Preparation & Self-Care in Relational EMDR Therapy® (R-EMDR)

Like many therapists, I first came to EMDR therapy seeking healing from “big T” trauma. At the time, I was new to the field, caught in a cycle of over-functioning, exhaustion, and dysregulation. My early life had taught me that value and connection came from hard work and performance. I’d give everything to others, then collapse in private. This strategy worked…until it didn’t.

When I began EMDR therapy, I didn’t realize this coping pattern was part of what needed to change. I was so used to it, I didn’t even name it to my therapist. I insisted I was “fine,” just tired from working hard.

Two years into EMDR therapy, after meaningful progress with the symptoms and memories I originally came to address, I began training in EMDR therapy with Deany Laliotis, Founder and CEO of The Center for Excellence in EMDR Therapy. 

That’s when I began to understand something deeper: to truly support transformation in others, I had to start with myself. I had to let go of being the “agent of change” and begin to care for myself holistically; physically, emotionally, mentally, and spiritually.

I hadn’t realized the extent of my own self-neglect, or how deeply attachment wounds shaped my relationship with care. This personal realization expanded my understanding of how essential preparation and self-care are, not only for our clients, but also for us as therapists. I wanted to deepen my work and bring that intention into every phase of the EMDR process, starting with preparation.

Preparation in Relational EMDR Therapy

Preparation is often described as one of the less structured phases of EMDR therapy. But in Relational EMDR Therapy, it’s a deeply active and intentional process. Alongside tools like Safe/Calm Place and Resource Development and Installation (RDI), we engage through our presence, attunement, and relationship with the client (Laliotis, 2023).

Francine Shapiro emphasized the importance of this foundational phase:

“The clinician must be finely attuned to the needs and particular characteristics of the client…The clinician’s job is to facilitate the client’s self-healing process. Any nonspecific aids, including therapeutic bonding and unconditional support, will increase therapeutic effectiveness” (Shapiro, 2018, p. 114).

Shapiro gave us permission to bring our full clinical selves; our curiosity, humility, and adaptability, into EMDR preparation.

Some clients arrive to therapy ready: they’re curious, self-aware and regulated, and have a good enough relationship with emotions, boundaries, and asking for help. In these cases, a few resources and a review of self-care practices may be enough.

But many clients are not there. For them, preparation becomes a phase of skill-building, education, and co-regulation. It’s a time to introduce adaptive information and foster curiosity about their internal experience.

I often begin this work by exploring what adaptive information may be missing:

• Do they understand what a healthy relationship with self and others looks like?
• Can they recognize and manage triggers and impulses?
• Are they aiming to feel less or avoid pain altogether?
• Do they have any grounding or mind-body practices?

We also use psychoeducation to gently “unteach” internalized messages, like the idea that self-care is indulgent, selfish, or something to check off a to-do list. 

While we often think of the question, “What are you noticing as you’re telling me this?” as an interweave in reprocessing, I use this question as early as the first session to get a sense of a client’s ability to attune to their own experience. If they are unable or unsure of how to answer that, I orient them to why I am asking this and consider practicing experiential mindfulness with them. 

One question I always ask of assessing readiness for memory processing is: “How do you care for yourself?”

This question can be powerful. For clients with complex trauma, self-care often feels unfamiliar, shameful, or simply impossible. Many have been conditioned to prioritize others’ needs or to equate care with productivity.

Part of preparation is meeting clients where they are without judgment and being curious about how their current approach is working for them. 

When clients respond with “I’m fine,” we can explore: What does “fine” mean? How do they relate to rest, food, movement, or saying no? Are they rushing through life and therapy alike?

True self-care is intuitive, flexible, and personalized. Helping clients explore their own version of care is foundational to building the internal capacity needed for EMDR reprocessing.

Preparation for Complex Trauma

Clients with complex developmental trauma often require extended preparation. Reprocessing may trigger depressive symptoms or maladaptive patterns, but these are not setbacks. Rather, they are signals to pause, reconnect to safety, and reassess readiness.

Such clients may hold blocking beliefs like:

• “It’s selfish to care for myself.”
• “If I set boundaries, I’ll lose connection.”
• “My needs don’t matter.”

Many have adapted by people-pleasing, suppressing emotions, or over-giving. These once helped them survive but now interfere with healing.

As EMDR therapists, we can gently explore:

• What happens when they try to slow down?
• What gets in the way of setting limits?
• What would new forms of self-care look like for them?

Working relationally with these beliefs invites clients into new possibilities for self-connection, agency, and regulation. Over time, care shifts from effort to rhythm, and the healing process deepens.

A Client Story: The Positive Feedback Loop of Improved Self-Care & Deeper Healing

As we heal, our capacity for self-care expands. One of my young adult clients is a beautiful example of this process.

This client came to me with PTSD, panic attacks, emotional dysregulation, and complex trauma stemming from childhood neglect, severe bullying, and sexual assault. She identified as “mentally ill” and lived in a cycle of chaos; emotionally supporting others, fighting perceived injustices, and neglecting herself.

The neglect contributed to the development of a binge eating disorder. While she knew her patterns were harmful, she didn’t know how else to cope. When she described her “panic attacks”, I offered psychoeducation on emotional dysregulation and helped her name and track her symptoms. We explored adaptations through the lens of the nervous system and attachment trauma.

As her capacity grew, she started sleeping better, spending time in nature, and finding nourishing routines. She began setting boundaries, reducing reactivity, and seeking rest rather than chaos.

She was able to approach her patterns of rescuing, victimizing, and adopting the victim stance with curiosity and compassion instead of shame.

Through reprocessing sessions that addressed each aspect of the trauma triangle, she grew more capable of caring for herself. She approached daily challenges with confidence and regulation rather than looking to others to fix her problems. She began setting boundaries with peers and family, arranged housing that supported her independence and wellness, and created routines that honored her needs for rest and nourishment.

As my client committed to caring for herself, she gained the capacity and energy to go deeper in her healing journey. 

The Therapist’s Self-Care: A Parallel Process

Everything we ask our clients to cultivate, including self-awareness, compassion and regulation, we must also nurture in ourselves. 

Many of us are “wounded healers,” and as Cruciani, Liotti, and Lingiardi (2024) note, our histories can make us deeply empathetic. 

But if we don’t tend to our own care, we risk burnout or reenacting old patterns in the therapy room.

When we commit to authentic self-care, we expand our ability to be present, attuned, and regulated. We model balance and invite our clients into a mutual process of healing. This is what Relational EMDR therapy is all about. 

As Deany Laliotis reminds us: “It’s about the we.”

We are not the agents of change. We are co-regulators and co-creators of transformation. 

Relational EMDR invites us to show up authentically, trust the client’s process, and hold space for growth, both theirs and ours.

Want to go deeper?
Explore The Craft, Thinking AIP, or Self-as-Therapist to learn more about preparing clients with complex developmental trauma for EMDR psychotherapy and begin or continue to deepen your own self-as-therapist journey.

References
Laliotis, D. (2023). Relational EMDR Therapy (Appendix B).
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy, 3rd ed.
Cruciani, G., Liotti, M., & Lingiardi, V. (2024). Motivations to become psychotherapists: Beyond the concept of the wounded healer.