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EMDR Case conceptualization and therapeutic process

documentation format
Clinicians questions or concerns regarding this
case:________________________________________________________________________
____________________________________________________________________________
_______
Presenting issues/symptoms/clinical picture
Presentingproblem(s)/symptoms(includeduration):
_______________________________________________________________________________
________________________________________________________________________________
Findingsbasedonthechecklistofclientselectioncriteria

Currentdiagnosesandmedicalhealthconditions:AxisI_____________________________
AxisII:____________________________ AxisIII____________________________________
AxisIV:____________________________AxisV:_____________________________________
DESscoresandanyDissociativesymptoms:
_______________________________________________________________________________
________________________________________________________________________________
Otherassessmentdata:
________________________________________________________________
Currentstability(noteanyimpulsecontrolproblemswithalcohol,drugs,violence,sexualacting
out,selfinjuriousbehaviors,etc.):___________________________________________________

Clientssociodemographicinformation:
Age:____Gender:____Maritalstatus:______________________Education
Profession:__________________
Currentfamilysupport:
_____________________________________________________________
________________________________________________________________________________

Caseconceptualizationandrecodingoftherapeuticprocess

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Socialsupportavailable:
_____________________________________________________________

Historytakingandtreatmentplan:
HistoryperAIPmodel:Threeprongedapproachincludingpastandpresentlifeissues,traumatic
events,childhoodattachmentstatus,significanthealthhistory(lifetime)
Current concerns/symptoms:
(Current symptoms are caused by earlier experiences that were not adequately processed due to
trauma or insufficient information)
Dominant Symptom (may not be NC):
Image representing the worst part of the experience
Dominant irrational belief___________________________________________________________
Positive Cognition_________________________________________________________________
Past incidents: touchstones memory or other experiential contributors
First:___________________________________________________________________________
Worst:__________________________________________________________________________
Other past events:_________________________________________________________________
Present triggers:_________________________________________________________________
Future challenges and desired
outcomes:__________________________________________________________
Treatment planning: (incident chosen for reprocessing that is contributing to the present problems)
_______________________________________________________________________________
________________________________________________________________________________
Resourcesincludingegostrengths,copingskills,positiveexperiences,selfcapacities:
________________________________________________________________________________
Pasttreatmentepisodesanddiagnoses:
________________________________________________________________________________
________________________________________________________________________________
Preparationnotes:
ClienteducationforEMDRandresponse:______________________________________________
Preferredmechanics:_____________________________________________________________

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Clientstabilityandcopingskills(metaphoroftrain,relaxation,stopsignal,container,safeplace,
anyother)_____________________________________________________________________

Assessmentphasenotes:
Targetchosenforthesession:_______________________________________________________
NC:____I______________________________________________________________________
PC:___I_____________________________________________________________________
VOC:___________________________________________________________________
Emotions:_______________________________________________________
SUDs__________________
Locationofsensations:_____________________________________________________________
Desensitizationprocess,reprocessingexperienceandnotesonclientsfeedback,bodylanguage,
emotionalresponses,changesindicatingreprocessing,images,cognitions,insights,feeder
memories,memorynetworks,blockedbeliefs,anysafetymeasuresused)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Notesoninstallation(checkingoninitialPC,VOC,anyfeedermemories,blockingbeliefs,
andecologicalsoundness),newskillsneeded:
________________________________________________________________________________
________________________________________________________________________________
Notesonbodyscan:__________________________________________________

Closure:(notesonclosingcompletetargetvs.incompletetarget,stabilization,
stateshiftmeasures,selfmanagementtechniquesdiscussed,useof
TICES,clientsgeneralappearance)

Durationandnumberofsessionsuntilclosure:________________________________________

Caseconceptualizationandrecodingoftherapeuticprocess

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Notesonreevaluationforeveryfollowupsession:(checkingresultsofearliersession,changes
inbehavior,insights,dreams,reactiontopresenttriggers,workingonothertargets,followup
andtermination)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Caseconceptualizationandrecodingoftherapeuticprocess