EMDR Therapy Quarterly

Authors: Dr Khyati Rawal, Dr Jonathan Hutchins, Dr Henk Swanepoel, Dr Sarah Gillanders, and Dr Clare Keogh

Introduction

Therapeutic interventions with unpaid dementia carers and those living with other degenerative diseases appear to still be in their infancy in terms of delivery, accessibility and research. When therapy is offered to these client groups, Eye Movement Desensitisation and Reprocessing (EMDR) is often given little consideration, despite its potential value. As someone with both lived experience of unpaid caring in this context and as an EMDR consultant, my colleagues and I argue that EMDR therapy ought to have a significant place in unpaid carer interventions and we present a range of ideas about how we might do this.

While we note that caregiving can have many positive aspects to it, for both the carer and the person being cared for, we recognise that this can also come with a high cost to psychological and physical well-being. We argue that EMDR has the potential to benefit carers in two key areas: firstly, as an early intervention aimed at reducing the risks of carer burnout, the breakdown of the caring relationship and to help manage the impact of ongoing stress, thereby improving resilience and self-efficacy in their caring role; and secondly, as a clinical intervention for depression, anxiety, posttraumatic stress disorder (PTSD), prolonged grief and acute stress.

What is an unpaid carer?

An unpaid carer (or informal caregiver) is anyone, including children and adults, who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, mental health problem or addiction. Many carers don’t see themselves as carers, and it takes them an average of two years to acknowledge their role as carers (NHS England, 2025).

Unpaid carers are not a homogeneous group and come from a range of ages and backgrounds, with individual challenges, circumstances and experiences. There is also a lot of variation in the type of care provided by unpaid carers and the impacts upon them. Therefore, approaching interventions from a person-centred perspective is essential to meet individual needs and provide tailored interventions where they could be useful. More than six decades of international research has shown that unpaid carers experience higher than average rates of poor physical and mental health, social isolation and financial distress (O’Dwyer et al., 2025). For example, unpaid carers are disproportionately at risk for affective disorders such as depression and anxiety Rosa et al., 2010

Understanding the context of caring for someone living with dementia and other neurodegenerative diseases

Dementia refers to a group of symptoms (syndrome) that occur when the brain is affected by certain diseases or conditions. It involves a decline in memory, thinking and social abilities severe enough to interfere with daily functioning. Dementia is not a single disease, but the term is used to describe symptoms caused by various disorders affecting the brain, including Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia and others. The specific symptoms and progression depend on the underlying cause and area of the brain affected (National Institute of Neurological Disorders and Stroke, 2025).

Many neurodegenerative diseases, such as dementia, advanced Huntington’s disease and motor neurone disease, are progressive and currently incurable, meaning they will worsen over time and eventually directly lead to death, otherwise known as a terminal disease. At best, any limited treatments are disease-modifying (i.e., may slow progression) but not curative. They are characterised by the progressive loss of nerve cells and brain tissue, leading to a decline in function, which may be gradual or accelerated.

However, there are other neurodegenerative diseases that may not be regarded as terminal, such as Parkinson’s disease, but become life-limiting/threatening in the later stages. It is helpful to be aware of the palliative nature of these conditions, in that support is symptom-focused and quality-of-life orientated, occurring alongside stabilising interventions early on. Prognosis can be difficult to predict, meaning it is hard to know how the illness will progress or what the journey may look like, contributing to high levels of uncertainty and providing a challenge for advanced care planning. For many, the shift from palliative care to end-of-life care will also need to be navigated at some point.  

We have chosen to focus on unpaid carers of neurodegenerative diseases, as they often must navigate some of the unique challenges described above. However, there is no doubt that some of the ideas in this paper could also apply to other areas of unpaid caring.

Experiences and challenges of unpaid caring of those living with dementia and neurodegenerative conditions

Carer demands can impact the physical and mental well-being of unpaid carers, affecting general quality of life (Aoun et al., 2013). As the disease progresses, the caring role may intensify as the individual becomes less independent and heavily reliant on the carer. Watching a loved one gradually lose independence, identity and communication abilities evokes significant emotional stress and a sense of loss, especially when unpaid caring is sustained over years.

Sleep deprivation for both the carer and the person being cared for, and the presence of incontinence and having to help support and manage this, can have a huge impact on the carer (Leggett et al., 2020). This lack of sleep is highly significant, as much of our healing and recovery for day-to-day physical and mental health takes place during REM sleep, providing support for the need to recreate a situation where carers can tap into their natural mechanism for healing, and one of these methods is EMDR (Shapiro, 2018).

While the trajectory of dementia is typically slow (if diagnosed early) and marked by cognitive decline, some degenerative diseases can involve a rapid physical decline. The person living with neurodegeneration can experience several difficulties as the illness progresses. Worsening of physical/motor functions may result in the need for walking aids and wheelchairs. There may be difficulty communicating (aphasia) and difficulty swallowing (dysphagia), leading to an increased risk of choking and developing pneumonia. These issues are often accompanied by other medical issues such as urinary tract and other infections, increased risk of falls and stressful hospital admissions. In many cases individuals may also be managing other comorbidities, further increasing the complexity of caring.

People being cared for may experience marked mood and behavioural changes, distress-related behaviours, or those resulting from unmet needs. For example, in the behavioural variant of frontotemporal dementia, behavioural variant (FTDbv), carers can be left feeling like their loved one’s personality has significantly changed due to the lack of empathy and loss of connection with them, as well as significant apathy and possible dependency (Fieldhouse et al., 2023). Such behaviours can be extremely distressing for the individual and their carer, especially if they escalate or present in the form of aggression and unpredictability, potentially leading to issues around risk and safety for all concerned. Anosognosia, or lack of insight, can also prevent the individual from recognising or acknowledging a brain disorder or its symptoms. 

Conditions like Huntington’s disease, motor neurone disease and familial frontotemporal dementia, for example, can also have a genetic component, meaning that family carers or their children may have to grapple with their own genetic risk (Cooper et al., 2025). 

The grief of unpaid caring

Carers often report feeling socially isolated and under-recognised, particularly when supporting someone with a less publicly understood disease. This is further compounded if the disease is considered less common or rare, as many healthcare professionals will be unaware of it or only have a limited understanding.

The losses experienced in this context can leave the carer with a sense of disenfranchised grief, that is grief which is not openly acknowledged or socially supported. This can significantly increase the risk of depression, anxiety and suicidal ideation among carers of individuals with dementia (Solimando et al., 2022). This is also evident in anticipatory grief and ambiguous loss (or living grief/pre-death grief), where the carer experiences grief before the death of the person with dementia or other terminal neurodegenerative disease, and prolonged/complicated grief, which may persist after death (Meuser et al., 2004).

How EMDR practitioners might work with grief and loss in this context

Grief can have both immediate and latent effects on depression over time, highlighting the need for interventions that address grief in unpaid dementia caring (Schulz & Martire, 2004). EMDR could have an important contribution to make here. One could draw on the work of Therese Rando (1984) in the field of complicated grief and mourning (Solomon & Rando, 2012; Solomon, 2024) as well as consider EMDR grief protocols, such as those by Marilyn Luber (2012) and Krista Helman (2025).

The Reconnection Protocol for Grief (Sellick & Holt, 2024) may be particularly useful, given the risks of prolonged grief for this client group, as it uses an EMDR’s Resource Development and Installation (RDI) approach. The protocol aims to help clients proactively access positive memories of their loved one, facilitating an ongoing healthy connection and providing attachment, security and safety. Accessing positive memories can be particularly difficult for carers where the person they know changes in so many ways and where the journey of caring is/was particularly difficult or distressing. While many positive memories of caring exist for an individual, they may become superseded by many of the heightened or negative experiences; for example, where they may be caring for someone with dementia for a long period of time and presenting with intense distress behaviours.

Overall, we recommend a tailored, compassionate and non-pathologising approach to grief and loss in EMDR delivery where possible.

Extreme feelings of guilt and judgement

It is no secret that feelings of guilt and fear of judgement can be profoundly felt by unpaid carers when caring for someone with a neurodegenerative disease. These feelings may be so powerful that there may be aspects of the caring experience that the carer may not feel comfortable sharing with anyone, including their therapist. Such experiences may include a situation in which the carer feels guilty about having a frustrated response towards the person they care for, the perceived sense that they made the wrong decision about something in the caring process, or wishing that the caring journey would come to an end. In these situations, there is the option to utilise the ‘blind to therapist’ protocol (Blore & Holmshaw, 2009; Farrell et al., 2022), in which clients can process trauma without revealing details and can feel safe from the risk of perceived judgement.

PTSD symptoms in unpaid carers

Carers of those living with dementia often experience high levels of stress and burden with effects comparable to those who have experienced a traumatic event (Passoni et al., 2018).

A UK study of unpaid carers of individuals with dementia, who had been providing care for one to three years for at least 50 hours a week, found that over half the participants scored in the clinically significant range on the Impact of Events Scale-Revised (IES-R). Additionally, 45 percent of the participants scored above the cut-off for a probable diagnosis of PTSD, and even the participants who fell in the non-clinical range reported symptoms of distress (Wood et al., 2021). Given that EMDR is recommended by the National Institute for Health and Care Excellence as a treatment for adult PTSD, EMDR could provide a valuable intervention for unpaid carers who present with symptoms of PTSD. This also suggests that we need to measure the levels of trauma and distress within this group to better understand the prevalence of PTSD so we can tailor EMDR interventions and signpost carers appropriately.

Unpaid caring from a trauma informed perspective

Despite the widespread acknowledgement of the detrimental impacts of caring for a person with dementia (and other neurodegenerative diseases), this experience is not often considered in a trauma-informed context (Wood et al., 2021). According to DSM-5, trauma is defined as exposure to actual or threatened death, serious injury or sexual violence through directly experiencing the traumatic event or witnessing in person the event as it occurred to others, learning that the traumatic event occurred to a close family member or friend, or experiencing repeated or extreme exposure to aversive details of the traumatic event.

While this definition may not encompass all forms of trauma experienced by individuals in various contexts, it can be agreed that chronic caregiver stress, consisting of repeated little ‘t’ traumas, can still lead to significant distress. It could be argued that a terminal neurodegenerative disease, such as dementia, is a direct threat to the life of a family member or friend who is cared for. Additionally, it more broadly threatens the psychological and social integrity of both the person with dementia and their carer, through changes in relational dynamics and key attachment bonds, losses and balancing ambivalent feelings (Wood et al., 2021).

Relational dynamics

The experience of caring for another person, such as a parent, will inevitably evoke conscious or unconscious feelings of the carer’s own experiences of being cared for. In some cases, the carer will experience struggles and losses that arise from role reversal. In instances where care provided in early life was neglectful, inconsistent or abusive, the caregiving relationship may trigger a trauma-based response, leading to powerful feelings or re-enactments (Baxter, 2020).

An EMDR-Integrated Group Traumatic Events Protocol (IG-TEP) study by Passoni et al. (2018) found that where unpaid carers described a poor-quality past relationship with the person they now care for, they reported higher levels of social and physical burden while caring for them. Wilson et al. (2019) describe how a history of trauma, significant life events and the accumulation of complicated family dynamics over the years often presents at this ‘unpacking’ phase of life.

EMDR can provide a valuable intervention in helping carers process some of their relational struggles and support them to focus on their own well-being, allowing them to continue with their caring role while reducing triggers. Attachment-informed EMDR/Attachment-focused EMDR may be considered in this context, as it is an approach that integrates the principles of attachment theory with the standard protocol to address complex trauma, particularly when early relational wounds influence current mental health (Brayne, 2022; Parnell, 2013).

Application of EMDR to unpaid carers of individuals with dementia and other neurodegenerative conditions

Adaptive information processing (AIP) and how it relates to unpaid caring

EMDR therapy, guided by the AIP model, can be particularly effective for carers of individuals with dementia and other neurodegenerative diseases by targeting and reprocessing the traumatic memories associated with their caregiving experiences. Through bilateral stimulation, EMDR facilitates the integration of these distressing memories into adaptive networks, thereby alleviating symptoms of PTSD and improving overall psychological well-being.

Ongoing exposure to caregiving stressors can result in the accumulation of unprocessed traumatic experiences. This dysfunctional stored material can manifest as heightened anxiety, depressive symptoms and diminished self-efficacy. Daily challenges, such as managing the behavioural and psychological symptoms of the disease, witnessing cognitive decline and experiencing anticipatory grief, can overwhelm carer coping mechanisms, leading to maladaptive memory networks and symptoms akin to PTSD (Wood et al, 2021).

The AIP model provides a comprehensive framework for understanding the chronic stress experienced by unpaid carers and underscores the potential of EMDR therapy to address the underlying maladaptive memory networks contributing to carer distress. By facilitating the reprocessing of traumatic caregiving experiences and facilitating their adaptive resolution, EMDR can enhance caregivers’ resilience and overall mental health, thereby improving their capacity to provide care and maintain their well-being.

Strengths-based EMDR/resourcing for unpaid carers

Strengths-based approaches in unpaid carers focus on identifying and utilising the carer’s existing skills, resources and support networks to enhance their well-being and carer effectiveness. These approaches emphasise empowerment, resilience and the capacity to adapt to challenges rather than solely address deficits. Research indicates that strengths-based interventions can lead to significant improvements in carer outcomes. For example, in a study involving unpaid carers of individuals with dementia, adopting a strengths-based perspective allowed carers to view their role as an opportunity to give back, discover personal strengths and become closer to their care receivers (Peacock et al., 2010). It could be argued that EMDR already has this approach built in, as evident in resource development, identifying positive cognition and reprocessing. It would make sense for EMDR practitioners to be mindful of this and even consider leaning into strengths-based aspects in their work with this client group.

In addition to safe (calm) space, appropriate resourcing can be considered in relation to the formulation. It is important to remember that, in addition to the EMDR processing giving rise to some potential expected discomfort, unpaid carers will have to manage this and still find the capacity to resume their caring role afterwards. Therefore, using the concept of a ‘container’, for example, may help to safely close the session down and leave behind/safely park some of the disturbing material.

EMDR formulation and case conceptualisation

Given the complexities and variability in the experience of unpaid carers and the time at which they may present for therapy, case conceptualisation and formulation are essential for EMDR treatment planning and considering which types of EMDR techniques and protocols may be useful. We recommend utilising the Santos Case Formulation Tool (Santos, 2019; 2022), which is a diagrammatic clinical tool grounded in the AIP model of EMDR therapy. The formulation tool allows for a comprehensive assessment, mapping out six key elements. These are unprocessed traumatic experiences, triggers, intrusions, negative beliefs, symptoms and resilience, providing a holistic view of the unpaid carer’s psychological landscape. It allows for the identification of specific areas of distress and strength, facilitating personalised treatment plans leading to targeted interventions.

This visual formulation tool has the potential to enhance client engagement due to the active collaboration between the therapist and the unpaid carer (client), leading to increased motivation and commitment to the therapeutic process. This tool also integrates resilience factors into the formulation, emphasising carer strengths and coping mechanisms, which is consistent with a strength-based angle. Please see ideas for adapting the Santos (2022) formulation tool below for carers of neurodegenerative conditions:

Assessment, screening and monitoring tools

While a practitioner may choose from a range of monitoring tools, such as PHQ-9, GAD-7, PCL-5 and IES-R, they may want to consider client-group-specific measures that will help with information gathering, monitoring and review. For example, the Caregiver Burden Inventory (Novak and Guest, 1989) ), the Zarit Burden Interview (Zarit et al., 1980), the Dementia Caregiver Burden Scale (Cho and Kim  2024) and the Carers Star^TM.

Group intervention: Application of G-TEP to unpaid carers of individuals with dementia and other neurodegenerative conditions

The EMDR Recent Traumatic Episode Protocol (R-TEP) is an individual evidence-based treatment, informed by the standard EMDR and Recent Event Protocol that is widely used for acute intervention. EMDR Group Traumatic Episode Protocol (G-TEP) was developed as a rigorous application of the R-TEP (Shapiro & Laub, 2008; Shapiro, 2014), for use with groups incorporating the principles of EMDR early intervention. The tool has great potential for use in specific carer groups; however, EMDR clinicians should be trained in G-TEP by an accredited trainer to ensure fidelity.

Originally intended for critical incident and disaster settings for treating distress and enhancing resilience, it is now also being successfully used for ongoing stress, preventing the accumulation of unprocessed trauma memories. This element of ongoing stress is often a large component in the experience of unpaid caregiving generally, but especially in neurodegenerative disease. When we consider the group EMDR protocol from the angle of guided self-help (Maxfield, 2021), it opens many future possibilities for application and development with this client group. 

The various safety and structured features of G-TEP that make it amenable for guided self-help or for video and web-based delivery, also make it suitable for scalable applications. Group protocols have the potential for lifting the burden of trauma. When embedded in peer support carer groups, they also have the potential to reduce social isolation.

In a study by Passoni et al. (2018), evaluating efficacy, the EMDR–IG-TEP was administered to 44 family caregivers of persons living with dementia. Overall, preliminary results showed a reduction in stress-related symptoms, anxiety and depression in carers. Three out of the five outcome measures assessed – specifically the Impact of Event Scale-Revised, anxiety and depression – demonstrated marked and multidimensional improvements following a brief two-month intervention. These preliminary findings provide support for the potential efficacy of EMDR–IG-TEP as a viable therapeutic approach for alleviating psychological distress among unpaid carers of individuals with dementia.

There were some complexities, potentially explained by the ongoing stressful nature of unpaid caring and the timing of interventions. The study suggests that early intervention is the best response, with interventions allowing unpaid caregivers to better cope with the unavoidable sequence of stressful events that are common for this group. The authors also argue that without early intervention, the progression of the disease might worsen the emotional condition of the unpaid carer to an extent that may make them much less responsive to treatment later in the caring journey. However, further research is required with larger sample sizes to better understand and interpret differential caregiver profiles.

Individual EMDR interventions with unpaid carers of individuals with dementia and other neurodegenerative conditions

As we have already highlighted, carers of individuals with dementia and other neurodegenerative conditions face an uncertain future, and this can become a central part of the disturbance. Fears and worries about the future may be targets themselves, and you might use techniques such as Flashforward (Logie & de Jongh, 2014) to process these feared catastrophic events.

Future Templates (Shapiro, 2018) may also be used to allow the carer to mentally rehearse adaptive responses to inevitable future situations, building self-efficacy and resilience, for example, by installing aspects of coping with future medical procedures, moving their person to a care facility, or end of life.

Given the intense context of unpaid caring and the potential for some discomfort to arise during EMDR therapy, practitioners may also want to consider the Flash Technique (Manfield et al., 2017), which provides a gentle approach, reducing emotional disturbance before trauma work or where trauma is only lightly or indirectly activated. This may provide a useful step before going onto full processing and to gauge how the carer is managing the therapy alongside their caring responsibilities.

EMDR–PRECI

The Protocol for Recent Critical Incidents and Ongoing Traumatic Stress (PRECI) is a specialised EMDR protocol designed to address acute and ongoing traumatic stress, particularly among first responders and individuals exposed to critical incidents (Jarero et al., 2019). However, the protocol has also been used with carers of those on the autism spectrum, suggesting that EMDR–PRECI could be an efficient and effective treatment to address a family caregiver’s PTSD, anxiety and depression symptoms (Encinas et al., 2019).  

EMDR–PRECI with unpaid carers of individuals with dementia and other neurodegenerative conditions

Given that the protocol could be a powerful tool for addressing chronic stress, trauma exposure and emotional burnout, there is a strong argument for considering its use with carers of those living with dementia and other neurodegenerative diseases, as well as carrying out future research in this area.

EMDR–PRECI could provide a structured, trauma-informed intervention to reduce emotional burden and traumatic stress experienced by carers. It has the potential to be used with carers experiencing chronic emotional strain, exposure to distressing events (e.g., disorientation, distress-related behaviours, medical emergencies and witnessing marked changes and deterioration in the person they care for), anticipatory grief, helplessness, symptoms of anxiety, burnout, compassion fatigue or secondary trauma.

Life after unpaid caring

While we have considered EMDR as a form of early intervention and its use with ongoing stress, EMDR can offer a lot to unpaid carers at the end of or after their caregiving journey. This could be through the processing of the journey itself, including experiences of end-of-life, grief and loss, but also supporting the carer to adjust to life without their person, as well as adapting to the loss of their carer identity. EMDR may also enable the individual to visualise and work towards a newly carved-out present and future (utilising EMDR-informed coaching, for example).

Considerations when delivering EMDR for unpaid carers of individuals with dementia and other neurodegenerative conditions

Delivery of interventions: Carers are busy and find it difficult to prioritise themselves. They often report feeling unseen. It is important to think about flexible appointment times and how they can be supported to have someone care for their person while they are receiving their therapy so they can feel safe and present. Similarly, for some carers , they may prefer (and be assessed as suitable for) an intensive EMDR intervention, especially where an extensive period of respite can be arranged or the situation of the person they care for has not yet worsened significantly. This also means that the intervention is completed in a shorter space of time and is therefore less impacted by the unexpected upheavals of the caring journey that may occur during a longer period of intervention.

Timing of interventions and focus: It is important to understand the carer’s journey to date and establish the time at which they are presenting for therapy (for example, their person may have been recently diagnosed, or they are already in the thick of their caring journey moving towards a worsening of the condition). Knowing this is essential in collaboratively establishing where the focus of EMDR will be most useful at this point.

Flexibility: It is important for EMDR practitioners to remain flexible in delivery, as unexpected crisis can strike during the caring journey at any time (e.g. falls, hospital admissions, onset of new symptoms). Therefore, during the resourcing stage, we are not only preparing for the potential intensity of EMDR processing, but we may also be assisting unpaid carers to be able to manage with sudden breaks in processing/therapy.

Accessibility: Due to the nature of unpaid caring, it is well known that carers can find it difficult to access or attend services. This can be further compounded for unpaid carers of BAME/marginalised groups. Ehsan et al. (2025) document that British ethnic minorities are underrepresented in neuropsychological services, emphasising the need for timely and accurate provision and a person-centred approach to care that accommodates for cultural needs while also understanding clients and individuals beyond their ethnicity. Gaps have been noted across the overall service pathway and at individual stages, from initial access to diagnosis and treatment. This has implications for unpaid carers’ experience of services as well as access, something that ought to be explored during EMDR assessment and formulation stages. 

Age: We acknowledge that some neurodegenerative conditions, such as early-onset dementias, can strike in the prime of life, meaning that individuals may have young families with child carers. EMDR can also be offered to children and young people by appropriately qualified EMDR practitioners specifically trained to work with this age group.

Practical considerations and signposting: In the spirit of improving self-efficacy and resilience, it is vital to take a holistic approach by signposting the unpaid carer to relevant information or services that may help with other aspects of day-to-day caring and preparing for the future. For example, specialist third-sector organisations may offer detailed material on the nature of conditions and may be able to provide other practical or financial support as well as advocacy services. Doing this allows the carer to feel more empowered and for us as practitioners to be able to focus fully on delivering the intervention.  

Conclusion

The use of EMDR with unpaid carers caring for someone with dementia and other neurodegenerative conditions is still in its early stages and, to the best of our knowledge, is being underutilised with this client group. Trauma-informed approaches appear to be lagging in this under-researched area, which is surprising given the large worldwide projected increases in neurodegenerative conditions such as dementia in the future. It is therefore essential that we raise awareness of this client group and that qualified EMDR therapists can develop their skills to be able to confidently offer EMDR to unpaid carers of those living with neurodegenerative conditions.

While preliminary studies are promising, the body of research on EMDR for unpaid carers of neurodegenerative conditions is still developing. Further research with larger-scale studies, standardised diagnostic tools and long-term follow-ups is needed to confirm these findings and refine treatment protocols. It is also important for future research to incorporate lived experience voices to ensure interventions are client-informed.

Given the impacts of unpaid caring already outlined, especially the high levels of PTSD-related symptoms within this group, EMDR has a lot of potential in offering a reduction in distress. It is important that, as practitioners, we routinely measure and screen for trauma symptoms in those we identify as unpaid carers to ensure they get the right psychological support. EMDR can help with managing ongoing stress and building resilience, as well as provide an intervention for carer PTSD, prolonged grief, acute stress and carer burnout/compassion fatigue. The nature of EMDR lends itself to individual or group delivery, virtually or in-person, offering much-needed flexibility to this client group.

This not only benefits the individuals providing care, but also, in turn, those they care for, protecting the system of caregiving. Similarly, while not within the scope of this paper, it is worth mentioning that the person living with a neurodegenerative condition such as dementia may themselves benefit from EMDR intervention (Hutchins et al., 2025).

We encourage all practitioners to detect and identify unpaid carers within their caseloads and to consider EMDR as an intervention or to ensure they have access to EMDR through onward referral. EMDR may also complement any prior work undertaken in other modalities. EMDR with unpaid carers in this context could be viewed as a specialist intervention, which requires the practitioner and/or their clinical supervisor to have some understanding of the context and a broad knowledge of the EMDR protocol and associated techniques.