Note from the editor

By Dean Whybrow

Welcome to this Summer 2026 edition of EMDR Therapy Quarterly, which arrives with a strong sense of momentum, curiosity and shared purpose. Across the issue, EMDR is presented not as a fixed set of techniques, but as a developing field shaped by research, clinical reflection, supervision, inclusion and careful attention to the people and communities we serve. 

A clear theme is thoughtful expansion. Articles consider EMDR with people with learning disabilities, military and veteran populations, families, medical trauma presentations and wider communities who may not always have felt fully represented or included. These contributions remind us that adapting EMDR well means staying grounded in the model while listening closely to individual needs, context and lived experience. 

Accessibility and inclusion run throughout the edition. Reflections from specialist groups and committees highlight person-centred adaptations, supervision, shared learning, marginalisation, climate, bursaries and the ongoing work required to make participation possible for more members. They invite us to ask not only whether EMDR works, but who can access it, who feels welcome within it, and how we respond when barriers are named. 

The research content is equally rich. New member-voted research priorities sit alongside evidence summaries covering a wide range of presentations, including non-PTSD difficulties, perinatal mental health, neurodivergence, children and adolescents, depression, personality disorder, functional neurological disorder and mechanisms of change. The material on veterans and military personnel offers both encouragement and caution, pointing to promising findings while underlining the need for stronger, setting-specific studies. 

Several pieces focus on developing practice. Post-training support, model fidelity, CPD, bilateral stimulation adaptations and work with relational, medical and family trauma all speak to the same question: how do we keep learning while remaining anchored? The answers offered here are practical and reflective, emphasising confidence, humility, preparation, supervision and compassion. 

The European Conference report places this work within the wider international EMDR community, capturing the value of connection, accreditation, shared learning and UK-based research. It is a reminder that EMDR develops through conversation as much as through publication: through services testing ideas, practitioners reflecting honestly, researchers asking better questions and communities making space for more voices. 

Of note, we have updated the advertisement policy for the ETQ. We welcome relevant advertising in EMDR Therapy Quarterly. Adverts must be more than 50% related to EMDR and can now include CPD events or recruitment. ETQ reaches more than 4,000 EMDR practitioners. Adverts are £100 per quarter or £300 annually. For queries, contact editor@emdrassociation.org.uk. 

As always, we warmly welcome your responses, ideas and contributions for future editions. If you have practice reflections, service developments, research updates, conference reports or stories from the EMDR community to share, please get in touch. I hope this issue offers something useful, thought-provoking and encouraging for your practice, and that it strengthens our shared commitment to thoughtful, inclusive and well-supported EMDR. 

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Learning Disabilities Special Interest Group

By Joanne Porter

The inaugural Learning Disability EMDR SIG meeting took place in May and brought together colleagues with a range of clinical and EMDR experience, creating a warm and supportive atmosphere. Members heard an inspiring example of successful EMDR processing using the standard protocol, supported by a person-centred explanation of the AIP model described as a “librarian and a pile of messy papers”. We are grateful to the individual who permitted this example to be shared.

It was particularly encouraging to welcome several clinicians currently undertaking EMDR training. Discussion focused on identifying suitable cases during training and the opportunities for gaining experience with clients who do not have learning disabilities, while recognising that people with learning disabilities can also be included as training cases if relatively few adaptations are required. The group also reflected on the anxiety commonly experienced by newly trained EMDR practitioners and acknowledged that this is a normal part of learning EMDR, rather than something unique to clinicians working in learning disability services.

The meeting concluded with a brief discussion about the storytelling approach in EMDR and signposted members to Using Stories in EMDR (Logie et al., 2024), available through the Trauma Response Network.

July’s meeting attracted 23 attendees and generated lively discussion about adapting EMDR language for people with learning disabilities. Members favoured a person-centred approach in which adaptations are made according to individual need. Examples included providing additional scaffolding to support understanding of negative cognitions, using visual aids to distinguish between “then” and “now”, drawing target images, and adapting SUD and VoC scales. Members also noted that many adaptations used with children and people with complex PTSD are particularly helpful when working with people with learning disabilities.

The final discussion explored members’ experiences of EMDR supervision. Most members received group supervision from consultants with child or adult mental health backgrounds, often alongside colleagues from mainstream services. A smaller number attended supervision with their EMDR-trained learning disability colleagues, while very few had access to supervisors with a learning disability background. Members were generally positive about the quality of supervision available to them, and there was strong interest in developing greater access to supervisors with learning disability experience.

Finally, Dr Jo Porter, Dr Emma Stevens and Dr Emma Hignett announced that they are currently writing a book on adapting EMDR for people with learning disabilities, which is expected to be published in late 2026. The next meeting will be 21^st September at 6pm. Email learningdisabilitiessig@emdrassociation.org.uk if you wish to come along.

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Update from the Equality, Diversity and Inclusion (EDI) Committee

By Heena Chudasama

We’ve had a very warm welcome to summer this year. As temperatures soar and the climate continues to change, we are all faced with new challenges. For the first time, I have come across a series of emails within the EMDR community about managing the heat in the UK. Times are changing, and we in the UK are not set up for a climate that is likely to continue on this trajectory year after year. Extreme weather can disproportionately affect marginalised and vulnerable people in society and globally.

EDI committee member news

Following our recent recruitment drive, we received some wonderful and passionate applications. We are delighted to welcome Gabriel Best, Davis Deen, William Fley and Claire Layhe to the EDI Committee.

As a reminder, the other members of the EDI Committee are: Emma Mullins Crocker (Chair), Heena Chudasama, Aisha Docrat, Kathryn Gough, Russ Hurn, Louise MacKinney and Taffy Tapfuma.

Both current and new members of the Committee bring their own lived experiences, alongside experience of working with people from both privileged and marginalised backgrounds in a variety of contexts. We reflect on and recognise our own experiences of privilege and marginalisation, as well as our positionality in different settings.

As a committee, we share a strong commitment to advocacy, growth, development and positive change. Members are encouraged to reach out to any Committee member to share their voice, experiences and perspectives.

A Multimedia Approach and Having a Voice

As you are aware, the Association is committed to a multimedia approach to both supporting and listening to our membership. The EDI Committee continues to source and deliver content with a particular focus on working with marginalised and underserved groups, adapting and developing EMDR practice.

If you are an EMDR therapist, practitioner, consultant, or trainer and would like to contribute, we would be delighted to hear from you.

Please reach out to:

• Dean Whybrow – ETQ contributions or publication ideas
• Heena Chudasama – ‘Extraordinary Stories’ for the ETQ (see below), webinar and conference contributions
• Aisha Docrat– Webinar contributions
• Russ Hurn – ‘Extraordinary stories’ and other podcast ideas

We welcome your suggestions for conference topics and speakers related to Equality, Diversity, Inclusion, and Social Justice.

Extraordinary Stories

The EDI Committee would love to hear about your work—or from clients who may wish to share their extraordinary stories- contributions can take the form of podcasts or written pieces for the ETQ.

We are actively seeking interviews to help amplify lived experiences and share stories of how EMDR is being used around the world. Our approach is intentionally collaborative and co‑produced.

Extraordinary Stories Podcast Series:
https://emdrassociationukpresentsemdrextraordinarystories.buzzsprout.com

Please contact us if you are interested in being involved or have a story to share.

Bursary to standard and child and adolescent EMDR training

The Association has agreed to offer some bursaries to support access to standard EMDR training, Child and Adolescent EMDR training, relevant books and clinical supervision. This is now with the operations team to execute a pathway to delivery. 

Awareness Days

We aim to work with Special Interest Groups (SIGs) and Regional Groups (RGs) to highlight awareness days and months. Aisha Docrat will be leading this work. While we may not be able to promote every event, highlighted topics will be rotated.

For queries, please contact Emma Mullins Crocker. Katy Bell will also continue to support and promote the work in this area.

Accessible Answerphone

To increase accessibility, the Association’s answerphone has been live since May 2023.

Accessible Answerphone: 0151 372 6802
This service is available for members who are unable to email. Please note it is not monitored at weekends or during holiday periods, and responses may take a few days.

If possible, please email:
admin@emdrassociation.org.uk

Reasonable adjustments and mitigating circumstances are available to members. Please contact admin to be directed to the appropriate person.

Heena Chudasama

HChudasama@emdrassociation.org.uk

EDI Committee Past Chairperson

EDI committee member

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Scientific and Research Committee (SRC) update – July 2026

By Anthea Sutton

Research Priorities

We are pleased to announce the top research priorities, as voted for by the EMDR UK association members:

• EMDR to treat trauma in non-PTSD mental health conditions
• Cost effectiveness of EMDR compared to CBT for any condition but especially PTSD
• EMDR to treat trauma in neurodivergent populations
• EMDR for anxiety disorders
• RCTs of EMDR for long term or treatment resistant depression
• Randomised controlled trials (RCTs) of EMDR for combat/military related PTSD
• EMDR for personality disorder (complex trauma/ cPTSD)
• RCTs of EMDR for PTSD in children and adolescents
• EMDR to treat perinatal mental health conditions
• Mechanisms of change in EMDR (e.g. memory reconsolidation, attachment-informed, and relational–neurobiological processes

The prioritisation exercise was undertaken by the Scientific and Research Committee in consultation with the membership, via an online poll which was launched at the 2026 annual conference in Bristol.  Over 300 responses were received.  The priorities will inform our new research strategy for 2026 and beyond. The EMDR UK Association is keen to support all rigorous and ethically sound research even if it is not on the priorities list. Researchers, academics, and clinicians can contact the scientific and research committee on researchofficer@emdrassociation.org.uk with questions, queries, or access to populations with EMDR experiences.  

Annual Conference

We are delighted to see that research presented as a poster at the 2026 conference is now a publication in the European Journal of Psychotraumatology.  Dr Leeanne Nicholls at the School of Psychology, University of Southampton, and colleagues conducted a Delphi study to establish practitioner consensus on adaptations to enhance the accessibility and effectiveness of EMDR for trauma in individuals with bipolar disorder.  You can read the full article here.

Looking ahead to 2027, the annual conference will take place in London on the 12^th and 13^th March, further details here: https://emdrassociation.org.uk/event/emdr-uk-annual-hybrid-conference-agm-2027/ We will shortly be opening an abstracts call for posters and research presentations so please watch this space.  If you wish to express your interest in submitting and to be alerted when the call opens, please email Anthea Sutton, Research and Academic Liaison, at a.sutton@emdrassociation.org.uk

New Research

The EMDR Publications Database has been updated in July 2026, you can read all about the latest research here [link].  If you have not done so already, you can access the database with your EMDR UK membership, see the “Member Resources” section when you login to the members area of the EMDR UK website.  If you have any queries about accessing or finding your way around the database, please email: emdrdatabase@sheffield.ac.uk

Evidence Briefing on EMDR with veterans and military personnel

Using the EMDR Publications Database, we have collated the current evidence base on EMDR with veterans and military personnel; you can read it in this issue of ETQ here [link].

Committee Membership

And finally, we are pleased to welcome new members Dr Ashia Begum and Dr Mani Mehdikhani to the Scientific and Research Committee. We also say farewell to Dr Oenone Dudley who has stepped down from the SRC.  Oenone joined the committee in 2024, and we would like to thank her for her time and input over the last two years.

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EMDR Publications Database

By Anthea Sutton

A selected summary of recent research added to the EMDR Publications Database

Systematic reviews and meta-analyses

Evidence for treating non-PTSD mental health conditions continues to grow. A meta-analysis and systematic review of the effectiveness of trauma-focused interventions for individuals with psychosis, including EMDR, found that EMDR significantly reduced PTSD symptoms both post-treatment and at a six-month follow-up compared with treatment-as-usual (Mason et al. 2026). Furthermore, EMDR was noted for its potential to reduce positive psychotic symptoms immediately following treatment, but the effect was not sustained at 6-month follow-up.  A mixed-methods systematic review highlights the role of mental imagery in body dysmorphic disorder (BDD), suggesting that imagery-based interventions like EMDR appear to be both feasible and clinically relevant for addressing the intrusive, vivid imagery characteristic of the condition (Hill et al. 2026). For perinatal mental health, a scoping review of EMDR for birth trauma (O’Donovan et al. 2026) found the therapy to be a promising intervention, though researchers emphasised the need for more diverse samples and long-term data.

Regarding collective trauma, a meta-analysis of the Group Traumatic Episode Protocol (Dalkilinc & Satici, 2026) demonstrated a large effect size in reducing PTSD symptoms, supporting its use as a feasible and effective intervention after disasters or social violence.

Randomised controlled trials (RCTs) and feasibility studies

Two RCTs focus on PTSD in children and/or adolescents. The “KIEM study,” a three-arm RCT (Velu et al. 2026), found that both EMDR and KIDNET significantly reduced PTSD symptoms in refugee minors compared to a waitlist control. Notably, EMDR showed a significantly greater reduction in clinician-rated PTSD symptom severity than KIDNET. Another study focusing on adolescents indicated that, while group-based EMDR is perceived as more feasible by those with higher resilience,  adolescents with higher levels of post-traumatic stress reported lower feasibility scores.  Key barriers included emotional dysregulation, confidentiality concerns, and scheduling difficulties.  The authors recommend that psychoeducational preparation, logistical flexibility, and attention to emotional safety are essential to support adolescent engagement in post-disaster mental health interventions (Cokluck 2026).

An RCT involving patients with major depressive disorder (Behnammoghadam et al. 2026) found that EMDR significantly reduced internalised stigma compared to standard treatment, with benefits maintained at a three-month follow-up. A feasibility RCT investigating the combination of Dialectical Behavioural Therapy Skills Training and EMDR for patients with comorbid borderline personality disorder and psychological trauma found that the integrated approach significantly reduced dissociative symptoms from baseline to post-phase 2 (Soler et al. 2026).  The authors recommend that a fully powered RCT is conducted to confirm the findings.

Comparisons between EMDR and CBT also featured in this latest database update. A trial with earthquake survivors in Turkey (Cinaroglu et al. 2026) found that remotely delivered EMDR and CBT both produced large reductions in PTSD symptoms (compared with a wait-list control group) and moderate-to-large improvements in depression and anxiety, with EMDR showing a tendency toward greater reduction in core PTSD symptoms.

In patients with co-occurring substance use disorders (SUD) and PTSD, a trial comparing simultaneous and sequential delivery found that adding EMDR to SUD treatment improved several psychosocial outcomes at 3-month follow-up and that simultaneous delivery of treatment provided faster benefits (Faber et al. 2026).

UK-Based Research

Several recent additions to the database are UK-specific evidence, covering diverse populations and conditions:

• Healthcare Workers and COVID-19: A study by Barron et al (2026) was conducted with 62 healthcare workers who sought support from the Trauma Response Network UK (the national EMDR response to mass trauma) during the first six months of the pandemic. The research found that while these professionals reported high levels of PTSD and depression, they also experienced moderate posttraumatic growth (PTG). Greater PTG was associated with higher resilience and lower PTSD.
• Bipolar Disorder: Utilising a Delphi method, Nicholls et al. (2026) established expert consensus on how EMDR can be best adapted for trauma-focused work within bipolar disorder.
• Functional Neurological Disorder (FND): Participants in the UK-based MODIFI RCT evaluating the feasibility of using EMDR for people with FND, shared their experiences of diagnosis and care. Qualitative findings by Pritomanova et al. (2026) emphasised the need for personalised, compassionate care and increased service provision for those navigating life with FND.
• Older Adults: A qualitative thesis by Blackford-Jones (2025) involved clinicians from two NHS trusts to explore EMDR for older adults. The study identified key themes in adapting the eight-phase protocol to meet the specific cognitive and emotional needs of later life.

Neurodivergent Populations

New research evaluated the EMDR storytelling method for adults with severe intellectual disabilities and PTSD (Hoogstad et al. 2026), showing significant reductions in PTSD symptoms and dysfunctional behaviours immediately after EMDR therapy and at three-month follow-up at group level.  At individual level reductions in PTSD symptoms were observed in most participants, whereas results for dysfunctional behaviours were mixed.  The authors conclude that the study provides preliminary support for the safety, suitability, and potential efficacy of the EMDR storytelling method in reducing PTSD symptoms for this population.

Mechanisms of Change

Two new doctoral dissertations exploring the mechanisms of change.  A grounded theory study on EMDR therapists’ use of empathic attunement, describes it as a bidirectional psychophysiological process where therapists use client cues to pace processing and adjust bilateral stimulation (Herman 2026). A dissertation on scene construction ability in PTSD across adolescence and adulthood (Marlette 2026) suggests that lateral eye movements may equalise fixation rates while reducing the subjective quality of distressing imagery, providing insight into the therapeutic mechanisms of EMDR.

Additional Research

Research into anxiety disorders extended to performance-related issues. A case series demonstrated that EMDR was effective in reducing test-taking anxiety among obstetrics and gynaecology residents with poor performance in the United States, leading to improved scores on qualifying board exams (DeCesare et al. 2026).

A doctoral dissertation conducting qualitative research into virtual delivery of the eight-stage protocol for complex trauma found that relational attunement can be effectively maintained in a remote setting (Ramirez 2026).

What else has been added to the database this quarter?

The most recent update to the database was in July 2026, when 47 new publications were added. Newly added publications can be easily viewed by clicking on the ‘NEW’ tag. Within the NEW tag, you can then select further tags of interest to see what has recently been added for specific topics and research types. Table 1 provides an overview of the topics and study designs added to the database this quarter. Please note that topic areas are not mutually exclusive; some publications may appear in more than one category.

Table 1: New research by topic and study design

How we populate the database (methods)

The EMDR Publications Database is developed collaboratively with the Sheffield Centre for Health and Related Research and is provided as a free resource for Association members. If you have not yet accessed this useful resource, you can find out how to do so in the members’ area of the EMDR UK website.

The EMDR Publications Database is a collection of peer-reviewed research and dissertations/theses focusing on EMDR. It contains over 2000 references, many of which have access to the full text. The references are categorised by ‘tags’ (keywords) relating to the clinical area and study type, allowing for easy browsing. The database can also be searched using specific terms of interest.

Searches to populate the database are conducted on the following international databases: MEDLINE, Embase, PsycINFO, ProQuest Dissertations & Theses, and PTSDpubs.

The next update of the publications database will be in October 2026 but, in the meantime, if you have any queries or comments, you are welcome to get in touch at: a.sutton@emdrassociation.org.uk.

If you are an EMDR UK member and wish to request access to the database, please email the team at the University of Sheffield: emdrdatabase@sheffield.ac.ukDisclaimer: this update reports study findings only; the research included in the database has not been assessed for quality and we recommend that evidence users make their own assessment before applying recommendations into practice. You can find out more about critical appraisal of research here: EMDR UK Association research webinars: Developing critical analytic skills – EMDR Therapy Quarterly

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EMDR in military/veteran populations with combat-related PTSD

By Anthea Sutton

Research briefing based on literature searches conducted in July 2026

What is the current evidence?

In military/veteran populations with combat-related trauma, the evidence on EMDR from randomised controlled trials (RCTs) is sparse and heterogeneous.  A military-focused meta-analysis from Kitchiner et al. (2019) found no statistically significant benefit for EMDR compared with waitlist/usual care (based on four small RCTs). Larger mixed-population meta-analyses exist but these studies are civilian focused and do not stratify results to allow for isolation of any military/veteran data.

A 2025 retrospective study provides new data regarding EMDR delivery to veterans in US Department of Veterans Affairs (VA) settings (Fairbanks et al. 2025). The study aimed to evaluate the effectiveness of EMDR among veterans and compare outcomes between in-person and telehealth modalities and included 279 veterans in its analysis. The work was supported by resources and facilities at multiple VA medical centres and healthcare systems across the United States.

Another US study by Lancaster et al. (2025) provides real-world data on treatment outcomes for military-affiliated clients, including veterans, active-duty service members and their adult family members, receiving care in a community mental health network (outside VA/US Department of Defense settings). The study examined the effectiveness of cognitive processing therapy (CPT), EMDR, and prolonged exposure (PE) using the PTSD Checklist for DSM-5 (PCL-5)(Department of Veterans Affairs 2025) measures throughout treatment. In this study of 2717 participants, 554 began EMDR treatment.

A 2025 retrospective cohort study from the Netherlands by Reij et al. (2025) examined changes in PTSD symptoms and diagnostic status after a brief intensive trauma-focused treatment programme (integrating prolonged exposure, EMDR therapy, psychoeducation, and physical activities) for 43 veterans and 43 matched non-veterans with war-related PTSD.

What are the key messages from the current evidence base?

• Based on Kitchiner et al.’s 2019 meta-analysis, RCT evidence directly in military/veteran samples is limited, with small, older EMDR trials and wide confidence intervals. Pooled EMDR compared with waitlist/usual care effects were not statistically significant in the existing military/veterans synthesis (Kitchiner et al. 2019).
• The 2025 VA retrospective study (USA) suggests that EMDR is an effective treatment for PTSD in veterans, showing a large effect size for PTSD symptoms and a medium effect size for depression symptoms. Both the telehealth and in-person modalities generally yielded similar outcomes in treatment completion and rates of clinical improvement. (Fairbanks et al. 2025)
• The outcomes for EMDR in the Lancaster et al. study (2025) delivered in a community mental health setting (USA) demonstrated large effect sizes, comparable to those of prolonged exposure and cognitive processing therapy,but the authors note that this finding is not consistent in military populations, according to the evidence, citing Kitchiner et al.’s systematic review (Kitchiner et al. 2019).
• Data from the Reij et al. Netherlands study, which used a brief intensive trauma-focused treatment programme including EMDR found moderate evidence that there is no difference between veterans and non-veterans in terms of loss of diagnostic status after treatment (74.4% for veterans and 76.7% for non-veterans). (Reij et al. 2025)
• Military-specific data on remission rates, functional recovery, suicidality/adverse events, and return to duty are largely absent in the existing literature. (Carlson et al. 1998; Fairbanks et al. 2025; Frappell-Cooke et al. 2019 ; Jones et al. 2020 ; Kitchiner et al. 2012, 2019; Lancaster et al. 2025; Reij et al. 2025)
• UK military-specific outcome data for EMDR is currently descriptive rather than trial based (Frappell-Cooke et al. 2019; Kitchiner et al. 2012).

What are the research gaps?

• Acute/early intervention and prevention in combat settings: There are currently no EMDR RCTs specific to recent combat exposure or early intervention in military cohorts.
• Head-to-head comparisons in military and veteran populations: There is a lack of adequately powered RCTs directly comparing the effectiveness of EMDR with other interventions in military and veteran populations. Existing studies are limited in number and often lack standardised outcome measures, making it difficult to draw definitive conclusions about comparative efficacy in these settings. (Kitchiner et al. 2019) However, the Lancaster et al. (2025) real-world study indicates comparable outcomes for EMDR compared with CPT and PE when administered to ‘military-affiliated clients’ in community settings.
• Critical Outcomes: Remission, functioning/quality of life, suicidality, serious adverse events, and return to duty are largely unreported in the existing military/veterans EMDR studies.
• Setting-level stratification: In the published RCTs evaluating the effectiveness of EMDR, there is no analysis that separates or compares results based on the setting, such as whether the study was done in the US Department of Veterans Affairs or Department of Defense, compared with non-US or specifically UK military or veteran healthcare systems.

Methods: Undermind AI was used to initially collate and summarise the evidence. Searches of the EMDR Research Publications Database, checking and editing of the evidence summary was conducted by Anthea Sutton, Research and Academic Liaison, EMDR UK.

Please note: this briefing reports study findings only; the research included has not been assessed for quality. We recommend that evidence users assess the evidence in the studies before applying recommendations in practice. You can find out more about critical appraisal of research in: EMDR UK Association research webinars: Developing critical analytic skills. EMDR Therapy Quarterly, Winter 2025.

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Practice observation and developing skills “PODS” in EMDR: a service evaluation

By Aimee Kidd

Acknowledgement – Simpson, C., McGlanaghy, E., McAuslan, L. 

Introduction

EMDR is a therapeutic approach designed to support individuals who have experienced traumatic or distressing events. It can help alleviate symptoms such as flashbacks, intrusive thoughts or images, mood disturbances and anxiety (Shapiro, 1989). The National Institute for Health and Care Excellence (NICE) recommends EMDR as an effective treatment for PTSD (NICE, 2018).

The EMDR Association UK (2019) recommends a minimum of one hour per month of individual supervision or two hours per month of group supervision (in a group of no more than six supervisees). An ‘SOS’ facility is also encouraged, whereby the supervisor can be contacted between supervision sessions for brief consultation. This supervision should be carried out by an EMDR consultant. Currently, within Forth Valley Health Board, these recommendations are unable to be fully met. There is only one EMDR consultant within the service who is responsible for the supervision of two accredited practitioners and consultants in training, several qualified therapists working toward accreditation and a number in practice who are not currently working towards accreditation.

EMDR in the context of an NHS health board adult psychological therapy service

A substantial and growing demand for psychological therapy, particularly among individuals presenting with PTSD and complex PTSD, has been observed within the service. Additionally, therapists trained in EMDR frequently prefer to use EMDR to treat complex PTSD, despite trauma-focused cognitive behavioural therapy also being an evidence-based treatment option for this population (NICE, 2018). Findings from a recent focus group conducted within the service revealed that most dual trained (EMDR/CBT) therapists expressed a strong preference for EMDR in their clinical practice.

The constraint of having one EMDR consultant across the health board limits EMDR supervision capacity and poses challenges to maintaining therapist competency and fidelity to the modal. These findings demonstrate a clear need to support and scaffold EMDR supervision provision to support therapist competency and service capacity, thereby improving timely access to effective trauma treatment for patients and improved outcomes.

Introduction to the EMDR PODS programme

A mixed-methods systematic review by Hammond et al. (2023) found that many therapists experience challenges when integrating EMDR into their practice. These challenges include a lack of confidence in their EMDR skills and anxiety about practising the therapy safely and effectively. The study emphasises the importance of organisational support and effective supervision in facilitating the adoption of EMDR by clinicians. Hammond et al. (2023) found that despite completing training, many reported feeling uncertain about applying the methodology in real-world settings. This lack of confidence can hinder clinicians’ ability to deliver effective therapy and fully integrate EMDR into their practice.

Challenges faced by newly trained EMDR therapists

Newly trained EMDR practitioners often encounter several clinical implementation issues. Many clinicians who train in EMDR experience difficulties in real world translation. Bernard (2023) emphasises the value of a staged and process-oriented approach to delivering and learning EMDR. However, EMDR training often focuses on client populations that differ significantly from those typically seen in NHS clinical settings. One UK mixed-methods study found that approximately 40% of therapists, particularly those from analytic or humanistic orientations, reported significant challenges in integrating EMDR into their practice (Dunne & Farrell, 2011). The structured phases, specialised terminology and technical procedures of EMDR can also lead to cognitive overload for new therapists.

The interval between initial EMDR training and attaining proficiency underscores the necessity for structured and supportive avenues for skill development. Without adequate supervision focusing on content and skills, newly trained practitioners may experience decreased retention rates. Effective supervision has been linked to increased job satisfaction and retention among therapists (Rothwell et al., 2021). In the context of EMDR therapy, adherence to the Standard Protocol is crucial, and supervision plays a vital role in ensuring this fidelity. Studies have indicated that EMDR therapists who have achieved accreditation, often through comprehensive supervision, report better treatment outcomes compared with those without accreditation (Logie, 2022). Clinicians who continue to use EMDR reported that they did so because of its effectiveness and the continuing consultation they received (Grimmett & Galvin, 2015).

A common constraint for practitioners where group supervision is offered is the limited time available in supervision sessions. Supervision often focuses on basic process or client-related concerns, leaving limited opportunity for deeper skill development in EMDR case conceptualisation and model application. Practitioners frequently bring repeated questions to supervision, suggesting the need for consistent, targeted support. While these questions demonstrate a desire to deepen understanding, they can take up time in the group when only one EMDR consultant is available to address the needs of multiple practitioners in the health board or trust.

To close the gap between novice and mastery, the EMDR consultant secured management and leadership approval to engage three highly experienced practitioners in exploring effective strategies to build confidence and competence in EMDR skills. This led to the development of a structured support mechanism, the EMDR Practice Observation and Development of Skills (PODS) programme, a collaborative and efficient approach to skills building. This model addresses key practitioner concerns, optimises supervision time and fosters learning and growth, ensuring that newly qualified practitioners feel confident in integrating EMDR and delivering better patient outcomes.

The EMDR Association UK commits itself to regulating and reviewing the EMDR accreditation process, supporting the clinical development of practitioners and upholding the highest standards of practice, which will in turn benefit EMDR therapy for the public. The cornerstone to achieving this is strengthening members’ knowledge, skills and professionalism through learning opportunities, access to resources and active participation in specialist groups and professional development forums. The implementation of the PODS post-basic training initiative would serve as a valuable tool in advancing the EMDR Association’s objectives by offering structured support, continuing education and a platform for practitioners to refine their expertise and maintain best practices in the field.

Methods

PODS sessions were held every six weeks over a 12-month period. Having group skills training every six weeks allows therapists extended time to apply learning in practice, reflect on group facilitation experiences and return with meaningful questions and case examples, thus enhancing integration of theory with real-world application (Powell, 2019). Furthermore, spacing learning over time can reduce cognitive overload and enhance deeper processing, retention, and transfer of learning (Carpenter et al., 2022; Wang et al.,2014) . It may also increase accessibility for participants managing busy clinical workloads or personal commitments, while supporting CPD (Lopez et al., 2022).  Allowing time between training sessions enables therapists to apply newly acquired skills in practice, reflect on their experiences, and return with clinical examples for discussion. Such cycles of application, reflection, feedback, and refinement are consistent with contemporary models of clinical supervision and deliberate practice that emphasise active learner engagement and responsibility for ongoing professional development (Rosén, 2025; Sacks, 2025).

Two of the PODS programmes were held online via Microsoft Teams. Online group training offers increased accessibility, flexibility and cost-effectiveness, allowing participants to attend sessions regardless of geographical barriers (Inchausti et al., 2020). In this case, participants were able to join from different NHS sites. Online platforms can enhance opportunities for observing diverse facilitation styles across sites, fostering exposure to various group dynamics (Lopez et al., 2022). Studies indicate that online training can maintain comparable satisfaction and perceived learning outcomes as face-to-face training, particularly when using interactive methods such as role play (Feijt et al., 2020). Additionally, online settings may reduce participant anxiety during practice-based activities, creating a psychologically safe environment conducive to skill acquisition (Reilly et al., 2021).

Despite its accessibility, online group training can limit the richness of non-verbal communication, making it harder for participants to observe and respond to subtle group processes and emotional cues (Humer et al., 2020). The lack of shared physical space may hinder the development of group cohesion among participants, potentially impacting the effectiveness of training in managing group dynamics and complex interpersonal interactions (Békés & Aafjes-van Doorn, 2020). One of the PODS groups was held in person and onsite. In-person training offers direct engagement with group processes, allowing participants to develop sensitivity to non-verbal cues, in-the-moment emotional shifts and the group energy essential for effective group facilitation (Powell, 2019). The physical environment can influence the development of group cohesion by creating a sense of safety, comfort, and interpersonal connection. A supportive group setting may facilitate greater participation, trust, and interpersonal learning, thereby enhancing relational learning among group members (Yalom & Leszcz, 2020)In-person roleplays and live supervision provide immediate, embodied feedback, facilitating reflective practice and skills generalisation in a context closely resembling real-world settings (Räuchle J., et al 2025).

 However, in person training may be less accessible for participants with geographical, financial or caregiving constraints, limiting the diversity of participants, (Inchausti et al., 2020). It typically requires higher logistical investment from both participants and the service, including travel, venue and accommodation (Feijt et al., 2020). In-person settings may also increase performance anxiety during experiential exercises, potentially hindering learning for some participants who require a psychologically safer distance to practice new skills (Reilly et al., 2021).

Three highly experienced EMDR nurse practitioners within the service were chosen to facilitate the first cohort of PODS groups while being supervised by the EMDR consultant on a six-weekly basis. All PODS leads were experienced supervisors, having undertaken the NHS Education Scotland Generic Supervision Certificate in Psychological Therapies and Intervention. They were all trained by a long-established approved training provider within a short period of each other, giving the advantage of consistent information being offered to participants. They had over 10 years’ experience in EMDR delivery and attending consultant-led supervision. EMDR was highly integrated within their regular practice, across a diverse and complex clinical caseload. The PODS leads met frequently to discuss progress.

Eleven participants were invited to attend the PODS programme, based on their being newly qualified to EMDR or having not used EMDR frequently in their practice and so needing to refresh their knowledge. Participants were from the wider psychological therapy service and included psychologists, nurse psychotherapists and psychological therapists. Criteria for inclusion/exclusion are listed in Table 1. Ten participants completed the PODS programme. Written consent was obtained from all participants to use their data.

Table 1: Criteria for inclusion/exclusion

Measures and aims

The self-reported evaluation form (Appendix 1) and structure of the groups were aligned with the core competencies for EMDR, ensuring that the content focused on the practical and clinical skills required for effective delivery. Participants were asked to complete the evaluation form at the beginning of their PODS journey to establish a self-reported baseline, and at the end. This allowed us to measure changes in their competence and confidence in delivering EMDR. As the primary aim of the group was to increase therapist competence and confidence in using EMDR and achieve optimal patient outcomes, it was deemed appropriate to evaluate progress specifically against the eight-phase protocol framework. This approach allowed for targeted identification of development areas while ensuring alignment with best practice standards in EMDR delivery.

The PODS programme was primarily set up for recently trained EMDR therapists; however, we recognised that therapists’ who had not used EMDR in their practice for a period would also benefit. The importance of supervision and skills training when returning to using psychological therapy, especially after a break, is significant for several reasons. These practices are essential for maintaining ethical, effective and evidence-based therapy. Supervision and training help clinicians to refresh and update their knowledge and skills. Returning therapists may experience self-doubt or anxiety about their competence. Skills training and supervision provide reassurance and structured support. Returning to psychological therapy without updated training and supervision is a risk to both practitioner and patient. Supervision and skills training ensure that therapists are safe, confident, ethical and effective in their work, which benefits client care and therapist wellbeing, (Lohani & Sharma, 2022; Rothwell et al., 2021). These studies collectively affirm that supervision and skills training are vital for therapists re-entering practice, ensuring that they provide competent, ethical and effective care.

Several academic studies from the past decade highlight the benefits of using evaluation forms and competency measures in psychological therapy training and supervision. These tools are instrumental in assessing therapist development, ensuring effective practice and enhancing client outcomes (Liness et al., 2019; Gonsalvez & Crowe, 2014; Barlow & Brown, 2020).

The self-reported evaluation forms were administered during both the first and last session to assess any changes in skill competency levels over the course of the PODS programme engagement. This approach allowed for a comparative analysis of participants’ self-reported abilities at the outset and conclusion of the groups, providing a measurable indication of skill development and the effectiveness of the intervention in enhancing EMDR skills. Each competency was measured on a scale of 1–5 (Table 2) and totals for each phase of the protocol are different, depending on how many competencies are included (Table 3). Participants were asked to assess themselves using the statement that fitted them best for each competency.

Table 2: Self-reported evaluation form scale

For the purposes of quantitative analysis, a 70% threshold was selected to indicate improvement, reflecting common practice in medical and psychological training where moderate cutoffs are used to denote basic competence. In this context, a 70% performance benchmark for EMDR competency assessment should be understood as a pragmatic standard aligned with broader clinical competency frameworks (Saigí Rubió et al., 2024; McCrossan et al., 2022), rather than one derived from any specific EMDR-based theoretical rationale.

Competency-based clinical guidelines, such as those issued by the American Psychological Association (2025) emphasise the importance of setting clear minimum competence criteria to ensure safe and ethical trauma related practice, reflecting how mid-range thresholds commonly function in regulating practitioner readiness. Within EMDR specifically, a 70% threshold aligns with the structured, developmental nature of training that emphasises progressive acquisition of protocol fidelity and attunement skills. EMDR’s foundation in the adaptive information processing model requires clinicians to demonstrate consistent application of core procedures but early career practitioners are not expected to reach full mastery before being judged minimally competent. A 70% standard appropriately acknowledges the steep learning curve involved while encouraging the continued professional growth necessary to achieve mastery over time (Wright et al., 2024).

Participants completed a structured feedback survey to obtain qualitative information on the effectiveness, usability and overall experience of the PODS programme. Ethical approval was not required as this was a service evaluation project. It was registered with the health board’s quality improvement department.

Table 3: Participants scores (and percentage) for each phase

Completed pre- and post-data were available for 7 of the 11 participants in the PODS programme. One additional participant left during the programme, while three failed to complete the post-group evaluation.

Table 3 presents participants’ scores and corresponding percentages for each competency across the phases. With the competency threshold set at 70%, four participants had already met or exceeded this benchmark before they undertook the PODS training, while three participants scored below the threshold before PODS engagement. Variability within the results may be attributed to factors such as the timing of participants’ training, the companies with whom they trained and the extent to which the training had been implemented between course completion and entry into a PODS group. Participant 1 scored marginally above the threshold in seven phases pre-PODS training; however, following participation, the scores increased across all phases, ranging from 82% to 100%. Participant 2 exceeded the threshold in all eight phases at baseline, with post-PODS programme scores increasing further to above 80% in every phase. Participant 3 met the threshold in five of the eight competencies; post-programme scores remained unchanged for the closure phase and decreased by 1 point in the evaluation phase, which perhaps may be indicative of an inflated competence phenomenon (Probst et al., 2022). Participant 4 exceeded the threshold in only three phases before participation yet achieved scores above the threshold in all phases post-PODS training, which represented the greatest overall improvement. Participant 5 scored just above the threshold in all eight phases pre-PODS training, with post-PODS scores increasing substantially to 89–100%. Similarly, participant 6 scored marginally above the threshold across all phases prior to PODS programme engagement, with post-programme improvements evident, including two phases reaching 100%. Participant 7 demonstrated the highest pre-PODS programme performance, achieving 100% in four phases; following programme participation, the remaining four phases also increased to 100%.

These scores show that while participants entering the PODS programme were mostly at the threshold for success in using EMDR, the training was effective in increasing their scores, implying that the PODS programme consolidated training, and encouraged confidence and competence within the eight phases

There are currently no published figures that directly measure the retention rates of newly qualified EMDR therapists in the UK, but some related evidence provides insight into how many continue to use EMDR in practice. One survey of EMDR therapists in the UK and Ireland found that only around 10–12% of those who complete a basic EMDR training go on to become accredited practitioners (Maxfield et al., 2019). This does not necessarily equate to therapists abandoning EMDR altogether, but it does suggest that many do not pursue further formal development or recognition.

Qualitative results

A follow-up feedback form was distributed to nine participants who remained employed within the health board area. This form was designed to collect qualitative data, in contrast to the evaluation form, which gathered quantitative data. Six completed feedback forms were returned, representing two responses per facilitator. Of these, four responses were from participants who engaged in online PODS support and two were from participants who took part in face-to-face PODS sessions. Full results are presented in Table 4.

Table 4: Qualitative results

Discussion

What have you learned from the research, and how does this contribute to your knowledge, practice and ideas for further research?

In the UK and Ireland, Farrell & Keenan (2013) reported that EMDR-accredited clinicians were more likely to have supervision arrangements and that these supervisors were more likely to be EMDR trained. Importantly, supervision by an EMDR-accredited consultant was statistically related to better outcomes. A 2023 mixed-methods systematic review by Hammond (2023) also emphasised that available supervision and organisational support are key facilitators for clinicians’ continued implementation of EMDR in practice. There remains, however, little direct experimental or longitudinal research testing how different forms, frequencies or qualities of continuing training and supervision affect EMDR competence, fidelity or client outcomes. Dyson (2024) echoed Hammond’s (2023) findings, highlighting that ‘of the therapists who do EMDR training, only 10–12% progress and add it to their therapeutic repertoire by becoming accredited in EMDR’. This figure indicates a relatively low level of progression from initial training to accreditation, which can be taken as one indicator of retention.

Several barriers to retention and long-term use of EMDR have been identified. These include difficulties integrating EMDR into existing service models, supervision structures and caseload demands (Maxfield et al., 2019). Cost and time commitments required for accreditation and supervision may also discourage therapists from continuing beyond the initial training (Woolliscroft, 2025). Institutional support, clinical pathways and workplace recognition of EMDR practice appear to be important factors influencing whether therapists retain and apply EMDR skills over time. Of the 11 participants in the PODS programme, 2 left their roles within the health board, where they will no longer be practicing EMDR, a retention rate of 82%. There did not seem to be any score differences within professional roles or between practitioners who attended in person compared with those attending an online forum.

The PODS programme provided several important insights. Overall, the findings suggest that structured follow-up support might be beneficial. The initiative demonstrated value in supporting both newly trained therapists and those seeking to refresh their skills to further develop their clinical practice.

Participation in the PODS programme enabled therapists to address fears and concerns, become less risk-averse and build confidence, particularly when working with complex clients. This highlights the role of structured support in facilitating the translation of training into proficient practice. The importance of managerial support was also evident. Staff release was crucial to participation and, without this support, engagement would probably have been constrained by service capacity and competing demands.

At initial survey, PODS participants described poor retention of knowledge and low confidence to commence EMDR in practice post EMDR training. This gap can contribute to insecurity and risk-averse decision making. Engagement in the PODS process helped to counter these challenges by providing a sense of scaffolding and support, which participants described as relieving and containing.

Finally, the shared structure of the PODS programme created a safe space for staff to come together to reflect, discuss experiences and share learning from a common starting point, further enhancing professional development and peer support.

Limitations

The participant sample is small, with 7 of 11 eligible participants taking part in self-reported evaluations. These small numbers limit the strength and generalisability of findings. The self-reported scores from the evaluation form could have been influenced by inflated competency (Probst et al., 2022). Using the competencies as an evaluation questionnaire involved an unvalidated measure, raising concerns about the reliability and accuracy of the findings. Without formal validation, the tool may not consistently assess the constructs it targets, potentially leading to misleading conclusions or under- or overestimation of participants’ skills (Probst et al., 2022). This study does not differentiate between competence in skill use and confidence in applying those skills. That distinction warrants future investigation, particularly as the self-report measure includes items assessing both understanding and confidence.

A further limitation was the high demand for places. There is currently a waiting list for PODS support via future cohorts, highlighting its perceived value but also underscoring the need for additional capacity. As this is a novel approach, no formal training for conducting such an initiative is available. Initial lack of clarity required several focused conversations and guidance with the PODS leads and EMDR supervisor to achieve consistency and confidence in the process. As this is not a structured training course, the absence of guidance led to some uncertainty about how best to facilitate the PODS groups and regular review and monitoring led to iterative changes. Alignment to the core competencies of EMDR in both the accreditation process and EFRS (Korn et al., 2018), provided helpful parameters. Offering orientation or light-touch training for leaders may help to increase consistency and confidence in delivery.

Summary and recommendations

The EMDR consultant supervisor reported that all participants who completed the PODS programme are now regularly presenting cases and contributing to group supervision with an increased level of competence and confidence. All practitioners who participated in the programme self-reported improvements in confidence and competence, which was highlighted in the pre- and post-evaluations. All participants reported that the PODS training added value to their existing knowledge and skills and self-reported feedback was unwaveringly positive.

This model demonstrates how targeted post-training support can optimise patient choice, contributing to improved delivery of evidence-based trauma therapies within NHS services, while also reducing supervision burden on the small pool of accredited consultants.

Current estimates indicate that only 10–12% of trained therapists pursue accreditation and consistently integrate EMDR into their practice (Farrell & Keenan, 2013; Dyson, 2024). Against this backdrop, the PODS model demonstrates a significant improvement: 82% of participants completed the programme and continued using EMDR clinically. This marks a notable departure from previous trends, with100% of participants who completed a PODS group reporting enhanced confidence and competence in EMDR delivery. This outcome underscores the potential effectiveness of structured, continuing skill-based support in bridging the gap between initial training and sustained clinical application.

The PODS programme demonstrates a practical solution to strengthen EMDR delivery, improve therapist confidence and maintain fidelity to the model. It supplements formal supervision, addresses systemic challenges and promotes sustainability within the NHS health board. Early findings suggest improved retention, enhanced competence and potential benefits for therapist wellbeing and service efficiency. This mental health nurse-led innovation offers a replicable model for other health boards/trusts.

This project has demonstrated that accredited and experienced EMDR practitioners are ideally positioned to lead PODS programmes, creating a safe, structured environment for professional growth. The process of evaluating PODS training not only ensures the quality and consistency of the groups but also generates valuable feedback that can be used to strengthen practice and identify areas for growth. The evaluations received have justified the continuation of this initiative with a new cohort, incorporating previous insights to deliver meaningful enhancements.

Engaging in PODS support offers multiple benefits across the wider EMDR framework. An unexpected benefit for PODS leads is the creation of a pathway towards consultancy and accreditation by offering hands-on leadership experience, opportunities for reflective practice and structured peer evaluation. For organisations, it supports succession planning by building a pipeline of skilled leaders who are confident in guiding others through safe EMDR practice. This ensures long-term sustainability and growth of expertise within the community.

The evaluations highlighted the importance of attendance and participation in the groups. This prompted the introduction of a participation agreement, designed to clarify expectations and secure commitment to the group learning programme. It is perceived that this agreement will reinforce the need for attendance and participation, reduce the need for repetition and allow participants to have a better understanding of the purpose and structure of the PODS groups.

The success of the first cohort of PODS participants highlighted the question of whether the benefits of attending would encourage or prepare practitioners to work towards accreditation. To address this issue, the question was added to the feedback form distributed at the end of the PODS programme. This will then enable the evaluation of whether the PODS programme will have any impact on practitioners’ desires to work toward accreditation.

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The zen of EMDR: where AIP meets body, mind and spirit 

By Rachel Rashkin

Just this moment, just this breath, just this sitting here, just this being human. Just this. Just this (Jon Kabat-Zinn)

EMDR as enlightening the self 

Vironika Tugalevam, author and poet, writes: ‘Emotional pain cannot kill you but running from it can…allow, embrace, let yourself feel, let yourself heal’. Like life itself, the EMDR journey has a certain, continuous flow, ever changing, moving from mundane to tragic and everything in between. Sometimes, people present with a clear internal map and the path that needs to be taken is already paved. Often, especially with complex trauma histories, there is no clearly defined path but a blurry, existential angst throbbing inside a fragmented system, one which requires a slower pace. Either way, much of EMDR might be thought of as a process of enlightenment of the self, as clients identify points of blockage and dissolve protective control strategies that no longer serve them well. Many, especially those with complex trauma histories, seek EMDR after years of distracting themselves from feeling vulnerable. This, by the way, is not a difficult task in a fast-paced, hi-tech world where cell phones (or perhaps more accurately, ‘self-phones’) separate rather than reunite, fuelling an already pervasive sense of isolation for many, in what is arguably a dissociative culture that encourages and enables disconnection (within the illusion of connection). 

No research studies are needed to observe that, as a society, we are constantly looking down rather than at, turning our attention away from, rather than towards, looking outside of ourselves rather than inwards, and basing our self-worth on our doing-self rather than our being-self. Therefore, it’s no surprise that so many clients fear not being able to tolerate the pain that inevitably emerges in EMDR, when we are not only hardwired to avoid pain but we live in a culture that encourages that avoidance in countless ways. Indeed, the whole notion of developing and using internal resources can seem daunting or even unfamiliar. Part of how we normalize pain is to help people understand that their suffering is not their fault, that their nervous systems have responded accordingly, and to instill hope by reminding them that, wherever there is disconnection, there is always the potential for reconnection. Entrenched in the fear many people have as to whether they can tolerate painful emotions in EMDR (and in psychotherapy, in general), is a fear they will drown in a swamp of shame, anger or grief; binding their negative beliefs as they begin to hate themselves not only for how they’re managing their symptoms but for even having those symptoms. This is what Buddhism refers to as the ‘second arrow’ … adding suffering to what is already causing pain, or in psychology is referred to as a ‘second emotional response’. The antidote to that is self-compassion. While some people may enter our offices with some capacity for self-compassion, many will not, so it will need to be taught and modelled repeatedly as its own powerful resource, and practiced outside of sessions, until they can invite it into their lives. 

Even with self-compassion present, however, there is no inner manipulation magically turning off painful emotions or thoughts in EMDR or in any form of psychotherapy. There is no artificial suppression of the turbulent waves that create tension in people’s lives. Quite the contrary: EMDR invites the waves and aims to help calm them enough so that they can be cradled by a larger ocean. We help people receive the gift of pausing just long enough to notice that not only can the waves not crush them but they can be transformed into rhythmic ripples, moving within them. Swami Satchitananda, an Indian yoga guru who brought the practice of yoga to the West, said You cannot stop the waves, but you can learn to surf’. So as people weave in and out of left and right brain processing, together with us as humble guides and empathic co-regulators, and gradually becoming aware of their surfboards, self-compassion has the potential to be birthed. 

Self-compassion 

Healing and entering our fullest selves requires self-compassion. In some ways, it serves as the blueprint to presence and awareness, and this is no easy feat for people who have been gripped in the throes of a negative thinking bias or for those whose systems are in chronic hyper- or hypo-arousal. Some people will enter our offices already possessing some level of self-compassion whereas others will have no idea what that feels like or even means. One way to understand compassion is that it is an extension of empathy, of being able to feel not for another but with another, of perspective taking, and with the added layer of deep care and concern. It is the antidote to many areas of suffering including the wishes to be more deeply seen and loved, to belong, feel appreciated, included, respected and connected. When we can help people view suffering as inevitable to the human experience, we remove some of the isolation around it and they begin to feel less alone and more open to the idea of self-compassion. False narratives entrenched in blame, shame, guilt, and people whose sense of selves have marinated in these narratives for decades, means that the process of cultivating compassion will need to be tenderly paced. Self-compassion need not be a prerequisite to successful EMDR but can develop alongside it, with the first steps being the acknowledgment a struggle exists, accepting the struggle and then helping people treat themselves with the same kindness as they would treat others. 

Noticing 

Clients seeking help are doing so because they have fallen; usual strategies to avoid pain are no longer effective and sometimes their wounds are open and bleeding. Like other modalities, EMDR helps people to blossom into the fullness of who they are, to develop a robust capacity to live within a state of awareness, by dissolving unwanted memories within the body and mind, connecting to a more adaptive way of being in the world, freeing up space to actualize potential and express the truest areas of the self. But, to do that, a crucial step is simply (or not so simply) to notice. As therapists we often adjust how we introduce ‘noticing’ because we cannot change the nervous system in a first (or second or third or …) session. Moreover, the act of noticing is in direct contradiction to how so many clients have spent their lives up until that point, for good reason. For clients with (and even without) a trauma history, whose nervous systems have been pervasively stuck in defence and survival, even basic suggestions of noticing or being kind to oneself can feel terribly unsafe, and perhaps catastrophic when the mind and body are unaccustomed to slowing down, and baseline levels are those connected to survival strategies. 

Additionally, the concept itself can be confusing; sitting with a noticing presence can be terrifying for clients to consider, and many won’t even understand what we are asking them to do. Even when there is a clear or relatively clear understanding, when an internal war is waging, and has been for months or years, asking people to notice what they are feeling in their bodies, or to create images that bring them a sense of peace or serenity, is not always going to work and may, in fact, backfire. Moreover, some clients will feel additional social and performance anxiety over trying to please the therapist, and may generate a response that is totally inauthentic, both to please the therapist as well as feel they aren’t ‘failing’ at what is being asked, perpetuating a cycle of inauthenticity and avoidance. With clients who have more severe attachment ruptures, fragmented self-states may be in conflict, and an entire internal battle may erupt without the therapist even being aware. This is where creativity, flexibility, attunement and understanding that a linear process of asking our clients to notice in the early stages of a process, or access any creativity whatsoever, may simply not work. Despite that, it is usually very empowering for clients to learn that they can indeed notice their body, notice their thoughts, words, sensations, and that they can even imagine a moment of nurturing, and nothing bad happens. The more gently and respectfully we help cultivate noticing, the more we help clients create disconfirming experiences around the expectation that noticing means worsening. 

Presence 

EMDR pulls for radical honesty, for people to begin to identify, very specifically, the unseen, unfelt parts of their lives that have resulted in suffering. Since trauma can partially be defined as a disconnect from the self, an absence of meaning, usually people have, to some extent, pulled away from their real self. There’s a discomfort in the undercurrent of fear and deficiency we all experience when we are not being honest. At the heart of presence, is relinquishing control or the desire to achieve, and instead just observing, slowing down, exploring and discovering. Through constructed beliefs about their lives, people begin to share general information and stories. As they are talking, fostering presence can begin to unfold by gently pausing and directing people towards inner experience throughout the telling, at strategic times that we determine are appropriate and not disruptive. 

By asking questions or offering comments that source for presence, people begin a process of ‘noticing’ long before the more intense phases begin, which will serve them well in terms of tolerating later painful material. Presence is cultivated each time we ask people to look around the room, find something they particularly enjoy looking at or that catches their attention – a favourite colour, a picture on the wall. We want people to wake up to something bigger than their pain or emotional reactivity, to come home to something larger. Small, brief, sensory exercises are often a good and tolerable place for people to start feeling what it means to be present and not enslaved to thoughts or emotions. Sometimes people get lost in an endless thought stream or begin emotionally checking out as they respond to questions that pull for presence. That is OK, normal and, in some cases, expected, and there are numerous ways therapists can reorient people back to present awareness, while still respecting the need to temporarily shut down. 

For some people, maintaining a light degree of dissociation throughout EMDR processing is helpful and necessary. The simplest way to circle back to presence is to just invite noticing; to sit with the feelings in the body, if those feeling and sensations can be noticed, or notice the sound of the therapist’s voice, for the therapist to use the client’s name, to notice the ways in which posture or other body positions have shifted or the way the sun is shining through a window. Other times, just noticing the attempt to notice, is perfect. As therapists practicing EMDR fostering a sense of here and now, we are looking to disconfirm information around the expectations people have so that we can capitalise on new learning to lower their baseline. Once people can begin to engage in present awareness, they suddenly have an opportunity to position themselves differently in relationship to their painful life experiences. As we anchor our own sense of presence and awareness within, we ask our EMDR clients to notice thoughts and emotions and notice how they feel about them, and we ask them to be aware of themselves as fully as they can, in a sacred space of just being with, of letting whatever emerge, emerge. 

Therefore, at its core, one might say that EMDR is, in fact, a profoundly body-based, integrative healing modality of practicing presence. While people dive into the past and sit with the immediacy of feelings in the present, they yield to the vulnerability of whatever emerges, to dissolve as much agitation of thought as possible, decreasing or eradicating unwanted and unpleasant sensations in the body, tolerating the discomfort of it all, all while anchored in the present moment. We ask people to trust their inner wisdom, while we lovingly partner with them, stepping in when needed to help navigate jagged or unexpected terrain. Throughout the most intense moments of processing, we help facilitate a space for them to meet that processing with compassion if they can, rather than self-deprecation, judgement, avoidance or dismissiveness. This is presence. Noticing the noticing. Intentionally. EMDR as a process of enlightenment of the self, is so much about nourishing and integrating the three components of: self-compassion, presence and noticing, so that we can be in healthy relationship with our histories and experiences and be of service to them, instead of the other way around. Regardless of the stories people carry, and levels of distress they bring, we strive for EMDR to be a process which is deeply liberating for all, where people begin to cease living in the shadows of unwanted experience, of emotional reactivity and of believing every thought as truth. We hope to facilitate dual attention in the sense of not only remaining within a tolerable emotional state but also teaching people to observe their struggles alongside kindness and courage, to not judge their judgement but to approach emerging activation with curiosity and love. When that self-compassion begins to unfold, it naturally frees up space for a truer, more authentic self to be unleashed. This allows clients to step out of judgment of themselves or other constricting emotions and, instead, infuse their lives with tenderness. In EMDR work, it is this compassionate pausing, this presence, this noticing, this let whatever comes, come, that cultivates an exquisite awareness in and out of the room and allows clients to eventually be welcomed home by a far more expansive, content, wiser and enlightened self. 

Final thoughts 

 The Indian philosopher, Krishna Merti, said his secret in awakening his heart was this: ‘I don’t mind what happens’. In a sense, we are asking our EMDR clients to do the same, with our help as humble guides, of course. To not mind, meaning to not fight so hard with the activating material that arises from within but instead to welcome it and, when possible, to suspend judgement and meet it (or even better, bombard it) with self-compassion. Rather than the arch of our client’s lives being hijacked by limbic dominance, we gently and tenderly encourage a shedding, a softening, surrendering and acceptance of limitations so they can retrain their brains, opening them up for creativity and flexibility. 

Surrender is not to be confused with resignation. The former is a letting go of, while resignation implies lack of agency and defeat. We want to help our clients embody an attitude of ‘I don’t mind what happens’ in the hope that they will derive empowerment and strength from it and begin to tolerate ambiguity, respond and not react to highly charged emotions, depolarise old patterns of thinking, connect to what is meaningful and unplug from what is not; to be open to the previously unknown cognitive, somatic, emotional and spiritual landscapes within themselves. When we help clients pause and sit with the agonizing memories and emotional reactivity that imprison them and then intentionally provoke activation, we create fertile ground that births awareness, presence and a real opportunity to hold that activation with curiosity and adjust the volume to tolerable levels. It doesn’t mean that difficult emotions will be eradicated but that the strong identification with them will be. We invite clients to experiment with the phrase ‘I don’t mind what happens’ based on the premise that whatever does happen (both in and eventually outside of session) ‘it will be OK. I will be OK. I’ve got this’. Clients with a more layered and difficult history around interpersonal wounds will move through this (understandably) with more anxiety to experiencing the pain, but fighting reality will never bring transformation or freedom. Fighting it with self-compassion, however, will. EMDR asks all of us to face losses in whatever doses we can. Doing so in the context of a safe and loving therapeutic environment evolves us as human beings, reminding us of our interdependence, that we don’t have to be alone, that we can become more aware, more present and happier, breaking the patterning in our nervous system that keeps us fixated on the negativity. 

Notice that. 

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Enhancing EMDR with bone‑conduction bilateral stimulation: a case study in an NHS talking therapies service

By Matthew Paknik-Riley

Introduction

EMDR is a first‑line trauma‑focused psychotherapy in the UK and internationally, supported by robust trial evidence across populations (National Institute for Health and Care Excellence, 2018; World Health Organization, 2013). In England, EMDR is commissioned within NHS talking therapies (formerly Improving Access to Psychological Therapies). These therapies emphasise evidence‑based delivery, routine outcome monitoring and clinical governance, (Health Education England (HEE) & NHS England (NHSE), 2024).

Ambulance paramedics face chronic, repeated exposure to potentially traumatic events including cardiac arrests, paediatric emergencies, sudden deaths, violent incidents and catastrophic injuries. Systematic reviews indicate markedly elevated PTSD prevalence in ambulance personnel compared with the general population, with pooled estimates around 11% for PTSD (pre 2018 literature) and around 20% for 12-month PTSD in high income settings, compared with around 3% in nonexposed populations (Petrie et al., 2018; Hoell et al., 2023). These epidemiological realities create a pressing need for tolerable, effective, guidelineconcordant trauma care within NHS settings (NICE, 2018).

Literature review

Clinical effectiveness of EMDR

Meta‑analyses and network/meta‑analytic syntheses show that EMDR produces large improvements relative to waitlist/usual care and performs comparably to trauma‑focused CBT post‑treatment with sustained effects at follow‑up (Bisson et al., 2019; Lewis et al., 2020; Mavranezouli et al., 2020).

Ambulance/paramedic mental health

Global reviews demonstrate elevated PTSD, depression and anxiety in ambulance personnel (e.g. pooled PTSD ≈11% with 15% depression/anxiety and 27% general distress) far above general population baselines. More recent pooled 12‑month PTSD estimates near 20% underscore the cumulative occupational burden (Petrie et al., 2018; Hoell et al., 2023).

Remote/technology‑assisted EMDR

Service evaluations and systematic reviews during and after the COVID‑19 period indicate that remote EMDR can be feasible and effective when delivered with appropriate safety and fidelity procedures, which is relevant for shift‑based paramedic work (McGowan et al., 2021; Kaptan et al., 2024).

Theoretical framework

Adaptive information processing conceptualises PTSD as arising from maladaptively stored traumatic memories; bilateral stimulation facilitates linkage to adaptive networks and reconsolidation. Concurrent neurophysiology during EMDR sessions suggests a functional shift from limbic to cortical associative activity as processing progresses (Pagani et al., 2012). Complementary experimental work supports a working‑memory taxation account; pairing aversive memory recall with a concurrent dual task reduces subsequent vividness/emotionality and shows persistence at follow‑up when the load is sufficient (Van den Hout & Engelhard, 2012; Leer et al., 2014).

Bone‑conduction bilateral stimulation uses specialised headphones to deliver alternating auditory and tactile input without requiring visual engagement, which may reduce visual trigger activation in paramedics while maintaining adequate dual‑task demand. Bone‑conduction headphones provide lateralised auditory/tactile cues without visual load, which may reduce visual‑trigger risks in paramedics while maintaining adequate dual‑task demand. Although ocular movements may produce larger working memory load effects in laboratory settings, clinical sufficiency rests on adequate load plus therapeutic pacing (Van den Hout & Engelhard, 2012; Pagani et al., 2012).

Methods

Design and setting

A single case service evaluation in an NHS talking therapies service, adhering to national governance (Health Education England (HEE) & NHS England (NHSE), 2024) reporting an adult ambulance paramedic who met PTSD criteria linked to a workplace critical incident. The history included childhood adversity and cumulative adult traumas that increased vulnerability. Measures included the Impact of Event Scale Revised (IES‑R), Patient Health Questionnaire–9 (PHQ‑9), Generalised Anxiety Disorder-7 (GAD‑7), Work and Social Adjustment Scale (WSAS), all standard instruments in UK services (Creamer et al., 2003; Kroenke et al., 2001; Spitzer et al., 2006; Mundt et al., 2002).

Intervention

Standard eight phase EMDR using bone conduction bilateral stimulation (BLS; alternating left/right tones, adjustable speed/intensity) instead of visual BLS, with stabilisation, target sequencing, desensitisation, installation, body scan and re evaluation. (NICE, 2018; Shapiro, 2018).

Ethics/governance

The client was fully anonymised. Written permission for anonymised use of the patient’s clinical information was obtained.

Results

The patient demonstrated significant reductions in symptoms across all outcome measures (Table 1). The IES-R score decreased from 68 to below the clinical threshold (probable PTSD threshold ≈33) within eight sessions, while scores on the PHQ-9 and GAD-7 also improved markedly. Functional improvements were reflected in WSAS scores, with changes consistent with clinically meaningful improvement and in line with those observed in EMDR trials. Patient feedback indicated enhanced comfort and engagement compared to prior EMDR using light bars.

The patient reported that their nightmares remitted, flashbacks reduced in frequency and intensity, sleep improved and they completed a graded return to work, including revisiting the incident location with manageable distress. This is consistent with traumafocused therapy goals in the national guideline (NICE, 2018; Lewis et al., 2020).

Table 1: Scores across outcome measures

Discussion

The observed symptoms and functional gains align with meta‑analytical evidence supporting EMDR’s effectiveness and with NHS talking therapies’ focus on recovery and reliable improvement (Bisson et al., 2019; Lewis et al., 2020; NHS England, 2024). Given the elevated and chronic exposure profile of ambulance personnel, modalities that are acceptable, portable and efficient are advantageous (Petrie et al., 2018; Hoell et al., 2023).

For paramedics with visual sensitivity or incident‑linked visual triggers, bone‑conduction offers lateralised stimulation while minimising visual load. Although laboratory working memory studies sometimes find stronger effects for eye movements than simple tones, clinically adequate working memory taxation can be achieved by tuning audio parameters and pacing, which is consistent with the results for this patient (Van den Hout & Engelhard, 2012; Leer et al., 2014). The approach is also compatible with remote delivery models shown to be feasible in evaluations (McGowan et al., 2021; Kaptan et al., 2024).

Limitations and future research

This single case design and lack of long‑term follow‑up limit generalisability and durability claims. Future studies should compare bone conduction, ocular and tactile BLS modalities in randomised designs, including mechanistic endpoints (e.g., electroencephalogram/functional magnetic resonance imaging) and should report implementation outcomes salient for ambulance services (acceptability, drop‑out, time‑to‑response; Pagani et al., 2012; Lewis et al., 2020).

Conclusion

Within NHS talking therapies, EMDR using bone‑conduction BLS produced clinically significant reductions in PTSD, depression, anxiety and functional impairment for an ambulance paramedic, alongside meaningful real‑world gains (return to work; trigger mastery). The modality is feasible, acceptable and theoretically coherent. Further controlled evaluation is warranted for ambulance/paramedic populations.

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EMDR UK annual conference: EMDR and the family system

By Jennifer Lonsdale

Michel Sylvestre drew on his wealth of experience of integrating his learning from work as a family therapist to his practice as an EMDR therapist in this informative and engaging presentation. Michel explained how, in his practice, he has embraced doing both family and individual work, rather than adopting an either/or position, where the family may be seen all together or the child seen for individual work. He eloquently describes this as ‘not one or the other – you have to do one and the other’. Michel reminded us of Pierre Janet’s (1929) comment that ‘Narrowmindedness and specialisation are never a good thing, especially when dealing with psychology’. 

Michel explained that the rationale for integrating systemic family work with EMDR is because trauma leads to different types of trauma wounds. Michel argues that while individual work may address the individual wound, there is also a need to offer intervention for the relational wounds that occur after trauma; failure to do so has been linked to poor outcomes for family relationships. Difficulties with relational difficulties can impact the child’s affect regulation and the child’s experience of their family as a safe base. Asking questions about what has changed for the family since the trauma, and whether family routines have continued, can offer the therapist insights into these relational shifts. When integrating the individual and relational wounds, Michel spoke of the importance of maintaining a developmental perspective and the adaptive information processing model in co-regulation. 

Michel explored how both parents and child as can be mutual triggers within their relationship. Where this is apparent, he argues that it needs to be the starting point of the work, as it is important that parents can act as containers when they think of their child, to enable the ‘relationship to act as an emotional scaffolding’ and keep parents within their own windows of tolerance. Michel is an advocate for one therapist working with the whole family rather than referring different therapists to work with individual family members. In this regard, the role of the therapist becomes a ‘stable anchor’. 

In planning intervention, Michel advocates for completing the family work first before moving to individual EMDR. After the initial family meeting and evaluation of the dynamics within relationships, he decides whether to work with the parents, the family or to work with the child and/or siblings. Key points in evaluating the family dynamic are consideration of safety, early attachment rituals (such as bedtime routines, mealtimes), reviewing whether the family hierarchy is functional (i.e. appropriate boundaries between parent and child), determining what is the quality of the attunement between parents, and the consistency of narrative stories within the family. 

Work on the family narrative might include ensuring that all family members are able to talk about what they know about the problems and encouraging no secrets to be kept. Advice may be given on increasing family presence in daily routines to enhance attachments. 

Michel spoke of the importance of all the family being regulated during the work, so the therapist might switch between appointments for different members simultaneously rather than completing one intervention before moving on to start with another family member. Much time is spent in phases 1 and 2, understanding safety and dynamics in the family relationships. Then, after individual work is completed, the therapist views in phase 8 how well the child is getting along within the family. 

Michel illustrated his skill at integrating family work with EMDR through his clinical practice with numerous clinical cases. He shared photos to illustrate the use of family drawings and GTEP in sessions and the importance of understanding the quality of relationships between siblings as well as between parents with the child. 

The audience asked a range of questions. Have you worked with families where there is sibling abuse and how do you approach this? Michel discussed the importance of perpetrators recognising that abuse has occurred and preparation work in the family. He advised against bringing together victims of domestic violence and abuse with perpetrators where there is not recognition of what has occurred as abuse. 

When working with a couple and the treatment is the same, do you follow an individual or group protocol? Michel responded that while a group protocol could be used, this approach has been developed for use with groups of children so he would use an individual protocol with both adults. 

Do the family members have the same safe place and containers? Michel explained that each will have their own, according to their level of development, with children able to observe parents completing their own safe place and containers first. He then completes installation together. 

How might you involve parents where they have a difficult relationship such as following a difficult divorce? Michel explained that there is an increased level of complexity in seeing children with each parent. Sometimes it is appropriate to also offer to parents a joint session to explore their caregiving responsibilities. 

Further reading 

Silvestre, M., Tarquinio, C., L., (2022). Systemic family therapy and EMDR therapy: an integrative approach. European Journal of Trauma and Dissociation 5, 100196. https://doi.org/10.1016/j.ejtd.2022.100291 

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Holding the frame: preventing model drift in EMDR practice in the context of expanding CPD 

By Deborah Kingston

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. 

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Q&A with Katie Egan 

By Katie Egan

Katie Egan is an EMDR consultant who was awarded the Dorothy Mandelstam Award at the annual Association of Continence Professionals National Conference 2026.  

How did you become an EMDR therapist? 

I became an EMDR therapist when the opportunity arose to attend EMDR training while I was working in an NHS Improving Access to Psychological Therapies (IAPT) service in Bristol. Fortunately, my first EMDR case went well, and I quickly became immersed in the approach. 

I became an accredited EMDR practitioner in 2018 and an EMDR Consultant in 2022. Since then, I have used EMDR across a range of NHS specialist services, including a specialist pain service, an NHS Staff Psychology Service, and a Specialist Mesh Complications Centre. Working in these diverse settings has shown me just how adaptable and effective EMDR can be in helping people not just recover from trauma, but consequently, in some cases, improve physical symptoms. 

Why is EMDR relevant to continence? 

EMDR can help process disturbing memories, experiences, and future fears linked to being incontinent. Shame, embarrassment, disgust, and grief are common feelings linked to incontinence. It isn’t unusual for patients to have lots of safety and avoidance behaviours, which means their world gets smaller and smaller. For example, a future target or worst-case scenario that a patient might process is a ‘fear of their stoma bag exploding in a restaurant’. The negative cognition could be “I can’t cope [with the humiliation]”. By processing this target, the patient would feel better able to cope if the situation were to occur, and would therefore no longer need to avoid socialising and eating out. In turn, this can help mood because they would not miss out on pleasurable activities or connecting with others. 

What did the conference attendees know about EMDR? 

Not much, as far as I could tell. Many people seemed interested, however, and asked me follow-up questions throughout the rest of the conference. 

What is the Dorothy Mandelstam Award? 

The Award in Memory of Dorothy Mandelstam acknowledges Dorothy’s pioneering continence work as a founding member and first chair of the ACP. She was the first non-medical member to be admitted to the International Continence Society in 1975. Dorothy contributed to the development of pelvic floor muscle training and helped recognise the importance and advancement of non-surgical continence care. She was affectionately known as the “Queen of Continence.” 

Why were you awarded it? 

I presented on ‘Psychological approaches to incontinence’ and ‘Using EMDR for medical trauma in patients under a Specialist Mesh Complications Service’. Apparently, the award was for those presentations and the work I do every day helping patients adjust and manage their difficult thoughts, feelings and behaviours linked to their continence. I support people to reduce the impact of past trauma where appropriate and build lives that are guided by their values rather than their symptoms. It is a privilege to help patients improve their quality of life and regain a sense of confidence, purpose, and control despite ongoing health difficulties. 

What is the next step for you? 

It would be fantastic to contribute to research in this area, as it remains significantly under-researched. I would love to help build the evidence base and highlight the broad range of ways that EMDR can be highly effective, particularly for people experiencing medical trauma and long-term health conditions. 

In addition, I hope to become an EMDR trainer. I am incredibly passionate about EMDR as an effective therapy and would love the opportunity to support and inspire other clinicians to develop their skills so that more and more patients can benefit from this approach. 

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President’s reflection on the European Conference in Oslo 

By Russell Hurn

Lillestrøm formed the backdrop for this year’s European conference. Ten minutes from Oslo, Norway, in the vast NOVA Spektrum venue we were treated to a comprehensive mix of presentations, workshops and poster displays focusing on unlocking the power of AIP in our work. After a rather speedy visit to the city centre to soak up the splendour of the Opera House and the vivid emotional art of Norway’s most famous artist Edvard Munch, it was time to get down to the working part of the trip. The European conferences always include a lot of association business. The various committees meet in person (a rare experience) to review their work over the year and build relationships with the other European members. It was a pleasure this year to attend the Child & Adolescent Committee, to welcome the new Chair, Daniella Lampertz, and to honour the hard work of all those on the committee, past and present. I always feel rather humbled at these meetings, which are all conducted in English, and I must admit I feel rather guilty that I have not learned to speak another European language. The passion and dedication to EMDR across Europe is so clear to see and the 50,000 strong membership demonstrates this. 

The opening ceremony on Friday night featured two opera singers who surprised and delighted us with a rendition of Mozart’s Cat Duet. It was a sort bilateral meowing, which was strangely hypnotic. With 42 workshop hours over just two days it was not possible to see everything. Thank goodness for a replay service. I did have the pleasure of chairing on Saturday afternoon and introducing Manuela Spadoni. Manuela, a psychotherapist from Italy, has spent many years training with Jim Knipe and she was tasked by him on his retirement to continue his work. A challenge that she has risen to. Manuela went into detail about the key aspects of parts and defences relating to a client’s difficulties. She then developed her argument further by explaining how the original Knipe tools like CIPOS and LOPA could be integrated into case conceptualisation and, in doing so, demonstrated her Toolbox method. This was a comprehensive review but also a clear outline of how to integrate theory into regular clinical practice, rather than just thinking of the Toolbox as something to dip into occasionally. 

The conference featured many poster presentations of research projects and it was lovely to see the UK represented by Dr Alice Emond and her colleagues, who have conducted a pilot study into EMDR as a routine psychological intervention in a family paediatric oncology psychology service. This work targeted related traumatic memories for 18 young people and their carers, reducing PTSD symptoms and impacting positively on the participants’ quality of life. 

Over the weekend I had the pleasure of meeting up with our colleagues from Ireland as well as making new acquaintances with members from newly emerging associations like Armenia and Lithuania. It was lovely to hear about the growth of EMDR within their countries and how the UK and Ireland associations have contributed to developments, particularly through the dedicated work of Maeve Crowley but also the many consultants who have offered pro bono supervision to colleagues. 

After the conference I also attended the European Board meeting. It was encouraging to see that the UK is ninth in the table for number of practitioners per million inhabitants – for the UK this is a 20% increase. We are third in the table for child and adolescent practitioners, increasing in number by 20 to 86, placing us third behind Germany with 221 and the Netherlands with an amazing total of 920. The increase in accredited members is vitally important for the Association but also for the standing of EMDR within the UK. It ensures fidelity to the approach, increased therapeutic skills and better outcomes for clients. The new EMDR Europe accredited logo is also available, which can endorse your work and communications. Details on how to access it will be sent out to members soon. 

What is still apparent, though, is the need for more UK-based research and larger trials to reinforce the evidence for the work we all do. The conference next June is in Lausanne, Switzerland, and it would be great to see the UK represented with more research-based contributions. 

After five days nonstop, it was a weary trip back at 5am but with a wealth of new information, friends, contacts and hope for the year ahead. As a member of your national association, you are a part of the expanding European and global community working to ensure that the work we do is not only clinically effective but also recognised and valued across the world. 

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