Top 5 Mistakes EMDR Therapists Make (And How to Avoid Them)

My internal reaction when I think about some of my past EMDR sessions...

I really don't think EMDR gets enough

credit for how bloody complicated it can be to do really well. Below I have listed my thoughts on the top mistakes EMDR therapists make that can seriously impact your treatment efficacy and outcomes. I know this because I've made all of these mistakes and many more! Read on for my thoughts on the most common EMDR faux pas.

1) Making assumptions about certain targets being the source of the problem

Big, obvious, traumas can act as red herrings; while they might seem like the most logical cause of your client's difficulties, they are not always connected to the presenting problem the client is seeking assistance with. Most people have experienced significant adverse events in their life - don't make assumptions.

I watched an episode of House (the show with the cranky doctor) a while ago, where he said something I thought was great: "Most people have about three things wrong with them at any given time. We found the wrong one!" 

Everyone has some big stuff in their past. It doesn't necessarily mean it's relevant. But, it might be, which is why we assess and conceptualise.

EMDR therapists can also run into trouble when making purely logical links between memories and symptoms. For example, assuming a fear of flying must be due to the client's past experience of severe turbulence. This can sometimes be the case, but often it oversimplifies the case conceptualisation.

Clients frequently do this too - they will rationalise their symptoms with cause-and-effect explanations, such as "I experienced X, so it must have caused Y". This is completely reasonable logic - they aren't EMDR experts! But their assumptions about the target memory might not be accurate and we shouldn't just take their word for it. Not to say their thoughts aren't meaningful and important, but if we didn't do our due diligence, we wouldn't be doing our jobs properly 😎.

Moral of the story: Never make assumptions about memories and targets. Thorough assessment is essential every time to ensure the correct targets are identified for processing. There's nothing more demoralising than doing some brilliant work on a memory target, only for it to have absolutely no effect on the client's symptoms whatsoever.

2) Not obtaining a meaningful positive cognition (PC) and validity of cognition (VoC) rating

I have observed debate in the trauma and EMDR communities about whether the positive cognition (PC) is actually necessary in EMDR.

My opinion? Hell yes it is.

While it's true that a PC can sometimes emerge organically through processing, this is not always the case! And... what about when it doesn't? With no identified PC, processing can get stuck, leaving the client unable to fully integrate and resolve their distress.

Establishing a meaningful PC with genuine, emotionally resonant buy-in from the client (reflected in a validity of cognition [VoC] rating above 1/7) is important to ensuring smooth and effective reprocessing. And yes, you MUST have a 1.5 or more out of 7 VoC. If you don't, you need to change the PC to something that the client is able to access a glimmer of believability in. Otherwise their brain might struggle to link things.

You might say "but I often get a 1/7 and it works anyways!" - yes, but what about when it doesn't? Of course sometimes it works regardless - that's your client's amazing brain doing amazing things! By maintaining procedural fidelity, however, we cover ourselves for the times our client's brains need a boost.

3) Intervening prematurely or unnecessarily during processing

Therapists can panic when clients experience high distress during processing, feeling compelled to step in and assist. And I completely understand, because I did this for a long time too. Let's call a spade a spade, though: this is rescuing behaviour.

We need to sit in our discomfort and tolerate the distress in front of us without jumping in to save our client. Their brain knows what to do. It's your job to stay calm, confident, and trust that they can do it!

They are already scared that they can't - they don't need you agreeing with them.

If you need to, increase the working memory taxation you apply to help boost the processing speed so they don't have to sit in it for as long. This can be achieved by simply increasing the speed of eye movements, or adding tapping such as the butterfly hug.

When we don't stay out of the way in these critical moments, we disrupt the client's natural processing system. The EMDR protocol is designed to allow the brain to process the memory to resolution, and unnecessary interference can prevent this from occurring.

By intervening too soon, we may unintentionally introduce material that contradicts or diverts from where the client’s brain was naturally heading. This can disrupt adaptive information processing and leave clients stuck.

Additionally (and perhaps even more importantly), when we intervene unnecessarily, we erode the client's confidence in the process and inadvertently send the message that we don't think they can handle it (the very opposite of how we want them to feel).

Instead of reacting, trust the process and allow your clients to follow their processing path. Trust that their brain knows what to do. Of course, if the client is looping or blocked, intervention is necessary - don't stay out of the way in these situations.

4) Using cognitive interweaves too quickly

This is an extension from point 3, but it gets it's own point because it's rife in clinical practice. Similar to intervening prematurely during processing, using cognitive interweaves too quickly can disrupt the natural adaptive processing system. When we introduce an interweave, we are making a clinical judgment that the client is unable to link adaptive information on their own. This is a significant decision and should only be made after unblocking strategies have been attempted. Jumping to an interweave too soon can interfere with the client’s natural ability to process and integrate material. Instead, give their brain a good chance! You might be surprised. Remember, as per protocol fidelity, two consecutive sets with no change are required before any intervention is indicated.

5) Unnecessarily introducing other therapy approaches during processing

This is a wildly unpopular opinion, but I'm saying it anyway!

I truly believe EMDR is a robust therapy that works, on it's own, the vast majority of the time. If we frequently find ourselves integrating other therapeutic approaches during processing, it may indicate gaps in our knowledge or EMDR skills, or countertransference issues. I know for me, when I have found myself repeatedly leaning on other therapy approaches (cough, looking at you parts work) it has been a combination of those factors.

While it's true that some situations require additional interventions, EMDR—when applied correctly—can handle most clinical presentations. This is absolutely supported by the extensive evidence base.

If another approach is introduced, it should be done briefly and with a clear purpose — for example, as a focused, targeted interweave before we go right back to EMDR processing. If we repeatedly shift into another modality, such as parts work, it may be a sign that we need to refine our EMDR skills rather than relying on external frameworks.

That's not to say we can't adapt the standard EMDR protocol as per client needs - this is a clinical judgement and is entirely appropriate in many situations.

Trusting the EMDR process and fully utilising its structured approach ensures that the therapy remains as effective as intended. When I stopped relying on other therapies and improved my EMDR knowledge and skills via consultation, I noticed major improvements in client outcomes.

It's stuffy and unpopular these days to bang on about fidelity, but I really do believe the true magic is in high-fidelity EMDR with excellent case conceptualisation.

Are you making these top 5 EMDR therapist mistakes?

That's okay — we've all been there. There are so many moving parts to EMDR we're all bound to make some blunders. Mistakes aside, all therapists have genuine desire to help, and all is done with beautiful intention. I know this about you!

High quality EMDR therapy requires patience, skill, a deep trust in the process — and in the fabulous wonder of our client's brains.

If I can leave you with any advice, it would be a) trust the protocol, it works, and b) trust your client's brain, it also works.

If you need help doing fabulous EMDR, contact me for EMDR consultation. Or, if you want to hear more from me, including updates, content and free stuff, sign up to my mailing list.