EMDR Consultation: Common Clinical Questions
In consultation, EMDR clinicians often mention that they have so many questions but don't know where to start. This page shows examples of the types of questions that come up in consultation — from basic implementation to advanced applications. Some will be immediately relevant to your practice. Others won't matter until you're working with more complex presentations. Consultation addresses whatever is most relevant to your current work.
Getting Started: Where Do I Begin?
Target Selection & Treatment Planning
- Where do I start with a new client?
- How do I choose which memory to target to get a certain result?
- How do I know if I have the right feeder memory?
- When would I work with a more recent memory instead of going back to earlier childhood material?
- What do I do when the client is focused on a recent incident and is hesitant to go to the earlier touchstone memory?
- What if I can't find feeder material but I think it exists?
- How do I identify unprocessed channels?
- How do I work with dreams and nightmares?
- What do I do when a client brings up a negative past experience they had with EMDR?
- What does Low Hanging Fruit refer to in EMDR?
- How soon after a traumatic event can a client start EMDR?
- How is working with recent trauma different from older trauma?
- When do I use the Recent Traumatic Event Protocol?
History Taking
- How do I gather history without overwhelming my client?
- How do I use Manfield's top 17 traumas in history taking?
- How do I use the three areas of distortion (Responsibility, Safety, Choice) for case conceptualization?
- Is there a 4th area of distortion related to Connection & Belonging?
- How do I assess a client's window of tolerance, affect regulation, and resources during Phase 1?
Contraindications & Scope
- When is EMDR contraindicated?
- How do I work with clients who are on medication for trauma symptoms?
- How do I handle it if a client has seizures, is pregnant, or has medical issues?
- How do I handle EMDR when a client is involved in legal proceedings or needs to provide testimony?
Working Experientially vs. Intellectually
A common challenge in EMDR is helping clients access experience rather than staying in intellectual description:
- How do I know if I'm working too intellectually with my client?
- How do I help clients experience — not just intellectually describe — target material?
- How do I help clients access the somatic experience of the target rather than just describing it intellectually?
- What are the signs that my client is stuck in intellectual processing?
- How do I shift from intellectual processing to experiential processing during a session?
Assessment & Target Development
Setting Up Solid Targets
- How do I set up targets with good alignment (where memory components fit together)?
- What if I can't find an image or the client is struggling with the image?
- How do I use the somatic bridge effectively?
- What is the difference between a Floatback and a somatic bridge?
- Are there questions you can use to help determine if there is a feeder memory?
- How long should Phase 3 take?
Working with Cognitions
- What are strategies to find effective cognitions?
- How do I use the three areas of distortion to help identify the negative cognition?
- What do I do if the client identifies two negative cognitions? How do I determine which one to use for the target setup?
- What if the client is struggling to identify the positive cognition?
Assessment Challenges
- How do I make sure I'm getting an accurate SUDS reading?
- What does it mean if there's a high SUDS and a high VOC?
- What do I do when the client wants to please me (and might not give accurate ratings)?
- What if the client struggles to identify emotions?
- What if the client gives me a thought instead of a cognition?
Bilateral Stimulation: The Mechanics
Types & Variations
- What are the differences between eye movements, taps, and tones, and when should I use each?
- How do I use bilateral stimulation speed, angle, and set length to get different results?
- What purpose does bilateral stimulation serve in the healing process?
During Processing
- What do I do when the client talks during bilateral stimulation?
- What if the client says nothing happened at the end of a set?
- How do I help clients who struggle to "just notice" during bilateral stimulation?
- How do I handle when clients get confused about what to do during bilateral stimulation sets?
- Can you explain how channels of association work in Phase 4?
- How do I know when to go back to target?
- How often should I check the SUDS?
Client Process
Talking & Pacing
- What do I do if clients talk more than necessary between sets and it pulls them out of the flow of processing?
- What if clients use a lot of session time at the beginning checking in and it eats away at time needed for EMDR?
Recognizing What's Happening
- What are the signs that a target is processing versus the client dissociating or avoiding?
- How do I know if targets have actually processed versus the client avoiding?
When Things Get Stuck: Blocks & Troubleshooting
Common Blocks
- What do I do when I've hit a block to processing?
- What can block grief processing and what do I do about it?
- How do I clear obstacles that prevent clients from accessing and processing their grief?
- How do I work with avoidance?
- What if the client doesn't want to address something because they want to protect their relationship with their parents (or others)?
- What do I do when the target jumps to a present issue?
Processing Patterns
- What do I do when processing seems to loop back to the same material repeatedly?
- How do I recognize and work with blocking beliefs?
- Are there ways to keep targets contained and avoid target drift?
Resource & Regulation Issues
- What do I do when the calm place and container aren't working?
- What does it mean if the client gets anxious or feels unsafe when trying to use their Calm Place?
- How do I co-regulate with clients during processing to help them stay within their window of tolerance?
- I've built good resources with my client in Phase 2, but when they get activated during processing, I don't know how to help them actually access and use those resources in the moment. How do I activate resources during processing when my client needs them?
- What are strategies for managing strong affect during processing?
- How do I build confidence and momentum with clients who struggle with affect regulation and lack necessary adaptive perspective?
- How do I work with challenging or potentially overwhelming targets?
Clinical Interventions & Advanced Skills
Cadence Comments
- What are cadence comments and how do I use them effectively?
- What is the point of cadence comments?
- What's the connection between cadence comments, cognitive interweaves, positive cognition, resourcing, and adaptive perspective?
Cognitive Interweaves
- What are cognitive interweaves and how do I use them effectively?
- When do I use a cognitive interweave versus staying out of the way?
General Intervention Decisions
- When should I intervene versus stay out of the way?
- How do I intervene effectively, if it's needed?
- When would I consider using EMD vs. EMDR and why?
Installation Phase
- What do I do during Phase 4 when positive material surfaces (before installation)?
- What do I do when the positive cognition is not increasing?
- What if the VOC doesn't reach 7?
- What if the VOC goes down during installation, instead of increasing?
Body Scan Issues
- What do I do if new disturbance comes up during the body scan?
- How do I handle chronic pain or physical symptoms that show up during body scan?
Special Populations & Adaptations
Complex Trauma & Developmental Issues
- How do I work with clients with complex PTSD or developmental trauma?
- When should I use a more stabilization-focused approach versus standard protocol?
- How do I adapt EMDR for attachment trauma?
Specific Populations
- How do I work with clients who have ADHD?
- How do I adapt EMDR for clients on the spectrum?
- How do I work with clients who have alexithymia (difficulty identifying emotions)?
- What adaptations help when working with neurodivergent clients?
- What do I do if a client has aphantasia and can't identify an image?
- How do I work safely with clients who have addictions or compulsive behaviors?
- How do I integrate parts work with EMDR?
Working with the DES
- How do I work effectively with the DES (Dissociative Experiences Scale)?
- Are certain DES questions more important than others?
- Do different DES questions correlate with different types of dissociation?
- Do you give the client the DES to take at home, in the office, or is there another way to use it?
- Do I use the DES with all clients?
Future-Oriented & Specialized Techniques
Float Forward & Future Template
- When and how do I use the Future Template?
- How does the Float Forward method work and what is it used for?
- How do I use the Float Forward Technique for anticipatory anxiety or future fear?
Flash Technique
- What is the Flash Technique and when should I use it?
- How does the Flash Technique differ from standard EMDR?
- When should I choose the Flash Technique over the standard EMDR protocol?
- What are the steps of the Flash Technique?
- What makes a good Positive Engaging Focus (PEF)?
- How do I help clients develop an effective Positive Engaging Focus (PEF) for Flash?
- What do I do if the client gets activated or overwhelmed during the Flash Technique?
- How do I know if the Flash Technique is working?
- What if the client's SUDS doesn't decrease with the Flash Technique?
- Can the Flash Technique be used as a standalone treatment or does it need to be followed by standard EMDR?
- How many Flash sessions should I do before moving to standard EMDR processing?
- Can I use the Flash Technique for recent trauma?
- When is the Flash Technique contraindicated?
- Can the Flash Technique be used with all clients or are there specific populations it works best with?
- How does the Flash Technique work with the Umbrella Technique?
Learn more about the Flash Technique →
Other Specialized Techniques
- What is the Umbrella Technique?
Practical Session Management
Time Constraints
- What do I do when I'm running out of session time and there's a high SUDS?
- How do I restart the next session when a target is not resolved?
Closure
- What's the best way to close an incomplete session?
- How do I help clients manage between-session disturbance?
Reevaluation & Session Continuity
- What does it mean if the SUDS comes back up at reevaluation?
- How do I know when to move to a new target versus continue with the current one?
- How do I check whether processing a target actually affected the presenting issue?
- What do I tell clients to expect between sessions?
Client Education
- How do I educate clients about various aspects of EMDR to help keep the process on track?
- How do you educate a client who is hesitant and/or anxious about starting EMDR so they can make an informed decision?
- Is informed consent necessary for EMDR?
Telehealth EMDR
- What kinds of bilateral stimulation are effective for telehealth?
- Is it possible to use eye movements with telehealth?
- Are there important considerations to be aware of when using EMDR via telehealth?
Building Resources & Preparation
- How do I build resources and then test that my client can effectively use them?
- How do I help clients strengthen their own adaptive material?
- How do I develop necessary adaptive perspective with clients?
- How much preparation is enough before starting reprocessing?
- What if my client wants to skip preparation and "just process"?
- How do I balance building resources with client motivation to move forward?
Therapist Self-Care & Professional Development
- How do I take care of myself when doing a lot of trauma work?
- What do I do when I feel triggered or overwhelmed by client material?
How Consultation Works
Consultation is responsive to your actual clinical questions — we don't march through a predetermined curriculum. When you bring cases and questions to consultation, we address what's immediately relevant to your practice.
In group consultation, you benefit from:
- Your own questions and cases
- Learning from others' clinical challenges
- Diverse perspectives on similar issues
- Community with other EMDR clinicians
In individual consultation, we can:
- Dive deep into complex cases
- Focus on specific skill development
- Address questions requiring more privacy
- Work systematically toward certification
Ready to Get Support for Your Questions?
Whether you're just starting EMDR or refining advanced skills, consultation provides the guidance you need.
Phone: (503) 887-3309
Email: Contact Form
Learn more:
Contact Information
Phone: (503) 887-3309
Email: Contact form
Office Location: 1832 NE Broadway, Portland, OR 97232
Serving: Portland metro area, including Beaverton, Hillsboro, Lake Oswego, Tigard, West Linn, Milwaukie, Oregon City, Tualatin, Gresham, and Vancouver, WA.
Ross Cohen, MA, LPC, LLC
EMDR Certified Therapist | EMDR Approved Consultant | EMDR Training Facilitator
Virtual EMDR consultation via Zoom — serving clinicians worldwide.
In-person therapy and consultation sessions available at my NE Portland, Oregon office.
Telehealth available for clients throughout Oregon.
