Hint Handouts PDF Kiessling 2

Handouts
and
Worksheets
Presented by
Roy Kiessling, LISW
The Neurobiology of Memory
(Kiessling: based upon van der Kolk and Shapiro’s trauma processing models)
The Fundamentals of Memory
The neurobiology of a memory
1. A memory
b. A network of neurons stored throughout the brain !
• Senses: % images,$ sounds,# smells,! tastes, " touch
$
"
c. Emotions/Sensations
d. Core Beliefs - the verbalization of the memory system
# %
2. Forming a Memory !
a. An event occurs drawing attention $ "
Thalamus
• Thalamus-maintains brain activity
% #
• Frontal lobe-keeps attention locked on target
b. Sensory information is sent to the amygdala Amygdala
• Assigns emotional significance

c. Sensory cortices begin forming perceptions
d. Pre-frontal cortex/hippocampus begin to Pre-frontal
Cortex Brainstem
categorizing the experience Hippocampus
e. Working memory
3. Long term memory storage

Stored for future retrieval
4. Memory Retrieval
a. Memories, when retrieved from the hippocampus, are brought back into
working memory
b. When in working memory, memories can be modified according to present
information, i.e., “updated”
c. The updated (re-consolidated) memories are then returned to the
hippocampus for storage
!
$ #
"
Analogy: Working with a word document on a computer

1. A word document is developed in the computer’s “working memory.”
2. Once completed, the document is saved (consolidated) and stored on the
computer’s hard drive (hippocampus).
3. The document is re-opened (retrieved) and revised/updated in “working
memory”.
4. Once completed and saved, the document is updated on the hard drive
(hippocampus).
Reference source: www.human-memory.net/processing_storage.html

The Development of an Adaptive Neural Network
(Kiessling, 2017)
Adaptive Memory Network Development

An experience occurs - adaptive perceptions, attitudes, behaviors form
Up-dated
1. Hebbs’ axiom: “Neurons that fire together tend to wire together."
b. An experience occurs forming adaptive perceptions,
attitudes, and behaviors.
c. The next similar experience reactivates
previous learning.
d. Past and present experiences link and consolidate
into an up-dated neural network. Past Present
2. Adaptive Information Processing (AIP)-keeps what is helpful, discards what is no

longer needed, prepares for the next occurrence.
3. Repeated occurrences develop into an adaptive memory network.
A
D a/b/c/D a/b/c/D
A Consolidation
P
T
I
V
a/b/C a/b/C
Consolidation
E
L
E a/B
A a/B
R Consolidation
N
I
N A A
G
Memory
The Development of an Isolated Neural Network
(Kiessling, 2012)
Negative emotionally charged memories develop into negatively charged neural

networks.
1. Disturbing events are encoded with higher emotions/sensations (amygdala).
! # "
$ %
Thalamus
Amygdala
Pre-frontal
Cortex Brainstem
Hippocampus
I’m worthless.
2. Repeated exposure leads to an emotionally charged neural network.
Family of origin: 0-4 yrs of age
3. Adaptive neural networks develop from other environments.

Extended family, teachers, coaches, etc.
4. Present triggers activate past emotions/sensations.

5. When triggered, past experiences influence perceptions,
attitudes, behaviors, and Core Belief, e.g., I’m worthless.
I’m worthless.
Emotionally charged networks may become isolated/unable to link with adaptive
networks.
Negative/Isolated Network Adaptive Network
I’m worthless I’m worthwhile, regardless
Teacher’s/mentor’s encouragement
Family criticism
Negative networks are unable to consolidate with adaptive networks.
Frozen Memories (a.k.a. PTSD)
(Kiessling 2-12: Adapted from van der Kolk: Traumatic Stress: pg 293-295)
Formation of a Single incident PTSD memory

1. A highly traumatic incident overwhelms the system.
2. The amygdala fires “life or death” emotions.
3. The intensity of the incident’s emotions freezes the system.
4. Amygdala/limbic system encodes a “fight, flight, freeze, numb, dissociate,
collapse” response.
5. Adaptive neural networks are “locked out.”
Adaptive updating, i.e. linking, blending and consolidation, is prevented.
• Sleep patterns are disrupted, adaptive integration is prevented
• Sleep disturbance/nightmares of the actual event occur.
Thalamus
Amygdala
Limbic
System
I’m trapped
PTSD Flashbacks
1. Present triggers activate the past.
Past experiences are relived as though they are happening now (flashbacks).
2. Once activated, that frozen memory hijacks the brain’s functioning.
3. The past memory’s components are re-experienced as though happening now:
emotions, sensations, images, etc.
4. Adaptive neural networks are “frozen out” and shut down.
5. Flashbacks of the event occur. FLASHBACK
Meeting with supervisor
Thalamus
Thalamus
Amygdala
Limbic
Amygdala System
Limbic
System
The past is relived in the present.

I’m trapped
*Phase 2: Preparation
From a Belief Focused Perspective
(Kiessling 2012)
Integrative Psychotherapy
CBT, Solution Focused, Psychodynamic, EMDR, DBT, IFS, Somatic Experiencing, Hypnosis
EMDR
Stage 1 Stage
Stage22 Stage 3
Case Conceptualization Treatment
Processing Integration
Phase 2 2
Phase Phase 3 Phase 8
Preparation
Stabilization Access & Activate Reevaluation
Affect Management
Phase 1 Phase 4 3 Prongs
Phase 1
Target Planning Desensitization - Past
Treatment Planning: - Present
Target Sequence Plan Phase 5 - Future
Installation
Resourcing
(Strengthening Neural Networks )
Phase 6
Body Scan
Closure
*For training purposes and when treating complex client

presentations, preparation skills may need to be taught first
Phase 2: Preparation:
1. Extended Resourcing Interventions:
a. Stabilization
• Self use
b. Affect Management
• Container
• Inner peaceful place
Bilaterally Enhanced Resourcing Techniques
(Container/Inner Peaceful Place/Resourcing)
Goal: To enhance positive experiences (resources) through slow, soothing bilateral

stimulation (BLS) administered or mirrored by the clinician
Seating
1. Off-set like two automobiles passing one another on a two-lane highway
2. Consider: Right brain to right brain, i.e., sitting left to left (Kiessling)
Bilateral Stimulation (BLS): Tapping in/walking through rationale

1. Many clients, in order to fully “sink into” the experience, prefer to close their eyes
2. Tapping in/walking through allows the client to establish a slow, calm, and
soothing rhythm to enhance the emotions and sensations associated with their
resource
Demonstrate "Tap in" and "Walk through"
"Tap in" and "Walk through" Resourcing Techniques:

1. Tap in:
Client or clinician taps slowly on client’s hands/knees
(Laurel Parnell - Tapping In)
2. Walk through:
Client slowly moves heels up and down in a walking-in-place manner
Extended Resourcing Procedures
Steps
1. Access and Activate:
Identify the desired resource (breathing, container, inner peaceful place, etc.)
2. Emotions and sensations:
As you experience the resource, what positive/adaptive feelings, emotions, and
sensations are you experiencing right now?
3. Enhancement:
Heighten awareness of emotions, sensations, beliefs, somatic experience (add
body posture or movement).
4. Deepen with BLS: (Tap in/walk through)

5. Cue word: Put language to the experience - Cue word or phrase, strengthen the
linkage with BLS (Tap in/walk through)
6. Cueing with disturbance (affect shifts):
a. Imagine a very recent negative experience, then use the cue word to shift to
the more positive emotions and sensations
b. Clinician assists in affect shift if needed
c. Strengthen the ability to shift with BLS: (Tap in/walk through).
7. Self-cueing:
a. Client imagines a very recent negative experience, then uses the cue word to
shift to the more positive emotions and sensations.
b. Strengthen the ability to shift with BLS: (Tap in/walk through).
8. Extended Resourcing
a. Rescript
• Identify a recent past experience — last couple of weeks when the
resource/skill would have helped
• Rescript how perceptions, attitudes, and behaviors would have been
different if the resource/skill had been used. Enhance/strengthen the
positive changes with BLS: (Tap in/walk through)
Rescripting does not change other’s behaviors
• Repeat as often as is helpful
b. Rehearse
• Imagine future events where the resource/skill would be helpful and
rehearse how using that resource/skill will change perceptions, attitudes,
and behaviors.
• Enhance/strengthen the positive changes with BLS: (Tap in/walk through).
• Repeat as often as is helpful.
9. Closure
Some times it will work, sometimes it will be forgotten, sometimes it will not
work as planned.
Stabilization: Self Use
Acupressure Breathing
1. Locate the muscle between your thumb and index finger.
2. Firmly and slowly massage the muscle with the thumb and index finger of your
other hand.
3. Massage and breathe in rhythm.
4. Cue with disturbance, then shift to using the acupressure breathing.
5. Tap in any positive sensations the client experiences.
6. Extend, i.e., rescript and rehearse
Belly Breathing
1. Stand, sit, or lie down comfortably in a quiet place.
2. Close your eyes and loosen any tense muscles. Make sure to relax your
shoulders.
3. Place one hand on your upper chest and the other on your belly button.
4. Breathe in slowly through your stomach, letting it expand like blowing up a
balloon. Your chest should remain still.
5. Breathe out slowly through your mouth. Feel your stomach move back.
6. Repeat this several times, gradually increasing the time you take to breathe in
and out.
7. Cue with disturbance then shift to be belly breathing.
Butterfly Hug Breathing (modifi ed Artigas, Jarero)

1. Cross your arms at the wrists, interlocking thumbs to form a butterfly’s body,
fingers to form the butterfly’s wings.
2. Rest the butterfly on your chest, wings pressing on the soft spots located just
below your collarbone on each side of your chest.
3. Begin your breathing and have the butterfly’s wings gently massage the soft
spots located just below your collarbone.
4. Cue with disturbance, then shift to the butterfly breathing.
Butterfly Hug: Lucina Artigas/Ignacio Jarero Hurricane Pauline - Acapulco, Mexico (1998)
7. Variations to Butterfly
a. Arms crossed, tapping on elbows/tapping the biceps
b. Tapping on knees; toes up and down in shoes; heels moving up and down
Developing a Container
(Adapted from Landry Wildwind)
Access and Activate

1. Design characteristics
Strong: Have your container be strong enough to hold whatever you put into
it.
Two-way system: Have a two-way system that allows you to put things in
and take things out when you choose.
Comfortable inside: Have it be comfortable enough inside so that whatever
you put in will be willing to stay inside until you are ready to work with it.
Tell me about your container.______________________________
2. Imagine using the container

Now imagine how it feels knowing that you can use your container to hold
things until you are ready to work with them.
What do you notice?________________________________________
3. Deepen with BLS

Now slowly (tap in/walk through) that process, noticing your positive
emotions, sensations, and thoughts.
Practice
4. Cue word
Give your container a name. Now repeat that name and the positive feelings
you have when using it.
What do you notice?__________________________________________
(Tap in/walk through the client’s positive association of word and feelings)
5. Using with a disturbance

Think of a mildly disturbing recent experience. Put it into your container and
notice the shift you experience.
(Tap in/walk through if the client had a positive shift — focusing on the shift)
Extend
6. Rescript
Is there a recent situation where it would have been nice to be able to use
your ___________________________?
(name the container)
Tell me a little about that situation. _______________________________
Imagine using your _______________ in that situation and notice how you
would have felt. (name the container)
What are you noticing?________________________________________

(Tap in/walk through to strengthen the positive linkage)
Optional: Repeat 1 and 2 with other recent past situations where using
the container would have been helpful.
7. Rehearse
Can you imagine a situation in the near future where your ____________
would be helpful? (name the container)
Tell me a little about that situation._______________________________
Imagine using your ____________ in that situation and notice how you will
behave and feel. (name the container)
What are you noticing? ________________________________________

Optional: Repeat 1 and 2 with other near future situations where

using the container will be helpful.
Closure
I’d like you to remember the work we have done today. Use your container daily.
Sometimes it will work, sometimes you may forget to use it, and perhaps,
sometimes it will not work as you had hoped. When we meet again, we’ll talk
about how things worked.
Enhancing an Inner Peaceful Place
(Safe Place: Shapiro, 2001)
Access and Activate

1. Accessing a inner peaceful place
Imagine a place or experience where you recently felt peaceful or calm.
2. Emotions and sensations

Tell me about the images, sensations, smells, sounds you are
experiencing when you imagine that experience.
3. Enhancement
Now focus on the image, sensations, smells, sounds and notice the secure,
calm, inner peace you are experiencing.
4. Deepen with BLS (tap in/walk through)

Slowly tap in or walk through the experience, noticing your positive
emotions, sensations, and thoughts. What do you notice?
Practice
5. Cue word
Give that positive experience a word or phrase. Now repeat that word along
with its positive emotions and sensations.
What do you notice?___________________________________________
(tap in/walk through the client’s positive association of word and feelings)
6. Cueing with disturbance

Now think of a mildly disturbing recent experience. Now shift your focus to
your cue word and its positive feelings and sensations.
What do you notice?____________________________________________
(tap in/walk through if the client had a positive shift — focusing on the shift)
7. Self-cueing with disturbance

Now practice shifting a disturbance on your own.
Extend
8. Rescript
Is there a recent situation where it would have been nice to be able to use
your ___________________________?
(name the inner peaceful place)
Imagine using your _______________ in that situation and notice how you
would have felt.(name the inner peaceful place)
Optional: Repeat 1 and 2 with other recent past situations where that
Inner peaceful place would have been helpful.
9. Rehearse
Can you imagine a situation in the near future where your _________________
would be helpful? (name the inner peaceful place)
Imagine using your ____________ in that situation and notice how you will
behave and feel. (name the inner peaceful place)

Optional: Repeat 1 and 2 with other near future situations where the
inner peaceful place will be helpful.
Closure
I’d like you to remember the work we have done today. Use your inner peaceful
place daily. Sometimes it will work, sometimes you may forget to use it, and
perhaps, sometimes it will not work as you had hoped. When we meet again,
we’ll talk about how things worked.
Securing your Space
(Establishing some degree of security regardless of where you are)
(Adapted from Jim Knipe)
Goal: To help clients who are unable to access a “safe place” or let their guard down
by developing skills to “secure their present space” as well as possible,
regardless of the situation.
Steps:
1. Explain the concept of creating a secure space:
a. Soldiers, when they stay out in the field overnight, secure their sleeping area;
parents ensure that their children are in a safe environment.
b. Securing your space “well enough” takes into consideration the surrounding,
so that the environment is as secure as possible, however, it may not always
be totally safe. The surrounding environment will be as secure as it can be
under the circumstances.
c. Today we are going to help you learn how to secure your space, regardless of
where you are, as well as possible under the circumstances.
2. Access and activate the present degree of security in the office:

How secure do you feel sitting here right now?
_____________________________________________________________________
3. Measure it:
How secure do you feel right now on a scale from 0-10 where 0 is not secure at
all and 10 is as secure as you can ever imagine being?
0 1 2 3 4 5 6 7 8 9 10
4. Enhance it
a. Tell me what you did to develop this level of security.
b. List and tap in or walk through each strategy the client has used to establish
their level of security
c. If not mentioned, bring up:

• How they developed a degree of security with you.
• How they developed a degree of security in your office.
________________________________________________________________
________________________________________________________________
5. Remeasure it:
Now how secure do you feel on a scale from 0-10 where 0 is not secure at all
and 10 is as secure as you can ever imagine being? (Tap in or walk through if an
increase is reported)
0 1 2 3 4 5 6 7 8 9 10
6. Cue word/Reminder:
Is there a word or phrase we use to remind you about how you can secure your
space, as well as possible, regardless of where you happen to be. (Tap in)
_______________________________________________________________
8. Extend:
a. Rescript recent events where "securing your space" would have helped (tap
in or walk through)
b. Rehearse anticipated events where "securing your space" will be helpful (tap
in or walk through)
9. Closure
Try to use this as often as possible when you start to feel a little insecure.
Sometimes it will work. Sometimes you may forget to use it. Sometimes it may
not work as well as you had hoped.
When we seen each other again, we’ll review how things went and strengthen
times when it worked, rescript times you forgot, and find other skills you can use
in situations where this did not work as you had hoped.
Reevaluation
Review what happened.
1. Strengthen by tapping in or walking through each successful experience
2. Rescript the times when it was forgotten and strengthen by tapping in or walking
through.
3. When it didn’t work, develop a new behavioral coping skill that would have
helped. Follow with Extended Resourcing as needed
Phase 1: Target Sequence Planning
Belief Focused Target Sequence Plan
Kiessling, 2006
EMDR
Stage 1 Stage
Stage22 Stage 3
Phase 2 2
Preparation
Affect Management
Phase 1
Installation
Resourcing
Phase 6
Body Scan
Closure
Entering the “maze” of exploration and discovery

3-Stage Processing Approach
Stage 1: Case Conceptualization

1. Identify the presenting problem/issue
b. Identify its emotions/sensations
c. Clarify frequency, situations, etc.
2. Identify its negative core belief
3. Develop an outline of incidents that resonate with the

negative core belief
• Past, present and future anticipated incidents
4. Identify the preferred adaptive positive belief
5. Develop an outline of present experiences that

resonate with the preferred adaptive positive belief
Stage 2: Processing: Neural network consolidation

1. Access and activate the incident that
represents the entry point into the negative neural network
(negative belief)
2. Activate the positive adaptive neural

network (positive belief)
3. Process (BLS), i.e., link, blend and consolidate

the negative into the adaptive positive neural network
• BLS activates the Adaptive Information Processing System
• Keeps what is valuable, discards what is no longer needed
Stage 3: Integration
1. Expand adaptive perceptions, attitudes, and behaviors
2. Teach new adaptive skills

a. Psychotherapy interventions
b. Extended resourcing
Emotional Encoding Hierarchy
(Kiessling, 2010)
Beliefs are the verbalization of activated emotions/sensations
Negative/Irrational Adaptive/Preferred
Age
I can
I’m Vulnerable protect
vulnerable myself
7+
I can
Guilt accept
myself
I do bad things 4+
I’m not
responsible for
I‘m responsible
Worthiness everything
I don’t have
I have to control
everything
Responsibility to control
everything
Control
I’m bad 3-4 I’m okay
I’m going to die

Existence I’m going to
0 survive
Erickson’s Developmental Milestones
From a Belief Focused Perspective: Kiessling 2012
Negative Core Beliefs Adaptive Core Beliefs
I’m worthless Role 13-19 Identity I have self-worth

Confusion years regardless
I can’t trust my I can learn to trust

Inferiority 5-12 years Industry
judgment my judgment
I do bad I can learn from

Guilt 4-5 years Initiative
things my experiences
I’m okay the way I am

I’m bad Shame Autonomy
I can learn to
accept appropriate
I’m responsible 2-4 years responsibility
for everything
I can learn what I

I have to be in can and cannot
control control
Mistrust Trust
I can’t trust my I can trust my
23 months
instincts instincts
to
I don’t deserve Extinction Survival I deserve to exist

to lives In Utero
Attachment Theory (Ainsworth)
(From a Belief Focused Perspective: Kiessling: 2012)
Onset: Birth through early childhood. May be stored in implicit, preverbal memory networks.
May or may not have easily identifi able beliefs or memories (touchstone) as to the origins of the
feelings, emotions, sensations, and/or perceptions.
Child Secure Caregiver
Secure Uses caregiver as a Responds appropriately,

Adjustment
secure base promptly, consistently
Validation
Security
Insecure
Ambivalent Unable to use caregiver Inconsistent

Vulnerability between
Resistant Seeks proximity, distressed appropriate and
on separation with neglectful
ambivalence, anger responds only
reluctance to proximity after child’s
increased effort
to attach
Guilt
Avoidant Little affect sharing in play Little or no
Little if any distress upon response
Discouraged separation. Feels as though Discourages
there is no attachment crying,
Rebellious, low self-image Worthlessness independence
and self-esteem.
Responsibility
Instinct
Control
Disorganized Freezes/rocks upon Frightened or
Instinct
connection, no attachment frightening
strategy. Disoriented behavior,
contradictory behaviors intrusive
Shame
approach/avoidance withdraws,
Instinct negative,
role confusion
Lacks non-verbal Existence/Survival
communication Instinct
skills
Right Brain Psychotherapy
(A. Schore: Affect Regulation and the Repair of Self, 2003)
Brain Hemispheres Left Hemisphere Right Hemisphere
1. Right Brain Language Imagery

b. Non-verbal, unconscious processing
c. Rapid response to danger/urgent problems
d. Primary processing: emotionally/affectively Limbic system
Motivation and Emotion
2. Left Brain
a. Verbal, conscious processing Brainstem
b. Secondary processing Sympathetic and Parasympathetic
Flight/fight/freeze Relax and digest
Non-verbal Communication
1. Right brain to right brain
Primary processing: implicit communication, i.e., “non-verbal communication”
a. Eye contact, facial expression, tone of voice, body posture, gestures, timing
and intensity
(“How to Successfully Build the Integrated Child”)
Siegel: https://www.youtube.com/watch?v=h51lgvjI_Zk
2. Clinician’s Role
a. Non-verbal communication, i.e., right brain to right brain
b. Maintains environmental security
c. Affirms and validates
d. Teaches safe affect regulation
3. Core Beliefs
Beliefs are the verbalization and validation of activated emotions and sensations.
d. Naming the emotions/beliefs calms the neural network system down
Name it to Tame it: Siegel: https://www.youtube.com/watch?v=ZcDLzppD4Jc
4. EMDR Processing
Non-verbal communication between client and clinician during BLS
Developing the Target Sequence Plan
Client readiness
1. Bio-psychosocial evaluation has been completed
2. Rapport and “good enough” stability have been established
3. Client is ready to address a presenting problem/complaint/symptom
Belief Focused Targeting Plan Approach

1. Symptom Focused Approach
2. Variations of the Symptom Focused Approach:
a. Genogram
b. Chronological Timeline
c. Multiple Issues
d. Recurring Triggers
e. Vague Targeting
f. Network Mapping
Gather symptom information: Clinical judgment/pacing

1. Core Negative Beliefs (NB) may be identified at any time during the target
planning process
b. Present
• Severity, frequency, triggers
c. Past
• Disturbing experiences/memories
• Root Cause: First recalled experience (aka: Touchstone)
c. Future
• Identify future triggers when the emotional/sensorial/belief will be
activated
2. Core Adaptive Belief (PB)
a. May be identified at any time during the target planning process
b. Clinical judgment/pacing
c. Identify the preferred presently adaptive belief
• Should be an adaptive acceptance to all the identified experiences
• Fear of retirement:
Ex: NB: I’m totally helpless. PB: I am empowered to cope.
Target Sequence Plan

1. Transfer information to the Target Sequence Plan Target Sequence Plan
Target Treatment Plan Summary
Name:____________________________________________. Date: ____/____/_______
2. Discuss treatment options with client

Negative Belief Adaptive Belief
___________________________________ _________________________________________
_______________________________
Future
Psychotherapy and/or EMDR

_______________________________
_________________________
______________________________
Present _________________________
______________________________
• Target Selection
_________________________
______________________________ ____________________
______________________________
Past
• Processing Modality ______________________________

Root Cause___
Closure:
[ ] Breathing. [ ] Acupressure. [ ] Butterfly [ ] Secure Place. [ ] Container. [. ] Other
(Processing Continuum: EMD^, EMDr, EMDR) Additional treatment notes
___________________________________________\
Clinician Signature
It is the clinician’s responsibility to support the client’s journey
of discovery and adaptive change
The clinician therefore:
a. Guides
b. Suggests
c. Questions
d. Probes
e. Educates
Identifying Negative Beliefs:

1. Negative belief hierarchy
b. Survival (Existence)
c. Responsibility/control (of others/situations)
d. Worthiness/lovability
e. Guilt (behavior)
f. Vulnerability (environment)
2. What causes the response? Name the cause, not the response
Trigger. Emotional Response Negative Belief
a. People Anxiety - need to care for another Responsibility
b. Places Anxiety - crowds Vulnerability
c. Things Bridges - fear Trapped, going to die
d. Behaviors Anger, yelling when not listened to Abandonment
e. Events Fear of retirement Helplessness
3. Consider developmental onset

The more dramatic the symptom, the earlier the onset (Tronic’s “Still Face”)
Negative beliefs:
1. Resonate with the client’s (and clinician’s) felt-sense of
the symptom’s emotions and sensations Negative Belief
2. Have a strong “external locus of control”
I’m unlovable (because my mother doesn’t hug me).
3. What the client says about themselves is not necessarily what is really
happening (perceptions of self may be from their point of view; may not be
factual)
Look beyond the self-talk and explore the circumstances:
Negative self-talk Circumstances Core Belief
I’m not good enough. My supervisor criticizes my work. I have to be perfect .
I can’t stop my spouse from drinking. I’m responsible.
All memories resonate with the presenting complaint’s/symptom’s negative core
belief:
Identify the experiences across the neural network’s lifespan (past, present,
future) that resonate with the presenting complaint’s negative core belief
Future Retirement
The presenting complaint

I’m totally helpless Kayaking
(Jocelyn video)
Slipping out
Past experiences of boat
Touchstone (onset of the symptom)
Hogtied on
dock
I’m totally helpless.

Identifying the Positive Belief: How would you prefer to…
Adaptive, preferred beliefs:
1. Resonate with the emotions and sensations of the desired resolution of the
presenting complaint
2. Have a strong internal locus of control - I’m empowered to cope.
3. Are adult, adaptive, and realistic
Negative/Irrational Positive/Adaptive
I’m totally helpless……………………….…I’m empowered to cope.
(Validating a strong internal locus of control)
When there’s a will,

there’s a way.
4. Are adaptive across the neural network’s life span

I’m empowered to cope.
5. Resonate as the adaptive solution for:
Retirement
a. The presenting complaint
Kayaking
b. Future triggers
Slipping
c. Present triggers out of
boat
d. Past experiences Hogtied
I’m totally helpless.

Identifying Negative and Positive Neural Networks
The mental health continuum

Mental health is having the ability, at any moment, to have access to an infinite
number of choices along a continuum of polarities. (A. Schore)
I’m totally responsible. I’m not at all responsible.
I can recognize appropriate responsibility.
Possible Core Belief Structures

Negative Adaptive
Polarity: Black and white thinking

NB: I’m bad. PB: I’m good.
Continuum: Life functions along a continuum of choices
NB: I’m responsible for everything. PB: I can recognize
appropriate responsibility.
Simple:
NB: I’m defective. PB: I can accept myself as I am.
Bundled:
NB: Because I’m defective, PB: I’m worthwhile regardless of
I’m worthless. my imperfections.
Destination:
NB: I’m incompetent. PB: I am competent regardless.
Journey:
NB: I’m incompetent. PB: I can begin to learn to accept
my strengths and
weaknesses.
Adult Core Belief Clusters
Developmental Plateaus
NEGATIVE / IRRATIONAL ADAPTIVE / PREFERRED
{
I can’t protect myself.
{ Vulnerability I can protect myself.
Stage 2:
{
I do bad things.
I’m not good enough.
{ Guilt
I can learn from my mistakes.
I am good enough.
I’m a failure. I did the best I could.
I should have done something.
{
I’m unlovable.
I’m worthless.
{ Worthlessness/
I’m okay as I am.
I can accept myself.
I’m inadequate. Lovability
I’m responsible
(for everything).
{ Responsibility
Instinct
{ I can recognize appropriate
responsibility.
I should have done something. I did what I could.
{
I have to be in control.
I’m powerless.
I’m helpless.
{ Control Instinct
I can safely let go of some control.
I can recognize what I can
and cannot control.
I’m trapped. I can control what I can…even when…
I’m discarded. I can survive / exist / get my needs met.
{
I’m defective.
I’m abandoned.
{ Survival Instinct
I’m okay as I am.
I can begin to learn when and how to…
I’m alone. I have value regardless.
It’s not safe to feel. I can get my needs met.
I’m unimportant.
I’m invisible.
I don’t deserve to exist I deserve to exist.

Name:____________________________________________. Date: ____/____/_______
___________________________________ _________________________________________
_______________________________
Future
_______________________________
_________________________
______________________________
Present _________________________
______________________________
_________________________
______________________________ ____________________
______________________________
Past
______________________________
Root Cause___
Closure:
Additional treatment notes
___________________________________________\
Clinician Signature
Processing
(Kiessling 2008)
EMDR
Stage 1 Stage
Stage22 Stage 3
Phase 2 2
Preparation
Affect Management
Phase 1
Installation
Resourcing
Phase 6
Body Scan
Closure
Phases 3-7: Processing
1. Informed Consent
b. EMDR processing
c. Target selection
d. The Processing Continuum: EMD^, EMDr, or EMDR
2. Processing:
a. Phase 3: Access and Activate worksheet
b. Phase 4: Desensitization-BLS (EMD^, EMDr, EMDR)
c. Phase 5: Installation-BLS
d. Phase 6: Body Scan-BLS
e. Phase 7: Closure
Informed Consent
1. Explanation of EMDR Processing

Eye movements or other forms of bilateral stimulation seem to activate your problem
solving process, something that happens during REM sleep when your eyes are
darting back and forth. By focusing on a specific problem, and both its negative and
positive emotions, sensations, and beliefs, then adding bilateral stimulation, your
brain begins problem solving. Since you are focused on the specific problem, your
brain is able to work through it more effectively than if it randomly comes up while
you are sleeping.
2. Consent to use EMDR Processing

a. Client selection criteria
• Clinician and client have discussed any important
concerns regarding BLS processing
b. Processing
• Emotions and sensations may arise during processing
• Processing may continue after session
Client has good enough stabilization, grounding, and state change skills
3. Consent to select an incident within the Target Sequence Plan
c. Defined by the presenting complaint’s belief and adaptive resolution
d. All incidents contribute to and resonate with the presenting complaint
e. Incident to be used to begin processing may be:
• A future trigger
• A present trigger
• A past memory
• Worst incident/the root cause (touchstone)
4. Consent to what will happen once processing begins Adaptive
Negative
The Processing Continuum: EMDR EMDr EMD^

Processing BLS Techniques
Seating
• Offset, i.e., two automobiles passing one another on a two-lane highway
Demonstration of eye movements

• Position your fingers at the client’s eye level
• Hand distance: As close to the face as is comfortable for the client
• Hand: Several fingers or full hand
Processing Speed Eye Movements: (EMD^, EMDr, EMDR)

• Rapid (approximately 2 round-trips per second)
• Sweep across face - eye level
• Arm angled forward at approximately 45-60 degrees pointing over client’s
forehead or just above client’s eyebrows
Alternative:
• Tapping
• The Clinician taps on client’s knees or on client’s hands that are placed
on client’s knees or on top of a pillow or book
• The Client taps (on their own knees) following clinician’s tapping,
matching speed, rhythm, starts/stops
EMD^: Restricted Processing
The Processing Continuum: EMD^, EMDr, EMDR
(Kiessling: 2006) (Kiessling: 2013)
EMD^: Restricted Processing

Container Adaptive Neural Network
Incident
Negative Neural Network
EMD^: Restricted Processing’s Purpose:

1. To manage the client’s affect during processing
2. To restrict processing to a single incident
Primarily Desensitization, i.e., SUD: 0 or > 0?
Client:
1. Has difficulty managing affect during the development of the targeting plan
2. Easily floods/becomes overwhelmed, etc.
3. Cannot manage staying on a single incident within the Target Sequence Plan
Clinician:
1. Manages the client’s affect
2. Restricts the client’s processing to a single incident within the Target Sequence
Plan
Phase 3: Access and Activate Checklist (EMD^)
(Restricted Processing [EMD] Checklist: Kiessling)
Targeted Incident: We have decided to work on ______________________________.

(name the incident)
Does that still fit or is there a better one? _____________________________
Worst Part: Tell me the worst part of the incident.
__________________________________________________________
Negative Belief (NB): We have decided your negative belief was ________________.
(name the negative belief)
Does that still fit or is there a better one now?
________________________________________________________
Positive Belief (PB): We have decided a more adaptive belief was_______________.
(name the positive belief)
________________________________________________________
Validity of Positive Belief (VoC): When you think of the incident, how true do the
words ___________________________________________________
feel to you now on a scale from 1 (totally false) to 7 (totally true)?
1 2 3 4 5 6 7
Emotions: When you think of the incident and ________________________________,
what emotions are you feeling now?
____________________________________________________________
SUD: On a scale from 0 (no disturbance) to 10 (highest disturbance), how

disturbing is it now?
0 1 2 3 4 5 6 7 8 9 10
NO BODY LOCATION (Links to other memories in the neural network)
Stop Signal: Remember to use your stop signal if anything other than the targeted
incident comes up.
Begin Restricted Processing: I’d like you to focus on the incident, the negative belief
_______________________, and follow my (BLS, i.e., eye movements or tapping).
Phase 4: Desensitization (EMD^ - Restricted Processing)
1. Start BLS: 5-10 seconds of BLS (processing speed)
2. Stop and take a SUD
Take a breath….When you think of the incident, how disturbing is it now:
0-10? … Go with that. (BLS: 5-10 seconds)
3. Repeat 1 and 2 for a total of three times, then:
4. After the 3rd. set of BLS, ask the client to report changes to the incident
Take a breath….When you think of the incident, what is different/changed
about it now? How disturbing is it now: 0-10? …Go with that. (BLS: 5-10
seconds)
5. Repeat that 3-1 ratio (1, 2, 3 & 4) until the SUD stops decreasing, then
proceed to Installation
Phase 5: Installation
1. Link incident and positive belief
As you think of the incident, does the original positive belief still fit or is
there a better one? If there is a better one now, use it for installation
2. Process
When you think of the incident and your positive belief, how true does it
feel now, 1-7? Go with that. (BLS: 5-10 seconds-processing speed)
Take a breath, now when you think of the incident and your positive belief,
how true does it feel, 1-7?
3. Proceed to Phase 7: Closure if:
a. The client reports a 7
b. The VoC the client reports makes sense under the circumstances
Phase 7: Closure
1. Debrief: Discuss experience, insights, Treatment Session Notes
Clinician:____________________________
Client:__________________________________________Date:____/____/______
how to apply new learning Presenting symptom: ________________________________________________
Treatment Session: (circle one)
EMDR Treatment:
First Reevaluation Session #______
Target: (circle one) Past Present Future _________________________________
2. Close: Remind client that processing Negative Belief: ____________________________________________________

Positive Belief: _____________________________________________________
VoC: (circle one) 1 2 3 4 5 6 7
will continue after the session and

Emotions: _________________________________________________________
SUD: (circle one) 0 1 2 3 4 5 6 7 8 9 10
Body Location: _____________________________________________________

(EMDr & EMDR only)
complete the Treatment Summary Notes

Processing Modality: (circle one) EMD^ EMDr EMDR
Clinical Judgement: To be completed with the client or after they leave
Session Outcome: (circle one) Completed Unfinished

SUD [Optional} : (circle one) 0 1 2 3 4 5 6 7 8 9 10
VoC: (circle one) 1 2 3 4 5 6 7
Closure: If needed (check)

[ ] CID [ ] Stabilization/Grounding [ ] Secure Place [ ] Container
Treatment Notes:
Additional Interventions Planned:
___________________
Clinician Signature
EMD^ (Restricted Processing) Q&A
What if the SUD does not go to 0?

Because we are accessing a part of an entire neural network, SUD’s may not go to 0;
the SUD may represent other components of the neural network.
What if another incident comes up?

If choosing EMD^ because of client affect management issues, place the new incident
in a container then:
3. Consider shortening the BLS even more - perhaps 6 round trips
4. Consider slowing down the speed of the BLS
5. Consider fragmenting the incident into small pieces and processing each with EMD^
Do we have to put new incidents in a container, or can we expand processing to

EMDr or even EMDR?
Trust your clinical judgment and discuss options with the client to restrict or expand
processing.
If the SUD doesn’t go to 0, do we proceed to Installation anyway?

Yes. Whatever has been accomplished in lowering the SUD is all that can be
accomplished at this time. Proceed to Installation and strengthen the VoC.
EMDr: Contained Processing
The Processing Continuum: EMD^, EMDr, EMDR
(Kiessling: 2006) (Kiessling: 2006)
EMDr: Contained Processing

Container Adaptive Neural Network
Incident’s
Arena
Negative Neural Network
EMDr: Contained Processing’s Purpose:

To contain processing within an arena associated with an incident or part of a neural
network
Client:
1. Can choose what aspects of a target plan to process
2. Can manage affect
3. Can manage the incident within the targeting plan
Clinician:
When necessary, assist the client to contain processing within an agreed incident’s
arena
Phase 3: Access and Activate Checklist (EMDr)
(Contained Processing [EMDr] Checklist: Kiessling)

(name the incident)
__________________________________________________________
________________________________________________________

________________________________________________________
words ___________________________________________________
1 2 3 4 5 6 7
____________________________________________________________

0 1 2 3 4 5 6 7 8 9 10
Body location: Where do you feel it in your body? _____________________________

(EMDr & EMDR only)
Stop Signal: Remind client to stop if processing activates something they don’t want to
be activated.
Begin Contained Processing: I’d like you to focus on the incident, the negative
belief ________________, and where you feel it in your body and follow my (BLS, i.e.,
eye movements or tapping).
Phase 4: Desensitization EMDr (Contained Processing)
Client demonstrates the ability to “self-contain” processing
with an agreed upon arena with minimal assistance from the clinician
1. Start BLS
10-15 seconds, processing speed
2. Stop and ask:
Take a breath. Let it go. When you think of the incident, what do you
notice now? Go with that. (BLS: 10-15 seconds)
3. Repeat 1 & 2 as long as the client reports change then:
4. Take a SUD: Take a breath, now when you think of the incident, how
disturbing is it, 0-10 where 0 represents no disturbance and 10 the highest
disturbance you can imagine?
5. SUD>0: Ask if the SUD can decrease anymore or if the disturbance (SUD)
remaining related to the memories that are off limits.
a. If the client reports that the SUD may go lower, return to processing,
i.e., steps 1-4 until the SUD no longer decreases, then proceed to
b. If the client reports that the SUD is related to memories that are off
limits or cannot go any lower, proceed to Phase 5: Installation
1. Link incident and positive belief
As you think of the incident, does the original positive belief still fit or is
there a better one? If there is a better one now, use it for installation
2. Process
When you think of the incident and your positive belief, how true does it
feel now, 1-7? Go with that. (BLS: 5-10 seconds-processing speed)
Take a breath, now when you think of the incident and your positive belief,
how true does it feel, 1-7? If less than 7: (BLS: 5-10 seconds-processing
speed). (Optional) If 7, add one more set of BLS: 5-10 seconds-
processing speed
3. Proceed to Phase 6: Body San
a. The client reports a 7
b. The VoC the client reports makes sense under the circumstances
Phase 6: Body Scan
If the SUD = 0 and the VoC = 7, conduct a body scan
1. Think of the incident and your positive belief, scan your body, report any
sensations you are experiencing.
a. Confirm the body sensation is related to the targeted incident
b. If related to another incident, skip the body scan and proceed to
future template or closure
2. Apply BLS: 5-10 seconds processing speed
3. Repeat 1 and 2 until the body scan is calm/neutral. (Optional) Once
neutral, add one more set of BLS: 5-10 seconds, to solidify the calm/
neutral sensations.
4. If another incident emerges, put into their container and proceed to Phase
7: Closure.
Phase 7: Closure
1. Stabilize as needed
CID (on SUD)/breathing/inner peaceful place/container

2. Debrief
Discuss the processing experience, insights, how to apply new learning
3. Close
Remind client that processing will continue after the session and complete
the Treatment Summary Notes
Treatment Session Notes
Clinician:____________________________
Client:__________________________________________Date:____/____/______
Presenting symptom: ________________________________________________
Treatment Session: (circle one) First Reevaluation Session #______
EMDR Treatment:
Negative Belief: ____________________________________________________

Positive Belief: _____________________________________________________
VoC: (circle one) 1 2 3 4 5 6 7
Emotions: _________________________________________________________
SUD: (circle one) 0 1 2 3 4 5 6 7 8 9 10
Body Location: _____________________________________________________
(EMDr & EMDR only)


VoC: (circle one) 1 2 3 4 5 6 7
Treatment Notes:
___________________
Clinician Signature
EMDr (Contained Processing) Q&A
When do we decide to use EMDr?
When the client demonstrates adequate compartmentalization skills and does not want
to process the entire neural network system, just a part of it.
Compared to EMD^, what’s different about EMDr?

BLS sets are somewhat longer (10-15 seconds). When stopping, return to the incident
and ask “What are you noticing now?” rather than taking a SUD.
What if memories not agreed upon (having been put into the container) come up
during processing?
Use clinical judgment and discuss with the client whether to add that memory to the
processing or return it to the container.
When something comes up and we put it back into the container, what do we do
next?
1. Re-access the agreed upon incident and begin EMDr. Approximate how many
round trips activated the other incident, and cut back on the number of round
trips.
2. You may consider doing EMD^ for a couple of sets then gradually transition back
to EMDr.
With EMDr, will the SUD always go to 0?

Maybe yes, maybe not. Depends upon the client’s compartmentalization skills.
If the SUD doesn’t go to 0, do we proceed to Installation?

Most times yes, if it seems appropriate. You could ask the client if the SUD could go any
lower without tapping into off-limit memories.
Will the VoC always go to 7?

Not always. It depends upon what has happened during processing as well as the
ending SUD.
When conducting the Body Scan, are there any considerations?

Yes- generally it is best to ask if the body sensation being experienced during the scan
is related to the incident or “other stuff” that has been off limits.
What if the body scan activates “off limits” memories?

Put whatever came up back into the container and, proceed to closure.
The Processing Continuum Comparison Chart
EMD^ EMDr EMDR
Phase 3: Access and Activate Phase 3: Access and Activate Phase 3: Access and Activate
1. Incident’s worst part 1. Incident’s worst part 1. Incident’s worst part
2. Negative Belief 2. Negative Belief 2. Negative Belief
3. Positive Belief 3. Positive Belief 3. Positive Belief
4. VoC: 1, 2, 3, 4, 5, 6, 7 4. VoC: 1, 2, 3, 4, 5, 6, 7 4. VoC: 1, 2, 3, 4, 5, 6, 7
5. Emotions 5. Emotions 5. Emotions
6. SUD: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 6. SUD: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 6. SUD: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10
7. Body Location 7. Body Location
7. Stop signal 8. Stop signal 8. Stop signal
Phase 4: Desensitization Phase 4: Desensitization Phase 4: Desensitization

1. BLS: 5-10 round-trips 1. BLS: 10-15 seconds 1. BLS 15-30 seconds
2. Breathe. 2. Breathe. 2. Paced: client non-verbals
3. Think of the incident. 3. Think of the incident. 3. Breathe.
4. SUD: 0-10? 4. What do you notice now? 4. What do you notice now?
5. Go with that. 5. Go with that. 5. Go with that.
6. 4th BLS: 6. Repeat until no change 6. Repeat until no change
• What’s changed? 7. SUD: 0-10 7. SUD: 0-10
• SUD: 0-10 8. Go with that. 8. Go with that.
• Go with that. 9. End of desensitization 9. End of desensitization
7. End of desensitization • SUD=/>0? • SUD=0
• SUD=/>0?
Target specific desensitization Processing the incident with Desensitization of entire neural
insights as well as desensitization network, not just a specific incident
may take multiple sessions
Phase 5: Installation Phase 5: Installation Phase 5: Installation

1. Think of the incident and the 1. Think of the incident and the 1. Think of the incident and the
positive belief. positive belief. positive belief.
2. Hold the two together. 2. Hold the two together. 2. Hold the two together.
3. VoC: 1, 2, 3, 4, 5, 6, 7 3. VoC: 1, 2, 3, 4, 5, 6, 7 3. VoC: 1, 2, 3, 4, 5, 6, 7
4. BLS: 5-10 round-trips 4. BLS: 5-10 seconds 4. BLS: 5-10 seconds
5. VoC<7? 5. VoC<7 5. VoC=7
Phase 6: Body Scan Phase 6: Body Scan

1. Hold incident and positive 1. Hold incident and positive
belief belief
2. Scan your body 2. Scan your body
3. BLS: 5-10 seconds with any 3. BLS: 5-10 seconds with any
sensation sensation
4. Goal: calm or neutral 4. Goal: calm or neutral
sensations sensations
Phase 7: Closure Phase 7: Closure Phase 7: Closure

1. Debrief 1. Stabilize as needed 1. Stabilize as needed
2. Integrate 2. Debrief • Especially with SUD>0
• Extended Resourcing 3. Integrate 2. Debrief
• Extended Resourcing 3. Integrate
• Extended Resourcing
Stage 3: Integration
(Kiessling, 2012)
EMDR
Stage 1 Stage
Stage22 Stage 3
Phase 2 2
Preparation
Affect Management
Phase 1
Installation
Resourcing
Phase 6
Body Scan
Closure
Phase 8: Reevaluation:
Integration
EMDR enhanced Psychotherapy
EMDR interventions that support the overall

psychotherapy treatment plan and goals
Phase 8: Reevaluation
Goal
Integration of neural networks
• Link and consolidate
Reevaluation: Three tiered process

1. Global bio-psychosocial check-in
General
d. How the week has gone
e. New issues
2. Presenting complaint check in

a. Present triggers
Symptom
b. Dreams
c. Responses
d. Attitudes
3. Target specific check-in

a. Insights
b. Level of Disturbance
Incident
Integration options
Normal clinical interventions to help clients integrate the changes that occur as a result
of processing
3. Insights
4. Behaviors
5. Attitudes
6. Changes in behavior
a. Current
b. Anticipated
Processing the neural networks
1. Continue processing the initial target until completed

2. Choose another target within the neural network, i.e., finish the Target Sequence
Plan: past, present, and future, as is appropriate
3. Use the appropriate processing modality
a. EMD^: Restricted Processing
b. EMDr: Contained Processing
c. EMDR: Unrestricted Processing
Important note
1. Neural network consolidation may not be completed in one processing session.
Multiple processing sessions may be needed for full network consolidation,
i.e., past, present and future
2. Not all clients may wish to process all targets within the Target Sequence Plan
3. After the initial processing session, use clinician judgment to consider smaller
blocks of the neural network for processing.
Psychotherapy
1. Talk about the experience
2. Teach new skills
3. Use Extended Resourcing to integrate new learning into the client's daily life
What to do next?
Review your Treatment Sessions Notes and Target Sequence Plan
1. Unfinished target, i.e., SUD > 0
Re-target and process
• Access and activate what is now the worst part of the incident
• Process (Choose the processing modality: EMD^, EMDr, EMDR)
2. Finished target, i.e., SUD = 0/VoC = 7/neutral body scan (EMDr, EMDR)
a. Return to the targeting plan
• Process remaining targets within the plan
b. Integration
• Educate, teach new skills, practice with role-plays, etc.
Frequently asked questions

1. Session frequency?
Whatever will fit within your clinical schedule and the client's availability
2. Session length
a. 45-50 minutes using the belief focused approach (Kiessling)
b. Targeting plans have been fully identified in previous sessions
c. Belief focused approach to target planning and processing
d. Phase 3: Access and Activate takes less than 5 minutes.
3. Do we have to use BLS every session?
No. This is a client centered approach: use clinical judgment and proceed
with what is best to help the client achieve their treatment goals.
Treatment goal: Integration and consolidation of neural networks

1. Review Targeting Summary Notes and continue processing any remaining
targets.
Complete the Target Sequence Plan.
2. Integration
a. Teach new skills through role-plays, psycho-education, etc.
b. Use Extended Resourcing to solidify new skills.
What if they didn’t like it?
1. Processing exceeded the client’s window of tolerance?
b. Consider EMD^ or EMDr, if EMDR had been used.
c. Consider targeting the “fear of processing” with CID.
2. If the client doesn't feel they have talked enough about their issues, consider:
a. Negotiating BLS and talking segments, i.e., 15 minutes for processing, the
remaining session time for talking, validating and integrating.
b. An unidentified core belief has been exposed, e.g., fear of feeling
• Consider developing a new target plan around that core belief, e.g., "It’s not
safe to feel."
3-pronged Processing
Top-down
Complex (Unstable clients)
Top down (Kiessling, 2012) Negative Adaptive
Phase 2: Preparation
• Stabilization
• Grounding
• Affect Management
Prong 3
Phases 3-7: Targeting
• Future triggers
• Initial intervention(s) - EMD^
• Once tolerated - EMDr
Prong 2
• Present triggers
• EMDr, EMDR
Prong 1
• Past memories
• Past
• EMDr
• EMDR
• Worst
• EMD^
• EMDr
• Touchstone
• EMD^?
• Fragmented
Touchstone
3-pronged Processing
Bottom Up
(Modified “Standard 3 Prong Protocol”: Francine Shapiro)
Straight forward (stable clients)
Bottom Up (Kiessling, 2012)
Prong 3
• Future Triggers
• EMDR
•
Prong 2
• Present triggers Consolidated
• EMDR Adaptive
&
Functional
Prong 1
• Past Memories
• Past
• EMDR
• Worst
• EMDR
• Touchstone
• EMDR
Phase 2: Preparation
• Stabilization
• Grounding
• Affect Management
Integration Q & A
Do we have to use BLS every session?

No. Use your clinical judgment regarding how to best accomplish the client’s
treatment goals.
What if we can’t meet weekly?

EMDR integrates into your treatment schedule, it is not essential to meet weekly.
How do we start processing again:

1. If the original incident is unfinished, i.e., SUD>0?
When the client is ready to begin processing, access and activate the original
incident and process with the modality of choice: EMD^, EMDr, EMDR.
2. It the original incident was completed, i.e., SUD=0, VoC=7?
Return to the Target Sequence Plan and continue processing the neural
network choosing the next appropriate incident (past, present or future) as
your next starting point.
How much remaining time in the session do we need to have to begin processing
again?
After the first processing session, you can use shorter blocks of time to process.
We want to model that together, we are bigger than the issue, so we can start and
stop processing whenever we choose.
What if the client wants to change the processing modality?

Discuss potential benefits or concerns you may have regarding changing the processing
modality and then proceed accordingly.
What if they didn’t like it?

Discuss what they did not like. If it is possible to modify the process, discuss those
options, otherwise, transition into other therapy modalities to continue working on the
neural networks that have been outlined in the Target Sequence Plan.
If something else comes up during the week, can we process that?

Discuss with the client whether it is part of the belief system being processed or from
another neural network.
3. If related to the targeted neural network, then consider using that incident as the
entry point to begin processing.
4. If unrelated, and an acute stress, consider CID or A-TIP.
5. If unrelated but a strong trigger, discuss with the client whether to shift focus of
treatment to that issue or to set it aside. If shifting, then develop a new Target
Sequence Plan.
Developing a Container
(Adapted from Landry Wildwind)
Access and Activate

1. Design characteristics
• Strong: Have your container strong enough to hold whatever you put into
it.
• Two-way system: Have a two-way system that allows you to put things in
and take parts out when you choose.
• Comfortable inside: Have it comfortable enough inside so that whatever
you put in will be willing to stay inside until you are ready to work with it.
• Tell me about your container.______________________________
2. Imagine using the container

• Now imagine how it feels knowing that you can use your container to put
things in until you are ready to work with them.
What do you notice?________________________________________
3. Deepen with BLS

• Now slowly (tap in/walk through) that process, noticing your positive
emotions, sensations, and thoughts.
Practice
4. Cue word
• Give your container a name. Now repeat that name and the positive
feelings you have when using it.
(Tap in/walk through the client’s positive association of word and feelings)
5. Using with disturbances

• Think of a mildly disturbing recent experience. Put it into your container
and notice the shift you experience.
(Tap in/walk through if the client had a positive shift — focusing on the shift)
Extend
6. Rescript
1. Is there a recent situation where it would have been nice to be able to use
your ___________________________?
(name the container)
2. Imagine using your _______________ in that situation and notice how you
would have felt. (name the container)

Optional: Repeat 1 and 2 with other recent past situations where using
the container would have been helpful.
7. Rehearse
1. Can you imagine a situation in the near future where your ____________
would be helpful? (name the container)
2. Imagine using your ____________ in that situation and notice how you will
behave and feel. (name the container)

Optional: Repeat 1 and 2 with other recent future situations where

using the container will be helpful.
Closure
I’d like you to remember the work we have done today. Use your container daily.
Sometimes it will work, sometimes you may forget to use it, and perhaps,
Enhancing an Inner Peaceful Place
(Safe Place: Shapiro, 2001)
Access and Activate

1. Accessing a secure place
Imagine a place or experience where you recently felt secure or calm.
2. Emotions and sensations

Tell me about the images, sensations, smells, sounds you are
experiencing when you imagine that experience.
3. Enhancement
Now focus on the image, sensations, smells, sounds and notice the secure,
calm, inner peace you are experiencing.
4. Deepen with BLS (tap in/walk through)

Slowly tap in or walk through the experience, noticing your positive
emotions, sensations, and thoughts. What do you notice?
Practice
5. Cue word
Give that positive experience a word or phrase. Now repeat that word along
with its positive emotions and sensations.
What do you notice?___________________________________________
(tap in/walk through the client’s positive association of word and feelings)
6. Cueing with disturbance

Now think of a mildly disturbing recent experience. Now shift your focus to
your cue word and its positive feelings and sensations.
7. Self-cueing with disturbance

Now practice shifting a disturbance on your own.
Extend
8. Rescript
1. Is there a recent situation where it would have been nice to be able to use
your ___________________________?
(name the secure place)
2. Imagine using your _______________ in that situation and notice how you
would have felt. (name the secure place)

Optional: Repeat 1 and 2 with other recent past situations where that
secure place would have been helpful.
9. Rehearse
1. Can you imagine a situation in the near future where your ____________
would be helpful? (name the secure place)
2. Imagine using your ____________ in that situation and notice how you will
behave and feel. (name the secure place)
Optional: Repeat 1 and 2 with other recent future situations where the
secure place will be helpful.
Closure
I’d like you to remember the work we have done today. Use your secure place
daily. Sometimes it will work, sometimes you may forget to use it, and perhaps,
Securing your Space
(Establishing some degree of security regardless of where you are)
(Adapted from Jim Knipe)
Goal: To help clients who are unable to access a “safe place” or let their guard down
by developing skills to “secure their present space” as well as possible,
regardless of the situation.
Steps:
1. Explain the concept of creating a secure space:
d. Soldiers, when they stay out in the field overnight, secure their sleeping area;
parents ensure that their children are in a safe environment.
e. Securing your space “well enough” takes into consideration the surrounding,
so that the environment is as secure as possible, however, it may not always
be totally safe. The surrounding environment will be as secure as it can be
under the circumstances.
f. Today we are going to help you learn how to secure your space, regardless of
where you are, as well as possible under the circumstances.
2. Access and activate the present degree of security in the office:

How secure do you feel sitting here right now?
_____________________________________________________________________
3. Measure it:
How secure do you feel right now on a scale from 0-10 where 0 is not secure at
all and 10 is as secure as you can ever imagine being?
0 1 2 3 4 5 6 7 8 9 10
4. Enhance it
a. Tell me what you did to develop this level of security.
b. List and tap in or walk through each strategy the client has used to establish
their level of security
c. If not mentioned, bring up:

• How they developed a degree of security with you.
• How they developed a degree of security in your office.
________________________________________________________________
________________________________________________________________
5. Remeasure it:
Now how secure do you feel on a scale from 0-10 where 0 is not secure at all
and 10 is as secure as you can ever imagine being? (Tap in or walk through if an
increase is reported)
0 1 2 3 4 5 6 7 8 9 10
6. Cue word/Reminder:
Is there a word or phrase we use to remind you about how you can secure your
space, as well as possible, regardless of where you happen to be. (Tap in)
_______________________________________________________________
8. Extend:
a. Rescript recent events where "securing your space" would have helped (tap
in or walk through)
b. Rehearse anticipated events where "securing your space" will be helpful (tap
in or walk through)
9. Closure
Try to use this as often as possible when you start to feel a little insecure.
Sometimes it will work. Sometimes you may forget to use it. Sometimes it may
not work as well as you had hoped.
When we seen each other again, we’ll review how things went and strengthen
times when it worked, rescript times you forgot, and find other skills you can use
in situations where this did not work as you had hoped.
Reevaluation
Review what happened.
1. Strengthen by tapping in or walking through each successful experience
2. Rescript the times when it was forgotten and strengthen by tapping in or walking
through.
3. When it didn’t work, develop a new behavioral coping skill that would have
helped. Follow with Extended Resourcing as needed
Extended Resourcing
(Behavior)
Identify a Current Anxiety

Examples: 1 - A challenging situation
2 - Using EMDR with your most difficult client
or Tell me a situation that you would like to handle better.
Access and Activate

1. Identify and develop the resource
What skill or resource do you think you need to handle it better?
2. Identify
Tell me a time when you have used this skill.
3. Enhancement
Tell me more about it. __________________________________________
What positive belief about yourself goes best with this experience?
___________________________________________________________
(Example: I am capable, competent, in control, etc.)
Focus on that experience and its positive feelings, emotions, and sensations.
(Tap in/walk through the experience)
As you focus on that positive experience, what body posture or movement

would represent those feelings now?
Focus on that body posture/movement.

(Tap in or walk through the experience)
4. Rescript
1. Is there a recent time when that situation occurred where you could have
used your resource?
2. Imagine using your resource in that situation and notice how you would
have handled that situation differently. What are you noticing?
Optional: Repeat 1 and 2 with other recent past situations where

that affect skill would have been helpful.
5. Rehearse
1. Can you imagine that situation happening in the near future where your
resource would have been helpful?
2. Imagine using your resource in that situation and notice how you will
behave and feel. What are you noticing?

the affect skill will be helpful.
Closure
I’d like you to try to remember the work we have done today, write down your
resource, and read it every day, especially before situations you know might
create a little anxiety. Next session, we’ll review how things have gone
Resource Strengthening
From the client’s Targeting Sequence Plan

1. Put the adaptive positive belief in the center of the circle
2. Around the outside of the circle, list times (at least 4) when the adaptive belief was
experienced
3. Between the circles, access and enhance the emotions and sensations associated
with each experience (BLS)
Experience Experience
Emotions/sensations Emotions/sensations
Positive Belief
Emotions/sensations Emotions/
sensations
Experience
Experience
2. Rescript
a.. Is there a recent time when that situation occurred where you could have
used your resource?
b. Imagine using your resource in that situation and notice how you would
have handled that situation differently. What are you noticing?
Optional: Repeat 1 and 2 with other recent past situations where

that affect skill would have been helpful.
3. Rehearse
a. Can you imagine that situation happening in the near future where your
resource would have been helpful?
b. Imagine using your resource in that situation and notice how you will
behave and feel. What are you noticing?

the affect skill will be helpful.
Closure
I’d like you to try to remember the work we have done today, write down your
resource, and read it every day, especially before situations you know might
create a little anxiety. Next session, we’ll review how things have gone
The Target Sequence Plan Worksheet
Presenting complaint (AIP informed, belief focused):
Gather necessary information about the client’s presenting complaint,

triggers, and symptoms
Identify without activating or treating
Typical questions (Attune to the client)

Tell me about a problem or situation you’d like to address?
What triggers it?
How do you feel when it happens?
_________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Negative Belief: Help the client fi gure out their negative belief by offering possible
clusters you think may fit (attune to the client)
[ ] I am inadequate [ ] I am worthless [ ] I am not good enough
[ ] I am incompetent [ ] I am a failure [ ] I am unimportant
[ ] I am invisible [ ] I am alone [ ] I am abandoned
[ ] I am vulnerable [ ] I am powerless [ ] I am helpless
[ ] I am responsible (for everything) [ ] I have to be in control
[ ] other:
__________________________________________________________
Past:
Tell me times when you have felt (negative belief) the same way in the past.
______________________________________________________________
______________________________________________________________
______________________________________________________________
Any situations as a child with either of your parents or siblings when you felt
the same way?
_____________________________________________________________
______________________________________________________________
______________________________________________________________
*Touchstone: When is the earliest time you can recall?
______________________________________________________________
Future Triggers:
As you think of your negative belief, tell me some times in the future when you
may feel the same way.
______________________________________________________________
______________________________________________________________
______________________________________________________________
Positive Belief (as the client thinks of the touchstone):
Help the client identify a positive belief congruent with their negative belief and
appropriate for all the experiences listed above. If the client is unable to develop
an adaptive belief, consider suggesting one or more of those listed below. The
belief should be congruent with the presenting complaint’s negative belief,
although the situations may be different.
[ ] I’m good enough [ ] I’m okay as I am [ ] I can accept myself

[ ] I’m okay regardless [ ] I did the best I could [ ] I’m lovable
[ ] I can only control what I can [ ] I don’t have to be perfect all the time
[ ] I can (begin to) recognize appropriate responsibility
[ ] Serenity Prayer — I can recognize (learn) what I can and cannot…
Other: _________________________________________________________
______________________________________________________________
Positive Belief History:
Tell me about some times in your life when you have felt that way.
______________________________________________________________
______________________________________________________________
______________________________________________________________
Double-check for congruency within The Targeting Sequence Plan
• The negative and positive belief resonate with the presenting complaint, past
memories, and future triggers outlined within the plan
• Past, present triggers, and future triggers
• The positive belief is an adaptive resolution for ALL the memories
• Past, present triggers, and future triggers
Stabilization:
Utilize the client’s favorite stabilization exercise to reground the client before taking
a break and reversing roles.
Transfer this information to the Target Sequence Plan

Name:____________________________________________. Date: ____/____/_______
___________________________________ _________________________________________
_______________________________
Future
_______________________________
_________________________
______________________________
Present _________________________
______________________________
_________________________
______________________________ ____________________
______________________________
Past
______________________________
Root Cause___
Closure:
Additional treatment notes
___________________________________________\
Clinician Signature
EMD^
(Restricted Processing Worksheets)
Target Information:
Refer to the Target Sequence Plan Worksheet
Selected incident: ______________________________________
Negative belief: ________________________________________
Positive belief: _________________________________________
Instructions for restricted processing (EMD^):

I’m going to read a series of questions to remind us of the incident we have chosen to
start processing today.
After that, we will begin the eye movements. Generally, we’ll do this for about 10
seconds and then stop. During the stimulation, just notice what is happening.
When I stop, I’ll ask you to rate, from 0 to 10, where 0 is no disturbance and 10 is the
highest disturbance, how disturbing you think the incident is. I’ll then repeat the
stimulation.
We’ll do that three times, and then I’ll ask you to briefly describe what you think is
changing about the incident. Then we’ll repeat the eye movements and rate the
disturbance another three times, after which you can tell me what is changing again.
We’ll continue to repeat that cycle as long as the disturbance decreases.
Once it has stopped decreasing, we’ll focus on how you’d like to handle the situation
and strengthen it the best we can. We may or may not work on how you will handle
other aspects of the incident.
Stop signal
Remember, you have a stop signal that you can use any time you want to stop or
something other than the incident _____________________________ comes up.
(name the chosen incident)
You also have your ________________________________________________.

(name the stabilization / containment skill that has been developed)
Use your stop signal any time you’d like to stop, perhaps to take a break or put
something into your container.
Phase 3: Access and Activate Checklist (EMD^)
(Restricted Processing [EMD] Checklist: Kiessling)

(name the incident)
__________________________________________________________
________________________________________________________
________________________________________________________
words ___________________________________________________
1 2 3 4 5 6 7
____________________________________________________________

0 1 2 3 4 5 6 7 8 9 10
NO BODY LOCATION (Links to other memories in the neural network)
Stop Signal: Remember to use your stop signal if anything other than the targeted
incident comes up.
Begin Restricted Processing: I’d like you to focus on the incident, the negative belief
_______________________, and follow my (BLS, i.e., eye movements or tapping).
EMD^ (Restricted Processing) “Cheat sheet”
Bring up the incident, the negative belief, and follow my (BLS)
5-10 round trips
Phase 4: Desensitization
1. Stop and take a SUD
a. Take a breath.
b. When you think of the incident, how disturbing is it now: 0-10?
c. Go with that.
2. Repeat 1 and 2 several times (BLS)
3. Report changes to the incident
a. Take a breath.
b. When you think of the incident, what is different/changed about it now?
c. How disturbing is it now: 0-10?……. Go with that. (BLS)
4. Repeat 2, 3, and 4 until SUD stops decreasing, then proceed to
Installation
1. Think of the incident and your positive belief.

2. 1-7, how true does it feel?…..Go with that. BLS
5-10 round-trips - 2 round-trips per second
3. Repeat until VoC=7 or makes sense
Phase 7: Closure
1. Use stabilization skills as necessary

2. Debrief the session, complete the Treatment Session Notes
3. Remind client that processing may continue after session
EMDr
(Contained Processing Worksheets)
Target Information:
Refer to the Target Sequence Plan Worksheet
Selected incident: ______________________________________
Negative belief: ________________________________________
Positive belief: _________________________________________
Instructions for contained processing (EMDr)

I’m going to read a series of questions to remind us of the incident we have chosen to
start processing today.
After that, I will begin the [BLS]. Generally, I’ll do this for about 10-15 seconds and then
stop. During the stimulation, just notice whatever is happening. There are no supposed
to’s.
When I stop, I’ll ask you to think of the incident and tell me what you are noticing. Then,
we’ll do another set of [BLS]. We’ll repeat that process as long as things are changing.
Occasionally, I may ask you to rate how disturbing the incident feels to you on a scale of
0-10 where 0 is no disturbance and 10 the highest disturbance you can imagine. Once
you report your disturbance, we’ll go back to processing.
When the incident is no longer disturbing or feels appropriate under the circumstances,
we’ll focus on how you’d like to handle the situation and strengthen it the best we can.
Once you feel good about that, we’ll spend a moment or two processing any body
sensations that may be related to the incident.
Stop signal
Remember, you have a stop signal that you can use any time you want to stop or
something other than the incident _____________________________ comes up.
(name the chosen incident)
You also have your ________________________________________________.

(name the stabilization / containment skill that has been developed)
Use your stop signal any time you’d like to stop, perhaps to take a break or put
something into your container.
Phase 3: Access and Activate Checklist (EMDr)
(Contained Processing [EMDr] Checklist: Kiessling)

(name the incident)
__________________________________________________________
________________________________________________________

________________________________________________________
words ___________________________________________________
1 2 3 4 5 6 7
____________________________________________________________

0 1 2 3 4 5 6 7 8 9 10
Body location: Where do you feel it in your body? _____________________________

(EMDr & EMDR only)
Stop Signal: Remind client to stop if processing activates something they don’t want to
be activated.
Begin Contained Processing: I’d like you to focus on the incident, the negative
belief ________________, and where you feel it in your body and follow my (BLS, i.e.,
eye movements or tapping).
EMDr (Contained Processing) “Cheat Sheet”
Phase 4: Desensitization
1. BLS: 10-15 seconds, processing speed - 2 round-trips per second

2. Take a breath. Let it go. When you think of the incident, what do you
notice?
3. Go with that (BLS: 10-15 seconds, processing speed)
Continue processing as long as the client reports change
4. When the client reports no change, take a SUD

If SUD > 2: Go with that. BLS
SUD = 1 or 2: Is there anything that will help this go lower?
or
Has it gone as far as it can under the circumstances?
STOP if processing opens up new incidents and discuss options with the
client
1. Think of the incident and your positive belief. 1-7, how true does it feel?
2. Go with that. (BLS: 5 - 10 seconds at processing speed)
3. Repeat until VoC = 7 or it makes sense to the client
Phase 6: Body Scan - If the SUD = 0 and the VoC = 7, conduct a body scan
1. Think of the incident and your positive belief
2. Scan your body, report any sensations you are experiencing
Process any sensations (BLS: 5 - 10 seconds at processing speed)
3. Repeat 1 and 2 until the body scan is neutral
Phase 7: Closure
1. Use stabilization skills as necessary
2. Debrief the session, complete the Treatment Session Notes
3. Remind client that processing may continue after session
Treatment Session Notes
Clinician:____________________________
Client:__________________________________________Date:____/____/______
Presenting symptom: ________________________________________________
Treatment Session: (circle one) First Reevaluation Session #______
EMDR Treatment:
Negative Belief: ____________________________________________________
Positive Belief: _____________________________________________________
VoC: (circle one) 1 2 3 4 5 6 7
Emotions: _________________________________________________________
SUD: (circle one) 0 1 2 3 4 5 6 7 8 9 10
Body Location: _____________________________________________________

(EMDr & EMDR only)
VoC: (circle one) 1 2 3 4 5 6 7
Treatment Notes:
___________________
Clinician Signature
Reevaluation Worksheet
1) Reevaluation: 10-15 minutes
Discuss: How long has it been since our last session?
Global:
___________________________________________________________________
___________________________________________________________________
Bio-psychosocial
___________________________________________________________________
check-in
___________________________________________________________________
___________________________________________________________________
_________________________
Presenting Complaint ___________________________________________________________________
___________________________________________________________________
1. Symptoms? ___________________________________________________________________
2. Triggers? ___________________________________________________________________
3. Behaviors / responses? ___________________________________________________________________
4. Insights? ___________________________________________________________________
5. New memories? ___________________________________________________________________
6. Dreams? ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Target Specific ___________________________________________________________________
1. Insights ___________________________________________________________________
2. New memories ___________________________________________________________________
3. SUD: 0-10 ___________________________________________________________________

___________________________________________________________________
___________________________________________________________________
2) Target additional incidents

Time permitting, review the Targeting Sequence Plan and process additional
incidents within the plan using the processing modality of choice, i.e., EMD, EMDr,
EMDR.
Processing Comparison Chart
EMD^ EMDr EMDR

Phase 3: Access and Activate Phase 3: Access and Activate Phase 3: Access and Activate
1. Incident’s worst part 1. Incident’s worst part 1. Incident’s worst part
2. Negative Belief 2. Negative Belief 2. Negative Belief
3. Positive Belief 3. Positive Belief 3. Positive Belief
4. VoC: 1, 2, 3, 4, 5, 6, 7 4. VoC: 1, 2, 3, 4, 5, 6, 7 4. VoC: 1, 2, 3, 4, 5, 6, 7
5. Emotions 5. Emotions 5. Emotions
6. SUD: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 6. SUD: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 6. SUD: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10
7. Stop signal 7. Body Location 7. Body Location
8. Stop signal 8. Stop signal
Phase 4: Desensitization Phase 4: Desensitization Phase 4: Desensitization

2. Breathe. 2. Breathe. 2. Paced: client non-verbals
3. Think of the incident. 3. Think of the incident. 3. Breathe.
4. SUD: 0-10? 4. What do you notice now? 4. What do you notice now?
5. Go with that. 5. Go with that. 5. Go with that.
6. 4th BLS/DAS: 6. Repeat until no change 6. Repeat until no change
• What’s changed? 7. SUD: 0-10. Go with that. 7. SUD: 0-10. Go with that.
• SUD: 0-10 8. End of desensitization 8. End of desensitization
• Go with that. • SUD=/>0? • SUD=0
7. End of desensitization
• SUD=/>0?
Target specific desensitization Processing the incident with Desensitization of entire neural
insights as well as desensitization network, not just a specific incident
May take multiple sessions
Phase 5: Installation Phase 5: Installation Phase 5: Installation

1. Think of the incident and the 1. Think of the incident and the 1. Think of the incident and the
positive belief. positive belief. positive belief.
2. Hold the two together. 2. Hold the two together. 2. Hold the two together.
3. VoC: 1, 2, 3, 4, 5, 6, 7 3. VoC: 1, 2, 3, 4, 5, 6, 7 3. VoC: 1, 2, 3, 4, 5, 6, 7
5. VoC<7? 5. VoC<7 5. VoC=7
Phase 6: Body Scan Phase 6: Body Scan

1. Hold incident and positive 1. Hold incident and positive
belief. belief.
2. Scan your body. 2. Scan your body.
3. BLS (5-10 seconds) with any 3. BLS(5-10 seconds) with any
sensation sensation
4. Goal: calm or neutral 4. Goal: calm or neutral
sensations sensations
Phase 7: Closure Phase 7: Closure Phase 7: Closure

1. Stabilize 1. Stabilize with SUD>0 1. Stabilize with SUD>0
2. Debrief 2. Debrief 2. Debrief
3. Integrate 3. Integrate 3. Integrate
• Extended Resourcing? • Extended Resourcing? • Extended Resourcing?
1. Hear it 2. Measure it 3. Suggest it
Tell me what happened. Rapid eye movements seem to
How upset are you? help reduce how upset we feel.
(circle one)
If people have difficulty
telling their story, consider ! 10 A lot
4. Consent to it
having them walk around as 9 Would you be willing to try it
they tell you what happened. 8
(This helps calm them down.) 7 5. Explain it
6 As you think of the incident and
___________________________ 5 Somewhat how upset you are, watch my
___________________________ 4 hand as I move it back and
___________________________ 3 forth. When I stop, I’ll ask you
___________________________ how much what happened
2 bothers you. We will, then, do
___________________________ 1 another set of eye movements.
___________________________ " 0 Not at all We’ll keep doing that until you
___________________________ no longer feel as upset. Then,
Or just: we’ll talk about other things
___________________________
How much does it bother you can do to deal with it.
you?

How upset are you? help reduce how upset we feel.
(circle one)
telling their story, consider ! 10 A lot 4. Consent to it
___________________________ 6 As you think of the incident and
___________________________
5 Somewhat how upset you are, watch my
4 hand as I move it back and
___________________________ forth. When I stop, I’ll ask you
3
___________________________ 2 how much what happened
___________________________ bothers you. We will, then, do
1 another set of eye movements.
___________________________
" 0 Not at all We’ll keep doing that until you
___________________________ Or just: we’ll talk about other things
you?

How upset are you?
help reduce how upset we feel.
(circle one)
telling their story, consider ! 10 A lot 4. Consent to it
___________________________ 6 As you think of the incident and
___________________________ 5 Somewhat how upset you are, watch my
4 hand as I move it back and
___________________________ forth. When I stop, I’ll ask you
3
___________________________ how much what happened
2
___________________________ bothers you. We will, then, do
1 another set of eye movements.
___________________________
" 0 Not at all We’ll keep doing that until you
___________________________ Or just: we’ll talk about other things
you?
6. Stop it 7. Desensitize it
Stop me if you anything
other than the incident
1. Think of the incident
2. Apply 10 round trips of EMs
CID™
Critical Incident Desensitization
comes up. 3. Take a breath, let it out, think
of the incident, how much
does it bother you now 0-10?
If you have to stop the eye
movements, revert to listening 0 1 2 3 4 5 6 7 8 9 10
to the person and help them Or
decide what to do next. How much does it bother you
now?
- Safety 4. Go with that: 10 round trips of
EMs. If they don’t like
- Resource (food, shelter, EM’s, have them run in
etc.) place or pump their arms
- Other support 5. Repeat 1-4 until disturbance Critical Incident Desensitization
no longer drops
Developed by
8. Closure Roy Kiessling
1. Discuss with them what to do
next:
CID™

now?
- Resource (food, shelter, etc.) EM’s, have them run in
- Other support place or pump their arms
5. Repeat 1-4 until disturbance Critical Incident Desensitization
no longer drops
Developed by
8. Closure Roy Kiessling
next:
CID™
now?
- Resource (food, shelter, etc.) EM’s, have them run in
- Other support place or pump their arms
5. Repeat 1-4 until disturbance no Critical Incident Desensitization
longer drops
8. Closure Developed by
Roy Kiessling
next:
9. Stop it if… 11. Strengthen it 12. Plan for it A-TIP™ is a protocol using eye
Stop me if anything other than 1. Think of the incident and
your preferred thoughts,
1. Imagine how you will handle movements or other forms of A-TIP™
the incident comes to mind. other thing related to the bilateral stimulation (BLS) that Acute Traumatic Incident Processing
how true does it feel now? incident when they come up may be used by para-professionals
10. Process it 2. 10 round trips of EM’s to immediately desensitize acute
1 2 3 4 5 6 7
1. Think of the incident Totally Totally 3. Repeat 10 round trips of stress in crisis situations.
2. Apply 10 round trips of EM’s False True EM’s as long as new ideas
emerge
3. Take a breath, let it out, think 2. 10 round trips of EM’s A-TIP™ may be used in:
does it bother you now 0-10? 3. How true does it feel now?
13. Close it Disasters
0 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 Accidents
Totally Totally Plan for other options, Assaults
4. Go with that:10 round trips of EM’s False True services support as School Behavior
needed or refer to:
5. Repeat 1-4 until disturbance 4. Repeat 2 & 3 until preferred Peer Support
no longer drops thoughts no longer [ ] Psychotherapy The
strengthen [ ] Other referrals? To learn more visit:
6. When the disturbance stops 5. When the preferred thoughts CPR
dropping, proceed to: no longer increase, proceed www.emdrconsulting.com of Psychological Trauma
Congratulate them for the
to
work they have done.
11 Strengthen it 12 Plan for it Developed by
Roy Kiessling
9. Stop it if… 11. Strengthen it 12. Plan for it A-TIP™ is a protocol using eye
Stop me if anything other than
the incident comes to mind.
1. Think of the incident and
your preferred thoughts,
1. Imagine how you will handle
other things related to the
movements or other forms of
bilateral stimulation (BLS) that A-TIP™
Acute Traumatic Incident Processing
how true does it feel now? incident when they come up may be used by para-professionals
10. Process it 2. 10 round trips of EM’s to immediately desensitize acute
1 2 3 4 5 6 7
1. Think of the incident Totally Totally 3. Repeat 10 round trips of stress in crisis situations.
2. Apply 10 round trips of EM’s False True EM’s as long as new ideas
3. Take a breath, let it out, think 2. 10 round trips of EM’s emerge A-TIP™ may be used in:
Disasters
does it bother you now 0-10? 3. How true does it feel now? 13. Close it Accidents
0 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7
Totally Totally
Plan for other options, Assaults
4. Go with that:10 round trips of EM’s False True
services support as School Behavior
needed or refer to: Peer Support
5. Repeat 1-4 until disturbance 4. Repeat 2 & 3 until preferred
no longer drops thoughts no longer [ ] Psychotherapy The
strengthen [ ] Other referrals? To learn more visit: CPR
6. When the disturbance stops 5. When the preferred thoughts
dropping, proceed to: www.emdrconsulting.com of Psychological Trauma
no longer increase, proceed Congratulate them for the
to work they have done.
11 Strengthen it Developed by
12 Plan for it Roy Kiessling
Cut from this side
1: Hear it 2. Name it 3. Measure it 4: Re-Name it 6. Suggest it
As you think of the How upset are you? How would you prefer to help reduce the incident’s
. (circle one) think about it? vividness and disturbance.
incident, what are your
(If they have difficulty [ ] It’s over, I survived
thoughts about it?
“telling their story,” consider ! [ ] I can get through it 7. Consent to it
having them walk around [ ] I’m going to die 10 A lot
[ ] I did the best I could Would you be willing to try it?
as they tell the story [ ] I’m overwhelmed 9 [ ] I’m okay
( Helps calm them down.) [ ] I can’t handle it 8
[ ] It’s my fault 7
[ ] I’m good enough 8. Explain it
_______________________ [ ] _________________ As you to think of the incident
[ ] I should have done 6 and its disturbance, watch my hand
_______________________
_______________________
something
[ ] I’m a failure
5 Somewhat
4
5. Validate it as I move it back and forth. When I
stop I’ll ask you how much it
bothers you, then do another set of
[ ] I’m bad How true does that feel to eye movements. We’ll keep doing
_______________________ 3
you now? that until the disturbance stops
[ ] I’m not good enough 2
_______________________ dropping. We’ll then strengthen
[ ] I’m incompetent # 1 2 3 4 5 6 7 $ how you prefer to handle it.
_______________________ 1 After that we’ll talk about other
Totally Totally
[ ] ________________ " 0 Not at all False True things you can do to deal with it.
1: Hear it 2. Name it 3. Measure it 4: Re-Name it 6. Suggest it
As you think of the How upset are you? How would you prefer to help reduce the incident’s
. (circle one) think about it? vividness and disturbance.
incident, what are your
(If they have difficulty [ ] It’s over, I survived
thoughts about it?
“telling their story,” consider ! [ ] I can get through it 7. Consent to it
having them walk around [ ] I’m going to die 10 A lot Would you be willing to try it?
[ ] I did the best I could
as they tell the story [ ] I’m overwhelmed 9
( Helps calm them down.) [ ] I’m okay
[ ] I can’t handle it 8 [ ] I’m good enough 8. Explain it
[ ] It’s my fault 7 [ ] _________________ As you to think of the incident
_______________________ and its disturbance, watch my hand
[ ] I should have done 6
_______________________ as I move it back and forth. When I
_______________________
something
[ ] I’m a failure
5 Somewhat
4
5. Validate it stop I’ll ask you how much it
bothers you, then do another set of
_______________________ [ ] I’m bad How true does that feel to eye movements. We’ll keep doing
3 that until the disturbance stops
[ ] I’m not good enough you now? dropping. We’ll then strengthen
_______________________ 2
[ ] I’m incompetent # 1 2 3 4 5 6 7 $ how you prefer to handle it.
_______________________ 1 After that we’ll talk about other
Totally Totally
[ ] ________________ " 0 Not at all False True things you can do to deal with it.
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• Assigns emotional significance

3. Long term memory storage

Analogy: Working with a word document on a computer

Reference source: www.human-memory.net/processing_storage.html

Adaptive Memory Network Development

2. Adaptive Information Processing (AIP)-keeps what is helpful, discards what is no

Negative emotionally charged memories develop into negatively charged neural

3. Adaptive neural networks develop from other environments.

4. Present triggers activate past emotions/sensations.

Formation of a Single incident PTSD memory

The past is relived in the present.

*For training purposes and when treating complex client

1. Extended Resourcing Interventions:

Goal: To enhance positive experiences (resources) through slow, soothing bilateral

Bilateral Stimulation (BLS): Tapping in/walking through rationale

Demonstrate "Tap in" and "Walk through"

"Tap in" and "Walk through" Resourcing Techniques:

4. Deepen with BLS: (Tap in/walk through)

Butterfly Hug Breathing (modifi ed Artigas, Jarero)

Access and Activate

2. Imagine using the container

3. Deepen with BLS

5. Using with a disturbance

Tell me a little about that situation. _______________________________

What are you noticing?________________________________________

Tell me a little about that situation._______________________________

What are you noticing? ________________________________________

Optional: Repeat 1 and 2 with other near future situations where

Access and Activate

2. Emotions and sensations

4. Deepen with BLS (tap in/walk through)

6. Cueing with disturbance

7. Self-cueing with disturbance

Tell me a little about that situation. _______________________________

Tell me a little about that situation._______________________________

What are you noticing? ________________________________________

2. Access and activate the present degree of security in the oﬃce:

c. If not mentioned, bring up:

Entering the “maze” of exploration and discovery

Stage 1: Case Conceptualization

2. Identify its negative core belief

3. Develop an outline of incidents that resonate with the

4. Identify the preferred adaptive positive belief

5. Develop an outline of present experiences that

Stage 2: Processing: Neural network consolidation

2. Activate the positive adaptive neural

3. Process (BLS), i.e., link, blend and consolidate

2. Teach new adaptive skills

Beliefs are the verbalization of activated emotions/sensations

I’m going to die

Negative Core Beliefs Adaptive Core Beliefs

I’m worthless Role 13-19 Identity I have self-worth

I can’t trust my I can learn to trust

I do bad I can learn from

I’m okay the way I am

I can learn what I

I don’t deserve Extinction Survival I deserve to exist

Child Secure Caregiver

Secure Uses caregiver as a Responds appropriately,

Ambivalent Unable to use caregiver Inconsistent

Brain Hemispheres Left Hemisphere Right Hemisphere

1. Right Brain Language Imagery