Clinical Choice Points in EMDR Early Intervention

Guest Blog Post by Marlene Kenney, LICSW

EMDR therapy is grounded in the eight phases of treatment, which provide a structured pathway for resolving overwhelming experiences from the past, present, and future. When these phases are applied with fidelity, clients often experience an increased capacity to function across multiple domains of life. At the heart of EMDR lies the Adaptive Information Processing (AIP) model, which guides both therapist and client. The therapist trusts the protocol; the client’s nervous system does the work.

The eight phases are not always linear in practice. Each is necessary to complete the work on a target memory, whether the target is rooted in the past, connected to the present, tied to anticipated future challenges, or emerging from a recent traumatic event. Within these phases, however, lie clinical choice points—moments when the therapist makes strategic decisions to help the client move as far as possible in their adaptive processing. These decision points can be daunting for practitioners, especially when uncertainty arises around “what to do next.” Developing confidence in recognizing and using choice points is essential to effective practice.

Lessons from EMDR Early Intervention (EEI)

My understanding of clinical choice points has been profoundly shaped by teaching, consulting, and practicing EMDR Early Intervention (EEI). EEI requires rapid assessment, often with limited preparation, less client history, and shorter timelines than traditional therapy. The focus is usually on a single incident, with the aim of finding a “more adaptive” resolution rather than full resolution.

In these contexts, the therapist must lean heavily on trust—both in the protocol and in the client’s innate capacity for adaptive change. Even with modest goals, such as attending a memorial, returning to a damaged home, or completing necessary paperwork, significant shifts can occur. These outcomes reaffirm the value of fidelity to the eight phases while also demonstrating the importance of flexibility in applying them.

The role of choice points

All clinical decisions are anchored in AIP: the model that explains how overwhelming experiences are processed and resolved. Not every client will reach a Subjective Units of Distress (SUD) of zero, a Validity of Cognition (VOC) of seven, or a fully neutral body scan. At times, the therapist must assess whether the client has gone “as far as they can” while still maintaining fidelity to the model.

Effective decision-making in EMDR therapy rests on three considerations:

The structure of the eight phases.
The client’s nervous system responses.
EMDR-specific strategies such as interweaves, ecological validity checks, and target shifts.

Working with choice points in reprocessing

Two common areas where choice points emerge are ecological validity and cognitive interweaves.

Ecological validity asks whether a client’s progress is realistic given their circumstances and patterns. For instance, if a client still reports a faint “pit in the stomach” during the body scan, the therapist and client must decide: is this residual sensation ecologically appropriate, or does it signal unresolved material requiring further work?
Cognitive interweaves represent another set of choice points, employed sparingly to help move processing forward when the system is blocked. Similarly, transitions between phases—such as moving from desensitization to installation—require the therapist’s attuned judgment, balancing fidelity to the protocol with responsiveness to the client’s process.

Choice points in group protocols

The Group Traumatic Episode Protocol (GTEP) highlights choice points uniquely. Here, disturbance points may remain silent and private to each participant. Participants work on individual points of disturbance and check and record the SUD 3 times. The collective SUD is not conditional on moving on to the next point of disturbance found by scanning the upsetting episode. In the Recent Traumatic Episode Protocol (RTEP), an individual early intervention, we are making choices about EMD (Shapiro, 2018, pp 220-222) or EMDr strategy based on what the client reports directly.

This flexibility is an exercise of clinician choice based on the AIP system of the client. We also define SUD zero as when you are “able to think about the target and remain neutral,” when it becomes a processed memory from the past (even the recent past) rather than a triggered and distressing experience in the present. Even without explicit knowledge of each client’s targets, the GTEP protocol carries the client’s work as far as it can go. Clients often report adaptive shifts such as “I can cope” or “I did the best I could”—outcomes that, while modest, reflect meaningful change and improved present safety.

Broader implications

My experience with EEI has reinforced the value of fidelity to the eight phases while also deepening my confidence in making informed, flexible choices. EEI serves as a training ground for therapists, building the capacity to apply creativity within the bounds of the model. In longer-term psychotherapy, such choice points expand clients’ tolerance for distress, enable work with more challenging targets, and foster greater hope, agency, and internal locus of control.

Clinical choice points are not shortcuts. They are informed decisions that emerge from a therapist’s attunement to the client, their understanding of the AIP model, and their fidelity to EMDR’s structured phases. Ultimately, EMDR therapy’s goal is to help clients form more adaptive relationships with overwhelming experiences—so the past remains in the past, and the present offers new opportunities for resilience, choice, and growth.

Marlene Kenney is a licensed clinical social worker whose community response and EMDR psychotherapy practice is based in Arlington, MA. Kenney is part of the G-TEP global network and uses group EMDR for critical incident response. She is an EMDR training facilitator, and an EMDRIA Approved Consultant™. Kenney has worked with the Massachusetts Department of Public Health, Boston Resilience Center, Federal Emergency Management (FEMA/Mass Support), and is a member of the Riverside Trauma Center Critical Incident Team, as well as the EMDR Humanitarian Assistance Program. She provides clinical and crisis management consultation and support to municipalities and organizations nationally and internationally.

References

Roberts, A. (2023). EMDR Early Intervention Overview. EMDRIA Focal Point Blog. https://www.emdria.org/blog/emdr-early-intervention/

Shapiro, E., & Laub, B. (2008). Early EMDR Intervention (EEI): A summary, a theoretical model, and the recent traumatic episode protocol (R-TEP). Journal of EMDR Practice and Research, 2(2), 79–96. https://doi.org/10.1891/1933-3196.2.2.79

Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford.

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Clinical Choice Points in EMDR Early Intervention