EMDR:

SCRIPTED
PROTOCOLS
ADAPTED BY MARILYN LUBER, PH.D.

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 TABLE OF CONTENTS

ACKNOWLEDGMENTS 6

PHASE 1: CLIENT HISTORY – COLLECTING INFORMATION

EMDR Summary Sheet (Luber) 7

Handbook For EMDR Clients

PHASE 2: PREPARATION PHASE – CREATING RESOURCES

Francine Shapiro’s Safe/Calm Place Protocol 8

Luise Reddemann’s Exercise of “The Inner Safe Place” 9

Setting up Your Resource State (Genie LaBorde) 10

Four Elements Exercise for Stress Management (Elan Shapiro) 11

Constructing a Container (EMDR-HAP Manual) 12

Resource Focusing (EMDR-HAP Manual) 14

The Eight Step Resource Development Exercise (EMDR-HAP Manual) 15

Wedging (EMDR-HAP Manual) 16

The Butterfly Hug (Artigas and Jarero) 17

Resource Connection Envelope in the EMDR Standard Protocol (B.Laub) 19

The Resource Map (Elan Shapiro) 21

The Basic EMDR Resource Development and Installation Protocol 25

(EMDR Institute Part 2 Manual)

RESOURCES FOR DISSOCIATIVE DISORDERS

Back of the Head Scale (Jim Knipe) 29

The Method of Constant Installation of Present Orientation and Safety 30

(CIPOS) (Jim Knipe)

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 PHASES 3-7: ASSESSMENT PHASE – CLOSURE PHASE
FRANCINE SHAPIRO’S MANUALIZED PROTOCOLS

Operationalized Protocol for Single Traumatic Event 34

Operationalized Protocol for Current Anxiety and Behavior 39

Operationalized Protocol for Recent Traumatic Events 43

Operationalized Protocol for Phobia 49

Operationalized Protocol for Excessive Grief 60

Operationalized Protocol for Illness and Somatic Disorder 65

EMDR and EARLY INTERVENTION PROCEDURES

Guidelines (Shapiro and Laub) 76

Emergency Room (ER) Protocol (Quinn) 77

EMDR Protocol for ER and Wards (Guedalia and Yoeli) 78

EMD Worksheet for Acute Stress Disorder (E. Shapiro) 85

Recent Traumatic Episode Protocol (RT-EP) Schemata (E.Shapiro and B.Laub) 91

Recent Traumatic Episode Protocol (RT-EP) (E.Shapiro and B.Laub) 92

PAIN PROTOCOLS FOR EMDR

Pain Control with EMDR: An Information processing approach 95

(Grant)

EMDR Pain Protocol (de Roos and Veenstra) 98

Operationalized EMDR/Phantom Pain Research Protocol 104

(Wilson and Tinker)

ADDICTION PROTOCOLS FOR EMDR

Operationalized Protocol for DeTUR, an Urge Reduction Protocol for

Addictions (Popky) 114

SUPERVISION
The Clinician Self Awareness Questionnaire in EMDR (Dworkin) 122

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 PULL-OUT WORKSHEETS

Past 127

Present Triggers 128

Future 129

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 4 ELEMENTS EXERCISE FOR STRESS
MANAGEMENT
(EARTH, AIR, WATER AND FIRE)
BY ELAN SHAPIRO

Rationale:

• External and internal stress triggers have a cumulative effect during the day.
• We cope better with stress when we stay within our arousal “window of tolerance”.
• An antidote to stress triggers: frequent random monitoring of stress level with simple stress
reduction actions to keep stress levels within our “window of tolerance”.
•
Suggestions:
• Wear a 4 Elements bracelet* (such as a coloured rubber band or string or use a bracelet that
you wear on a regular basis) on your wrist and every time you notice it take a quick reading of
your current stress level (Subjective units of disturbance or SUD) and perform 3 or 4 brief self
calming /self control exercises (see below for 4 suggestions –the 4 elements) and then take a
second SUD reading.
• Alternative: place a small sticker or label on your watch, mobile phone etc]
• The (modest) goal is to reduce your stress level by 1 or 2 units each time, to do this at random
times and at various initial stress levels. By preventing your stress responses from
accumulating, you may be better able to stay within your “window of tolerance”.
•
Tips:
• Option to use a rubber band AND a label on cell phone or watch.
• The rubber band can be stretched (gently) and released each time to signal the beginning of
the 4 Elements exercise to stop negative thoughts and to ground quickly in the present.
• The sequence of the 4 Elements -Earth-Air-Water-Fire- is now designed to follow the body up
from the feet to the stomach and chest, to the throat and mouth and up through the head.

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Directions for 4 Elements Exercise for Stress Management (Elan Shapiro):
Say, “Let’s take a current reading of your stress level where 10 = the most stress and 0 no
stress at all, where are you now with stress with our 0-10 scale”? /10
• EARTH : GROUNDING , SAFETY in the PRESENT /REALITY
Say, “Take a minute or 2 to “land”… to be here now.
Place both feet on the ground, feel the chair supporting you. Direct your attention outwards.
Look around and notice 3 new things. What do you see? What do you hear? (notice 3 things)
(Don’t ask this if it draws attention to on-going dangers e.g. if there are explosions still going
on)
• AIR: BREATHING for STRENGTH, BALANCE and CENTERING
(Anxiety = excitement without oxygen and you stop breathing. When you start breathing your
anxiety reduces).
Say, “As you continue feeling the SECURITY NOW of your feet on the GROUND, take 3 or 4
deeper slower breaths from your stomach, making sure to breathe all the way out to make
room for fresh energising air. As you breathe out, imagine that you are letting go of some of
the stress and breathing it out Direct your attention inwards to your center.”
• WATER : CALM and CONTROLLED -switch on the RELAXATION RESPONSE
Say, “As you continue feeling the SECURITY NOW of your feet on the GROUND and feel
CENTERED as you BREATHE in and out, notice if you have saliva in your mouth? Make more
saliva because when you are anxious, or stressed your mouth often “dries” because part of
the stress emergency response (which has to do with the Sympathetic Nervous System) is to
shut off the digestive system. When you start making saliva, you switch on the digestive
system again (or the parasympathetic nervous system) and the relaxation response. This is
the reason why people are offered water or tea or chew gum after a difficult experience. A
Spanish surgeon uses this production of saliva to train his patients to ignore pain while he
performs surgery without anaesthetics. When you make saliva, your mind can optimally
control your thoughts and your body. Direct your attention up to making saliva”.
• FIRE: LIGHT/FIRE up the path of your IMAGINATION
Say, “As you continue feeling the SECURITY NOW of your feet on the GROUND and feel
CENTERED as you BREATHE in and out and feel CALM and in CONTROL as you produce
more and more SALIVA, bring up the image of your SAFE PLACE (or some other
RESOURCE).
Where do you feel it in your body?
Install with brief slow BLS / butterfly hugs.
Direct your attention to feeling good in your body.”
Say, “As you continue feeling the SECURITY NOW of your feet on the GROUND;
and feel CENTERED as you BREATHE in and out; and feel CALM and in CONTROL as you
produce more and more SALIVA; you can let the FIRE LIGHT the path to your IMAGINATION
to bring up an IMAGE of a place where you feel SAFE /or a memory in which you felt good
about yourself.Go with that (using bls). Now touch your bracelet (or sticker, etc), thinking
about earth, air, water and fire and go with that “(to install your bracelet). Now, let’s take a
current reading of your stress level where 10= the most stress and 0 no stress at all, where are
you now with stress with our 0-10 scale”? /10.
Repeat 3 to 4 times or as needed until the SUDS level decreases to 0 or a tolerable amount.

Option: this can be a way of introducing the Safe Place exercise as the 4th element, especially
when there is a greater need for stabilisation or ongoing danger.

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 PHASES 3-7:ASSESSMENT PHASE-
CLOSURE PHASES
MANUALIZED PROTOCOLS FOR EMDR FROM
FRANCINE SHAPIRO’S 2001 TEXT
ADAPTED BY MARILYN LUBER

Manualized Protocol for a Single Traumatic Event

(Shapiro, 2001) Adapted by Marilyn Luber
(For single traumatic events, the standard protocol should be applied to the following
targets (assuming they are available.)
Shapiro’s Protocol Summary:
1. Memory or image of the actual traumatic event
2. Flashback scene (which may differ from the recalled image that
represents the trauma).
3. Dream image, or most traumatic scene in a recurring nightmare.
4. Present stimuli that trigger the disturbing memory or reaction (such
as the sound of a car backfiring or being touched in a certain way).
5. Create a future template

Name: __________________________ Date: __________________

1. Memory or image of the actual traumatic event

Image: Say, “What image represents the worst part of the memory or
incident?”

Negative Cognition: Say, “What words go best with that picture that express
your negative belief about yourself now?”

Positive Cognition: Say, “When you bring up that picture/incident, what

would you like to believe about yourself now”?

VoC: Say, “When you think of that picture/incident, how true do those words
(repeat the PC) feel to you now on a scale of 1-7, where 1 feels completely
false and 7 feels totally true”? /7

Emotions: Say, “When you bring up that picture/incident, and those words
(repeat the NC), what emotion(s) do you feel now”?

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 SUD: Say, “On a scale of 0 to 10, where 0 is no disturbance or neutral and 10
is the highest disturbance that you can imagine, how disturbing does it feel
to you now”? /10

Sensation/Location: Say, “Where do you feel it in your body”?

2. Flashback scene (which may differ from the recalled image that represents
the trauma).

Say, “Is there a flashback scene that arises concerning the trauma”?

Target/Memory:

Image: Say, “What image represents the worst part of the memory or
incident?”

Negative Cognition: Say, “What words go best with that picture that express
your negative belief about yourself now?”

Positive Cognition: Say, “When you bring up that picture/incident, what

would you like to believe about yourself now”?

VoC: Say, “When you think of that picture/incident, how true do those words
(repeat the PC) feel to you now on a scale of 1-7, where 1 feels completely
false and 7 feels totally true”? /7

Emotions: Say, “When you bring up that picture/incident, and those words
(repeat the NC), what emotion(s) do you feel now”?

SUD: Say, “On a scale of 0 to 10, where 0 is no disturbance or neutral and 10

is the highest disturbance that you can imagine, how disturbing does it feel
to you now”? /10

Sensation/Location: Say, “Where do you feel it in your body”?

3. Dream image, or most traumatic scene in a recurring nightmare.

Say, “Is there a dream image or a recurring nightmare that occurs
concerning the trauma?

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 Target/Memory:

Image: Say, “What image represents the worst part of the memory or
incident?”

Negative Cognition: Say, “What words go best with that picture that express
your negative belief about yourself now?”

Positive Cognition: Say, “When you bring up that picture/incident, what

would you like to believe about yourself now”?

VoC: Say, “When you think of that picture/incident, how true do those words
(repeat the PC) feel to you now on a scale of 1-7, where 1 feels completely
false and 7 feels totally true”? /7

Emotions: Say, “When you bring up that picture/incident, and those words
(repeat the NC), what emotion(s) do you feel now”?

SUD: Say, “On a scale of 0 to 10, where 0 is no disturbance or neutral and 10

is the highest disturbance that you can imagine, how disturbing does it feel
to you now”? /10

Sensation/Location: Say, “Where do you feel it in your body”?

4.Present stimuli that trigger the disturbing memory or reaction (such as the
sound of a car backfiring or being touched in a certain way).
Say, “What are the stimuli that trigger your trauma (state the trauma) Let’s
process these triggers one by one”.
Triggers:

Target/Memory: Say, “Which trigger would you like to work on?”

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 Image: Say, “What image represents the worst part of the memory or
incident?”

Negative Cognition: Say, “What words go best with that picture that express
your negative belief about yourself now?”

Positive Cognition: Say, “When you bring up that picture/incident, what

would you like to believe about yourself now”?

VoC: Say, “When you think of that picture/incident, how true do those words
(repeat the PC) feel to you now on a scale of 1-7, where 1 feels completely
false and 7 feels totally true”? /7

Emotions: Say, “When you bring up that picture/incident, and those words
(repeat the NC), what emotion(s) do you feel now”?

SUD: Say, “On a scale of 0 to 10, where 0 is no disturbance or neutral and 10

is the highest disturbance that you can imagine, how disturbing does it feel
to you now”? /10

Sensation/Location: Say, “Where do you feel it in your body”?

5.Incorporate a detailed template for a trauma-free future action:

Say: “I would like you to imagine yourself coping effectively with/in

in the future. With the positive belief and your new sense
of (ie. strength clarity, confidence, calm,) imagine
stepping into this scene.
Notice what you see and how you are handling the situation.
Notice what you are thinking, feeling, and experiencing in your body.
Are there any blocks, anxieties, or fears that arise as you think about this
future scene?”

If yes, say: “Then focus on these blocks and follow my fingers (or any other
bls)”.
If the blocks do not resolve quickly, evaluate if the client needs any new
information, resources, or skills to be able to comfortably visualize the future
coping scene. Introduce needed information or skills.

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Say: “What would you need to feel confident in handling the situation?” or
“What is missing from your handling of this situation?”

If the block still does not resolve and the client is unable to visualize the future
scene with confidence and clarity, use direct questions, the Affect Scan, or the
Float-back technique to identify old targets related to blocks, anxieties, or
fears. Use the standard protocol to address these targets before proceeding
with the template.

If there are no apparent blocks and the client is able to visualize the future
scene with confidence and clarity,
Say: “Please focus on the image, the positive belief, and the sensations
associated with this future scene and follow my fingers (or any other bls).
Do several sets until the future template is sufficiently strengthened.

Then say: “Close your eyes and keep in mind the experience that you will have
in the future. Then bring your attention to the different parts of your body,
starting with your head and working downward. Any place you find any
tension, tightness, or unusual sensation, tell me”.

If any sensation is reported, do bls. If a positive/comfortable sensation, do bls

to strengthen the positive feelings. If a sensation of discomfort is reported,
reprocess until the discomfort subsides. Check the VOC.

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 EARLY INTERVENTIONS

Emergency Room (ER) Protocol

(Gary Quinn 2006)

Note to readers: This protocol presumes familiarity with the EMDR protocol (see note
below), of which it is an adaptation. Readers not familiar with the protocol will still benefit
from this report by clinicians who are highly experienced in dealing with this special
population. This procedure was initially developed to help to victims of terror within hours
of a terrorist attack. It can be applied to any situation where patients have experienced
danger, such as following car accidents. Some of these patients come in shaking and
unable to speak, and others will not talk, despite appearing quite distressed. This has
been used in an emergency room setting and, afterwards, if the patient is not ready for
discharge, it can be used on the hospital ward floor.

Caution: This procedure has not received official sanctioning from the EMDR
Institute and has not been validated by research. This procedure can only be
considered after all medical needs have been evaluated and/or treated.

Usage:

n Timing: Within hours of the trauma.

■ Indication: “Silent terror” or highly agitated state

Initial Preparation

 Normalization while uncontrollable shaking and overwhelmed.

Say, “This is the body’s normal healthy way of dealing with a dangerous
situation”.

Preparation

n Brief explanation describing EMDR:

Say, “I will be using a procedure based on the natural state of dreaming when
your eyes move rapidly back and forth. This can help you learn new things and be
calm. It will also help you come back to the present.”

Say, “I am going to ask you to follow my fingers with your eyes or with your
permission, I am going to tap on your hands”.

Assessment:

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 n No formal assessment as already accessing memory

n Assumed initial NC: “I am in danger”

n PC : “I am safe now from that event”

NB: With those that appeared catatonic-like and non-responsive, BLS was used to help
them come out of their catatonic-like state. The patients in the ER are very ‘in’ their
internal world. The assessment phase of EMDR is not needed because these patients
were actively accessing the emotional and feeling aspects of the memory and the event.

This procedure is based on the concept of utilizing dual attention.

The patient is directed to ‘focus’ on the ‘here and now’ of being safe in the hospital
outside of their shaking bodies and away from the flashbacks of the incident Although
their flashback of the incident keeps them in the past, by seeing, hearing and ‘feeling’
the therapist during this intervention and augmenting this with bilateral stimulation (such
as eye movements or hand tapping), the bilateral stimulation and voice of the therapist
brings them back to the present and current reality of their safety

NB: Sound bilateral stimulation is not readily available because of the fatigue factor of
snapping fingers unless you have brought a sound device with you.

Desensitization

n Begin bilateral stimulation.

n At first, there can be a re-experiencing of trauma followed by calming and the

ability to communicate.

Say, “I am going to ask you to follow my fingers with your eyes (or with your
permission, I am going to tap on your hands)”. Begin bilateral stimulation.

Say, “You are in the emergency room and you are safe. That event is over out
there. You are safe here in the emergency room. Focus on being in the hospital
and safe, notice my standing with you, listen to my voice and feel my hands
tapping on yours”.

Do bls. Repeat several times.

Say, “Take a breath, Let it go, what are you noticing?”

Completion

n Narrative of event

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At first, there can be re-experiencing of trauma followed by calming and the ability to
communicate. At this point, it is possible for the patient to give a narrative of what they had
experienced. This narrative is therapeutic.

n And/or EMD (if time)

n At times, patients may still remain distressed because another negative

cognition is active, such as a false sense of responsibility as in survival guilt.
With these patients, EMD may be utilized if there is time. Usually, this is difficult
because there are many people waiting in a disaster.

n Then, they receive a brief statement describing EMDR as similar to REM sleep
that seems to have a calming effect on a person and helps them put things in
proper perspective.

Say, “EMDR is similar to REM sleep. EMDR is an excellent treatment when the
effects of the trauma last more than 3 days. If the symptoms of trauma continue
after that time, the EMDR can help you identify what is the false negative belief
that keeps the feelings active such as a false sense of responsibility, the lack of a
sense of a present safety or a sense of the absence of control or choices. So if
you do not see yourself improving you could either call me or use the referral list
of EMDR therapists that can help you find the alternative positive statement.
which will help you to improve”.

Say, “Please tell me what happened.”

At this point, either with or without EMD, patients are available to talk and listen., NB..
they were in “silent terror” when they entered the ER. Since they can talk, they are
permitted to leave with a referral for further treatment if necessary. Then, it is more like
a regular situation in which they have been traumatized but can communicate. The fact
that they know there is a treatment that can help them is itself very helpful.

Say, “This is the body’s normal, healthy way of dealing with a dangerous
situation”.

Closure

 Closure is done with the following statement:

Then say, “You may still have a day or two of anxiety, disrupted sleeping and/or
an increased startle reaction. If you find these symptoms lasting longer than that
and not subsiding, you can seek further treatment”.

n They are given a final medical exam, and are seen by a Social Worker and
Psychiatrist/Psychologist before being discharged

n Fact sheet and referral numbers to call for further treatment

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 ADDICTION PROTOCOLS FOR EMDR

Manualized Protocol for DeTUR, an Urge Reduction

Protocol for Addictions
(Popky, A.J., R. In, Shapiro, Ed. “EMDR Solutions: Pathways to Healing”. New
York: Norton and Norton, Publishing, Inc., 2005 pp. 167-188; A.J. Popky, private
communication and seminar, 2004, 2006; Sharon Rollins, personal
communication, 2006 (special thanks for Trigger pull out sheet) adapted by
Marilyn Luber

Name______________________________ Date:

1. Internal Resource State:

Say “Recall a time when you felt resourceful, powerful, in control and focus on
those experiences and feelings”.

Relate back to the client the what he has told you that he sees, hears, smells
and/or tastes etc while doing BLS, keeping the client in the positive feelings.
Say, “So focus on that time when you were seeing (state what client seeing),
hearing (state), feeling (state), smiling (state) and tasting (state) and follow my
fingers”(or whatever BLS you are using).

Use bilateral stimulation to empower clients and allow the process to move faster.

2. Positive Treatment Goal (PG): (not necessarily a goal of abstinence, p. 172-3)

Help them build the picture.
Say, “Imagine seeing a picture of yourself already achieving your goal.
Think about what your life be like without ?”
(list the addiction, or dysfunctional behavior the client would like to be rid
of)
Say, “What will you be doing instead”?

Say, “What do you want”?

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Say, “What will it get you”?

Say, “How will you know when you have gotten it”?

Say, “What would you be seeing”?

NB. The PG does not have to include abstinence but should help them create a
clear image of how they would look being successful and fully functional, having
attained their goal. The PG should be stated in positive terms, time related (within
a fairly close time period), reasonable, achievable, descriptive of coping and
functioning successfully in their terms, and attractive, magnetic and compelling.

After they have built the picture, check to see if this is really what they want.
Say, “Is this what you really want”?

Say, “Is it desirable? Does it have a strong attraction or pull to it”?

Say, “Does it feel better if you make the picture bigger, clearer, brighter, bring
it
in closer and/or add sounds”?

Help them make any adjustments to make it more appealing.

Then do BLS.

3. Positive State:
Fully associate a positive state with the PG by anchoring and strengthening.
Say, “You can build your positive treatment goal. Bring up a clear picture
of it. What are the kinds of things that you will be able to do when you
have it”?

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 Say, “Step into your picture of your positive treatment goal, into that
body posture (as-if state). Notice and experience the positive feelings,
breathe into these feelings, move around in them, experience being
successful. Notice what you see, hear, feel smell, and taste. Notice what
it’s like to function successfully. As you notice and experience those
positive feelings, touch your knuckle in this positive state until your
positive state is the most desirable. Increase pressure slightly to that
same place on your knuckle as your positive feelings peak,
strengthening the mind-body link”.
(As you or the client push the anchor, do BLS).

Repeat the same process using sounds:

Say, “As you listen to the positive words or sounds that you are
saying to yourself and the positive words that others would be saying,
adjust the auditory components: the volume, the tone, the tempo, and the
balance etc. and as the positive experience peaks, touch your anchor”.

Apply the anchor touch and the simultaneous BLS to further anchor the feelings
of success into their physiology as the association with success peaks. Do BLS.

Test the positive state by having the client touch the knuckle and notice the
results. They should report a positive experience. It is important for the client to
have a strong, positive, sensory-based experience of having successfully
achieved their goal anchored into their physiology.
Say, “Now touch your knuckle. What do you feel”?

4. Identify Triggers (p. 175)

Say, “How do you know when to
(use/do the activity to which you are addicted)?
What prevents you from being in your positive state? These triggers
can be a place, person, time, emotion, smell, taste, event, action or
object”.
Make a list below of all the triggers for use, indicating the level of urge
(LOU) on the 0-10 scale with 10 being the strongest urge. Then rank
them based on intensity on the chart below from weakest (0) to
strongest (10) by level of urge”.
Say, “Bring up the picture, along with any words, tastes, smells that
go with it.

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How strong is the Level of Urge (LOU), right now, from 0-10, where 0 is
lowest and 10 is the strongest?”

Beginning Ending
t1: LOU=
t2: LOU=
t3: LOU=
t4: LOU=
t5: LOU=
t6: LOU=
t7: LOU=
t8: LOU=
t9: LOU=
t10: LOU=

(Use extra paper as needed.)

4. Desensitization,
Beginning with “t1” (weakest) and proceeding through the final trigger
(strongest), repeat the following procedure:

Say, “Bring up the picture of that trigger along with any words, tastes,
smells, sounds that go with it. How strong is the Level of Urge
(LOU), right now, from 0-10 where 0 is no urge and 10 is the
strongest? /10

Say, “Where are you feeling that number in your body”?

Say, “Hold the picture along with all the associated words, tastes, and
smells. Notice what and where you are feeling the urges in your
body”.

Begin using BLS (Use about 24 passes and watch for changes in the client
physiology. As you notice changes:

Say, “Good." Or, “That’s right”.

After each set of BLS ask,

“What are you getting now? or “What is coming up now?” or
“What are you noticing now”?

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Say, “Go with that”. Or “Concentrate on that”. Or, “Think about that”
Resume BLS.

Repeat until the desire drops to 0 (LOU=0)*

When the client reports a LOU=0:

Say, “Go with that.” Do another set of BLS.

*Troubleshooting:
*If the client is looping, or getting off track say,
“Return to the target trigger and what is the LOU? Focus on the body
location and go with that”.

*If a client reports no change, increase the width, distance, speed,

number, or direction.

*If the client intellectualizes, increase the speed.

*If a client abreacts, continue the BLS until they calm down.
You may remind them, “It’s in the past, a long time ago…it’s old stuff”.

*If client dissociates, keep them in their body by saying,

“Notice where in your body you are feeling it and any change, even the
smallest change”.

*If traumatic material/core issues emerge as you address a trigger, you

can continue or switch to the standard EMDR protocol and process
that material until the SUDS is reduced to 0. Do another set.

6. Installation:
After the LOU for a specific trigger reduces to 0 with BLS, anchor and install.
Say, “Bring up the triggering incident again and apply slight pressure to your
knuckle”.

You do BLS. Whatever positive feelings or statement the client reports after the
set, say,
“Hold that,” and do another set of BLS.

If the client’s report is negative, usually another channel has opened up and
needs to be addressed.

7. Test Installations and Future Check after each trigger is desensitized.

Say, “
To test the installation, say,
Say, “Bring up the trigger again and what is the LOU?” ______/10

If the LOU is above 0, repeat the desensitization process with that trigger.

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Say, “Bring up the triggering incident again and apply slight pressure to your
knuckle”.

You do BLS. Whatever positive feelings or statement the client reports after the
set, say,

“Hold that,” and do another set of BLS.

If the client’s report is negative, usually another channel has opened up and
needs to be addressed.

If the LOU=0 have the client imagine a time in the future and check the LOU again.

Say, “Imagine a time in the future and the trigger. What is the urge”? ______/10

Do another set of BLS along with the anchoring pressure to the knuckle.

REPEAT STEPS 5 and 6 FOR EACH TRIGGER

8. Closure and Relapse Prevention:

Explain that processing continues after they leave, and they may or may not
experience additional changes. Remind them that they can call if necessary.

Say, “The process continues after the session is over and you may or may not
experience new thoughts, memories or experiences, please make note of it for the
next session.
If you have any major concerns or questions, please call me.
If you feel any urges, notice what and where you are feeling it/them.
If any uncomfortable urges arise, pick a spot on the wall and move your eyes
rapidly back and forth until the urge/desire fades and then touch your knuckle (ie.
anchor the positive state). If the urge remains, call your sponsor or support
group/person. If you are unable to prevent the urge and indulge in the
dysfunctional behavior, remember that this is new information emerging and
make a note of it so we can work on it during your next visit. It is like peeling away
the leaves of an artichoke to get to the heart of the matter”.

8. RE-EVALUATION
At the beginning of each session, check for the following:
*new targets/relapse triggers, *new information, *previously desensitized triggers.
Do BLS on all successes to build ego strength. If client relapses, begin working
on the triggers causing the relapse. If there are new stressors, target them as
triggers.

Say, “Okay, let’s go over what happened since our last session and if you have
learned any new information concerning your urges. What is happening
concerning the triggers that we have worked on”.

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For clinical use by EMDRIA/EMDR Europe approved therapists only
If the client is successful,
Say, “Think about the success that you have accomplished and do (BLS)”.

If client reports relapse, work on the newly emerging triggers that brought up the
urge to use. Address any new stressors which clients have experienced between
sessions and also target these stressors with BLS.

21
For clinical use by EMDRIA/EMDR Europe approved therapists only