In the EMDR basic training or consultation meetings, Phase 1: History Taking is generally the least discussed phase. The first counseling step is establishing therapeutic relationships and taking the client’s history, which is taught in ALL mental health training programs. Therefore, most clinicians overlook this phase or take it for granted because “I have done it hundreds of times since graduate school!”
As a clinician, my role in phase 1 is pivotal. I have two primary goals: establishing a therapeutic relationship with the client and setting the treatment goals. Your expertise and guidance are crucial in this phase.
To be more clear, establishing a therapeutic relationship means building an environment where the client”feels safe enough to feel.” This corresponds to the “safe enough to feel” in the preparation hierarchy. For clients to “trust the process” and “go with it,” they need to feel safe in the therapeutic relationship.
Developing the treatment goals corresponds to the “notice and name” in the preparation hierarchy. In addition, the treatment goal is to assess where the clients put their motivations.
If I had to write out my goals for phase 1, it would look like this:
Phase 1: History Taking
Goal # 1: Establish treatment relationships
Objective # 1: The client will feel safe enough in the therapeutic relationship and environment to experience.
Objective # 2: The client will understand what EMDR is and its eight-phase and three-pronged protocol.
Objective # 3: The client will feel safe enough to share the history of the presenting issues and how the AIP model relates to the presenting issues.
Goal # 2: Treatment plan
Objective # 1: The client will notice their presenting issues and name the difficulties of the present life situation.
Objective # 2: The client will name their ideal future scenario.
Objective # 3: The client and the clinician will develop the treatment plan and its connection to the past trauma and identify the targets to process.
In this entry, I will first share how I am building therapeutic relationships in my intake process.
For the Goal # 2, treatment plan, please see this entry.
Here are my processes and procedures to build the therapeutic relationship.
1) Before the first meeting:
Once I have the intake date and time, I send the intake paperwork via my client portal and ask the clients to complete it beforehand. The instruments I included in the intake included intake questionnaires (background information, purposes for treatment, prior treatment experiences and reasons, medications, health issues, work, education, relationships, and family of origin), PHQ-9 (for depression), PCL-5 (for PTSD), GAD-7 (for anxiety), ACE (for childhood trauma), MDQ (for Bipolar), DES (for dissociation), and Adult ADHD Self-Report Scale.
It’s important to note that many trainers and consultants recommend discussing DES with clients. However, this is a decision that should be made based on your specific client population. It’s crucial to consider the developmental stages of children before asking them to complete all the assessment instruments independently or asking parents to complete the assessment. For adult clients, these assessments serve as a tool to raise their self-awareness before the intake sessions.
2) The day before the first intake session, I cross-check the answers from all the assessment instruments and make notes for further questions in the intake session. I generally watch out for the symptoms that could be either depression or anxiety and cross-check the PCL and ACE scores to differentiate them. I also check anxiety and ADHD by checking GAD and ADHD scores to differentiate them. I also double-check anxiety and bipolar by checking PCL and ACE to differentiate them. In addition, I cross-check DES, MDQ, and PCL to check for dissociation.
3) In the initial meeting, I thanked the clients for taking the time to fill out the assessments, and I asked them if they had any questions regarding all the assessments they filled out beforehand. The goal in the first few sessions is to stay at the “present” prong. I invited the clients to discuss their presenting issues and the motivation to seek assistance. If the clients specifically asked for EMDR, I asked them how they learned about it and how much they knew about it. I offered “what is EMDR” based on what they know and adding on to their information or correcting the misconception. Depending on the time, I might use the client’s presenting issues to introduce “what is EMDR.” Generally, I stayed with the client’s verbal and nonverbal reports to see if they confirmed the assessments or needed more discussion and clarifications. I also notice clients’ relationship experiences by asking them about their experiences working together.
You might wonder why you underwent such a lengthy evaluation and preparation process.
Phase 1 is where you start to integrate your theoretical orientation and your theory about change. As a clinician, accurate diagnosis informs a precise treatment plan. In addition, clients have to feel safe and connected with me to be able to share their traumatic experiences with me (feel secure enough to feel).
I went through such a lengthy assessment and spent a lot of time ahead of time cross-checking each instrument to start preparing myself for the client’s experiences. In addition, I want to identify the common issues clients experience while cross-checking all the instruments. Why? Identifying common client issues is crucial as it helps you to prepare for the initial session and establish a more effective therapeutic relationship. The therapeutic relationship starts when the clients make an appointment and fill out the assessment instruments. The assessments help the clients to gain awareness of their issues and to have the language to talk about them while helping me to identify the common presenting issues. During the first intake session, when I can share what I learned from the intake paperwork and further clarify the gaps, I aim to ensure I truly hear and see the clients.
In addition, if I could identify some themes from the intake paperwork, I tried to prepare “What is EMDR” based on what I learned from the client’s experiences. For example, suppose the client identified the feeling of fatigue and consistently oversleeping. In that case, I might ask about her self-perception of her behaviors of oversleeping (negative cognition) and use that to explain the dorsal vagal shutdown, the autonomic nervous system, and the connection to the AIP model behind EMDR. Then, I can describe the eight phases of the protocol and inform clients what to expect in therapy. The sense of safety increased when the clients knew why I asked specific questions, what was going on in the treatment, and what to expect next.
So, as a clinician, this is the beginning of asking yourself:
What is my theoretical orientation?
What issues do my clients generally bring in?
As a clinician, it’s important to ask yourself: What is my theoretical orientation? What issues do my clients generally bring in? How can I integrate my theoretical orientation and personal style into Phase 1 to effectively communicate about EMDR with the client?
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