EMDR EMDR with Children & Adolescents 3 — Questions and Answers
Question 1: When adapting the Negative Cognition (NC) step of EMDR's assessment phase for a 7-year-old, the therapist should:
- Use exact adult NC language such as 'I am defective'
- Ask the child to write down their negative belief independently
- Offer simplified feeling-based language like 'I am bad' or 'It was my fault' (Correct answer)
- Skip the NC entirely for children under age 10
Correct answer: Offer simplified feeling-based language like 'I am bad' or 'It was my fault'
Young children have limited abstract cognitive ability, so therapists simplify NC language to concrete, feeling-based statements the child can understand and identify with.
Question 2: The 'Butterfly Hug' is used in EMDR with children primarily because:
- It replaces the need for a trained therapist in group settings
- It provides a self-administered tactile bilateral stimulation that children can control (Correct answer)
- It is the only form of BLS approved for children under 12
- It eliminates the need for a resource installation phase
Correct answer: It provides a self-administered tactile bilateral stimulation that children can control
The Butterfly Hug (crossing arms over the chest and alternately tapping shoulders) gives children an autonomous, self-soothing form of bilateral stimulation they can apply independently.
Question 3: A therapist is using EMDR with a 14-year-old who experienced bullying. The adolescent's SUDS remains at 6 after multiple BLS sets. The most appropriate next step is to:
- End the session and reschedule
- Introduce a cognitive interweave to address a stuck point (Correct answer)
- Increase BLS speed to force processing
- Immediately begin installation of the positive cognition
Correct answer: Introduce a cognitive interweave to address a stuck point
A plateau in SUDS reduction suggests processing is blocked; a targeted cognitive interweave can introduce new information or perspective to restart adaptive processing.
Question 4: Which trauma-informed adaptation helps address hypervigilance in adolescents during the preparation phase of EMDR?
- Beginning EMDR processing in the first session to reduce anticipatory anxiety
- Creating a detailed Safe/Calm Place with multi-sensory anchoring (Correct answer)
- Requiring the adolescent to verbally recount the trauma before starting BLS
- Focusing solely on psychoeducation about the brain without any experiential exercises
Correct answer: Creating a detailed Safe/Calm Place with multi-sensory anchoring
A well-developed Safe/Calm Place resource with rich sensory detail provides an internal anchor adolescents can access when distress escalates during later processing.
Question 5: In EMDR with children, the term 'interweave' refers to:
- Alternating between bilateral modalities within a single session
- Therapist-introduced statements or questions designed to unstick blocked processing (Correct answer)
- A relaxation script read aloud during BLS
- The process of weaving the caregiver's narrative into the child's session
Correct answer: Therapist-introduced statements or questions designed to unstick blocked processing
Cognitive interweaves are therapist-directed prompts (questions, statements, or psychoeducation) used to shift stuck processing and introduce adaptive information.
Question 6: Which of the following EMDR resources is specifically designed to target shame-based trauma presentations common in adolescents?
- The Calm Place
- Nurturing Figure / Inner Wise Being (Correct answer)
- The Relaxation Response Protocol
- The Future Template
Correct answer: Nurturing Figure / Inner Wise Being
A Nurturing Figure or Inner Wise Being resource helps counteract shame by installing the felt sense of being accepted and worthy, which is particularly therapeutic for shame-laden adolescent presentations.
Question 7: When treating a child with complex developmental trauma using EMDR, the therapist should prioritize:
- Rapid processing of the earliest trauma memory in the first few sessions
- Extended stabilization and ego strengthening before attempting trauma processing (Correct answer)
- Focusing exclusively on the most recent traumatic event
- Skipping Phase 1 history-taking to protect the child from re-exposure
Correct answer: Extended stabilization and ego strengthening before attempting trauma processing
Children with complex developmental trauma often require extensive stabilization and ego strengthening to build sufficient affect regulation capacity before any trauma processing begins.
EMDR EMDR with Children & Adolescents 3
When adapting the Negative Cognition (NC) step of EMDR's assessment phase for a 7-year-old, the therapist should: