Clinical Competencies for the Six Core Competencies: An Update on the Work of the EMDRIA Professional Development Subcommittee

Transcription

1 Clinical Competencies for the Six Core Competencies: An Update on the Work of the EMDRIA Professional Development Subcommittee Wendy J. Freitag, PhD, Chair; Jocelyn Barrett, MSW, LICSW, Co-Chair, Standards & Training Committee; Nancy Errebo, PsyD; Regina Morrow, Ed.S, LMFT, LMHC Abstract: This document presents the efforts, to date, of The Professional Development Subcommittee to define standards for EMDR International Association (EMDRIA) credentialing, as charged by the EMDRIA Standards and Training Committee. The development of defining the standards at each credential level (Certification, Approved Consultant, and Approved Trainer) requires a multi-stage approach. This document, which reflects the second stage in the development process, identifies and delineates the Clinical Competencies for each of the Essential Competencies within the six Core Competencies for EMDRIA Certification in EMDR. This document will undergo review and public comment; therefore, what is presented here is subject to revision. Further, this document does not represent the policy of EMDRIA. Building on Freitag s (2012) foundation, the subcommittee proposed that a competency-based system of credentialing replace EMDRIA s current hours-based requirement system. Competency-based training and practice of psychotherapy has emerged as a significant movement in response to the Institute of Medicine s (2003) recommendation that mental health disciplines define a set of core competencies for clinical practice. The most recent effort in developing competency-based practice is in trauma mental health (Cook, Newman & The New Haven Trauma Competency Group, 2014). Sperry s (2010) Core Competency Model was chosen as the template for the subcommittee s work because, like EMDR, Sperry s model is integrative. Last year the subcommittee delineated Sperry s Six Core Competencies and the Essential Competencies within each Core Competency as particular to the EMDR therapy as defined by EMDRIA (2012). In the current document, each Essential Competencies has been further defined into Clinical Competencies particular to EMDR therapy. These Clinical Competencies define the knowledge, skills and attitudes that are necessary for EMDRIA Certification in EMDR.

2 Core Competency # I: Conceptual Foundation I.1. Conceptual Foundations of the EMDR Approach to Psychotherapy The candidate demonstrates understanding of the Adaptive Information Processing (AIP) model that is the basis of the EMDR Approach to psychotherapy and the application of AIP in EMDR protocols. The candidate is able to clearly and succinctly define EMDR, articulate AIP principles to clients, colleagues, and the public, and describe the Eight Phases of EMDR and the Three- Pronged Protocol (EMDRIA, 2012). The candidate demonstrates the capacity to understand, articulate, and elucidate the following fundamental principles of the EMDR Approach as defined by EMDRIA: 1) EMDR is an approach to psychotherapy, not a technique (EMDRIA, 2012). 2) EMDR is an integrative psychotherapy approach that evolved primarily from clinical experience. Integrative has several meanings (International Integrative Psychotherapy Association, 2013). a) It draws from many views of human functioning: client centered, behavioral, psychodynamic, cognitive, body-focused, Gestalt, and cognitive neuroscience (Norcross & Shapiro, 2002; Shapiro, 2001, 2002a). b) It is intended to integrate the personality, bringing unassimilated negative information together with positive resources to empower a whole human capable of love and service (EMDRIA, 2012; Parnell, 2007; Shapiro, 2002a; Siegel, 2002). c) It is intended to bring together the affective, cognitive, behavioral, physiological, and spiritual systems of a person to facilitate healing of psychological disorders (EMDRIA, 2012; Krystal, et al., 2002; Parnell, 2007; van der Kolk, 2002). 3) EMDR therapy is based on the Adaptive Information Processing (AIP) model. The principles of AIP are as follows (EMDRIA, 2012; Shapiro, 2001) a) Every individual has an inherent information processing system that naturally reorganizes disturbing life events to an adaptive resolution. b) This information processing system is sometimes disrupted by life experiences that are inadequately processed. c) EMDR protocols, combined with Bilateral Stimulation (BLS), activate the inherent information processing system and keep it active until an adaptive resolution is achieved. The concept of self-healing is central to this principle. d) EMDR reprocessing facilitates associations within and among memory networks, ultimately achieving the integration of the disturbing memory with the individual s resources. 4) EMDR therapy has Eight Phases, each with its own purpose and tasks (EMDRIA, 2012; Shapiro, 2001). 5) In the Three-Pronged Protocol, EMDR addresses past experiences that have set pathological trajectories, present stimuli that trigger problem emotions, body sensations, thoughts, and behaviors, and templates for desired future behaviors (EMDRIA, 2012; Shapiro, 2001). 6) EMDR occurs in the context of an empathic, collaborative therapeutic relationship (EMDRIA, 2012; Shapiro, 2001). 7) EMDR protocols and procedures are embedded in a comprehensive treatment plan guided by the client s goals and the therapist s expertise (EMDRIA, 2012; Shapiro, 2001).

3 I. 1. Conceptual Foundations of the EMDR Approach to Psychotherapy KNOWLEDGE SKILLS ATTITUDES 1. The candidate is able to clearly and succinctly communicate the definition of EMDR, AIP principles, and EMDR protocols to clients. 1. The candidate understands that EMDR is an approach to psychotherapy, not a technique, and that BLS is only one component. 2. The candidate understands the EMDRIA definition of EMDR. 3. The candidate understands that EMDR was derived from clinical observation rather than from theory. 4. The candidate understands that EMDR is an integrative psychotherapy for the following reasons: a. It draws from many views of human functioning. b. It is intended to integrate the personality. c. It brings together affective cognitive, behavioral, physiological and spiritual systems of an individual. 5. The candidate understands the principles of the AIP Model. 6. The candidate identifies the Eight Phases of EMDR and the purpose of each phase. 7. The candidate understands the purpose and procedures of the Three- Pronged Protocol. 8. The candidate recognizes and describes the 2. The candidate is able to articulate how he or she integrates EMDR into his or her theoretical orientation. 3. The candidate is able to clearly and succinctly communicate the definition of EMDR, AIP principles, and EMDR procedures to colleagues. 4. The candidate is able to clearly and succinctly communicate the definition of EMDR, AIP principles, and EMDR procedures to the public. 1. The candidate demonstrates respect for the AIP Model and EMDR protocols and procedures. 2. The candidate demonstrates willingness to deepen and broaden his or her understanding of AIP principles and EMDR procedures. 3. The candidate demonstrates willingness to develop his or her ability to communicate about AIP and EMDR in speaking and writing.

4 similarities and differences between EMDR and other approaches to psychotherapy. I. 2. Theory of Personality The candidate demonstrates the capacity to understand, articulate and elucidate a theory of personality based on the AIP model (EMDRIA, 2012). The AIP model regards the personality as a constellation of characteristic patterns and responses, each of which is considered an interaction of genetic factors and experiences. The basis of personality development is regarded as the assimilation of experiences into the associative memory networks and accommodation of each experience into the person s selfidentity (Shapiro, 2001, 2002a). I. 2. Theory of Personality KNOWLEDGE SKILLS ATTITUDES 1. The candidate communicates the AIP understanding of personality to clients, colleagues and the public. 1. The candidate understands that the personality, according to the AIP Model, is a constellation of characteristic patterns and responses. 2. The candidate understands that personality traits are an interaction of genetic factors and actual life experiences. 3. The candidate understands that the personality develops as life experiences are assimilated into memory networks. 4. The candidate recognizes and describes similarities and differences between AIP and other theories of personality development. 2. The candidate integrates AIP understanding of personality development with his or her preferred theoretical orientation. 3. The candidate reconciles differences between AIP and his or her preferred theoretical orientation that might interfere with fidelity to EMDR protocols and procedures. 1. The candidate demonstrates respect for the AIP Model of personality development. 2. The candidate demonstrates willingness to conceptualize personality development from an AIP point of view. 3. The candidate demonstrates willingness to integrate the AIP point of view on personality development with his or her theoretical orientation. I.3 Theory of Psychopathology The candidate demonstrates the capacity to understand, articulate, and elucidate a theory of psychopathology based on the Adaptive Information Processing (AIP) model. The Adaptive Information Processing (AIP) model hypothesizes that disturbing life experiences

5 maladaptively encoded in memory and thereby preventing adequate linkage to adaptive information are the basis of psychopathology (Bergmann, 2012; EMDRIA, 2012; Shapiro, 2001; Stickgold, 2002). Singular traumatic experiences appear to disrupt the information processing system, resulting in a disturbing episodic memory that is unable to link to general semantic networks. Chronic adverse experiences appear to decrease flexibility in the information processing system, favoring one maladaptive way to process information (Leeds, 2009, Stickgold, 2002, 2013). New learning cannot link with this disturbing episodic memory because of the intense affect generated whenever the disturbing memory is stimulated by present events. When the disturbing information is stimulated, the individual feels, thinks, and behaves in a manner similar to how he or she did at the time of the disturbing event (EMDRIA, 2012; Leeds, 2009; Shapiro, 2001, 2002a). I. 3. Theory of Psychopathology KNOWLEDGE SKILLS ATTITUDES 1. The candidate understands that, according to AIP, disturbing information maladaptively encoded in memory, is the basis of psychology. 2. The candidate understands that, according to AIP, singular maladaptively encoded episodic memories are unable to link to more adaptive semantic networks. 3. The candidate understands that, according to AIP, chronic adverse experiences decrease flexibility in the information processing system, favoring one maladaptive way to process information. 4. The candidate understands that, according to AIP, intense affect generated by present stimuli prevents new learning from linking with the maladaptively encoded information. The candidate understands that, according to AIP, 1. The candidate verbally describes the basis of psychopathology according to AIP. 2. The candidate verbally describes how disturbing life experiences are stored in the nervous system, according to AIP. 3. The candidate verbally describes why new learning does not influence maladaptively encoded information, according to AIP. 4. The candidate verbally describes how disturbing life experiences are manifested in the present, according to AIP. 5. The candidate verbally explains his or her integration of the AIP model of psychopathology into his or her preferred theoretical orientation. 1. The candidate displays respect for the AIP model of psychopathology. 2. The candidate displays willingness to integrate AIP into his or her preferred theoretical orientation.

6 whenever the disturbing information is stimulated by present stimuli, the individual thinks, feels, and/or behaves similar to the way he or she did at the time of the disturbing event. I. 4. Theory of Psychotherapeutic Process: EMDR is an integrative psychotherapy with principles, procedures, and protocols that are embedded in a comprehensive treatment plan. EMDR therapy proceeds in eight distinct phases. EMDR addresses past experiences, current challenges, and desired future behaviors. In the reprocessing phase of treatment, Bilateral Stimulation (BLS) is employed to stimulate the inherent information processing system in its work of transmuting disturbing memories to an adaptive resolution. The client s own brain is doing the healing, so the therapist is a guide, rather than a director, of the process. Thus, during this phase, the therapist refrains from offering interpretations or engaging in dialogue. As long as spontaneous reprocessing, indicated by shifts in affect and cognition, is taking place, the therapist gives minimal input. If reprocessing stalls, the therapist applies brief interventions to resume effective reprocessing. Phase Eight, Reevaluation, guides ongoing work towards the treatment goals and maintains client stability (EMDRIA, 2012; Leeds, 2009; Shapiro, 2001). The candidate demonstrates capacity to understand, describe, elucidates the following: 1) Identify the Eight Phases of the standard EMDR therapy. Delineate the specific purposes, goals, and tasks of each phase. 2) Identify the Three-Pronged Protocol. Delineate the purposes, goals, and tasks of each prong. 3) Describe the indicators of effective reprocessing in Phases Four and Five. 4) Describe the indicators of ineffective reprocessing and brief interventions to stimulate the AIP and resume effective reprocessing in Phases Four and Five. I. 4. Theory of Psychotherapeutic Process KNOWLEDGE SKILLS ATTITUDES 1. The candidate identifies the Eight Phases of EMDR. 2. The candidate identifies the purpose and tasks of Phase One: History-Taking. a. Purpose: Identifying Memories for Reprocessing. b. Tasks: Assess client s capacity for integration. 1. The candidate verbally lists the Eight Phases of EMDR. 2. The candidate verbally lists the purposes, goals, and tasks of each of the Eight Phases of EMDR. 3. The candidate verbally delineates the Three- Pronged Protocol of EMDR. 4. The candidate verbally communicates the concept 1. The candidate displays respect for the concept of self-healing. 2. The candidate displays respect for committing to memory the Eight Phases and Three-Prongs of EMDR.

7 Assess affect tolerance Assess internal and external resources. Assess attachment history Assess readiness for change Assess current psychosocial factors. Assess complexity and pace of treatment. 3. The candidate identifies the purpose and tasks of Phase Two: Preparation. a. Purpose: To ensure that the client can shift emotional states. b. Tasks: Establish therapeutic rapport and safety Help client develop the capacity to tell the truth about internal experience. Educate client about EMDR mechanics and procedures. Establish informed consent Teach coping skills 4. The candidate identifies the purpose and tasks of Phase Three: Assessment. a. Purpose: To access the memory as it is currently experienced. b. Tasks: Image Negative Cognition (NC) of staying out of the way of spontaneous processing to clients, colleagues, and the public.

8 Positive Cognition (PC) VoC (Validity of Cognition) Emotions SUD Physical Sensation c. The candidate understands the importance of staying on script in Phase Three 5. The candidate identifies the purpose and tasks of Phase Four: Desensitization a. Purpose: Reprocess negative life experiences to a positive resolution. b. Tasks: Candidate identifies instructions to begin Phase Four. Candidate understands length and rate of BLS Candidate understands how to give feedback between sets of BLS. Candidate understands how to assess whether information is shifting. Candidate understands the importance of staying out of the way of spontaneous processing. Candidate understands strategies for keeping process moving. Candidate understands when to return to target. Candidate can define Feeder Memories. Candidate can define

9 Blocking Beliefs Candidate can identify how to handle strong emotional responses during Phase Four. 6. The candidate identifies the purposes and goals of Phase Five: Installation. a. Purpose: Strengthen linkage of target memory to adaptive semantic memory. b. Tasks: Candidate identifies pairing target memory with Positive Cognition (PC) until VoC = 7 6. The candidate identifies the purposes, goals and procedures of Phase Six: Body Scan. a. Purpose: Resolve residual physiological disturbance. b. Task: Direct client s attention to body and apply BLS. 8. The candidate identifies the purposes, goals, and tasks of Phase Seven: Closure. a. Purpose: Ensure that client shifts to neutral or positive emotional state and reorients to present time. Provide information about continuing reprocessing. Assure client of clinician s availability. 9. The candidate identifies the purposes, goals, and tasks of Phase Eight: Reevaluation.

10 a. Purpose: Systematic evaluation of treatment gains Adjustment of treatment plan. 10. The candidate identifies the Three-Pronged Protocol of EMDR: Past, Present, and Future. Core Competency # II: Relationship Building and Maintenance II. 1. Establish An Effective Therapeutic Alliance The candidate demonstrates capacity to achieve a therapeutic alliance during Phases One and Two that supports the reprocessing of disturbing life events (Leeds, 2009; Shapiro, 2001, 2005). The candidate demonstrates capacity to describe the elements of establishing the therapeutic alliance that are particular to EMDR: 1) The candidate helps the client develop trust not only in the therapist but also in the principle of self-healing and the AIP model. 2) The candidate helps the client develop the capacity and skill to make the honest, accurate self-report of internal, private experience that is necessary to maintain client stability and guide reprocessing and ongoing treatment. 3) The candidate recognizes and articulates potential difficulties in EMDR treatment that may arise from assumptions about the therapeutic alliance that are perceived to conflict with EMDR procedures. The candidate reconciles those conflicts and integrates EMDR and AIP into his or her preferred approach to establishing the therapeutic alliance in a way that maintains fidelity to EMDR procedures (Adler-Tapia & Settle, 2008; Korn, Zangwill, Leeds, 2009; Lipke, & Smyth, 2001). The candidate collaborates with the client to set treatment goals and tasks that take into account the client s expectations and wants as well as the therapist s expertise. II.1 Establish An Effective Therapeutic Alliance KNOWLEDGE SKILLS ATTITUDES 1. The candidate explains AIP and EMDR procedures to the client simply and effectively. 1. The candidate describes the role of the therapeutic alliance in reprocessing disturbing life experiences. 2. The candidate describes how to establish a therapeutic alliance in terms of the AIP model. 2. The candidate works collaboratively with the client in setting goals. 3. The candidate helps the client develop trust in the AIP model 1. The candidate demonstrates trust in the principle of self-healing. 2. The candidate demonstrates respect for the AIP model. 3. The candidate integrates EMDR and AIP into his or

11 3. The candidate identifies his or her assumptions about establishing the therapeutic alliance. 4. The candidate identifies and reconciles potential conflicts between his or her assumptions about the therapeutic alliance and EMDR procedures. 5. The candidate describes how to maintain fidelity to EMDR procedures while maintaining the therapeutic alliance. and the principle of selfhealing a. Metaphor b. Identifying disturbing life experiences for reprocessing 4. The candidate explains to the client how the clinician s demeanor may change during the different phases of EMDR. 5. The candidate demonstrates the capacity to help the client develop the ability to observe and describe his or her inner experiences moment by moment in session. 6. The candidate explains how the therapeutic relationship may be affected by the introduction of EMDR. her viewpoint on the therapeutic alliance while maintaining fidelity to EMDR protocols. II. 2. Assess Readiness and Foster Treatment Promoting Factors The AIP model posits that current problems are rooted in past disturbing life experiences. Reprocessing those negative experiences, using the Three-Pronged Protocol, in Phases Three through Seven, results in positive changes in feelings, thoughts, and behavior that occur naturally, organically, and without conscious effort (EMDRIA, 2012; Shapiro, 2001). The candidate articulates, elucidates, and applies elements of motivation and readiness that are particular to EMDR therapy: 1) Client Readiness for reprocessing of disturbing life experiences in Phases Three through Eight comprises the following: (Leeds, 2009; Parnell, 2007; Shapiro, 2001) a) Affect tolerance b) Ability to shift from a negative emotional state to a neutral or positive emotional state c) Adequate physical, social, financial, and emotional resources to sustain ongoing treatment d) Ability to devote adequate time and attention to the treatment without undue interference from other commitments on the part of both client and therapist e) The candidate is proficient in assessing readiness for reprocessing and in interventions that remediate deficiencies and promote readiness. 2) Motivation to proceed with reprocessing may be reduced by fear and/or secondary gain issues. The candidate is proficient in resolving those issues so that the client is able to reprocess disturbing life experiences.

12 II. 2. Assess Readiness and Foster Treatment Promoting Factors KNOWLEDGE SKILLS ATTITUDES 1. The candidate identifies childhood and current attachment patterns. (Phase 1) 2. The candidate identifies nature and degree of dissociation. (Phase 1) 3. The candidate assesses, teaches, and reassesses dissociation reduction skills. (Phases 1 & 2). 4. The candidate provides psycho-education on client s role in session, (i.e., mindful noticing and accurate reporting of private experiences). (Phase 2) 5. The candidate provides a metaphor to enhance mindful noticing? (Phase 2) 6. The candidate assesses, teaches, and reassesses anxiety-reduction skills. (Phase 2) 7. The candidate identifies the presence or absence of the following criteria that indicate the use of RDI (Phases 1 & 2) a. Impaired self-regulation skills. b. Maladaptive tension reduction. c. Substance abuse d. Therapy interfering behaviors e. Fears of starting EMDR reprocessing f. Standard methods for selfcontrol have proven to be insufficient. 8. The candidate identifies the 1. The candidate understands readiness factors for EMDR reprocessing. 2. The candidate understands client s role in EMDR reprocessing. 3. The candidate understands criteria that indicate the use of Resource Enhancement and Development. 4. The candidate understands risk factors for premature termination of treatment if EMDR reprocessing is started. 1. The candidate appreciates the importance of assessing readiness for the reprocessing phases (3-8) of EMDR reprocessing 2. The candidate demonstrates willingness to acquire skills for increasing client s readiness for the reprocessing phases of EMDR

13 presence or absence of a substantial risk that the client would terminate treatment prematurely if EMDR reprocessing were started (Phases 1 & 2) a. Shifts from idealizing to devaluing clinician. b. Weak ego strength c. Intolerable shame d. Re-experiencing of painful memories. *The above skills have been adapted from Leeds, 2009) II. 3. Recognize and Resolve Resistance and Ambivalence The candidate articulates, elucidates, and applies understanding of resistance and ambivalence particular to AIP and EMDR (Dworkin, 2005; Leeds, 2009; Parnell, 2007; Shapiro, 2001). 1) AIP views resistance and ambivalence as fears, phobias, or blocking beliefs originating in disturbing life events. 2) The memories of the disturbing events can be targeted and reprocessed, thus organically resolving ambivalence and resistance to ongoing EMDR work. 3) The candidate recognizes the impact of client s and therapist s attachment style on resistance and ambivalence in EMDR therapy 4) Resistance and ambivalence can appear in any phase of EMDR therapy. II. 3. Recognize and Resolve Resistance and Ambivalence KNOWLEDGE SKILLS ATTITUDES 1. The candidate helps client identify fears regarding EMDR reprocessing (Phases 3-8). 1. The candidate understands and articulates the AIP view on resistance and ambivalence. 2. The candidate understands methods of identifying earlier memories associated with resistance and ambivalence. 3. The candidate understands the impact of attachment style on 2. The candidate helps client identify earlier memories associated with fears of EMDR reprocessing. 3. The candidate helps client identify blocking beliefs regarding EMDR reprocessing. 4. The candidate helps client identify earlier memories associated with blocking beliefs. 1. The candidate displays willingness to view resistance and ambivalence from an AIP perspective. 2. The candidate integrates AIP into his or her preferred theoretical view of resistance and ambivalence 3. The candidate maintains fidelity to EMDR protocols and procedures while addressing

14 resistance and ambivalence in EMDR therapy. 5. The candidate helps client identify earlier memories related to attachment figures. 6. The candidate helps client resolve resistance and ambivalence by: a. Understanding that the mere identification of the memory may alleviate the resistance and/or ambivalence enough to proceed with reprocessing. b. Reprocessing the earlier memory associated with resistance and/or ambivalence. c. RDI resistance and ambivalence. II. 4. Recognize and Resolve Transference-Countertransference Enactment The candidate articulates, elucidates, and applies understanding of transference and countertransference enactment that are particular to EMDR therapy. 1) In addition to transference and countertransference to one another, both therapist and client may have transference to EMDR protocols and procedures themselves (Parnell, 2007). 2) The transference-countertransference enactment may have its origins in earlier life experiences. 3) The therapist responds effectively to transference material that spontaneously emerges during Phase Four, Desensitization (Dworkin, 2005; Leeds, 2009). 4) The therapist recognizes his or her countertransference that arises from his or her own earlier life experiences (Dworkin, 2005; Parnell, 2007). II.4. Recognize & Resolve Transference-Countertransference Enactment KNOWLEDGE SKILLS ATTITUDES 1. The candidate helps the client identify earlier memories associated with the transference - countertransference enactment. 1. The candidate understands his or her own emotional reactions to EMDR protocols and procedures in AIP terms; that is, that the clinician s reactions to EMDR may have their origins in the clinician s earlier experiences. 2. The candidate understands 2. The candidate helps the client resolve the transference - countertransference enactment by: 1. The candidate displays willingness to understand transference and countertransference in AIP terms. 2. The candidate integrates and/or reconciles AIP with views on transference and countertransference of

15 client s transference to EMDR protocols and procedures in AIP terms; that is that the client s reactions to EMDR may have their origins in the client s earlier experiences. 3. The candidate understands that fidelity to EMDR protocol is associated with positive treatment outcomes. 4. The candidate understands that transference - countertransference enactment can occur in any phase of EMDR. 5. The candidate understands that the client s transference material that emerges in Phase 4, Desensitization, is associated with the target memory, according to AIP. 6. The candidate understands that the clinician s countertransference responses may have their origins in the clinician s earlier experiences. a. Understanding that the mere identification of the memory may allow the work in any of the Eight Phases to continue. b. Earlier memories associated with transference may become EMDR targets those memories for reprocessing. 3. The candidate identifies and resolves earlier memories regarding his or her own transference to EMDR protocols and procedures. 4. The candidate identifies and resolves earlier memories regarding client s transference to EMDR protocols and procedures. 5. The candidate identifies and resolves his or her own countertransference material that arises from client s EMDR reprocessing. 6. The candidate keeps the reprocessing going when transference material arises in Phase 4. a. Saying, Go with that. b. Identifying feeder memories and/or blocking beliefs if necessary. c. Employing Cognitive Interweaves as necessary. his or her preferred theoretical orientation. 3. The candidate maintains fidelity to EMDR protocols when working with transference and countertransference. II. 5. Recognize Therapeutic Alliance Rupture The Candidate articulates, elucidates, and applies understanding of ruptures to the therapeutic alliance and the repair of those ruptures that are particular to EMDR and AIP. 1) The client and therapist are able to communicate about the client s inner experience in a way that allows EMDR to continue safely and effectively.

16 2) The therapist recognizes and repairs ruptures to the therapeutic alliance as they occur in the therapeutic moment (Dworkin, 2005). II. 5. Recognize Therapeutic Alliance Rupture KNOWLEDGE SKILLS ATTITUDES 1. The candidate provides psycho-education on the potential for alliance rupture in each phase of EMDR. 1. The candidate describes the potential for rupture to the therapeutic alliance in each of the Eight Phases of EMDR. 2. The candidate understands the importance of recognizing and resolving ruptures to the therapeutic alliance in the therapeutic moment. 2. The candidate helps the client recognize therapeutic rupture and communicate explicitly about it at the moment it occurs. 3. The candidate communicates with the client about the therapeutic relationship in all phases of EMDR as it unfolds in the therapeutic moment. 1. The candidate understands the importance of the therapeutic relationship in reprocessing traumatic memories. 2. The candidate demonstrates respect for the importance of directly communicating with the client about therapeutic ruptures. Core Competency # III: Intervention Planning III. 1. EMDR Approach to Performing a Comprehensive Assessment The candidate demonstrates capacity to understand, articulate, elucidate and apply the principles of AIP to obtain and organize information about the client problems, goals and resources across behavioral, affective, cognitive, and somatic domains (Leeds, 2009; Greenwald, 2007; Parnell, 2007; Shapiro, 2001). The Comprehensive Assessment occurs in Phase One, History-Taking and is revised as treatment proceeds through the other EMDR phases. 1) Present complaints 2) Goals and Desired Outcomes 3) Type and severity of symptoms 4) Characteristic patterns of perceiving, thinking, and responding 5) Triggers or stressors that elicit negative pattern 6) Etiological events in maladaptive memory networks and adaptive memory networks 7) Intrapersonal, interpersonal, and systemic vulnerabilities 8) Intrapersonal, interpersonal, and systemic resources 9) Possible obstacles and challenges in the therapy process, especially those particular to each of the Eight Phases of EMDR. 10) Preparation for termination of treatment The candidate describes the difference between performing a comprehensive assessment in Phase One, History Taking, and Phase Three, Assessment (Shapiro, 2001).

17 The candidate demonstrates knowledge of standardized tools for history taking and treatment planning (Leeds, 2009). III. 1. Performing a Comprehensive Assessment KNOWLEDGE SKILLS ATTITUDES 1. The candidate lists the client s presenting complaints (symptoms in behavioral, cognitive, affective, and somatic domains). 1. The candidate knows that the Comprehensive Assessment is performed in Phase One, History Taking and is revised as EMDR treatment proceeds. 2. The candidate describes the purposes of performing a Comprehensive Assessment in terms of the AIP Model a. Client Selection b. Identifying potential targets for reprocessing from negative and positive life events c. Identifying present triggers d. Identifying future goals e. Determining the nature and extent of positive and negative memory networks. f. Determining the client s capacity for working collaboratively with the clinician. 3. The candidate understands how to utilize current behavioral, cognitive, affective, and somatic complaints (symptoms) to access relevant negative memory networks for the purpose of identifying disturbing life experiences for EMDR reprocessing. 4. The candidate understands 2. The candidate identifies current (present) external and internal stimuli and patterns of behaviors, thoughts, emotions, and body sensations associated with the client s presenting complaints (symptoms). 3. The candidate identifies the client s desired future behavioral, somatic, affective, and cognitive changes. 4. The candidate identifies the client s treatment related concerns and fears. 5. The candidate obtains a history of the client s adverse and traumatic events, especially those related to the client s presenting complaints. 6. The candidate obtains a life history of the client s positive events that represent internal and external resources, especially those related to the client s presenting complaints. 7. The candidate identifies childhood and current attachment patterns. 8. The candidate rules out medical and other risk issues for EMDR reprocessing. 1. The candidate demonstrates an attitude of collaboration with the client in identifying treatment goals and target memories. 2. The candidate demonstrates an appreciation that historytaking is an ongoing process from start to finish of EMDR therapy. 3. The candidate demonstrates willingness to accept his or her strengths and weaknesses regarding assessment. 4. The candidate demonstrates willingness to embrace the value and importance of performing a written comprehensive assessment.

18 how to utilize future goals and aspirations (behavioral, cognitive, affective, and somatic) to access relevant positive memory networks for the purpose of identifying strengths and deficits in internal and external resources (i.e., those that will support EMDR reprocessing of negative life experiences). 5. The candidate identifies potential obstacles to reprocessing traumatic memories (i.e., medical issues, dissociation, substance abuse, suicidal ideation, self-harming behavior, Axis II features, insecure attachment status, fears, secondary gains). 6. The candidate demonstrates knowledge of clinical interviewing and standardized tools for assessment of potential obstacles to reprocessing traumatic memories (i.e., dissociation, substance abuse, attachment status, suicidal ideation, etc.). 7. The candidate describes the difference between performing a comprehensive assessment in Phase One and the steps of Phase Three, Assessment. 8. The candidate describes the adaptation of performing a Comprehensive Assessment in Phase One, History- 9. The candidate identifies nature and degree of structural dissociation? 10. The candidate assesses history and current substance abuse. 11. The candidate assesses history and current danger to self or others. 12. The candidate assesses history and current tension reduction, self-injurious, and therapy interfering behaviors. 13. The candidate tailors the assessment in Phase One to the therapeutic setting. 14. The candidate develops a collaborative treatment plan and sequence of targets. 15. The candidate plans for termination of treatment. *These skills have, in large part, been adapted from EMDR Fidelity Rating Scale for History Taking, Case Formulation, Treatment Planning, (Leeds, 2009).

19 taking in various therapeutic settings, (e.g., private practice, inpatient, disaster, etc.). III. 2. Specify An Accurate Diagnostic Formulation The candidate demonstrates the capacity to specify a focused descriptive appraisal about the nature and severity of client s presenting symptoms and current functioning in Phase One, History-Taking. This appraisal includes a DSM and/or ICD diagnosis, and also specifies immediate treatment considerations, problems in living, and client s capacity for the reprocessing phases of EMDR (Phases Three Eight). The candidate demonstrates knowledge of standardized diagnostic tools, especially those that have a bearing on capacity for effective EMDR reprocessing. III. 2. Specify an Accurate Diagnostic Formulation KNOWLEDGE SKILLS ATTITUDES 1. The candidate lists the nature and severity of client s presenting complaints (symptoms). 1. The candidate demonstrates understanding of DSM and ICD diagnostic systems. 2. The candidate integrates AIP principles with DSM or ICD diagnosis. 3. The candidate identifies standardized diagnostic tools that have a bearing on effective EMDR reprocessing. 4. The candidate identifies factors (internal and external resources) that determine client s capacity for the reprocessing phases of EMDR (Phases Three - Eight). 2. The candidate administers and interprets standardized diagnostic tools, if appropriate. 3. The candidate incorporates findings from standardized diagnostic tools in the diagnostic formulation, if appropriate. 4. The candidate identifies specific DSM or ICD Axis I diagnoses and identifies or rule out Axis II diagnoses. 5. The candidate specifies immediate treatment considerations a. Medical issues b. Current substance abuse c. Current danger to self and/or others d. Current tension reduction, self-injurious, and therapy 1. The candidate demonstrates respect for the diagnostic process. 2. The candidate recognizes the importance of assessing the client s capacity to reprocess memories of traumatic life experiences in EMDR Phases Three-Eight.

20 interfering behaviors e. Nature and degree of dissociation f. Attachment status 6. The candidate writes a concise descriptive appraisal of nature and severity of client s symptoms and current functioning as step one in writing a comprehensive case report. *These skills, in large part, have been adapted from EMDR Fidelity Rating Scale for History Taking, Case Formulation, Treatment Planning, (Leeds, 2009). III. 3. EMDR Approach to Developing an Effective Clinical Formulation The candidate demonstrates the capacity to understand, articulate, and elucidate a compelling explanation for the client s presenting problems and maladaptive patterns derived from developmental, social, and health histories and based on the AIP Model and the Three-Pronged Protocol of EMDR. The candidate understands, articulates, and elucidates the influence of cultural dynamics in the client s behavior and functioning. The candidate understands, articulates, and elucidates assessment of attachment status and dissociation (Leeds, 2009; Parnell, 2007). III. 3. Developing an Effective Clinical Formulation KNOWLEDGE SKILLS ATTITUDES 1. The candidate understands that the clinical formulation provides an explanation of the development and perpetuation of symptoms and maladaptive patterns. 2. The candidate understands that the clinical formulation is a link 1. The candidate writes a compelling, concise clinical formulation as Step Two in producing a written case report. 2. The candidate develops the clinical formulation based on developmental, social, health, and cultural factors gathered in the 1. The candidate demonstrates willingness to explain the client s complaints (symptoms) and maladaptive patterns in AIP terms. 2. The candidate demonstrates willingness to integrate and/or reconcile AIP with his or

21 between the diagnostic formulation, which is a description of the symptoms, and the treatment formulation, which specifies interventions. 3. The candidate understands that, according to AIP, symptoms and maladaptive patterns originate from life experiences. 4. The candidate understands that, according to AIP, internal resources and strengths originate from life experiences. 5. The candidate understands the role of attachment status in the development and perpetuation of symptoms and maladaptive patterns. 6. The candidate understands the role of dissociation in the development and perpetuation of symptoms and maladaptive patterns. Comprehensive Assessment. 3. The candidate explains the client s presenting complaints (symptoms) and maladaptive patterns in AIP terms. 4. The candidate identifies key adaptive and maladaptive memory networks that are the basis of the client s presenting complaints and maladaptive patterns. 5. The candidate integrates other theoretical perspectives with AIP, as necessary. 6. The candidate addresses attachment status and dissociation issues in the clinical formulation. 7. The candidate revises the clinical formulation as treatment proceeds. her preferred theoretical orientation for the purpose of maintaining fidelity to EMDR protocols. 3. The candidate demonstrates willingness to accept and improve his or her strengths and weaknesses in writing a clinical formulation. 4. The candidate demonstrates willingness to embrace the value and importance of performing a written treatment formulation. III. 4. Develop an Effective Treatment Formulation The candidate demonstrates the capacity to collaborate with the client to set treatment goals and treatment focus. The candidate demonstrates the capacity to identify adaptive and maladaptive memory networks underlying the client s problems using direct inquiry and also bridging techniques (Leeds, 2009; Parnell, 2007; Shapiro, 2001). The candidate demonstrates the capacity to collaborate with the client to select and prioritize memories to target for EMDR reprocessing (Leeds, 2009; Parnell, 2007; Shapiro, 2001). The candidate understands, articulates, and elucidates strategies for addressing treatmentrelated fears. The candidate understands, articulates, and elucidates the client s internal and external resources that will support EMDR reprocessing of target memories (Leeds, 2009; Parnell, 2007;

22 Shapiro, 2001). III. 4. Develop an Effective Treatment Formulation KNOWLEDGE SKILLS ATTITUDES 1. The candidate identifies the client s treatment goals (behavioral, somatic, affective, and cognitive changes). 1. The candidate understands how to collaborate with the client in setting treatment goals based on the client s presenting complaints and desired treatment outcomes. 2. The candidate understands strategies for identifying adaptive and maladaptive memory networks. 3. The candidate demonstrates knowledge of identifying and prioritizing targets for EMDR reprocessing in terms of the Three-Pronged Protocol. 4. The candidate demonstrates understanding of identifying and resolving client s fears of EMDR treatment. 5. The candidate demonstrates understanding of identifying and resolving therapyinterfering behaviors. 6. The candidate demonstrates understanding of the importance of the client s internal resources to the effective EMDR reprocessing of traumatic memories. 7. The candidate lists the four criteria for using RDI prior to EMDR reprocessing of traumatic memories (Leeds, 2009) a. Impaired self-regulation b. Risk of premature termination of treatment if EMDR reprocessing is 2. The candidate uses direct questioning to identify adaptive and maladaptive memory networks. 3. The candidate uses bridging techniques (i.e., Floatback and Affect Bridging) to identify adaptive and maladaptive memory networks. 4. The candidate collaborates with the client to select a sequence of targets for EMDR reprocessing. 5. The candidate identifies and ameliorates treatment-related fears. 6. The candidate specifies a preparation phase of appropriate length, based on client s internal and external resources and considering therapy-interfering factors, (e.g., non-life threatening substance abuse and selfharm, secondary gain, environmental obstacles, therapeutic alliance, etc.) 7. The candidate identifies gaps in skills that will need to be strengthened or developed in support of EMDR reprocessing of traumatic memories 8. The candidate identifies the 1. The candidate demonstrates willingness to write a treatment formulation. 2. The candidate demonstrates respect for the importance of a written treatment formulation. 3. The candidate recognizes the need for incorporating flexibility in the treatment formulation in order to respond to the momentto-moment therapeutic environment. 4. The candidate demonstrates willingness to develop a written format that will be effective in his or her own therapeutic setting.

23 started c. Over-whelming affect and/or incoherent narrative d. EMDR reprocessing has had adverse impact on functioning 8. The candidate demonstrates knowledge of formulating a treatment plan appropriate to the treatment setting, time available, and current life circumstances. presence of one of four criteria for using RDI prior to reprocessing of traumatic memories (Leeds, 2009) a. Impaired self-regulation b. Risk of premature termination of treatment if EMDR reprocessing is started c. Over-whelming affect and/or incoherent narrative d. EMDR reprocessing has had adverse impact on functioning 9. The candidate writes a draft of the treatment goals, a sequence of targets for reprocessing, and a preparation phase of appropriate length as the third step in producing a written case report. *These skills were adapted, in large part, from EMDR Fidelity Rating Scales (Leeds, 2009) III. 5. Draft A Clinical Case Report The candidate writes a succinct, coherent case report: 1) Consistent with the client s presenting problem and goals (i.e., Case Conceptualization through the Comprehensive Assessment and Diagnostic Formulation) 2) Formulated in terms of AIP principles and the Three-pronged Protocol of EMDR therapy (i.e., Clinical Formulation) 3) Specifies a treatment plan that identifies and prioritizes target memories for EMDR reprocessing (i.e., Treatment Formulation) 4) Identifies obstacles and challenges to each of the Eight Phases of EMDR therapy (i.e., Treatment Formulation) III. 5. Draft a Clinical Case Report KNOWLEDGE SKILLS ATTITUDES

24 1. The candidate knows what information should be included in an AIP-informed written clinical case report. 2. The candidate knows that the clinical case report can take various forms based on setting and candidate preference. 1. The candidate organizes his or her drafts of Case Conceptualization, Diagnostic Formulation, Clinical Formulation, and Treatment Formulation to construct a succinct, coherent Case Report in Phase One, History- Taking. a. Consistent with client s presenting problem and goals. b. Formulated in terms of AIP and the Three-Pronged Protocol. c. Identifies and prioritizes target memories for EMDR therapy reprocessing. d. Identifies obstacles and challenges to each of the Eight Phases of EMDR therapy. 1. The candidate understands the importance of writing a clinical case report. 2. The candidate demonstrates willingness to improve writing, conceptualization, and organization skills. Core Competency # IV: Intervention Implementation IV. 1. Establish Treatment Focus, Goals, and Strategy Treatment Focus is the central therapeutic emphasis of a given therapeutic approach. Treatment Goals are the outcomes mutually agreed upon by client and therapist. Treatment Strategy is an action plan for specific intervention methods. The candidate understands, articulates, and elucidates the following central therapeutic emphasis of EMDR Treatment Focus in terms of the AIP Model, the Three-Pronged Protocol, and the Eight Phases of EMDR therapy: Reprocess disturbing life experiences to an adaptive resolution utilizing Bi-Lateral Stimulation, thereby integrating unassimilated negative information together with positive information to empower a whole human capable of love and service (EMDRIA, 2012; Shapiro, 2001, 2002a; Siegel, 2002). The candidate understands, articulates, and elucidates the Treatment Goals in terms of the AIP Model, the Three-Pronged Protocol, and the Eight Phases of EMDR therapy (Leeds, 2009;

25 Shapiro, 2001). The candidate understands, articulates, elucidates, and clinically applies the Treatment Strategy in terms of the AIP Model, the Three-Pronged Protocol, and each of the Eight Phases of EMDR therapy. The candidate understands, articulates, elucidates, and clinically applies ways Treatment Goals and Strategy might be modified as treatment proceeds. IV. 1. Establish Treatment Focus, Goals and Strategy KNOWLEDGE SKILLS ATTITUDES Phase 1: History-Taking 1. The candidate understands that the Treatment Focus of EMDR Therapy is to reprocess disturbing life experiences to an adaptive resolution using BLS. 2. The candidate understands that the Treatment Goals are the client s desired outcomes. 3. The candidate understands that the Treatment Strategy is the application of the Eight Phases of EMDR and the Three- Pronged Protocol. 4. The candidate identifies stabilization strategies and tools. 5. The candidate identifies the purpose of stabilization tools and strategies in each phase of EMDR, why and how to use stabilization tools not only in preparation for reprocessing, but also during history gathering and between sessions. 6. The candidate identifies the mechanics and procedures of resourcing. 7. The candidate identifies the mechanics and 1. Candidate obtained a list of presenting complaints (symptoms). -AL- 2. Candidate identified client s treatment goals regarding behavioral, somatic, affective, and cognitive changes. -AL- 3. Candidate identified client s treatment related concerns and/or fears. -AL- 4. Candidate identified defenses that can potentially block processing (i.e., substance abuse, shame, self-injurious behavior). -JK- 5. Candidate produced evidence of formal, systematic assessment of client s readiness for reprocessing (i.e., checklists, standardized measures, questionnaires, etc.). -RM- 6. Candidate obtained a life history of adverse and traumatic events. -AL- a. Relevant to presenting complaints and future goals. b. Methods: Direct Questioning, Floatback, and Affect Scan. 1. The candidate understands the importance of establishing Treatment Focus, Goals, and Strategy in Phase One. 2. The candidate understands the value of fidelity to EMDR protocols. 3. The candidate understands the importance of modifying Goals and Strategy as treatment proceeds.