Welcome Packet for EMDR Consultees

Lori Cao’s Contact Information

Email: lori@moderncounselinggroup.com

Cell: (612) 730-4649

Note: I am best reached via text vs email. 

Appointment Cancellation Policy: My cancellation policy is 72 hours in advance of your consultation session or the fee will stand. Please note that due to my schedule, I do not have room for frequent cancellations or rescheduling. Thank you for honoring this boundary. 

Link to schedule your consultation appointments:

Overview of Consultation Process

The purpose of this packet is to provide information and to establish clear expectations of the consultation process between consultants and consultees.  This packet includes information for mental health professionals interested in EMDR Certification and EMDR Consultation towards becoming an EMDRIA Approved Consultant, which are separate processes.

Consultation in this context focuses on the mastery and integration of standard EMDR therapy in practice. The consultant values the integrity and independence of the consultee. The consultant and consultee are expected to operate within the ethical standards and scope of practice of their respective professional licenses. 

The intended purpose of consultation is for the consultant to provide guidance and feedback to the consultee regarding their use of standard EMDR therapy with clients, understanding that consultation is not supervision. The consultee maintains full responsibility and autonomy for the decisions involving their clients’ treatment. The consultant provides feedback on the consultee’s implementation of standard EMDR therapy and is not directive with client treatment. The consultant’s primary responsibility is to evaluate the consultee’s ability to implement the standard EMDR therapy’s eight phase protocol, three-pronged approach. The consultee should also demonstrate an awareness of situations in which modifications to standard EMDR therapy are necessary in order to safely and effectively treat the client. If there are concerns about the consultee’s ability, the consultant is responsible for communicating those concerns as early as possible during the consultation process so that appropriate corrective measures can be taken by the consultee. 

Consultants are expected to provide up-to-date and relevant information regarding the utilization of standard EMDR therapy with various client populations. The consultant recognizes their limits of competency and, when appropriate, will refer the consultee to another consultant who is more familiar with a specific client population.

Consultation

Consultation is a collaborative relationship between mental health clinicians in which the consultant reviews the consultee’s EMDR client case material and provides feedback to the consultee regarding their use of standard EMDR therapy with clients. The consultation is expected to be consultee-centered which means the focus is on the skills and knowledge of the consultee’s use of standard EMDR therapy with clients. The consultation should be structured in format and consultees are expected to provide examples of their clinical work as part of the consultation process. This may include video recordings, audio recordings, near verbatim transcripts, and/or EMDR case presentation forms. The consultant is expected to review and evaluate the consultee’s work as part of the consultation process. 

EMDR basic training consultation – The EMDR basic training consultation hours are focused on implementation and initial application of standard EMDR therapy and the AIP model in work with actual client cases. Each person must complete 10 consultation hours in order to complete basic training in EMDR Therapy.

EMDRIA Certification consultation – The certification consultation hours are focused on demonstrating proficiency and fidelity to the standard EMDR therapy and also demonstrating an awareness of situations in which modifications to standard EMDR therapy are necessary in order to safely and effectively treat the client.

Note: Consultation is not equivalent to clinical supervision. Hours accrued toward EMDRIA Certification do not co-occur with supervision (for licensure). Consultation is also not equivalent to provision of psychotherapy services, which poses an ethical issue of dual relationship.

Individual Consultation

Individual consultation includes a total of two individuals, the consultant and the consultee (1:1). Individual consultation hours can be accrued in a group setting under certain conditions (see group consultation below).

Standard EMDR Therapy

Standard EMDR therapy means maintaining fidelity to EMDR therapy’s eight phase, three-pronged approach (Shapiro 2018).

What the Consultee can expect of Consultant

1. EMDRIA currently requires a minimum of 20 hours of consultation (at least 10 hours must be individual consultation) to apply for EMDRIA Certification. I require work samples of all 8 Phases and 3 Prongs of the standard EMDR therapy, and evidence of correcting any concerns prior to writing a recommendation letter for EMDRIA Certification. If you use more than one Approved Consultant in your journey toward EMDRIA Certification, I require a minimum of 10 hours of consultations (with a minimum of 5 for individual consultation) prior to writing a recommendation letter for you to submit for EMDRIA Certification.

2. I encourage you to seek consultation from other consultants if they have a specialty area which fits your needs. Please notify me if additional consultants are utilized for hours towards EMDRIA Certification. The guidance provided to you will be enhanced if you grant both consultants permission to speak to each other. 

3. I will track our time spent in consultation. I will write a letter of recommendation or written verification if you have acquired the skills and knowledge base to be Certified and demonstrate this. If the skills and knowledge have not been demonstrated, I can provide written documentation of the time spent in consultation, the skills and knowledge acquired and the areas still needing improvement. We will discuss issues as they arise especially if you are having difficulty.  

4. I will keep abreast of current trends and changes happening with EMDR and trauma treatment. I will provide consultees with new information and accommodate your needs as long as it stays within the scope of my knowledge. I will refer to other consultants if your needs are beyond my scope.

5. We will schedule our individual appointments as schedules permit. Suggested frequency is 1-2 hours per month.

6. I will make efforts to provide a safe and supportive learning environment. Any concerns about this, when shared with me, will be addressed with you in private.

What is expected of Consultee

1. You are expected to come prepared to present case material, complete with notes on that case, as well as any questions about the case in relation to the standard 8-phase protocol. 

2. You are expected to review any notes, books, or manuals in preparation for our consultation.

3. Do not include any information that will identify the case you are presenting on materials you share with me.

4. You are expected to practice within the ethical guidelines of both your license and professional associations. EMDRIA states that if there is no professional association, then the APA’s code of ethics will be the standard for all EMDRIA members. It is your responsibility to stay current on both the laws and ethics applicable to them.

For EMDRIA Certification

1. You will need to be prepared to present a case using the case example format (template attached). 

2. Examples of your clinical work are essential to the consultation process. You will need to submit near verbatim transcripts/video/audio recordings of your client session(s), which must show a minimum of: Phase 3 or 8; Phase 4; and Phase 8. You will need to obtain the necessary releases from clients. The verbatim/video/audio must include your words and interventions. You will need to obtain the necessary releases from clients

3. You will need to demonstrate proficiency and fidelity to the standard EMDR therapy and also an awareness of situations in which modifications to standard EMDR therapy are necessary in order to safely and effectively treat the client. This may include reading and training outside of consultation.

Consultation vs Supervision

Consultation is not supervision. Consultation focuses on mastery of standard EMDR therapy and integrating EMDR into your practice. You are responsible for the therapeutic relationship with your clients and competency in the modalities you offer. As a consultant, I do not hold liability for how you practice. 

If you are seeking consultation toward EMDRIA Certification, I will be evaluating your proficiency and fidelity to the standard EMDR therapy and your awareness of situations in which modifications to standard EMDR therapy are necessary in order to safely and effectively treat the client. 

In order to use these consultation hours towards Certification it is understood that I will be evaluated by Lori Cao, LMFT, who is an EMDRIA Approved Consultant.  I understand that I will be evaluated in several areas pertinent to the EMDR Therapy model.  I understand Lori Cao asks for a minimum commitment of 10 of the 20 hours towards certification and must be advised the number of hours you would like to do prior to starting the process. Together, we will create a structure and schedule for your consultation sessions. As well, I understand I will be requested to use one case and present this case either in blocks based on each phase of EMDR, or in its entirety prior to the end of the 10 or 20 hours.  If deemed necessary, additional behavioral samples may be required to demonstrate the basic skills and knowledge appropriate for EMDR Certification.  I am aware that if Lori Cao does not see the necessary proficiency of EMDR skills and abilities demonstrated in the 10 or 20 hours, more consultation time may be needed for an additional fee.  I also understand that, if for whatever reason, Lori Cao, is unable or unwilling to endorse my application for Certification in EMDR, I will be notified as soon as possible.

It is understood that neither Lori Cao, as the Approved Consultant, nor other therapists/participants shall be construed as providing supervision to a participant on any 

specific case during certification sessions.  While clinical possibilities will be discussed and ideas shared in relation to the clinical situations presented, the therapist is solely responsible for the clinical management of the client/patient and is expected to exercise his/her best judgment in all relevant clinical matters.  I also understand that whatever information is presented in these sessions is to be kept confidential among the participants both during and after your participation in the group.

A collegial atmosphere is advocated and will be fostered at all times during this process. In the rare event of a conflict, Lori Cao, agrees to resolve any issues in a professional manner.  It is also understood that Lori Cao, agrees to abide by the code of ethics of the professional organization(s) to which she belongs. 

Brief Description of EMDR

EMDR is an information processing therapy that uses an eight-phase approach.  When something traumatic or negative occurs, sometimes people store this event in their brains in a dysfunctional manner and many of the elements of the event freeze or are stuck and remain unprocessed.  When the person thinks about the event or trauma, or when the memory is triggered by similar situations, the person may feel like they are reliving it.  This reliving can be in the form of thoughts, feelings, body sensations or flashbacks.  A trauma can be described as a big T or a little t.

After identifying what is at the root of what is bothering the person the most, in the desensitization phase, using eye movement, auditory sounds or hand sensors, the bi-lateral stimulation serves to help release the dysfunctional, unprocessed material and integrate it with the more functional part of the brain.  In other words, the person will not forget (memory erase) the trauma or negative experience but it will reduce the emotional charge attached to it and, in most cases, the person will no longer be triggered.

The GOAL of EMDR is to provide the most profound and comprehensive treatment in the shortest amount of time while maintaining a stable client in a balanced system.

Necessary Criteria for Certification in EMDR

Case Conceptualization and Treatment Planning: 

• Candidate understand how past experiential contributors’ impact/inform present day disturbances and can be used to predict or inform positive outcomes. 
• Candidate understands the AIP model.
• Candidate can state what a treatment plan is, what strategies are used to identify targets and triggers, and can identify the difference between memories, triggers, and symptoms. 
• Candidate is competent at determining the past events and knows the utmost importance of reprocessing the past events first, unless there is a valid reason why not to reprocess the old material first (i.e., recent event or acute stress reactions). Candidate has thoughtful understanding and offers valid reasons for not proceeding in this manner. 
• Candidate is competent at determining and carrying out the individualized treatment plan including the three-pronged approach (past events, present day triggers and future template). 
• Candidate understands the treatment plan is a growing document that is the roadmap for treatment and is dictated by the client’s level of affect tolerance. 
• Candidate understands how the client’s symptoms manifest behaviorally, emotionally, somatically, relationally, and cognitively. 
• Candidate understands and knows how to determine the client’s readiness for reprocessing. S/He knows how to adequately prepare the client for reprocessing. Candidate understands that positive memory networks are necessary for reprocessing and how to develop them. 
• Candidate understands the complexity of multiple early trauma and disturbing materials and the influence or complications it causes to treatment planning.
• Candidate is able to demonstrate how to proceed with the reprocessing treatment plan, when blocking beliefs or feeder memories or other disturbing events surface.

Phase 1: History Taking 

• Candidate appropriately gathers historical information both in general and EMDR specific (attachment and trauma history). In regards to the EMDR specific history gathering, the candidate appropriately identifies the earlier experiences (e.g., traumatic and disturbing live event) as well as negative themes or beliefs which influence and impact the present life experiences. 
• Candidate understands timing of this phase is key and depends on the client’s level of affect tolerance.
• Candidate appropriate identifies what earlier life events could have contributed to developmental deficits and maladaptive learning and is able to identify the earliest contributors to the client’s pathology and behavioral/emotional dysfunction. 
• Candidate understands the importance of the concepts of Fault/Responsibility, Safety, and Power/Control to determine treatment planning. 
• Candidate understands the importance of assessing dissociative symptoms.

Phase 2: Preparation 

• Candidate has appropriate therapeutic relationship before starting to reprocess memories 
• Knows how to conduct multiple tools for stabilization 
  1. Safe/Calm Place 
  2. RDI 
  3. Container 
  4. Relaxation and other stress management strategies 
• Candidates understands why and how to use stabilization tools not only in preparation for reprocessing, but also during history gathering and between sessions. 
• Candidate understands the main elements of this phase: resourcing/skill building, education of process, psycho-education of the brain/ANS/dissociation etc., ensuring emotional/cognitive/somatic literacy. 
• Candidate understands all the mechanics and procedures involved in resourcing and reprocessing. 
• Candidate explains all these elements of EMDR to client as part of the explanation of EMDR. 
  1. Formats, with EM as the preferred 
  2. Differences for resourcing verses reprocessing 
  3. Stop Signal/Metaphors 
     • Seating
     • Distance
  4. BLS – types to use chosen in this phase. 

Phase 3: Assessment 

• Candidate understands that this phase is about accessing and activating the memory by “zooming in,” which in turn provides a baseline to understand how the memory exists for the client (or an assessment of the memory)
• Candidate arranges seating position, determines distance, stop signal and preferred BLS method before proceeding with the Assessment. The candidate also provides explanation of the procedures and expectations of the client during reprocessing. 
• The memory for reprocessing is adequately chosen and accessed by identifying all components of the traumatic memory:

1. Target Memory
2. Image
3. Negative Cognition (NC)    

• • Negative/Irrational,
  • Self-referencing Statement,
  • Generalized to the whole self
  • Present-Tense, while re-experiencing the old memory now 

4. Positive Cognition (PC) 

• • Positive, Self-referencing Statement 
  • Present-Tense 

5.   Validity of Cognition (VOC 1-7) 
6.   Emotions/Feelings 
7.   Subjective Units of Distress (SUDS 0-10)
8. Location of Body Sensation

Phase 4: Desensitization 

• Candidate understands the goal of this phase is to process and reduce the level of disturbance associated with the memory
• Candidate understands DAS – Disturbance reduction, Assimilation, Synaptic connections
• Candidate conducts BLS appropriately given clients presentation 
• Candidate stays appropriately “out of the way” 
• Candidate gives appropriate support, uses metaphor during a set of BLS, if necessary
• Candidate knows when and how to intervene when reprocessing is stalled or looping 
• Candidate understands plateaus of information processing.
• Candidate appropriately manages client’s abreactions 
• Candidate appropriately knows when, why and how-to re-access target memory 
• Candidate understands the difference between going back to target, when SUDS are needed, and when you have reached the end of a channel. 
• Candidate knows the measuring scale and how to take a SUDs and what to do if it is >0 
• Candidate knows what to do if SUDs = 0 (1, if ecologically sound) 
• Candidate appropriately responds client’s stop signal, if appropriate 
• Candidate understands the difference between the end of a channel and end of phase. 
• Candidate knows how to close down an incomplete session

Phase 5: Installation 

• Candidate understands this phase is about strengthening positive memory networks and attaching a new meaning to the memory. 
• Candidate understands the criteria for being a cognition. 
• If SUDs = 0 (1, if ecologically sound), candidate pairs original positive cognition with the targeted memory to check its appropriateness. If not, the candidate facilitates the client to determine a more suitable positive cognition. 
• Candidate appropriately checks the VoC rating of the suitable positive cognition paired with the targeted memory. 
• If VoC is <7, candidates knows how to determine what is preventing it from being a 7 and resume reprocessing. 
• When VoC is = 7, candidate conducts a set of BLS to complete Installation.

Phase 6: Body Scan 

• Candidate has client perform a Body Scan while pairing targeted memory with PC, requesting client to noticing any disturbing thoughts, emotions or body sensations. 
• If necessary, candidate resumes reprocessing by having the client focus on disturbing material. 
• Candidate understands the kind of BLS/DAS used. 
• Candidate conducts another Body Scan, once disturbing material is reprocessed.

Phase 7: Closure 

• Candidate understands that the goal of this phase is to preserve and maintain stability and balance in between sessions (bringing client back to emotional balance and homeostasis). 
• Candidate knows not to check SUDS here and that every session ends here.
• Candidate knows that closing is based on individual client needs ex. Up or down regulation strategies
• If it is an incomplete EMDR session at the end of a therapy session:
  • Candidate appropriately conducts container and affect management exercises
  • Candidate does appropriate debriefing

1. 1. Explanations – i.e., reprocessing may continue
   2. Recommendation of the use of containers, safe place, and other affect management strategies between sessions
   3. Expectations of client, such as keeping a log

•  If it is a completed EMDR session
  • Candidate does appropriate debriefing

1. 1. Explanations – i.e., reprocessing may continue
   2. Expectations of client, such as keeping a log

• Containment for any disturbing materials which was activated during reprocessing but not directly related to reprocessed targeted memory

Phase 8: Re-Evaluation 

• Candidate understands every session begins here. 
• Candidate appropriately checks in with client about experiences since last session (general re-evaluation – any changes or new information, how they are managing and using their coping skills, symptoms worsening or better AND SUD/VOC specific) 
• Candidate arranges seating position, determines distance, stop signal and preferred BLS method before proceeding with any further reprocessing or setting up the next target memory. 
• In the event of an incomplete reprocessed EMDR target in previous session, candidate appropriately re-accesses target and continues with reprocessing. 
• In the event of a completed EMDR target in previous session, candidate appropriately proceeds with the individualized treatment plan by choosing and reprocessing the next target memory. 

Future Template 

• When past events and present-day triggers are adequately reprocessed, candidate continues with Future Template protocol.
• Candidate understands the procedural steps of future template around triggers and challenges.
• Candidate understands the difference between RDI future template, reprocessing anticipatory fears and triggers, and future template as a procedural step and the 3rd prong of the three-prong protocol.