EMDR Therapy Quarterly

As my readers will know by now, I love to tell a story, and sometimes I forget whether I have already told it. This may be one of those occasions, but even if you’ve heard it before, I think it needs retelling for the purposes of this column:

Emily and the horse

My daughter Emily is a farm vet. When she was training at Bristol University, she was required to carry out a procedure on a horse and was observed by one of her tutors to check whether she was carrying out the procedure according to the approved protocol. The horse had to be restrained whilst Emily injected it in the leg. There were several things that Emily was required to do before the injection. However, the horse was becoming increasingly agitated, and Emily knew that if she did not inject quickly, the horse would become out of control, and she would be unable to safely administer the injection. She therefore skipped one part of the procedure, jabbed the needle into the horse and injected it safely.
When the procedure had been completed, Emily’s tutor asked her if she could state what the correct procedure was. Emily correctly outlined the procedure. Her tutor asked her, therefore, why she had omitted one part of the procedure. Emily explained that if she had done it according to the book, there was a distinct risk that the horse’s agitation would have made it impossible for her to give the injection. The tutor told her that she was absolutely right and awarded her full marks for the assessment.

The message of this story, if it hasn’t become obvious already, is that it is important to know what the protocol is. There are times when you need to deviate from the protocol, but you should do so knowingly and be able to give a rational justification for doing so.

This month, I plan to focus on the ‘evaluating’ function of EMDR supervision. Just to recap again, I have called the three basic functions of supervision (with the older terms in brackets) as follows:

• Educating (formative)
• Enabling (restorative)
• Evaluating (normative).

The three Es, as I like to call them.

Why do we need a system of accreditation?

Firstly, the basic seven or eight-day training in EMDR does not include an element of evaluationof the trainee. At the end of each part of the training, the trainee receives a certificate of attendance. This shows that they have attended the training but does not state that they have attained any particular level of competence. It is only during the next stage in their training, whilst receiving supervision during the process of accreditation as an EMDR practitioner, that any actual evaluation of the supervisee’s abilities takes place.     

While training consultants Sandi Richman outlines why accreditation as an EMDR therapist is important. In the acquisition and development of skills and knowledge, an EMDR clinician moves from being an EMDR novice to hopefully achieving a high level of EMDR proficiency and expertise. One of the important ways of achieving this is through accreditation. According to Sandi, the benefits of accreditation are that it:

• Maximises the teaching and learning experience of EMDR training
• Ensures ethically sound and robust EMDR clinical practice
• Enhances EMDR treatment fidelity
• Monitors and maximises client protection
• Enhances quality control
• Greatly assists towards research fidelity
• Defines a minimum standard of practice across the whole of Europe.

EMDR Europe accreditation system

There are a number of criteria that need to be satisfied in order to become accredited as an EMDR Europe practitioner. Most importantly, the applicant needs to have:

• Treated a minimum of 25 clients (minimum of 50 sessions) since completing their basic EMDR training, all of whom the supervisee has discussed with their supervisor
• Received a minimum of 20 hours of supervision from an EMDR Europe-accredited consultant (including the 10 hours received during training)
• Demonstrated competency in all parts of the competency framework, which has included the supervisor directly witnessing the supervisee’s EMDR work on video or in vivo.

It is the last of these that is, in fact, the most important. To illustrate this, I often tell my trainees and supervisees the story of my own experience when I was at this stage of my development as an EMDR therapist. After the required minimum of 20 hours of supervision, I asked my supervisor if he would now sign me off and approve my accreditation as a practitioner. I don’t recall his exact words, but it will have been something along these lines: “Well, Robin, actually, I don’t think you are quite ready yet. There are still some things that we need to work on. I need to be sure you are really sticking to the protocol, and I am not yet satisfied that you are.” In retrospect, I am sure that he was right. The bottom line in terms of accreditation is that the supervisor needs to be certain that the supervisee really has the EMDR standard protocol under their belt and is able to use EMDR competently.

So how can an EMDR consultant assess the extent to which their supervisees are competent? Bernard and Goodyear (2019) outline the different media by which we can receive information regarding our supervisee’s work as follows:

• Reporting back on therapy sessions
• Written transcripts of sessions
• Live supervision
• Viewing videos of sessions
• Role play.

It is the first of these (reporting back on therapy sessions) that will usually form the bulk of the information the supervisor will have at their disposal when evaluating the extent to which the competency framework criteria are being met.

But it is during the observation of a video or in vivo observation that the supervisor gets a real feel for what their supervisee is actually doing. Understandably, producing a video can be quite scary for the supervisee and there is often quite a lot of resistance to this.

I am currently preparing a presentation together with Naomi Fisher for the next Consultants Day in November, when we will be addressing the issue of how to assess videos that have been submitted for accreditation purposes. We have had a lot of fun recording video role plays of getting the therapy wrong and then also getting the supervision wrong. I seemed to get more enjoyment than I should have done when acting the part of the arrogant and over-defended supervisor!

One of the points that Naomi and I want to make is that, although these recordings are only usually prompted by the need for evaluation in relation to accreditation, the fact that supervisors are picking up mistakes from the videos means that the educating function is also very much at play here and that supervisees will learn so much from the feedback when they present the videos.

Measuring competency

How does the supervisor evaluate whether their supervisee is ‘competent’ and suitable for practitioner accreditation, based upon what they have observed of their practice and have been told in supervision? In EMDR, we have the advantage of having a clear list of desired competencies.

Recently, EMDR Europe has introduced the ‘algorithm’ version of the accreditation form. Instead of writing a short report in relation to each set of competencies, consultants can opt to rate each individual competency on the following scale:

• Novice (score = 1)
• Intermediate (score = 2)
• Competent (score = 3)
• Advanced (score = 4).

The evaluation of competency does not need to be a one-way process. If the supervisor and supervisee can collaborate on this process, it can lead to a more satisfactory and dynamic supervisory relationship. “Self-assessment is at the heart of developing and maintaining competence…as an individual must identify areas of strength and weakness to establish priorities and to commit to learning strategies to ensure competent practice” (Falender & Shafranske, 2007, p. 236). Requiring supervisees to provide a final narrative, self-reflective report helps them to review the supervision experience in its entirety and synthesise the various aspects of their growth process. Jessica Woolliscroft suggests that EMDR therapists are asked to write the first draft of their own accreditation application as a way of helping them reflect on their progress in relation to their EMDR practice.

Recently, I have also experimented with one of my own supervisees, asking her to write an appraisal of her therapy video and to specify each time she deviated from the protocol, a) deliberately, or b) accidentally. We all deviate from the protocol by accident at times (well, I know I do) but we also deviate from the protocol on purpose at times because it is necessary to do so, as ‘Emily and the horse’ illustrates. This way of doing things with my supervisee felt so much better and more collaborative.

Ensuring ethical practice

The evaluation component of EMDR supervision is not just about accreditation, however. Whether or not a supervisee wishes to become accredited, there is an additional evaluating function for EMDR supervisors – to ensure that their supervisees are practising safely and ethically. To be honest, none of the issues are specific to EMDR and are, in fact, relevant to anyone practising as a psychological therapist.

We should bear in mind that, in order to train as an EMDR therapist, an individual must be accredited in their core profession with a professional body such as the British Association for Counselling and Psychotherapy (BACP) or the Health and Care Professions Council (HCPC). Ultimately, it will be to the accrediting body of their core profession that any complaints about their practice will be made. EMDR supervisors are usually acting in a capacity of consultancy and are not legally responsible for their supervisee’s practice. However, it would be their duty to address any issues that have come to their attention regarding supervisees’ fitness to practise and, if necessary, report this to their accrediting professional organisation. 

Bernard and Goodyear (2019) refer to “problems of professional competence” (PPC) and use the definition of Shen-Miller et al. (2015): “PPC include difficulty in acquiring or maintaining developmentally appropriate levels of skill, functioning, attitudes, and/or ethical, professional or foundational domains in one or more settings” (p.162). 

Any issues should, of course, be raised with the supervisee first. But supervisors must accept that, if things cannot be satisfactorily resolved, they may need to report their concerns to the supervisee’s employer or professional organisation.

In conclusion, it is important to point out that the evaluative function of EMDR supervision relates mainly to the process of accreditation. However, the feedback that our supervisors give about our practice should be an ongoing process throughout supervision. If this is achieved successfully, it is less likely that there will be a major disruption to the supervisory relationship when the time comes to discuss whether we are ready for accreditation.

Robin Logie is a clinical psychologist, EMDR Europe accredited consultant and senior trainer. He is a former president of the EMDR Association UK, a current member of its Accreditation Committee and runs EMDR consultant training on behalf of the Association. His book, EMDR Supervision, was published by Routledge in 2023. Positionality Statement: "I am a straight, white, cisgender, male from a middle-class background. My mother was a Jewish refugee from Nazi Germany and my father was from a Christian family. Both were atheists and I was brought up with no religion. In writing about issues of diversity regarding EMDR supervision, I have recently become more aware of my position in society, the privileges it has afforded me and how it will affect those who relate to me who come from different backgrounds. I try to help this to inform my own clinical practice and how I consume research."