Clearly, the basics of rapport building and therapeutic alliance (as a course in Humanistic Psychology 101 would teach us) have a place in EMDR treatment. As Fadalia’s case demonstrates, showing basic human decency and respect to a client goes far in establishing your credibility, something that is crucial for successful EMDR treatment with complex clients. A number of issues are unique to EMDR and offer us chances to further empower clients.

One issue is that because EMDR may sound strange to uninformed clients, before you begin using EMDR, you should explain the approach and allow clients to decide whether they would like to try it. This should go without saying as part of an ethical preparation for and orientation to EMDR (Shapiro Phase 2; 2001). Present the therapy in a style that suits you and fits the client’s level of understanding best, and be sure it is clear to the client that he or she does not have to do EMDR. Encourage him or her to go online and read about it, and invite the client to ask questions before he or she officially makes the decision to continue.

This is a simple strategy that may seem like common sense, but you’d be surprised how many clinicians miss it. I have encountered clinicians who are orthodox in their stance that EMDR is an approach to psychotherapy, yet they have made clients feel as though EMDR is the only option. A clinician may hand an EMDR pamphlet to a new referral saying, “This is what I do,” and the client may not have sufficient ego strength to voice his or her potential discomfort with the therapy. Although we may think that EMDR is the best way to go for a client’s problem, it is never ethical to pressure a client into doing EMDR.

When I work with a client whom I think would benefit from EMDR, I endorse it but always offer at least two other treatment options that I can employ to help the client reach his or her goals (which is one of the benefits of being an eclectic therapist). A client is much more likely to feel better about EMDR when he or she has had the choice to do it. Even if a client initially chooses another modality of therapy, I have found that many are more likely to reconsider EMDR if you gently bring it up again later in the treatment because you showed enough respect to provide a choice in the first place.

There is debate among EMDR clinicians regarding which form of bilateral stimulation works best. Therefore, it is good practice to provide clients with the choice of how EMDR treatment will be executed. There are many purists (mostly Face 1 and some Face 2 practitioners) who believe that because eye movements are the most widely researched EMDR technique, this is the only form of stimulation that should be used or, at very least, strongly suggested to clients. However, a great deal of case evidence, pilot research (Grey, 2008), and experiential clinical knowledge suggests that alternating tones or various forms of tactile stimulation can work just as well.

Because there are three major forms of stimulation used in EMDR (i.e., eye movements, tactile stimulation, alternating tones) with multiple variants of each (e.g., eye movements can be created with a hand, wand, toy, or mechanical “light bar”; tactile stimulation can come in the form of direct touch, from a mechanical pulser machine, or through physical activities such as walking or drumming, you can turn this issue into an empowering choice for clients. I always let clients choose which form of stimulation to be used for our EMDR sessions, and I let them know that they can choose to change the form of stimulation at any time. Although I may make suggestions (e.g., when processing seems to be stuck, I may propose that we switch stimulation forms), I am committed to leaving this choice in clients’ hands (or eyes or ears). From my experience, providing this choice does wonders for allowing the client to feel empowered and respected. I discuss the issue of modality choice again in Chapter 5.

(c) Jamie Marich, 2011