How to Know When a Client is Prepared Enough to Start Processing Memories in EMDR Therapy?

I’m answering this question through two lenses that I hope are helpful.  The first focuses on what is required to do EMDR therapy at all.  EMDR requires that clients with complex trauma have the capacity to do all the following things:

• Activate, but do not overactivate a specific memory.  Clients whose activation across all memory territories is more like an on/off switch than a dimmer switch, you will need to show them how to access memory content without flooding.
• The client must be able to slow down, be present in this moment, and deeply notice what was activated.  If clients can’t slow down, be present, and notice, we need to show them how to do these things safely enough so that the can do them.  They are absolute requirements.
• The distress that comes must come within the client’s window of tolerance.  What that means is that your client has to have a window of tolerance.
• The client needs the capacity to self-regulate.  They need a brake pedal.  Ideally multiple.
• The client needs to be able to not follow every possible chain of connection in that memory network.  With really complex trauma, especially when we are just starting, we do not want everything that might want to come into awareness to come.  There are a lot of memories in the individual memory networks of clients with complex trauma and we are trying to resolve one of them, not the whole theme.
• The client needs to be embodied enough to notice.  EMDR is a somatic psychotherapy, it’s bottom-up, and it’s a goose-chase for people who don’t have a bottom.
• The client needs to not have blocks or survival strategies that prevent them from doing what you are asking them to do.
• They need to be able to work in channels that are productive at the particular stage of processing that they are in.  Clients with tendencies to want to figure out the trauma, those who walk through the memory one piece at a time (but aren’t noticing anything in the present moment), or clients who struggle noticing how distress is appearing in the right-now body are likely to really struggle in the EMDR processing phases.
• Clients need to understand what EMDR therapy is, otherwise they are likely to revert to doing what they always do when their bodies feel a certain way.  EMDR is different than our culturally intuitive strategies and if clients are doing what they always do when they are this type of triggered, then the bilateral alone isn’t going to replace the absences of everything else they are not doing that are core components of EMDR therapy.
• On any given day, the client has to have the capacity to feel worse.  EMDR is typically a dive into distress and you have to have the cushion for that today.
• Even if the client can do all of these things, there is one more thing that needs to be in place.  Some part of them already has to know the correct answer to the problem of this trauma.  Beneath the surface and below awareness, all of the noticing the client is doing is moving the content so that it can connect with the already-present right-now adaptive information.  Enough of it has to be there.  You have to have a boat of adaptive information big enough to land all of the content that you hooked onto in this session.  EMDR does not work absent enough of the needed adaptive information.  How do you know if the client has it?  A VOC of one is sometimes a canary in the coal mine for this.  Listening for how clients talk about themselves is another way.  You can also ask yourself, “When in this client’s lifespan would they have the opportunity to develop this needed adaptive information, this type of experiential learning that is different than the learning in the trauma?”

That’s a lot of stuff that needs to be in place and it’s not the whole list.  You can read more about each of these in the book EMDR With Complex Trauma.

The second lens on the question about knowing when the client is prepared to start asks, “prepared to start where?”  Are we preparing the client to be able to handle the worst things that they carry, or are we preparing the client to be able to start somewhere? The way I work is to prepare the client to start somewhere.  The challenge with complex trauma is that too often we never start.  I want to prepare the client to start somewhere. 

And you may ask, “isn’t somewhere just going to float back to the worst stuff anyway?”  Not necessarily, if you educate the client about what our goal is in this session.  With clients with complex trauma, I don’t encourage everything that might want to come to come.  If we are trying to catch a fish that is really small (because that’s a sensible way to start with people who are fishing in small boats in an ocean filled with monsters), it’s possible that a shark might bite that small fish.  It’s also probable that it won’t.  With the severity of clients that I have worked with, if I had to prepare them for Moby Dick before we even start, I would still be preparing with most of them.  A lot of my client’s enhanced resourcing comes from resolving smaller targets first.  Working on smaller targets does many really good things, including building a bigger and bigger boat of adaptive information so that the client has a reasonable chance of landing the biggest monsters eventually.