and  maladaptive  memory  networks.  

3. The  candidate  uses  bridging  techniques  (i.e.,  Floatback  and  Affect  Bridging)  to  identify  adaptive  and  maladaptive  memory  networks.  

4. The  candidate  collaborates  with  the  client  to  select  a  sequence  of  targets  for  EMDR  Therapy  reprocessing.  

5. The  candidate  identifies  and  ameliorates  treatment-­‐related  fears.  

6. The  candidate  specifies  a  preparation  phase  of  appropriate  length,  based  on  client’s  internal  and  external  resources  and  considering  therapy-­‐interfering  factors,  (e.g.,  non-­‐life  threatening  

1. The  candidate  demonstrates  willingness  to  write  a  treatment  formulation.  

2. The  candidate  demonstrates  respect  for  the  importance  of  a  written  treatment  formulation.  

3. The  candidate  recognizes  the  need  for  incorporating  flexibility  in  the  treatment  formulation  in  order  to  respond  to  the  moment-­‐to-­‐moment  therapeutic  environment.  

4. The  candidate  demonstrates  willingness  to  develop  a  written  format  that  will  be  effective  in  his  or  her  own  therapeutic  setting.  

 

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effective  EMDR  Therapy  reprocessing  of  traumatic  memories.  

7. The  candidate  lists  the  four  criteria  for  using  RDI  prior  to  EMDR  Therapy  reprocessing  of  traumatic  memories  (Leeds,  2009)  a. Impaired  self-­‐regulation  b. Risk  of  premature  termination  of  treatment  if  EMDR  Therapy  reprocessing  is  started  

c. Over-­‐whelming  affect  and/or  incoherent  narrative  

d. EMDR  Therapy  reprocessing  has  had  adverse  impact  on  functioning  

8. The  candidate  demonstrates  knowledge  of  formulating  a  treatment  plan  appropriate  to  the  treatment  setting,  time  available,  and  current  life  circumstances.  

   

substance  abuse  and  self-­‐harm,  secondary  gain,  environmental  obstacles,  therapeutic  alliance,  etc.)  

7. The  candidate  identifies  gaps  in  skills  that  will  need  to  be  strengthened  or  developed  in  support  of  EMDR  Therapy  reprocessing  of  traumatic  memories  

8. The  candidate  identifies  the  presence  of  one  of  four  criteria  for  using  RDI  prior  to  reprocessing  of  traumatic  memories  (Leeds,  2009)  a. Impaired  self-­‐regulation  b. Risk  of  premature  termination  of  treatment  if  EMDR  Therapy  reprocessing  is  started  

c. Over-­‐whelming  affect  and/or  incoherent  narrative  

d. EMDR  Therapy  reprocessing  has  had  adverse  impact  on  functioning  

9. The  candidate  writes  a  draft  of  the  treatment  goals,  a  sequence  of  targets  for  reprocessing,  and  a  preparation  phase  of  appropriate  length  as  the  third  step  in  producing  a  written  case  report.  

 *These  skills  were  adapted,  in  large  part,  from  EMDR  Therapy  Fidelity  Rating  Scales  (Leeds,  2009)  

 

III. 5. Draft A Clinical Case Report  The candidate writes a succinct, coherent case report:  1) Consistent with the client’s presenting problem and goals (i.e., Case Conceptualization

through the Comprehensive Assessment and Diagnostic Formulation) 2) Formulated in terms of AIP principles and the Three-pronged Protocol of EMDR Therapy

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(i.e., Clinical Formulation) 3) Specifies a treatment plan that identifies and prioritizes target memories for EMDR Therapy

reprocessing (i.e., Treatment Formulation) 4) Identifies obstacles and challenges to each of the Eight Phases of EMDR Therapy (i.e.,

Treatment Formulation)

III.  5.  Draft  a  Clinical  Case  Report  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  knows  what  information  should  be  included  in  an  AIP-­‐informed  written  clinical  case  report.  

2. The  candidate  knows  that  the  clinical  case  report  can  take  various  forms  based  on  setting  and  candidate  preference.  

             

1. The  candidate  organizes  his  or  her  drafts  of  Case  Conceptualization,  Diagnostic  Formulation,  Clinical  Formulation,  and  Treatment  Formulation  to  construct  a  succinct,  coherent  Case  Report  in  Phase  One,  History-­‐Taking.  a. Consistent  with  client’s  presenting  problem  and  goals.  

b. Formulated  in  terms  of  AIP  and  the  Three-­‐Pronged  Protocol.  

c. Identifies  and  prioritizes  target  memories  for  EMDR  Therapy  reprocessing.  

d. Identifies  obstacles  and  challenges  to  each  of  the  Eight  Phases  of  EMDR  Therapy.  

1. The  candidate  understands  the  importance  of  writing  a  clinical  case  report.  

2. The  candidate  demonstrates  willingness  to  improve  writing,  conceptualization,  and  organization  skills.  

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Core Competency # IV: Intervention Implementation

IV. 1. Establish Treatment Focus, Goals, and Strategy  

Treatment Focus is the central therapeutic emphasis of a given therapeutic approach.  Treatment Goals are the outcomes mutually agreed upon by client and therapist.  Treatment Strategy is an action plan for specific intervention methods.  The candidate understands, articulates, and elucidates the following central therapeutic emphasis of EMDR Therapy Treatment Focus in terms of the AIP Model, the Three-Pronged Protocol, and the Eight Phases of EMDR Therapy:  

Reprocess disturbing life experiences to an adaptive resolution utilizing Bi-Lateral Stimulation, thereby integrating unassimilated negative information together with positive information to empower a whole human capable of love and service (EMDRIA, 2012; Shapiro, 2001, 2002a; Siegel, 2002).    

The candidate understands, articulates, and elucidates the Treatment Goals in terms of the AIP Model, the Three-Pronged Protocol, and the Eight Phases of EMDR Therapy (Leeds, 2009; Shapiro, 2001).  The candidate understands, articulates, elucidates, and clinically applies the Treatment Strategy in terms of the AIP Model, the Three-Pronged Protocol, and each of the Eight Phases of EMDR Therapy.  The candidate understands, articulates, elucidates, and clinically applies ways Treatment Goals and Strategy might be modified as treatment proceeds.  

IV.  1.  Establish  Treatment  Focus,  Goals  and  Strategy  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  that  the  Treatment  Focus  of  EMDR  Therapy  is  to  reprocess  disturbing  life  experiences  to  an  adaptive  resolution  using  BLS.  

2. The  candidate  understands  that  the  Treatment  Goals  are  the  client’s  desired  outcomes.  

3. The  candidate  understands  that  the  Treatment  Strategy  is  the  application  of  the  Eight  Phases  of  EMDR  Therapy  and  the  Three-­‐Pronged  Protocol.  

4.  The  candidate  identifies  

Phase  1:  History-­‐Taking  1. Candidate  obtained  a  list  of  presenting  complaints  (symptoms).    -­‐AL-­‐  

2. Candidate  identified  client’s  treatment  goals  regarding  behavioral,  somatic,  affective,  and  cognitive  changes.    -­‐AL-­‐  

3. Candidate  identified  client’s  treatment  related  concerns  and/or  fears.    -­‐AL-­‐  

4. Candidate  identified  defenses  that  can  potentially  block  processing  (i.e.,  substance  abuse,  shame,  self-­‐injurious  behavior).    -­‐JK-­‐  

1. The  candidate  understands  the  importance  of  establishing  Treatment  Focus,  Goals,  and  Strategy  in  Phase  One.  

2. The  candidate  understands  the  value  of  fidelity  to  EMDR  Therapy  protocols.  

3. The  candidate  understands  the  importance  of  modifying  Goals  and  Strategy  as  treatment  proceeds.  

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stabilization  strategies  and  tools.  

5. The  candidate  identifies  the  purpose  of  stabilization  tools  and  strategies  in  each  phase  of  EMDR  Therapy,  why  and  how  to  use  stabilization  tools  not  only  in  preparation  for  reprocessing,  but  also  during  history  gathering  and  between  sessions.  

6. The  candidate  identifies  the  mechanics  and  procedures  of  resourcing.  

7. The  candidate  identifies  the  mechanics  and  procedures  of  the  reprocessing  phases  of  EMDR  Therapy.  

8. The  candidate  identifies  the  informational  plateaus  of  Responsibility,  Safety,  and  Choice.  

9. The  candidate  identifies  the  qualities  of  the  Cognitive  Interweave.  

10.  The  candidate  identifies  situations  where  the  Cognitive  Interweave  is  indicated.  

 

5. Candidate  produced  evidence  of  formal,  systematic  assessment  of  client’s  readiness  for  reprocessing  (i.e.,  checklists,  standardized  measures,  questionnaires,  etc.).  -­‐RM-­‐    

6. Candidate  obtained  a  life  history  of  adverse  and  traumatic  events.  -­‐AL-­‐  a. Relevant  to  presenting  complaints  and  future  goals.  

b. Methods:  Direct  Questioning,  Floatback,  and  Affect  Scan.        

Phase  2:    Preparation    1. Candidate  explained  to  client  how  their  presenting  issues  are  related  to  past  experiences  and  how  EMDR  Therapy  reprocessing  can  help  them  organically  achieve  their  future  goals.    -­‐RM-­‐  

2. Candidate  obtained  EMDR  Therapy-­‐specific  informed  consent.    -­‐AL-­‐  a. Re-­‐experiencing  aspects  of  traumatic  event.  

b. Remembering  suppressed  or  dissociated  material.  

c. Changes  in  the  ways  memories  are  experienced.  

3. Candidate  demonstrated  to  client  the  mechanical  elements  of  the  reprocessing  phases  of  EMDR  Therapy.  a. Seating  b. Distance  c. BLS  Formats,  with  EM  as  the  preferred  

d. Differences  for  resourcing  verses  reprocessing  

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e. Stop  Signal/Metaphors  4. Candidate  demonstrated  ability  to  track  client’s  internal  processes  of  cognitions,  affect,  and  body  sensations.    –RM-­‐  

5. Candidate  helped  client  develop  the  ability  to  observe  their  own  internal  processes  of  cognitions,  affect,  and  body  sensations.  -­‐RM-­‐  

6. Candidate  helped  client  develop  ability  to  accurately  report  their  present  internal  experience  of  cognition,  affect,  and  physical  sensations.        

7. Candidate  taught  client  tools  to  ensure  client’s  ability  to  shift  affective  states:  a Safe/Calm  Place  b RDI  (general  and/or  target  specific)  

c Container  d Other  affect  management  tools  

*The  following  is  “The  EMDR  Therapy  Fidelity  Rating  Scale  for  Calm  Place-­‐Safe  Place  Exercise,”  (Leeds,  2009,  p.  341).  a. Did  the  clinician  provide  an  explanation  and  purpose  for  the  exercise?    

b. Did  the  clinician  assist  in  identifying  an  appropriate  memory,  image  or  other  sensory  component?    

c. Did  the  candidate  elicit  additional  sensory  details?  

d. Did  the  clinician  add  brief  sets  (4–12  cycles)  of  BLS?    

e. Did  the  clinician  ask  subject  to  report  feelings  and  

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observations  after  each  set  of  stimulation?    

f. Did  the  clinician  ask  subject  to  identify  a  cue  word  or  phrase  and  rehearse  it  with  the  imagery  and  additional  sets  of  stimulation?  

g. Did  the  clinician  ask  subject  to  rehearse  the  imagery  and  cue  word(s)  without  guidance?    

h. Did  the  clinician  ask  subject  to  remember  a  disturbing  incident  or  situation  and  then  rehearse  the  exercise  again  with  guidance?  

i. Did  the  clinician  ask  subject  to  remember  another  disturbing  incident  or  situation  and  then  rehearse  the  exercise  again  without  guidance?  

8. If  the  tool  is  contaminated  by  negative  associations,  the  candidate  a. Recognizes  b. Discards  c. Replaces  with  a  non-­‐contaminated  tool.  

9. Candidate  evaluated  client’s  readiness  for  reprocessing  phases  as  measured  by  client’s  ability  to  shift  from  distressed  states  to  more  neutral  states.  

Phase  3:    Assessment  1. Assessment  Phase  was  done  at  the  beginning  of  a  distinct  therapy  session  and  directly  followed  by  Phase  4  in  the  same  session.  

2. Assessment  Phase  was  succinct  (i.e.,  3  -­‐  10  minutes).  

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3. Candidate  arranged  seating  position,  determined  distance,  stop  signal  and  preferred  BLS  method  before  proceeding  with  obtaining  the  Assessment  Phase  components.  

4. The  candidate  asked  the  client  to  identify  all  the  components  of  the  chosen  target  for  reprocessing  as  they  are  currently  stored:  a. Target  memory  b. Image  (or  other  sensory  memory)  

c. Negative  Cognition  (NC)  • Negative/Irrational,  Self-­‐referencing  Statement  

• Present-­‐Tense,  while  re-­‐experiencing  the  old  memory  now  

d. Positive  Cognition  (PC)  • Positive,  Self-­‐referencing  Statement    

• Present-­‐Tense  e. Validity  of  Cognition  (VOC    1-­‐7)  

f. Emotions/Feelings  g. Subjective  Units  of  Distress  (SUDS    0-­‐10)  

h. Location  of  Body  Sensation  5. Did  the  candidate  follow  the  assessment  sequence  listed  above?  

Phase  4:  Desensitization  1. Immediately  after  Phase  3,  Assessment,  the  candidate  instructed  client  to  focus  on  the  image,  the  NC  (in  first  person),  and  the  body  location  and  then  begins  BLS.  

2. The  candidate  administered  an  initial  set  of  BLS  of  24-­‐36  repetitions,  or  another  length  based  on  client’s  window  of  

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tolerance.  3. At  the  end  of  each  discrete  set  of  BLS,  the  candidate  succinctly  assessed  the  presence  of  change  and  the  client’s  dual  awareness  by  eliciting  a  report  on  the  client’s  current  experience  (e.g.  “Okay.”  “Take  a  breath,”  “What  do  you  notice  now?”)  and  then  immediately  resumes  BLS  after  the  client’s  response.  

4. During  BLS,  the  candidate  stayed  out  of  the  way  of  spontaneous  reprocessing.  

5. The  candidate  offered  periodic  nonspecific  verbal  support,  (e.g.,  “Good  job.”    “It’s  in  the  past.  “,  etc.),  as  needed.  

6. The  candidate  demonstrated  understanding  that  every  response  produced  by  the  client  (e.g.,  transference  and/or  performance  anxiety  remarks,  or  when  the  mind  goes  to  another  time  and  place),  is  associated  with  the  target  and  simply  said  “Go  with  that.”      

7. The  candidate  recognized  when  the  client  reaches  the  end  of  a  channel,  as  indicated  by  verbal  reports  and  observation  of  nonverbal  cues,  and  returned  to  the  target.    

8. On  the  returning  to  target,  the  candidate  asked  the  client  to  scan  for  any  remaining  disturbance  and  then  resumes  BLS.  

9. The  candidate  varied  the  characteristics  of  BLS  as  

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necessary  to  facilitate  reprocessing.    

10. As  necessary  to  facilitate  reprocessing,  the  candidate:  a. Explored  for  an  earlier  disturbing  memory  with  similar  affect,  body  sensations,  behavioral  responses,  urges,  or  belief  

b. Explored  for  a  negative  belief,  fear  or  concern,  and  a  related  memory.  

c. Explored  target  memory  for  more  disturbing  images,  sounds,  smells,  thoughts,  beliefs,  emotions,  or  body  sensation.  

d. Invited  client  to  imagine  expressing  unspoken  words  or  acting  on  unacted  urges.  

e. Offered  an  interweave  11. The  candidate  showed  appropriate  judgment  in  selecting  and  offering  an  interweave  from  among  the  categories  of  responsibility,  safety,  and  choices  while  avoiding  excess  verbiage.    

12. As  long  as  the  client  maintained  dual  awareness,    the  candidate  responded  to  client’s  extended  intense  emotion,  by  continuing  sets  of  BLS  with  increased  repetitions  per  set,  maintaining  a  calm,  detached,  compassionate  demeanor,  and  providing  verbal  cueing  paced  with  the  BLS  (e.g.,  “just  notice”  or  “follow.”)  

13. If  Phase  4,  Desensitization  

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was  not  complete,  as  indicated  by  SUD  >  0,  the  candidate  appropriately  ended  the  session  without  reactivating  the  residual  disturbance  in  the  target.      The  candidate  proceeded  directly  to  Phase  7,  Closure,  omitting  Phase  5,  Installation  and  Phase  6,  Body  Scan.      

14. If  Phase  4,  Desensitization  was  completed,  as  indicated  by  SUD  =  0  or  ecologically  valid,  the  candidate  continued  on  to  Phase  5,  Installation.  

Phase  5:  Installation  1. The  candidate  inquired  if  the  original  PC  still  fits  or  if  another  PC  is  more  suitable.  

2. The  candidate  asked  client  to  pair  target  with  the  final  PC  and  to  rate  the  pairing  on  the  VoC  scale,  then  administered  BLS.  

3. At  the  end  of  the  set,  the  candidate  asked  the  client  to  focus  on  the  target  and  the  PC  and  continued  to  apply  more  sets  of  BLS  until  VoC  =  7,  or  an  ecologically  valid  rating.  

4. If  VoC  is  <7,  the  candidate  explored  what  prevented  it  from  being  a  7  and  resumed  reprocessing.    

5. When  VoC  is  =  7,  candidate  applied  a  set  of  BLS  to  complete  Installation.  

6. The  candidate  continued  sets  of  BLS  beyond  VoC  =  7  as  long  as  the  positive  change  continued,  time  permitting.  

Phase  6:  Body  Scan  

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1. The  candidate  asked  client  to  pair  the  target  with  the  PC  performing  a  Body  Scan,  requesting  client  to  notice  body  sensations.  

2. The  candidate  asked  client  to  focus  on  the  sensations  and  continues  sets  of  BLS  until  the  sensations  became  neutral  or  positive.  

3. If  the  Body  Scan  did  not  become  neutral  after  several  sets  of  BLS,  the  candidate  explored  what  prevented  it  from  being  neutral.  

4. If  a  new  memory  emerged,  the  candidate  made  an  appropriate  decision  regarding  the  new  memory  (to  target  it  now  or  work  it  into  the  treatment  plan).    

5. If  pleasant  sensations  were  reported,  the  candidate  strengthened  them  with  sets  of  BLS.      

Phase  7:  Closure    1. The  candidate  allotted  sufficient  time  for  Phase  7,  Closure  to  ensure  that  the  client  left  the  office  oriented  to  present  time  and  in  a  neutral  or  positive  state.  

2. The  candidate  asked  the  client  how  s/he  was  feeling  and  thinking  about  the  session.    To  ensure  that  the  client  left  the  session  in  a  grounded  state,  this  debriefing  occurred  prior  to  containment  and  psycho-­‐education.  

3. The  candidate  offered  empathy,  psycho-­‐education,  and  statements  to  put  into  

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perspective  the  client’s  experience.  

4. The  candidate  assured  that  client  was  reoriented  to  the  present  by:  a. Assessing  the  client’s  residual  distress  and  need  to  change  state  

b. Reminding  the  client  of  established  stabilization  skills.  

c. Offering,  if  necessary,  additional  structured  procedures  (such  as  guided  imagery,  breathing  exercises,  grounding)  for  decreasing  anxiety,  distress,  and  dissociation.  

5. The  candidate  made  a  closing  statement  that  included  the  following  information:  a. Reprocessing  may  continue  between  sessions  

b. The  client  should  keep  a  log  of  thoughts,  feelings,  images,  sensations,  urges,  behaviors,  other  memories  or  dreams.  

c. The  client  should  use  a  stress  management  technique  daily  

d. Remind  the  client  that  they  can  call  if  necessary  

Phase  8:  Re-­‐Evaluation  1. The  candidate  conducted  a  systematic  reevaluation  of  the  target  at  the  beginning  of  the  next  session.  

2. The  candidate  arranged  the  environment  that  facilitated  moving  into  Desensitization,  Phase  4.  

3. The  candidate  assessed  the  

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subject’s  experience  since  the  last  session  with  attention  to:  a. Feedback  from  the  log,    b. Changes  to  presenting  complaints,    

c. Responses  to  current  stimuli,  and  

d. Additional  memories  or  issues  that  might  warrant  modifications  to  the  treatment  plan  

4. The  candidate  checked  SUD  and  VoC  on  the  target  from  the  last  session.  

5. The  candidate  checked  for  additional  aspects  of  the  target  from  the  last  session  that  may  need  further  reprocessing,  

6. The  candidate  resumed  Phase  4,  Desensitization,  if  SUD  of  the  target    is    >  0.      

7. If  SUD  =  0,  and  VoC    <  7,  the  candidate  resumed  Phase  5,  Installation.  

8. If  SUD  =  0  and  VoC  =  7,  the  candidate  refers  to  the  treatment  plan  by  choosing  and  reprocessing  the  next  target.  

9. Throughout  the  treatment,  the  candidate  engaged  in  ongoing  reevaluation  until  all  past  and  present  targets  were  reprocessed,  emerging  memories  were  worked  into  the  plan,  and  future  templates  were  employed  to  ensure  achievement  of  treatment  goals.  

Future  Template  The  candidate  is  able  to  employ  

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three  kinds  of  future  templates:  1. Standard  Future  Template:  Overcoming  residual  anticipatory  anxiety  and  avoidance  by  reprocessing  image  of  the  future  with  low  to  moderate  SUD  ratings  

2. Positive  Template:  combines  mental  rehearsal  of  new  skills  and  adaptive  behaviors  to  potential  challenges  with  bilateral  stimulation  to  improve  self-­‐confidence  and  skills  

3. Fostering  a  New  Self-­‐Concept:  consolidating  a  new  sense  of  self  by  gathering  mastery  memories  representing  treatment  gains  and  images  that  symbolize  a  new  identity  defined  by  current  values,  capabilities,  and  goals.  

   *The  above  skills  were  adapted,  in  large  part,  from  Wendy  Freitag  (WF),  Jim  Knipe  (JK),  Andrew  Leeds  (AL),  and  Regina  Morrow  (RM).  

 

IV. 2. Maintaining Treatment Focus  The ECT understands, articulates, and elucidates the maintenance of Treatment Focus in each of the Eight Phases of EMDR Therapy, including reestablishing and revising treatment focus in each phase, especially Phase Eight, Reevaluation.  

IV.  2.  Maintaining  Treatment  Focus  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  demonstrates  knowledge  of  the  challenges  to  maintaining  treatment  focus  in  each  of  the  Eight  Phases  of  EMDR  Therapy.  

Phase  1  

In  each  of  the  Eight  Phases:  A. The  candidate  integrated  EMDR  Therapy  with  verbal  exploration  and  other  therapeutic  modalities  while  maintaining  fidelity  to  EMDR  Therapy  protocols  and  AIP  

1. The  candidate  demonstrates  respect  for  the  importance  of  each  of  the  Eight  Phases.  

2. The  candidate  demonstrates  respect  for  the  Three-­‐Pronged  

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a. Identifying  life  experiences  for  EMDR  Therapy  reprocessing,  both  positive  and  negative,  while  establishing  rapport  and  attending  to  current  life  situations.  

b. Adjusting  scope  of  treatment  according  to  client’s  available  resources  and  treatment  setting.  

Phase  2  a. Emphasizing  the  importance  of  client’s  practice  of  stabilization  skills.  

b. Assessing  client’s  ability  to  shift  states  before  beginning  reprocessing  phases.  

 Phase  3  a. Keeping  the  Assessment  Phase  brief  

b. Encouraging  client  to  stay  with  treatment  plan,  rather  than  avoiding  reprocessing.  

 Phase  4  a. Monitoring  client’s  state  to  ensure  that  client  is  within  the  therapeutic  window  of  tolerance.  

b. Managing  emerging  information  from  the  memory  networks.  

c. Candidate  monitors  his  or  her  own  emotional  response  to  the  client’s  reprocessing.  

 Phase  5  a. Candidate  begins  the  

principles.  B. The  candidate  utilized  various  therapeutic  modalities  based  on  client’s  needs.      

Phase  1    1. The  candidate  maintained  focus  on  identifying  earlier  life  experiences  for  reprocessing  and  positive  resources  to  facilitate  adaptive  reprocessing  while  establishing  rapport  and  attending  to  current  life  situations.    

2. The  candidate  attended  to  client’s  current  difficulties,  especially  crises,  but  did  not  allow  them  to  overshadow  gathering  and  organizing  information  needed  for  the  reprocessing  phases  of  EMDR  Therapy.    

3. The  candidate  helped  the  client  understand  the  tasks  of  Phase  One  by  explicitly  linking  present  difficulties  to  disturbing  life  experiences.  

4. The  candidate  educated  the  client  about  AIP  and  EMDR  Therapy  in  order  to:    a. Encourage  client  to  enter  into  the  memory  networks.  

b. Develop  a  treatment  plan  appropriate  to  the  client’s  needs  and  resources.  

c. Obtain  informed  consent.  5. The  candidate  determined  a  scope  of  treatment  appropriate  to  the  therapeutic  setting.  

6. The  candidate  regarded  the  case  conceptualization  as  a  work  in  progress  and  assimilated  emerging  material  

Protocol  of  EMDR  Therapy.  

3. The  candidate  recognizes  that  EMDR  Therapy  is  a  focused  therapy  approach  and  demonstrates  willingness  to  maintain  the  treatment  focus.  

 

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Installation  Phase  only  after  the  Desensitization  Phase  is  complete  (SUD  =  0,  or  ecological)  

b. Candidate  ends  Installation  Phase  when  the  PC  is  linked  with  the  target  memory  (VoC  =  7).    

Phase  6  a. All  body  sensations  should  be  processed  with  BLS  

b. Some  body  sensations  may  not  be  associated  with  the  target  memory  and  will  not  remit  with  BLS.  

c. Body  Scan  does  not  begin  until  SUD  =  0  and  VoC  =  7.  

Phase  7  a. Client  must  be  stable  before  leaving  the  office  

b. Candidate  tells  client  what  to  expect  between  sessions  and  reminds  client  of  clinician’s  availability.  

Phase  8  a. Reevaluation  is  systematic  

b. Reevaluation  redirects  client  to  target  memory  

c. Reevaluation  redirects  client  to  treatment  plan            

2. The  candidate  revises  treatment  plan  as  needed.  

3. The  candidate  understands  that  Present  Triggers  and  Future  Template  are  necessary  for  generalization.  

 

to  the  treatment  plan.  Phase  2  1. The  candidate  maintained  treatment  focus  by  emphasizing  practice  of  stabilization  skills  between  sessions.  

2. The  candidate  determined  the  beginning  of  the  reprocessing  phases  based  on  client’s  ability  to  shift  states.  

Phase  3  1. The  candidate  stayed  on  script  in  order  to  keep  Phase  3  brief  and  to  ensure  full  access  to  the  components  of  the  target  memory.  

2. The  candidate  encouraged  the  client  to  stay  with  the  treatment  plan  rather  than  avoiding  reprocessing  the  target  memory.  

Phase  4  1. The  candidate  monitored  client’s  state  during  reprocessing.  a. Dissociation  b. Defenses  c. Allowing  spontaneous  reprocessing  vs.  cognitive  interweave  

d. Appropriate  return  to  target  e. Intense  emotion  f. Transference  material        

2. If  a  more  recent  memory  emerged,  the  candidate  acknowledged  its  significance,  offered  to  return  to  the  more  recent  memory  later,  and  redirected  the  client  back  to  the  selected  target  memory  within  one  or  two  sets  of  BLS.    

3. If  an  earlier  (antecedent)  

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memory  emerged,  the  candidate  continued  BLS  until  the  earlier  memory  was  resolved  before  redirecting  the  subject  back  to  the  selected  target  memory.  

4. Candidate  monitored  his  or  her  own  state.  a. Countertransference  b. Affect  tolerance  (his/her  own  and  the  client’s)  

c. Time  management    Phase  5  Installation  1. The  candidate  refrained  from  Phase  5  until  SUD  =  0,  or  is  ecologically  valid.  

2. The  candidate  stayed  on  script.  

3. The  candidate  maintained  speed  and  length  of  BLS,  showing  understanding  that  Phase  5  is  a  reprocessing  phase.  

4. The  candidate  completed  Phase  5  when  the  PC  was  linked  with  the  target  memory  (VoC  =7),  rather  than  letting  the  positive  associations  continue  indefinitely.  

Phase  6  Body  Scan  1. The  candidate  attempted  to  process  every  body  sensation  with  BLS.  

2. The  candidate  recognized  that  some  body  sensations  may  have  no  association  with  the  target  and  discontinued  BLS  after  a  brief  set.  

Phase  7  Closure  1. The  candidate  allotted  sufficient  time  for  closure.  

2. The  candidate  ensured  that  client  was  stable  before  s/he  

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left  the  office.  3. The  candidate  reminded  the  client  to  use  containment  skills  and  to  call  if  necessary.  

Phase  8  Reevaluation  1. The  candidate  developed  client’s  report  rather  treating  reevaluation  as  a  checklist.  

2. The  candidate  refrained  from  lengthy  summaries  and  interpretations  during  reevaluation;  recognized  that  reevaluation  is  not  a  talk  therapy  session.  

3. The  candidate  maintained  focus  by  a. Completing  the  target,  or  b. Moving  to  the  next  target  in  the  treatment  plan,  or    

c. Targeting  material  that  emerged  in  the  reprocessing  session.  

4. The  candidate  discussed  his  or  her  observations  from  the  reprocessing  sessions  with  the  client.  

5. The  candidate  provided  client  with  education  and/  or  skills  as  necessary  to  continue  the  treatment  plan.  

6. The  candidate  recognized  when  one  segment  of  the  treatment  plan  (targeting  sequence  plan)  was  complete  and  proceeded  to  the  next  segment.    

7. The  candidate  integrated  EMDR  Therapy  with  verbal  exploration  and  other  therapeutic  modalities  while  maintaining  fidelity  to  EMDR  Therapy  protocols  and  AIP  principles.  

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 8. Candidate  remembered  to  reprocess  Present  Triggers  and  use  Future  Template.  

 

IV. 3. Recognize and Resolve Therapy-Interfering Factors  The candidate understands, articulates, and elucidates the AIP viewpoint on four categories of therapy-interfering factors: 1) Client Factors, 2) Client-Clinician Relationship Factors, 3) Treatment and Intervention Factors, and 4) Clinician Factors (Sperry, 2011).  The candidate recognizes and resolves therapy-interfering factors specific to each of the Eight Phases of EMDR Therapy and demonstrates the capacity to anticipate, recognize, and resolve them in the therapeutic moment (Greenwald, 2007; Parnell, 2007; Shapiro, 2001).  

IV.  3.  Recognize  and  Resolve  Therapy-­‐Interfering  Factors  KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  identifies  four  kinds  of  therapy-­‐interfering  factors.    a. Client  Factors  b. Client-­‐Clinician  Relationship  Factors  

c. Treatment  and  Intervention  Factors  

d. Clinician  Factors  2. The  candidate  understands  that,  from  an  AIP  point  of  view,  the  source  of  many  therapy-­‐interfering  factors  is  in  earlier  life  experiences.  

3. The  candidate  understands  how  to  identify  earlier  memories  that  are  the  source  of  therapy  interfering  factors,  and  thus  can  be  resolved  by  EMDR  Therapy  reprocessing.  

4. The  candidate  identifies  therapy  interfering  factors  that  should  be  resolved  before  the  reprocessing  phases  of  EMDR  Therapy.  

5. The  candidate  identifies  therapy  interfering  factors  that  need  to  be  resolved  

A. The  candidate  recognizes  the  manifestation  of  four  kinds  therapy-­‐interfering  factors  during  each  Phase  of  EMDR  Therapy.  

1. Client  Factors  such  as:  a. Cancellations  and  no  shows  b. Excuses  for  not  reprocessing  

c. Confusion  about  procedures  d. Self-­‐harming  behaviors  

2. Client-­‐Clinician  Relationship  Factors  such  as  described  in  Core  Competency  II.  a. Alliance  ruptures  b. Transference  -­‐countertransference  Enactments  

3. Treatment  and  Intervention  Factors    a. Internal  factors  such  as:  • Infrequency  of  sessions  • Scheduling  problems  • Poor  lighting  • Poor  parking  

     b.  External  factors  such  as  • Medical  conditions  

1. The  candidate  demonstrates  respect  for  the  AIP  view  on  Therapy-­‐Interfering  Factors.  

2. The  candidate  demonstrates  flexibility  in  adapting  to  the  moment-­‐by-­‐moment  therapeutic  environment.  

3. The  candidate  demonstrates  willingness  to  identify  and  resolve  his  or  own  therapy  interfering  factors.  

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with  education  and  skill  acquisition.  

6. The  candidate  identifies  ways  to  recognize  and  resolve  therapy  interfering  factors  that  originate  in  the  clinician.  

   

• Limited  finances  • Limited  social  support  

4. Clinician  Factors  such  as:  a. Countertransference  b. Failure  to  use  case  conceptualization  to  guide  treatment  

c. Failure  to  maintain  fidelity  to  EMDR  Therapy  protocol  

d. Failure  to  use  the  Three-­‐Pronged  Protocol  

e. Failure  to  provide  adequate  informed  consent.  

B. The  candidate  and  client  collaborate  to  anticipate,  recognize,  and  resolve  therapy-­‐interfering  factors  as  they  arise  moment-­‐by-­‐moment  in  the  Eight  Phases  of  EMDR  Therapy.  

1. The  candidate  and  client  together  identify  life  experiences  that  are  the  source  of  the  client’s  therapy-­‐interfering  behaviors.  

2. The  candidate  distinguishes  between  those  therapy-­‐interfering  factors  that  must  be  resolved  before  the  initiation  of  the  reprocessing  phases  EMDR  Therapy  and  those  therapy-­‐interfering  factors  that  will  need  to  be  managed  in  the  reprocessing  and  reevaluating  phases.  

3. The  candidate  distinguishes  between  therapy-­‐  interfering  factors  that  need  to  be  resolved  by  reprocessing  earlier  life  experiences  and  those  that  need  to  be  resolved  through  education  and    skill  acquisition.  

4. The  candidate  reprocesses  

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earlier  life  experiences  that  are  the  root  of  the  therapy-­‐  interfering  factors  thus  freeing  the  client  to  continue  with  the  treatment  plan.      

5. The  candidate  provides  education  and  resources  that  will  allow  reprocessing  to  continue.  

6. The  candidate  recognizes  and  resolves  his  or  her  own  therapy-­‐interfering  factors.  a. Consultation  b. Identifying  relevant  earlier  life  experiences.  

c. Personal  EMDR  Therapy    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Core Competency # V: Intervention Evaluation and Termination

V. 1. Monitoring Progress and Modifying Treatment Accordingly  

The candidate understands, articulates, elucidates, and demonstrates the purposes and effective uses of the SUD and VoC scales and Phase Six, Body Scan, to monitor progress and modify EMDR Therapy treatment (Leeds, 2009; Shapiro, 2001).  During Phase Eight, Reevaluation, the candidate utilizes assessment of client stability and functioning between sessions to monitor progress and modify EMDR Therapy treatment.  The candidate demonstrates the ability to select and utilize standardized assessment and treatment outcome scales (Sperry, 2010).  

V.  1.  Monitoring  Progress  and  Modifying  Treatment  Accordingly  

KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  identifies  the  purpose  of  the  SUD  and  VoC  scales  in  monitoring  progress  and  modifying  treatment  in  the  EMDR  Therapy  in  the  therapeutic  moment  in  Phases  Four  and  Five.  

2. The  candidate  identifies  the  purpose  of  the  SUD  and  VoC  scales  in  monitoring  progress  and  modifying  in  EMDR  Therapy  in  Phase  Eight.  

3. The  candidate  recognizes  that  new  information  that  emerges  in  the  Reprocessing  Phases  may  require  alterations  in  the  Diagnostic  Formulation,  the  Clinical  Formulation,  and/or  the  Treatment  Formulation.    

4. The  candidate  identifies  the  purpose  of  Phase  Six:  Body  Scan  in  monitoring  progress  in  the  EMDR  Therapy  treatment  plan.  

5. The  candidate  identifies  

1. The  candidate  articulates  and  elucidates  the  purpose  of  the  SUD  and  VoC  scales  and  the  Body  Scan  to  clients  and  consultants.  

2. The  candidate  utilizes  information  from  the  SUD,  VoC,  and  Body  Scan  to  make  moment-­‐to-­‐moment  decisions  in  modifying  EMDR  Therapy  treatment.  

3. The  candidate  demonstrates  the  ability  to  select  standardized  assessment  and  outcome  instruments  appropriate  to  his  or  her  treatment  population  and  setting.  

4. The  candidate  demonstrates  the  ability  to  utilize  data  from  standardized  assessment  and  outcome  instruments  in  monitoring  progress  and  ongoing  treatment  planning.  

5. The  candidate  assesses  client  stability  and  functioning  between  sessions  in  all  Eight  Phases  of  EMDR  Therapy,  but  especially  Phase  Eight,  to  

1. The  candidate  acknowledges  and  appreciates  that  the  Body  Scan  and  the  SUD  and  VoC  scales  are  integral  strengths  of  the  EMDR  Therapy  method  in  monitoring  progress  and  modifying  treatment..    

2. The  candidate  demonstrates  willingness  to  learn  and  use  standardized  scales  to  monitor  progress  and  modify  treatment.  

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standardized  assessment  and  treatment  outcome  scales  for  specific  populations.  

6. The  candidate  recognizes  that,  in  all  Eight  Phases  of  EMDR  Therapy  -­‐-­‐-­‐but  especially  Phase  Eight-­‐-­‐-­‐,  assessing  client  stability  and  functioning  between  sessions  is  an  essential  element  of  monitoring  progress  and  modifying  treatment.  

monitor  progress  and  modify  treatment.  

 

V.2. Maintaining Treatment Gains  The candidate understands, articulates, and elucidates, and implements the Three-Pronged Protocol of EMDR Therapy in maintaining treatment gains (Shapiro, 2001).  

1) Reprocess disturbing past target memories in sequence according to treatment plan 2) Reprocess remaining current target memories. 3) Use a future template to anticipate and rehearse desired future responses 4) Throughout treatment, identify skills necessary to maintain treatment gains and help client

learn and practice them. V.2.  Maintaining  Treatment  Gains  

KNOWLEDGE   SKILLS   ATTITUDES  

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1. Candidate  understands  how  the  reprocessing  of  past  experiences  maintains  treatment  gains.  

2. Candidate  understands  the  role  of  second-­‐order  conditioning  in  present  triggers.  

3. Candidate  understands  the  assessment  and  resolution  of  missing  information  and  skills.  

4. Candidate  understands  the  importance  of  anticipating  and  rehearsing  future  responses.  

5. Candidate  understands  the  procedures  of  the  future  template.  

1. Candidate  demonstrates  ability  to  maintain  treatment  focus  on  past  targets  until  targets  obtain  SUD  =  0,  VoC  =7  (or  ecologically  valid)  and  clear  body  scan.  

2. Candidate  demonstrates  ability  to  maintain  treatment  focus  on  present  targets  until  targets  obtain  SUD  =10,  VoC  =  7  (or  ecologically  valid)  and  clear  body  scan.  

3. Candidate  employs  Future  Template  Protocols  to  help  the  client  anticipate  and  rehearse  desired  responses.    

4. Candidate  demonstrates  ability  to  use  Phase  Eight,  Reevaluation,  to  ensure  reprocessing  of  all  channels  of  disturbing  life  events.  

5. Candidate  demonstrates  ability  to  identify  and  teach  missing  information  and  skills.    

1. Candidate  displays  willingness  to  employ  the  Three-­‐Pronged  Protocol  of  EMDR  Therapy  in  treatment  planning  and  implementation.  

 V. 3. Preparing for Termination  

The Candidate articulates and elucidates the process of collaborating with the client on reviewing the treatment and bringing it to an end in an orderly and positive manner.  The Candidate articulates the following indicators (Shapiro, 2001):  

1) Client’s presenting problem is resolved, or symptoms are reduced or alleviated. 2) The client has developed sufficient insight to understand the problem and change the

patterns that led to treatment. 3) The client’s coping skills are sufficiently increased for dealing with life circumstances. 4) The client has developed capacity to plan and work productively on post-termination

issues.

V.  3.  Preparing  for  Termination  

KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  lists  the  four  indicators  that  treatment  is  complete.  

   

1. The  candidate  demonstrates  the  capacity  for  collaborating  with  the  client  to  review  treatment  in  order  to  terminate  treatment.  

2. The  candidate  reviews  all  four  

1. The  candidate  demonstrates  willingness  to  collaborate  with  the  client  on  bringing  treatment  to  an  orderly  end.  

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indicators  of  completed  treatment  with  client.  

3. The  candidate  demonstrates  skill  in  choosing  EMDR  Therapy  targets  that  address  termination  issues.    

V.4. Utilizing Consultation to Monitor and Evaluate Treatment Progress  

The candidate demonstrates the capacity to present case material to an EMDRIA Approved  Consultant.  The candidate demonstrates the capacity to utilize feedback from an EMDRIA Approved Consultant to modify focus and direction of EMDR Therapy treatment.  

V.4.  Utilizing  Consultation  to  Monitor  &  Evaluate  Treatment  Progress  

KNOWLEDGE   SKILLS   ATTITUDES  

1. Candidate  identifies  the  purpose  of  consultation  in    EMDR  Therapy.  

               

1. Candidate  demonstrates  skill  in  presenting  case  material  in  verbal  form.  

2. Candidate  demonstrates  skill  in  presenting  case  material  in  written  form.  

3. Candidate  demonstrates  skill  in  presenting  case  material  in  direct  observation  format  (live,  video).  

4. Candidate  utilizes  feedback  from  consultant  to  modify  focus  and  direction  of  treatment  as  evaluated  by  verbal  report,  written  report,  and/or  videotape.  

1. Candidate  demonstrates  respect  for  the  consultation  process.  

2. Candidate  demonstrates  openness  to  feedback  from  consultant.  

3. Candidate  demonstrates  willingness  to  modify  treatment  based  on  consultation.  

   

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Core Competency # V: Culturally and Ethically Sensitive Practice

VI. 1. Develop Effective Cultural Formulations  

The candidate articulates and elucidates the importance of the therapist’s cultural awareness, knowledge, sensitivity and competence to the therapeutic relationship and positive treatment outcomes.  The candidate demonstrates the capacity to perform an accurate, comprehensive cultural assessment as a part of Phase One, History-Taking. The cultural assessment will include the following:  

1) Cultural Identity 2) Age 3) Ethnicity and Race 4) Gender and Sexual Orientation 5) Religion 6) Migration and Country of Origin 7) Socioeconomic Status 8) Level of Acculturation 9) Language 10) Explanatory Model and Illness Perceptions 11) Education

The candidate demonstrates the capacity to utilize the resources of the global EMDR Therapy community to ensure cultural competence.  

1) The Francine Shapiro Library 2) Consultation

VI.  1  Develop  Effective  Cultural  Formulations  

KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  identifies  impact  of  culture  on  positive  treatment  outcomes.  

2. The  candidate  identifies  the  range  of  cultures  to  which  clients  may  belong.    

3. The  candidate  identifies  resources  in  the  global  EMDR  Therapy  community.  

1. The  candidate  demonstrates  the  ability  to  perform  a  comprehensive  cultural  assessment.  

2. The  candidate  utilizes  the  resources  of  the  global  EMDR  Therapy  community  in  performing  a  cultural  assessment.  

1. The  candidate  displays  respect  for  clients’  cultures.  

2. The  candidate  embraces  the  complexity  of  cultural  factors.  

3. The  candidate  displays  willingness  to  learn  about  clients’  cultures.  

VI. 2. Planning Culturally Sensitive Interventions  

The candidate demonstrates the capacity to adapt EMDR Therapy language and procedures in a culturally sensitive manner while maintaining fidelity to the EMDR Therapy protocol.  The candidate demonstrates the capacity to utilize the resources of the global EMDR Therapy community to ensure cultural competence.  

1) The Francine Shapiro Library 2) Consultation

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VI.  2.  Planning  Culturally  Sensitive  Interventions  

KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  the  importance  of  adapting  EMDR  Therapy  language  and  procedures  to  client’s  culture.  

2. The  candidate  understands  the  importance  of  maintaining  fidelity  to  EMDR  Therapy  protocols  while  making  cultural  adaptations.  

3. The  candidate  demonstrates  knowledge  of  the  resources  of  the  global  EMDR  Therapy  community  in  planning  culturally  sensitive  interventions.  

1. The  candidate  collaborates  with  the  client  in  adapting  EMDR  Therapy  language  and  procedures  to  client’s  culture.  

2. The  candidate  maintains  fidelity  to  the  EMDR  Therapy  protocol.  

3. The  candidate  utilizes  consultation  in  planning  culturally  sensitive  interventions.  

4. The  candidate  utilizes  the  resources  of  the  global  EMDR  Therapy  community  in  planning  culturally  sensitive  interventions.  

1. The  candidate  displays  respect  for  planning  culturally  sensitive  interventions.  

2. The  candidate  displays  respect  for  maintaining  fidelity  to  EMDR  Therapy  protocols.  

3. The  candidate  displays  willingness  to  utilize  the  resources  of  the  global  EMDR  Therapy  community  in  planning  culturally  sensitive  interventions.  

VI. 3. Making Ethically Sound Decisions  

The candidate articulates and elucidates an empathic understanding of the potential impact of each of the Eight Phases of EMDR Therapy on the individual client and the client’s social systems.    The candidate articulates and elucidates the ethical issues of providing EMDR Therapy treatment in terms of EMDRIA’s definition of the purpose of EMDR Therapy. That is: alleviating human suffering and assisting individuals to fulfill their potential for development, while minimizing risks of harm in its application.    VI.  3.  Making  Ethically  Sound  Decisions  

KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  identifies  the  potential  impact  of  each  of  the  Eight  Phases  of  EMDR  Therapy  on  the  client.    For  example:  a. Phase  One,  History  Taking,  may  activate  intense  affect  beyond  the  client’s  affect  tolerance.  

b. Phase  Two,  Preparation,  may  tax  client’s  

1. The  candidate  skillfully  describes  to  clients  the  potential  impact  of  each  phase  of  EMDR  Therapy.  

2. The  candidate  skillfully  describes  to  clients  the  potential  impact  of  withholding  the  reprocessing  phases  of  EMDR  Therapy.  

3. The  candidate  provides  all  information  needed  for  

1. The  candidate  displays  willingness  to  embrace  the  complexity  of  EMDR  Therapy  treatment.  

2. The  candidate  displays  willingness  to  use  consultation  in  making  ethically  sound  decisions.  

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resources.  c. Phase  Three,  Assessment,  may  activate  performance  anxiety  and  challenge  client’s  organization  skills.  

d. Phase  Four,  Desensitization,  requires  stamina  and  affect  tolerance.  

e. Phase  Four,  Desensitization,  may  affect  the  image  that  represents  the  memory.  

f. Phase  Five,  Installation,  may  lead  to  behavioral  changes  that  may  affect  the  client’s  social  system.  

g. Phase  Six,  Body  Scan,  requires  increased  body  awareness.  

h. Phase  Seven,  Closure,  requires  client  to  shift  states.      

i. Phase  Eight,  Reevaluation,  requires  client  to  incorporate  changes  into  personal  and  social  systems.  

2. The  candidate  identifies  the  impact  of  withholding  the  reprocessing  phases  of  EMDR  Therapy.  

3. The  candidate  identifies  methods  of  minimizing  possible  risks  of  EMDR  Therapy  treatment.  

clients’  informed  consent  to  reprocessing  phases.  

4. The  candidate  skillfully  manages  client  pressure  to  move  prematurely  into  the  reprocessing  phases  of  EMDR  Therapy.  

5. The  candidate  skillfully  manages  client  reluctance  to  move  into  the  reprocessing  phases  of  EMDR  Therapy.  

 

VI 4. Practicing in an Ethically Sensitive Manner  The candidate articulates and elucidates an understanding of EMDRIA’s Professional Code of Conduct (EMDRIA, 2013).  The candidate recognizes the scope of his or her proficiency and practices EMDR Therapy within those boundaries.  

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The candidate obtains education, training, and consultation to expand the scope of his or her proficiency.  The candidate stays abreast of current topics in EMDR Therapy research, theory and practice.  

VI.  4.  Practicing  in  an  Ethically  Sensitive  Manner  

KNOWLEDGE   SKILLS   ATTITUDES  

1. The  candidate  understands  the  EMDRIA  Professional  Code  of  Conduct.  

2. The  candidate  identifies  ways  and  means  of  keeping  abreast  of  current  topics  in  EMDR  Therapy  research,  theory,  and  practice.  

             

1. The  candidate  integrates  the  EMDRIA  Professional  Code  of  Conduct  into  the  ethical  code  of  his  or  her  professional  discipline.  

2. The  candidate  recognizes  the  scope  of  his  or  her  proficiency  in  EMDR  Therapy.  

3. The  candidate  engages  in  continuing  education  to  expand  the  scope  of  his  or  her  proficiency.  

4. The  candidate  engages  in  activities  to  keep  abreast  of  current  topics  in  EMDR  Therapy.  

1. The  candidate  displays  constant  mindfulness  of  ethically  sensitive  practices.  

2. The  candidate  displays  willing  to  practice  in  an  ethically  sensitive  manner.