You’ve finished your Basic Training and are excited to take your next steps. You now have this powerful, transformative therapy approach to offer, but what happens next?
I know the leap from training to practice is a scary one. I remember that feeling well from my own experience as a fledgling EMDR therapist!
If you’re anything like I was, you might start flipping through your manual, searching for that outline of client selection criteria and list of client readiness factors you seem to remember from your training weekend. Ah, there they are.
First of all, does my client have any risk issues, medical concerns or safety concerns that are potentially destabilizing? Do they have any time or other resource constraints that might get in the way of doing this work?
Once you check those boxes, you start assessing your client’s capacities. Can my client:
- Access their experience and notice their response to it?
- Tolerate their emotional experience while staying in their window of tolerance?
- Apply self-soothing strategies and use them between sessions?
- Shift from a state of distress to a state of relative calm?
- Maintain dual attention between past and present?
- Access adaptive information?
These are all crucial precursors to using EMDR therapy safely and effectively with your clients.
But at The Center, we practice Relational EMDR Therapy. And so, the number one question I’m considering when I think about heading out of the train station is:
Can I travel with this client and can they travel with me?
Okay, Sheryl. That sounds nice and all, but what does this really mean?
Is there enough trust?
Trust goes both ways. Our client’s ability to trust us and our ability to trust them to tell us the truth about what’s happening and how they’re doing are part of what makes it possible to travel together. I wouldn’t expect any client – particularly one who’s experienced a lot of trauma – to trust me 100%. But I need clients to trust me enough to allow themselves to settle into memory reprocessing, to know that I’ll help them maintain dual awareness and stay in their window of tolerance, and to believe that I’ll work with them to get them through the process — even if we don't know how it's going to unfold moment to moment.
In turn, I have to be able to trust my clients enough to be honest with me about what they’re experiencing both during and outside of sessions — even if it’s not what they think I want to hear. That way, we can make adjustments as needed, so it's not harder than it has to be.
Is there enough motivation and readiness?
All therapy clients have some level of ambivalence about change. Change is scary, and it’s even scarier when you don’t necessarily know what’s on the other side of healing. Many trauma survivors have trouble imagining a future without pain, a future where they can feel different and move through the world differently than how they’ve been operating for months, years and sometimes even decades.
What I’m looking for in clients is a desire and willingness to change – because they’re sick and tired of feeling a particular way, because they want to break a cycle of trauma for their own children, or because they want to be better prepared for something else they’re really wanting to go well: a presentation, a move, a relationship.
EMDR therapy is remarkable in its capacity to create lasting change for clients. It also can be very hard work for clients, both in and out of session. That means they need to be willing to observe their reactivity, practice self-soothing skills, and reach out to social supports when struggling.
Each time you check in with your client in session is an opportunity to ask yourself: If I can be all in with my client, is my client ready and motivated enough to do this kind of work?
Is there enough connection between us?
In Relational EMDR Therapy, the therapist’s use of self is paramount. As Deany has said, “We’re not just technicians here,” administering some scripted protocol and completely “staying out of the way” of the client. We need to travel with our clients.
If you want to do this work and do it well, you have to feel connected to your clients. So when I’m assessing clients’ readiness, I’m always checking in with myself: Do I feel connected to this client? Do they feel connected to me? Does it feel like we're a team?
Everyone likes to feel liked, but this is not what this is about. This is about being able to have a working alliance and knowing that the client will let me in enough to support them in offering interweaves, helping them maintain dual awareness, and co-creating a new experience of feeling less alone with their trauma.
How do I know for sure?
If all of this feels like a tall order, remember that the therapist-client relationship doesn’t need to be perfect to proceed with EMDR therapy. As Winnicott would say, it just needs to be “good enough."
In almost every consultation group I’ve led or attended, this topic comes up. What may begin as a question about why a therapist is stuck with a particular client often ends with the realization that the relationship – that capacity to travel together – just isn’t there yet.
So, take a moment now and move out of your head and into your body. Of the clients you’re working with right now, who did you intuitively know you could travel with right away? Who did you feel less certain about starting on this path with? All of what I just described can often be felt in a first session if you’re really tuning into the relationship and your felt experience of it. And based on this assessment, you’ll find that some clients can jump into reprocessing very quickly. Others will need more time to get there with you.
The next time you’re thinking of diving in with a client, be sure to ask yourself and feel into this: Do the client and I – do we – have everything we need in this relationship to start off on this journey together? Are our bags packed enough that if we run into some obstacles, we can get through them together?
What if we’re not ready?
If the answer is “no, we can’t weather these storms as a team” that’s really OK. It’s just a signal to take a pause and get some additional support in consultation. Much better to sort this out before proceeding than to forge ahead and end up getting stuck in the weeds.
I promise you: If the relationship isn’t there, things will not go smoothly– for the client or for you. Let your consultant and colleagues help you figure out how to either build a better therapist-client relationship or talk with your client about what’s getting in the way so you can decide what to do next.
Most of all, know that you are not alone in this experience. Even the most expert EMDR therapist cannot and should not move forward with a client if the relationship isn’t solid enough. The key is having the foresight and humility to know that we can’t just magically heal our clients if we’re not in it together.