EMDR Therapy Quarterly

I learnt the trumpet as a child, and each lesson involved my teacher listening to me playing. Sometimes that went well, and sometimes it didn’t. But it meant that when I started doing EMDR, it didn’t feel particularly strange to me to be observed. That’s not the case for everyone, however.

Once a year, the UK EMDR consultants meet for a consultants’ day. At the most recent of these, I presented a workshop with Naomi Fisher titled, Is this video good enough? There is often a considerable amount of anxiety about having one’s therapy practice observed, due to a fear of being exposed, and this was something we addressed right at the start of our workshop. We asked the consultants to remember their own experience of having their work observed and how this had felt. As you read this column, perhaps you could take a moment to do the same, and if you haven’t yet submitted any videos, you might think about the fears you may have in doing so.

Unfortunately, most supervisees will only produce videos of their work while working towards accreditation; therefore, it is seen solely as a way of evaluating their work. In our workshop, I reminded the attendees of the ‘three Es’ (‘Educating’, ‘Enabling’ and ‘Evaluating’, which I have described in earlier editions of this column) and that sharing videos can be as much about educating and, to a lesser extent, enabling as it is about evaluating, even though it is likely to be for evaluation that the video will usually have been submitted in the first place.

To put the observation of videos into context, let’s take a step back and look at the different ways supervisees can share work with a supervisor, each with its own advantages and disadvantages.

Verbal report

This is what usually occurs in most supervision sessions. We just tell our supervisor about our client and where we feel stuck. We provide them with the information we think is relevant or relates to the questions they ask.

Verbatim report

This is a more structured form of supervision where we provide a written blow-by-blow account of everything that was said and experienced in a particular EMDR session.

Written/clinical documentation review

This is where the supervisor reviews all our notes and any other documentation. This would usually be used in order to ensure that the supervisee is practising safely and effectively in line with the approved procedures for their particular organisation.

Simulation

This is a role-play re-enactment of a therapy session. This can be particularly useful to home in on a particular technical issue regarding the EMDR protocol.

Live observation

The supervisor sits in on an EMDR session, physically in the room, behind a screen or online. The advantages of this are that the supervisee cannot select just the ‘best bits’ for their supervisor to see, and the supervisor can intervene if it is helpful to do so.

Video recording

The supervisor observes a pre-recorded video of the supervisee’s work, either together with the supervisee or separately. This is relatively easy to arrange and has the advantage that the supervisor can actually pick up on any potential mistakes the supervisee is making, as well as those that the supervisee has chosen to bring to supervision.

EMDR Europe requires the last two of these ( live observation and video recording) to evaluate a therapist’s practice for accreditation. (Interestingly there is no such requirement to be accredited with EMDRIA, the accrediting organisation across the Atlantic.)

Now, let’s think a little more deeply about recording an EMDR therapy session. As an introduction, I particularly like this quotation:

“The word supervision is derived from the Latin super, meaning ‘over’, and videre, ‘to see’. In a literal sense, audio- and video-recordings provide a direct, factually correct vision of what transpired in the therapy session. It is this direct access, unfiltered through the therapist’s recollections, that is the prime advantage of the recording. The patient and therapist can be heard in action, and seen if videoed, which is a very different matter from those events being reported. The simple exercise of comparing one’s notes on a session with a tape-recording dramatically highlights the deficiencies of memory, especially when emotionally charged and complex issues are emerging and being explored. In recollection, whole segments of interaction are not recorded in memory, the sequence of interactions become reordered, key statements by the patient are either misheard or not heard, elements are magnified or diminished, and interpretations take on a wishful perfection.”

Aveline, 1997, p. 82

What are the advantages of recording therapy sessions for supervision? The main reason for doing so relates to the inadequacy of alternatives. Most supervision is based on verbal reporting. “Many supervisors who rely on self-report have fallen into stagnation … at its worst, self-report is a method whereby supervisees ‘distort’ (rather than ‘report’) their work, even if they are not consciously doing so” (Bernard & Goodyear, 2019, p. 164). Muslin et al. (1981) found that 54% of the themes of videotaped interviews were not reported in supervision, and some degree of distortion was present in 54% of the interviews. Additionally, Ladany et al. (1996) reported that 97% of supervisees were conscious of keeping relevant material out of their supervision.

For a therapy such as EMDR, which has a clear, structured procedure, it is particularly important that the supervisor has an opportunity to observe their supervisee’s work to make sure they are adhering to the EMDR protocol.

As I mentioned at the start, the experience of having your work observed can be unnerving, and there is often the fear of shame attached to showing oneself at work in what is usually a private and confidential setting. This may be an issue in itself that needs to be addressed in supervision. Neufeldt et al. (1996) found that a willingness to experience vulnerability was a necessary quality in relation to agreeing to use recordings of therapy sessions. Scaife (2019) suggests that the supervisor should share their own willingness to show their vulnerability by letting clients see recordings of their work. Tony Rousmaniere, a big name in clinical supervision research, “starts each training year by showing his trainees a clip of a video in which he forgets the client’s name” (Bernard & Goodyear, 2019, p. 167).

One reason offered by supervisees for avoiding making recordings relates to consent and their assertion that their clients would be uncomfortable about the recording of sessions. However, a study by Briggie et al. (2016) found that 52% of clients expressed no or slight concerns, and 71% were willing to consider audio or video recording. It has certainly been my own experience and that of my supervisees that, once you pluck up the courage to ask your clients about recording sessions, most clients will agree. I will share with my supervisees that it can be scary to ask and that I have found this to be so myself. But once you get into the habit of asking, you will be surprised by the positive response.

One of the questions we addressed at the consultants’ day was whether the video had to be ‘perfect’ to be deemed acceptable for accreditation. To answer this question, I told a story (as I often do) about a supervisee of mine who produced a video with quite a few mistakes in it. I gave her some feedback to help improve her practice, and I asked her to produce another video. This second video proved to be much better yet still had quite a few errors; I therefore asked her for a third video. At this point, she became demoralised by the whole process and said she was wondering whether it was worth pursuing accreditation. I suggested that, for her third video, she also provided a written appraisal of the video outlining where she had a) deviated from the protocol by mistake and b) where she had deviated deliberately because it was sensible to do so with that particular client. Though not absolutely perfect, her third video was a great deal better. However, it was her written comments that indicated she fully understood the protocol. I decided that we were now in a position to put her forward for accreditation. So, to answer my question, no, it doesn’t have to be perfect, but the supervisee needs to know where they went wrong and why.

To be honest, even after using EMDR for 25 years and having been an EMDR consultant for 14 of those, I still occasionally, in the heat of the moment, do something wrong. In fact, when teaching and showing videos, I often ask my trainees to spot my mistakes. This is a task which, for some reason, they particularly enjoy!

Giving feedback

Giving feedback can be scary for both the supervisor and supervisee. For the supervisor, who wants to be supportive and is used to being a therapist who is supportive to their clients, giving feedback can feel quite brutal and undermining. For the supervisee, it can be triggering, perhaps reminding them of some unprocessed experiences from their school days. Most of us have a fear of failure and negative cognitions regarding self-defectiveness can be easily triggered.

The supervisee may be thinking:

• What if they tell me I’m no good at this?
• What if they think I’m a useless therapist?
• What if I’m doing this all wrong?
• What if this exposes me as completely incompetent?

But bear in mind that your supervisor may have a parallel set of issues:

• What if they get really angry with me?
• What if I come across as undermining?
• What if they complain about me to other people?
• What if I’m not actually right about the things they are getting wrong?
• What if they don’t like me after I give them feedback?

So, what is feedback for? For the supervisor, it is to give effective and constructive feedback to enable the supervisee to act upon it to improve their practice. For the supervisee, it is to hear the feedback without becoming defensive, and to integrate this into their practice.

Once both the supervisee and supervisor feel relatively comfortable with this (and the more they do, the easier it will get), they can develop a relationship where the supervisee’s practice can grow and develop.

The medium by which EMDR supervision is provided is crucial in terms of the three functions of supervision. Of particular importance is having one’s work observed, either through a video recording or in vivo. Supervisees will learn much more about their practice and how it can be enhanced if their supervisor observes them at work. They will feel supported and enabled, and most importantly of all, the supervisor will be able to accurately evaluate their supervisee’s adherence to the EMDR protocol for the purposes of 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."