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Holding the frame: preventing model drift in EMDR practice in the context of expanding CPD
Holding the frame: preventing model drift in EMDR practice in the context of expanding CPD
By Deborah Kingston, Jonathan Hutchins, Simon Proudlock
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The proliferation of CPD options and integrative therapeutic approaches offers EMDR practitioners a rich landscape for growth. However, the increasing tendency for therapists to deviate from the standard eight-phase EMDR model, known as model drift, poses significant challenges to fidelity, effectiveness and the evidence base. This article examines why drift occurs and why it matters and proposes practical strategies for maintaining adherence to EMDR protocols while engaging with innovation.
Introduction
The field of EMDR therapy has evolved rapidly since its initial formulation (Shapiro, 1989, 2001; Laliotis & Shapiro, 2022). Contemporary practitioners have access to a vast array of CPD options, including workshops on ego state therapy, parts work, somatic approaches and narrative techniques. This expansion reflects a positive commitment to professional growth and clinical nuance. However, supervisors and consultants have observed a growing phenomenon of model drift, where therapists diverge, sometimes subtly, sometimes significantly, from the standard eight-phase EMDR protocol (EMDRIA, 2019; Maxfield & Hyer, 2002).
Understanding model drift
Model drift refers to the gradual deviation from established therapeutic protocols, often occurring without deliberate intent (Waltz et al., 1993). In EMDR, this may manifest as skipping or abbreviating phases, altering core procedures or integrating other therapeutic methods in ways that fundamentally displace the EMDR framework (Maxfield & Hyer, 2002).
Several factors contribute to drift:
- Enthusiastic integration: therapists may adopt new therapeutic modalities and weave them into EMDR without sufficient reflection on fidelity to the eight-phase, three-pronged model (EMDRIA, 2019; Shapiro, 2018).
- Confidence gaps: practitioners may feel less skilled in particular phases (e.g. phase 3 [assessment] or phases 4–6 [desensitisation, installation, body scan]), leading to premature modifications.
- Organisational pressures: service demands, time constraints and caseload pressures can push therapists towards shortcuts or condensed protocols (Valiente-Gómez et al., 2017).
- Conceptual uncertainty: some clinicians are unclear about the distinction between adaptations within the model and departures from it (EMDR Europe, 2019).
Dissociation, parts and complex presentations
An additional factor contributing to drift, particularly among less-experienced EMDR practitioners, is limited awareness of dissociation and parts work when working with clients presenting with complex PTSD. When EMDR therapy was first developed in the late 1980s and early 1990s, and even when Shapiro’s (2018) second edition was published, the ICD-11 diagnostic category of complex PTSD was still in development, only being finalised in 2018 (World Health Organization, 2018). As a result, early EMDR training and manuals were primarily focused on single-incident trauma presentations. In contrast, many contemporary EMDR clinicians work with individuals who have extensive histories of childhood adversity, chronic trauma and dissociative processes (Knipe, 2015; Van der Hart et al., 2006).
Dissociation and parts phenomena can emerge naturally during EMDR processing in clients with complex trauma histories, sometimes unexpectedly for novice therapists. Without a foundational understanding of how dissociation may present, and how to pace and sequence EMDR accordingly, therapists may inadvertently drift from the Standard Protocol in attempts to manage destabilisation or confusion in sessions (Knipe, 2015). This underscores the importance of embedding basic awareness of dissociation, ego states and parts work within EMDR basic training, not as a replacement for the eight-phase model but to enable therapists to recognise when adaptations in pacing, preparation or target selection are clinically indicated within the fidelity of the model.
Why fidelity matters
The effectiveness of EMDR is strongly tied to fidelity to the eight-phase model. Research consistently demonstrates that adherence to the standard eight-phase protocol predicts better client outcomes (Maxfield & Hyer, 2002; Karlin et al., 2010). Each phase of the model serves a distinct function; for example, thorough preparation in phase 2 establishes safety and stabilisation, while closure in phase 7 supports containment and integration between sessions (Shapiro, 2018).
Skipping or diluting key elements can have significant clinical consequences. Inadequate assessment may lead to poorly targeted reprocessing. Insufficient preparation increases the risk of abreactions or destabilisation and truncated closure can leave clients dysregulated between sessions (EMDRIA, 2019; Shapiro, 2018). From a research perspective, drift threatens the integrity of outcome data and undermines the evidence base underpinning EMDR’s inclusion in treatment guidelines (NICE, 2018; WHO, 2013).
Balancing innovation and fidelity
Complementary approaches can enrich EMDR practice when integrated thoughtfully. Many innovative methods can be integrated within the eight-phase structure rather than in place of it. For example, ego state interventions can enhance phase 2 preparation (Forgash & Copeley, 2008) and somatic tracking can deepen processing within phases 4–6 (Knipe, 2015). The key distinction lies in anchoring these adaptations within the EMDR procedural framework.
Strategies to prevent drift
Preventing model drift requires both individual reflection and systemic support. The following strategies may be helpful:
- Return to the manual: revisiting Shapiro’s original texts (2001, 2018) and current EMDR Europe/EMDRIA guidelines can clarify the rationale for each phase and reinforce procedural discipline.
- Supervision and consultation: regular consultation with EMDR consultants who emphasise fidelity supports accountability and reflective practice (Maxfield & Hyer, 2002).
- Keep the Standard Protocol worksheet in front of you at all times when working with clients. This can help us to keep fidelity to the model and know that we are asking the core questions of EMDR as Shapiro (2018) designed rather than skipping phases or embellishing the questions with our own spin on them, which can lead to drift from the model.
- When we learn something new from a CPD workshop, consider where this fits within the Standard Protocol, is this a phase 2 intervention or will it interfere with phases 3 and 4? If it is a method to enhance what we do, always consider our formulation of the client and whether or not the new approaches are needed or if the Standard Protocol may still work if given more time?
- Use of fidelity measures: structured fidelity checklists or adherence measures can provide objective anchors for clinical work (Waltz et al., 1993; Karlin et al., 2010).
- Thoughtful CPD selection: therapists should critically assess whether new CPD offerings complement or risk displacing core EMDR processes. Following attendance at CPD, integration of new learning should be discussed with the clinician’s own EMDR consultant.
- Community dialogue: encouraging open discussion about fidelity in peer groups and professional forums can normalise reflective practice around integration and adherence.
- Attendance at an EMDR refresher workshop facilitated by EMDR Europe accredited trainers.
Conclusion
Innovation and fidelity need not be opposing forces. EMDR’s strength lies in its structured, phase-based approach, which provides both safety and therapeutic power. By holding the EMDR frame firmly, therapists can integrate new learning in ways that enhance rather than dilute the model. Preventing model drift is a collective professional responsibility – one that safeguards both client outcomes and the integrity of EMDR as an evidence-based intervention.
References
EMDR Europe. (2019). EMDR Europe accredited practitioner competency-based framework: Algorithm version. EMDR Europe Association. https://www.emdr-europe.org/sites/default/files/2025-05/4.%20EMDR-Europe-Accredited-Practitioner-Algorithm-Version-DF30092019.pdf
EMDRIA. (2019). EMDRIA definition of EMDR. EMDR International Association. https://www.emdria.org/wp-content/uploads/2020/04/EMDRIADefinitionofEMDR.pdf
Forgash, C., & Copeley, M. (2008). Healing the heart of trauma and dissociation with EMDR and ego state therapy. Springer.
Karlin, B. E., Ruzek, J. I., Chard, K. M., Eftekhari, A., Monson, C. M., Hembree, E. A., et al. (2010). Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23(6), 663–673. https://doi.org/10.1002/jts.20588
Knipe, J. (2015). EMDR toolbox: theory and treatment of complex PTSD and dissociation. Springer.
Laliotis, D., & Shapiro, F. (2022). EMDR therapy for trauma-related disorders. In U. Schnyder & M. Cloitre (Eds.), Evidence based treatments for trauma-related psychological disorders: a practical guide for clinicians, 2nd ed., pp. 227–254. Springer. https://doi.org/10.1007/978-3-030-97802-0_11
Maxfield, L., & Hyer, L. (2002). The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology, 58(1), 23–41. https://doi.org/10.1002/jclp.1127
National Institute for Health and Care Excellence. (2018). Post-traumatic stress disorder NICE Guideline NG116. https://www.nice.org.uk/guidance/ng116
Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2(2), 199–223. https://doi.org/10.1002/jts.2490020207
Shapiro, F. (2001). Eye movement desensitization and reprocessing: basic principles, protocols, and procedures (2nd ed.). Guilford Press.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: basic principles, protocols, and procedures (3rd ed.). Guilford Press.
Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Pérez, V., & Amann, B. L. (2017). EMDR beyond PTSD: a systematic literature review. Frontiers in Psychology, 8, 1668. https://doi.org/10.3389/fpsyg.2017.01668
Van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: structural dissociation and the treatment of chronic traumatization. Norton.
Waltz, J., Addis, M. E., Koerner, K., & Jacobson, N. S. (1993). Testing the integrity of a psychotherapy protocol: assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61(4), 620–630. https://doi.org/10.1037//0022-006x.61.4.620
World Health Organization. (2013). Guidelines for the management of conditions specifically related to stress. World Health Organization.
World Health Organization. (2018). International Classification of Diseases 11th Revision (ICD-11)*. World Health Organization. https://icd.who.int/en
I have to say that this leading article in ETQ leaves me, as post-basic EMDR workshop leader and ai-EMDR enthusiast, with quite a b it of discomfort.
Much though I respect and like the authors, I have a number of problems with the argument, particularly around the term “model drift.” Let me explain.
I teach EMDR’s standard eight phases. I use them. I think the structure is what makes EMDR work, and I’ve seen what happens when a therapist skips preparation because they’re running behind, or targets something they haven’t properly assessed.
Targeting, the adaptive information processing model, structure, focus. Those are the fundamentals, and without them you’re doing something else and calling it EMDR. So this isn’t a plea for making it up as we go along.
But here is my question. Is it model drift to change the order in which I work through phase three? Is it model drift to leave out the positive cognition at that point, and come to it later, or differently?
I do and teach both of these things, deliberately, with reasons I can explain, and I teach why. I don’t think I’ve drifted anywhere. I think I’ve made a clinical judgement inside a structure I understand well.
Yet nothing in the article gives me a way of saying that.
It offers two boxes, adaptations within the model and departures from it, never tells us where the line falls, and never says who gets to draw it.
Jamie Marich wrote about this very term only last week, in a piece arguing that treating complex trauma with EMDR is nothing new. She says she cringes when she hears model drift used, in her phrase, in a shaming way towards those newer to EMDR, and that hearing it can leave people believing they don’t have permission to modify, or to put stabilisation and the relationship in the foreground.
That matches what I see. The phrase is intimidating and it is disempowering, and it does most of its damage to exactly the people who most need the confidence to think.
I did go and look at the research the article rests on, because the claim that fidelity predicts outcome is doing all the work in the piece and I wanted to know how solid it was.
Two sources are given. One of them, Karlin and colleagues, turns out to be about the rollout of two other therapies, cognitive processing therapy and prolonged exposure, across the American veterans’ health service. It isn’t about EMDR at all.
The other, Maxfield and Hyer, does find something real, but it’s a finding about published studies rather than about therapists: better-conducted trials, including those where fidelity was checked, reported larger effects.
That is worth knowing. It is not the same as showing that a clinician who follows every step more tightly gets better results with their clients.
Outside EMDR, people have looked at this properly. There’s a large recent review of adherence and competence across adult psychotherapy which found no reliable link between adherence on its own and how clients did, but did find one for competence, meaning the skill with which the work is delivered.
More interesting still, where anyone has found a shape to the adherence relationship, it isn’t a straight line going up. It curves.
Moderate adherence looked best, with both loose and very tight adherence doing worse.
I’m not going to pretend that settles anything. But an article telling us to hold the frame more tightly is arguing for one end of that curve, in the name of evidence, and I don’t think the evidence is on that end.
What troubles me most, though, isn’t the research. It’s the culture.
The EMDR establishment in Europe particularly has drifted, if I can use the word, into behaving like a regulator. Its instinct now is to police the boundary rather than to ask what’s happening at it.
There’s a lot of energy in this field at the moment, people trying things, noticing things, finding that something works and wanting to say so. A professional body could meet that with curiosity. Ours mostly meets it with a warning.
And it’s worth remembering that EMDR itself got here by exactly the process the article describes as a risk.
What Francine Shapiro was doing in 1989 is not what the eight phases became, and it changed again and again after that, largely because she kept changing it. A definition of drift that can’t tell that kind of development apart from carelessness isn’t yet a definition. It’s just a way of saying no.
So, three questions I’d genuinely like colleagues to take on.
Where does new clinical knowledge enter EMDR?
Who decides what counts as development rather than drift?
And what happens to the practitioner who finds something that works and says so out loud?
I’ve more overlap than not with the authors here, and I hold all the authors in high regard. But on the word itself, and on what it’s doing to us, I think we’re in quite different places.
Jamie Marich, “Treating Complex Trauma with EMDR is Nothing New”: https://jamiemarich.substack.com/p/treating-complex-trauma-with-emdr
The meta-analysis referred to is Power, N. et al. (2022), Associations between treatment adherence-competence-integrity and adult psychotherapy outcomes, Journal of Consulting and Clinical Psychology, 90(5), 427–445.
Thanks Mark. I think there is probably more agreement here than disagreement, but I also think we may be talking about slightly different things.
I have completed your ai-EMDR course, as well as child and adolescent EMDR training, so I absolutely understand that there are times when a developmental or attachment-based approach may be much more appropriate for the client in front of us. I am certainly not arguing that every client should receive EMDR in exactly the same way, or that thoughtful developments and adaptations amount to drift.
We are also not talking about ai-EMDR in this article. ai-EMDR has its own clearly articulated rationale and protocols.
What we are trying to gently draw attention to is something different: therapists moving between multiple interventions and models without a clear clinical rationale or case conceptualisation for why they are doing so.
I increasingly see this in supervision. Processing becomes difficult, so we add some parts work, then perhaps something somatic, then something from another model, then another intervention from the latest CPD course. Before long it can become a bit of a “kitchen sink” approach, without anyone being entirely clear about what the treatment plan is or where EMDR sits within it.
For me, that is very different from an experienced clinician saying: “Given this client’s developmental history, attachment experiences, dissociation or current presentation, I am deliberately adapting my approach in this way, and this is my clinical rationale.”
That is clinical thinking.
The intention of the article was never to shame innovation or discourage therapists from thinking. It was a gentle encouragement to remain curious about our own practice and ask: Why am I doing this? What is my case conceptualisation? Where does this intervention sit within the treatment plan? Is it enhancing the EMDR work, or have I inadvertently moved away from EMDR altogether?
And sometimes, particularly when we have accumulated lots of exciting CPD, the most useful thing may simply be to come back to EMDR, trust the process and give the model a little more time.