I really don't think EMDR gets enough credit for how bloody complex it can be to apply effectively. Read on for the top five mistakes EMDR therapists make that impact treatment efficacy, and what to do instead.
1. Making Assumptions About Certain Targets Being the Root Cause of the Presenting Problem
Big, obvious, traumas can act as red herrings; while they may seem like the most logical cause of distress, 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 - we can't make assumptions about what experiences have led to current problems. I watched an episode of House (the show with the cranky doctor) a while ago, where he said something I found quite profound: "Most people have about three things wrong with them at any given time. We found the wrong one!" I thought this was a fantastic concept to apply to EMDR treatment.
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 matter. 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 may not be accurate and we shouldn't just take their word for it. Not to say their thoughts aren't meaningful, 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.
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? Heck yes it is.
While it is 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 original PC, processing will become stuck, leaving the client unable to fully integrate and resolve their distress. Establishing a meaningful PC with genuine buy-in from the client (reflected in a validity of cognition [VoC] rating above 1/7) is crucial 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 may be unable to integrate the adaptive information.
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 aren't able to do this.
3. Intervening Prematurely or Unnecessarily During Processing
Therapists can panic when clients experience high distress during processing, feeling compelled to step in and assist. This is rescuing behaviour; you must sit in your discomfort and tolerate the distress in front of you without jumping in to save them. Your client's brain knows what to do. It's your job to stay calm, and trust that they can do it. They are already scared that they can't - they don't need you agreeing with them.
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 work through distress to reach completion, 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 the adaptive resolution process and leave clients stuck rather than allowing them to move through the distress to resolution.
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 impulsively, we must trust the process and allow our 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 situation.
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 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 believe EMDR is an extremely 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.
While it is 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. 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 improvement 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.
Final Thoughts on Common Errors EMDR Therapists Make
High quality EMDR requires patience, skill, and a deep trust in the process (and in the fabulous wonder of our client's brains).
Many of the common mistakes therapists make stem from a genuine desire to help their clients and all is done with beautiful intention. But, true healing often requires allowing the brain to do its work without unnecessary interference.
By refining assessment skills, ensuring meaningful positive cognitions, resisting premature interventions, using cognitive interweaves judiciously, and trusting in the EMDR framework rather than defaulting to other modalities, therapists can facilitate more effective and lasting healing. As with any therapeutic approach, continued learning and consultation are key to becoming a more confident and competent EMDR practitioner.