Understanding Adjunctive Care in EMDR Therapy
Many people ask about my approach to adjunctive care in EMDR therapy. It is not uncommon for clinicians who are not trained in EMDR therapy to want to refer their clients for EMDR therapy and still maintain their role as the primary therapist to their client. This can be a great collaboration as long as it is managed well by both therapists. Understanding both the pros and cons of this approach can lead to a better outcome for the client and can help both clinicians to create an adjunctive plan that will be conducive to optimal treatment gains. From the viewpoint of the client, it can be difficult to leave a trusted therapist in order to receive EMDR therapy with a new clinician. Many clients feel safest thinking that they can just go have a few EMDR sessions with someone new, but reserve their primary therapist for all of their talk therapy. There are some cases where it may be best for the client to make a full transition to the EMDR therapist and then plan to return to their previous therapist at the conclusion of the EMDR therapy. However, there are other circumstances when a client is too fragile, a client is dealing with addictions and is seeing an addictions counselor concurrent to the EMDR therapy, or a client is too anxious about starting therapy with a new clinician. In these cases, it may be best to embark in a collaborative approach to therapy.
In order for the referring clinician and EMDR clinician to most effectively facilitate the collaboration it is helpful to underscore some key aspects of EMDR therapy:
EMDR therapy is therapy in the full sense that both a trusted therapeutic relationship and comprehensive intake and preparation are necessary for treatment to be successful The EMDR therapist needs to spend time building rapport with the client, gaining an understanding of their history and determining an appropriate treatment plan. This history taking and preparation could take anywhere from a few sessions to a couple of months or more, depending on the client’s issues, concerns, goals and coping skills. During the course of the EMDR desensitization phase, the client may have significant shifts in their perspective. They also may find that new issues emerge that need to be addressed. The client’s perspective of the issue is likely to evolve dramatically during the course of just one session and may impact their perspective of many areas in their life, as opposed to just that one. So, how should this collaboration be accomplished in a way that is most beneficial for the client?
Consider the possibility of the client meeting only every two to three weeks with the referring therapist during the time that the EMDR therapy is taking place. Regardless of the spacing of the appointments, if the therapy proceeds as adjunctive care, make sure that there is a signed release and regular communication between therapists. Sometimes the presenting problem is not directly the focus of the EMDR and so it is helpful for the referring clinician to understand why this is and how the EMDR can have an impact on numerous areas of the client’s life. Therapists should respectfully share the insight they may have about the client and the progress being made. EMDR therapy is such a tremendously valuable approach that it definitely warrants referrals. As therapists, we each bring something different and unique to the table for a client; and, clients benefit from the different approaches to treatment and from the confidence that is developed through multiple positive therapeutic relationships. Understanding, support and respect will foster the best feelings for everyone involved, not to mention the best treatment results.