Phase 1 of EMDR

When does it start? Does it always come first? When are we done with it? It depends…if we are approaching any phase of EMDR from a whole brain perspective grounded in the AIP framework - questions are welcome.  Phase 1 is truly the start of EMDR. When history taking and treatment planning are done through an AIP lens it provides the information that all other phases are based upon. It’s tempting to conceptualize that information gathering begins with intake, when realistically it starts with the first contact (email, first phone call and initial paperwork). From the very first time someone reaches out to inquire about EMDR services they are giving you information and their nervous system is receiving information about you and your practice.  As EMDR clinicians we can take a look at intake paperwork and start to conceptualize and make hypotheses about the client’s capacity for change and how their symptoms make sense. We trust our Vagus nerve to give us insight as to what is going on beyond just the words on the paper or the voice on the phone. Basic training gives us multiple tools to gather necessary information and to start being aware of targets. We are also looking for insights about how this information comes together to explain symptoms and presenting concerns. We work as detectives to theorize how the pieces of the puzzle came together. But ultimately, it’s going to be the Treatment Plan/Targeting Sequencing plan and the client's brain that confirms how the pieces are meant to be assembled. When we choose to undergo EMDR training our facilitators often stress the importance of phase 1 and gathering information from multiple angles. One of the foundational elements of counseling that we are taught in graduate school is to ask open ended questions. We are instructed to inquire about mood, motivation, sleep, appetite, family systems, substance use, hopes, dreams and so on. We invite you to welcome all of that back and be curious about what else might be helpful for us to know about this client's nervous system.  Some great conceptualization questions to ask yourself as the clinician while gathering information from a client are outlined here to further develop your skill set: 1. "How do these symptoms make sense to me?” 2. “How are those specific symptoms adaptive for them?” 3. “ What about this case is surprising me so far?”  The EMDR clinician truly is a detective paying attention to not only the words that are being said, but rather how they are being said and how that person shows up in front of them. We use our skills to discern what may be going on beyond the words. We look at tone, body language, affect, and notice where they’re glancing in the room and how they’re presenting. We make mental notes of attachment and connections as they talk about their history. Treatment planning and targeting sequencing starts from that very first phone call.  This is the groundwork and the start of the standard protocol of EMDR as a whole. One thing that can be overlooked in basic training is that phase 1 is ongoing, we are always assessing and always taking in information as a good EMDR clinician. The detective work in that case conceptualization, won’t go away once we move on to phases 2 and 3 but rather we will work to understand the whole system throughout all of our time shared with our clients. We dive into phase 1 and even phase 2 to give some resources from the very first introduction to somebody. We meet our clients where they are at and adjust accordingly. We use psychoeducation to let them know a little bit more about EMDR and how it works. Ultimately we become sales representatives for the treatment model that speaks to us and we sell it to people so that we can help them with their healing through EMDR. So why come back and write a whole blog post about phase 1 you may ask? It is because we can start to overlook that phase 1 is all around us and the work we have done with our clients. Phase 1 is the foundation and we get stuck with clients who are looping or blocked, it can be because we are missing a piece of the puzzle or we don’t truly understand that foundation. If we look at trauma work as a house we can remodel a lot of the rooms upstairs and make them beautiful but ultimately if there is a crack in the foundation all of that work won’t last. Phase 1 is showing us the cracks in the foundation that need to be remedied because once they are, it's a lot easier to work on making the house beautiful inside and out. Our job is to listen and show up to meet our clients with where they are at but it is also to be curious and hold space for how these things make sense, how their presentations align with the adaptive information processing model and once we can do that, we truly can watch the healing unfold.