EMDR Clinical Application & Case Management 3 — Questions and Answers
Question 1: When using the cognitive interweave technique, the clinician's goal is to:
- Replace the client's negative cognition with a therapist-selected positive one
- Jumpstart blocked processing by introducing information linked to the three domains of responsibility, safety, and choices (Correct answer)
- Distract the client from overwhelming affect during reprocessing
- Reinforce the positive cognition during the installation phase
Correct answer: Jumpstart blocked processing by introducing information linked to the three domains of responsibility, safety, and choices
The cognitive interweave addresses blocking in processing by offering targeted statements or questions in the domains of responsibility, safety, or choices/control.
Question 2: A child client (age 8) is beginning EMDR. Which adaptation is most appropriate?
- Use the standard adult protocol with no modifications
- Use shorter processing sets, developmentally appropriate language, and incorporate play or art (Correct answer)
- Avoid BLS and substitute purely narrative exposure
- Require the child to score SUD numerically as with adults
Correct answer: Use shorter processing sets, developmentally appropriate language, and incorporate play or art
Child EMDR adaptations include shorter BLS sets, child-friendly explanations, and integration of expressive modalities to match developmental level.
Question 3: A client processes a traumatic memory to SUD=0 and VOC=7, but during the body scan notices persistent chest tightness. What does this indicate?
- The session is complete and the tightness is unrelated to the trauma
- Residual trauma material remains and BLS should continue until somatic disturbance resolves (Correct answer)
- The positive cognition should be changed to address the somatic experience
- The client should be referred for a cardiac evaluation before continuing
Correct answer: Residual trauma material remains and BLS should continue until somatic disturbance resolves
A positive body scan requires the absence of somatic disturbance; persistent tightness signals that additional processing is needed.
Question 4: Which of the following best describes 'looping' in EMDR?
- The client repeatedly returns to the same disturbing material without reduction in SUD (Correct answer)
- The clinician uses repeated BLS sets to enhance resource installation
- A dissociative client cycles through different trauma memories sequentially
- The client loops between the target memory and a safe place automatically
Correct answer: The client repeatedly returns to the same disturbing material without reduction in SUD
Looping refers to processing that cycles without progress, often requiring the clinician to use a cognitive interweave or change the approach.
Question 5: A client who experienced childhood emotional neglect rather than a discrete traumatic event presents for EMDR. The most appropriate initial focus is:
- Decline EMDR treatment as it requires a single-incident trauma
- Identify the earliest or most representative memory of the neglect experience as the target (Correct answer)
- Begin immediately with present-day triggers without linking to childhood origins
- Conduct only future template work to build positive expectations
Correct answer: Identify the earliest or most representative memory of the neglect experience as the target
For chronic or developmental trauma, EMDR targets representative or earliest memories that embody the maladaptive belief network formed by the neglect.
Question 6: What is the primary purpose of the 'future template' in Phase 8 of EMDR?
- To install a positive memory from the client's past as a resource
- To help the client rehearse adaptive responses to anticipated future situations (Correct answer)
- To evaluate the effectiveness of past BLS sets
- To close incomplete sessions safely
Correct answer: To help the client rehearse adaptive responses to anticipated future situations
The future template allows the client to mentally rehearse coping successfully with future triggers, completing the three-pronged protocol.
Question 7: A client discloses active suicidal ideation with a plan at the start of an EMDR session. The clinician should:
- Proceed with EMDR targeting the suicidal crisis as the trauma memory
- Conduct a full suicide risk assessment and address safety before any EMDR processing (Correct answer)
- Skip to Phase 7 (closure) to stabilize the client
- Continue the scheduled EMDR session since the protocol is stabilizing
Correct answer: Conduct a full suicide risk assessment and address safety before any EMDR processing
Active suicidal ideation with a plan requires immediate safety assessment and safety planning before any trauma reprocessing can occur.
EMDR Clinical Application & Case Management 3
When using the cognitive interweave technique, the clinician's goal is to: