Preparing Clients for EMDR Reprocessing: A Trauma-Sensitive Approach

By Dr Julia Andre, Trauma Specialist

When working with complex trauma, preparation isn’t just helpful — it’s essential. Many of my clients have extensive trauma histories spanning decades, severe PTSD symptoms, chronic pain, dissociation, and often very limited support systems. Most do not initially come seeking full healing — they simply want to feel less miserable.

Yet, with the right preparation, EMDR can offer profound shifts. It also increases the chance that clients will stay engaged and build trust in the process.

Here’s a look into my structured yet flexible approach to preparing clients for EMDR reprocessing.

1. Trauma-Informed Assessment

A trauma-informed assessment must balance thoroughness with sensitivity. Trauma histories are often overwhelming to recall — and sometimes retraumatising if handled too soon.

My general guidelines:

• Early on, I explain that we don't need to discuss past traumas in detail yet — we focus instead on how past experiences affect the client today.
• I normalise trauma responses as natural reactions, not pathology.
• Tools like the PCL-C (PTSD Checklist - Civilian Version) allow symptom assessment with minimal triggering language.
• Dissociation screening (using the DES) is vital. Severe dissociation calls for extra resourcing before reprocessing.
• I also assess the client's somatic awareness. If body sensations aren't accessible, we work on developing that capacity.

Importantly, I avoid rushing to formal PTSD diagnoses in the first sessions. Safety and connection come first. AND FOREMOST, NO NEED TO SHARE ANY DETAILS OR CREATE ANY DETAILED TRAUMA HISTORY!

2. Building a Shared Language: Metaphor Development

Metaphors can save enormous time in helping clients make sense of their experiences. I often use the "seeping box" metaphor to explain unresolved trauma and describe the therapy journey as a process — one step at a time, session by session.

A shared language creates safety and clarity.

3. Assessing the Client's Capacity to Notice

EMDR depends heavily on clients being able to notice shifts in their body, emotions, and thoughts. Many trauma survivors have learned to disconnect from internal sensations to survive.

We work gently to rebuild this awareness, using small noticing exercises long before beginning any trauma reprocessing.

4. Psychoeducation About Trauma and EMDR

From early sessions, I provide trauma education:

• Trauma responses are natural, not signs of being "broken" or "crazy."
• The brain and body can heal — even if belief in healing takes time.
• I explain the EMDR process clearly: the therapist's role, the client’s role, and what to expect during and after sessions.
• We discuss the importance of being able to stop (using grounding or resources) if needed during reprocessing.

Setting realistic expectations early on empowers clients and builds collaborative trust.

5. Medication and Substance Use Considerations

If a client presents with active psychotic symptoms or mood instability, I refer for psychiatric stabilisation before beginning reprocessing.

We also discuss how substances like benzodiazepines, marijuana, or alcohol can interfere with EMDR effectiveness — especially if used shortly before or after sessions.

Timing sessions around patterns of use can help ensure better outcomes.

6. Careful Review of Existing Resources and Adaptive Information

Clients with developmental trauma often have little internal or external support. When reviewing resources, I explore:

• How the client self-soothes now.
• Past figures of support (teachers, relatives, even nurturing memories).
• Presence of spirituality, friendships, or caregiving experiences.

When deficits are present — especially around shame and self-blame — we prioritise building strong, personalised resources before trauma work begins.

7. Skill-Building for Managing Acute Symptoms

Before any trauma reprocessing, clients need "fire extinguishers" — quick tools to manage intense symptoms:

• Visual grounding techniques to rapidly displace flashbacks.
• Deep breathing exercises tailored to clients’ bodies and experiences (with troubleshooting if "breathing doesn’t work").

These are simple but powerful interventions that help build confidence before facing deeper work.

8. Informed Consent and Collaborative Planning

I always ensure clients have a full understanding of EMDR:

• How it works.
• What a typical session looks like.
• Common changes during reprocessing.
• Options for pacing and approaching memories (not rushing into the "worst" memory).

Clients are partners in their healing journey — not passive participants.

9. Clients Must Be Adequately Resourced Before Reprocessing

Starting EMDR without reliable resources is like driving without brakes — possible, but dangerous and unethical.

Clients must demonstrate that they can access their grounding resources both in and outside of sessions. I am flexible about what the resource is (it can be somatic, symbolic, relational, or spiritual) — but having it accessible is non-negotiable before we begin reprocessing.

Final Thoughts

Preparation is not a checkbox. It’s an act of respect for the client’s nervous system, a commitment to safety, and a foundation for deep healing.

Sometimes preparation takes three sessions. Sometimes it takes months. Every client’s pace is honoured.

By investing fully in this phase, we give trauma survivors the best possible chance to not only survive therapy — but to thrive beyond it.

👉 My name is Dr. Julia A. Andre, CPsych AFBPsS , and I am a Clinical Psychologist and Trauma Specialist.

Complex & Childhood Trauma ▪️ DID ▪️ Experiential Therapy Techniques ▪️ EMDR ▪️ Inner Child ▪️ Intensive & Holistic Trauma Treatment