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Case Conceptualization: Treatment Planning and Target Sequencing

“The difference between an EMDR clinician and a great EMDR clinician is the clinician’s ability to conceptualize a case” (7:00).

  • Treatment planning helps the clinician know and be confident in where we’re going, why we’re going there, and how to get there
  • Clinical knowledge and understanding of EMDR allow the clinician to let go of rigid protocols, allowing for greater fluidity and flexibility in treatment.

Treatment Approaches

  • There are three types of treatment plans: acute, belief/issue, and developmental
  • Note, each has its pros and cons and none are inherently “better”
  • Remember, be flexible in which approach you use with each client and session
  • Playing ‘whack a mole’ is sometimes necessary at the beginning while figuring out which direction to go

Acute Focused Treatment Planning

  • Used when the symptom is from a single or a few incidents
  • Importantly, if the symptom is truly from a single incident reprocessing will go away
  • Useful for symptom reduction, rather than complete alleviation of symptoms
  • A great starting place for the sake of regulation and motivation for the client
  • Importantly, this treatment plan is the most appropriate when the client hires you for something specific or has limited means

Belief Driven Treatment Planning

  • Also called cluster or issue approach
  • Finding the link that connects the symptoms, presentation, memories
  • For example, the link can be a belief such as “I’m not good enough,”
  • Or, a physical sensation, such as knot in the stomach
  • Once you’ve found the link, identify each memory within that network
  • A chronological cluster would involve a sequence of events surrounding a traumatic experience
  • Changes are more generalizable
  • Limitations: takes longer than acute approach

Developmental Treatment Planning

  • Also called the comprehensive approach
  • Viewing the client as a nervous system that has dramatically been impacted and shaped by the life experiences they’ve had
  • The therapeutic relationship is the therapy 
  • To clarify, this is because the client is experiencing a safe relationship, maybe for the first time
  • Importantly, their nervous system can integrate this relationship as a resource
  • Processing preverbal memory is powerful.
  • However, it is a unique experience that can be overwhelming for clients beginning EMDR
  • Limitations: takes a significant amount of time, cost more 

Target Sequencing

  • An effective sequence is first, worst, most recent
  • However, this can be too overwhelming for the nervous system
  • Keep in mind the needs of the specific client and their window of tolerance
  • Another approach is to start with recent low impact events that are still related to the treatment plan
  • This allows the client to gain trust in EMDR treatment, reveals breadcrumbs, and builds adaptive networks
  • Don’t just determine and prescribe the treatment plan
  • Instead, use it as a relational tool
  • Always, invite the client to be part of the decision making
  • Finally, remember to stay flexible!

Don’t forget to check out Episode 61: Three Channels of Processing

Resource Links