Where to Start?
I’ve often thought that the first session with a client feels a little like being given a whole pie and trying to digest it all. I’ve also realized that clients feel the same way! They are sometimes exhausted after an intake, sometimes surprised at they ways they’ve began to connect the dots, and, I hope, are leaving feeling a seed of hope about how therapy can help them.
When clients come to us with a desire to process trauma using EMDR, our next step is knowing where to start. An intake where we understand the client’s biological, physical, psychological and social history is the right and best first step in Phase 1 (History Taking), but it’s truly only the first step. History taking will continue over the next few sessions. If we’re completely honest, History Taking and assessment will and should be an ongoing part of our treatment—often, new information and insights will come for the client which will help us continually narrow our focus to target a client’s main pain point.
These questions can be helpful to guide you after the Fire Hose Exhaustion Surprising Hope Nugget of your intake session:
What is the client’s goal? This underrated question protects us and the clients from our secret therapist goals. We may identify pain points that the clients bring that feel important, but is that what the client wants to change? How does your client want things to be different in, say, 3 months?
What gets in the client’s way? Some client’s come in to therapy with insight into the beliefs or the memories that are limiting their healing. They can pinpoint the worst flashback memories; they know what they tell themselves. Other times, this will take some work to identify. When clients are stuck here, it can be helpful to look for clues in current conflicts. What do they tell themselves during these arguments with their spouse? What keeps them from taking that next step at work? What keeps them up at night?
When did this start? How long has this belief, behavior, or memory been disruptive in their life? Any related time frames or memories are helpful to note on a timeline, but clients don’t need to name every single incident in their lives. For some clients, especially those with childhood trauma or neglect, this can cause unnecessary distress.
What can the client tolerate? Some clients enter therapy ready to address past trauma. Others come tentative—they want this pain to end, but are apprehensive. Other clients spend most of their time in hyper-arousal or hypo-arousal and are rarely able to stay in their Window of Tolerance. EMDR is a wonderful tool in that Phase 1 (History Taking) and Phase 2 (Preparation) both provide time and tools to build trust and rapport as well as to build a client’s Window of Tolerance in order to move forward in process past events. Note areas of both strength and need to help focus your work as you move into Phase 2.
The most important reminder for yourself as the clinician during the History Taking phase of EMDR is that you are working with a client’s story one piece of the pie at a time. You are not expected—or able—to heal the entire pie by your second session! Curiosity and compassion, with some courage sprinkled in, will be endlessly helpful as you move forward.