The goals and objectives of EMDR Phase 1 involve collaborating with the client to identify and prioritize specific issues to target during the treatment. Treatment planning includes comprehensively understanding the client’s history and symptoms and setting particular treatment goals for processing past memories, current triggers, and future actions.
I noticed many consultees were eager to go into Phase 2 to do a “safe and calm place” or Phase 4 to reprocess. When I asked them what the treatment goals were and why they chose specific memories to process, I often encountered a blank face.
I remembered my “a-ha” moment when I realized the EMDR 8-phases and three-pronged protocol is like “the mirror on the wall,” showing me where I overlooked or cut corners in the treatment process. Before I learned EMDR, I would develop treatment goals with the clients but never really focus on them. In my mind, if the clients continue to come back if the clients’ “general feelings” about life or if the clients’ “reactions about triggers” are different, it must mean “progress.” I didn’t check the specific goals regularly and often just “review” with the clients annually.
Learning EMDR made me realize that the more thorough I am in Phase 1, the smoother the Phase 4 reprocessing will be. By establishing the treatment goals and discussing which memories to process, I am establishing collaborative relationships with the clients and increasing their motivation to change.
Please see this entry for the first goal in phase 1 for more explanation.
Goal # 2: Establish an EMDR Treatment Plan, meaning the target memories reprocessing sequences
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.
I shifted among these three topics at the beginning of my EMDR therapy: history, goals, and introducing what EMDR is.
Generally, at the end of the first session, I asked the clients to bring 1-3 issues they want to change in their current lives. If the clients get the general goals for discussion at the second session, I ask about the history of these symptoms or issues and their impact on the client’s life. I also inquire about the ideal life the clients have in mind. In addition, I explained the AIP model and Polyvagal Theory from the client’s history description.
If the clients didn’t bring any specific goals to discuss, I would summarize what I learned from the client in the previous session and the assessments from the intake process. I collaborate with the clients to materialize my perception from the first session and the assessments into concrete goals that speak to the client’s difficulties and the goals for therapy. Then, we will explore the histories of these symptoms and issues and their impact on the client’s life.
Usually, I might take about 3-4 sessions if I did a thorough job discussing the histories of these symptoms and their impact on the client’s life while integrating with the assessments done in the intake process.
If the clients and I couldn’t specify clear goals to change, I invite them to keep a TICES journal. TICES means target, image, cognition, emotions, and sensations, the five elements in the Phase 3 assessment. I invite the clients to keep a journal for a week, writing down one thing that bothers them the most of the day and rating it based on ten as the most disturbing while 0 means not at all. In the following session, we would discuss the incidents recorded in the journal to identify the triggers/issues, negative cognition, emotions, and bodily sensations.
Generally, I assisted the client in identifying the patterns or connections of the presenting issues if there were more than one. I also discussed prioritizing which goal to alleviate the suffering with the clients first.
For example, if the client’s presenting issue is anxiety, isolation, and self-doubt, We discussed that anxiety makes the client count on the outcome and, therefore, isolate themselves to avoid the catastrophic outcome. Thus, the priority might be working through anxiety.
Once we can identify the recent triggers/issues and the negative cognition, emotions, and sensations, my go-to strategy is to “float back” to the first and worst memories. I did this with each target issue/symptom. For example, if the clients experience flashbacks, hypervigilance, and fatigue, I will check the recent triggers for each one of them and float back to find the first and worst memories.
After the client and I discussed the priorities of the symptoms, the following discussion was whether I wanted to target the first or worst memories. There are different ways to decide which one to target. I often used this opportunity to explain the AIP model and inform clients that the first memory sets the foundation of the memory network, while the worst brings out the most emotional charge. The clients and I discussed which makes more sense when deciding which memory to target.
My go-to strategy for identifying the first and worst memory that is connected to the present trigger is the “float back” technique. I found that most clients have a difficult time directly connecting the present trigger to past traumatic experiences. Or, they reported the memories they remembered or believed could be the ones.
I typically start by asking clients about their most recent experiences related to their triggers, symptoms, or other relevant events. Then, I inquire about the image representing their experiences’ most challenging parts, negative thoughts, emotions, and physical sensations. I ask the client to imagine as if they are watching a movie showcasing similar past experiences, emphasizing bodily sensations, and trying to return to the earliest similar experience. After a brief 10-second pause, I ask the client, “What comes up?”
If I encourage the client to focus closely on their body experiences, they can often recall an earlier memory. Many clients have told me, “I haven’t thought about that memory for a long time!” or “It’s surprising to think about that one as the first memory, but it makes sense!”
When clients have difficulty recalling past experiences, it is helpful to establish a timeline with them. I learned this strategy at an EMDRIA conference during the early stages of the pandemic. The presenters discussed creating a timeline of depressive episodes with clients, and I have since used this approach with clients who struggle to remember significant events. I start by identifying the most recent triggers, events, or symptoms and then ask the client, “Did you experience anything similar about six months ago?” I repeat this process for different time intervals, such as a year ago and three years ago, to help the client recall memories and associated emotions. I continue this process, exploring memories from earlier in the client’s life as much as they are comfortable with.
