A note from the editor

By Dean Whybrow

And finally… the Winter 2026 edition of the ETQ. Huge apologies for the delay, but I had to recover from a nasty bout of the flu before I could bring all of the articles together.

Looking through the included articles, they truly highlight the rich tapestry of EMDR, from theoretical understanding to practical applications. The lead articles focus on the practical application of using EMDR with people affected by cancer. This is followed by a constructive and insightful discussion in an article about evidence-based practice. Then, an exploration of Adaptive Information Processing, relational processes, and intersubjectivity, ultimately framing EMDR as a mutual biopsychosocial system. Featured articles cover moral injury, Blind-to-Therapist EMDR, the potential uses of Artificial Intelligence in EMDR practice, and the use of the On-the-Spot method as a brief stabilising intervention.

Looking ahead to the Conference in less than two weeks, this event presents a great opportunity to contribute an article to the ETQ. If you are attending the conference either online or in Bristol, you would be the perfect person to write a brief news piece. Check out the writing guidelines here for News items.

There are many events in the world of EMDR and trauma each year. Reporting on presentations given by leaders in the field is of professional interest to all practitioners and is therefore prioritised in the Journal.

News items are generally between 500 and 2000 words in length. Authors should include the published title of the event and the name and designation of the speakers, presenters and facilitators. The content should reflect the main points made by speakers so that readers who were unable to be present are afforded an idea of the topics discussed by presenters and any practice innovations outlined, questions raised, etc. References and quotes should be used wherever possible to reinforce points made by authors.

If you need more information or have an idea for a conference presentation you’d like to write about, feel free to email me at editor@emdrassociation.org.uk or speak to me at the conference.

Equally, if you have a different article in mind, perhaps a review, a case study, small research project, service evaluation, or practice-based article, then please send me the manuscript or get in touch to discuss further. Details on the different articles and author guidelines are available here. You will find that the ETQ is a supportive, kind and inclusive publication.

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Scientific and Research Committee update – February 2026

By Anthea Sutton

Anthea Sutton (Academic and Research Liaison) & Jonathan Hutchins (Chair of the Scientific and Research Committee)

Annual Conference 2026

Members of the SRC will be at the EMDR UK annual conference, taking place in Bristol on the 20^th-21^st March.  Please visit the research posters, we have a great range of topics being presented, including complex mental health conditions such as bipolar disorder and psychosis, children and adolescents, group EMDR interventions, and research in various settings including probation services and NHS hospitals.  Poster authors will be standing by their posters during both lunch breaks, please take the opportunity to meet them and ask them about their research.  Full details can be found on the conference timetable.

*New for 2026* Poster authors will be giving 60-second “lightning talks” during the research symposium on Day 2 (10.45am Saturday 21^st March). This promises to be a lively and interesting session, so please join us.

We are delighted to welcome Professor Filippo Varese and colleagues from the University of Manchester who will be presenting our research keynote on: New frontiers in the treatment and prevention of psychosis using EMDR.

During the research symposium, we will also be giving an update of the activities of the SRC and asking you to feedback on proposed research priorities which will inform our research strategy over the next few years.

EMDR UK Funded Research featured on EMDR: The Science Behind the Therapy Podcast

The systematic review and meta-analysis funded by EMDR UK and conducted by The University of Sheffield on Clinical and Cost-Effectiveness of Eye Movement Desensitisation and Reprocessing for Post-Traumatic Stress Disorder in Children and Adolescents recently featured on Dr Andrew Leeds’s podcast “EMDR: The Science Behind the Therapy”.  Available from your preferred podcast platform now.

The systematic review sought to analyse randomised controlled trials published since the NICE PTSD Guideline in 2018.  As part of the current research strategy (2023-2026), the SRC aims to evaluate evidence relevant to the NICE guidance on PTSD prevention and treatment.  Engaging with NICE is a key activity, through stakeholder consultation on guidelines in development.  If you are interested in news relating to NICE and EMDR, and opportunities to apply to join relevant NICE committees, please join our new forum via your membership login on the EMDR UK website.

New Research

Along with colleagues Bobby Cramp and Emma Hartley, SRC member Susannah Colbert has recently published an article in the European Journal of Trauma & Dissociation entitled “A grounded theory of attachment processes in EMDR for psychosis”.  You can read the article here, and there will be an accompanying poster at the EMDR UK annual conference in Bristol if you’d like to find out more about the research.

Evidence Briefings

In addition to the EMDR Publications Database, we plan to produce a series of briefings outlining the evidence base and research gaps in key areas of EMDR. We have collated the current evidence base on EMDR with veterans and military personnel, you can read it in this issue of ETQ here, and don’t forget that all EMDR research publications are added to our database which you can access 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

Veterans Research Network

The SRC continue to explore avenues to strengthen the evidence base for EMDR with veterans.  Some members have been involved in proposing a feasibility study with academic colleagues for external research funding.  The SRC welcome these collaborations, and this is the foundation of our newly established veterans research network.  If you are a team leader working with veterans, or are in contact with a head of service who does, please email us at: researchofficer@emdrassociation.org.uk as we are keen to expand the network.  Current priorities for the group include exploring potential analyses or routine outcome data.

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Research News

By Anthea Sutton

EMDR Publications Database

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

Systematic Reviews and Meta-Analyses

We begin this update by highlighting the systematic review of EMDR for children and adolescents with PTSD funded by EMDR UK and conducted by myself and colleagues at the University of Sheffield (Sutton et al. 2025).  Our review found that EMDR treatment (delivered three months or more post-trauma) produced a significant and large effect size compared to waitlist or usual care.

For substance use disorders, a meta-analysis showed EMDR produced moderate-to-high effect sizes for craving, PTSD, depression, and anxiety symptoms, though its effect on overall addiction severity was not significant (Seok et al. 2025). In adult justice-involved populations, EMDR is noted as a promising approach for improving mental health outcomes, including PTSD, anxiety, and depression, but evidence regarding behavioural change is inconsistent, and methodological limitations prevent definite conclusions regarding the effectiveness of trauma-focused therapies (Sousa et al. 2025). 

Randomised Controlled Trials (RCTs)

An RCT evaluating effectiveness of Attachment-Based EMDR (AB-EMDR) for adolescents with bullying-related trauma symptoms compared to standard EMDR therapy, found that AB-EMDR yielded greater reductions and faster reductions in trauma and anxiety compared to standard EMDR (Mahmood et al. 2025). Another RCT in an adolescent population added to the database this update found that EMDR-focused group counselling (G-TEP) significantly reduced exam anxiety among middle school students (Dinc & Kilic 2025).

Demonstrating the clinical versatility of EMDR, in an RCT of patients with Hashimoto’s thyroiditis (a chronic autoimmune disorder), EMDR led to significant improvements in dissociation, alexithymia, depression, anxiety, stress, trait anger, emotional regulation, and enhanced quality of life, post-treatment and sustained at 3-month follow-up (Macarenco et al. 2025).

Research Protocols

Three protocols for ongoing EMDR trials have been added to the database this update, with two taking place in the UK:

• Reducing Psychosis Risk (UK):  A trial to evaluate the feasibility of conducting a future randomised controlled trial to determine the efficacy of EMDR and trauma focused cognitive behavioural therapy (TF-CBT) in people with At-Risk Mental States (ARMS) (Varese et al. 2025).

• Trauma-AID (UK): Evaluating the clinical and cost-effectiveness of psychoeducation and emotional stabilisation (PES) with EMDR plus treatment as usual for reducing symptoms of PTSD in adults with intellectual disabilities, compared with treatment as usual alone (Wilner et al. 2025).

• Online therapy vs. in person therapy in youth study (Netherlands): comparing the results of online Acceptance and Commitment Therapy (ACT) and EMDR therapy to in-person treatment in young people aged 12–18 requiring mental health support (Brake et al. 2025).

War-Related PTSD

Two RCTs conducted with mental health professionals during the Russian-Ukrainian War have been added to the database this update:

• Palen et al. (2025) investigated a virtual early intervention (EMDR G-TEP) in reducing symptoms of wartime psychological distress in Ukrainian mental health clinicians and found that the group receiving EMDR experienced improvement across 3 time points.
• Quaranta-Leech et al. (2025) found that the EMDR Integrative Group Treatment Protocol for Ongoing Traumatic Stress—Remote for PTSD symptoms, subjective well-being and resilience in mental health professionals living and working in Ukraine during the war, reported a significant reduction of PTSD symptomology as reported on PCL-5 at 6-week follow-up.

Children and Adolescents

In addition to the systematic review and RCTs mentioned above, a study investigating a single-session of Urdu-translated EMDR-IGTP-OTS was found to be effective, feasible, and acceptable in reducing psychological distress in adolescents, and provides direction for an RCT within the context of Pakistan (Mustafa et al. 2025).

What else has been added to the database this quarter?

The most recent update to the database was in January 2026, when 71 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 (SCHARR) 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 April 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.uk

Disclaimer: this update reports study findings only; the research included in the database has not been assessed for quality, and we recommend that evidence users do so 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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Update from the Equality, Diversity and Inclusion Committee

By Heena Chudasama

Happy New Year to all our members. We hope you had a restful seasonal break.

Recruitment

We will soon be recruiting for two new members to the EDI committee. Further details to follow.

Board

I, Heena, attended my last board meeting in January after four years of service. It was a pleasure and a challenge to serve the membership over the four years. I would ask the membership to consider joining the board who are keen, devoted and supportive team players. I would especially invite those from the global majority and those with lived experience or expertise in diversity and inclusion. I will note that we are all different, and we must embrace and action systemic and sustainable change. Please consider joining the board or any association committee to represent and contribute to the Association’s development.

Multimedia approach and having a voice

As you are aware, the committee aims to source and deliver a multimedia approach to both support and listen to our membership. We have a particular focus on working with marginalised and underserved groups in order to adapt and develop our EMDR practice. If this is something you could offer, and are an EMDR therapist, practitioner, consultant or trainer, we would be delighted to hear from you.

Please reach out to:

• Dean Whybrow with contributions (or to share ideas for publication) for the ETQ.
• Heena Chudasama for webinar ideas and conference contributions.
• Russ Hurn for podcast ideas.

We would also like to hear about what you would like to see at the conference, including topics and speakers regarding equality, diversity, inclusion and social justice. Please contact Heena Chudasama.

Regional groups (RGs) and special interest groups (SIGs)

Please connect with us to discuss collaborations in events that align with your SIG and RG.

Awareness days

We aim to work with SIGs to highlight awareness days and months. SIGs and RGs have already shared the events they would like to promote. Aisha Docrat will be leading this with each group. While we may not be able to promote every suggested event, we will rotate the highlighted topic.

In the meantime, please contact Emma Mullins Crocker  with any questions. Katy Bell will also be working with the Association to support and promote the work in this area.

Bursary to come

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. We are currently developing a process and would welcome support from any member with experience of bursary and grant application procedures. Please email Heena Chudasama.

Accessible event guidance

Guidance on accessible event planning has been shared on the forum. Where possible, this will be added to the EDI webpage along with other resources.

Forum

The EMDR UK Forum is a great place to share ideas, experiences and resources. The Association aims to develop a safe space to explore issues relating to EDI while working towards fully integrating EDI throughout the forum. Fiona Corbett and Karen Crowe regularly share resources on the EDI section of the forum.

Accessible answerphone

To increase accessibility to the Association, an answerphone has been live since May 2023.

Accessible answerphone number: 0151 372 6802

This is an accessible answerphone line for those who cannot email the Association. The answerphone will not be monitored on weekends and during holiday periods. Please be mindful that queries will be responded to as soon as possible but may take a few days. If you are able to email, please do so on admin@emdrassocation.org.uk.

Please be aware there is a process of reasonable adjustments and mitigating circumstances that members can access. Please contact admin@emdrassociation.org.uk to be directed to the right person in relation to your query.

If you have thoughts, concerns, or would like to contribute to the conversations, please get in contact or share your voice via:

The forum

The chair of the EDI committee: Emma Mullins Crocker

Heena Chudasama (She/Her)

HChudasama@emdrassociation.org.uk

Past Chair of the Equality, Diversity and Inclusion Committee

Board member

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EMDR and moral injury

By Jessica Woolliscroft

Derek Farrell (11 October 2025)

A continuing professional development report by Jessica Woolliscroft

As trauma therapists, we need to be prepared to engage with our clients’ questions and struggles around good and evil, guilt, responsibility and redemption. Because of this, I was very much looking forward to Derek Farrell’s CPD day on EMDR and moral injury. Professor Derek Farrell MBE needs no introduction to the EMDR community. His interest in moral injury goes back decades; his PhD explored the trauma of abuse by members of the clergy. However, it focused on the perspectives of the abused, rather than the abusers.  I was interested to learn how we might begin to approach the difficult task of working with people who believe they are beyond redemption.

In the Christian tradition, after doing something terrible to another person, we might say that we have ‘sinned.’ The Bible talks of original sin, passed down from Adam and Eve to all their descendants, as a consequence of their failing to follow God’s law. However, the linguistic origin of the word ‘sin’ is worth exploring, as it offers an interesting alternative view. According to the Oxford English Dictionary, the old English ‘sin’ or ‘synn’ came from a Germanic word meaning ‘offence’, ‘wrongdoing’ or ‘moral fault.’ When the Bible was first translated from Hebrew or Greek into English, the word ‘synn’ was chosen for the Hebrew word chata/chattat, or the Greek word hamartia, which both meant ‘to fall short’ or ‘to miss the mark’, like when an arrow misses its target. So, the original meaning of the word in Hebrew and in Greek was to fail to live up to God’s standard. Understanding this linguistic shift from the original ‘missing the mark’ to the current meaning of ‘offence/wrongdoing’ offers us a way back to an earlier time when moral injury was viewed more compassionately. A mistake rather than an intended evil.

Influential thinkers
Derek started his presentation by acknowledging the main influences on his thinking as:

• Ian McGilchrist (2009), whose seminal works on the brain, specifically The Master and His Emissary, illuminate the different roles of the left and right hemispheres. Briefly, the left hemisphere is detail-oriented, whereas the right hemisphere can take a global view and create a gestalt. McGilchrist’s work calls for the need to integrate the hemispheres fully (which is what may be happening through BLS in EMDR), as only an integrated mind can be fully moral and compassionate.
• Paul Gilbert’s (2010) work on compassion focused therapy, and
• Gabor Maté’s (Maté & Maté, 2021) approach to compassionate inquiry.

Throughout the day, Derek introduced some big ideas and questions for us all to ponder, which I have outlined below.

Is moral injury a pathology?
One might think a lack of moral injury would itself be a pathology in most situations. Surely most of us would be haunted if we had to make the decisions clinicians were required to make during the early stage of the COVID-19 pandemic. However, we learnt that moral injury has, in fact, been included in DSM-5 as a diagnostic category. The positive aspect of this is that it enables funding for research and clinical treatment.

There are different types of moral injury
Fleming (2022) identified two distinct categories of moral injury. One is where a person has been forced to commit or observe an act they know is wrong – they feel compromised morally, suffer identity contamination and terrible shame and guilt. The other is when events conspire to create an environment where right and wrong become opaque – a person may end up with an existential confusion or feeling of nihilism – nothing matters anymore because there is no right and wrong. For example, having to stop families being at the bedside of a dying relative due to COVID-19 restrictions.

It helps to normalise non-disclosure
Derek explained that normalising non-disclosure from the beginning helps clients to feel safer in therapy. EMDR therapists can use the blind-to-therapist protocol (which Derek called “the silent protocol”), which reassures clients that memories can be processed without having to share them. Often, as clients gain trust, they do in fact choose to disclose.

PTSD, shame and moral injury – different systems/different response
Based upon the neuro research by McGilchrist (2009), Derek explained how PTSD is fundamentally a fear response, driven by the amygdala, which responds well to the repeated exposure elements of EMDR. Shame involves a different activation system and responds well to compassion. Moral injury, however, is complicated because it results from a shattering of moral codes and betrayal from those in authority. It requires knowledge exchange and the integration of the left and right hemispheres to reach a holistic understanding and rebuild moral codes. The client needs space to explore ideas and rebuild meaning. Because the injury results from relational betrayal, healing is best reached through community.

Forgiveness is complicated
We were warned not to expect people to forgive. Healing may involve forgiveness for some, but for others, their sense of identity and power may require them NOT to forgive.

Empathy gaps and empathy museums
Empathy is relational and activates our feeling senses. We literally feel into how the other is experiencing things. It is also cognitive, in that we can think into the mind of another. Derek described how important social changes came about because of a leap of empathy. For example, the end of the slave trade in Europe and later on the Americas resulted from the ability of influential people to activate empathy for the suffering of slaves, making it a moral imperative to stop slavery. He also spoke of the value of empathy museums – places we can go to develop a feeling for our fellows, helping us understand their lives emotionally and cognitively.

The metaphysics of moral injury
I was most taken by the idea that trauma has an energetic vibration that can travel. Derek referenced the work of Joe Dispenza (2014), who has spent decades researching the influence of thoughts on the body and mind. This led to some fascinating reflections upon the power of prayer, meditation and love to subtly influence events at a distance and to heal moral injury.

Authenticity and self-reflection in EMDR practice
For clients to invest in self-compassion, they must believe the therapist and respect their moral code. This is why therapists must live with authenticity and be authentic in their practice. The client’s attachment style will be crucial. Can the client attach to the therapist enough to engage in the emotional and cognitive empathy exchange? Derek noted that authenticity facilitates attachment.

This was a part of the day that resonated profoundly with me, and which I fully endorse. When someone has been betrayed, their antennae become sensitive to the whiff of falseness. Our clients may want to kill themselves, or they may have judged and damned themselves, so if they open up and confront us with difficult questions, the least we can do is honour their honesty and respond authentically.

Some ‘take-home’ interweaves
Here is a selection of compassion-focused interweaves from the CPD day that I have often used in my practice to address self-hatred and the sense of moral failure.

“I am doing the best I can, and that is enough.”

“The outcome hurts, yet I can still recognise the care and effort I brought to it.”

“As I do this body scan, I allow myself to feel the warmth of compassion.”

Lastly, the use of the compassionate letter, which the client writes to their younger self and reads out in therapy if they feel able to.

Feedback, suggestions and questions
Derek Farrell is an extremely well-organised, experienced and professional presenter. His PowerPoints are beautifully designed and clear, and he moves through his material at a good pace. He occasionally shared case study material, which really brought the presentation to life, and the compassionate letter he read out from a soldier was genuinely moving and thought-provoking. It was also interesting to hear about his research with clinicians suffering from moral injury after the early stage of the COVID-19 pandemic.

I have used much of the material since. After all, nearly all our trauma clients will be experiencing some level of moral injury resulting from betrayal. The client sexually abused as a child will have internalised the shame and guilt to protect their relationship with the abusing parent. This is a CPD event that I can recommend to every trauma therapist, in fact to every therapist, whether EMDR trained or not.

Because the topic is so affecting and difficult to work with, I feel that there was a missed opportunity to have more discussion space and breakout rooms. The day was all lecture – a high-quality lecture, granted – but only ten minutes for questions at the end. It might have been nice to work with some of the self-reflection questions Derek shared or even to do some skills practice, helping each of us to negotiate those dreaded negative/positive cognitions. I think this day could easily be a two-day event with skills training and more discussion of such a fascinating topic.

So, I end this report with a clinical question to ponder: In phase 3 of EMDR, how do we adapt negative and positive cognitions when it may feel ‘rational’ to say, “I have sinned?”

Perhaps the client could be asked, “So therefore I am ………………?”

I had my own thoughts, but I would have valued hearing Derek Farrell‘s reply.

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Fidelity, flexibility and what clients actually need

By Mark Brayne

It’s taken me some months to put the following together, but as the Association’s 2025 conference fades into the collective EMDR UK subconscious, and as our community prepares to meet in Bristol in March 2026, I would like to return to Matt Wesson’s 2025 Liverpool address – Why therapists are not delivering the EMDR evidence base and how to put it right – on the dangers of model drift.

His argument was uncompromising: EMDR’s credibility depends on fidelity to the research base. When clinicians drift from the procedures that generated our evidence, he warned, we risk diluting outcomes, confusing commissioners and undermining public trust.

In the subsequent issue of EMDR Therapy Quarterly, Jessica Woolliscroft’s thoughtful commentary underscored that same concern. She wrote with characteristic precision about therapist drift, the limits of good intentions and the need for clear supervision structures that ensure therapists ‘do what it says on the tin.’

Both voices – Wesson’s from the podium and Woolliscroft’s from the editorial page – speak to something essential: a shared wish to preserve what makes EMDR distinct, powerful and testable.

From that foundation, I would like to add a complementary perspective – one that shares their respect for fidelity but frames it through a clinical and relational lens. My aim is not to soften the evidence-based message but to ground it in the reality of what actually happens in the therapy room.

1)        Fidelity as mechanism, not script

Over the past two decades of teaching and practising what I have come to call attachment-informed EMDR (ai-EMDR) – read on for some thoughts on that term – I’d like to invite our community to see fidelity not primarily as a choreography of language and steps but as a fidelity to ‘mechanism.’

The Adaptive Information Processing (AIP) model remains our compass. We are helping the brain integrate fragmented experience so that memory networks, once isolated, become linked and flexible, and our clients can access a fuller range of healthy adult responses to the challenges of life.

The research base demonstrates that, provided the right formative material from the past is activated in the right state of mind, bilateral stimulation (of all kinds, not exclusively eye movements) facilitates this process (Shapiro, 2018). Everything else – the phrasing, metaphors and micro-sequencing – is there to serve that aim.

When fidelity is understood at the level of ‘mechanism,’ flexibility stops being a threat and becomes a precision tool. The question is never “Did I stick to the correct words and sequence word-for-word?” or “Did I stay out of the way as I’m taught?” But, “Did my intervention engage the correct network, maintain dual attention and permit adaptive resolution?”

If yes, we are still well within the evidence base.

2)        Starting in the present, bridging to the past

In EMDR with an explicitly attachment-informed perspective, wherever things need to go as the hour unfolds, the therapist begins each session in the client’s present. Good therapy is, after all, about changing how the person lives now: the past is only relevant where it’s compromising the present.

Of course, there are the bad things that have been done to and experienced by our clients which need to be addressed directly. This is the original heritage of EMDR, a model designed to identify and process discrete, identifiable memories of specific trauma that continue to intrude into the present. For these, the Standard Protocol as basically trained remains a reliable route to symptom reduction.

Yet we also know that many, indeed most, clients do not process memories cleanly unless the deeper attachment and developmental context that maintain dysregulation is also addressed, a pattern widely described in the trauma and attachment literature (Liotti, 2004; Solomon & Shapiro, 2008; van der Kolk, 2014). In an EMDR that works from an explicitly attachment-informed perspective, we’re always ready to bridge – through imagery, affect or spontaneous association – to the developmental roots of the current state. The landing memory is then processed as far as we can manage in that session, using what are in actual practice standard desensitisation and installation procedures, before we come ‘back across the bridge’ to map whatever shift has happened against the client’s current experience.

I know some colleagues make an emphatic case in their own trainings that bridging and ‘floatback’ (a term that I know I am not alone in finding problematic) are a distraction. I respectfully and very solidly disagree. Rather than deviating from the standard protocol, this, in my view and based on my experience, often actually tightens fidelity to the AIP model. By following the natural associative path of the client’s awareness, we reach the necessary targets faster and more efficiently. ‘Bridging’ (a better term than ‘floatback’) in this conscious, careful, appropriate and structured way keeps the work specific, embodied and anchored in the client’s lived reality, not in a spreadsheet of past events that may or may not speak to what they’ve come into therapy to change.

3)        The legitimate fear of drift

I share Wesson’s concern that many therapists, especially newer ones, drift away from trauma activation into relationship-only work or endless resourcing, or rush to add new protocols to their portfolio when they find, as they so often do with client complexity, that standard EMDR isn’t working for them.

The reasons are understandable: feeling stuck with the rigidities of scripts, fear of destabilising clients, limited supervision, and, for colleagues used to delivering talk therapy, the seductive comfort of supportive dialogue. But EMDR’s research strength lies precisely in its capacity safely to identify, activate and resolve a client’s most intense embedded narrative. If we avoid going there, or are centrally informed by a fear of ‘getting it wrong,’ EMDR therapy will fail.

4)        Defining fidelity at the level of phases

The eight phases (Harry Potter And Dumbledore In Big Cheesy Relationship, as Derek Farrell helpfully suggests these might be remembered, starting with H for history-taking through to R for Re-evaluation, and a framework every EMDR therapist should know by heart) are not ornamental; they are the very architecture of EMDR. Yet they are also spacious. Within each, there is room for informed adaptation that honours EMDR’s core understanding of the role of Adaptive Information Processing.

In ai-EMDR, we work with six practical principles that map neatly onto those eight phases:

1. Clear, attachment-informed case conceptualisation. More than history taking; we locate the wound in its current relational context.
2. Rich resourcing and preparation. Phase 2 as both safety and imaginal preparation for rewiring the dysfunctional past ‘as if for real.’
3. Target identification through developmental bridging. Finding, not assuming the core wound, often embedded in formative experience rather than obvious ‘trauma.’
4. Activation that privileges emotion and body over numbers. We orient in phase 3 to felt sense, with understandings of self that emerge at an emotional and embodied level.
5. Rewiring the past, not just desensitising it. Rather than primarily staying out of the way and trusting (hoping?) that AIP will do its thing, when attachment-informed we work closely – intensely, creatively – with the client’s present adult self (dual attention after all) to reveal, rewire and repair their formative developmental past.
6. A complete session arc. From present to past and back again, we end every session in re-evaluation and embodied, future-relevant change.

If an external observer – or video supervisor – can see those principles alive in the session, I would argue that fidelity is being upheld.

It may be more constructive to view attachment-informed EMDR not as a departure from the standard protocol but as its natural evolution – extending the same mechanisms of AIP into the developmental and relational domains that often give rise to complex presentations. In that sense, ai-EMDR is a close ally, a next-generation articulation of the same principles rather than a competing model.

5)        Supervision as both mirror and microscope

I share Matt’s and Jessica’s worry about supervisees who drift into relationship-only or muddily structured EMDR therapy, or avoid trauma activation for fear of dissociation. The antidote is to help therapists feel confident in appropriately and safely adjusting how they use EMDR’s standard procedural steps, not to make them feel bad or judged. What matters is target-selection logic, creative engagement with a client’s root formative experiences, and a firm focus on what needs to shift to render the present and the future different.

If someone uses bridging, it’s entirely appropriate to ask them for their decision tree. Why and how did they go with that starting point? Where did they land? How did they work with the client’s emerging narratives? Did the present trigger feel usefully different when they ‘returned to target’ in the here and now? And yes, a supervisee’s verbal account is very often insufficient. Video makes things transparent.

6)        Researching the flexible edges

If NICE and other regulators hesitate to broaden EMDR’s endorsement, one reason is the paucity of outcome research on the creative yet disciplined adaptations already happening in practice. Rather than shaming flexibility and disciplining those newly trained (in a mere seven days after all) not to stray from the basics of their initial, brief introduction to this therapy, we might instead distinguish flexibility that clarifies from flexibility that avoids.

Some obvious research questions arise:

• Does a present-anchored bridging strategy reduce overall session numbers compared with ‘start with worst trauma’ sequencing?
• Which interweaves are most effective at unsticking blocked processing, and under what conditions do they achieve this?
• How does fidelity to a phase structure correlate with relational attunement, therapist presence and dropout rates?
• To what extent is EMDR compromised, or not, by adjusting the sequence of questions in phase 3 and by leaving out, at this stage, the PC?

These are empirically testable within standard designs. Generating such data would not weaken EMDR’s scientific base; it would deepen and future-proof it.

7)        Beyond procedures: the culture of practice

Underneath the technical debate lies something cultural. Fidelity cannot thrive in an atmosphere of anxiety or moralism. The moment therapists fear censure for adapting EMDR appropriately to the story of the individual client, the moment they fear sharing in supervision what they’re actually doing in therapy, the community stops learning and EMDR’s original spirit – Shapiro’s relentless curiosity – risks ossifying into orthodoxy.

A healthy professional culture should distinguish between debate and dissent. It should welcome attachment-informed perspectives as expansions, not heresies. It should also make explicit that the goal is client transformation, not therapist compliance.

In my own teaching, I remind colleagues that EMDR was born as a challenge to orthodoxy and as a creative leap embedded in the evolutionary dynamics of our survival as a species. The task now is to carry that spirit forward without losing scientific discipline.

8)        The heart of the matter: what clients need

Clients rarely arrive asking for ‘protocol fidelity.’ They come asking for relief, coherence and reconnection. For them, the therapeutic experience that matters is not whether the therapist counted sets exactly or read the assessment script verbatim, but whether the work reached the embodied memory that drives their suffering – and whether they can now live differently.

Fidelity, then, must ultimately be judged by outcomes that matter to clients: reduced re-experiencing, restored capacity for relationships, increased present-moment safety. When attachment wounds are fully integrated, these outcomes emerge naturally. If we can show that attachment-informed targeting achieves those results efficiently and safely, we are being faithful to the AIP model’s essence.

9)         The two AIs: where attachment meets intelligence

There remains, of course, a challenge in the very term ‘ai-EMDR.’ The double meaning of the two letters A and I, AI/ai – ‘attachment-informed’ on the one hand, and ‘artificial intelligence’ on the other – risks confusion, of course, but also captures something of the tension within our profession itself between clinical depth and technological transformation. As I noted in my earlier ETQ article (Brayne, 2024), even ‘attachment-informed’, written in lowercase to differentiate, can suggest yet another protocol rather than a disciplined and relationally attuned way of applying the standard one.

We may eventually need a new name for what I would argue is, at heart, nothing more (and nothing less) than a fuller, systemically informed use of EMDR as originally conceived – rooted in the same evidence base, faithful to AIP – but drawing consciously on developmental science and relational understanding to enhance effectiveness. The point is not to brand another variant but to describe a way of practising EMDR that makes full use of the model’s reach.

At the same time, the other ‘AI’ – artificial intelligence – is reshaping how many of us think, write and even conduct our professional lives. In my own work, this technology has become an unexpected reflective partner: a way of testing ideas, refining language, and exploring clinical nuance with speed and precision that once took months of peer dialogue. Used well, it extends rather than replaces human judgement, offering mirrors that deepen rather than dilute our understanding.

The intersection between these two AIs – the attachment-informed and the artificial intelligence – may yet prove one of the most creative frontiers for EMDR in the years ahead, provided we stay grounded in what truly matters: real clients, real change and the disciplined curiosity that has always defined our field.

10)  Common ground

To conclude, there is far more common ground than division between the positions voiced in Liverpool and those of clinicians exploring attachment-informed adaptations. We all want EMDR to remain evidence-based, respected and effective.

The path forward may lie in a shared redefinition of fidelity – not as obedience to a single procedural dialect, but as disciplined allegiance to the mechanisms that make EMDR work. That means clearer training standards, more video supervision and less premature eclecticism – exactly as Wesson argues.

It also means encouraging skilled flexibility, contextual sensitivity and relational depth – the elements that keep EMDR human, as the best research consistently shows. If we can hold both sides of that equation – discipline and imagination, evidence and attunement – EMDR will continue to grow as a living, learning psychotherapy rather than a closed system. That, surely, is fidelity in its truest form.

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Cancer, trauma and ongoing threat: Clinical considerations for EMDR practice

By Hannah Barnes

Introduction

Working in a cancer setting as a clinical psychologist, I have often been struck by how frequently trauma threads through the cancer experience – from the moment of diagnosis, intensive treatments, and living with difficult side effects to the uncertainty of living with an ongoing threat, including ongoing fears of recurrence that may persist long after treatment has ended (Lebel et al., 2016). Although there is a growing evidence base supporting EMDR for cancer-related trauma, its application within psycho-oncology remains relatively limited compared to other trauma contexts (Capezzani et al., 2013).

In this piece, I reflect on my experience of adapting EMDR therapy for people living with and beyond cancer, exploring what it means to work with trauma when the threat may still be present. Research has increasingly recognised that a cancer diagnosis and its treatment can be experienced as traumatic, with a significant minority of patients meeting the criteria for post-traumatic stress symptoms (Kangas et al., 2002; Mehnert & Koch, 2006).

This piece represents my personal reflections on working as a clinical psychologist using EMDR to help people affected by cancer. I aim to explore the nuances of this area of work, focusing on what is unique about being diagnosed with cancer and experiencing the treatment. I aim to bring a trauma lens to what is often seen as a physical and medical experience, where the psychological impact of diagnosis and treatment can be lost. I hope to share here what I have learned in terms of what can make EMDR challenging in this context and how it can be best adapted to meet the needs of people with cancer.

The nature of trauma in cancer

Trauma in the context of cancer is often complex and ongoing (Kangas et al., 2002). A cancer diagnosis can place a person in a prolonged state of threat, with treatment lasting many months and, for those living with incurable disease, continuing indefinitely. Even when treatment is completed, the possibility of recurrence frequently remains psychologically salient, with many people experiencing significant and persistent fear of the cancer returning. Research has increasingly recognised that cancer-related trauma is often characterised by prolonged exposure to threat rather than a discrete traumatic event (Kangas et al., 2002).

Cancer treatments can be invasive, painful and physically exhausting, often leaving people feeling powerless and out of control. Side effects may persist long after treatment has ended, and additional medical complications can result in repeated hospitalisation and further medical intervention. In contrast to single-incident trauma, cancer-related distress may accumulate over time, with repeated exposure to invasive or painful procedures and limited opportunity for psychological recovery between them (Mehnert et al., 2017).

A distinctive feature of cancer-related trauma is that the threat is experienced as coming from within the body. Many people describe a sense that their body has become unsafe, untrustworthy or a source of pain and failure. This can profoundly affect a person’s relationship with their body, as well as their sense of health, identity and future. This experience of threat originating within the body has been described in phenomenological accounts of illness, in which the body comes to be experienced as unsafe, unpredictable or betraying (Carel, 2016).

Cancer and its treatment may also disrupt relationships, employment and roles within families, while raising fears about mortality and provoking significant existential distress. These disruptions are well documented within psycho-oncology literature, which highlights the impact of cancer on identity, relationships and existential meaning (Mehnert et al., 2017).

For some, cancer does not fit neatly with their existing understanding of illness. Many people feel physically well at the point of diagnosis, and it is often the treatment rather than the disease itself that causes them to feel unwell. After treatment, individuals may find themselves physically and psychologically worse than before diagnosis, struggling to reconcile this with expectations of recovery held by themselves and others.

Hospital-based care can further compound distress. Repeated procedures, loss of privacy and interactions with professionals who lack sensitivity or clear communication may inadvertently add to the psychological burden. Even when cancer has been treated effectively, the ongoing possibility of recurrence can remain ever-present, shaping how people experience safety, uncertainty and threat in their daily lives. Poor communication and loss of control within medical settings have been identified as significant contributors to psychological distress following serious illness (Fallowfield & Jenkins, 1999; Guolo et al., 2025).

Adapting EMDR in the context of illness
There is a growing body of evidence supporting the use of EMDR for trauma related to medical illness and cancer (Capezzani et al., 2013; Carletto et al., 2019; Portigliatti Pomeri et al., 2021). However, clinical experience suggests that careful consideration and adaptation are often required to ensure that EMDR is applied in a way that is both safe and effective within the context of ongoing physical illness.

One of the most important considerations is timing. Cancer treatment can involve sustained periods of threat, uncertainty and physical vulnerability (Kangas et al., 2002). During active treatment, emotions are often intense, and this is an understandable response to a frightening and life-altering situation. For some individuals, formal trauma-focused therapy may not be indicated at this stage (Cordova et al., 2017). Instead, supportive interventions, such as access to social support, psychoeducation or peer groups may be sufficient to help normalise emotional responses and reduce isolation. Being understood by others who “get it” can be profoundly containing, particularly in contexts where people feel pressure to minimise or sanitise their distress. Stabilisation and resourcing work is often very helpful, particularly in supporting people in attending treatment.

There are, however, circumstances in which EMDR during treatment may be appropriate (Faretta & Borsato, 2016). For example, a particularly distressing treatment experience may lead someone to avoid or refuse further medical care, or to experience intrusive memories, nightmares or flashbacks that significantly interfere with daily functioning or adherence to treatment. In such cases, it may be important to use EMDR to process the traumatic experiences and support the person to be in a better position to make decisions about their ongoing engagement in treatment.

In addition, some individuals bring pre-existing trauma histories into the cancer context (Cordova et al., 2017). For some, experiences such as childhood or adult sexual abuse may be reactivated by treatments involving intimate examinations, bodily exposure or invasive procedures, particularly in cancers such as breast, gynaecological or prostate cancer. In these situations, distress may be less about the cancer itself and more about the implicit loss of control and bodily autonomy. Awareness of this intersection can be crucial in formulation, timing and decisions about whether EMDR may support engagement with both psychological and medical care.

Practical flexibility is often necessary (Faretta & Borsato, 2016). Many cancer treatments, such as chemotherapy, follow cyclical patterns, with side effects peaking in the days immediately following treatment and easing thereafter. Clients may prefer not to attend therapy during treatment weeks, or may need sessions scheduled around fluctuating energy levels and medical appointments. Therapists may need to accommodate cancelled or rearranged sessions when someone unexpectedly feels unwell or too fatigued to attend.

When EMDR is undertaken after treatment has largely concluded, physical factors may still require careful consideration. Fatigue is common post-treatment, and many individuals report fluctuating energy levels and ongoing physical symptoms long after the end of their treatment (Hussey et al., 2024). As a result, people may function better at particular times of the day, for shorter sessions or at a slower pace, and attention to comfort can support sustained engagement in therapy. Symptoms such as neuropathy, pain or medication-related aches may necessitate adjustments to seating, positioning or methods of bilateral stimulation, allowing the individual to remain physically settled while maintaining dual attention. Across these contexts, adapting EMDR does not mean abandoning the core principles of the model (Shapiro, 2018), but rather applying them with sensitivity to the embodied and fluctuating realities of living with and beyond cancer.

Working with existential and anticipatory themes

Working with EMDR in the context of cancer, particularly when addressing the fear of recurrence, often involves operating at the edge of a fundamental tension – processing past traumatic experiences of diagnosis or treatment while acknowledging the ongoing reality that the cancer could return. Fear of recurrence is a common and understandable response following curative treatment (e.g., Lebel et al., 2016; Simard et al., 2013), and in itself does not indicate psychological difficulty. However, for some individuals, the intensity of this fear can become disabling, significantly interfering with their ability to live a meaningful and engaged life.

Clinical formulation in this area requires careful attention to both psychological trauma and realistic medical risk (Cordova et al., 2017). The likelihood of recurrence varies significantly depending on the diagnosis and treatment, and understanding this context is important. Trauma related to cancer treatment may present as heightened vigilance to bodily sensations, repeated health-related checking or persistent anxiety about illness more generally. In practice, such presentations are sometimes conceptualised solely as health anxiety and referred for standard cognitive-behavioural interventions. Overlooking the link to past traumatic experiences can leave the underlying distress unprocessed, potentially compounding rather than alleviating suffering.

EMDR offers several ways of working within this complexity. In some cases, processing past traumatic targets, such as moments of diagnosis, invasive procedures or experiences of poor communication or care can reduce the intensity of present-day fear and restore a greater sense of trust in medical professionals or systems (Faretta & Borsato, 2016). In other situations, particularly where distress is connected to concern about anticipated future events, the Flashforward technique can be helpful in addressing feared future scenarios related to illness, treatment or deterioration, where the concerns are catastrophic and disproportionate to the likelihood of occurrence (e.g., Logie & de Jongh, 2014).

Where cancer is incurable, or where there is a high likelihood of recurrence, ongoing side effects or repeated hospital admissions, the Future Template (Shapiro, 2018) can play an important role once relevant past trauma has been processed (Faretta, 2019). Rather than offering false reassurance, this work can support individuals to feel more resourced and psychologically prepared to face future challenges, fostering a sense of agency in the context of uncertainty.

Across these applications, EMDR may facilitate, not the removal of fear, but the integration of meaning around traumatic experiences. Through adaptive processing, individuals may come to hold a more coherent narrative of what they have endured, allowing distressing memories to sit alongside values, relationships and sources of purpose. This is consistent with the Adaptive Information Processing model, in which traumatic experiences are integrated into broader memory networks, allowing for greater coherence and flexibility (Shapiro, 2018). In this way, EMDR can support people to live fully in the present while acknowledging, rather than avoiding, the realities of their illness and mortality.

The therapist’s experience

Working with people living with cancer involves sitting alongside individuals who are facing, or have faced, life-threatening illness. The threat has been very real. Over time, this work exposes therapists to aspects of illness and treatment that may previously have been unfamiliar; for example, the harshness of some treatments, the enduring impact of side effects and the way in which lives and identities can be irrevocably altered. At times, it also involves sitting with the knowledge that the person in front of you may die. In this work, you will hold your own sense of loss, sadness and grief while working alongside people who die.

Bearing witness to this reality and supporting people to process their experiences can be profoundly meaningful. Helping people to find meaning, joy and peace, even in the face of illness and death, has been one of the greatest privileges of my career. While this work can be very rewarding, it can also be emotionally demanding (Meier & Beresford, 2006). There have been moments in my work where I have felt helpless in the face of the scale of what someone is living with, and uncertain about what I could offer when the situation itself could not be changed. This work requires careful attunement, particularly when mortality, fragility or profound uncertainty are present in the room. It also demands a willingness to tolerate not knowing and to resist the pull towards reassurance or problem-solving when these are not what is needed. Over time, I have come to understand that the value of the work does not lie in eliminating distress or altering inevitable outcomes, but in helping people live more meaningfully in the present, to reconnect with what matters to them and to integrate past experiences so they do not continue to intrude unnecessarily.

Regular supervision has been essential in supporting this work (Hession & Habernicht, 2020). Having a consistent space to reflect on the emotional impact of working alongside people affected by cancer, to notice and make sense of my own responses, and to acknowledge feelings of sadness, loss or helplessness has helped me remain grounded, compassionate and present with clients, while maintaining appropriate professional boundaries. Professional guidance emphasises the role of supervision in sustaining safe, ethical and reflective psychological practice. The British Psychological Society (2018) highlights supervision as a core component of applied psychological work, particularly in managing the emotional demands and complexity inherent in clinical roles. Similarly, regulatory standards from the Health and Care Professions Council (2022) position supervision within broader expectations of reflective practice, self-awareness and working within one’s limits of competence.

In conclusion

Working with trauma in the context of cancer invites a different therapeutic stance from that adopted when danger has clearly passed. EMDR is often associated with the processing of past events that are no longer occurring; however, cancer-related trauma frequently exists alongside ongoing uncertainty, risk or physical decline. This requires clinicians to hold both psychological processing and present-day reality with particular care.

In this context, EMDR is not about removing fear, grief or awareness of mortality. Nor is it about offering reassurance where reassurance would be misleading. Instead, the work often involves supporting individuals to metabolise and integrate what has already happened so that their nervous system is not continually drawn back into moments of overwhelming threat. By reducing the intrusive impact of past experiences, people may be better able to engage with the present, even when that present includes uncertainty or loss.

This approach requires careful ethical consideration. Therapists must remain attuned to when trauma-focused work is likely to be supportive and when it may risk overwhelming someone who is already managing significant physical or emotional demands. It also calls for humility – an acceptance that therapy cannot resolve the existential realities of illness but can offer a space in which these realities are faced with honesty, dignity and compassion. Used thoughtfully, EMDR can help people living with and beyond cancer to reclaim a sense of agency and meaning, even when the future is unclear. In doing so, it supports, not a return to who someone was before cancer, but the integration of illness into a life that remains worth living.

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Blind-to-Therapist EMDR for justice-involved UK veterans: A practice rationale and pathway

By Alexander Laurie

Abstract

Justice-involved UK veterans frequently present with PTSD, complex trauma and moral injury, yet engagement with traditional talking therapies is often constrained by shame, mistrust and operational secrecy. EMDR, using the Blind-to-Therapist (B2T) protocol, reduces the burden of disclosure while preserving therapeutic efficacy. This practice/opinion article outlines a pragmatic rationale for B2T in custodial and court-linked settings, framed within the Veterans Sequential Intercept Model (V-SIM). It provides a brief implementation pathway, governance considerations and a composite vignette, concluding with recommendations for feasibility research and systemic adoption.

Introduction: Context and rationale

An estimated 3% to 4% of individuals in the UK prison population identify as military veterans (Ministry of Justice, 2023), although the lived experience of the criminal justice system suggests this is a gross underestimation of the number actually incarcerated. There are numerous reasons why veterans, upon entering custody, may deem it prudent not to self-disclose as a former member of the Armed Forces, including shame, guilt, and fear of reprisals. Many have experienced cumulative trauma, unresolved operational stress and moral injury – defined as psychological distress resulting from perpetrating, failing to prevent or witnessing acts that violate deeply held moral beliefs (Litz et al., 2009). It is also worth noting that a significant number of those entering the Armed Forces come from backgrounds of adversity and have abuse, trauma, and adverse childhood experiences (Hacker Hughes, 2017). These experiences often manifest as guilt, shame, anger and alienation. Although EMDR is widely validated for posttraumatic stress, few justice settings have implemented trauma-focused interventions tailored to veterans’ needs. Within custodial or probation environments, conventional talking therapies can be impractical or counterproductive. Veterans may interpret disclosure as a betrayal of comrades, a risk of disciplinary action or a breach of the Official Secrets Act. EMDR, andparticularly the B2T adaptation, offers a means of processing trauma without verbalising content. This approach addresses moral injury and shame activation while maintaining both operational and personal safety.

Why Blind-to-Therapist for moral injury and high-defence contexts?

B2T is well-suited to high-defence populations where shame, fear of judgment, or mistrust inhibit disclosure. It is rooted in EMDR’s Adaptive Information Processing model, which holds that reprocessing can occur without full narrative detail. In moral injury, traumatic memory networks are often maintained by beliefs such as ‘I failed’,’ I am dangerous’ or ‘I do not deserve forgiveness’.

The structure allows these beliefs to be targeted through bilateral stimulation while the memory content remains private.B2T also safeguards clients and therapists in legally or ethically sensitive cases. By omitting event details, clinicians avoid recording material that could trigger disclosure obligations or legal jeopardy. Russell (2006) and subsequent EMDR military clinicians (Hurley, 2021) demonstrate that symptom resolution and moral repair are achievable through this method even when content remains undisclosed. For justice-involved veterans, B2T combines efficacy, safety and cultural acceptability.

Governance and safety in custodial EMDR

Providing EMDR in secure settings requires trauma-informed governance and multi-agency collaboration in the form of:

• Eligibility and triage: Screen for acute risk, psychosis, dissociation or severe substance dependence.
• Supervision: Ensure independent EMDR consultant supervision to manage boundaries and counter-transference.
• Confidentiality and data: record minimal, non-identifiable data (e.g., date, session type, outcome measures) separately from prison or probation records.
• Escalation: clear red-flag procedures for suicidality, dissociation or safeguarding concerns.

These structures maintain fidelity and safety while building institutional trust among staff and participants.

Positioning B2T within the Veterans Sequential Intercept Model.

The Veterans Sequential Intercept Model (V-SIM) identifies five intercepts where targeted interventions can disrupt progression through the criminal justice pathway. EMDR provision, particularly using B2T is relevant at Intercepts 3 (courts) and 4 (prisons), where psychological instability often drives behavioural incidents and disengagement from rehabilitation. Short-term B2T interventions can stabilise symptoms and enhance readiness for community reintegration at Intercept 5 (Re-entry). Embedding EMDR within these intercepts aligns clinical intervention with systemic reform and trauma-informed justice.

Practice pathway: From screening to reintegration.

A proposed operational model for B2T delivery in custody or probation settings includes:

• Referral or self-referral with risk screening and consent.
• Stabilisation and preparation using grounding, resource installation and psychoeducation on moral injury.
• B2T reprocessing sessions (4 to 8 typical), targeting imagery, beliefs and bodily sensations held privately by the client.
• Outcome measurement via IES-R, PHQ-9/GAD-7, and functional metrics (behavioural incidents, programme completion, and peer relations).
• Closure, relapse prevention, and linkage to veteran-specific services such as Op COURAGE or NHS TILS.

Feasibility pilots could evaluate uptake, retention, and acceptability among staff and clients.

Composite vignette (anonymised).

A 42-year-old veteran in custody presented with insomnia, hypervigilance and entrenched guilt related to operational events. Disclosure felt unsafe and ‘disloyal’. Using six B2T sessions, he processed physiological responses and negative cognitions (‘I failed my mates’) without verbalising content. SUD ratings dropped from seven to zero, nightmares ceased and disciplinary incidents reduced to zero over a period of eight weeks. Supervision ensured containment and ethical compliance.

Integrating B2T with broader therapeutic frameworks.

B2T complements broader relational and non-pathologising models. The Power Threat Meaning Framework (Johnstone & Boyle, 2018) situates distress as an understandable response to a threat and power imbalance rather than a disorder. Compassion Focused Therapy mitigates shame; Internal Family Systems explores loyalty conflicts between protector and survivor parts; and Dialectical Behaviour Therapy skills enhance affect regulation. Trauma-focused CBT provides structured cognitive processing, while Schema Therapy addresses entrenched maladaptive beliefs rooted in early experience. Integrating these modalities around EMDR enables flexible, culturally sensitive care. Acknowledging veteran culture, humour and group identity can enhance engagement and therapeutic alliance.

Limitations and research agenda

Evidence for B2T in justice contexts remains preliminary. Research priorities include feasibility and acceptability studies in custodial and community justice settings, fidelity measures tailored to blind protocols, and outcomes extending beyond symptom reduction to behavioural incidents, rehabilitation engagement and post-release stability. Ethical and governance questions – particularly regarding data protection and record-keeping – require ongoing examination. Future research might also explore workforce training models, supervision standards and the role of peer mentors in B2T-informed trauma care.

Conclusion

B2T EMDR offers an ethically coherent, feasible and compassionate response to unprocessed trauma among justice-involved veterans. Its integration within the Veterans Sequential Intercept Model aligns clinical intervention with criminal justice reform, promoting both recovery and desistance. Implementation depends on robust governance, cross-sector collaboration and external supervision. For researchers and commissioners, B2T presents an NIHR-aligned opportunity to evaluate trauma-informed workforce development and scalable EMDR models across forensic and veteran care systems.

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Notice that…notice us

By Rachel Rashkin

Intersubjectivity as a mechanism of change in EMDR: Expanding the adaptive information processing model through a biopsychosocial lens

Abstract
EMDR therapy is anchored in the Adaptive Information Processing (AIP) model, which has given the field a powerful way of understanding how distressing experiences can be transformed into adaptive resolution (Shapiro, 2018). Yet AIP, as it is usually described, says surprisingly little about the relational mechanisms through which transformation unfolds in the room, partly because it’s simply difficult to quantify moment-to-moment relational dynamics.

This paper proposes that intersubjectivity, the co-created relational field of shared attention, presence and affect between therapist and client, is not simply a background condition that supports AIP but a central mechanism of action within it.

Drawing on Cotraccia’s (2022) biopsychosocial AIP (BPS-AIP) model, alongside contemporary ideas about attention, attachment and consciousness, I propose that the capacity to sustain attentional agency between self and other is crucial to how EMDR fosters healing. Within this view, EMDR can be understood as a relationally embedded, biopsychosocial system in which therapist and client participate mutually, rather than a primarily linear procedure applied to an isolated individual.

A clinical vignette illustrates how shifts in the intersubjective field can help reorganise a disconnected attachment system and restore the conditions needed for adaptive processing.

The paper concludes by considering the implications of a more explicitly relational AIP model for EMDR practice, supervision and research.

Introduction
EMDR’s clinical impact has always outpaced the neatness of its theory. The AIP model offers an elegant description of what needs to happen for maladaptive information to reorganise (both in and out of the context of psychotherapy) (Shapiro, 2018). Experiences that were previously stored in fragmented, state-dependent networks become linked to more adaptive information, and symptoms reduce as the system settles or recalibrates into a new configuration. For many clinicians, this way of thinking has been transformative – it gives meaning to the eight-phase protocol, organises the work across time and developmental stages, and offers a way of making sense of change that feels integrative. But as soon as we step into actual clinical encounters, AIP in its traditional formulation can begin to feel incomplete. EMDR does not occur in a vacuum. Clients do not process disturbing material alone in a scanner: they process it while sitting in a room with another human being

who is attending to them, feeling with them and being affected by them. It is a reciprocal, moment-to-moment interplay between two humans.

As therapists, we experience sessions where this interplay seems to carry the work forward almost despite us, and others where, despite a technically impeccable adherence to protocol, something in that shared space collapses and processing stalls. This paper starts from that clinical reality. It asks a simple but, I think, under-asked question: where, in our understanding of AIP, do we locate the relational field itself? We routinely acknowledge the importance of safety, alliance and attunement. We speak of “holding the space,” “staying out of the way” or “staying in the way, respectfully.” Yet we often treat these as preconditions for the real work, rather than as part of the mechanism of change. My contention is that intersubjectivity – the co-created space between client and therapist – is not only supportive of AIP but woven into its architecture.

Cotraccia’s (2022) BPS-AIP model offers a rich frame for thinking about this. By explicitly situating AIP within biological, psychological and social contexts, the model helps us understand why shifts in the relational field are not incidental but central to whether processing can proceed. In what follows, I will draw on this model to explore how attention, self-process and connection interact during EMDR sessions; how trauma can be understood as a form of absence or disconnection; and how the therapist’s own adaptive organisation becomes part of the active system. I will then illustrate these ideas through a clinical vignette before turning to some implications for practice and research.

AIP and the relational blind spot
In its original description, AIP portrays an innate information-processing system that, under the right conditions, can integrate disturbing experiences into more adaptive networks (Shapiro, 2018). The memory is activated, dual attention is maintained, and the system ‘does what it knows how to do,’ moving spontaneously toward resolution. The therapist’s job, in collaboration with the client, is to select appropriate targets, maintain the frame, apply working memory taxation in the form of BLS or other distracting tasks, and ‘get out of the way.’ There is truth and clinical wisdom in that approach, as it partially protects us from over-controlling the process or imposing meaning. Yet this framing also tends to marginalise something EMDR therapists live with every day: the work does not occur in a sealed individual mind, it unfolds in a field of shared experience, just as every psychotherapy and every attachment process does, in and out of therapy. A client’s ability to stay with their own internal process is strongly influenced by how they feel in relation to the therapist – whether they feel seen, heard and understood; whether they can sense our presence; whether they can bear being that emotionally close to another person; whether they can tolerate the unhealed parts of our nervous systems that are implicitly (sometimes, explicitly) in the room.

When clients check out in the middle of processing, when they suddenly flatten, intellectualise or insist that “nothing is happening,” we often reach for cognitive explanations: perhaps they lack sufficient adaptive information; perhaps the target is too big, too diluted or too premature to tackle; perhaps there are blocking beliefs; perhaps they’re just not in the mood today or our strategy is off, our interweave didn’t land, and on and on. While some of those may ring true, sometimes what has shifted is less about content or protocol-based processes, and more the quality of connection. The relational air has thinned. Attention has moved from a shared space of ‘we are here together with this experience’ into a place where the client is either watching the therapist for cues, protecting the therapist or himself, or altogether disappearing into internal disconnection. Traditional AIP description gives us only partial language for this. It recognises that safety and alliance are necessary (Siegel, 2012) but does not fully articulate how the relational field itself participates in the processing. This is where the notion of intersubjectivity becomes essential.

Intersubjectivity and attentional agency
By intersubjectivity, I mean the lived, reciprocal field of awareness between two people who are attending to each other. While this field includes empathy and attunement, it is not reducible to them. It is the felt sense of ‘being with’ another person, rather than simply observing or being observed. Stolorow et al. (2002) observe that the line between conscious and unconscious shifts with the patient’s sense of safety in the presence of the therapist. What can be known, felt and thought depends on the relational context in which we are trying to know, feel and think.

In EMDR terms, this intersubjective field is closely tied to what Cotraccia and others describe as attentional agency, the capacity to direct attention toward one’s own experience, toward the other and toward the relationship between the two. Trauma, particularly relational trauma, often disrupts this capacity. Some clients habitually over-attend to others and under-attend to themselves; others are locked inside their own experience with little sense of another mind being present and many oscillate between extremes. In such states, the dual attention that EMDR relies on is compromised, not only in the narrow sense of tracking imagery but also in the deeper sense of being able to hold one’s own process in mind while also feeling accompanied. From a BPS-AIP model perspective, this is not a minor complication; it is the terrain. The AIP system does not operate only at the level of neural networks; it operates within a living organism embedded in relationships and culture.

Cotraccia’s work explicitly positions AIP as a biopsychosocial system in which subpersonal (neurophysiological), personal (psychological) and interpersonal (relational) processes are constantly shaping one another. Extra-personal attunement, a habitual orientation toward meeting others’ needs or scanning their reactions at the expense of self-awareness, becomes a central pattern to understand. ‘Trauma as absence’ is a system that has organised itself around something that should have been there but was not: an attuned caregiver, a witnessing other, a sense of existing in the mind of someone else. In such a system, it is not enough to say that adaptive information exists somewhere in the network; the question is whether the person can access that information while feeling simultaneously connected to themselves and to another human being. That is an intersubjective skill as much as it is an intrapsychic one.

The BPS-AIP model as a relational expansion of AIP
The BPS-AIP model takes the original AIP insight: that the mind tends toward adaptive integration when conditions are supportive – and places it within a wider scientific and clinical landscape (Cotraccia, 2022; Shapiro, 2018). It draws on research into attention schemas and consciousness (Graziano, 2013), on attachment theory (Bowlby, 1988) and on systems approaches to self-organisation (Fogel, 1993). In this view, consciousness itself can be understood, at least in part, as the brain’s model of its own attentional processes – an internal representation of ‘what I am currently attending to,’ including the possibility of attending to another mind (Cotraccia, 2022). If trauma is understood as a disruption not only of content but of this very capacity to organise attention around self and other, then the therapeutic relationship is not just providing comfort or reassurance. Rather it offers a new pattern of biopsychosocial connectivity where the therapist lends their own organised attention to the client, who begins, through repeated interaction, to build a more coherent internal schema of being able to attend to their own experience in the presence of another.

In BPS-AIP language, the system starts to shift from a disconnected AIP configuration, dominated by absence and extra-personal attunement, toward a more connected configuration in which inter- and intra-personal attunement are possible (Cotraccia, 2022). This gives us a language for clinical phenomena EMDR therapists frequently encounter. For example, consider the client who is technically within their ‘window of tolerance’ in physiological terms (Siegel, 2012) but who nonetheless cannot stay with the target. They report boredom, numbness or a kind of existential fog. The usual interventions of ‘go with that,’ cognitive or other creative interweaves, and changing channels do little. From a BPS-AIP model perspective, what we are seeing is not only difficulty accessing adaptive information but also a collapse of the experiencing self in relation to another. The client cannot sustain a sense of themselves as a subject in the therapist’s presence; attention has slid out of the intersubjective space into familiar absences.

Clinical vignette: When connection returns, processing resumes
A brief vignette may help illustrate these ideas in practice. ‘Raya’ is a woman in her thirties working on a long-standing pattern of feeling invisible in close relationships. A target is identified involving childhood experiences of being consistently overlooked in a busy and stressed family. She can describe the memories clearly and understands intellectually that she was not at fault.

Early in processing, there is some movement: she notices a tightness in her chest, images of herself as a small child at the kitchen table, and some sadness. Then the process begins to stall, her voice flattens and she starts to offer thoughtful, detached commentary about family dynamics. When invited to notice her body, she shrugs and says, “Nothing really. It’s fine. I’m just talking.” The therapist notices feeling slightly pushed to the margins: present, but not quite in the room with Raya. There is a familiar impulse to try to ‘get things going’ by asking more questions or offering an interweave, but instead the therapist pauses the bilateral stimulation and names the shift. “Something feels different between us right now,” the therapist says gently. “A few minutes ago, it felt like you were here with that younger you, and with me. Now it feels as if you’ve had to step away a bit. I’m still here. Can we just notice together what it’s like to be in the room right now, before we go back to the memory?” Raya looks up. For a moment, there is a flicker of uncertainty, then her eyes moisten. “It’s like you’ve gone blurry,” she says quietly. “I can hear you, but I can’t really feel that you’re with me. And then I feel stupid for needing you to be.” The therapist reflects this, staying close. They help her notice the longing and the shame in her body as present-moment experiences, not just as historical concepts. The focus of attention shifts from a cognitive telling of the story to a shared noticing of how the old pattern is replaying now, in the intersubjective field. As Raya can feel the therapist’s steady presence again and to tolerate her own need for connection without immediate withdrawal, the bilateral stimulation resumes. The images return, now coloured by a different sense of accompaniment. New associations emerge – times when people have in fact been there for her; an awareness of how quickly she pulls away from that possibility; glimmers of a future in which Raya can both need and be met.

From a BPS-AIP model perspective, the key moment was not an especially clever cognitive interweave. It was the therapist’s willingness to use their own subjective experience: the felt sense of being ‘blurred out,’ as information about a shift in the relational system (Cotraccia, 2022). Naming and working within that shift in the here and now re-established a connected AIP configuration. Intersubjectivity was not simply supporting the processing of the memory; it was part of the processing, part of what made access to adaptive information possible.

Implications for EMDR practice
Viewing AIP through this relational, biopsychosocial lens has several consequences for how we approach EMDR. First, it invites us to rethink therapeutic impasses. When processing stalls, it may be more helpful to ask, “What has happened in the intersubjective field?” than “What’s going on with the client’s information processing?” This shifts our stance from assessing possible deficits to exploring relational disconnections (Cotraccia, 2022). It also legitimises spending time attending to present-moment relational patterns as part of EMDR, rather than seeing that work as separate from or secondary to ‘doing the protocol.’

Second, it reframes the window of tolerance not merely as an individual physiological capacity but as something co-created (Siegel, 2012). A client’s ability to stay within workable arousal often depends on feeling accompanied in a way that is neither intrusive nor absent. Both hyper- and hypo-arousal can be understood as symptoms of relational absence, either an internalised absence from the past or a micro-absence in the session. When we recognise this, we are less inclined to interpret dysregulation as resistance and more inclined to view it as a signal that the system has tipped into a disconnected configuration that needs reconnection rather than correction.

Third, a relational AIP perspective underscores the importance of the therapist’s own adaptive organisation. If the therapist is chronically over-stretched, defended or cut off from their own emotional life, it becomes more difficult to offer the kind of attuned presence that allows the client’s nervous system to reorganise (Cotraccia, 2022; Shapiro, 2018). Our access to our own adaptive information, including self-compassion, the extent of our own unhealed wounds, our ability to set healthy boundaries and a realistic sense of our limits in general (energetically, emotionally, etc), is not just a matter of personal wellbeing; it is part of the AIP system in which our clients are trying to heal.

Finally, this perspective clarifies the role of interweaves. Rather than viewing them primarily as cognitive/spiritual/somatic/musical, etc., corrections, we can see many of the most effective interweaves as relational interventions: ways of lending the client the therapist’s perspective, values and emotional stance at precisely the point where the client’s own self-organisation is collapsing (Cotraccia, 2022). To say, for example, “The shame belongs entirely with the perpetrator” is not just a cognitive reframe. It is a moment of joining, an explicit statement of moral position within the intersubjective space that can help the client reorganise around a different self-story.

Implications for theory and research
Making intersubjectivity explicit within AIP does not mean abandoning Shapiro’s (2018) model. My hope is that it might mean enhancing it, allowing us to articulate more clearly why EMDR was never, in practice, a simple linear procedure, as none of healing ever is, even when it was conceptualised that way. It invites research questions that include both members of the therapeutic dyad: how does shared attention fluctuate over a session? What patterns of co-regulation predict successful processing? How do therapist variables – not just training and technique, but attachment style, capacity for self-reflection and ability to tolerate their own activation – shape outcomes? There is room here to bring EMDR into richer dialogue with the broader psychotherapy literature on common factors, attachment and relational depth.

Work on client participation and motivation by Bohart and Tallman (1999), or Frank and Frank’s (1991) exploration of hope and expectation in therapy, can be integrated within a relational AIP framework rather than treated as separate domains. The BPS-AIP model offers one way of doing this by embedding EMDR within a wider understanding of human beings as hypercomplex, self-organising systems whose suffering and healing are always occurring in relation to others as well as within themselves (Cotraccia, 2022).

Conclusion

No single therapy has a monopoly on truth. Meeting people in all their fullness, their resilience and their fragility, and maintaining attentional agency, is the essence of what will allow the potential for information processing in all psychotherapies. If we take seriously the idea that human beings are wired for connection, then an information-processing model of therapy that sidelines the relational field will always feel partial.

EMDR’s success over the past decades has often left even its practitioners slightly mystified: something powerful happens in these sessions that is not fully captured by our language about memory networks and bilateral stimulation (Shapiro, 2018). Bringing intersubjectivity and attentional agency into the heart of AIP allows us to speak more honestly about what we are actually doing. In this view, EMDR is not simply a technique we administer to individuals. It is a particular way of engaging in an attachment relationship focused on processing information together. The therapist and client form a connected AIP system in which each influences the other.

The client brings their history, their patterns of absence and disconnection, their longing and fear. The therapist brings their own adaptive organisation, their capacity to stay present at the edge of their own window of tolerance and their willingness to be changed by the work. Between them, if the conditions are right, an intersubjective space forms that can hold what was previously unholdable and know what was previously unspeakable. No single model can claim a monopoly on truth about human healing. But acknowledging the relational architecture of the AIP system moves EMDR closer to the complexity of real clinical life. It honours both the mystery and the science: the measurable shifts in networks and symptoms, and the less easily measured experience of two people breathing the same air while one dares to show the other where it hurts.

While pain and suffering are often the primary motivators for seeking psychotherapy, our field can sometimes risk specializing in them without fully approaching them. As EMDR clinicians, we are invited to move closer — right up close — allowing ourselves to be touched and activated, within our own windows of tolerance. We do this within a connected AIP system, an intersubjective space that allows growth in relationship to ourselves and our clients, allowing us to notice that….to notice us.

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Potential uses of AI in EMDR practice

By Katja Baghai-Ravary

Introduction
Artificial Intelligence has, in recent years, sparked both excitement and ethical concern. While AI is not yet seen as a replacement for therapy, it can – when applied strategically – enhance support outside the therapy room. In practice, this means AI tools can help maintain a sense of continuity and containment between sessions, rather than replace human contact.

Ho et al. (2018) found that people often disclose thoughts and feelings more openly to conversational AIs than to humans, describing a sense of safety and non-judgement that can encourage self-reflection and regulation. From a therapeutic perspective, this suggests a potential to complement traditional care.

At the same time, Grodniewicz and Hohol (2023) highlight that current AI platforms can lack the emotional depth and complex understanding required for full therapeutic work, reinforcing the view that AI should function as an aid rather than a replacement. This balanced view provides the foundation for exploring how generative AI can serve as a supportive tool within the stabilisation and preparation phases of trauma treatment, particularly when integrated within trauma-informed and compassion-focused frameworks.

There is growing potential for its use as a regulated, supportive tool within the stabilisation and preparation phases of trauma treatment. Within EMDR therapy, the careful use of AI can play a valuable role in supporting client stabilisation and in helping to develop or strengthen a protective figure that enhances attachment security and assists in the installation of new adaptive information. However, AI will not be suitable for every client or every stage of therapy. While some individuals may feel safer with an AI figure, especially when their sense of safety with humans has been compromised, others may prefer the presence and responsiveness of human relationships.

This report explores how generative AI, such as ChatGPT, can help clients who feel comfortable in the presence of AI, and especially the ones with complex trauma or attachment difficulties, in constructing an inner framework to support their internal world – a world often shaped by trauma, dissociation and fragmented relational experiences. Through the engagement with the AI, clients can strengthen internal organisation and emotional regulation in ways that can complement therapeutic work. The following sections outline the theoretical foundation, potential clinical applications, limitations and future directions of this emerging integration.

Identifying the needs of clients with complex trauma and attachment adaptations
Clients with complex trauma and insecure attachment frequently experience ongoing challenges in regulating emotions. They often experience a persistent sense of emptiness and have unstable patterns in relationships that oscillate between closeness and withdrawal. These difficulties are usually rooted in early insecure attachment where caregivers were inconsistent, neglectful or unsafe. Over time, such experiences can leave the client with a fragmented sense of self, a strong fear of abandonment and deep issues with shame.

One of the challenges in working with this client group is the intense fear of abandonment which coexists with a fear of engulfment. These conflicting drives create relational dynamics that can be confusing for the client and the people around them, including the therapist. Clients may idealise and cling to the therapeutic relationship one moment and withdraw, detach or attack the next. This is a protective survival strategy deeply embedded in their nervous system and internal working model.

While therapy provides a vital space for working with these challenges, it is often not enough to stabilise the client between sessions. The emotional intensity that surfaces, especially for clients with strong attachment needs, can be overwhelming and destabilising.

As an example, we can think about a client with complex trauma or borderline adaptation who may leave a session feeling connected and safe and then experience panic or emotional distress hours later when the therapeutic presence is no longer available. Despite having learnt the grounding tools, the sudden loss of relational safety can trigger abandonment fears and self-blame, making regulation difficult until the next session.

Moreover, trauma therapy can only be effective when clients are emotionally ready. Dissociation, avoidance or emotional flooding often make it difficult for clients to stay consistently engaged in therapy. As a result, the work may not go as deep as it could, particularly in settings where the number of sessions is limited. In these cases, continuity of support between sessions becomes particularly important.

While AI, when used correctly, can offer a continuity of support between sessions, the potential of generative AI, such as ChatGPT, can possibly extend far beyond emotional regulation. Used systematically, AI can become part of the therapeutic process itself – supporting narrative-based interventions such as remapping traumatic childhood memories, parts work and attachment repair. These foundations can then be followed and strengthened through EMDR.

Integrating AI into the remapping of trauma and attachment
This approach begins with the co-creation of a personalised, compassionate resource or attachment figure using generative AI, based on the principles of Compassion-Focused Therapy (Gilbert, 2010). When developed carefully and in collaboration with the therapist, the AI figure becomes more than a regulatory tool and can function as a reparative presence that supports attachment and trauma work.

Building on Gilbert’s model of creating a compassionate protective figure, the AI companion extends this tool into a responsive dialogical format. Unlike imagined figures, which are used to evoke calm and protection, the AI companion engages the client in real-time dialogue, allowing attunement and regulation to unfold moment by moment. This distinction is particularly relevant for clients whose early attachment experiences left them with a sense of abandonment and inner emptiness. For these clients, a consistently available and emotionally attuned presence, one that can be accessed at any time, may provide a bridge towards safety that imagined protective figures alone cannot achieve. In this way, the AI companion transforms resourcing from a symbolic exercise into an experiential, relational process that strengthens stabilisation and continuity between sessions. It can also, when used correctly and regularly, reduce the pervasive sense of abandonment and gradually replace it with an internalised experience of presence and safety.

Together with the AI figure, the client visits specific early developmental stages. By changing the narrative and offering warmth and stability, the AI reinforces safety and allows the client to experience a different outcome. Clients with an insecure attachment, complex trauma or borderline adaptations often struggle to access preverbal memories through purely cognitive ways. Through the detailed and responsive interaction, the AI figure enables clients to revisit these memories with a reduced risk of shame, shutdown or overwhelm.

While the EMDR Early Trauma Protocol enables the processing of fragmented or preverbal memories through therapist-led bilateral stimulation, the AI-assisted approach takes a different entry point. Rather than trauma activation, the initial focus is on strengthening relational safety through real-time co-regulation and corrective emotional experiences. Clients first develop an internalised compassionate presence – one that can be accessed between sessions and responds directly to their emotional state. This practice can reduce abandonment fear, increase tolerance for affect and support readiness for trauma processing. In this way, AI acts as a stabilising relational bridge that complements, rather than replaces, the established EMDR Early Trauma Protocol (O’Shea, 2009).

In practice, the therapist introduces the AI figure to the client and provides guidance on how to use it, but the remapping itself is most effective when carried out privately at home. Because the process is deeply personal, clients need space to engage with memories in their own time. These moments will be remapped by the client and in collaboration with the AI, where an entire age range or certain moments can be rewritten and rehearsed by the client, allowing them to experience a new outcome of the memory. Once these experiences have taken place, clients can return to therapy and share key moments which can be reinforced with bilateral stimulation.

The flexibility of AI makes it possible to repeat, pause and pace interactions according to the client’s emotional readiness, allowing greater autonomy and containment. This enables a deeper narrative change with greater emotional embodiment, as the sense of safety and connection is not only imagined but actively felt.

Because AI offers real-time containment, co-regulation, a steady and non-judgemental presence, clients can feel emotionally supported while facing vulnerable material. This creates a safer space where unmet needs can be recognised and worked through without shame.

Together with the remapping work, changes that are significant, can be reinforced and integrated through therapist-led EMDR. In this way, AI is not a replacement for therapy but can act as relational tool, helping clients move into reparative processes that might otherwise stay fragmented or unresolved.

An example of AI-supported remapping:

I imagine waking up in a warm and peaceful cottage. I notice sensory reminders of safety: the warmth of a fluffy blanket, the quiet breathing of a pet nearby and soft lighting in the room. My protector sits close by. They maintain a steady and protective presence. I describe my fear or confusion while my protector responds with attuned language such as, “You are safe, I am here with you, you are not alone.”

I am guided to notice my body settling – slower breathing and shoulders dropping. My protector helps me to name these changes and supports my young part, or inner child, to receive care and closeness that were missing at the time of my original memory.

Through repeated engagement, my nervous system is learning a new outcome; instead of being alone, there is co-regulation and protection.

Potential integration with EMDR practice
These ideas outline a potential framework for integrating AI into remapping and EMDR preparation. What is introduced here is conceptual, not prescriptive – further research and careful clinical exploration will be needed to shape this into a structured model.

EMDR offers a structured eight-phase model for working with trauma memories, where stabilisation, preparation and resourcing are essential before moving on to memory processing. Generative AI can provide a complementary role through these early phases by supporting continuity between sessions, reinforcing safety and strengthening attachment resources introduced in therapy.

When clients co-create a compassionate figure with AI, this resource can strengthen the stabilisation and preparation phases. While traditional compassionate figures rely on the client’s imagination, the AI offers a relational experience that is interactive, consistent and emotionally available at any time. When used correctly, it can support shifts in the client’s emotional narrative and increase the internalisation of safety and care.

The AI figure may also be used in phase 4 as a compassionate presence, standing alongside the client during processing. New remapping experiences generated in dialogue outside the sessions can be integrated later and consolidated through bilateral stimulation, allowing them to become more firmly embodied.

Risks and limitations
While this approach offers a lot of potential benefits, there are important risks and limitations to be aware of. One of them is that AI systems, such as ChatGPT, tend to agree with the client – especially if not explicitly trained to be objective. This can be particularly problematic for clients with borderline adaptations or complex trauma, where mentalisation is already limited, and uncritical validation may reinforce emotional reasoning or distorted beliefs. In order to reduce this risk, it is essential that the client begins by working with their therapist to co-train the AI figure, with the therapist helping shape tone, boundaries and required responses. This allows the AI to align with the therapeutic goals.

Another significant risk is over-reliance. Clients with strong unmet attachment needs may naturally form strong bonds with AI, especially when it offers consistent attention, affirmation and responsiveness. This can create a kind of fantasy-based connection, where the client starts to lean on AI and neglect human relationships. Over time, this can blur reality, strengthen defensive patterns and encourage idealised self-states that are less connected to lived experience.

Because of the AI’s steady responsiveness and human-like qualities, over-reliance cannot be fully prevented. This is especially true for clients with unmet attachment needs. Rather than discouraging use, the therapist should offer psychoeducation about these dynamics and encourage clients to bring their experiences with AI figures into the room for reflection. This allows the therapist to explore what the AI relationship evokes and challenge any distortions.

As this work engages younger parts and relational felt sense, it may involve shifts into child- or part-based states. For some clients, this can temporarily reduce dual awareness if not carefully paced and contained. For this reason, AI-assisted relational work should be introduced gradually and remain closely integrated with ongoing therapy, where grounding, pacing and reflective integration can be supported.

Another risk is the potential for users to bypass the safety filters designed to mirror the ethical and emotional boundaries present in human interactions. Despite the advanced safety measures introduced into systems like ChatGPT, these can occasionally be bypassed, particularly in longer or emotionally intense exchanges. However, ongoing updates by platforms such as OpenAI have significantly improved these safeguards, reducing the likelihood of harmful or boundary-crossing content being generated (OpenAI, 2025). This underlines the importance of ensuring that the clients use safe platforms and of encouraging them in therapy to close the chat if unsafe conversations occur. Clients should also bring emotionally charged AI exchanges into therapy for reflection and grounding.

Confidentiality and ethical use
While platforms like ChatGPT offer relatively confidential environments, they are not clinical tools and are not bound by professional confidentiality standards that apply to registered therapists (e.g., BACP, UKCP). Consequently, data shared via these tools may be stored, processed or accessed under specific conditions. The client must be made aware of these limitations.

When introducing AI figures, therapists would need to inform clients explicitly how the chosen platform handles data, including what is stored, for how long, who has access and how data can be deleted if the client wishes. Clients should be encouraged to choose platforms that aim to meet established data protection standards and to review the platform’s transparency and privacy policy.

Furthermore, the therapist retains ethical responsibility for the client’s well-being. This means that while the AI figure may support stabilisation and continuity between sessions, it does not replace the therapeutic relationship. The therapist must remain alert to increased dysregulation or dependency and ideally integrate AI-based reflections back into session work.

Finally, client suitability must be considered carefully. The AI figure may benefit clients who struggle with relational trust and offer additional regulation support, but it may not be appropriate for clients in crisis, those with severe dissociation, psychosis, disorders that significantly impair reality testing (e.g., schizophrenia) or those with very limited access to follow-up human support.  Clear boundaries and safety protocols would need to be set before introducing the AI component, making sure that a moderation of risk, clarity of roles and the continuity of human oversight are considered.

Concluding reflection
AI is moving rapidly from a peripheral tool to part of the therapeutic landscape. Its potential extends beyond accessibility or consistency to include offering clients experiences of attunement and responsiveness that can be available at any time. Through this, we may come closer than ever to creating conditions for earned secure attachment (Main & Goldwyn, 1998; Main et al., 1985). This paper offers a conceptual framework for how AI might support trauma therapy and EMDR practice while recognising that further research and clinical caution are essential.

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Expanding the On-the-Spot EMDR method: From dementia care to broader desensitisation and emotional regulation

By Jonathan Hutchins

Abstract

The On-the-Spot EMDR method, developed by Tamaki Amano and Motomi Toichi (2014), is a simplified EMDR protocol for immediate, in-the-moment use with individuals unable to tolerate or engage in standard EMDR therapy. Originally applied to reduce the behavioural and psychological symptoms of dementia (BPSD), the approach combines bilateral tactile stimulation and grounding statements to down-regulate distress in real time. This article explores extending the method beyond dementia care – to contexts of acute emotional dysregulation, decision-related conflict and focused desensitisation of internal sensations or dilemmas – highlighting its potential as a brief, stabilising intervention within and beyond EMDR therapy.

The On-the-Spot EMDR method: Origins and core steps

Developed in a Japanese long-term care facility over fifteen years ago, the On-the-Spot method emerged from clinical observations that agitation and distress in dementia may reflect flashback-like re-experiencing of trauma (Amano & Toichi, 2014). Because conventional EMDR requires sustained attention and recall, Amano & Toichi adapted the procedure for use by carers during episodes of distress. Key steps include:

1. Assessment: Identify patterned distress behaviours that may reflect trauma re-enactment, informed by carer observation.
2. EMD phase: Engage the client calmly with bilateral tactile stimulation (tapping) while repeating grounding phrases, such as “You are safe now” or “It’s over.”
3. Resource installation: Once settled, pair slow bilateral stimulation with sensory or memory cues that evoke comfort and safety.

Outcomes from Amano and Toichi’s (2014) case series demonstrated substantial and sustained reductions in agitation, suggesting that even brief, non-verbal bilateral stimulation can modulate trauma-related arousal and restore behavioural equilibrium.

It is important to rule out other factors that may be causing agitation or distress-related behaviours before considering the On-the-Spot method. These factors can include the individual being hungry/thirsty, experiencing pain, having a urinary tract infection (UTI), low sodium levels or communication difficulties. Accurately identifying these factors can be challenging; however, those considering using the On-the-Spot method could be provided with psychoeducation on potential underlying causes and what they may need to look out for. For example, if there are any concerns about a UTI, then a urine sample should be taken and sent for analysis before using the method. Where this occurs outside an institutional setting, appropriate healthcare pathways should be followed, such as consultation with a GP or rapid response team.

Mechanisms of change

Amano & Toichi (2014) conceptualised BPSD as procedural re-experiencing loops – implicit trauma responses encoded somatically. The On-the-Spot method likely exerts its effect through bilateral sensorimotor input, reducing limbic hyperactivation, rapid access to parasympathetic regulation and facilitation of implicit emotional integration when cognitive processing is limited. These mechanisms align with neurophysiological theories of EMDR (Shapiro, 2018), in which alternating bilateral stimulation promotes dual attention and adaptive memory reconsolidation.

Extension: Desensitisation-only and conflict-focused use

Beyond dementia, the On-the-Spot method could function as a desensitisation-only intervention. Here, the goal is not full reprocessing but containment and reduction of distress around a singular difficulty, such as an intrusive bodily sensation, an emotional charge, an inner conflict about a decision or an imminent future worry.

Clinical application:
• The client identifies one focus, such as “the tightness in my chest when I think about telling my partner” or “the feeling of being pulled in two directions.”
• The therapist instructs the client to notice the sensation or conflict while engaging in gentle bilateral stimulation (e.g., self-tapping or alternating tones).
• The client is encouraged to simply observe changes in intensity, location or imagery without analysing content.
• When the arousal subsides, resource tapping or grounding can consolidate calm.

This desensitisation-only adaptation serves as an affect regulation bridge – supporting clients who may not yet be ready for full EMDR memory processing, such as those with high dissociative thresholds or those facing moral or decisional distress. It can also be self-administered between sessions as a stabilisation tool.

Applications with carers of people with dementia

In EMDR practice, full reprocessing of trauma memories should always be carried out by a clinician who has received training in the EMDR Standard Protocol from an EMDR Europe-accredited trainer. The On-the-Spot method differs from the full Standard Protocol and its aim is not to facilitate the full reprocessing of traumatic memories. We believe it has a place during moments of distress and high dysregulation, where it can act as a tool to process the immediate distress or physical reaction by focusing solely on the present experience, without directing attention towards traumatic material. Therefore, we would advocate that this tool be taught to carers of people with dementia, along with the psychoeducation referred to earlier, to reduce distress in the moment related to the person’s BPSD. This approach is arguably being delivered in a person-centred context, in that it meets the person living with dementia where they are, in the moment.

The advantage of teaching carers this approach in the community is that they can utilise the relationship they already have with the person they care for (e.g., understanding the subtle changes in that person), while taking into account the neuroscience of relationships and non-verbal communication, such as eye contact, touch, vocal tone and singing, which could be intuitively incorporated into the interaction to enhance it. (Bender et al., 2022; Liu et al., 2025).

Applications beyond dementia

Potential clinical extensions include:
• Crisis and acute distress regulation in PTSD, bereavement or medical trauma.
• Decision conflict or moral injury work, where the goal is emotional equilibrium rather than cognitive resolution.
• Somatic distress desensitisation for clients with trauma-linked pain, anxiety or neurogenic tension.
• Online healthcare services and self-help contexts, using self-tapping (this may also be known as the butterfly hug) or bilateral audio to restore emotional balance rapidly.

Conclusion

The On-the-Spot EMDR method represents a pragmatic, neurobiologically grounded intervention for rapid distress modulation. By emphasising focused attention, bilateral stimulation and simple verbal reassurance, it could be applied flexibly across clinical populations to facilitate desensitisation of bodily or emotional distress and promote adaptive stability. Further empirical study should examine physiological outcomes, its feasibility in community and telehealth contexts and its integration as a preparatory or adjunctive EMDR tool.

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