Consultation to meet EMDRIA standards. How to use work samples and case documentation in remote EMDR Consultation

Consultation to meet EMDRIA standards How to use work samples and case documentation in remote EMDR Consultation Andrew M. Leeds, Ph.D. (707) 703-1827 1049 Fourth St., Suite G ALeeds@theLeeds.net Santa Rosa, CA 95404-4345 www.andrewleeds.net EMDRIA permits either individual or group settings for both: Basic training in EMDR Effective June 2007, EMDRIA requires 10 hours of consultation as part of basic training in EMDR (EMDRIA, 2007). Certification 20th EMDRIA Conference Atlanta August 29, 2009 To achieve the designation of EMDRIA-Certified Therapist in EMDR, in 1999, EMDRIA established a requirement of 20 hours of consultation after completing basic training in EMDR (EMDRIA, 2008b). 1 2 1 2 EMDRIA policies for applicants for EMDRIA Certification (EC) wishing to obtain required hours of consultation by telephone or VOIP (Voice Over Internet Protocol) services. Applicants may obtain hours of consultation via telephone or VOIP (Voice Over Internet Protocol) services without prior approval from EMDRIA. Originally established for clinicians in rural areas, remote consultation may be used by applicants in suburban and urban areas to save travel time and transportation costs and to gain access to Approved Consultants with specific expertise or favorable fees (EMDRIA, 2008c). Consultation for Basic Training EMDRIA standards May be integrated in curriculum structure and fee or obtained independently. All hours may be provided by a Consultant-in-Training (CIT) under the supervision of an Approved Consultant (AC - EMDRIA, 2007). Consultation is about real cases and not experiences that occur in practicum (EMDRIA, 2007, p. 10). Minimum group duration is the number of participants times 15 minutes. Participants may receive credit for the duration of each group (whether or not they present case material or actively participate). 3 Providers of Basic Training may have higher standards. 4 3 4 Consultation for Basic Training must provide opportunities to assess Consultation for Certification EMDRIA standards EMDRIA standards require that consultation provide opportunities to assess the strengths and weaknesses [italics added] of each trainee s overall understanding and knowledge of EMDR, and the practice of EMDR skills, and the opportunity to tailor further learning experiences to address deficits! (EMDRIA, 2007, p. 10). EMDRIA has not specified any objective standards for minimum knowledge or skills to be achieved by trainees in order to complete basic training in EMDR nor a minimum number of clinical sessions in which trainees have used EMDR reprocessing (Leeds, 2009, p. 310). Providers of Basic Training may have higher standards. A maximum of 15 hours can be earned with a Consultant-in-Training. The remaining 5 hours must be earned with an Approved Consultant. Up to 10 hours can be group hours obtained during group consultation with a maximum of eight consultees in attendance. It is possible to earn some or all individual hours of consultation during group consultation sessions. EMDRIA requires Approved Consultants to base their letters of recommendation for Certification on applicants utilization of EMDR! (EMDRIA, 2008a). 5 6 5 1 6

Approved Consultants must play two roles during consultation for Certification A primary responsibility of the consultee: Avoiding disclosure of patients names or other identifying information in verbal presentations, written documentation, or recordings of patient sessions (Leeds, 2009, p. 323). (a) educators, reviewing concepts, principles, and techniques covered in the EMDR basic training and in scholarly publications on EMDR in the context of specific clinical cases (Leeds, 2009, p. 321) (b) evaluators of consultees readiness for Certification expected to communicate concerns about the applicant s readiness for Certification early in the consultation process so appropriate corrective measures can be taken by the applicant (EMDRIA, 2008a). While AC must educate and assess consultees knowledge and skills in the context of specific clinical cases, AC must remain in their roles as consultants -- not as supervisors who are responsible for treatment. Thus, for risk management purposes, AC should never become aware of the identity of a consultee s patient -- true name, face, or other identifying information. 7 8 7 8 Evaluating consultees readiness A Sample certification in EMDR evaluation form (EMDRIA, 2008a, 2008b, 2008f) available on the EMDRIA web site includes 17 scaled items and 2 summary statements for strengths and weaknesses. Three issues not covered in this sample evaluation form include assessing: Knowledge of EMDR s principles, protocols, and procedures as described in the required text (Shapiro, 2001). Ability to apply the standard reprocessing procedural steps from memory with good fidelity. Assessing knowledge of EMDR s principles, protocols, and procedures Accredited, graduate level university courses that meet standards for EMDRIA s basic training in EMDR generally require objective tests to assess fundamental knowledge of EMDR theory and procedures. (Leeds, 2009, p. 320). Until EMDRIA or another respected EMDR association develops a scientifically validated objective examination for assessing EMDR knowledge and skills, Approved Consultants need to review and evaluate clinicians work samples! (Leeds, 2009, p. 320). Ability to achieve treatment outcomes consistent with the scientific literature on EMDR. 9 10 9 10 Options for obtaining work samples in consultation Observing trainees responding to written or videotaped vignettes In evaluating candidates for certification, Approved Consultants should consider incorporating the use of standard fidelity rating scales, session summary forms, and treatment summary forms (Leeds, 2009, p. 320). There are six possible options (being listed does not mean recommended): 1.Observing trainees responding to written or videotaped vignettes 2.Direct observation of practicum exercises between a pair of trainees 3.Listening to verbal summaries of actual clinical interactions and reprocessing sessions with patients 4.Review of near-verbatim transcripts, actual clinical interactions, or reprocessing sessions with patients 5.Review of audio or video recordings of actual clinical interactions or reprocessing sessions with patients 6.Observing actual clinical sessions through a one-way mirror Advantages The consultant can directly observe trainees abilities to perceive, conceptualize, and respond to selected clinical challenges. The consultant can present trainees with a graduated range of simple to more complex vignettes that provide common challenges encountered by newly trained clinicians. Disadvantages Trainees responses under such artificial circumstances may not accurately reflect their level of perceptual, conceptual, or practical skills when they are with an actual patient in their customary clinical setting. This method fails to address the requirement for a review of the clinical application of EMDR from actual cases. 11 12 11 2 12

Direct observation of practicum exercises between a pair of trainees Listening to verbal summaries of actual clinical interactions and reprocessing sessions with patients Advantages The consultant can directly observe how the trainee gathers, organizes, and makes use of the information offered by the patient. The consultant can choose to give real time or delayed feedback. Other trainees may find that these exercises give them opportunities to learn from others skills and mistakes. Disadvantages Live practicum is extremely time consuming; only one clinician may get time to present per group session. This method creates multiple relationships. Issues and the level of functioning of the patient are not likely to be as challenging or complex as trainees encounter in their clinical settings. Practicum exercises fail to meet the requirement for review of clinical application with actual cases by each trainee. Advantages The easiest method for implementing actual clinical case review. It requires the least amount of preparation by trainees and consultant. Disadvantages Verbal summaries offer the least amount of detail and are subject to the limitations of incomplete and distorted recall. Because trainees often do not yet know what to look for in their clinical work, their verbal summaries often fail to provide critical perceptual and behavioral information consultants need to determine what a more experienced EMDR clinician might perceive or do in a given situation. 13 14 13 14 Review of near-verbatim transcripts of actual clinical interactions or reprocessing sessions with patients Review of audio or video recordings of actual clinical interactions or reprocessing sessions with patients Advantages Written summaries can provide concise, well-organized information on patient history, diagnoses, mental status, treatment goals, medical issues, and interventions used in an actual course of treatment. Near-verbatim transcripts offer members of consultation groups a timeefficient format to visualize and discuss the sequence of an entire session. It is easy to remove, redact, or alter identifying information from copies of existing records to present them for review in consultation. Clinicians learn during their preparation. Are easily shared for remote consultation via telephone or video chat. Disadvantages They can be time consuming to prepare. They cannot directly capture timing of interactions, voice tones, facial expressions, and body postures. Advantages Video recordings provide the greatest information on nonverbal elements of patient communications as well as the timing of responses. Information the clinician did not initially notice or understand can be highlighted and discussed to improve perceptual and conceptual skills. Password-protected online storage can allow members of a consultation group: Independent review of complete video or audio recordings. Simultaneous review of selected video or audio segments. 15 16 15 16 Review of audio or video recordings of actual clinical interactions or reprocessing sessions with patients Observing actual clinical sessions through a one-way mirror Disadvantages Video (and audio) recordings are generally too time consuming to review entire treatment sessions. Audio recordings can capture timing of verbal interactions and voice tones, but do not indicate facial expressions, and body postures Self-selected segments fail to capture complete sessions and may not reflect clinicians other areas of strength or weakness. Video recording equipment is costly and often unavailable. It can be difficult to obtain a written release. There are fundamental dilemmas and challenges regarding masking the identity (the face) of the patient and names mentioned during recordings. Advantages The Consultant and group members may observe all the information available to the clinician and all of the clinician s responses with actual clinical use of EMDR. The Consultant may respond in real time, or comment afterwards. Disadvantages Live observation is extremely time consuming; only one clinician may get time to present per group session. Clinicians do not know what might occur next: more performance anxiety. Patients may feel uneasy about other clinicians observing and become reluctant to allow more challenging material to emerge. Significant risk management issues for the Consultant as it not practical to maintain the anonymity of the patient s identity. Pre- and postgraduate internship settings provide the most likely settings. 17 18 17 3 18

Elements of a Contract for Consultation toward EMDRIA Certification Responsibilities of the consultee 1) Specifying the nature of the relationship consultation not supervision 2) Describing the financial arrangements 3) Listing the responsibilities of the consultee 4) Listing the responsibilities of the Approved Consultant. For sample contracts and guidelines see: EMDRIA, 2008f Leeds, 2009, pp. 323-329. 1) Obtaining written consent for the release of information to the Approved Consultant from each patient prior to presenting case material during consultation. 2) Keeping a completed written release form in the patient s chart. 3) Avoiding disclosure of patients names or other identifying information in verbal presentations, written documentation, or recordings of patient sessions. 4) Presenting case summaries, treatment plans, session summaries, behavioral work samples of sessions, and self-assessments that assist both the consultee and the Approved Consultant to assess the consultee s knowledge of EMDR theory, principles, and skills in the use of EMDR. 5) Honoring the financial agreement with the Approved Consultant. 6) Relying on the consultee s own discretion in selecting and using key information, principles, and methods the approved consultant brings to the consultee s attention. 7) Considering the need for additional reading, education, consultation, or training to meet minimum standards for knowledge and skills based on community and professional standards and as recommended by the Approved Consultant. (Leeds, 2009, p. 323) 19 20 19 20 Responsibilities of the Approved Consultant Responsibilities of the Approved Consultant 1) To have a completed, written agreement with consultees prior to starting consultation. 2) If a consultee is working under legally required supervision, to have the supervisor s name, contact information, and written acknowledgement that the consultee is obtaining consultation on their clinical use of EMDR. 3) To keep accurate records and to provide documentation of hours of consultation to the consultee and to the EMDRIA Education and Training coordinator. 4) To remain current on EMDR-related research, books, EMDRIA standards, and resources. 5) To be aware of the consultant s own limits of knowledge and competence for specific patient populations and, when warranted, to refer consultees to other Approved Consultants who are more familiar with the population being treated by the consultee. 6) To encourage consultees to create appropriate written records and behavioral work samples of their clinical application of EMDR and to engage in self-evaluation of these records through the use of fidelity rating scales. (Leeds, 2009, p. 323-234) 7) To provide clear, specific, and objective feedback on consultees knowledge and application of EMDR theory, principles, and skills based on consultees self-report, behavioral work samples, and the use of fidelity rating scales. 8) To review, clarify, and, where appropriate, instruct the consultee in knowledge and skills covered in the EMDRIA-required curriculum of the basic training in EMDR and in the relevant professional literature that supports the clinical use of EMDR. 9) To communicate concerns about areas where the consultee is in need of further development and the consultee s readiness to meet standards for EMDRIA certification periodically and as early in the consultation process as possible. 10)To recommend additional specific reading, education, training, and/or consultation to help consultees address areas in need of further development. 11)To provide the EMDRIA Education and Training coordinator a written recommendation or, if warranted, expression of concern about areas in need of further development when consultees complete their consultation requirement or withdraw from consultation. (Leeds, 2009, p. 323-234) 21 22 21 22 Conducting remote group consultation Using audio or video recordings in remote EMDR Consultation Group Voice Over Internet Protocol (VOIP) and video conferencing Group conferencing using VOIP and video meetings are technically possible, but not yet practical due to inconsistent access: to computer equipment, high-speed internet, and cross-platform issues. http://vyew.com/ (provides a free web conference service) http://www.wiziq.com/ (provides free webinar services) Free telephone conference calling services (bridge calls) FreeConferenceCall.com FreeConference.com Organizer is given a consistent toll call phone number and selects a pin. A toll-free (800) option is available, but at significant cost. Audio recording of conference calls is available. Make inexpensive or free calls to toll numbers with unlimited monthly calling plans, Skype out, cell phones, prepaid calling cards, etc. Have clinicians (select segments of) the recording they want to share. Upload the recording to a secure online storage. Motionbox.com (video sharing with access control) Blip.tv (only pro account offers access control for $8/month). Box.net (free file-sharing services available). Skydrive.live.com (free file-sharing services available). Fileburst.com (fee only file-sharing service). For short segments, clinicians can watch (or listen) independently during group time. For longer segments or full session video (or audio), clinicians can watch (or listen) in advance and make notes. 23 24 23 4 24

How to distribute written work samples and case documentation in remote EMDR Consultation Documenting EMDR case conceptualization and treatment planning Paper documents can be faxed to each group member, but this inconvenient. Handwritten documents can be scanned and digitally distributed as PDF files. Digital documents can be more easily and securely distributed than paper. As email attachments to: a distribution list of individual email addresses. a mail list group: google, yahoo, etc. Placed by each participant into a secure file sharing service set up by AC. Box.net (free file-sharing services available). Skydrive.live.com (free file-sharing services available). After meetings, annotated documents can be returned to the participant. Clinicians may have their own agency required forms or individual processes for documenting case conceptualization. An EMDR Case Inquiry Format adapted from (Forgash and Leeds, 1999): http://www.andrewleeds.net/training/prodownloads_files/summary.pdf and in (Leeds, 2009, pp 314-315). The Psychotherapy Assessment Checklist (PAC) Forms (McCullough, 2001) http://www.affectphobia.org/pacforms.html Photocopy ready treatment planning, session summary and other forms are available in: Adler-Tapia & Settle, 2008; Leeds, 2009; and Shapiro, 2006. 25 26 25 26 Creating near verbatim transcripts Tips for preparing near-verbatim summaries Producing near verbatim transcripts Audio record and transcribe later Accurate, but time consuming, omits non-verbal observations. Handwritten - transcribe in real time Tends to be incomplete due to writing pace, includes non-verbals. Laptop - transcribe in real time For faster typists, can be complete and include non-verbal observations as well as time notations. Format available at: http://tinyurl.com/emdrsessionmaster Save the summary as a Word file (.doc) for ease of sharing. Turn on page numbers (see Word s Insert menu) and line numbering (See Format menu, Document Layout area) for ease in verbally referencing text. Start a new line after each set of bilateral stimulation. Indicate the number of movements per set and any changes of direction. Include non-standard phrases spoken by clinician and descriptions of significant changes in facial expression and non-verbal behaviors in square brackets. Ok to omit standard phrases spoken by clinician. 30: She told me it was my fault my father never came back. [Continues to sob, takes another face tissue and wipes tears.] [Interweave: And as an adult today, who do you believe was responsible for your father leaving? That 5- year old boy or the alcoholic parents who couldn t make their marriage work?] 27 28 27 28 Published fidelity rating scales Assessing ability to apply the standard reprocessing procedural steps from memory with good fidelity Three published fidelity rating scales are available: EMDR Implementation Fidelity Rating Scale available on request from the EMDRIA Research Committee (Korn, Zangwill, Lipke, & Smyth, 2001). 14 pages. Separate scales for all 8 phases of EMDR. For evaluating treatment outcome research. EMDR Fidelity Questionnaire (with child clients) (Adler-Tapia & Settle, 2008, pp. 101-103). 3 pages. One scale for all 8 phases of EMDR for child clients. For clinician self-assessment and consultation toward EMDRIA Certification. Fidelity Checklists (Leeds, 2009, Appendix A, pp. 337-345). 8 pages. Six separate scales for all 8 phase of EMDR. For clinician selfassessment, consultation toward EMDRIA Certification, and treatment outcome research. Ask consultee to write down from memory and in order the standard phrases used in Phases 3-6 (Assessment, Desensitization, Installation, and Body Scan). Submit this document for review and comment to the group. Ask consultee to prepare a near verbatim summary of an actual EMDR reprocessing session from their clinical practice. Then ask consultee to self-rate the session using one of the available fidelity scales. Ask the consultee to submit the near-verbatim summary and fidelity rating to the group. 29 30 29 5 30

EMDR Case Inquiry Format (adapted from Forgash and Leeds, 1999) When consulting on clinical cases related to the application of EMDR, please consider providing the relevant portions of the following information to assist me in responding to your inquiry. NOT all these points need to be covered. There may be additional points that you need to include. Keep in mind you are responsible for obtaining your client s permission for the release of any confidential information and for disguising any identifying data. Clinician orientation 1) Please indicate your theoretical orientation before EMDR training: Family Systems and Narrative Tx. 2) EMDR training level and experience. Specify L1, L2, additional advanced EMDR training: L1, L2, Strengthening the Self Part 1 & 2, EMDR Treatment Made Simple 3) Duration of EMDR experience: ~4 years Client data Presenting problem(s) (include duration): functioning below potential ~30+ years. Client s Treatment goal(s): To have a purpose, a goal, hope and ambition. He wants to publish his writing, and to have a relationship with a woman that will last. Age:_58_ Gender: M_ Marital status: Divorced. Ethnicity: Caucasian Current family system: Ct. lives with his 81 yr.old mother, he has a conflicted relationship with his bro. and sis., and 28 yr. old son. Social support system: little here locally, good friends four hours south. Synopsis of client s history including past and present life issues, traumatic events, childhood attachment status, significant health history (lifetime) Parents divorced when client was 2yrs., chaotic home, lived with mother s parents who fought, home always filthy->shame. Vietnam, injured, in hosp.1 1/2 yrs. Friend since 5 th grade, suicide in 93 >client lost hope. Resources including ego strengths, coping skills, self capacities: Healthy life style for past 13 yrs. (after 30 yrs drinking, smoking & overweight), copes by not showing feelings. Determination to make his life better. Past treatment episodes and diagnoses: 1992/3---1998-2003 PTSD Past responses to treatment both positive and negative: In 1993 he felt hopeful, ready to get on with his life & go to college, friend suicide-> Ct. lost hope. 2004 hypnosis, not much help. 6/04 to present working with me. Current diagnoses and medical health conditions: (Axis I, II and III) Axis I PTSD & Maj. Depressive D/O, Axis II NO Dx. Axis III Global Assessment of Functioning (GAF): 55, flat affect, difficulty with social functioning DES scores and Dissociative symptoms: no Dissociative symptoms case inquiry form page 1 of 3 6

Other testing data: Defenses: Current stability (note any impulse control problems with alcohol, drugs, violence, sexual acting out, self-injurious behaviors, etc.): Stable. Treatment Plan: Please describe your overall treatment plan and estimated duration of treatment: Increase hope, increase connection to others, process trauma of Vietnam and his return, process early childhood shame, process friend s suicide. Duration? As long as it takes. EMDR Protocol(s) Which EMDR protocol is being used (i.e. Single Traumatic Event, Current Anxiety and Behavior, Recent Traumatic Event, Process Phobia, Excessive Grief, Somatic, Performance Enhancement, DETUR, Positive Affect Tolerance, Distress Tolerance, etc.): Trauma protocol Treatment Responses: Ego strengthening and stabilization. Please describe any relaxation training, imagery, hypnosis or other stabilization and resource development interventions and results: Safe Place VOC-3 Ct. expressed apprehension with me. He has used hypnosis and yoga breathing to relax. When relevant, please note any information about the organization of discrete behavioral states and interventions used to decrease dissociative responses: For any resource development and installation (including safe place) please describe the resource memory/experience and response to bilateral stimulation (eye movements, tones or taps). Resource 1: Safe Place- beach, soft sand, clear, fresh water in a cave next to the beach. apprehension with me he said, (and maybe the unfamiliar process). Response to bilateral stimulation: Apprehension with me he said, (and maybe the unfamiliar process). Resource 2: I did the best I could, I am worthy, I have choices. Response to bilateral stimulation: VOC-3 0r 4. For disturbing targets that have been processed (past, present or future), please give the assessment of the target(s) before and after the treatment session. If multiple targets have been processed please indicate approximately how many have been processed and with what outcome. Please give one or two specifics examples of processed target following the format below. Pretreatment (indicate target as _X_ past, present, future): Target situation: Catholic school Kindergarten Ct. couldn t tie his shoes when teacher told him to / wet his pants when he had to go and teacher would not allow him to leave the room. Image: Sister Mary, class room, he had to wear coat kept in room for kids with wet clothes. case inquiry form page 2 of 3 7

NC: I m not good enough. PC: I am good enough just the way I am. VoC: 3 Emotion(s): fear, trepidation, anxiety, anger. SUDs: 8 Location of body sensations: hollow feeling in gut. End of session, (post-treatment): SUDs: 3 VoC: 4 Body scan: some feeling in stomach. Complete Incomplete _X_ PC: (final): Ct remembered more sources of shame. Reassessment (follow up session): Please describe any changes in how the client functioned following the session(s) in which bilateral stimulation protocols were used whether on resource, past, present or future targets: Not much change. Pretreatment (indicate target as past, present, future): Target situation: wounded in Vietnam. Image: He is isolated from his unit, explosion in the trees overhead, injury in arm spurting blood, near death, saw portal with shadowy image (death incarnate). NC: I m overly confident, getting short, felt bullet proof. PC: I did the best I could. VoC: 3 Emotion(s): anxiety, curiosity SUDs: 10 Location of body sensations: Belly. End of session, (post-treatment): SUDs: 6 or 7 VoC: 4 Body scan: uneasy in stomach Complete Incomplete X PC: (final): I did the best I could. Reassessment (follow up session): Please describe any changes in how the client functioned following the session(s) in which bilateral stimulation protocols were used whether on resource, past, present or future targets: not much change Since 1/1/05 focus has been on Vietnam experience this is starting to help. Please describe the issue or concern that you would like to address through consultation: Where to focus? I started with early memories of school and struggles with his brother and resource development, with not much success. We have recently been focusing on Vietnam, which seems to be helping, he acts less angry, reports more positive feelings and memories of friends. I plan to continue with all associated memories of Vietnam. case inquiry form page 3 of 3 8

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 For EMDR case consultation 4/13/07 Reasons for bringing this case: This is the first time doing an EMDR process with this client, L. We have done two sessions so far. When we set up the protocol she was not able to bring up a specific memory. So we identified a felt sense of the issue and the NC that goes with that I would like to talk about how to clearly identify the target when not working on a specific traumatic event. As we started processing it was slow, and seemed to me not to be flowing very well. Mostly she reported slight changes in physical sensations, which would loop back to where they started. As we went through the sets I found myself redirecting her back to target frequently. My questions are about whether or not I kept too tight a rein redirecting her back to target too frequently. Maybe there were ways I wasn t seeing to work with the sensations she was reporting and follow her process out more fully. I would like to talk about my reasoning and what may have been going on for me, what other options I could have chosen and where to go from here in the next session. Summary: Age 45 Civil union, 2 children ages 6 and 9 Accomplished professional In treatment for breast cancer.--inoperable tumor with metastasis to bones and brain. Brain lesions are under control since last round of chemotherapy. Has many resources for healing, internal and external Self-aware, self-responsible, positive, admirably strong in the face of her very difficult physical challenges In her family of origin she was the middle child and always felt very alone. Her parents described her as the most difficult child because she was too needy. The family story about her is L is not quite making it. She got the message that no one was interested or had time to attend to her feelings or needs. She was supposed to buck up and do better. She got a lot of stomach aches. At age 16 her parents took her to a psychiatrist after which time she became consumed with understanding the mind and finding her spiritual path. When we talked about EMDR and I explained the theory and practice we identified her safe space and did some sets of EMs First EMDR Process: Safe space: A lake outside of Taos. Sitting on a rock by the water, sunny, a safe, visionary place. Andrew Leeds 4/20/07 9:51 AM Comment: Please ask patients like this one to give you some specific examples from each parent. For your initial target for reprocessing pick the earliest memory with the parent with whom the patient most experience this lack of support as painful. 9

44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 Target: felt sense of being very alone in my life as a child and a teen NC: I m not quite good enough (not quite worthy) to be loved SUD 8 PC: I am worthy and full of love and completeness. VOC 1-2 Feelings: tight in chest and throat, sadness [tears] N: Think about that felt sense and the words I m not quite worthy to be loved //////////// L: Feels very tight in area of my heart and throat N: Just notice that ///////////// L: Heard the words you fool and felt a slight opening in my chest N: Go from there ////////////// L: Chest feels more constricted again Back to target ////////// L: Now the tightening is more in my stomach, a feeling of dis ease. Had a memory of spilling my milk out as a child because of my stomach aches N: go from there////////// L: I know how to do this [tears] N: Yes, your brain and your body know how to heal this, just go from there //////////// L: I m shutting down and walling off, feeling alone. It s a metaphor for what s happening in my body. [lots of tears] N: Its just old pain, just notice//////////// L: I want the walls to come down N: go with that//////// L: feel energy circulating through my legs and stomach and as the walls come down I want them to burst Andrew Leeds 4/20/07 9:46 AM Comment: Chosing not to select a specific event is a deviation from the model and the standard protocol. Even if there are many similar events, it s always helpful to select a representative one. This will help to avoid vague physical sensations because it allows you to direct the reprocessing to other specific aspects of the memory network. Andrew Leeds 4/20/07 9:49 AM Comment: The SUD is not a rating of the NC, but a rating of the memory network as a whole and is taken after identifying the disturbing emotion. Please correct your sequence Select a specific Target Picture NC PC VoC Emotion SUD Location First SEM 10

How to Use Work Samples in Remote EMDR Consultation EMDRIA 2009 References Adler-Tapia, R., & Settle, C. (2005). EMDR Fidelity Treatment Manual: Children's Protocol. Hamden, CT: EMDR HAP. Adler-Tapia, R., & Settle, C. (2008). Treatment Manual: EMDR and the art of treating children. New York: Springer Publishing. American Association for Marriage and Family Therapy (2001). AAMFT Code of Ethics. Retrieved April 28, 2008, from http://www.aamft.org/resources/lrm_plan/ethics/ethicscode2001.asp American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57(12), 1060-1073. EMDRIA (2007). Basic training curriculum. Retrieved March 11, 2007, from http://www.emdria.org/displaycommon.cfm?an=1&subarticlenbr=281 EMDRIA (2008a). EMDR International Association Consultation Packet. Retrieved May 3, 2008, from http://www.emdria.org/displaycommon.cfm?an=1&subarticlenbr=45 EMDRIA (2008b). History. Retrieved May 5, 2008, from http://www.emdria.org/displaycommon.cfm?an=1&subarticlenbr=72 EMDRIA (2008c). Certification criteria; application for EMDRIA certification in EMDR; frequently asked questions. Retrieved May 23, 2008, from http://www.emdria.org/displaycommon.cfm?an=1&subarticlenbr=41 EMDRIA (2008d). Application for EMDRIA approved consultant. Retrieved May 30, 2008, from http://www.emdria.org/associations/5581/files/2007%20ac%20application.pdf Andrew M. Leeds, Ph.D. 2009 page 1 of 2 11

How to Use Work Samples in Remote EMDR Consultation EMDRIA 2009 EMDRIA. (2008e). Resources for researchers. Retrieved May 31, 2008, from EMDRIA Web site: http://www.emdria.org/displaycommon.cfm?an=1&subarticlenbr=34 EMDRIA (2008f). EMDR International Association consultation packet. Revised July 2008. Retrieved December 12, 2008, from http://www.emdria.org/displaycommon.cfm?an=1&subarticlenbr=45 Korn, D. L., Zangwill, W., Lipke, H., & Smyth, M. J. (2001). EMDR Fidelity Scale. Unpublished monograph, The Trauma Center, Brookline, MA. Leeds, A. M. (2009). A Guide to the Standard EMDR Protocols for Clinicians, Supervisors, and Consultants. New York: Springer Publishing. Maxfield, L., & Hyer, L. (2002). The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology, 58(1), 23-41. Perkins, B. R., & Rouanzoin, C. C. (2002). A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points of confusion. Journal of Clinical Psychology, 58(1), 77-97. Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing, Basic Principles, Protocols and Procedures. (2nd ed.). New York: The Guilford Press. Shapiro, F. (2006). EMDR - New Notes On Adaptive Information Processing With Case Formulation Principles, Forms, Scripts and Worksheets. Hamden: EMDR HAP. Andrew M. Leeds, Ph.D. 2009 page 2 of 2 12