EMDR Clinical Application & Case Management 2 — Questions and Answers
Question 1: A client with complex PTSD has difficulty tolerating the distress involved in EMDR reprocessing. Which modification is most appropriate?
- Proceed with standard EMDR protocol to build distress tolerance
- Extend the preparation phase and strengthen affect regulation skills before processing (Correct answer)
- Refer the client to CBT as EMDR is contraindicated for complex PTSD
- Begin reprocessing immediately to reduce avoidance behavior
Correct answer: Extend the preparation phase and strengthen affect regulation skills before processing
Clients with complex PTSD often require extended preparation, including robust affect regulation and stabilization skills, before trauma reprocessing begins.
Question 2: During the installation phase, the client's Validity of Cognition (VOC) remains at 5 despite multiple sets of BLS. What should the clinician do?
- Accept the VOC of 5 as sufficient and close the session
- Check for blocking beliefs or ecological validity concerns that may be limiting the VOC (Correct answer)
- Increase the speed of bilateral stimulation to accelerate installation
- Return to Phase 3 and select a new positive cognition
Correct answer: Check for blocking beliefs or ecological validity concerns that may be limiting the VOC
A VOC that does not reach 6-7 may indicate a blocking belief or an ecologically invalid positive cognition that needs to be addressed.
Question 3: A veteran client reports flashbacks occurring daily despite completing several EMDR sessions. The most likely explanation is:
- EMDR is ineffective for combat-related PTSD and should be discontinued
- Insufficient number of trauma targets have been identified and processed (Correct answer)
- The flashbacks indicate the client is malingering
- The preparation phase was too long and should be shortened in future sessions
Correct answer: Insufficient number of trauma targets have been identified and processed
Ongoing symptoms after some sessions often indicate that additional trauma targets, touchstone memories, or earlier contributing events still need reprocessing.
Question 4: Which client presentation would most warrant postponing EMDR reprocessing and returning to stabilization work?
- A client who reports mild anxiety between sessions
- A client who is currently experiencing a domestic violence situation with ongoing threat (Correct answer)
- A client who has recently started a new job
- A client who reports occasional nightmares but good daytime functioning
Correct answer: A client who is currently experiencing a domestic violence situation with ongoing threat
Active ongoing threat is a contraindication for trauma reprocessing; safety must be established before processing past trauma.
Question 5: A client's SUD rises from 4 to 7 mid-session after new traumatic material emerges. The best response is to:
- Immediately stop BLS and use grounding techniques to close the session
- Continue BLS and allow the new material to process within the same session (Correct answer)
- Switch to EMDR's cognitive interweave immediately to lower distress
- Reassure the client the rising SUD is a mistake and re-score
Correct answer: Continue BLS and allow the new material to process within the same session
Increased distress when new material emerges is a normal part of processing; continuing BLS allows associated memories to be reprocessed.
Question 6: In EMDR case conceptualization, which element forms the foundation of the three-pronged protocol?
- Current triggers, future templates, and presenting symptoms
- Past events, current triggers, and future templates (Correct answer)
- Negative cognitions, somatic responses, and BLS type
- Resource installation, EMDR processing, and relapse prevention
Correct answer: Past events, current triggers, and future templates
The three-pronged protocol addresses past events that underlie the problem, present triggers that activate it, and future templates for adaptive behavior.
Question 7: A dissociative client unexpectedly switches to an alter personality mid-EMDR session. The clinician should first:
- Continue BLS to process the alter's trauma directly
- Calmly orient the system, ensure safety, and stop reprocessing for the session (Correct answer)
- Ignore the switch and continue with the original target
- Immediately refer to a psychiatrist and terminate treatment
Correct answer: Calmly orient the system, ensure safety, and stop reprocessing for the session
When dissociation occurs during reprocessing, the priority is to stabilize and orient the client system before any further processing.
EMDR Clinical Application & Case Management 2
A client with complex PTSD has difficulty tolerating the distress involved in EMDR reprocessing.
Which modification is most appropriate?